Mind the bump
Despite being the most natural physical process a woman can go through, pregnancy is incredibly taxing on the body.
Nausea, back and pelvic pain, skin break-outs, melasma, exzcema and insomnia are just some of the physical challenges faced by women during pregnancy, some of them mild but some severe and debilitating. Unfortunately, pregnant women are also subject to a number of safety contraindications that ban the use of treatments and products traditionally used to manage these complaints. 
Although it is recommended that pregnant clients avoid any spa treatments during their first trimester due to the risk of complications, there have been a number of studies proving the benefits of pregnancy massage to ease the discomforts of the second, third and even fourth (post-birth) trimesters. 
One of the most common pregnancy complaints is back pain, affecting at least 76 percent of women due to the extra weight they are carrying, and also the hormone relaxin which works to loosen the ligaments around the pelvis in preparation for childbirth. 
On the back of this, a recent Auckland University study linked the use of acetaminophen (paracetamol) while pregnant to children with emotional and behavioural difficulties such as attention deficit and hyperactivity disorder (ADHD). Although further studies are necessary, the opportunity for alternative pain relief through massage is clear.
A 2006 study into the use of tactile massage on women suffering from severe nausea and vomiting during pregnancy found that massage offered a relieving moment of rest and relaxation at a time when feels as though it has control of a woman’s body.
Another study looked at the benefits of massage on pregnant women diagnosed with major depression. The women were given twice-weekly massages for 12 weeks, as opposed to a control group who received no massages. By the end of the 12 weeks, the massage therapy group women versus the control group women not only had reduced depression during pregnancy, but they also had reduced depression and cortisol levels during the postpartum period. Their newborns were also less likely to be born prematurely and at low birth weight, and they had lower cortisol levels too.
The noted benefits of prenatal massage include:
  • Reduced incidence of pre and post-natal depression or anxiety caused by hormonal imbalances.
  • Relaxation, which in turn may assist in labour or alleviate insomnia.
  • Helping the pregnant woman connect with her changing body.
  • Relief or reduction from neck, back and pelvic pain.
  • Better posture.
  • More energy.
The pregnant ankle: the massage or not to massage?
Therapists are often taught not to massage the ankles of pregnant women due to the risk of stimulating miscarriage or the onset of labour. Leslie Stager, a perinatal massage specialist, doula and perinatal bodywork lecturer at the Oregon School of Massage has this to say:
“As we examine the warning against ankle massage – which has permeated not only massage schools, but the general public as well – we must seek clarification. What is really meant by the ankles? Is it the boney malleolus or does it include the inner calf and foot? What type of massage it is referring to – all touch, or specifically to effleurage, deep tissue, acupressure, shiatsu, or reflexology? 
The term massage is not clearly defined, but to be relevant to massage therapists, one might assume that it refers to effleurage or other Swedish massage manipulations. It does not seem to specify acupressure, which is the only technique that actually may have a relevant contraindication.
“There are four common reasons that the prohibition of ankle massage during pregnancy seems to have developed:
  1. There is still a common belief that pregnancy is a delicate or dangerous condition.
  2. There is misinformation about uterine and ovarian reflexology zones located around the ankles.
  3. There is misinformation about acupressure points near the ankles that may be used to support labour.
  4. There is an underlying fear of a woman miscarrying after a massage.
“Despite the prevalence of miscarriage and the fear of preterm labor, gentle therapeutic massage to the feet and ankles is not an associated cause. According to obstetrician Pete Chandler, as well as midwives Carol Gray and Sue Firman, CNM, if contractions could be intentionally started with a few minutes of effleurage to a woman’s ankles, everyone would use synthetic hormones to avoid medical inductions of labour.
