Preterm Labor and Massage

This was one request I had not run into before – a gentleman called to request I do a half-hour pregnancy massage for his wife, who was undergoing pre-term labor (33 weeks) contractions and was in the hospital.

I have been certified in pregnancy and post-partum massage for several years, but I must admit this request stumped me. In general, instructors tell therapists to steer clear of people having contractions and/or in the hospital. I told the gentleman about those guidelines, and he told me the doctor suggested a 30-minute pregnancy massage as both safe and helpful to his wife.

I empathize with the problem at hand – most likely stress and anxiety without organic dysfunction -- but I must say I decided to turn this down.I told the gentleman that I would not do the massage not because it could create a problem, but because I had no experience with this circumstance and was unsure. I suggested someone with more experience might have a different opinion.

One of the tipping points for me came after looking online at various massage and pregnancy sites for pregnant women and for therapists. About half the sites said go for it, and half said no way. I tried reaching my pregnancy massage instructor, a nationally known expert, to no avail. I assume with the holidays my instructor was on vacation or off teaching somewhere.

It seems to me that some therapists out there may have encountered experiences with pre-term labor massages and may have some advice for me on this subject. Is it safe for the pregnant person? Is it safe for the massage therapist? What are possible indications or contra-indications? Are there any studies?

These questions come up because I've found a wide divergence over the years between beliefs about pregnancy massage, practices and comfort levels amongst therapists.

An example: My pregnancy massage class was taught by a very well-respected instructor. It was attended by several massage therapists from the USA and European countries, as well as aestheticians practicing both skin care and massage.
During our class, the instructor talked about using pillows and body cushions, positioning for comfort, ground rules for communication, etc.

Then we got to the aromatherapy question. The folks trained in Europe were very concerned about using any essential oils, saying their training said that oils could create severe skin rashes. Lavender, our most common oil used for relaxation massages, was considered a powerful trigger for labor contractions and was absolutely banned from use in pregnant women.

Our instructor, who had performed thousands of pregnancy massages, said she has always used oil scented with lavender throughout the entire term and never had a problem with any client.

A rather awe-inspiring silence followed.

USA meets Europe isn't always a comfortable match. Our European therapists looked horrified and our USA folks were un-nerved. The massage lead for a spa broke the silence. If some folks were horrified, then some pregnant folks would be too, if they had been told aromatherapy could harm them or their baby. Best not to offer any aromatherapy in pregnancy massages at all, in order to practice defensively. Who would want a pregnant client to call back after a massage and claim they might be damaged by lavender scent?

Not a very scientific reason, but a practical one.

All this led to a much more fun discussion about foot reflex points and triggering contractions. Our Europe friends said the point on the little toe would help trigger contractions, so they should be avoided at all costs unless the woman was past due and trying to start contractions.

An expert reflexologist with USA/Chinese training in our class popped up with his two cents: The little toe point was more for pain relief than contractions, and was a great toe-hold for expectant fathers trying to help their spouses during labor.

To which our very experienced instructor added a little observation: If the little piggy point caused contractions, the line outside her office door would snake around the block with past-due women willing to try anything to get that baby out of there!

Which Slipper to Wear to the Ball?

Generally, my work doesn’t cause me a lot of pain, and I have a pretty high pain tolerance. I get tight shoulders like everyone else in the world, and my left hip, which has always been my vulnerable spot, sometimes has me limping a little at the end of a long day. Those are common pains, and ones I’ve always managed quite well with a little chiropractic, acupuncture, and massage work. But lately, my feet and shins have been killing me. I mean a lying in the floor grasping my ankles and whimpering kind of killing me. My doctor father used to say that when any pain gets to the point where you’re ready to get a hand mirror and a steak knife and deal with it yourself, not only are you truly in pain, but you need help . . . really fast.

