In preparation for the many changes ahead of her, the one thing a pregnant woman needs most — even more than pickles and ice cream — is nurturing, especially in the form of bodywork.

Massage therapists have long catered to the pregnant client, helping her relax, renew, and even physically prepare for the strenuous birth date. Now spas are picking up the pregnancy pace as this unique client is walking through their doors seeking respite more than ever before.

In today’s market, it’s almost unusual to find a day spa that doesn’t have some sort of service directed toward the pregnant client. Looking at the ever-growing number of women becoming pregnant, and the expanding age range in which they do so, it’s understandable — the pregnant woman is big business, and the number of those vying for her interest increases every day. Several new publications focusing on the pregnant woman, and more websites and online publications than you can count, have entered an already tight market in the last three years. Clothing, cosmetics, fitness, and every type of resource imaginable are being retooled for the pregnant woman. Even a home makeover show for expectant moms has found its audience. It makes sense, then, that well-being would eventually become a suitor as well.

With more than 4 million U.S. births every year, there are plenty of mommy clients just waiting for a prenatal or postnatal massage by someone who understands their particular bodywork needs. But even as lucrative as the mommy market might be, both client and spa need beware — combining bodywork and pregnancy requires a specialized skill set crucial to keeping mother and child healthy. When approached with care and commitment, however, this type of work can be a win-win for everyone.

A Growing Business

Rebecca Matthias recognized the opportunity and today finds herself in the spa business after combining the growing acceptance of bodywork and self-care with her years of catering to the pregnant woman. Matthias, founder of Mother’s Work, the largest maternity company in the world¹, says by listening to her clientele, a maternity spa seemed both a logical business opportunity and a valuable service.

As part of a larger plan to create a destination shopping opportunity for pregnant women, Mother’s Work began regionally consolidating some of its stores into one setting — Destination Maternity — from which Matthias “stole” away valuable retail space for a small, pregnancy-focused spa. She called it Edamame Maternity Spa, and the first one opened in Charlotte, N.C., in December 2004. Two more will follow in 2005.

The decision to bring a spa into her already successful retail plan makes sense, since the Destination Maternity locations already include a learning center, Pilates and yoga classes, a juice bar, kiddie corral, and an entire line focusing on mind, body, and spirit. And with more than a dozen Destination Maternity locations being rolled out across the country, the opportunity for more Edamame spas is a real possibility.

Each of these maternity spas is designed to house three treatment rooms, a lounge area, and a changing/shower area. The entire focus is on pampering the pregnant woman. “That’s all we do,” Matthias says.

While some might say the biggest challenges in working with pregnant women is dealing with their heightened emotional state, Matthias considers the “hormone high” a positive thing. “I think they’re the greatest to work with.”

As for the bodywork itself, Matthias says her staff is specially trained to serve this client and her needs. “It’s about really understanding our client.” Matthias says so many women are familiar with massage these days, and already utilizing it in their general health regimen, that they aren’t ready to give it up just because they’ve become pregnant. “If anything, this woman needs pampering more than anyone,” she says. “We don’t want her to be afraid to get what she needs now more than ever.”

In helping educate clients of their choices, the Edamame spa menu classifies the efficacy of treatments for before, during, and after pregnancy. Treatments applied in the “before” phase are designed to “reestablish equilibrium.” The goal of treatments in the “during” phase is to maintain that equilibrium. And, the goal in the “after” phase is to provide energy and stress relief for the new mom.

The signature service for the newly-opened Edamame is the Mom-to-be New Life Massage, a $98 customized massage treatment that focuses on areas of stress, such as the lower back and hips. Illipe butter cream is used to moisturize and firm the skin, while a fresh concentrate of cold-pressed mint juice is applied to the legs and feet to help reduce water retention and restore energy.

Other Edamame maternity services include a nutritional organic body mask, an aromatic massage of fruit acids and jojoba oil, and a host of facial treatments.

In the end, it’s about the pregnant woman being pampered. That’s how Matthias sees it. “We’re passionate about this customer.”

Pregnancy Spa Menus Expand

While maternity massage is certainly the most popular offering spas have for pregnant clients today, some take it a step further by making options a bit more enticing.

At La Bella Spa & Salon in Albuquerque, N.M., expectant mothers can choose from a balancing facial that works to counteract the effect of pregnancy’s hormonal fluctuations; a Body in Balance treatment designed to exfoliate, moisturize, release tension, improve circulation, and move lymph in the legs; or a pregnancy pedicure to reduce swelling in the ankles and feet, as well as calm the accompanying aches and pains.

