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Print Preview Chapter 1Massage During Pregnancy: A Unique OpportunityLEARNING OBJECTIVESAfte r r ead ing th i s chap te r, you shou ld be ab le t o :

Unders t and the un ique a spec t s o f work ing wi th p regnan t , l abo r ing , and pos tpa r tum women . Desc r ibe an ove rv iew o f t he wor ldwide p reva lence o f t ouch t r ad i t i ons du r ing p regnancy and b i r th .

Lis t and exp la in the bene f i t s o f t ouch du r ing the ch i ldbea r ing cyc le .

Desc r ibe the mul t ip l e l eve l s on wh ich touch du r ing p regnancy a ff ec t s a woman and he r baby i s l i f e .

Discuss t he myths and f ac t s abou t t he dange r s o f t ouch du r ing p regnancy.

Massage the rap i s t s who work wi th women du r ing the i r pe r ina t a l cyc l e have an exc i t i ng and un ique oppor tun i ty t osha re in wha t i s o f t en the mos t l i f echang ing and impor t an t expe r i ence o f a woman ' s l i f ethe p rocess o f c r ea t ing ,nu r tu r ing , and b i r th ing l i f e . Massag ing p regnan t women can be ex t r ao rd ina r i ly d i f f e ren t f rom work ing wi th o the r c l i en t s . Fo r i n s t ance , ove r t he span o f 9 mon ths , a massage the rap i s t obse rves and f ee l s unde r he r o r h i s hands thesub t l e and d rama t i c changes tha t a r e occu r r ing in a p regnan t mo the r ' s body : changes in shape , compos i t i on ,ho rmona l f l ow, f a t and we igh t d i s t r i bu t ion , and pos tu re . The the rap i s t w i l l s ee the no rma l ly nonpregnan t c l i en t g row

in to a woman who i s ca r ry ing 30 pounds o r more o f ex t r a we igh t , mos t ly on the an te r io r s ide o f he r body, and someof i t k i ck ing v i s ib ly th rough he r g rowing be l ly.Add i t iona l ly, i n t he cour se o f he r p regnancy, a woman o f t en expe r i ences impor t an t changes emot iona l ly,ene rge t i ca l ly, and sp i r i t ua l ly. The massage the rap i s t who sees he r r egu la r ly may wi tnes s t he c l i en t ' s f l uc tua t ingsense o f i den t i t y and he r u l t ima te t r ans fo rma t ion in to he r new ro l e a s mo the r.When work ing wi th p regnan t , l abo r ing , and pos tpa r tum women , massage the rap i s t s p rac t i ce spec i f i c pos i t i on ing togua ran tee the sa fe ty o f bo th the mothe r and baby. More p i l l ows , suppor t s , and cush ion ing a s we l l a s c r ea t iv i ty w i l lbe needed to ensu re comfor t fo r each ind iv idua l on your t ab l e . The use o f s ide ly ing and semi - r ec l in ing pos i t i ons i s anecess i ty, a s we l l a s l ea rn ing to be mob i l e w i th your massage when a woman i s i n l abo r. Massage the rap i s t s whowork o f t en wi th p regnan t women deve lop sk i l l s and ve r sa t i l i t y t ha t w i l l improve the i r ab i l i t y t o s e rve and mee t t heneeds o f a va r i ed popu la t ion .Mos t amaz ing ly, a massage the rap i s t work ing wi th a p regnan t woman has an oppor tun i ty t o a ff ec t two peop le a tonce , wh i l e t ouch ing the sk in o f on ly one pe r son . Each t ime a p regnan t woman i s massaged , t he baby in u t e ro , a s

we l l a s t he mothe r, i s a f f ec t ed ene rge t i ca l ly and phys i ca l ly.Massage the rap i s t s work ing f r equen t ly wi th p regnan t c l i en t s a l so have an ind i r ec t and bene f i c i a l ro l e i n t he b i r thpassage o f bo th mothe r and in fan t . Wi th encouragemen t f rom the massage the rap i s t , t he c l i en t l ea rns sk i l l s fo r r e l ax ing when touched . When nu r tu r ing touch and emot iona l suppor t i s t hen o ff e red du r ing l abo r, t he woman mayf ind tha t she can more r ead i ly cu l t i va t e r e l axa t ion in t h i s newP.4

s i tua t ion ,1 , 2 reduc ing pa in3 and he r r i sks o f med ica l i n t e rven t ions and p rema tu re b i r th ,4,5 ,6 and inc reas ing he r po ten t i a l fo r a more s a t i s fy ing b i r th expe r i ence . Add i t iona l ly, t he se s s ions o f nu r tu r ing massage tha t t he the rap i s thas o ff e red the mothe r du r ing p regnancy o r l abo r w i l l g ive he r f i r s t -hand expe r i ence in t he the rapeu t i c bene f i t s o f t ouch . Because o f t h i s , she may f ind tha t she na tu ra l ly i nc reases t he f r equency and du ra t ion o f t he nu r tu r ing touchand massage tha t she o ff e r s t o he r newborn . 7 , 8Af te r t he b i r th , t he massage the rap i s t migh t have the oppor tun i ty t o mee t t he baby whom she saw mov ing in s ide the

mothe r ' s be l ly and whom she had ac tua l ly massaged th rough the ma te rna l abdomen . Some women may choose tob r ing the i r i n fan t w i th them to a massage se s s ion , and so the the rap i s t w i l l f i nd he r se l f o r h imse l f con t inu ing to u ses ide ly ing pos i t i on to suppor t t he mothe r who wi shes to ho ld o r nu r se he r i n fan t du r ing the massage . As she o r hemassages , t he the rap i s t w i l l no t i ce tha t phys i ca l ad jus tmen t s i n t he pos tpa r tum c l i en t ' s body a re con t inu ing to occu r fo r mon ths a f t e r b i r th . Massage can a s s i s t t he new mothe r ' s r ecove ry f rom the muscu loske le t a l s t r a in s and ho rmona ls t r e s ses o f p regnancy and b i r th and can con t inue to be an impor t an t a spec t o f a new mothe r ' s l i f e . When t r a ined inin fan t massage , t he the rap i s t may be a sked to sha re wi th the pa ren t s ways o f o ff e r ing nu r tu r ing touch to t he i r newbaby.The massage the rap i s t has a un ique ro l e i n t he l i f e o f a ch i ldbea r ing woman who r e l i e s on the the rap i s t fo r he lpwi th r e l i e f o f d i scomfor t s and fo r enhanc ing the senso ry expe r i ence o f he r p regnan t body. P regnancy, b i r th , and
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mothe r ing a re impres s ive even t s i n a woman ' s l i f e , and the memor ie s o f t he massage the rap i s t who suppor t ed he r t h rough those phases may r ema in impr in t ed in he r mind fo r a l i f e t ime .The pu rpose o f t h i s chap te r i s t o i n t roduce you , t he massage the rap i s t , t o t he un ique a spec t s o f massage fo r p regnan t women and to l ay a t heo re t i ca l founda t ion on wh ich l a t e r chap te r s a r e bu i l t . La t e r chap te r s w i l l cove r t hespec i f i c s o f work ing wi th l abo r ing and pos tpa r tum women . Cove red be low a re a f ew t r ad i t i ons o f t ouch fo r p regnancytha t have been a founda t ion o f pe r ina t a l ca re a round the wor ld , and some key bene f i t s and i s sues to cons ide r whenoffe r ing massage to p regnan t women .

