Massage Therapy During Pregnancy: Safety and Recommendations
Massage therapy is safe during pregnancy for healthy women without complications, and should be encouraged as it provides significant benefits including reduced stress, pain relief, improved mood, and potentially better birth outcomes. 1, 2
Safety Profile in Healthy Pregnancies
Massage therapy demonstrates an excellent safety record in uncomplicated pregnancies:
- No evidence of harm to mother or fetus has been documented in randomized controlled trials of pregnant women receiving massage after 12 weeks gestation 1
- An observational study of 101 pregnant women found zero maternal or fetal physical harm events from massage therapy 3
- Side effects, when they occur (40% of cases), are minor and transient in nature 1, 3
- The common myth that foot massage during pregnancy is dangerous is not supported by evidence—97% of women in one study received full-body massage including feet without adverse outcomes 3
Clinical Benefits
Massage therapy provides measurable improvements in pregnancy-related conditions:
- Reduced back and leg pain, which are among the most common complaints (33.7% seek massage for low back pain) 1, 3
- Decreased stress, depression, and anxiety with increased serotonin and dopamine levels 1
- Improved sleep quality and range of motion 3
- Higher fetal birth weight and reduced risk of preterm delivery 1
- Enhanced immune response during pregnancy 1
Absolute Contraindications
Massage must be avoided or performed with extreme caution in the following situations:
- Deep vein thrombosis (DVT) or risk factors for DVT—leg massage can dislodge thrombi, causing fatal pulmonary embolism 4
- Active preterm labor 5
- Severe pre-eclampsia 5
- Placental abruption or vasa previa 5
- Uncontrolled medical conditions requiring activity restriction 5
Critical DVT Warning
A case report documented a fatal massive pulmonary embolism in a 25-week pregnant woman following leg massage with unrecognized DVT 4. Pregnancy increases thromboembolism risk, making screening for DVT symptoms essential before leg massage 4.
Practical Implementation
When to start: Massage can begin after 12 weeks gestation in healthy pregnancies 1
Frequency and duration: Evidence supports bi-weekly 30-40 minute sessions, though benefits are seen even with single sessions 5
Technique considerations:
- Full-body massage including feet is safe in uncomplicated pregnancies 3
- Use trained, licensed massage therapists familiar with pregnancy-specific modifications 5
- Appropriate positioning and draping should accommodate the pregnant body 5
Pre-Massage Screening
Before each massage session, screen for:
- Leg swelling, pain, or warmth (DVT symptoms) 4
- Vaginal bleeding or regular contractions 6
- Severe headache, visual changes, or epigastric pain (pre-eclampsia symptoms) 5
- Decreased fetal movement or other concerning pregnancy symptoms 6
Evidence Quality and Gaps
The available evidence shows good methodological quality but has limitations:
- Most RCTs have unknown risk of bias due to inability to blind participants 1
- Studies typically exclude high-risk pregnancies, limiting generalizability 1
- Direct evidence from clinical trials specifically examining miscarriage risk is lacking, though physiological mechanisms provide no plausible pathway for massage to cause miscarriage 7
- The perception that first-trimester massage causes miscarriage is not supported by scientific rationale and likely reflects correlation with the naturally high miscarriage rate (8-30% of conceptions) during this period 7
Integration with Exercise Guidelines
Massage complements the broader recommendation for physical activity during pregnancy:
- Regular moderate-intensity exercise reduces pregnancy complications by ~40% without increasing miscarriage, preterm birth, or low birth weight risk 5
- Many traditional contraindications to activity are based on outdated expert opinion rather than evidence of harm 5
- Removing barriers to physical activity, including massage, may benefit maternal-fetal health outcomes 5