Massage During Pregnancy: Trimesters, Positioning and Warning Signs

Urgent Signs First

Some symptoms in pregnancy need a clinician right away, whether or not you have had a massage. In the US, call 911 for a suspected blood clot with chest pain or shortness of breath. The NHS pages we read use UK emergency numbers, so use your local number.

• Possible blood clot (DVT) in a leg: the NHS lists throbbing pain in one leg, usually in the calf or thigh, and swelling in one leg. [1] The NHS says to get help immediately if these come with shortness of breath or chest pain, because a clot can travel to the lungs. [1]
• Possible pre-eclampsia (a pregnancy condition with high blood pressure): the NHS lists a severe headache that does not go away with simple painkillers, blurred vision or flashing lights, pain below the ribs, and sudden swelling of the face, hands or feet. [2]
• Baby moving less than usual: the NHS says to call your midwife or maternity unit immediately and not to wait until the next day. [3]
• Back pain with fever, vaginal bleeding or pain when you pee, or back pain in the second or third trimester that could be a sign of early labour. [4]

If any of these happen after a massage, stop and get care. Do not wait to see if it settles.

Why Clots Come First on This Page

The NHS lists being pregnant, or having had a baby in the previous 6 weeks, among the times when a DVT is more likely. [1] Massage presses and moves leg tissue, so the worry is that it could dislodge a clot nobody knows about. A 2020 case report describes a 25-year-old Thai woman who had massage at a traditional massage shop at 25 weeks of pregnancy; the report says that after leg and foot massage she collapsed, was found to have a massive pulmonary embolism, and the fetus died in utero. [5] The authors argued that leg massage with an undetected DVT can dislodge a clot and should be contraindicated. [5]

This is one reported case, not a rate. It is the reason that leg massage, and deep pressure anywhere, deserves a conversation with your midwife or doctor first, especially if you have had a clot, have a swollen or painful leg, or have been told you are at higher risk. See massage and blood clots.

What Trials Found

A 2021 systematic review of 12 randomized trials of relaxation massage in pregnancy reported reduced stress, back and leg pain, depression and anxiety. [6] Only 2 trials reported side effects, and these were minor and short-lived. [6] The same review notes limits: the trials were of good quality but with unknown risk of bias, and seven excluded women with difficult pregnancies or existing complications. [6] Massage trials cannot hide who got massage, so reports of pain and mood may partly reflect expectation and the comfort of being cared for. A separate review article describes the literature for massage in pregnancy and labor as limited, though growing. [7]

An Australian observational study of 101 women had no mother or child physical harm events, but its authors said it was not powered to determine safety. [8]

For back pain in pregnancy, the NHS lists having a massage among its self-help suggestions, alongside rest, a warm bath and back care classes. [4]

1. Does massage ease stress, back and leg pain in healthy pregnancy?

   Promising but limited

   Reductions reported in 12 trials

2. Is it safe?

   Insufficient evidence to state a rate

   Minor, short-lived side effects in 2 trials; no harm events in a small observational study

3. Can leg massage dislodge an unknown clot?

   Case report only; the reason for caution

   One fatal case report

4. Is massage helpful in labour?

   Promising but limited

   Low-quality evidence of less pain in the first stage in a Cochrane review; few trials measured safety [9]

Trimesters

• First trimester (to about 12 weeks): every woman in the trials above was at least 12 weeks pregnant when the studies began. [6] Cleveland Clinic quotes a licensed massage therapist who is also a nurse saying that waiting until you are out of the first trimester is advisable. [10] That is professional opinion, not a trial result. Proper evidence not found on massage before 12 weeks; we searched PubMed for massage and pregnancy reviews and read the NHS and Cleveland Clinic pages.
• Second trimester onward: the trials began at 12 weeks or later, so this is where the trial evidence sits. [6] The licensed therapist quoted by Cleveland Clinic says most pregnancy providers recommend waiting until the second trimester begins. [10]
• Third trimester: back pain now needs a second look, because the NHS says it can be a sign of early labour. [4] Ask your midwife before booking.

Positioning and Pressure

Cleveland Clinic's source says prenatal massage is usually done lying on your side with pillows or bolsters, because lying on the stomach or back raises the risk of low blood pressure and may press on nerves. [10] It describes very light pressure, no more than firm to medium. [10] We did not find a trial that compared positions, so treat this as expert advice. For "pressure point" claims, see pressure-point myths.

Who Should Check First

Check with your pregnancy provider before any massage. [10] Take extra care if you have had a blood clot, have high blood pressure or pre-eclampsia, diabetes in pregnancy, bleeding, or signs of early labour. [10] NCCIH also says not to use massage to postpone seeing a health care provider about a medical problem. [11] Read the prenatal massage guide and safety overview.