Pregnancy & Childbirth

Chapter 22: Round Two

Ariel Ng Bourbonnais

I’m relieved I don’t miss Dr. Singh’s call. I’ve been dying to know if my über-low egg reserve is now extinct. It’s been nearly two years since I’ve tested my AMH levels and I’ve mentally prepared myself to find out I have zero eggs left, at the tender middle age of 35.

What’s AMH? I had no idea until it was too late for me. AMH stands for anti-Müllerian hormone, and it’s easily measured by taking a blood sample. This test is not currently covered by the Ontario Health Insurance Plan (OHIP), but I think it should be because it’s important for women to benchmark their fertility health. And this blood test is a simple and quick way to capture a snapshot. High AMH generally indicates a greater egg reserve and better-quality eggs. Low AMH indicates a smaller reserve and sometimes that the quality is degraded, too. I tell myself it’s okay if my eggs are now rotten because I’ve already come to terms with my infertility after one miscarriage a few years back and many more years of struggling to conceive. I recently asked my doctor if I could pay for the AMH blood test again because it’s worth $75 to give me peace of mind, which is why Dr. Singh is calling me today. When I see her name pop up on my phone, I pick up right away. As usual, she doesn’t mince words.

“Ariel, the rest of your blood work is fine but we have your AMH results and you are at 2.9.” She sounds excited for the first time in our entire history of fertility-related conversations.

My coffeeless brain tries to compute what she’s saying. “2.9. How is this even possible?” My AMH was recorded at 0.78 a few years ago. I didn’t think I could improve my egg reserve at all and especially not by that much. It’s truly inconceivable, pun intended.

“I don’t know, but it’s a good thing. I know you said you and your husband were done trying, but I think you should go back to the fertility clinic. This at least warrants another conversation.”

“I guess we could talk about it again. 2.9, are you sure?” I ask.

“That’s what your results say. I’ll send your referral to the fertility clinic today, and if you don’t hear back from them within a few weeks, you call and let them know you’re a former patient of theirs and need to set up a new appointment.”

I’m glad she outlined the exact next steps I need to take, because I’m in a state of total shock. Hell, I think Dr. Singh is in shock, too. “Thank you for making my day,” I simply say.

I hang up and immediately call my husband, Lawrence. He’s not going to believe that I went from the 10th percentile of fertility to the 50th. I thought I had the eggs of a 45-year-old woman, but now I am back in my true age box. I’m skeptical. Something doesn’t add up and I’m trying to figure out what it is. I wonder if this is a miracle because of my recent lifestyle changes. I stopped eating meat and started doing cardio a few months ago. Could a regular trampoline class and no-burger lifestyle get me knocked up, with the help of my husband, of course? I’m confused but happy. Then I start to wonder if the lab made an error and my AMH is really 0.29 instead of 2.9. This would be logical, would make sense, and would align with my previous diagnosis. A score of 2.9 is heavenly, unimaginable, luxurious.

Lawrence picks up. “What’s up? I’m about to leave for work.” “Dr. Singh called and my AMH is 2.9, not 0.78.”

“See, I told you. I knew you were okay.” He sounds so relieved.

“I’m going to book us in to see the specialist, Dr. Adatia, again. Maybe we can do the government-funded IVF this time.”

My husband and I paid for one round of IVF two years ago because we wanted to save the government funding, in case we decided to proceed with an egg donor. The egg donor IVF is more expensive than my round of low-stimulation IVF was. My eggs needed to be more gently drugged because the regular doses of medication would have killed them off. During our IVF cycle, we retrieved four measly eggs and only one acted like it was supposed to with the sperm. One. This hurt even more when my best friend went through the IVF process a few months after I did and was able to retrieve 18 eggs.

We implanted the only egg with potential and it failed. My husband and I thought we were being smart by saving the government funding, but it ended up being a dumb decision because we didn’t go the egg donor route. We gave up all fertility treatments when the IVF didn’t work with my own eggs, and that was the end of that.

Or so I thought.

“Amazing, Love. I’m so happy. I knew it!” He is so happy that it turns my hardened heart as soft as a peony petal. I want to at least try to have his baby again. The worst that can happen is that it doesn’t work, and we’ve already come to terms with a no-kids lifestyle.

Or have we?

A few days later in a bathroom stall at work, my absolute favourite place to discover pregnancy, I find out that, in fact, I am pregnant. I had all the telltale signs that week. I had tender breasts, I was peeing every two minutes, and I was exhausted. I just didn’t believe it was actually possible for me to get pregnant again, so I read the signs as extra PMS fun.