“Another common reason cited for avoiding massage to the ankles is the fear of stimulating acupressure points that might trigger contractions. Again, misunderstandings abound regarding the use, locations, and methods of accessing acupoints, as well as the differences between acupressure as opposed to acupuncture prohibitions. Acupressure and shiatsu can be used to support the induction of labor when desired; however, in order to have any hope of encouraging uterine contractions, a different type of touch is required than is provided by general massage. Acupressure typically requires applications of direct pressure stimulating specific points over a period of hours or days in order to have a lasting and cumulative effect. Even then, many skilled practitioners are not successful in inducing contractions.”
Dwight Byers, director of the International Institute of Reflexology, agrees: “If it was that easy to stimulate labour, reflexologists would have a big business running reflexology-induced abortion clinics and pregnant women, partners, midwives and doctors would use this noninvasive method for inducing labour.”
A note on client comfort:
It is not recommended that women in their second or third trimesters lie on their back for extended periods of time due to the pressure the baby places on the abdominal aorta and inferior vena cava. Although some spas and salons purchase specific massage pillows or tables with holes cut out for the pregnant woman’s bump, many clients find these uncomfortable and may prefer to lie on their side, supported by pillows. Your client may also need your help to help her get into and out of position on the treatment bed.
Aromatherapy / essential oils
Although It is widely known that essential oils pose a potential risk to pregnant women, there is confusion and misreporting about which ones. Although it is unlikely that the level of exposure from a massage or beauty treatment would cause problems, for safety reason some essential oils, known as ‘emmenagogues’ are known to induce bleeding and should be avoided throughout pregnancy or if a client is trying to conceive. 
Contraindicated oils:
  • Chamomile.
  • Cinnamon.
  • Fennel.
  • Ginger.
  • Jasmine.
  • Juniper.
  • Myrrh.
  • Peppermint.
  • Rose.
  • Sage.
  • Eucalyptus.
  • Rosemary.
  • Cedarwood.
  • Frankincense.
  • Geranium.
  • Nutmeg.
  • Basil.
  • Camphor.
Safe oils*:
  • Citrus oils, including tangerine and neroli.
  • German chamomile.
  • Lavender.
  • Black pepper.
  • Peppermint.
  • Ylang ylang.
  • Bergamot.
  • Cypress.
  • Tea tree.
*Clients with a history of miscarriage, vaginal bleeding, epilepsy, heart problems, diabetes, blood clotting problems, or thyroid, liver or kidney disease should avoid ALL essential oils during pregnancy and breastfeeding.
Treating common cosmetic pregnancy complaints
Pigmentation: Melasma, also called chloasma or ‘the mask of pregnancy’, are dark patches that appear on the face during pregnancy. Likewise, the linea nigra is a dark line that runs from navel to pubic bone and often appears during pregnancy. Triggered by hormones, both will usually fade by themselves in the months following childbirth, and treatment is not recommended while pregnant or breastfeeding. Recommend that your client uses a good sun protection product and mineral foundation in the meantime, and once pregnancy and breastfeeding have ceased, any remaining pigmentation can be treated with lasers and topical medication if desired. 
Stretch marks: nine out of 10 women will develop stretch  marks during pregnancy, as the body grows more quickly on the inside than the skin can keep up with. Although stretch marks will fade with time, they are permanent and almost impossible to treat once they have appeared. Because of this, prevention through the use of moisturisers is recommended, although if your client is genetically predisposed to stretch marks, they are likely to get them regardless of their beauty regime.
Acne: Hormone changes and elevated levels of the stress hormone cortisone may cause acne during pregnancy, but unfortunately most topical acne treatments and modalities are contraindicated. Mild AHAs may help treat excess oil or acne, but approach with caution even if they have not caused a skin reaction in the past. For severe acne, advise your client to see a dermatologist. 
Spider veins: Common on the face and legs of pregnant women, these visible blood vessels are easily and effectively reduced with laser or photorejuvenation therapy, however both must wait until after childbirth and breastfeeding have ceased. Sclerotherapy is another effective treatment for leg spider veins, which involves the injection of a concentrated salt solution into the spider veins.