So I first began asking questions about our floors. As it turns out, the carpet in my room is covering hard tile, which probably isn’t helping matters. At the place I worked previously, the carpets were extra thick and had extra padding underneath, which may explain why this problem is new to me. So one possible answer to my problem would be re-carpeting the room—extremely unlikely. Another solution might be impact mats, but those can get to be a real problem too, as most of them don’t make very tasteful room decorations. Not only that, but I don’t want to hurt myself worse by tripping over mat edges or getting my stool caught on them.

Hmm. So if new carpets and mats are out, that leaves better shoes, perhaps. I have really nice work shoes (Landaus), which I wear with my orthotic inserts, but they weren’t necessarily made for standing in one place for five hours. My boyfriend got me a pair of athletic Sketchers, but only two hours in those made me feel like I’d been standing strapped to concrete blocks, and they went right back into their box. I’ve been researching all sorts of shoes from Z-Coils (another possible way to break my neck) to Nike Shox, but I just really have no idea which would be best and I need to do something fairly quickly. Any ideas out there? This Massage Princess needs to find new slippers before her feet turn into pumpkins!

The Skin Horse Tells His Story

In the morning, my boyfriend Marshall and I will be traveling to Bellingham, a Seattle suburb, for his grandmother’s memorial service: she died last week at the age of ninety-two. Although the family had a known for a while that she would soon be passing, it was still difficult, in some ways, to see her end unfold. I watched Marshall hold her pale, thin hand in his large strong ones as he leaned in trying to understand what she was saying to him. His eyes kept tearing up and spilling over as he studied her face intently. It occurred to me then that someone had been speaking earlier of a birthmark that Grandma had that covered a large portion of her left cheek and neck. According to accounts, Grandma had spent her life ashamed of that birthmark because it prevented her from being perfect or beautiful. And yet at that moment, where the end was fading into another beginning, Grandmas’ skin was so thin and bloodless that you could hardly even discern the birthmark’s existence. It was easy to see, however, that Marshall loved his grandmother deeply and had never cared less whether that face was clear or marked.

I have many clients who end up on my massage table saying, “I’m a mess” or “I’m just a wreck.” I discourage this kind of talk because on the one hand, I believe words have power, and I don’t want clients giving their bodies negative messages that either cause further suffering or prevent healing. I also discourage such talk because it often seems to come with a sense of self-loathing. For example, it’s not only the neck and back pain that makes clients say “I’m a mess,” it’s how she perceives some extra weight or spider veins or how he resents the shoulders he can’t always seem to pull up straight or the arms that won’t work for eight hours without pain like they did twenty years ago. Sometimes I almost feel that they see pain as a punishment for not being able to do what all the advertisements imply they should do: stay young forever, unchanged and unmarked. As that would be a futile and indeed impossible task, I find the stress that it causes to be extremely saddening.

So at Christmas time, I’d like to share with my readers—my friends, my family, my peers, my clients—a few lines from a favorite book, The Velveteen Rabbit or How Toys Become Real by Margery Williams. In The Velveteen Rabbit, the Skin Horse explains to the Rabbit about nursery magic and why only some toys become Real. He explains that it is the toys that are really loved—not just looked at or played with, but loved—become Real. The Skin Horse also tells the Rabbit that becoming real hurts sometimes, but that one doesn’t mind as being loved is a wonderful thing: “It doesn’t happen all at once . . . You become. It takes a long time. That’s why it doesn’t often happen to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But, these things don’t matter at all, because once you are Real, you can’t be ugly, except to people who don’t understand” (13). The Rabbit is not comfortable with this concept at first; but read the book, and you’ll find that becoming Real turned out to be the greatest blessing and bliss that the this little Rabbit could have imagined.

I’m almost forty years old, and I’m a massage therapist. I love what I do and the relief and healing that I help bring to my clients, and yet I limp out some days with a sore hip and aching shins and incredibly non-lustrous hair. I’m Real, I believe, and happier this way than I’d be in any other, with people who come back to see me time after time. Marshall’s grandmother—tiny and stooped and curled up like fading petals--was so very Real to him. Love makes you Real. Set out to give some, and it will come back to you in a myriad of ways that make the imperfections of existence much, much less important. When you think about it, isn’t being Real the greatest gift you could ever receive?