“We conceived naturally,” I keep whispering to myself over and over again. This week is madness: first my AMH levels are practically in the normal range. Then I’m pregnant for the second time in my life without the intervention of a team of specialists. Somebody stop me.

When I tell Lawrence, he proudly says, “Cool, I knew it.” And he really did. Lawrence always believed there was a chance I could get pregnant again, but I shut him down each and every time. I owe everyone who’s ever told me that miracles happen a formal, written apology. The pessimist in me now has to believe in miracles, because this truly is a miracle. If I thought my AMH returning to normal levels for my age was good news, this is cake on top of cake on top of cake.

“Do you understand the situation?”

Dr. Fiala, a neonatologist, looks warily at Josh and me. She seems to be waiting for some reaction, so we nod. It feels like the thing to do.

“I’m not sure what more I can tell you,” she continues. “At twenty-four weeks gestation, sixteen weeks premature, Madeline will be lucky to survive this week.”

We look at our hands, at our shoes, at the tiled floor, anywhere but at Dr. Fiala. We don’t want to face the ugly truth presented by the kind and gentle doctor. It’s the combination of message and messenger that jars us. If the dire news had come in a stapled report typeset with serifs, we’d be braced for its severity, but this way—whispered sympathetically by another mother—confuses our expectations. Nice people don’t tell you horrible things. They just don’t.

“Any questions?” the doctor asks.

We shake our heads so she leaves us alone, sitting bolt upright on the sagging couch, like fence posts rammed into shifting clay. We’re hardly aware of each other’s presence, yet we hold hands, my left in Josh’s right. He grips my hand so tightly that my rings dig into my fingers. We feel each other’s anxiety, our stress, but we don’t comfort each other. We just stare numbly into dusty corners as intercoms and alarms sweep over us.

“She looks so fragile,” I murmur.

“I know.” Josh closes his eyes, inhaling deeply, perhaps trying to free himself from the fear that grips his chest. He hasn’t slept decently in a week and looks it. His eyes are smudged dark. His hair is matted and greasy. I know I look the same but I don’t care. In fact, I care about so little it frightens me. All the things that worried me last week have faded away—income tax filing, studio scheduling, meals in the freezer—wisps of smoke, nothing more.

Josh and I finally look at each other—husband, wife; father, mother—but we don’t smile, not even a forced smile of reassuring optimism. It would take too much energy; besides, we understand how the other feels. We’re stunned by what we’ve seen and heard. We’ve glimpsed the dark side of nature, its capability to churn out mistakes, to mangle lives, and it happened too quickly to make sense of it. Yet, we must pull ourselves together. My room in the Maternity Ward must be packed up and my discharge papers signed. Groceries have to be bought and laundry has to be washed. There is a life to return to even if we don’t remember it. We pull ourselves off the couch and tiptoe to Room A for one more look at Madeline.

In an incubator, she lies on her back, a limp bundle of wrinkled flesh, taped and wired to multiple lines. She has no will of her own, no strength. Her survival relies on the platoon of machines that queue around her incubator like sentries on duty, watching over her, tallying up numbers and percentages, pumping oxygen and nutrients into her body through narrow lines.

The incubator’s thick, curved Plexiglas walls bend our perception, like a glass of water confusing the world beyond. Although the incubator protects and warms her, it also keeps us away. We are outsiders, observers. Look, but don’t touch.

A quilt, sewn by a volunteer, covers the incubator, blocking sunshine by day and fluorescent light by night. Lifting the corner of the quilt feels like a sacred ritual, a prayer in action. I lift, look, and breathe, “Oh dear God. She looks so awful. So very, very awful. Save her, I pray. Save her.”

As each hour since birth slides by, I begin to accept her death as inevitable. I hadn’t pictured a loss after birth, but that’s what it will be—a labour-in-vain, a miscarriage, a “not-meant-to-be” as people so infuriatingly say. I always thought if I were to lose a baby, it would happen early on, at twelve weeks maybe, a splash of blood and then—all over. But a birth, followed by a suffering death, might be the cruelest loss of all. I will have to watch her give up. At least if I had miscarried, I wouldn’t have to see her fingers claw when needles are sunk into her veins, or listen to the alarms wail when her oxygenation plummets and heart rate drops down to nothing.

Through the gap in the incubator’s blanket, I memorize Madeline’s face in case she gives up before I return later this evening. It’s an odd face, barely-formed. So impossible. So strange to see.

