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Are all prenatal massages equal?

I've had another round of new clients who sought me out after an experience at a day spa or similar establishment that offered "maternity massage" but didn't deliver what the woman was expecting, let alone needing. Some of my clients tell me they are initially drawn to day spas or massage centers because they assume that these places are more professional and trustworthy than a random independent therapist (who might be working out of her home). Following that logic, these establishments would seem even more a safe choice during pregnancy. This is sometimes a good conclusion, but not necessarily so! Here are some actual experiences of my clients:

  • The therapist was great, but was afraid to touch certain parts of the woman's body, including her low back and feet -- which were quite in need of touch!

  • One woman came to see me who actually developed some neck pain after a "precious moments" maternity massage at a day spa because the therapist did not know how to safely accommodate her pregnant body and kept her in uncomfortable positions throughout the massage.

  • Another woman felt suffocated as she went face down on a "pregnancy pillow" on the table with no air hole to breathe through.

  • In general, clients tend to complain that the therapists didn't touch them confidently and were afraid to give deeper touch that is so helpfully in alleviating the strong muscle tension created by pregnancy.

This is not at all meant to be a slam against therapists working in day spas and massage centers; there are great therapists who have worked for a long time in these arena, many of whom are properly trained in pregnancy work. In many places, therapists have reduced control over the types of massages they give and to whom -- these decisions are being made by non-therapists. We have moved from a time when massage schools taught everybody that pregnant women should never be massaged, to a time when therapists are being asked to deliver pregnancy massage with little or no training. Experts in the field fear that as the massage industry continues to grow (in a climate where "maternity" is big money), therapists' ability to deliver quality work is continually compromised.

The Rapid Growth of the Massage and Spa Industries Over the past several years, the spa industry has grown by leaps and bounds as massage and related services are sought by a larger section of the population. Day Spas are proliferating and new types of establishments such as Massage Envy, Just Massage, and, here in San Diego, the Knot Stop, are turning up in more and more neighborhoods. Their mission is to make massage available to more people, and in the case of the latter, usually below market rates. Admirable idea and smart business given the increased demand for massage services. And, often you can get just what you need at these establishments. But. Because you can tell there is a "But" coming. Massage centers such as Massage Envy are, from a therapist's perspective, often nothing more than "massage mills." They are not optimal settings for therapists who often report that their quality of work is consistently compromised. Below I detail some stuff to keep in mind as you wade your way through your options:

  • If you are receiving a "deal" on your massage, then the therapist is most likely not being paid well. Which is wrong. And it begs questions around how committed the therapist is to his or her work, to your massage session. Are they present in the room with you, or racing through to get to the next massage to make more money? The rise of Massage Envy has yielded affordable massages and droves and droves of disgruntled therapists -- a quick search online will give you a peak into the hostility therapists tend to feel towards this employer in particular (here's one example).

  • Therapists at these "massage mills" often work double shifts and you could be the 8th massage of their work day. No matter how amazing the therapist is, they have human limitations. Massage is physicallyand emotionally draining work, and for most therapists (surveying my peers), their ability to deliver good work is significantly diminished after 4 or 5 sessions. (I was somebody's 8th massage at one of these places last summer -- he was revved up on caffeine, super chatty, sloppy with the sheet, and rough with his elbow. And he tried to get me in "on the ground floor" of some great opportunity!).

  • You will often be churned on through: an hour massage is really only 45 to 50minutes, and the therapist will be starting another massage at the end of the 60minutes.

In my experience, your best luck is going to be with a place that has low therapist turnover -- they tend to take care of their employees and have a healthier environment that their therapists can thrive in (don't you want the therapist who is touching your body to be thriving?). And, when you go in, make a point of really connecting with the therapist and letting her know you appreciate her time; tip accordingly as they work hard and are usually quite underpaid. And if a friend recommends a day spa or other establishment, get the name of the therapist they saw.

Pregnancy Massage Specialists So most of these places offer pregnancy massage. Most licensed therapists with some training should be able to deliver safe touch to you during your pregnancy (assuming your pregnancy is healthy, not high risk and without major complications). That does not mean, however, that most therapists know how to accommodate your body on the table to make you super comfortable, nor does it mean they know how to work specifically with pregnancy aches and pains. A therapist with specialized training is going to do more than adapt their regular old massage routine to your body; the massage will be designed for your pregnant body from start to finish. Here are some points to be wary of:

  • Wide range of training. Many establishments (most!) offer prenatal massage and most of these are conscientious about hiring therapists who have some sort of training in prenatal work; however this training could range from 3 hours in massage school to a 4-day training. You and the receptionist booking your appointment are not always going to know how extensive the training was.

  • False training. Occasionally a day spa or similar venue will send one therapist to a training, and then he or she will come back and teach what they learned to the other therapists. (as I read recently in Massage & Bodyworkmagazine).

  • Experience. Even if they have solid training, therapists in a more general setting often may see one or two pregnant women a month at best which limits their ability to really get to know pregnant women's bodies and needs.

  • Policy limitations. Many establishments limit the types of touch that therapists can offer to pregnant clients. This is partly about safety, but mostly about liability. As in the case of some my clients, this may mean little or no work on your low back or feet!

All that said, you can get good massage during pregnancy at lots of day spas and massage establishments. Particularly if you and the baby are healthy, and you are experiencing a low risk pregnancy and no complications. If you are nervous about pregnancy massage, experiencing a lot of pain or complications, or have a higher risk pregnancy, check with your doctor/midwife and seek out a specialist who works with pregnant women regularly.

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