One of the most common questions I get about pregnancy massage is whether I use one of those fancy tables where you get to lie on your belly even if you’re 42 weeks pregnant.

My short answer is no.

Although when you’re pregnant it seems like a miracle to be able to lie face-down, those so-called pregnancy massage tables ultimately do not serve you well, and can actually cause injury to your body or even your baby.

My reasons have to do with the mechanics of the spine and abdomen. Pregnancy massage tables are only able to be customized to a certain degree, which means you will likely be lying over a hole that’s too wide, too narrow, too deep or too shallow for your body at any given stage in your pregnancy. Essentially, while lying face-down, there are two situations:

1.  The gap is loose and does not apply pressure on your belly, but the weight of your uterus will be pulling your abdomen into the hole, increasing the curve of your lumbar spine and adding to the stress on your sacral and uterine ligaments. This effect is increased even further if a massage therapist were to press down, working the muscles of your lower back. Pregnancy already creates a tendency toward increased spinal curvature and ligament tension; this is quite likely one reason you’d like a massage right now, and I would much rather help alleviate that discomfort, instead of compounding it.

2.  Your belly and spine are well supported, but the trade-off is that the weight of your body and any added pressure from a massage therapist’s hands are translated directly into compressing your abdomen and uterus.

These concerns also apply to the cut-outs provided for your enlarged and tender breasts, which are likely not to appreciate either compression or dangling.

There is one thing the pregnancy massage table does well: it allows therapists to perform the same massage for prenatal clients that they do for non-pregnant clients, instead of learning a specialized treatment plan or advanced skills. Anyone using the table becomes a “prenatal specialist,” regardless of training or experience. However, the art & science of pregnancy massage is not just figuring out how to maneuver around your growing belly.

Pregnancy Massage Positioning

For these reasons, I do my 2nd and 3rd trimester massages in the sidelying position on my extra-wide massage table. I use about 8 pillows of various sizes and shapes to support the healthy alignment of your spine and pelvis. As your pregnancy progresses, we might also add a small pillow underneath your belly to support against gravity and reduce rolling forward.

Sidelying allows me to work your lower back without risk of increasing uterine pressure; it also provides perfect access to your quadratus lumborum and other muscles commonly stressed in pregnancy. The added benefit of doing massages this way is that together we will learn exactly which pillows go where to make you the most comfortable, and you can then try a similar setup at night to help you sleep more comfortably.

Another solution I frequently use for pregnancy massage requires even more pillows to create a semi-reclining position one of my clients calls a “princess chair.” This position avoids the problems that we might encounter if you were lying flat on your back for a long time, namely compression of your abdominal blood vessels by your heavy uterus, which could lead to dizziness, anxiety, and ultimately reduced blood flow to baby (no good!). Because you’re partially upright, this position can also be great if you have nausea or heartburn when you lie down. I love to use this position at the end of a session, for massaging your face, hands, belly and feet.

In the first trimester (or a little sooner or later; we’ll look at your needs individually) as well as postpartum, I always give you the choice of the standard face-down/ face-up positions, the above pregnancy-specific positions, or a combination. Some clients early in their pregnancy or in the first weeks postpartum have a lot of breast tenderness, so lying face-down is uncomfortable, but face-up is no problem. In these cases we’ll often do the massage in thirds: 1/3 on each side and 1/3 on your back.

There are related products comprised of specially-shaped cushions that make the million-pillow sidelying position a bit easier. I have tried several brands and found them comfortable and easy to work with. On my own holiday/ birthday wish list is the Sidelying Positioning System, designed by a respected pregnancy massage therapist who’s been at this even longer than I have, and constructed by a skilled maker of massage tables.

* When I say “pregnancy massage tables” in the title, I use quotation marks to indicate my disagreement with the term being applied to these products, as I consider them contraindicated for pregnancy.