A ghastly memory flashes and I try to ignore it, but it won’t go away. It keeps coming back to mind, to the mental view that flits away when you really try to look at the details. It’s from when I was a little girl on the farm. I was six or seven maybe, visiting a batch of new baby piglets in the farrowing barn. Outside their pen though, Dad had piled a half-dozen stillborn piglets. Wet and red, awaiting burial, they were a mass of taut, translucent skin. They were haphazardly stacked because, really, they didn’t matter anymore. They were dead.

The resemblance between those pigs and Madeline is uncanny. The wet, red skin. The fused eyes. The half-formed features. I want to gag, yet I can’t turn away from the incubator. How can I? This poor child is mine.

CHAPTER 1: PREGNANCY MASSAGE BASICS

This book covers massage for every stage of bringing a new baby into the world, from the massages leading to pregnancy to the baby massages so important to parental bonding and baby thriving.

This chapter begins with the basic strokes and equipment you will need. Chapter 2 helps you learn massage techniques for each trimester of pregnancy, and chapter 3 suggests specific massage treatments of some of the most common conditions in pregnancy. Chapter 4 deals with labor and delivery, and chapter 5 gives massage for the physical and emotional needs of the postpartum phase. Chapter 6 explains how to massage for the challenges of breastfeeding, and chapter 7 gets you set up for the most fun of all: massaging your new baby!

Role of Massage in Pregnancy

In a typical healthy pregnancy, there is much to treat with massage therapy, from the discomfort of prenatal headaches to flat feet. Low back pain, digestive troubles, and respiratory tension are the most common complaints in the body of a pregnant woman. Added body weight and extra fluid in the extremities give rise to carpal tunnel syndrome and numbness in the fingers. The lower extremities sport the conditions of sciatica, contracted iliotibial bands, knee problems, spasms in the calves, swollen ankles, and foot cramping.

Massage is the best way to get feedback from your body even before you are pregnant. I always encourage couples to look at the year of getting pregnant as preparing for a major sports event. Signing up for the race is a commitment to be as strong as possible for the event. Anyone can train for success if they have enough time and a good team to help keep them on track.

The Maternity Team

The most common maternity team is made up of the core players that make the event happen in the first place: the couple working to get pregnant. But there are others to invite into this inner sanctum at the beginning of the marathon. Usually, the people we inform first become important players on our maternity team. When I found out I was pregnant, I told my husband first, and then our parents and best friends. I knew my team would be these people, those who would be there for me, hands on at every stage.

Over the years, I have worked with an incredible variety of birthing teams. One patient, a single mother having her fourth child, had a wonderful family and mother who all showed up to the labor room. When I arrived, it looked like a family reunion with seven adults and three children talking and laughing in excitement. I quickly got the mob under control and focused by giving them each a hands-on job to do. To this day, that is still my biggest team.

I’ve had a transgender couple, gay couples, single moms, adopting parents, giving-up-for-adoption moms, and surrogate moms; they all had their own special teams of people. I once had a best man massaging his friend’s wife in the final month of her pregnancy. I’ve also had many lesbian couples, who sometimes involve their other single lesbian friends; for many, this is the only birth they may ever experience. When my patients Selena and Julie had Dénali, there were so many female couples at that baby’s celebration, it seemed like a women’s festival.

Although the people on your team might not be instinctively good at doing massage, they share your joy and enthusiasm for the new baby. I am always surprised at the efforts families make to become comfortable massaging the pregnant woman. With the right feedback about their touch, even the most ungifted tactile types can be taught to listen and feel with a touch that is not only therapeutic but also relaxing. Never underestimate the power of family for helping throughout the pregnancy and then through the miracle of labor and delivery.

My mom was very good with her hands. My father was also a hands-on person. Together they gave me the gift of touch. Even though she couldn’t be with me when I gave birth to my daughter, my mom came to mind when I was in the throes of despair in my labor. I talked with her on the phone from the bathtub; I cried for her as I was wheeled down the hospital corridor; from across the country, she was with me in my moments of pain. She was still on my team, even from a distance.

Just last year, I taught my daughter’s fiancé, Joel, to do the massages for her second trimester in a tandem massage tutorial. He has a natural touch. I felt inspired and confident that I was leaving her in good hands when I saw how quickly he picked up her feedback and adapted his strokes to suit her.

So many pregnant women could benefit from daily massages but don’t have people with available hands to work on them. Sometimes pregnant partners are working away from home or simply are not the helpful hands-on type. I would like to see a buddy system for pregnancy involving volunteers, especially in the senior age group, who would be available to regularly massage moms-to-be. The latest reports from Statistics Canada show there are, for the first time, more seniors than youth in the country. Let’s put those experienced hands to work as partners in maternity massage.

