I’ve been on again off again researching Thai prenatal and postpartum practices ever since my first trip to Thailand, about twenty years ago when I met a woman in a village in the far north who taught me Thai techniques for massaging babies. In the years since then I sought out prenatal and postpartum information from time to time on various trips to Thailand, read any papers I could find on the subject, and summer before last I traveled through the northern mountains with a lovely group of five female students of mine to learn from Thai midwives as well as some women who didn’t identify as midwives, but who had extensive experience assisting with traditional births. And lastly, to spend time with my teacher getting clarity on the things we had learned.
The western Thai massage community has been asking me a lot of questions lately about Thai prenatal and postpartum work. I’m working on a more in-depth write up on the subject, but in the meantime, due to the preponderance of questions and sadly, misinformation that is floating around, I’ve decided to share in brief, a handful of things that I hope will be helpful.
Please note: You cannot learn all there is to learn from a short blog post. If you have the opportunity to learn from an actual Thai midwife or other experienced practitioner in Thailand who is working with prenatal and postpartum knowledge and techniques as they have historically been practiced, this is where the real learning is. I’m just here to share a bit, to hopefully be helpful. I will follow this up with a separate blog post titled “Postpartum In Brief”.
The following is from my studies with traditional Thai healing arts practitioners in Thailand. Nothing is taken from outside sources such as Chinese or Ayurvedic medicine, however I do use some wording that is specific to western medical language in order to be easily understood. The information here is as I have been taught by my teachers in Thailand. I specifically seek out doctors who follow old traditions and are not teaching in diluted and westernized fashion. To the best of my knowledge I am simply passing along ancient traditions, and any errors here are my own. Also, apologies for how much longer the “don’t” list is than the “do” list, but understanding cautions is important with pregnancy, and a longer “do” list would require in-person training as it’s more hands on. But this should give you an idea and a start. I do think that you can do limited work on pregnant women without hands on training, just know your skill limits and use caution.
The beautiful hands of a midwife in her 70s demonstrating a deep prenatal technique in a small village in northern Thailand.
Prenatal Don’ts
• Traditionally bodywork is not done during the first trimester. Of course, if the mother has specific physical care needs she can be attended to, but it’s not a time for generic or more random work.
• The type of Thai massage that most are familiar with, the combination of palming, thumbing and stretching, is not what is done with pregnant women (and all who become pregnant regardless of gender identity*). You should not simply adapt a standard Thai massage routine to a pregnant body. This is not done in Thailand and while you may find it harmless in most cases, the risks of the rare case in which it causes harm are real and must be accommodated for.
• Stretching, for the most part, is not done on pregnant women due to the very real chance of over stretching, which is not as easily noticed due to the presence of relaxin, a hormone released during pregnancy that softens our tendons and ligaments in order to help the body to be able to open up for the passage of the baby during childbirth.
• Thumbing the sen is also not done during pregnancy. The tissue of the pregnant woman becomes more watery than usual as water, the element of creation and becoming, is increased. Watery tissue is more easily bruised and otherwise injured, so thumb pressing has a higher risk of causing damage. Also, pregnant women have increased chance of deep vein thrombosis, so any strong pressing, particularly in the inner legs, bears the chance of throwing a blood clot (this last bit is knowledge that I have from western medicine, not Thai; they may well have this same knowledge in Thailand, but I was not taught this there so I cannot be sure).
• Inversions are not done on pregnant women. Think blood pressure changes, nausea and dizziness. Once one of my students showed a midwife in Thailand a picture of someone placing a pregnant women in an inversion and the midwife quite literally gasped in horror.
• Whole body deep tissue (which much Thai bodywork is) is not usually done on pregnant women. Pregnancy is a time for gentleness and not for work that leads to systemic detoxification,* which can cause the mother to feel unwell and may be harmful to the baby. Most bodywork that is done on pregnant women is spot specific to attend to a problem. It is sometimes physically intensive as needed, but in this we are talking about skilled technique application for specific problems. They seem to have a fairly hands off approach to pregnancy in Thailand; if all is well, leave it be.
• Don’t use herbal products containing herbs that move wind. This is a lot of the warming herbs, many of which are found in generic Thai herbal compresses (herb balls).
• Do not put pregnant women into the prone position, even if you have one of those tables with a cut out for the belly to hang through. These are a western creation and shouldn’t factor in a Thai massage practice anyhow, but since I’ve heard students of mine suggest them I wanted to address the idea. I’m going to quote an authority on western prenatal massage, Carol Osborne-Sheets, from her excellent book Pre-and Preinatal Massage Therapy:
Some women like to sleep on their belly or in a 3/4 prone position with pillow supports through much of their pregnancy. This may be a safe, comfortable resting position, but one pressure is applied for massage this is no longer a reliably safe option. Prone positioning on a flat therapy table exerts strain on the lumbar, pelvic, and uterine structures. Posterior musculature is shortened; the lumbar vertebra and lumbosacral junction are compressed and anteriorly displaced; the sacroiliac joints are rotated; and strain on the sacrouterine ligaments is increased. Obviously, the prone position aggravates the very causes of many women’s back discomfort, particularly in later pregnancy.
