Changes in the baby
The foetus also makes an incredible journey during this time. Once sperm and egg fuse, the single cell starts to divide while travelling down the fallopian tube to embed in the womb. In the second month limb buds and facial features begin to appear and bones begin to form and a heart beat will be visible by scan. By the third month, the organs are fully formed and will mature over the rest of the pregnancy, she can be seen to arch
her body and move her lips as she starts to practice sucking.

Massage
Regarding the massage itself, every woman will come with different needs, so as always we should be guided by her process in the moment rather than her symptom; you may not alter your work so much, but be guided by what she presents from session to session. As there is so much change during this period, and tiredness, nausea and anxiety are common, touch that will help to stabilise and confirm is helpful. The following is a general guideline as to what might be useful:

Matter of fact intention
Using a ‘matter of fact’ touch can be very calming. This would include tangible elements such as speed, direction and depth as well as internal attitude and the quality of relating. The contact would be on the muscle sheath, the rhythm a little like the music that introduces the shipping forecast ‘Sailing By’. The internal attitude would include an awareness of where our boundaries meet and holding a reassuring thought of ‘you’re OK’. This should help work towards a sense of containment for the client, while avoiding provoking more up-drift.

Holding
In this technique the therapist uses full hand contact, placing her palms on the client’s body for a few breath cycles and moving to the next position on the out-breath. This can be focussed on any level that feels appropriate; bone, muscle, skin or aura. The intention is to contain, give boundaries and reassurance.

Membrane Massage
This works on the muscle membrane, the therapist uses the pads of her fingers to move the membrane over the muscle in a soothing waltz rhythm. The intention is to integrate, digest and ground.

Muscle holding
This is as much technique as intention, using the whole hand to gently grasp the muscle and moving slightly away from the bone, towards the periphery. The intention is to put the client in contact with the strength in her muscles and by association her inner strength: ‘I can cope!’, ‘I can do it!’.

Packing
This is a refinement of holding in the aura and uses a patting motion to confirm and seal energetic boundaries, usually done around four inches from the body or where the temperature/sensation in the hands changes.

Grounding
By which I mean any sort of massage or exercise to encourage the energy into the legs and feet. This could be energetic holding, muscle holding, gentle stretches or rotations.

Working to client’s boundary
This can help foster a feeling of safety for the client. It requires very slow, sensitive movement; for example, when doing shoulder rotations, sensing where the resistance is and stopping at that edge, then working gently by trying to avoid triggering resistance. It can also be done verbally by acknowledging the holding to the client.

Abdomen
Helping the energy to settle in the abdomen is good, some women like energetic holding here or on the lower back, though it’s always worthwhile checking to see what feels OK.

Giving space
A vital part of the work at this time is to give the woman space to experience how she is in this new place; pregnancy brings with it a particular softness and permeability which makes the influence of the outside world and the rush of her internal life especially overwhelming, and it is easy for women to lose touch with themselves. This would include space to talk about herself, space to feel her body and to experience her feelings.

Connecting with baby
Work can also start to make a connection with the baby. As movement isn’t usually felt until 20 weeks or so, this would be in the form of focussing attention, breathing or visualisation. In Chinese and Japanese traditions there is a meridian that connects the heart to the uterus known as Bao mai; this meridian can be tremendously grounding as it provides a link between fire and earth elements. It can be brought into awareness by touch e.g. palming, breathing meditation or visualisation.

Massage styles to avoid
The mother and baby’s systems are in such a state of flux at this time, work that creates more change and upheaval are to be avoided. This would include vigorous or provocative techniques, particularly on the lower back which might be uncomfortable. As Relaxin levels are high to soften the tendons, strong stretches should be made with a great deal of care, if at all. Lymphatic work is also best avoided at this time as the release of toxins can unsettle the delicate hormonal balance. Stretches, opening work and emptying in the groin area might be best avoided early in pregnancy. The main guideline as with all sorts of massage is for our clients to listen to their bodies and give feedback to the therapist. But as in the rest of our practice we should be guided by our own boundaries to show us what we are willing to work with.

 Fear of miscarriage
From my own experience of pregnancy and from working with pregnant women, I have observed that there is a lot of unexpressed anxiety about pregnancy both in women themselves and in our society. Expecting a baby is usually (though not always) a joyful prospect, but we are not good at allowing our fears a voice. Probably as a consequence of this, we are bombarded with often contradictory advice about what might harm the baby. The first trimester is the period when there is most risk of miscarriage with about one in four pregnancies ending this way. It can be a lonely, painful experience and the grieving process needs time and space. Most women who have suffered a miscarriage never find out exactly what the cause was, and it can be very hard to accept that there was nothing they could have done to change the outcome. Listed below are the five common causes of miscarriage:

  1. A genetic abnormality is the most common cause of about 50% of miscarriages; the baby does not develop normally from the start and cannot survive; however subsequent pregnancies need not be affected.

  2. An imbalance in pregnancy hormones can cause conditions such as polycystic ovaries and irregular periods which can cause miscarriage. There are treatments available for hormonal imbalance.

  3. Structural problems such as a weak cervix, abnormally shaped uterus or large fibroids.

  4. Infection can impact pregnancy, not coughs and colds but a very high temperature, and infections of the blood such as hepatitis, toxoplasmosis and
german measles.

  5. Blood clotting disorders can affect the flow of blood to the placenta which in turn would deprive the baby of oxygen and nutrients.

It is hard to see how massage can affect any of the above conditions, and it has never been shown as a cause of miscarriage. Like moderate exercise, massage can make a great contribution to the well-being of both mother and baby.

Contraindications
There are some instances when massage is not recommended. If a client reports any of the following events she should ask her mid-wife or doctor for advice:
Vaginal bleeding (often occurs in a normal pregnancy that is brought to term)
Pelvic cramps
Abdominal pain
Dull ache in lower back
Clot-like fluid or tissue from the vagina
Fever, weakness

My conclusion is that therapists shy away from massaging women early in pregnancy not because the massage itself may damage, but because miscarriage, as common as it is, is a bereavement and a profound loss that many women continue to feel for the rest of their lives and we are afraid of coming into contact with this loss. Also therapists are afraid of contributing to a miscarriage, or of being seen to have caused one, and just not
knowing if this was the case. It is understandable that many professionals choose to work with pregnancy when it enters a more stable phase, but early pregnancy is such a vulnerable period, surely these women would benefit from more support rather than less.

References
Gordon, Yehudi. Birth and Beyond...London: Vermilion,2002
Kitzinger, Sheila The New Pregnancy and Childbirth (4th Edition). London: Dorling
Kindersley, 2003
www.tommys.org
www.miscarriageassociation.org.uk
www.wellmother.org
Yates, Suzanne. Shiatsu for Midwives. Elsevier Science Ltd, 2003