Merry Christmas,

Lynna

Manners, Grace, and Hospitality

When I first became a massage therapist, my boss at the time would frequently ask, "Did you ask the client to come back?" At first, I was a little shocked. Of course I had asked my client to come back; that's part of what good hospitality is, isn't it? Later, the question insulted me a little. I was gently bred in the original Land of the Thank-You Note, you know, the last bastion of lady-like behavior. Much later, the question just plain irritated me, because you'd think she could remember what I'd said the first twenty times, but hey, that's not really important here.

What is important, I think, is that massage professionals realize how much good manners can make or break a therapist/client relationship. When I come out to meet a new client, I look her in the eye, hold out my hand, and say, "Hi, I'm Lynna. I'll be your therapist today. Come on back." I then ask her about what she needs and if she is having pain, etc. During this part--and this is important--I actually listen, and show through my speech with phrases like "really?" and "oh my gosh, that sounds painful" that I genuinely care. Finally, at the conclusion of the session, I make suggestions about the frequency of further sessions, always stressing that my suggestion is a suggestion, not an order, and that I will be happy to see her whenever she's able to come back in. It's amazing how many clients return to me for care, time and time again.

The problem with teaching good manners--or even agreeing on what they are--is that "good manners" differ from race to culture to region, etc. When I first moved to Seattle, I found the majority of people incredibly rude with a large dose of cold and indifferent, even those working in customer service, which confused me greatly. However, a Japanese friend once told me if I and my Southern Hostess genes went down the street in Tokyo smiling at strangers and making small talk, people would probably consider me insane, possibly dangerous, and definitely ill-mannered. Happily, though, my clients here in Seattle, though perhaps not raised to be warm and cuddly as a rule, seem to really, really appreciate a warm and caring approach to their massage treatment.

Having observed many therapists by this point in my career, I now know why my first boss kept running on a like broken record. It's because there are therapists that don't ask the clients to come back, who never touch a hand or a shoulder, and don't make their clients feel connected to them in the experience in any way whatsoever. Which is fine, I guess . . . but it's a major loss not only in therapist success, but in client well-being. And funny, that last reason's the one we supposedly become massage therapists in the first place.

1-800-NO-PERVERTS

It seems that at least once or twice a month our massage business gets a call from some weirdo/chauvinist/pervert. How does one get tagged with the label "weirdo/chauvinist/pervert?" Well, one calls the front desk of a massage business and asks about booking a massage and wants to know more about what kinds of massage we do. When a person mentions "kinds of massage," we (being sane) think in terms of Swedish, myofascial, lomi lomi, deep/light, etc. So we stupidly begin explaining types of massage, completely unaware that the person's (or weirdo's) next question will involve at least two of the following: therapist age, gender, and physical description; "groin injuries," "sudden erections," and in rare pseudo-intellectual calls, the ol' "inguinal ligament issue." And ninety-nine percent of the time, all of these questions will be posed by weirdos/chauvinists/perverts because . . . normal, well-adjusted people just don't ask them, at least in this context. Come on people: if you have a legitamate groin injury, why would a young, busty female therapist be your only hope?

What irritates me most is the waste of time. We could be spending this time answering the legitimate questions of people who need our help instead of listening to people who say things like--and I quote--"It's just nicer to get a massage from a woman who doesn't look like a 450 pound gorilla." Um, sure, James Bond . . . if only I had a button I could hit that would fry your groin with a thousand points of light.

But alas, our phones have no such buttons. Instead, I've found the quickest way to deal with weirdos/chauvinist/perverts is to have the front desk tell them nothing but that they do have one therapist open who deals with "groin injuries," and HIS name is . . . You'd be surprised at how quickly such callers sudden realize that they don't really need a massage that much after all.