Mother Massage: Elaine Stillerman
THE FAR REACHING EFFECTS OF PRENATAL MASSAGE
by Elaine Stillerman
I wanted to write something appropriate about human touch, and reflect the work I do. Since starting my MotherMassage practice in 1980, I have become intimately involved with the process of gestation, birth, and postpartum recovery.
Prenatal massage has far-reaching and profound effects on the developing baby and birth which, up until recently, have only been hinted at but are now being medically investigated and scientifically proven.
I was always aware that massage during pregnancy has tremendous stress-reducing powers, but I was never too sure how much the fetus “felt”. When I met the babies of those clients who came regularly for massage, they all seemed to share similar characteristics: they slept better, ate better and gained weight faster, had sweeter dispositions and had fewer colicky outbursts than those newborns whose mothers did not get massaged regularly. Obviously, the massage had done something that went far beyond maternal benefits.
The idea that a massage treatment can have a positive influence on a developing fetus is very exciting. An entire new science, called epigenetics, or the study of how environmental factors like diet, stress and maternal nutrition can change gene function without altering the DNA sequence, has developed to better understand gene functioning. We understand that massage can eliminate stress by stimulating the secretion of beta-endorphins, serotonin, ect., and by lowering blood pressure, among many other influences. We also now recognize how dangerous maternal stress can be for the fetus. Since maternal and fetal circulatory systems are interdependent, whatever is secreted into the mother’s system--or whatever she feels –is shared by the developing fetus.
Stress factors have been found to adversely affect the in utero environment and have been shown to play a role in cancer, stroke, diabetes, schizophrenia, manic depression and other diseases in shaping behavioral traits in newborns.
The emotions of the pregnancy as well as external pressures and stress factors can cause maternal physiological responses such as muscle tension, tachycardia, sweating and anxiety (Aschers). These changes are mediated by the sympathetic nervous system which responds by releasing catecholamines (CAs) and increasing the circulating levels of adrenocortical and other stress hormones. Maternal stress and the resulting elevated levels of CAs can slow down the progress of labor, particularly in the first stage, by inhibiting the release of oxytocin. Oxytocin causes the patterned uterine contractions and also reduces stress. It is also the hormone of mother love. The placental vascular bed is highly sensitive to the narrowing effects of epinephrine, which can lead to a prolonged, dysfunctional labor and decreased circulation to the placenta and fetus.
Other naturally occurring hormones, beta-endorphins, are also implicated during stress. They are also released during a massage. But unlike the CAs which cause the “fight or flight” response to stress, beta-endorphins act as an analgesic during duress, and suppress the immune system. This is an important consideration during pregnancy-- the mother’s body doesn’t reject the fetus whose genetic make-up is different than hers.
Beta-endorphins cause feelings of euphoria, pleasure, and dependency. (It’s no wonder people talk about being “addicted” to massage therapy. The beta-endorphins are a naturally occurring opiate and work on the same brain receptors as morphine and heroine). Levels are high during pregnancy, and increase throughout labor when beta-endorphins and corticotrophin reach maximum levels. Corticotrophin, also a stress hormone, helps the laboring woman deal with pain and, when the birth is undisturbed (unmedicated), enter an altered state of awareness. It also gives her the endurance she needs for labor. In heightened levels of stress, beta-endorphins will inhibit oxytocin release and slow uterine contractions. Beta endorphins encourage the release of prolactin for milk production and help in the final stages of fetal lung maturation. Levels of this hormone will peak after twenty minutes of breastfeeding, creating contentment, bliss, and mutual dependency for mother and child.
While an undisturbed birth will allow the mother’s body to produce natural stress-fighting compounds, medical interventions and/or heightened reactions to stress can have a deleterious effect on labor. Synthetic oxytocin (pitocin) alters the pattern of uterine contractions and can reduce blood flow to the baby, can increase the resting tone of the uterus, and signals the woman’s body to shut down natural oxytocin production since the synthetic hormone is being administered.
When pregnant research animals were administered intravenous epinephrine (adrenaline) and norepinephrine (noradrenaline) in Ascher’s study, there was an increase in maternal blood pressure, resulting in a marked decrease in uterine blood flow. In another study using research animals, anxiety producing stimuli caused a 25-30% reduction in blood flow to the pregnant uterus. The changes to the fetuses’ condition included a lower heart rate and blood pressure, hypoxia (reduced oxygen) and acidosis and electrocardiographic changes. All of these reactions were related to the decreased uterine blood flow and consequent fetal asphyxia associated with higher stress levels during pregnancy.
Studies of human fetuses have recognized higher instances of fetal abnormalities and maternal obstetric complications, lower birth weight, and subsequent childhood ill health from heightened fetal stress. Another concern is the increased incidence of premature labor stemming from maternal stress (Newton). The study showed that the more anxiety the women felt, the more premature labors were experienced.
