The Wiltshire School of Beauty and Holistic Therapy · 2017. 7. 7. · advancing pregnancy. Early weeks in the second trimester are still very precarious, and miscarriages can still

The Wiltshire School of

Beauty and Holistic Therapy

Diploma in Pregnancy Massage

Practitioner’s Training Manual

W: www.wsbht.co.uk E: [email protected]

T: 01793 73 77 33 M: 07824 337333

http://www.wsbht.co.uk/

The Wiltshire School of Beauty and Holistic Therapy

Diploma in

Pregnancy Massage Training Manual ©

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CONTENTS

1. Course Details

2. Pregnancy Massage

3. Stages of Pregnancy & Common Discomforts

4. Massage Mediums

5. Positioning during massage and resources/props 6. Contra-Indications, Contra - Actions and After Care

7. Underpinning Knowledge

8. Results

9. Contact Details

10. Accreditation


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1. COURSE DETAILS During this course you will learn how to perform a professional Pregnancy Massage treatment. You will learn how to:

prepare the treatment area

prepare the client for treatment

carry out a pregnancy massage You will also study:

benefits of the treatment

different stages of pregnancy and expected related symptoms

contra-indications

aftercare and contra-actions Once you have successfully completed your practical training, you will receive The Wiltshire School of Beauty and Holistic Therapy Diploma in Pregnancy Massage, accredited by The Guild of Holistic Therapists.

Good luck and enjoy!


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2. PREGNANCY MASSAGE INTRODUCTION The Benefits of Pregnancy Massage To receive a professional massage at any stage of your life is a wonderful experience. Whether the aim of the massage is to provide a therapeutic or remedial effect will determine how the massage is carried out, and as a massage therapist, you will be able to determine the different strokes and techniques to use. Pregnancy massage is a little different than a normal Swedish massage. Most women who are requesting a massage during pregnancy will do so for a reason. It maybe that they are feeling stressed and anxious, or they may be experiencing some of the many discomforts associated with pregnancy. For whatever the reason why they have requested the massage, it will be down to your professional judgment to select the correct techniques, positioning and mediums to allow them to meet their treatment objective. Pregnancy is one of the most wonderful but also daunting time of a woman’s life. It can be filled with apprehension, anxiety and excitement. Hormones will be surging through the body, which can cause mood swings, and the wealth of information available to a pregnant woman can be daunting. As a pregnancy massage therapist, it is important to remember that advice needs to come from the Midwife or GP, however much we feel inclined to assist. Of course, you are able to share your professional experiences with your clients to help allay any fears that they may have. Pregnancy Massage has many benefits:

It can help reduce muscular tension and restore postural balance, which is very common during pregnancy due to the changes in posture

As with all massage, it can help increase blood flow and lymph circulation

It can help reduce swelling (oedema) in areas such as ankles and hands

Pain can be eased, especially in problem areas such as the lower back

It can help create a feeling of wellbeing, by reducing stress and anxiety

If you are trained in aromatherapy/pre-blend, you can select appropriate oils to assist in lifting the mood or easing pain

The calming nature of massage helps the woman concentrate on breathing deeper

Blood pressure can be stabilised

Create a “pampering” effect

Touch can make us feel more connected to others and can improve self esteem

Body of evidence to show that relaxation during pregnancy can lead to calmer babies


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3. STAGES OF PREGNANCY AND

COMMON DISCOMFORTS

As a Pregnancy Massage Therapist, it is useful to recognise the different stages of pregnancy, and the common symptoms/discomforts that may be experienced by your clients. This is just a gauge, as everyone is different. Some women sail through pregnancy, whereas others will experience many common discomforts throughout. You will see as you read this manual further, it is important not to carry out a massage during the first trimester, which ends at 13 weeks. Many women, unless they have always had massages, will not even consider a massage until their pregnancy advances, usually until 20+ weeks, when they begin to start experiencing symptoms. It is advisable that you check with your insurance company to find out from what stage you are insured to treat a pregnant woman.