TRADITIONS OF TOUCH FOR PREGNANCYFor cen tu r i e s , midwives , dou la s , and f ami l i e s have known we l l t he bene f i t s o f suppor t ing women th rough p regnancy,b i r th , and pos tpa r tum and have nu r tu red them wi th the hea l ing too l s o f hands , words , wa te r, and warm he rba l o i l s(Figure 1.1) .

View Figure

FIGURE 1.1 Ancient Peruvian doll imagery displayingwomen's hands-on support of the birthing woman. Used with permission from Aaron Rubinstein.

Massage accompan ies ch i ldb i r th nea r ly eve rywhere in t he t r ad i t i ona l wor ld ( excep t , o f cou r se , where the mothe r b i r th s a lone ) .9 Accord ing to Nava jo t r ad i t i on , t he midwi fe was known as t he one who ho lds , r e f e r r ing to how she

wou ld o f t en ho ld the p regnan t woman f rom beh ind and massage he r be l ly t h roughou t l abo r wh i l e t he woman b i r thedthe in fan t .10 In Indones i a , t he t e rm fo r midwi fe l i t e r a l ly means , someone who knows how to massage . 11In Gua tema la and Be l i ze , t he midwi fe o r c o m a d r o n a t eaches young women to ca re fo r t he i r wombs wi th he rbs andu te r ine se l f -massage p r io r t o p regnancy ( c l a s s no te s f rom Ros i t a Arv igo ' s Mayan Abdomina l Massage P ro fes s iona lTra in ing , Massachuse t t s , 2000) t hen suppor t s t hem t h roughou t t he i r p regnancy and in l abo r by massag ing the i r backs , be l l i e s , and l egs .In Ind ia and Bang ladesh , a woman i s o f t en suppor t ed th roughou t he r ch i ldbea r ing yea r w i th massage and touch f romexper i enced women e lde r s o r t he t r ad i t i ona l midwi fe o r da i . In l abo r, acco rd ing to anc i en t Ayurved ic p re sc r ip t ion ,a p regnan t woman migh t be massaged by these e lde r women , who rubP .5

scen ted o i l s i n to he r back , l egs , a rms , b reas t s , and be l ly t o a s su re good baby pos i t i on ing and a hea l thy,comfor t ab le b i r th ing . Fo r weeks a f t e r b i r th , t he mothe r and baby bo th a re massaged da i ly t o a ide in t he i r r ecove ry

f rom the b i r th expe r i ence .12,13,14Whi l e ac tua l massage p rac t i ce s va ry wor ldwide , t ouch has commonly been used du r ing the pe r ina t a l cyc l e fo r s imi l a r r ea sons : a s a means to r epos i t i on the baby du r ing p regnancy, t o ea se p regnancy d i scomfor t s and l abo r pa in ,to a s s i s t t he p rog res s o f l abo r, t o s t imu la t e r e l ease o f t he p l acen ta and p reven t pos t -de l ive ry hemor rhage , t o speedpos tpa r tum recove ry, and to encourage l ac t a t ion and ease engorgemen t d i scomfor t .Fu r the rmore , i t i s impor t an t t o no te t he t r ad i t i on o f r e spec t t ha t su r rounds p regnancy and b i r th i n many cu l tu re s andto con t inue tha t t r ad i t i on in ou r app roach to c l i en t s . As we l ea rn to s uppor t women wi th touch and r ev ive thep rac t i ce o f honor ing women fo r t he i r c r ea t ive ab i l i t y, we can r emember o the r s wor ldwide who s t i l l a c t ive ly r eve reand honor women who have the capab i l i t y o f b i r th ing . Th i s i s ev idenced by peop le i n Assam, Ind ia , where the i r anc i en t t emple honor s t he yon i o r vag ina o f t he Goddess Khamakya (Figure 1.2). Once a yea r a t t h i s t emple , t he
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Language Word(s)

Afrikaans Ma, Moeder

Armenian Mayrig

Czech Matka, Matinka

Danish Mor

Hopi (Arizona) Maama

Hungarian Mama

Mayan Mamah

Old English Modor

Polish Matka

Quechuan Mama

Slovak Mamika, Mamka

Spanish Madre

Swahili Mama

Vietnamese Me, Me de


5/286

Zulu Umame

P.6

Tradit ional Bir th Pract ices:

Japanese Pregnancy MassageMore than 120 yea r s ago , Dr. George Enge lmann desc r ibed the me thods o f a J apanese hea l e r ca r ing fo r p regnan t

women a f t e r t he i r f i f t h mon th o f p regnancy : t he hea l e r man ipu la t e s t he abdomen o f t he pa t i en t , who c l ings abou th i s neck , p re s s ing h i s shou lde r s aga ins t he r b reas t s , and p re s s ing h i s knees be tween he r s , so tha t she i s f i rmlysuppor t ed . Then he p rac t i ce s a l a t e r a l massage wi th h i s hands , beg inn ing a t t he seven th ce rv i ca l ve r t eb ra , andrubb ing downward and fo rward , rubb ing a l so the [bu t tocks ] and h ips w i th the pa lm o f h i s hands , r epea t ing themovemen t f rom s ix ty to s even ty t imes eve ry morn ing a f t e r t he f i f t h mon th . 16

