A distinction should be made between therapeutic prenatal massage and perineal massage, the latter referring to the practice of manually stretching the tissues surrounding the birth canal to help reduce the risk of episiotomy or trauma associated with childbirth.

Hormone regulation
Studies done in the past 10 years have shown that hormone levels associated with relaxation and stress are significantly altered when massage therapy is introduced to women’s prenatal care. This leads to mood regulation and improved cardiovascular health.
In women who received bi-weekly massages for only five weeks, hormones such as norepinephrine and cortisol (hormones associated with stress) were reduced, and dopamine and serotonin levels were increased (low levels of these hormones are associated with depression).

These changes in hormone levels also led to fewer complications during birth and fewer instances of newborn complications, such as low birth weight. The evidence strongly suggests there are maternal and newborn health benefits when therapeutic massage is incorporated into regular prenatal care.

Reduction of swelling
Edema, or swelling of the joints during pregnancy, is often caused by reduced circulation and increased pressure on the major blood vessels by the heavy uterus. Massage helps to stimulate soft tissues to reduce the collection of fluids in swollen joints. This also improves the removal of tissue waste carried by the body’s lymph system.

Improvement of nerve pain
Sciatic nerve pain is experienced by many women in late pregnancy as the uterus rests on muscles of the pelvic floor and lower back. The pressure of the uterus spreads tension to the muscles of the upper and lower leg, causing them to swell and put pressure on nearby nerves.
Massage therapy addresses the inflamed nerves by helping to release the tension on nearby muscles. Many women have experienced a significant reduction in sciatic nerve pain during pregnancy through massage.

Other potential benefits of prenatal massage:

Reduced back pain
Reduced joint pain
Improved circulation
Reduced edema
Reduced muscle tension and headaches
Reduced stress and anxiety
Improved oxygenation of soft tissues and muscles
Better sleep

Precautions for prenatal massage?
As with any therapeutic approach to pregnancy wellness, women should discuss massage with their prenatal care provider. The best way to address the risks of prenatal massage is to be informed and to work together with knowledgeable professionals.
Many professionals consider the best position for a pregnant woman during massage is side-lying. Tables that provide a hole in which the uterus can fit may not be reliable and can still apply pressure to the abdomen, or allow the abdomen to dangle, causing uncomfortable stretching of the uterine ligaments. Consult your massage therapist before your first appointment to verify what position they place their clients in during the massage.

Seek an appropriate massage therapist
It is important to seek care from a certified prenatal massage therapist. Certified therapists have received training beyond the national standards for massage therapists and know how to address specific pregnancy and massage needs.
They are aware of how to position you safely and prevent strain to the uterine ligaments. They are also able to watch for symptoms of blood clots and varicose veins.
Women who have recently experienced bleeding, preterm contractions, or have any of the following conditions should speak with a health care provider prior to receiving a massage:

High-risk pregnancy
Pregnancy-induced hypertension (PIH)
Preeclampsia
Previous preterm labor
Experiencing severe swelling, high blood pressure, or sudden, severe headaches
Recently gave birth

Is prenatal massage safe throughout the entire pregnancy?
Women can begin massage therapy at any point in their pregnancy – during the first, second, or third trimester. Many facilities will refuse to offer massage to a woman who is still in her first trimester because of the increased risk for miscarriage associated with the first 12 weeks of pregnancy.

Prenatal Massage as part of Prenatal Care
The benefits of massage can improve overall prenatal health for many pregnant women. Along with the guidance and advice of a prenatal care provider, massage therapy can be incorporated into routine prenatal care as an emotional and physical health supplement shown to improve pregnancy outcome and maternal health. Consult with your midwife or obstetrician before beginning any new therapeutic practice.