Whatever the maternity massage team looks like, this book will help them be more comfortable being hands on during the pregnancy. Everyone is capable of learning basic massage skills.

Conceiving in Good Hands

The most important massage in the pregnancy story is the conception massage that gets everything off to a good start. Those marathon massages are ways to make the getting-pregnant session extra special. There is never too much massage for getting babies started!

The massage techniques used for pregnancy are also good for encouraging conception. I encourage couples wanting to get pregnant to make some changes to their normal bedtime massaging by checking in with each other about favorite massage strokes. Usually couples, young or old, think they know how to work with their partner because they are so used to each other. I ask them to pretend they are not that familiar, that they are fresh and new to the touch. This freshness is usually, for most, a marriage-enriching idea.

How can we get better at pleasing each other, at relaxing each other, and attending to each other’s everyday aches and pains? This is the phase of maternity massage that is as creative as the two people making love. Opportunities for bonding, loving, and procreating are right at the tips of our fingers.

The power of touch is also useful in the disappointments that accompany many couples through months and years without fertilization. I don’t use the word unsuccessful with the sometimes painfully long process of trying to get pregnant. I have worked with many couples who are infertile and never experience childbirth. I am inspired by their level of commitment to massaging each other and, in effect, softening the harshness of those continual disappointments. Their power of touch for each other helps them thrive as a couple and stay emotionally healthy throughout a difficult time.

The Maternity Training Program

We should have a workout program for conception. It would look like a training program for any other athlete. People would sign up for the event, grab a bag of massage gear, and head out to the training field. In this case, training would include massage, special baths, and lots of yoga and cardio exercise, especially swimming. I highly recommend swimming before and during pregnancy as a way to keep fit and be gentle on joints like the knees.

A good program to strengthen the abdominal muscles would also be key. Some pregnant women work to develop their abdominal muscles during pregnancy even though they didn’t before they became pregnant. There is such a rush to achieve a flat tummy postpartum that many women start early. Working on abdominal strength is great for those with low back pain. Abdominal exercises help strengthen and stabilize the low back and reduce the risk of developing back pain.

Women would get a coach or training partner and would set some goals and a timetable to achieve the strengthening needed in time for the big event. The training partner could be a pregnant friend or someone who just wants to be on the birthing team. Best yet, the woman’s conception partner would go running, go swimming, do yoga, and attend weekly pregnancy-massage classes, just to be in shape for new parenthood.

Massage Gear

You don’t need much in the way of special equipment for massage. You probably already have most of what you need.

Lubricant

Almost any viscous substance will do as a lubricant, as long as it is healthy: choose one that is edible and nourishing to the skin. Almond oil and cold pressed virgin olive oil are excellent, although they can stain your linens. Nonstaining oils, such as walnut and coconut, are also excellent. I’ve used coconut oil throughout my massage career. I used to find it only in health food stores, but today it’s readily available at nearly every grocery store. If the mom likes fragrances and doesn’t have any allergies or sensitivities, you might want to try aromatherapy oils and lotions.

Table

Massage tables are easily available from retail stores and online, but they are not a prerequisite to doing a great home massage. Your bed is fine. The bed is the place most pregnancies start and the place where many babies are born. I have the stature of a twelve-year-old, so I find it easy to move around on the top of a bed to do a massage. However, you might find it easier to stand beside the bed. Some beds today are so high that only a pole-vaulter can access them easily. But these high beds do make it easier for tall people who find it hard to squat or kneel on the bed while massaging.

If the bed seems too awkward, your dining room or kitchen table might be perfect, or you can massage on the living room rug. On a hard surface, lay down something soft, such as a couple yoga mats, to create a comfortable surface for the mom to lie on for about an hour.

Ice massage

I sometimes advocate using ice to treat uncomfortable maternity conditions and old, yet still uncomfortable, injuries. I use the edge of an ice cube to massage, or I make ice popsicles. Using a popsicle tray with pointed shapes to the cones, embed a facecloth at the thickest end of the stem and leave the rest hanging loose. Use the pointed end of the popsicle to massage and the loose end of the facecloth to mop up the melting ice as you go. Although you may not need ice popsicles until much later in the pregnancy, I have included the description here since many couples have told me they wish they’d known how to use them earlier.

Other preparation

You will want lots of towels and pillows to support the mom in different massage postures. Keep a stack of towels and five or six pillows at the ready. There are now fancy body pillows that can help support the mom comfortably, but this isn’t necessary, as you can easily get enough pillow support with regular pillows.