As a massage the rap i s t suppor t ing and touch ing a woman th rough the jou rney o f p regnancy, you migh t r emember he r a s a power fu l c r ea to r and cons ide r your se l f t o be the touch midwi fe , no t a s one who he lps de l ive r bab ie s , bu tin t he Old Eng l i sh mean ing o f t he word a s one who i s s imp ly wi th woman , ho ld ing , massag ing , and suppor t ing he r w i th a pa r t i cu l a r t ype o f nu r tu rance on he r b i r th ing jou rney. In t h i s ro l e a s a soma t i c suppor t e r, you can he lp womenf ind comfor t i n and ge t in touch wi th the i r phys i ca l , emot iona l , and sp i r i t ua l s e lves du r ing p regnancy, b i r th , andpos tpa r tum to he lp them fee l comfor t ab le , s a fe , and empowered by the i r cho ices .Though touch has long been used a s a s ign i f i can t hea l ing too l fo r women in the i r ch i ldbea r ing yea r s , i t s u se

d imin i shed in i ndus t r i a l i zed cu l tu re s du r ing the in t ens i f i ca t ion o f a l l opa th i c obs t e t r i ca l p rac t i ce s and g rowth o f med ica l t echno log ie s . Now i t i s be ing r ev ived aga in and h a i l ed a s an impor t an t supp lemen ta l suppor t du r ingpregnancy and b i r th a t hosp i t a l s , b i r th ing cen te r s , and a t t he home . Recen t r e sea rch , d i scussed be low, has he lpedto p romote touch a s a u se fu l and power fu l t oo l fo r t he pe r ina t a l cyc l e by d rawing a t t en t ion to i t s bene f i t s .

BENEFITS OF TOUCH DURING PREGNANCYWe know tha t t ouch has s ign i f i can t e ff ec t s on ou r l i ves ; i t i s c r i t i ca l t o ou r su rv iva l and the su rv iva l and hea l th o f a l lmammals . 17, 18,19,20,21,22,23 Touch i s a fo rm o f communica t ion , a l anguage tha t has t he po ten t i a l bo th to suppor tand nour i sh , a s we l l a s t o hu r t . Ch i ld ren in some o rphanages in t he l a t e 1800s had a mor t a l i t y r a t e o f 100%,a t t r i bu ted in l a rge pa r t t o a l ack o f t ouch .17 For a ch i ldbea r ing woman , t ouch ho lds i nc reased s ign i f i cance becausesk in s t imu la t ion , such a s massage , may suppor t t he p i tu i t a ry ' s mob i l i za t ion o f mothe r ing ho rmones tha t i n f luencebreas t deve lopmen t , enhance the c r i t i ca l func t ion o f t he p l acen ta , he lp the body s t ay p regnan t and p repa re fo r b i r thand mothe r ing , and s t imu la t e mo the r- in fan t nu r tu r ing .2 4,25Ti ff any F ie ld , PhD, a l ead ing r e sea rche r a t t he Touch Resea rch Ins t i t u t e i n Miami , has s tud ied the impac t o f t ouch

in p rema tu re in fan t s and , more r ecen t ly, t he e ff ec t s o f t ouch and dou la suppor t fo r women in l abo r. These s tud ie shave shown tha t women who a re t ouched compass iona te ly in p regnancy and l abo r end up touch ing the i r ch i ld renmore r egu la r ly, e f f ec t ive ly, and sens i t i ve ly.7,8 In one o f F i e ld ' s s tud ie s , women were g iven a 20 -minu te backmassage , f i ve t imes a week du r ing t he i r p regnancy. These women desc r ibed l e s s anx ie ty, had f ewer s t r e s shormones in t he i r b lood , and expe r i enced inc reased deep s l eep , improved moods , and f ewer pa in fu l back and l egcompla in t s . U l t ima te ly, t he r e su l t was a dec rease in p rema tu re de l ive ry and obs t e t r i ca l compl i ca t ions .26Chron ic s t r e s s , a cond i t i on many peop le expe r i ence in deve loped na t ions , con t r ibu te s t o numerous hea l th p rob lems ,inc lud ing some cond i t i ons tha t o f t en p l ague a woman in p regnancy, such a s a l t e r ed r egu la t ion o f b lood suga r l eve l s ,dec reased immuni ty, and inc reased occu r rences o f hype r t ens ion , i n somnia , dep res s ion , and pa in . When a p regnan t
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woman l ives w i th ch ron ic s t r e s s , he r baby in u t e ro i s a l so a ff ec t ed by the cons t an t f l ow o f s t r e s s ho rmonesc i r cu la t ing in t he ma te rna l b lood s t r eam. X- rays o f hands r evea l spec i f i c mark ings and l i nes on the bones o f ch i ld ren whose mothe r s unde rwen t s ign i f i can t emot iona l s t r e s s du r ing the i r p regnancy.27 Some s tud ie s i nd ica t e t ha tthe re may be an inc rease in a t t en t ionde f i c i t / hype rac t iv i ty d i so rde r i n ch i ld ren who expe r i enced in t r au te r ines t r e s s . 28Whi l e i t may be d i f f i cu l t t o e l imina te excess ive s t r e s s f rom one ' s l i f e , t he rapeu t i c massage , e spec i a l ly combinedwi th b rea th ing and v i sua l i za t ion , can he lp to dec rease i t s i n t ens i ty and r educe the po ten t i a l fo r t he abovecond i t ions . Fu r the rmore , t he massage the rap i s t mus t r emember tha t eve ry massage a ff ec t s no t on ly the f e tus ,phys io log ica l ly and emot iona l ly, bu t a l so the mothe r and how she wi l l l a t e r r e l a t e t o he r ch i ld . The fo l lowing l i s tou t l i nes t he bene f i t s o f massage du r ing p regnancy :

Improved Phys io log ica l Func t ion : Massage improves venous b lood f low and oxygen pe r fus ion29 whi l eas s i s t i ng r emova l o f ce l lu l a r

P .7

was te by inc reas ing lympha t i c f l ow.30,31, 32 In p regnancy th i s he lps dec rease nonpa tho log ica l edema ,r educe b lood p re s su re , 33,34 and r e l i eve headaches . 35,36,37 Wi th th i s improved c i r cu la t ion , e spec i a l lyth rough the l a rge ves se l s o f t he ingu ina l r eg ion , t he occu r rence o f edema and musc le spasms r e l a t ed topoor c i r cu la t ion can be r educed .