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Menstruation, Conception and Pregnancy

Menstruation is controlled by hormones and the cycle is usually a 28 day process, although this can vary greatly.

During day 1 – 5 the hormones oestrogen and progesterone reduce which causes a breakdown of the endometrium. This results in the discharge of blood, tissue fluid and mucus, but also in the preparation of a mature follicle.

During days 6 – 13, two more hormones, Follicle Stimulating Hormone (FSH) and luteinizing hormone stimulate the ovaries to produce more oestrogen. This in turn allows for the endometrium to re-build.

By now a mature follicle is ready to be released on day 14.

Between days 15 – 28, progesterone is stimulated by luteinizing hormone to prepare the uterus to receive the fertilised ovum, if there is one.

If fertilisation does not occur then the hormone changes will start the cycle over again and initiate the breakdown of the lining.

The process of conception is nothing short of a miracle. Once the ovum has been released, it travels along the fallopian tubes, producing an enzyme that attracts any sperm. One sperm will break through the tough coating of the ovum to fertilise it, which will then continue to the uterus. Once the zygote has arrived in the uterus it will implant itself into the endometrial lining and become an embryo.

The first four weeks after fertilisation will show a rapid amount of development as all of the major organs and body systems start to develop. The placenta and umbilical cord, which sustains pregnancy, are also being formed.

During weeks 5 – 8, the embryo starts to become recognisably human in form as the limbs begin to grow and the torso straightens out.

By weeks 9 – 12, the first trimester is closing and the foetus is almost double in length with all organs formed. The eyelids are fused with the eyes remaining closed.

Weeks 13 – 16 see the foetus rapidly increasing in size, with movements alerting the pregnant women of its presence. The foetal circulation is now established with the blood being pumped around its body.

By the fifth month, the skin of the foetus has become more mature and a network of blood capillaries and nerve endings has become established.


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The sixth month marks the end of the second trimester and the facial features are beginning to resemble those of a full term baby. The growth rate is slow but weight is being gained rapidly.

The last trimester up until 40 weeks is a period where the foetus continues to develop, but in a much smaller space.

By week 33, the foetus is still putting on weight at just over 5lb, but still lacks adequate fat stores under the skin.

The last few weeks of pregnancy can be a time of great discomfort for many women. For the foetus the fingernails have reached the ends of the digits and its body is covered in a coating called vernix. The average pregnancy lasts from 38 weeks from fertilisation or 40 weeks when calculated from the last day of the menstrual cycle.

Second Trimester 13-26 weeks Depending on the area and health authority in which your client lives in, the first ultra-sound scan may not take place until 18-24 weeks. Some areas will scan at around 10 weeks. Once the scan has taken place, the pregnancy feels even more “real” for the woman, and she may then become a little more confident about her advancing pregnancy. Early weeks in the second trimester are still very precarious, and miscarriages can still occur up until 23 weeks, after that, being classed as a still birth. At the age of 30 and under, there is a 10% risk of having a miscarriage, with the percentage increasing to 20% between the age of 35-40, and rising even further to 50% for a women over the age of 45 (Information courtesy of Tommy’s). During this exciting trimester, and especially towards the end of it, many women feel they are “blooming” and feel they have more energy than of recent. From around week 17, appetite can once again return, and hopefully any signs of nausea have disappeared. At 17 weeks the foetus is around 5 inches in length and weighs approximately 150g. For many women, weight increases steadily, whereas others notice “spurts” then they standstill for a while.


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Because of the extra blood flow and high levels of oestrogen, many women will notice changes to their skin, with tiny red marks called Spider Naevi being common on the face, neck, chest and shoulders, so if you notice this during a treatment, it is nothing to be concerned of. The pigmentation of the skin will almost certainly change, with a line of pigmentation running down the abdomen, called the Linea Nigra, and marks

the point in which the right and left abdominal muscles meet in the midline. The industry has recently announced that, even with a pregnancy massage qualification, a therapist should NOT massage the abdomen during pregnancy, unless it is right at the end of pregnancy and labour is looming. However, you are able to advise your client to self massage using a medium to keep the skin supple.