The Mountain Home Inn in Mill Valley, Calif., is unique in that it combines the relaxing environment of a rustic mountain retreat with the pregnancy-related bodywork, education, and fitness offerings of a health spa. Barefoot and Pregnant is the facility, and its packages are filled with specially-designed spa services, prenatal exercise classes, and pregnancy-friendly hikes. Intensive childbirth classes, expectant father workshops, belly casting, maternity photography, and sign language courses are also available.

La Costa Resort & Spa in Carlsbad, Calif., offers a warm sea foam maternity massage with “effervescent and self-heating sea mud applied along the spine to bubble away stress and tension,” and a relaxing maternity bath in seawater.

Energy medicine is much harder to find in spa settings in general, but especially so for the pregnant client. One of the few that does include it on the menu is the Mirabella Mansori Day Spa in San Diego, Calif. It offers specialized massage and subtle energy techniques to balance the pregnant woman’s body, mind, and spirit.

She Won’t Break

Regardless of the modality, there are certain areas of concern when working with pregnant women, some of which are still hotly debated.

First trimester: One of the main areas of contention for this client is whether or not to massage her at all during this period. A sampling of spas offering services for expectant moms shows several with the cautionary notice that women must be beyond their first trimester to receive bodywork at these facilities. While working closely with a woman’s obstetrician is smart, disallowing her the benefit of bodywork during the first three months of pregnancy is overkill.

“It is completely safe to work on a pregnant woman during her first trimester, if she is feeling good,” says Janet Markovits, owner of Maternal Massage and More in New York City. “Massage does not cause miscarriage,” she says. What can harm moms-to-be are therapists untrained, or poorly trained, in the field of maternity massage. “Massage therapists working on pregnant women should be prenatal certified,” Markovits says, which usually includes taking continuing education classes focused specifically on prenatal massage, taking a written exam, and getting experience working on pregnant women.

“Unfortunately, many spa therapists are not certified, and the massage these women so desperately need turns into what I call fluff work, where lotion is just being applied, but no therapeutic work is being done because therapists are afraid to apply pressure to the client.”

Heat: There is strong, general agreement that heat is not good for either mom or baby, although it’s not strictly outlawed on spa menus. Gentle treatments like warm mud applications are a far cry from hot stone massage, saunas, and the use of electric blankets — all no-nos for this client. Hydrotherapy is something clients should discuss with their doctors; regardless, water temperatures should not exceed 100 F. Markovits and others also suggest this client stay away from body wraps, as they might cause overheating.

Feet: Another area of debate revolves around the amount of work that can be done on a pregnant woman’s feet. While some spas describe their luxurious foot massage for pregnant women, others cringe at the idea. Markovits says there are several acupuncture points on the foot that can induce labor, but trained prenatal therapists will know to avoid them. These points fall on the mid-heel, the webbing between the big toe and second toe, and the acupuncture point known as Spleen 6, two-and-a-half inches above the ankle on the inside leg.²

Marie Scalogna, massage director at Advanced Skin Care, says she stays away from any points that can stimulate the uterus. “One area in particular is the heel of the foot,”³ she says. Another point is inside the leg just below the knee. “This is called the female tonification point, and we avoid it during pregnancy.”⁴

Positioning: About the only area of agreement on the subject of positioning is that pregnant women should not lie completely flat on their backs, but instead at a 45-degree angle and slightly to the left. Some also call this the standard first aid position. Contention arises, however, with the discussion of prone positioning for the pregnant client, with opinions varying considerably.

Markovits says using the body Cushion product by Body Support Systems allows expectant moms to lie on their stomachs while receiving bodywork. And sidelying, she says, with the support of properly placed pillows, is perfect.

Scalogna, however, says she follows the rule of prenatal massage expert Carol Osborne Sheets, which is to never have a pregnant woman lie on her stomach for massage after the first trimester, “whether it is with a special table with a cut-out or with a special prone body cushion.” The reason? “Lying face down during a massage will increase the strain on uterine ligaments that connect from the sacrum to the uterus and also cause increased uterine pressure.”⁵ Scalogna agrees, however, that sidelying, and utilizing positioning pillows when supine, are safest.

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As the mommy market continues to flourish, and as more expectant mothers realize how beneficial bodywork can be during this time, it’s important that spas providing these pregnancy services don’t take their role as healthcare providers lightly. Whether it’s her first trimester or her third, in the end, the most important thing to remember about this client is simply that she and her unborn baby require the utmost care, both in intention and quality of work. Proper training, attentive service, and common sense will help make the experience positive for everyone.