You will also want a couple hot water bottles, heating pads, or microwavable bean bags. I like to warm the mom’s feet and neck while working on other parts of her body. If the mom has an especially tight area, you might want to warm up the area before massage.

The mom can wear a bikini if you want to massage outdoors, or she might wear nothing if you’re massaging in private. Use a sheet as a cover to keep her warm or to keep the sun off.

Play music in the pregnancy massages that you can use later in early labor. Getting the brain to associate intense relaxation with certain music is a handy tool for the intensity of labor. For some people, this music is classical or New Age, while others want country ballads or rock and roll. Try the combined favorites of both partners.

Massage to Prevent Stretch Marks

My breasts were my first indication of confirmed pregnancy. It seemed like they popped out the moment I conceived! By my third trimester, they were three times their normal size. By the time I was in my seventh month, I was leaking at the slightest provocation.

Such growth in the breasts and abdomen is often faster than the skin can keep up to. The swelling is uncomfortable, the skin taut. The skin stretches and sometimes tears along the lines of tension, resulting in stretch marks.

Some people are more prone to stretch marks than others. Some of my pregnant patients have no sign of stretch marks in any of their pregnancies, while other moms get stretch marks in the first trimester. Taking steps to prevent stretch marks is especially important for women who have already seen their bodies produce stretch marks from growth spurts during puberty.

Self-massage is an easy way to help the skin’s elasticity and prevent stretch marks. I recommend massage using coconut oil and Vitamin E. You can get the vitamin oil by poking a Vitamin E capsule with a pin and squirting it onto your body. Spread the oil all around the edges of the breasts and lower abdomen and anywhere else it is needed at potential growth and tear sites. Do lots of massage to ease the tension and use lots of oil as your lubricant.

The best stretch mark story advocating therapeutic oils was told to me by Joni, an eighty-sixyear-old mother of six. She told me that during the final month of her fourth pregnancy, a Russian neighbor in Grahamdale, Manitoba, brought her goose grease made from rendering the fat from Canada geese (illegal now, but not sixty years ago). The neighbor showed Joni how to massage the odorless and easily absorbed grease into her skin twice a day.

Joni continued this self-massage throughout her last month of pregnancy with great results. The stretch marks from her other three pregnancies were already present, but the goose grease made sure there were no additional stretch marks with her next three babies. Her biggest baby was nearly eleven pounds, and the goose grease saved Joni’s stomach from additional stretching and tearing. Today, she still talks about the value of goose grease for making her tummy and breasts more elastic. This elasticity is what we are trying to achieve with our massages all the way through the pregnancy and throughout the breastfeeding months that follow.

Massage Length

Most professional massages run about an hour in length, which is ideal for a full-body massage if you can manage it. However, home massages do not need to be as long. It’s better that you do many short, daily massages rather than infrequent hourlong massages. I say the more massages the better, even if each is only a half hour long. On the other hand, a prepregnancy conception massage might be two (or more) hours long!

Principles of Massage

Over my years of teaching and practice, I don’t have many massage rules that haven’t been modified, changed, or simply ignored when they did not turn out to be true in real life. However, there are a few basic principles I always follow.

1. Uncork the bottle.

The key massage principle here is working from the area closest to the trunk of the body to the farthest away from the trunk. I call it uncorking the bottle. Think of it like this: if you want to get the contents out of a bottle, you need to uncork it first. So always work the part of the extremity (arm or leg) that is hooked up with the trunk of the body first before moving down the length of the extremity. So massage the shoulder first and then the upper arm and then the lower arm. It’s the same with the legs: massage the hips first, then the thigh, and then the calf.

2. Apply pressure toward the heart.

One principle of massage I always use is based on the way blood travels around the body. The heart is the pump of the circulatory system. It gives the blood a big push from the center of the body out to our arms and legs, right to the tips of our fingers and toes. These extremities must then work against gravity to return blood to the heart, so our veins are designed with little one-way valves like gates to keep blood moving in the right direction.

Although you start at the trunk and move out to the extremity, the pressure of each stroke must always go toward the heart. Your massage pressure always works with the natural blood flow of the body, not against it. Don’t push downward with any stroke, whether it be your starting general strokes or the nitty-gritty of therapeutic pressure—each stroke of pressure should go in an upward direction, always toward the heart.

3. Move from general strokes to local strokes and then back to general strokes.

Massage strokes include some superficial, general, large strokes and other smaller, focused, and intense strokes. The superficial strokes tend to smooth out and soothe, while the local strokes really get in and work out tight spots, decreasing contractures and increasing mobility. A massage routine should always start with general strokes, move to specific strokes, and then move back out to general strokes.