Due to the way in which the blood volume is distributed during pregnancy, it is common for the woman to feel dizzy if her position is changed suddenly, so be aware of that when you are moving your client around during massage and to allow for plenty of time for moving.

The Third Trimester 26 – 40 weeks At the beginning of 26 weeks, an average foetus measures approximately 10 inches and weighs 1kg, and by full term, the average baby will weigh between 3-4kg. Between 28 to 32 weeks, the average weight gain for the woman is as much as 500g and continues at a rate of about 250g up until 35 weeks. Heart burn is very common during this trimester, as the increasing uterus puts pressure on other organs, also increasing pressure on the bladder. It is important to remember that massaging a woman in later pregnancy may need to be interrupted by a toilet break! As the pregnancy advances, there can be a loss of energy and tiredness can set in. Sleep can be interrupted due to being uncomfortable and the need to have to get up during the night to use the toilet. Many women therefore enjoy the luxury of having a massage during this stage, if only for the opportunity to rest and have some time for themselves! Anxieties


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may start to build up over the prospect of the forthcoming and inevitable labour, so gentle calming breathing during a massage can help encourage relaxation for later on.

Common Discomforts During Pregnancy

Looking at this picture demonstrates the changes that the body goes through during pregnancy, and can explain the discomforts that can be experienced. Nausea – the most talked about side of pregnancy, nausea can affect a huge proportion of pregnant women, with it being particularly common in early pregnancy, and not necessarily during the mornings! Many women can experience the waves of sickness throughout the day for many weeks. If you are massaging a woman who is experiencing morning sickness, it is important to be aware of this. Certain smells may trigger nausea, so try and keep the room well ventilated, and use a plain massage medium. Keep a supply of biscuits to ease any nausea, and ensure that the client has plenty of time to sit and have a glass of water at the end of the treatment.


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Stuffy Nose – due to the increase in blood flow to the mucous membranes, it is common to experience a blocked nose feeling, even without having a cold. Massage to the face, applying pressure to the sinus cavities can ease these symptoms. Stretch Marks – unfortunately, there is no wonder cream to prevent stretch marks, however you can advise the women to moisturise well to keep the skin supple and smooth. By the end of pregnancy, the skin will have stretched an extra 1-2 square feet, and this can create an intense itchiness. Applying a soothing medium to the skin, such as a Vitamin E cream can help alleviate this. If the itching is severe, it is important that the client tells her midwife as this can be a symptom of a more serious condition called obstetric cholestasis. Leg Cramps – as the pregnancy progress, leg cramps can become very common, especially during the night. There are many theories to why this happens, but massage is a great way of relieving the intense pain experienced. Be aware that your client may experience cramp during a massage if they are in a position for too long. If this happens, ask them to stretch out the limb, whilst you massage the area. Varicose Veins – are very common towards the end stages of pregnancy. Your client should have been advised by their midwife to rest with their feet up as high as possible. Remember to varicose veins as a local contra-indication and not to massage directly over them. Excess Heat and Sweating- The increase in blood flow to internal organs means there is an increase to the skin, causing many women to feel the heat more. Be very aware of this during a treatment, as most women will not want to be covered up in layers of towels and blankets. Poor Posture – As the woman’s shape changes, and the centre of gravity alters, it is very likely that the posture is affected, and poor posture can cause back problems. Very often the shoulders can become rounded, which arches the back and causes the pelvis to tilt forward as a way of compensating for the changes to stability. By ensuring the shoulders are pulled back and down, and the abdominal muscles are engaged, back ache can be reduced. Using a pillow in the small of the back when sitting can also help. Sciatica – this pain can be constant or intermittent and can be felt in the lower back, buttock or even down the legs into the ankles. It is common during pregnancy due to the baby’s head pressing on the sciatic nerve. The symptoms can be a tingling or numbing sensation. Carrying out pelvic tilts can encourage the baby’s head to move. Coccygeal pain –the ligaments that supports the four coccyx bones can become displaced, then pain can be experienced in the very low back and can be excruciating.


