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Hormones prepare the mother's body for lactation, and the hormone relaxin, which is secreted in higher amounts between weeks 10–14, softens all connective tissue to allow her pelvis to widen for childbirth and all articulations to stretch for uterine growth. Relaxin softens the connective tissue throughout the body, resulting in lax fascia, ligaments (including the uterine ligaments that have to stretch as the uterus grows), and tendons. This contributes to joint instability and strain on weight-bearing joints as well as pelvic hypermobility and lower-back discomfort. Relaxin slows down femoral lymph absorption, which contributes to swelling in her lower extremities. The effects of relaxin stay in her body 4–6 months postpartum. Neurological System Most of the changes that occur to the nervous system are mitigated by the mother's posture. Carpal tunnel syndrome and de Quervain's syndrome are often caused by her protracted neck compressing the lower cervical vertebrae, swelling in her hands, and relaxin softening the flexor and extensor retinaculum that holds the carpals in alignment. Sciatica in early pregnancy is most likely caused by the softening effect of relaxin on the sacroiliac joints. As pregnancy progresses, sciatica is often caused by the pressure of the heavy uterus on the sciatic region, an occiput posterior presentation of the baby, tight hip rotators (especially the piriformis), the stretching of uterine ligaments, the diastasis recti, and the anterior pelvic tilt. Sciatica is rarely caused by nerve root damage or herniated discs during pregnancy. Sleep disturbances and headaches are also brought on by her constipation, hormonal changes, and physical discomforts. Appropriate modalities: lymphatic drainage on the arms, myofascial release, appropriate stretches, reflex treatment points, trigger point release, strain/counterstrain, and use of appropriate body mechanics. For more information on the treatment of neurological discomforts of pregnancy, read my Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork (Mosby, 2008). Reproductive System During pregnancy, menstruation and ovulation cease and the uterus grows to five times its normal volume. What started out as an organ weighing 2 ounces becomes a 2-pound home for the baby, placenta, and amniotic sac. A first-time mom might not be aware of it, but her uterus is contracting throughout her pregnancy. These pre- labor Braxton Hicks contractions are not labor contractions, but serve very distinct purposes: they strengthen the uterus for labor and encourage circulation between maternal and fetal circulatory systems. A new organ develops to support the baby: the placenta. This organ continues to grow and mature throughout pregnancy and serves numerous essential functions. It stores, manufactures, or elaborates the hormones (i.e., estrogen and progesterone) that support the pregnancy; it metabolizes fats, proteins, and carbohydrates so the fetus can assimilate these nutrients; it aerates fetal blood and takes waste products away; and it has bacteriostatic properties so the mother's body doesn't expel it. Within the uterus, the baby is encased in an amniotic sac filled with amniotic fluid. This fluid is the perfect temperature for the growing baby; acts as a shock absorber against any trauma to the mother's abdomen; permits the baby to grow symmetrically; prevents body parts from adhering to one another; provides a fluid environment so the baby can move its body parts; and is swallowed in small amounts to encourage and strengthen the sucking and swallowing reflexes at birth. Bear in mind that you are not just massaging the woman on your treatment table—mother and baby are inextricably linked. Notes 1. Marjorie R. Sable, "Pregnancy Interventions May Not be a Useful Measure for Research on Maternal and Child Health Outcomes," Family Planning Perspectives 31, no. 5 (1999): 249–50. 2. Ibid. 3. Ibid. 4. Pathik D. Wadhwa, "Study Suggests Maternal Stress and Stress Hormones May Influence Fetal Brain Development," University of Kentucky Chandler Medical Center, March 11, 1999, accessed October 2015, www.uky.edu/PR/ News/MCPRNews/1999/maternal%20stress.htm. Elaine Stillerman received her New York-state massage license in 1978 and began her pioneering work in prenatal massage in 1980. She is the developer and instructor of the professional certification course MotherMassage: Massage During Pregnancy and her most recent text is Modalities for Massage and Bodywork, 2nd ed. (Mosby, 2015). In 2013, she was the inaugural winner of the Alliance for Massage Therapy Education's Educator of the Year Award and was also inducted into the World Massage Festival's Massage Hall of Fame. Learn more at www.mothermassage.net. MASSAGE FOR MOMS-TO-BE F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 61