Massage and spa in pregnancy: what is safe and what to avoid

Lower back pain, swollen legs and difficulty sleeping are common in pregnancy. Massage can help with these — but during pregnancy "massage" is not one single thing, and some spa services are not suitable at this time.

This article gives general information and does not replace medical advice. Every decision during pregnancy should be made together with your doctor.

In brief

May be suitable: Pregnancy massage (with your doctor's approval and a trained therapist), gentle reflexology (with care), prenatal yoga.

Take care: Aromatherapy — many essential oils are unsafe in pregnancy.

Why is pregnancy massage a separate treatment?

It differs from a classic massage in four ways:

1. Position. Lying face down is not suitable in pregnancy. The session is done with you lying on your side, supported by cushions under the bump, at the lower back and between the legs. From the second trimester on, lying on your back for long periods is not recommended either — the growing womb can press on the main vein.

2. Pressure. It stays light to medium. No deep tissue work is done.

3. Areas avoided. The abdomen is not massaged. Certain points on the inner ankle and around the heel are avoided. No deep pressure is applied to the legs — this is a critical safety rule, because the risk of blood clots rises in pregnancy.

4. Oils. The oils that can be used in pregnancy are limited.

These differences call for specific training. Do not go to a place that says "We do massage, so we can do pregnant women too".

From which month?

Most venues do not give massages in the first trimester (the first 12 weeks) and accept clients from the second trimester onwards. This is a cautious approach — the first three months are naturally when the risk of miscarriage is highest, and venues do not want to take on responsibility during this period.

In every case, tell them how many weeks pregnant you are when you book.

Why your doctor's approval really is needed

This is not a formality. Massage may be unsafe in the following cases:

High-risk pregnancy
Pre-eclampsia (toxaemia of pregnancy)
High blood pressure
Gestational diabetes
Threatened premature labour
Placental problems such as placenta praevia
Bleeding
Multiple pregnancy

Your doctor should make the decision with full knowledge of your situation.

Emergency: swelling in one leg

In pregnancy, mild swelling in both legs that increases towards the end of the day is normal.

But if there is swelling, redness, warmth or pain on one side only, do not have a massage, and see a doctor straight away. These can be signs of a blood clot (deep vein thrombosis), and in that case massage is dangerous.

Why is heat a problem?

What the hammam, sauna, steam room, jacuzzi and thermal pool have in common is that they raise your body temperature. In pregnancy, especially in the first trimester, a marked rise in body temperature is not recommended.

On top of this, the wet, slippery floors in these areas carry a risk of falling; your balance already changes in pregnancy.

For the same reason, hot stone massage is not suitable in pregnancy either.

Aromatherapy: which oils are unsafe?

The oils it is recommended to avoid in pregnancy include sage, rosemary, jasmine, juniper, cinnamon and thyme. The list is longer than this, and it varies between sources.

The practical approach: if you want an aromatherapy massage, go to a therapist trained in working with pregnant women and consult your doctor. Ask what is in the blend.

How soon after giving birth?

After a vaginal birth, waiting a few weeks is generally recommended; after a caesarean, waiting until the wound has fully healed (usually 6-8 weeks). Make the decision under your doctor's supervision.

If you are breastfeeding, the choice of aromatherapy oils still matters.