Issue link: https://www.massageandbodyworkdigital.com/i/1276187
C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 57 for singleton gestation; after 12 weeks with multiples (Image 3). • After 22 weeks, only use semi-reclining and side-lying positions (Image 4). If you are well-trained to work with pregnant clients, then providing stable, aligned positioning in side-lying, supine, or semi-reclining is second nature to you. Of course, those therapists already skilled in side-lying positioning will also have that side-lying advantage with all clients, providing an alternative that keeps therapist and client from breathing face-to-face as necessitated when the client is supine. BLOOD CLOT CONSIDERATIONS Changes in clot-dissolving capacity occur in all pregnancies and are a normal and protective adaptation to avoid birth and postpartum hemorrhage. Safe perinatal massage therapy always requires taking precautions relevant to possible blood clots. Research points to approximately double the coagulation activity during pregnancy when compared to nonpregnant women, and a tendency toward formation of deep vein thrombosis (DVT) where clots form in the inguinal, femoral, and saphenous veins. 12 DVT is even more common postpartum, particularly for those who had cesarean births, other surgeries, or who hemorrhaged. Those expectant and postpartum individuals who are on bed rest are especially prone to clot production; that risk also exists for people who smoke, are over 35 years old, have varicose veins, have recently used birth control pills, are obese, have lupus, have been pregnant multiple times before, or are carrying multiples. If you are not fully educated about the physiology of normal and high-risk pregnancy- and postpartum-related hypercoagulation and guidelines to reduce chances of thrombi moving from the legs into general circulation during pregnancy and early postpartum, now's the time to learn, and wait to work with these clients until you do. The accompanying illustration offers a very quick review of the most relevant massage therapy adaptations to reduce complications related to hypercoagulation during pregnancy, especially those relevant for the legs (Image 5). Do not consider looking at this image as adequate education on this critical topic. The restrictions summarized in this illustration are aimed to reduce possible pulmonary embolisms (clots that have traveled from elsewhere that obstruct vessels in the lungs). It is critical you follow these for ALL prenatal and postpartum massage therapy clients, regardless of COVID-19. Of course, you also should observe your clients for any of the characteristic symptoms of leg thrombi—increased edema in the foot and/or leg (often unilaterally), localized swelling, heat, redness, and painful, achy legs that can be tender with palpable, ropy veins. These symptoms are particularly worrisome if they increase when your client Extended supine positioning in pregnancy often results in supine hypotensive syndrome. Note the relief of pressure on the vena cava when the client is side-lying instead. Side-lying positioning usually is safest and most comfortable and effective with sufficient supports under the abdomen and leg to maintain the client on their side with the hip, knee, and ankle of the supported leg staying level. Images courtesy Carole Osborne and excerpted from Pre- and Perinatal Massage Therapy, third edition. In weeks 13–22, placing a wedge-shaped pillow under the right pelvis shifts uterine weight off the vena cava. Another alternative to prevent supine hypotensive syndrome, which often reduces shortness of breath and/or heartburn, is semi-reclining. Maintain a hip joint to head angle of 45–75 degrees from the tabletop. 2 1 3 4