Beginning with the general strokes allows the body to adjust and prepare for the therapeutic application of deep tissue release. You want to get the body used to your touch and you want to command the attention of the nervous system to the part being massaged before you work into it. If I start work on a sore spot too fast, the body will repel me—no thanks!—and then I can get locked out.

So you want to make contact and take the superficial tension off before you work on the underlying tightness. This approach ensures you can get into the problem with a welcoming opening.

After giving a sore or tight spot focused attention, I always end with general strokes that erase the memory of the deeper, stronger strokes. I learned this in the barnyard where I worked with all sorts of injured animals. I always left each animal I worked on with a stroke memory that was positive, not necessarily therapeutic. If the animal remembered me as the one making it uncomfortable, even if there was later therapeutic gain, then it was going to be a lot harder to repeat the treatment. The animal would take one look at me coming into the barn and head for the other side of the stall. So I learned early to “trick” the tissues and leave a lasting impression of positive contact. Leave the area of treatment with the same introductory strokes you started with. As I did with injured horses, you want to leave the tissues happy to see you again.

4. Work both sides.

Another principle is to balance your massage on both sides of the body. People tend to have a favored side to rest on and may not want to lie on the other side very long. Still to this day, I find it hard to ask a comfortable pregnant patient to turn to her uncomfortable side. But even if you can only massage the disfavored side for a brief time, massaging both sides helps bring the person into balance.

Basic Anatomy

Professional massage therapists have extensive knowledge of anatomy, which is critical for solid therapeutic massage. However, you can apply effective massages at home with a basic knowledge of human anatomy. The illustration that follows on page 16 provides some of the basic anatomic knowledge and vocabulary you will find helpful as you work through the massages in this book.

Basic Massage Strokes

Effleurage Effleurage is a French term that means to cover or cloak. Fittingly, this stroke is most often used to cover or spread the body with oil. It is a warm-up stroke with a gentle, double-loop shape. An introductory stroke, it’s the one I use most often to get my hands accustomed to my patient and the patient accustomed to my touch. Effleurage also has its own standalone merits of promoting better circulation. The stroke encourages the superficial circulation to move more effectively, helping to reduce swollen legs or stress and helping to induce relaxation.

To begin a back massage, put some oil or lotion on your hands. It is important to get the right amount of oil, which may take some practice. You want enough oil to provide ease of movement, but not enough to make the person’s back slippery. You want your hands to have good contact and not just skate over the surface. Start with just a few drops (not a dollop) and then add more as needed. You don’t need to put on the total amount of oil you will use throughout the massage at the beginning. You can add lotion as the massage progresses. If you get too much, towel some off.

Place one hand on each side of the spine, applying firm, even pressure. Use the whole palmar surface of your hands, including fingers: don’t be dainty! Keep your fingers together but flat: effleurage is a flat-handed stroke.

Move your hands together from the shoulders down to the low back. At the base of the spine, loop your hands out to the outer back/sides and continue the pressure as you return along the length of the torso to the shoulders. Be firm, especially on the return stroke up the sides. At the shoulders, begin the stroke again. Introductory effleurage strokes are done at least three times. The first time spreads the oil, the second time allows you to get comfortable with the stroke, and the third time establishes pressure and gets the circulation moving.

Remember: when effleuraging the arms or legs, always push up, toward the heart, and never down. You must apply pressure only on the way up and no pressure on the way down, just a light touch. On the back it doesn’t matter—you can apply pressure in both directions. The heart is near the middle of the body and the circulatory system is more deeply buried, so the venous return is not directly affected by your direction of pressure.

As this is the beginning of the massage routine, this stroke gives you lots of information about the part of the body you are going to get to know and to accustom the mom to your touch. As your hands warm up, you may be able to feel areas of tension or sensitivity on her body.

I love this stroke. Effleurage is what to do in between other strokes. When you don’t know what else to do, effleurage! During pregnancy, this stroke is especially appreciated on the legs because of prenatal swelling and fluid retention. It offers a quick, yet powerful, way to improve circulation and reduce swelling.

I will sometimes talk about a mini-effleurage. This is a stroke that covers half or less of the surface covered in a full effleurage. For example, you do a mini-effleurage to start a foot massage, but a full effleurage on the whole leg. You might also use it to start the abdominal massage by effleuraging only the abdominal area, leaving out the breasts, or on the shoulders and neck to begin a head, neck, and shoulder massage.