Psoriasis: As well as being uncomfortable and unsightly, studies suggest that pregnant women with psoriasis have increased risk of poor birth outcomes, such as preterm births and preeclampsia. Women with severe psoriasis were also found to have a higher incidence of low birth weight babies compared to those without the disease. When it comes to treatment, experts recommend topical treatment with moisturisers and emollients such as petroleum jelly as the first-line therapy for psoriasis. If these are not successful, then low to moderate dose topical steroids may be used, followed by high-potency topical steroids only as needed in the second and third trimesters. Narrow band ultraviolet light B (UVB) phototherapy or light therapy should be the second-line treatment for pregnant women. Lastly, TNF inhibitors, a class of drugs that suppress the immune system, may be used with caution, as well as the immunosuppressant drug cyclosporine in the second and third trimesters.
Erring on the side of caution
There are a number of cosmetic treatments and ingredients that should be avoided during pregnancy, whether it is because they are known to be unsafe or because their effect on the unborn child is unknown. 
Laser hair removal
During pregnancy, women are advised to take caution with topical anesthetics, which can be absorbed into the blood stream and be transferred to the unborn baby. Because of this, laser hair removal (and any other treatments requiring the skin to be numbed with topical anesthetic) is contraindicated until after pregnancy has ceased.
There are also no studies that evaluate the safety of laser hair removal during pregnancy, so it is recommended against even without the use of topical anesthetic.
The vitamin A debate
Although it is one of the cosmetic industry’s powerhouse ingredients with a proven record for safety and efficacy, vitamin A (retinoids) is recommended against during pregnancy. This is because of studies showing that high doses of oral retinoids such as isotretinoin (Accutane) during pregnancy are linked to birth defects. In particular, can be harmful to an unborn child.
Although there is no clinical data showing that topical retinoids such as those used in professional skin care are harmful, there have also been no specific studies on pregnant women proving their safety, so most experts recommend erring on the side of caution.
Salicylic Acid (BHAs)
Although it is a completely safe choice for the treatment of acne and ageing in non-pregnant clients, salicylic acid in high dose oral form (aspirin) has been linked to birth defects and pregnancy complications such as bleeding. Although topical use has not been specifically implicated, health professionals recommend that pregnant women avoid it altogether. Alpha hydroxy acids (AHAs), glycolic acid and lactic acid are safe during pregnancy, although patch testing is recommended due to hormonal skin changes that can occur and increase sensitivity. 
Most doctors and health professionals recommend against electrolysis during pregnancy simply because of the lack of information about the effect it has on the unborn child. 
In particular, galvanic electrolysis and other galvanic treatments are not recommended, because the baby is surrounded by amniotic fluid, which acts as a conductor of electricity. 
Botox and fillers 
Because the safety of Botox and fillers such as Restylane or Perlane during pregnancy has not been proven, it is recommended that they are avoided until pregnancy and breastfeeding have ceased. 
Herbal teas
In the tradition of caring for your client’s well-being, you may wish to offer them a tea during or after their treatment, however there are some herbal teas that should be avoided.
Although herbal teas such as peppermint and thyme may be safe for pregnant or nursing mothers to drink occasionally in small amounts, drinking excessive amounts of any tea may be harmful. The herbs in teas are more concentrated than in food, so drinking them may be harmful even if eating them isn’t. Some herbs used in teas, when taken in large or medicinal amounts, may increase the odds of miscarriage, early labour, or low birth weight.
Unsafe herbal teas include: anise, ginger, lime blossom, rose hip, catnip, chamomile, comfrey, ephedra (called ma huang in traditional Chinese medicine and banned in NZ), European mistletoe, hibiscus, horehound, Labrador, lemongrass, licorice root, mugwort, pennyroyal, raspberry leaf, rosemary, sage, sassafras, stinging nettle leaf, vetiver, and yarrow.
Note: Ginger is commonly used to ease morning sickness during pregnancy, but there is also evidence that it may negatively affect fetal sex hormones, so caution is advised. 
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