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Abdominal Stitch – due to the increase in the size of the uterus, it is very common for a pregnant woman to experience a stitch like pain as the supporting ligaments are stretched. As the uterus expands, the lowest ribs begin to spread sideways, and the ribcage moves upwards by as much as 2 inches, which can cause discomfort.

Digestive problems – as the uterus enlarges and compresses the abdominal organs, it is inevitable that there are going to be some discomforts. One of the most common is heartburn, due to the valve relaxing between the oesophagus and the stomach and therefore being less efficient and preventing food from regurgitating backwards. Constipation can also occur due to the digestion being sluggish Headaches - are very common during pregnancy, and migraines can sometimes leave women debilitated. If during the consultation, it becomes apparent that your client experiences a lot of headaches, it is wise to get them to check this with their own GP or midwife as high blood pressure can cause headaches. A massage to the face and head can be very soothing during a headache, but do not attempt to massage in this area if your client has a migraine as it can worsen it.

Oedema - the body tissues begin to thicken as there is an increase in fluid due to the blood volume increasing by 25%. Fingers and toes can become swollen as fluid gathers in the lowest places of the body, though it is important to note that if swelling suddenly increases it may be a sign of pre-eclampsia which needs to be dealt with urgently. Massage can be very good at helping to reduce swelling as it is increasing venous and lymph circulation.

Baby’s positioning during pregnancy

How the baby is positioned in the uterus can have a vast difference on the discomfort the woman may experience. If the baby is lying occiput-posterior, with his spine closest to the woman’s then lower back pain is very common and massage can be of great benefit.


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4. MASSAGE MEDIUMS

Unless you are a qualified aromatherapist or pre-blend therapist, never add any essential oils to your medium whilst carrying out a pregnancy massage. Many essential oils are contra-indicated during pregnancy, such as:

Basil,

Chamomile

Camphor

Caraway

Cinnamon

Clary Sage

Cypress

Fennel

Frankincense

Jasmine

Juniper

Marjoram

Myrrh

Peppermint

Rosemary

Sage

Thyme

Wintergreen Due to the fact that whatever medium you use is absorbed into the skin, and can be transferred to the baby, it is good practise to use plain oil, such as:

Vitamin E

Calendula

Wheat germ

Plain mineral oil Almond Oil is best avoided due to the risk of allergies being passed onto the unborn baby.


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5. POSITIONING AND RESOURCES/PROPS

Positioning During the consultation, it is good practise to find out which position the client finds comfortable to sleep in as a good starting point. There are several positions that are appropriate for pregnancy massage.

It is important not to lie flat as the weight of the uterus will press on the major veins returning blood to the heart, which can cause faintness and a lack of supply to the baby.

Semi lying or semi reclining, using pillows/cushions to prop forward. Also raise the feet or legs to take the pressure off the lower back.

Side lying – preferably on the left side to reduce pressure on the inferior vena cava. Use a pillow under the bump and between the knees.

Forward leaning - sat on a chair, leaning onto a couch.

Sitting upright on a chair.

As the pregnancy progresses, it is important to be adaptable to the changing needs of the woman. The position which may have worked 3 weeks ago may now not be appropriate. Each time you treat a pregnant woman can seem like the first, so always build in extra time for consulting and positioning. It is not uncommon to have to change position several times during the massage, and therefore have to start on one part of the massage and return to it later, be aware of her comfort at all times. It is advisable to allow approximately an hour for a pregnancy massage, to include time for the consultation, undressing and also moving into appropriate positions. The massage itself will take around 40-45 minutes, as most women will not want to be in any position for too long as their pregnancy advances.


