I treat pregnant women in my practice, and after 13 weeks, regardless of client preference, I always treat in the side-lying position.
There are practitioners who use pregnancy pillows, or a cut-out table, where women are positioned face-down. Here is why I don’t do that:
- The prone, or face-down, position on a flat therapy table can exert strain on the lumbar, pelvic, and uterine structures.
- The side-lying position is the best position for optimal fetal blood supply.
- Prone positioning causes the muscles in the low-back to become shortened, and that compresses and pushes the vertebra in the low-back forward. The joints between the sacrum (the flat bone in your lower back region) and the pelvic bones becomes rotated, and strain on the sacrouterine ligaments is increased. The prone position often aggravates the causes of many women’s back discomfort, especially in the later stages of pregnancy. As well, the prone position, even in the early stages of pregnancy, can cause discomfort due to breast sensitivity.
- Some massage therapists use special pillows, or tables with a cut-out to try and lessen the problems of prone positioning while pregnant. However, these alternatives can further strain the lower back and the uterine ligaments, or even cause increased intrauterine pressure when sufficient pressure is applied to address the musculature of the back.
- In low-risk, uncomplicated pregnancies, some increase in intrauterine pressure can be acceptable for the first 13 weeks of the pregnancy, when the front of the hip bones protect the uterus from pressure. However, after that time, regardless of preference, I always position my pregnant clients in the side-lying position.
With proper use of pillows, most pregnant women find the side-lying position incredibly comfortable.