Wringing

The next two major types of strokes—wringing and kneading—are collectively known as petrissage. If effleurage helps surface tension dissipate, petrissage strokes are more specific and deep reaching in their therapeutic effect. I usually do wringing after effleurage, and then move on to the really focused kneading strokes.

Wringing moves the muscles around more vigorously. It moves the skin away from the underlying muscles to encourage the layers of the tissues to not adhere so tightly to each other. Wringing is another general stroke that helps establish or restore tolerance for more focused, uncomfortable strokes of the thumbs and fingertips. Wringing lengthens muscles by working transversely (across) the tissue. It is an exception to my general practice of massaging in the same direction the muscle fibers run.

On the back, for example, work at right angles to the spine and move your hands in opposition: one hand pushes the skin and underlying flesh away from you around the curve of the ribs, while the other pulls the skin toward you, from the other side of the back. Be sure not to apply any pressure directly onto the spine as you cross over it.

Your hands should be beside each other—close enough to touch—as they move in opposite directions back and forth across the muscles. If you are wringing with the correct technique, you can see the skin and tissues underneath your hands torqueing. Work up and down the whole length of the back. You will find you can move the skin and underlying muscles quite easily. It looks awful, but feels wonderful! Be sure to check the pressure of your touch with the person on the receiving end as you massage.

This stroke is one of my patients’ favorites, both pregnant and nonpregnant. There is something about the cross-fiber direction of the stroke that works on the nervous system differently from other massage strokes. It always gets the sleepiest of patients or the most relaxed moms-to-be purring and taking the effort to make a positive comment (especially at the knee, a favorite spot for wringing).

For the knee, I use a whole-handed wringing with an open hand above and below the kneecap housing the patella in between—a favorite with all my patients. Although you most often use your whole palmar surface for wringing, you can also use your thumbs for smaller areas, such as around the knees or on the ankles. I use thumb wringing at the base of the knee, at the attachment of the quadriceps tendon to the lower leg, and also at the ankle, wringing the front of the ankle joint when the mom is supine, or at the Achilles tendon attachment when she’s prone.

This stroke can be never overused. It is like the effleurage stroke that I use in between other strokes. It comes in really handy when someone is unable to turn or be arranged face down. The mom can be in a face-up position and get the backs of her legs massaged with a thorough wrap-around wringing.

Knowing the rules – types of bed rest

The term bed rest is extremely vague. For many they envision being confined to their bed until their baby is born, which, in reality, is the case for only a small percentage of women. The restrictions placed on bed rest are wide ranging and can vary throughout the pregnancy.

It is important to be clear on what type of bed rest you have been placed on and your restrictions. When I was first placed on home bed rest after being diagnosed with complete placenta previa with my daughter, my only limitations were minimal trips up and down the stairs, no working as well as resting when I could. I was still allowed to go on light shopping trips or out to coffee with a friend. This changed after a bleed that put me in the hospital for 48 hours. My restrictions were then more defined and my movements limited. On my weekly visits, my obstetrician (OB) would review my symptoms, ask me about movements and, if there were no complications, allow me certain outings – car rides with my husband or ice cream at the beach. But each outing had to be within a short drive of the hospital and was for a set amount of time. Then it was back on the couch or to bed.

Be careful about Googling the term bed rest. It is too easy to pick the definition you like the best, telling yourself “well this is bed rest, so it must apply to me.” Your medical provider knows you and your pregnancy best.

Here are some common clarification questions to ask your doctor.

Time off your feet

Am I to be in bed and/or on the couch all day? Can I walk about for short periods of time? What length of time? Can I get up to go to the bathroom? Take showers? Baths? If so, for how long? Can I go to the kitchen to make my meals?

Sitting versus lying down

Am I allowed to sit up or do I need to lay down all the time? Do I need to lie on my side or can I lay on my back, slightly elevated? If I can sit up, for how long? Can I eat meals at the table or do I need to be in bed?

Activity

Can I drive myself to appointments? Can I pick up my kids? Can I do prenatal yoga or other light stretching exercises? Can I get a massage or see a chiropractor? Can I climb the stairs? If so, how often? Can I lift things (like my kids)? Weight limits?

Make your own list of questions and discuss them with your healthcare provider. Then make a list of your restrictions, and review them each visit to see if any of the restrictions have changed. This is important, as your provider may not think to change restrictions based on changes in your pregnancy.