Muscu loske le t a l Pa in Reduc t ion : Massage he lps dec rease s t r a in on jo in t s and musc le s t ha t a r e impac tedby the ex t r a we igh t ga in o f p regnancy, r educ ing musc le t ens ion and back pa in .38,39

Improved Pos tu re : Bodywork se s s ions a re an oppor tun i ty t o t each pos tu re co r r ec t ion , r e l i ev ing r e l a t edmuscu loske le t a l compla in t s such a s l ow back pa in , headaches , neck and shou lde r pa in , foo t d i scomfor t ,and sc i a t i ca . 40

Enhanced Lac ta t ion and Inc reased P ro lac t in P roduc t ion : Nur tu r ing touch s t imu la t e s p ro l ac t in p roduc t ion ,enhanc ing a mo the r ' s nes t ing in s t inc t s and ab i l i t i e s t o nu r tu re he r i n fan t .24,25

Improved Emot iona l Wel lbe ing : S tud ie s i nd ica t e t ha t massage can dec rease s t r e s s ho rmones , r educedepres s ion and anx ie ty, and inc rease se ro ton in p roduc t ion , i nc reas ing one ' s s ense o f we l l -be ing . 5,26 , 41,42Al l t hese bene f i t s w i l l a l so improve ou tcomes fo r t he baby in -u t e ro .28, 43

Inc reased Immuni ty and Dec reased In t r a -Ute r ine S t r e s s : Touch enhances the immune sys t em func t ion byreduc ing s t r e s s . 44,45 Reduced ma te rna l s t r e s s means a dec rease in t he poss ib l e de t r imen ta l e ff ec t s o f i n t r au te r ine s t r e s s on the baby. 28,43

Per inea l Ease : Massage o f t he pe r inea l a r ea , be fo re and du r ing l abo r can he lp f ac i l i t a t e s t r e t ch ing o f t het i s sues du r ing b i r th .46,47,48 Due to t he in t ima te na tu re o f t h i s massage and l imi t a t ion o f s cope o f p rac t i cefo r massage , t h i s massage t echn ique i s u sua l ly exp la ined to t he mothe r and pe r fo rmed by he r pa r tne r,midwi fe , o r a t r a ined phys i ca l t he rap i s t , r a the r t han ac tua l ly p rac t i ced by the massage the rap i s t . However,pas s ing on the in fo rma t ion a s a massage t echn ique to a c l i en t can be he lp fu l , i f t ha t i s w i th in your s cope o f p rac t i ce . By deve lop ing f ami l i a r i t y w i th the s t r e t ch ing sensa t ions in t ha t a r ea , i t may be poss ib l e t o r educea woman ' s r e s i s t ance o r f ea r when the sensa t ions occu r du r ing b i r th , t he reby r educ ing he r r i sk o f ep i s io tomy and speed ing t i s sue hea l ing in pos tpa r tum. Many women have hea rd o f t h i s t echn ique , andapprec i a t e accu ra t e i n fo rma t ion abou t how to do i t .

Improved Re laxa t ion Sk i l l s and Se l f -Connec t ion : Massage enhances a woman ' s body-awareness bybr ing ing he r a t t en t ion to a r eas o f muscu la r t ens ion tha t can r e l ax wi th bodywork and focused b rea th .Massage p rov ides an oppor tun i ty fo r a woman to p rac t i ce t h i s r e l axa t ion and b rea th awareness i np repa ra t ion fo r t he b i r th p rocess . Assoc ia t ing touch wi th r e l axa t ionb e f o r e b i r th f ac i l i t a t e s na tu ra lr e l axa t ion wi th touch d u r i n g b i r th .1,49

Inc reased Ene rgy : Massage can r educe o r r e l i eve some o f t he common compla in t s o f p regnancy inc lud ingfa t igue , s t r e s s , and in somniaconce rns tha t s ap a woman ' s ene rgy. 26,39,50,51,52
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Inc reased Ab i l i t y t o Nur tu re O the r s : Massage p rov ides an expe r i ence o f nu r tu r ing , hea l ing touch , wh ichinc reases a woman ' s ab i l i t y t o t ouch he r i n fan t s imi l a r ly. (Th i s i s pa r t i cu l a r ly impor t an t fo r women wi th ah i s to ry o f s exua l , phys i ca l , o r emot iona l abuse . ) As the mothe r expe r i ences nu r tu r ing touch in p regnancy,she i s r e in fo rced wi th sk i l l s t o t ouch he r i n fan t w i th nu r tu rance ; t h i s i n t u rn e nab le s t he in fan t t o deve lop apos i t i ve expe r i ence o f t ouch and ca r ing and en te r t he wor ld wi th more secu r i ty, un l ike in fan t s who a re no ttouched , who become wi thd rawn and aggres s ive , w i th more t endenc ie s t oward an t i soc i a l

behav io r s .53,54,55, 56,57Clea r ly, t he massage the rap i s t can p rov ide an impor t an t s e rv i ce du r ing a woman ' s p regnancy. S t i l l , t he re a r e f ea r sand i s sues tha t some t imes p reven t p regnan t women f rom t ak ing advan tage o f t he bene f i t s o f massage the rapy.These a re d i scussed be low.

ISSUES WITH TOUCH DURING PREGNANCYCons ide r ing the we l l -documen ted impor t ance o f t ouch , i t ough t t o be a na tu ra l , common e l emen t i n a woman ' sexpe r i ence o f p regnancy, b i r th , and pos tpa r tum. However, fo r a va r i e ty o f soc i a l , med ica l , and l ega l i s sues , t ouch i so f t en l imi t ed and r e s t r a ined in s t ead . Le t u s l ook a t some o f t he s i t ua t ions and conce rns tha t may dec rease awoman ' s chances o f ge t t i ng touched du r ing he r p regnancy and how the massage the rap i s t migh t t ake these i s suesin to cons ide ra t ion .