Some practitioners may attempt to accommodate the pregnant belly and mechanically reduce lumbar strain by placing pillows under the chest and pelvic regions, by propping the upper torso on a stack of pillows, or by using equipment that is marketed as “the solution” for prone positioning for pregnant women. Neither pillow props, body cushions, pregnancy pillow, most on-site massage chairs, nor tables with cut-out ovals, with or without a sling or net designed to support the belly solves the problematic aspects of prone positions. These alternatives either (1) further strain the taxed uterine ligaments, especially the sacrouterine ligaments, by dangling the uterus from these attachments, or (2) create increased intrauterine pressure, particularly when sufficient pressure is applied to therapeutically address the posterior structures.
Prenatal Dos
• Use warm herbal compresses for mental and physical relaxation massage. You’ll probably have to make your own for pregnancy work because, as stated above, the generic pre-made compresses contain herbs that are contraindicated during pregnancy. Most prenatal general bodywork is done almost entirely with warm herbal compresses. You can find a prenatal compress formula in my book Seven Peppercorns, or if you don’t have that, contact me for information. So long as I have time, I’m happy to share.
• If taught how, you can use techniques to shift the baby’s position at certain times in pregnancy to alleviate discomfort to the mother. But you must learn this hands on, with a teacher. If you have trained as a western doula or midwife it is possible that you know western techniques for this and can apply these. Just stay clear with people about where the work comes from as Thai healing arts have enough confusion :) The moving of the baby is common with Thai midwifery, particularly at specific times during the pregnancy.
• Position pregnant clients on their side, back, or seated. Some pregnant women cannot lie on their backs comfortably or for very long as the uterus can press on the inferior vena cava. Just communicate with your client about this to find out what is comfortable for them. If there is discomfort in the supine position, try stacking a great many pillows under her upper back and head, creating a supported supine position. Or better yet, just work in side position.
• Encourage the mother to walk a lot. Every single Thai midwife I have spoken with has stressed this as being one of the single most important factors of pregnancy. Walk. Walk walk walk. Don’t do strenuous exercise, don’t jog, just walk everywhere that can be walked. Throughout the entire pregnancy. The midwives I have worked with all said that this, more than anything else done during gestation, assists with the pregnancy, delivery, and recovery. Getting those pregnant mamas walking might be more important than getting them onto the massage mat in many cases.
In addition to the dos and don’ts mentioned here there are a great many lifestyle recommendations that Thai traditions dictate for a pregnant woman such foods that are beneficial and foods that are harmful, and things that pregnant women should avoid doing, witnessing, or saying. I have tried to mostly stick with things that are applicable to a massage therapist here.
I hope that this has been helpful and I wish great health and well being to all the pregnant beings.
A word about those points around the ankles
One of the most common questions I get about prenatal work is if massaging the feet and ankles will cause a miscarriage. This comes from pop culture knowledge of Chinese acupuncture/acupressure points in which we find a commonly held belief that specific spots near the ankle (and a few other places), if pressed, will cause a miscarriage (or, at the end of pregnancy, initiate childbirth). Even though this theory is not Thai, I have looked into it due to the prevalence of people who are concerned about it. I’ve talked with several acupuncturists and midwives (western midwives; I have not talked about these points with Thai midwives) and all of them have agreed that these points are not a concern. Even if the points were likely to cause miscarriage, it would be through the skilled application of Chinese point work techniques, not through random massage. And if pressing on a point near the ankle caused miscarriage we would have acupressure abortion clinics; not only would women prefer a lovely foot massage to a traumatic D&C, but someone would realize they could profit from this. This said, because so many people have the idea that foot massage can cause miscarriage, I advise my students not to massage feet on pregnant women. I do not think that there is any real danger of causing miscarriage, but since miscarriage is quite common, there is a danger of being incorrectly blamed.
* A note on the term “detoxification”
I know that it has become popular in massage circles recently to say that there is no such thing as toxins and detoxification. I believe this is a misunderstanding of recent writings that put forth that many of the modern health industry diets and products marketed as detox methods are not in actuality creating any great cleanse in the body. This does not, however, mean that there is no such thing as toxins or detoxification. Feces, left too long in the body, are toxic to the body, and pooping is a form of detox; to put it overly simply. Vomiting up food that had harmful (or toxic) bacteria in it is detoxification. There are a great many toxins in the world that can get into our bodies in a huge variety of ways, and a great many ways that we get them out; including via the increased blood and lymphatic circulation that can result from bodywork.
* And finally, a word about gender
I use the word “women” in this blog and I want to acknowledge that there are people who identify as male, yet have bodies that are capable of pregnancy, and people who identify as women who do not. Language is complex and growing and changing, but all beings are included and welcome. Much love to all.
Special thanks to Khun Nuan, Khun Nat, Mae Nong, Mae Nit, Mae Lek, Khun Homprong, those whose names I do not remember from too many years ago, and especially, gratitude to Tevijjo Yogi.