What to expect

Okay, so now you’re clear on what bed rest means to you. You have your list of restrictions, now what? If you only have a few days left in your pregnancy, well then kick your feet up and enjoy the last quiet moments before baby arrives. That is if this is your first child. If you have other children, enjoy some cuddle time in bed with them. However, if you have a week or more before your baby’s birth, and for some a few months, it’s time to start thinking about what to do with yourself. The first few days you will likely try to sleep in, catch up on some television and get to that book you’ve been meaning to read. But once that is done, you’ll soon find the days can be long to fill.

The first thing is to get organized. Make a list of what you want to accomplish before your baby arrives. Is there a photo book you want to complete? A book series you’ve always wanted to read? A hobby you want to take up or master – such as knitting or jewellery making? It’s a good idea to list what interests you and how you can advance those interests from your bed. Even if you are a marathon runner, you can research running tips, set up a post pregnancy eating program or research marathons you’d like to eventually run. The idea is to fulfill your passions and spend this time filling your bucket versus emptying it in boredom.

You should also enter all your medical appointments into the calendar. If your restrictions don’t allow you to drive, you will need to schedule transportation for your appointments. It is also handy to create an in-case of emergency list that is near you at all times. Who can drive you to the hospital if needed? Who can come and quickly take care of your kids? Your pet? Planning in advance can relieve some stress as you know you’re prepared if an emergency arises – even if you never have to use your list.

Emotional rollercoaster

Being pregnant is a very emotional time for women. Then add bed rest to the mix, and it can be a tearful experience.

Be prepared for all the emotions that come with being confined to the couch or bed. Having your independence taken away is challenging, but remember it is only for a short time.

It’s important to know you are not alone – even though there are many times you feel you are the only person going through this experience and none of your friends and family understand. And realize those breakdown moments where the smallest thing puts you over the edge are okay. We all have our breaking points, and having a good cry is actually therapeutic.

What set me over the edge in my confinement were airplanes going over the house – the Canadian Snowbirds. For non-Canadians, the Snowbirds are an acrobatic elite team that performs at airshows across the country.

I had read in the paper they were coming to town. Even though I’d seen them perform in the past, I was disappointed I wouldn’t be able to go to the beach to watch them – as this point in my pregnancy confined me to the couch all day.

I was watching TV and heard the planes fly over. Since I hadn’t been off the couch for a couple of hours I went outside to sit on my deck to see if I could watch them. Unfortunately the best I could get was a one second glimpse as they passed over the trees.

I went back onto the couch and broke down. I cried for at least half an hour. It wasn’t about not seeing the airshow, but about the fact the choice to see the Snowbirds had been taken away from me. I cried for the loss of my independence. I cried for being alone as my husband was at work. I cried for all the stress and worry about my baby. This was the moment my bed rest caught up with me and I fell apart. For so long I had been trying to hold it all together. To put on a strong face for my friends and family and not admit I was scared and depressed.

By the time my husband came home, I felt better. But I decided to tell him about what had happened, as I was tired of putting on a brave face. It helped me realize that I wasn’t okay and I needed to be honest about my feelings. We had a great talk. After that he was more aware of my emotions, and talked with some of my friends to check in on me.

It’s important our support team is aware of the emotional support we need. It can be hard to let them see beyond the mask, but now, more than ever, you need people to keep an eye on your emotional and mental health.

This is an area I found lacking in obstetric care. Your medical team monitors your blood sugar, blood pressure, baby’s heartbeat, baby’s position, positioning and more, but often the emotional state and mental health of mothers is overlooked.

If you are struggling, make sure you talk to your medical support team. It’s especially important if you’ve suffered from depression before you were pregnant. But even if you haven’t, the raging hormones and isolation can impact your mental health.

It’s important our support team is aware of the emotional support we need. It can be hard to let them see beyond the mask, but now, more than ever, you need people to keep an eye on your emotional and mental health.

This is an area I found lacking in obstetric care. Your medical team monitors your blood sugar, blood pressure, baby’s heartbeat, baby’s position, positioning and more, but often the emotional state and mental health of mothers is overlooked.

If you are struggling, make sure you talk to your medical support team. It’s especially important if you’ve suffered from depression before you were pregnant. But even if you haven’t, the raging hormones and isolation can impact your mental health.

I never shared my story with my OB, nor did she ever ask how I was doing emotionally. Looking back I wish I had told her, as I suffered from baby blues for the first few weeks after my daughter was born – also in silence. I was however blessed to be surrounded by a supportive group of women that I met in my prenatal classes. Two of these women were on medical leave and, while not on bed rest, shared some of my feelings of isolation. We got together once a week and these friendships helped me get through the remaining days until my c-section.