Body ImageFor some women , body image can become a sou rce o f conce rn tha t p reven t s t hem f rom seek ing ou t massage . A

hea l thy woman wi l l t yp ica l ly ga in a t l ea s t 28 pounds du r ing a no rma l p regnancy, some o f wh ich i s na tu ra l lydepos i t ed in t he th ighs and bu t tocks . Wi thou t t h i s ex t r a we igh t , t he baby wou ld no t t h r ive ,P .8

the mothe r wou ld no t be ab le t o adequa te ly nour i sh he r f e tus , and the mothe r ' s body wou ld no t w i ths t and thes t r e s ses o f p regnancy. However, some women f ee l a shamed , una t t r ac t ive , and nonsexua l due to t he i r we igh t ga inand s top v i s i t i ng the i r massage the rap i s t a t t h i s t ime to avo id be ing s een wi th the i r added we igh t . They some t imeswi l l avo id touch f rom the i r i n t ima te pa r tne r s a s we l l .In o the r ca ses , t he woman ' s pa r tne r may avo id in t imacy due to t he changes in t he woman ' s body. A l though thewoman may r eve l i n he r g rowing s i ze and have a new sense o f con f idence r e l a t ed to he r f e r t i l i t y and c rea t iveene rgy, he r pa r tne r may become d i s t anced o r be subconsc ious ly in t imida ted by the changes in t he woman ' s body.As a r e su l t , t he i r i n t imacy may d imin i sh and f ami l i a r t ouch ing may become l e s s f r equen t be tween them.Be aware o f t he po ten t i a l fo r a poss ib l e sh i f t i n a p regnan t woman ' s r e l a t ionsh ip wi th he r massage the rap i s t o r w i th

he r pa r tne r a s a r e su l t o f changes in he r body. She may have emot iona l r e l ea ses du r ing a massage r e l a t ed to t hes t r e s s i n he r chang ing in t ima te r e l a t ionsh ip o r due to he r chang ing se l f - image . Take no te t ha t i n many cu l tu re s , ap regnan t woman was and s t i l l i s acknowledged a s a Goddessone who c rea t e s and b r ings f o r th l i f e , l i ke the g rea tEa r th Mothe r he r se l f . Images o f l a rge , s t rong , and so l id women in the i r fu l lnes s and sub l ime f emin ine na tu re havebeen c rea t ed by anc ien t cu l tu re s t ha t honored them fo r t h i s ab i l i t y. I f your c l i en t exp res ses conce rns abou t he r bodyimage , you migh t o ff e r pos i t i ve r eminde r s t ha t t he ex t r a we igh t i n p regnancy ind ica t e s hea l th , s t r eng th , and theab i l i t y t o nu r tu re he r young a s we l l a s r e in fo rcemen t o f t he g rowing goddess image .

Fear of Miscarr iageAnothe r ma jo r conce rn o f expec tan t mo the r s and the i r pa r tne r s i s t he f ea r t ha t t ouchby themse lves o r o the r scou ld l ead to a mi sca r r i age . Th i s becomes e spec ia l ly impor t an t a f t e r a woman f ee l s t he baby mov ing in s ide he r be l ly fo r t he f i r s t t ime , announc ing the r ea l i t y o f i t s ex i s t ence . A t t h i s t ime , t he mothe r and poss ib ly he r ma te maybecome more exc i t ed and s imu l t aneous ly more ove rp ro tec t ive and ne rvous . The pa r tne r may v i ew the mothe r a sf r ag i l e and the who le p regnancy uns t ab le and be l i eve tha t i f she i s t ouched the wrong way o r i n t he wrong p l ace ,the mothe r o r f e tu s cou ld be ha rmed . I f e i t he r t he woman o r pa r tne r en t e r t a in s t hese f ea r s , t hey may lo se muchfami l i a r t ouch be tween them s imply because o f t he d i s t ance tha t r e spec t o r i gnorance can some t imes b reed .Rece iv ing massage f rom a knowledgeab le t he rap i s t can he lp to ea se some o f t hese conce rns a s t he woman f ee l show conf iden t ly she i s t ouched , wh i l e be ing r eas su red tha t nu r tu r ing massage wi l l i n no way be ha rmfu l t o he r p regnancy o r baby. As the massage the rap i s t l ea rns appropr i a t e and sa fe ways to t ouch p regnan t women th roughou tthe ch i ldbea r ing cyc le , she o r he can educa te women and pa r tne r s abou t s a fe and nu r tu r ing touch du r ing p regnancytha t can he lp them improve the i r connec t ion wi th one ano the r.

Violat ion of Personal Boundaries
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To c rea t e t he mos t suppor t ive a tmosphe re fo r t he p regnan t c l i en t and to avo id common ac t ions o r comment s wh ichmay be d i s tu rb ing to he r, i t i s he lp fu l t o unde r s t and how the c l i en t ' s no rma l pe r sona l bounda r i e s may beinadve r t en t ly v io l a t ed du r ing he r p regnancy. Phys i ca l changes a re r ap id in p regnancy, and many women soon f ee lun fami l i a r w i th the i r bod ie s and the i r be l l i e s , wh ich p ro t rude in to the wor ld , bumping in to t h ings and some t imesge t t i ng in t he way. As much a s a p regnan t woman may f ee l a s t r ange r t o t he new sensa t ions and image o f he r body,s t r ange r s t hemse lves may be to t a l ly d rawn to he r i n ways she has neve r expe r i enced be fo re . She f inds tha t peop lecommonly wa lk up to he r, eye he r be l ly w i th de l igh t , and exc la im, Oh , how wonder fu l , how fa r a long a re you? ! a sthey r each ou t and l ay a hand on he r bu lg ing abdomen . Th i s can be a f r equen t occu r rence ! The mothe r ' s be l ly hassudden ly become pub l i c p rope r ty, where s t r ange r s p rac t i ce no r e s t r a in t and no rma l bounda r i e s and p r ivacy haved imin i shed . Wha t wou ld be inconce ivab le t o do to a nonpregnan t woman , sudden ly becomes commonp lace inp regnancy, caus ing some women to f ee l an ave r s ion to t ouch , even f rom a massage the rap i s t o r o the r s , apa r t f romher f ami ly.Along wi th th i s , many f r i ends and s t r ange r s f ee l t he need to r e l a t e t he i r own b i r th s to r i e s t o p regnan t women , o f t ent e l l i ng s to r i e s o f d i f f i cu l ty ; o f d i sma l , p ro longed l abo r s ; o r o f t e r r ib l e ou tcomes . A p regnan t woman i s l i ke a spongefo r ene rge t i c i n t e rchanges ; t he no rma l bounda r i e s t ha t may p ro t ec t u s f rom ano the r pe r son ' s i s sues a r e no t a s so l iddur ing p regnancy. Any nega t ive b i r th s to r i e s t ha t a r e t o ld to a p regnan t woman a re l i ke ly to s ink in immed ia t e ly tohe r p syche and have an in f luence on how she approaches he r own coming l abo r.Crea t e a s anc tua ry fo r t he c l i en t who may f ee l ove rwhe lmed in th i s way by o ff e r ing a hea l ing space where she caninv i t e nu r tu r ing touch r a the r t han ward o ff t ha t wh ich seems invas ive . Avo id your own impu l ses t o r each ou t andtouch he r be l ly immed ia t e ly a s she en te r s your o ff i ce , l ook ing much more p regnan t t han she was 2 weeks o r 1mon th be fo re ! In s t ead , g ree t he r a s an honored gues t and c l i en t and we lcome he r i n to your s anc tua ry. Avo idoffe r ing your own adv ice and s to r i e s abou t b i r th , bu t i n s t ead he lp he r t oP .9