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Resources/Props The biggest difference carrying out a pregnancy massage from a normal massage is learning to be adaptable. Having a variety of props to assist your massage and to create a comfortable experience is essential.

V shaped pillows can be used during the semi-lying position

Wedges can be used to slip under the abdomen

Extra pillows can be used piled onto the couch for the client to lean into

Rolled up towels to be used in the lower back to act as bolsters

Soft neck pillow

Body wrap – rather than using towels to drape your client with, as they may be too warm, you may find it easier using a body wrap, or you could make your own using a large sheet

It is not necessary to buy expensive massage couches with a “bump hole” cut out. In fact most experts do not advise a pregnant woman lying supine (front facing down) you are better off having a suitable amount of pillow and props.


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6. CONTRA–INDICATIONS, CONTRA- ACTIONS

AND AFTER CARE

Because you are carrying out a massage, the usual contra-indications will apply, however there are some specific to Pregnancy Massage that you need to be aware of:

Never treat during the first three months of pregnancy.

Any placenta problems – although placenta praevia (low lying) is ok as long as there is no bleeding.

High Risk Pregnancy – get permission from midwife.

Any risk of pre-eclampsia.

History of miscarriages - although you can treat after 24 weeks.

Any current bleeding or spotting, unless past 37 weeks.

Gestational Diabetes – get client to check with GP.

Anaemia unless on Iron tablets.

Varicose veins – avoid the area.

Percussion movements should be avoided.

Massage to the abdomen should be avoided.

As with any massage treatment there may be some contra-actions, so it is important to warn your client of them and to provide the normal aftercare that you would for a massage treatment.

As your client is pregnant, it is even more essential that you explain any contra-actions they may experience, such as feeling light headed or faint. Always give your client ample time to sit after the massage to allow their blood pressure time to re-adjust. Aftercare advice should always be given, and for good practice it should be written down so the client can refer to it after you have left.


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7. UNDERPINNING KNOWLEDGE

Please answer the following questions and send to [email protected] before your training day.

1. What are the benefits of a Pregnancy massage to the client?

2. List 3 contra-indications to a Pregnancy massage.

3. Discuss some of the resources and props that can be used, and how they can be of benefit.

4. Discuss the most appropriate mediums to be used and which mediums should be avoided?

5. What are the precautions that you need to consider when positioning a client?

6. What is oedema?

7. Why is heartburn so common during pregnancy?

mailto:[email protected]


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8. RESULTS

(Please bring this with you on your assessment session, to be completed and retained by the tutor) Student Name________________ Practical evidence Pregnancy Massage Treatment □ Theory evidence Completed assignment □ Diploma awarded Yes/No

If no, Action plan

Tutor name______________________________

Tutor signature___________________________

Date___________________________________

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9. CONTACT DETAILS

CONTACT DETAILS Principal : Tia Dowman Address : 706 Delta Office Park

Welton Road Swindon Wiltshire SN5 7XS

Telephone : 01793 73 77 33 Mobile : 07824 337333 Email : [email protected]

Website : www.wsbht.co.uk Like us on Facebook or follow @wsbht on twitter


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10. ACCREDITATION

This course is accredited by:

The Guild of Beauty Therapists

The Guild of Holistic Therapists WSBHT is registered with UKRPL

UK Register of Learning Providers No: 10027055

Medical Disclaimer It is advised that you take medical advice if you or any of your clients have a health problem. Any qualification from WSBHT will not qualify you to advise on any medical condition or to diagnose a condition. Liability WSBHT will accept NO liability for any person for any type of loss or damage whatsoever resulting from the use of materials within any course held by WSBHT. Copyright All copyright and other intellectual property rights in these materials are owned by or licensed by WSBHT. Copyright, adapting or other use of all or part of these materials without written permission of WSBHT is strictly prohibited.

Documents

The Wiltshire School of Beauty and Holistic Therapy · 2017. 7. 7. · advancing pregnancy. Early weeks in the second trimester are still very precarious, and miscarriages can still