The obstetric complications associated with high maternal anxiety can be life-threatening in some cases. In another study 146 women ranging in ages from 15 to 35 years old were given the IPAT Anxiety Self-Analysis Form during their third trimester (Crandon). Those women classified as “high anxiety” had significantly higher incidences of preeclampsia. They also had more forceps deliveries, prolonged labor, primary postpartum hemorrhage and retained placenta, requiring manual removal. The fetal distress associated with the high-anxiety women included fetal tachycardia, bradycardia, or meconium in the amniotic fluid.
Pregnant women who experience a lot of stress during their pregnancies may be altering their fetuses’ nervous systems for heightened reactions to stress and a higher risk of heart attacks later on in life. A 1999 study performed on 156 women by Dr. Pathik Wadhwa of the University of Kentucky College of Medicine in Lexington, showed that fetal heart rates jumped significantly higher and stayed high the longest in pregnant women with the highest level of stress hormones. This suggests a higher than normal risk of heart disease and diabetes later in life. A second study, performed at Cedars-Sinai Medical Center in Los Angeles, proved that heightened maternal stress retards fetal growth.
The point has been made: maternal stress can have an adverse impact on her pregnancy, labor and the health of her child. To combat the deleterious effects of stress, a study conducted by Clemson University proved that meditation or relaxation exercises can lower elevated blood pressure levels, fostering a healthier in utero environment.
Let’s add massage therapy to this mix. Massage lowers anxiety by stimulating the release of serotonin and beta-endorphins that lift the mood. Recent studies about endogenous endorphin and nonendorphin pain-controlling systems of the central nervous system were reported by Sandy Fritz in her ground-breaking massage therapy text, Fundamentals of Therapeutic Massage. She cites a study by Dr. Candice Pert who discovered several opiate-like compounds in the body, among them enkephalin and beta- endorphins. They work by attaching to opiate receptors, easing pain and promoting euphoria. In the end, pain, especially chronic pain, is relieved. Another hormone released during a massage is serotonin, which is implicated in relaxation and sleep, as well as having other functions. This, too, produces a calming effect and reduces stress. Massage also has a moderating influence on the autonomic nervous system.
In addition, when the muscle aches and pains of pregnancy are reduced through massage, oxygenated blood nourishes the tissue and helps in waste-product removal. The stiffness and soreness that many pregnant women experience is also minimized, so they naturally feel better.
One of the most obvious stress factors of pregnancy is labor, at least for a first-time mother. It is interesting to note how many anthropological texts recognize the use of touch during labor as a part of the care of a birthing woman. Nearly every culture has had its form of massage or physical support for the laboring woman. Traditionally, the techniques employed by indigenous people concentrated on correcting fetal malposition, encouraging uterine contraction and stimulating fetal expulsion. We now employ touch techniques to encourage relaxation, minimize stress and anxiety, and reduce pain for the laboring woman.
Since the dynamics of labor are always changing and the areas where the tension and pain are felt also change as the labor progresses, the massage techniques of labor must adapt to a woman’s particular needs. Techniques may include effleurage, counter-pressure, rocking, gentle stroking, pelvic tilts, sacral lifts, or any number of calmative techniques desired by the laboring woman. However, regardless of the techniques used, the pain relief provided by loving touch can be powerful enough to reduce and manage labor pain.
Five studies, conducted in Guatemala, Canada, the United States and South Africa, proved that the continous presence of a support person during labor, a doula--a trained lay person who provides emotional and physical support throughout labor-shortened the labor, alleviated stress in the laboring women, and reduced the number of c-sections. The statistics speak for themselves:
C-section rates dropped 56%, the need for epidural anesthesia dropped 85%, forceps deliveries were down 70%, the need to augment labor with synthetic oxytocin dropped 61%, the duration of labor was shortened by 25% and the neonatal hospitalization dropped 58% in the group who had the emotional and physical support of a Doula (Sobel). This is the power of touch and emotional support.
The evidence that prenatal massage can promote a healthy pregnancy and influence fetal devolpment is persuasive, and its ability to help shorten labor and minimize pain is incontrovertible. That it has an impact on a devolping human being is compelling. Prenatal massage indeed has far-reaching implications that can be enjoyed by generations to come.
Elaine Stillerman, LMT www. MotherMassage.net has been a licensed New York State massage therapist since 1978. She began her pioneering prenatal/labor support/postpartum massage work MotherMassage in 1980.
She is the author of:
- MotherMassage: A Handbook For Relieving the Discomforts of Pregnancy (Dell, 1992)
- The Encyclopedia of Bodywork(Facts On File, 1996)
- Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork (Mosby, 2008)
- She is the editor and contributing author of Modalities for Massage and Bodywork (Mosby,2009)
She can be reached at firstname.lastname@example.org.
Elaine has written numerous articles on prenatal massage therapy. She is the developer and instructor of the professional certification workshop MotherMassage: Massage during Pregnancy taught at prestigious massage schools, spas and resorts across the country.