env i s ion the beau t i fu l , e a se fu l t ype o f l abo r t ha t she wou ld mos t l i ke to have .

Body MemoriesMany women have been sub jec t ed to s exua l , phys i ca l , and emot iona l abuse and l i ve wi th the memor ie s andexpe r i ences impres sed in t he ce l l s o f t he i r body. Fo r some women , a s t he i r body uncon t ro l l ab ly and unden iab lychanges du r ing p regnancy and b i r th , emot iona l r e sponses a t t ached to d i f f i cu l t l i f e expe r i ences may be invoked .Somet imes th i s may occu r du r ing a massage ; soma to -emot iona l r e sponses a r e no t uncommon to expe r i ence du r inga t t en t ive bodywork . R i s ing emot ions can some t imes ove rwhe lm and t ake bo th c l i en t and the rap i s t by su rp r i se , and i f t he the rap i s t i s un t r a ined in suppor t ing a c l i en t du r ing these types o f expe r i ences , t he c l i en t may f ee l unsa fe to

re tu rn . Some women may f ind tha t when a l r eady uncomfor t ab le w i th the i r l o s s o f con t ro l ove r t he i r body du r ingpregnancy, massage du r ing the i r p regnancy may seem too f r igh ten ing and uncomfor t ab le t o cons ide r. The the rap i s tcan on ly o ff e r suppor t and sa fe ty to t he deg ree tha t she o r he i s expe r i enced , t r a ined , and comfor t ab le ; bu tunde r s t and ing tha t d i f f i cu l t emot ions a re o f t en t r i gge red by p regnancy, l abo r, and mothe r ing may encourage he r o r h im to ge t fu r the r t r a in ing in t he f i e ld o f soma to -emot iona l r e l ea se work .

Education for the Massage TherapistsA lack o f knowledge among massage the rap i s t s abou t how to massage du r ing p regnancy can be ano the r i s sue tha tp regnan t women encoun te r. Many women have found tha t d u r i n g pregnancy the i r r egu la r massage the rap i s tsudden ly becomes unwi ll i ng to s ee them, a s she o r he i s unce r t a in how to addres s t he needs o f a p regnan t c l i en t .Many the rap i s t s who have no t been t r a ined a re conce rned abou t do ing some th ing wrong o r c r ea t ing a p rob lem fo r wh ich they wou ld be l ega l ly l i ab l e . Whi l e caus ing p rob lems i s un l ike ly, t h i s conce rn i s va l id and the re ce r t a in ly a recon t r a ind ica t ions fo r massage du r ing p regnancy and t imes when ce r t a in types o f t ouch a re i nappropr i a t e .Bodyworke r s shou ld be aware o f t hese i s sues . (See Chap te r 4 fo r de t a i l s on p recau t ions and con t r a ind ica t ions . )Acqu i r ing the appropr i a t e sk i l l s and knowledge to addres s p regnan t c l i en t s w i l l ea se women ' s and the rap i s t sconce rns .

Education for the DoctorsMassage the rap i s t s a r e no t t he on ly ones who need to become be t t e r educa ted abou t massage du r ing p regnancy.Even though p regnancy massage i s becoming much more commonp lace , more educa t ion i s s t i l l needed wi th in themed ica l sys t em to he lp touch become fu l ly i n t eg ra t ed . Many obs t e t r i ca l phys i c i ans have hes i t a t ed when f i r s tapp roached abou t r e f e r r ing the i r p regnan t c l i en t s fo r massage the rapy. Massage can be a wonder fu l ad junc t ive too lto he lp women cope wi th the common d i scomfor t s o f p regnancy ; i t i s a l o s s when women a re no t t o ld tha t i t i s s a feand poss ib ly an exce l l en t cho ice fo r t hem to exp lo re du r ing p regnancy. However, t hese same doc to r s , a f t e r
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wi tness ing the r e su l t s o f c l i en t s who r ece ived massage and were then pa in - f r ee and much happ ie r w i th the i r g rowingbod ies , have come to accep t t ha t massage can indeed have a h igh ly bene f i c i a l impac t on a woman ' s expe r i ence o f p regnancy. To he lp expand the use o f massage th roughou t p regnancy, massage the rap i s t s may choose to o ff e r i n -se rv i ces and educa t iona l packe t s abou t t he bene f i t s o f p regnancy massage to doc to r s and midwives who may no tye t have r ecogn ized these bene f i t s .

Education for the Mothers

Fina l ly, t he mothe r ' s own l ack o f knowledge abou t t he sa fe ty and bene f i t s o f massage du r ing p regnancy can be anobs t ac l e . I t i s he lp fu l fo r you to have a span o f knowledge abou t t he pe r ina t a l cyc l e t o work conf iden t ly andreas su r ing ly, e spec i a l ly when work ing wi th women who have conce rns r ega rd ing the sa fe ty o f massage . Byeduca t ing your se l f abou t po ten t i a l r i sks and con t r a ind ica t ions r e l a t ed to spec i f i c t ypes o f bodywork moda l i t i e s andunde r s t and ing appropr i a t e ways o f do ing massage , pos i t i on ing , and touch ing the be l ly, you wi l l be ab le t oex t ingu i sh conce rns and educa te your c l i en t abou t p rac t i ce s t ha t a r e s a fe and wor ry - f r ee . Many women becomevorac ious r eade r s du r ing p regnancy, r e sea rch ing eve ry th ing they can ge t t he i r hands on r ega rd ing concep t ion ,ch i ldb i r th , and mothe r ing . They l ea rn tha t t he re may be va r ious dange r s on the p regnancy pa th ; ye t w i thou t de t a i l edin fo rma t ion , t hey may beg in to g row anx ious and unce r t a in abou t wha t i s r ea l ly s a fe o r unsa fe fo r t h i s unborn ch i ld .Fo r some , massage migh t s eem too r i f e w i th po ten t i a l fo r i n ju ry. Some women have expe r i enced more than onemisca r r i age , and massage migh t , i n t he i r mind , s eem r i sky fo r s t imu la t ing ano the r. Many women have hea rd tha tce r t a in acupres su re po in t s a r e dange rous o r t ha t massage to t he ank le s i s con t r a ind ica t ed du r ing p regnancy. Somemay f ee l more comfor t ab le avo id ing massage o r w i l l need to know they have found a we l l - t r a ined , knowledgeab le

the rap i s t i f t hey dec ide to s ee one a t a l l . I f you a re chosen a s he r knowledgeab le t he rap i s t , you wi l l be ab le t oa l l ev i a t e he r f ea r s , r a the r t han compound ing your own and he r s based on your unce r t a in ty abou t s a fe p rac t i ce s .P.10

DISPELLING MYTHS:

The Dangers of Pregnancy MassageI t i s no t d i f f i cu l t t o l ea rn abou t t he dange r s o f p regnancy massage . Anyone who wou ld l i ke to be conv inced o f i t sdange r s mere ly needs to u se t he top ic wordsDangerous p regnancy massagein an on l ine In t e rne t s ea rch eng ineand then r ev iew some o f t he massage and p regnancy s i t e s t ha t emerge . Some o f t he dange r s r epo r t ed inc lude thefo l lowing : massage shou ld be avo ided in t he f i r s t t r imes t e r due to t he r i sk o f mi sca r r i age f rom tox ic ove r load a f t e r massage ; f i r s t t r imes t e r massage i s t oo much s t imu la t ion fo r t he mothe r ; massage to t he f ee t , l ower l egs , and

abdomen cou ld cause misca r r i age ; abdomina l massage shou ld be avo ided due to t he po ten t i a l fo r caus ing se r iousp rob lems ; abdomina l massage shou ld be avo ided because bab ie s don ' t l i ke i t and s t a r t k i ck ing ; massage to t he lowback i s con t r a ind ica t ed du r ing p regnancy, w i th no r easons g iven .A newly p regnan t woman o r an un t r a ined massage the rap i s t migh t r ead th i s i n fo rma t ion and be l i eve tha t i t i s j u s ttoo f r igh ten ing to r ece ive o r g ive massage du r ing p regnancy. However, t hese b i t s o f adv ice a re no t subs t an t i a t edwi th r e sea rch o r documen ted r epor t s o f p rob lems . We can examine and d i sman t l e each o f t hese f ea r s .The f i r s t t r imes t e r i s i ndeed a t ime o f g rea t changes on many l eve l s ; a l l t he more r eason fo r r ece iv ing nu r tu r ingtouch to he lp a mo the r i n t eg ra t e t he changes tha t a r e occu r r ing . The re i s no r e sea rch tha t i nd ica t e s t ha t massagehas caused tox ic ove r load in a p regnan t pe r son and the reby caused misca r r i age . The rap i s t s a r e aware tha t massagecan s t imu la t e c i r cu la t ion and he lp f lu sh me tabo l i c was t e i n to the c i r cu la to ry sys t em. Acknowledg ing th i s e ff ec t ,many the rap i s t s a r e t r a ined to work l e s s i n t ense ly on peop le who have neve r had a massage be fo re , encouragec l i en t s t o d r ink wa te r a f t e r a massage , i n fo rm the c l i en t t ha t mi ld so reness fo r a day a f t e r massage cou ld occu r, andrecommend the c l i en t r e s t b r i e f ly be fo re r ecommenc ing he r day aga in a f t e r a massage . P regnan t women a re no

d i ff e ren t i n t h i s r ega rd . Women shou ld a lways be encouraged to d r ink wa te r a f t e r a massage . Massage in t he f i r s tt r imes t e r shou ld gene ra l ly no t be excep t iona l ly deep and s t imu la t ing i f i t i s t he f i r s t massage a woman has eve r r ece ived o r i f she i s expe r i enc ing nausea a t t imes . Massage shou ld no t be avo ided due to nausea , however, a smany s tud ie s i nd ica t e massage can he lp to r e d u c e nausea . 58, 59,60 Usua l ly, massage du r ing the f i r s t t r imes t e r canhe lp dec rease anx ie ty and he lp a woman r e l ax , have focused t ime to p rocess t he f ac t t ha t she i s p regnan t , and o ff e r he r a wonder fu l way to en te r i n to he r new p regnancy.Misca r r i age i s ex t r eme ly common dur ing the f i r s t t r imes t e r, ye t i t occu r s whe the r women a re massaged o r no t .Massage has neve r been c l ea r ly imp l i ca t ed l ega l ly o r s c i en t i f i ca l ly a s a cause o f mi sca r r i age . In t he ma jo r i ty o f ca ses , mi sca r r i age occu r s because the f e tus i s nonv iab le . Touch to t he abdomen , un le s s i t i s i n t en t iona l ly ha rmfu l ,does no t hu r t t he baby o r t he mothe r. The u t e rus du r ing the f i r s t t r imes t e r i s l ow in the pe lv i s and i s no t pa lpab le
http://pt.wkhealth.com/pt/re/9780781767538/bookContentPane_frame.01429482-1st_Edition-3.htm;jsessionid=MkQSzhTCnCzQ4BMTpplvvw08TDn3BJFGYDDNyfqVswjvQPQg6Fvs!628309595!181195628!8091!-1?bookaccessionpath=01429482-1st_Edition-3&bookmarkxpath=/CT%7B06b9ee1beed5941954d1e44d77709507de80015bab08bf9f06d7f8ebbd74e47dd7be22b912f265921630d57c070eb696%7D/OVIDBOOK[1]/TXTBKBD[1]/DIVISIONA[1]/CHAPTER[2]http://pt.wkhealth.com/pt/re/9780781767538/bookContentPane_frame.01429482-1st_Edition-3.htm;jsessionid=MkQSzhTCnCzQ4BMTpplvvw08TDn3BJFGYDDNyfqVswjvQPQg6Fvs!628309595!181195628!8091!-1?bookaccessionpath=01429482-1st_Edition-3&bookmarkxpath=/CT%7B06b9ee1beed5941954d1e44d77709507de80015bab08bf9f06d7f8ebbd74e47dd7be22b912f265921630d57c070eb696%7D/OVIDBOOK[1]/TXTBKBD[1]/DIVISIONA[1]/CHAPTER[2]http://pt.wkhealth.com/pt/re/9780781767538/bookContentPane_frame.01429482-1st_Edition-3.htm;jsessionid=MkQSzhTCnCzQ4BMTpplvvw08TDn3BJFGYDDNyfqVswjvQPQg6Fvs!628309595!181195628!8091!-1?bookaccessionpath=01429482-1st_Edition-3&bookmarkxpath=/CT%7B06b9ee1beed5941954d1e44d77709507de80015bab08bf9f06d7f8ebbd74e47dd7be22b912f265921630d57c070eb696%7D/OVIDBOOK[1]/TXTBKBD[1]/DIVISIONA[1]/CHAPTER[2]http://pt.wkhealth.com/pt/re/9780781767538/bookContentPane_frame.01429482-1st_Edition-3.htm;jsessionid=MkQSzhTCnCzQ4BMTpplvvw08TDn3BJFGYDDNyfqVswjvQPQg6Fvs!628309595!181195628!8091!-1?bookaccessionpath=01429482-1st_Edition-3&bookmarkxpath=/CT%7B06b9ee1beed5941954d1e44d77709507de80015bab08bf9f06d7f8ebbd74e47dd7be22b912f265921630d57c070eb696%7D/OVIDBOOK[1]/TXTBKBD[1]/DIVISIONA[1]/CHAPTER[2]http://pt.wkhealth.com/pt/re/9780781767538/bookContentPane_frame.01429482-1st_Edition-3.htm;jsessionid=MkQSzhTCnCzQ4BMTpplvvw08TDn3BJFGYDDNyfqVswjvQPQg6Fvs!628309595!181195628!8091!-1?bookaccessionpath=01429482-1st_Edition-3&bookmarkxpath=/CT%7B06b9ee1beed5941954d1e44d77709507de80015bab08bf9f06d7f8ebbd74e47dd7be22b912f265921630d57c070eb696%7D/OVIDBOOK[1]/TXTBKBD[1]/DIVISIONA[1]/CHAPTER[2]


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wi thou t deep abdomina l p re s su re , wh ich i s gene ra l ly con t r a ind ica t ed fo r massage the rap i s t s du r ing p regnancy.Ins t ead , nu r tu r ing touch to t he abdomen can be ex t r eme ly r e l ax ing fo r t he mothe r, and mos t women f ee l t ha t t hebaby i s r e spond ing in a pos i t i ve manner i f she o r he wakes up and s t a r t s mov ing du r ing a be l ly rub .Massage to t he l egs , f ee t , and be l ly du r ing the f i r s t t r imes t e r d o e s n o t cause misca r r i age . The re a re acupres su repo in t s i n t he lower l egs and f ee t t ha t a r e con t r a ind ica t ed fo r acupres su re o r acupunc tu re , bu t gene ra l massage tothe acupres su re po in t s a r eas w i l l no t s t imu la t e t hem s imi l a r ly.Wi th inc reased educa t ion r ega rd ing massage du r ing the pe r ina t a l cyc l e , t he f ea r s and myths abou t i t s dange r s canbe r educed . The rap i s t s can l ea rn wi th accu racy when cau t ion o r con t r a ind ica t ions a re t ru ly ca l l ed fo r, and he lpd i spe l my ths and a s suage unwar ran ted f ea r s . Armed wi th knowledge and g i f t ed wi th the ab i l i t y t o o ff e r nu r tu r ingca r ing touch , t he massage the rap i s t can he lp more p regnan t women r educe anx ie t i e s and d i scomfor t s , and inc reasethe i r chances fo r a p l easu rab le expe r i ence o f t he i r p regnancy.

CHAPTER SUMMARYThroughou t t he wor ld , t ouch has been used to improve and enhance women ' s expe r i ences o f t he i r p regnanc ie s andb i r th s . Ongo ing r e sea rch has he lped to suppor t t he c l a ims o f t he many psycho log ica l and phys io log ica l bene f i t s o f massage in gene ra l and spec i f i ca l ly du r ing the pe r ina t a l cyc l e . The massage the rap i s t , t r a ined in t he bene f i t s ,con t r a ind ica t ions , conce rns , and t echn iques o f pe r ina t a l massage , can con t inue th i s impor t an t t r ad i t i on o f t ouch . Byhonor ing the na tu ra l w i sdom o f women ' s bod ie s , r e spec t ing the i s sues tha t can deve lop a round p regnancy in ou r i ndus t r i a l i zed wor ld , and min imiz ing f ea r s w i th educa t ion , r ea s su rance and compe tence , t he the rap i s t can p rov idethe op t imum ind iv idua l i zed ca re fo r each p regnan t , l abo r ing , and pos tpa r tum woman .P.11

CHAPTER REVIEW QUESTIONS1 . N a m e f o u r e l e m e n t s o f b o d y w o r k w i t h p r e g n a n t c l i e n t s t h a t a r e d i f f e r e n t f r o m w o r k i n g w i t h n o n p r e g n a n t

c l i e n t s .

2 . W h a t a r e s o m e o f t h e s o c i a l i s s u e s t h a t m i g h t p r e v e n t a w o m a n f r o m g e t t i n g m a s s a g e d u r i n g p r e g n a n c y ?

3 . N a m e t w o r e a s o n s h o w t o u c h h a s b e e n u s e d i n t r a d i t i o n a l c u l t u r e s t o b e n e f i t a p r e g n a n t , l a b o r i n g , a n d

p o s t p a r t u m w o m a n .

4 . D i s c u s s w a y s t h a t y o u m i g h t c o n s i d e r c h i l d b e a r i n g a s a s i g n i f i c a n t r i t e o f p a s s a g e .

5 . D i s c u s s f o u r b e n e f i t s o f t o u c h f o r a w o

pregnancy massage book mosbys

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