Massage for Pre/Post Natal and Preconception: Unlocking the Belly

Have you ever had low back pain or sciatica?  What about leg swelling? Acid reflux? Pain during ovulation or painful cramps during menstruation?  Irregular cycles? Skin outbreaks? Painful sex? Constipation or diarrhea? Shoulder pain? Bloating? Incontinence? Hemorrhoids?

Living in our bodies, and in particular bodies with uteruses (or that once had uteruses) is an amazing gift, but can also feel complicated or even painful*.  The above symptoms can affect everyone, but can be especially persistent during pregnancy, post-partum, menopause, and in pre-conception. And despite the fact that these experiences are very common, it can be hard to find relief, and our bodies are stigmatized in such a way that we might even feel too embarrassed to ask for help.

The Abdomen: Starting from the Center

What all of the symptoms above have in common is that they often originate in the abdomen.  The abdomen starts at the very top of the pubic bone and extends up to the top of the bottom of the ribs and is the seat of many major body functions, including digestion, respiration, chemical processing and integration, and creation.  Different spiritual traditions describe the belly as the origin of creativity, connection to self, and as the place where we connect to our ancestors. Emotionally, the belly holds hope, fear, anxiety, protection, strength, and vulnerability.  Our abdomen is greatly impacted by our emotions. If you’ve ever had a “sinking feeling”, a “knot” in your stomach, or “butterflies” you know what I mean. Conversely, tension or pain in the abdomen can lead to a fuzzy brain feeling, depression, and anxiety.  



Why is it that this area has so many meanings, and can be related to so many feelings of joy and pain?  From a physiological perspective, the abdomen contains the liver and gallbladder (processing all chemical reactions in the body), the stomach and spleen, the pancreas, the intestines, the uterus, and the prostate**.  The abdomen is bordered by the respiratory diaphragm (which is responsible for controlling and allowing breath) at the top, the pelvic diaphragm (which holds up your reproductive organs, rectum, and intestines) at the bottom, and your aorta and vena cava (responsible for delivering all blood to your body and returning it to your heart) as well as the kidneys in the back. Muscularly, your abdomen is held together on the outside by a complex set of muscles that hold everything up as well as together and allow you to sit, stand, bend over, and keep your organs intact.  Your abdomen also contains portions of the powerful iliopsoas muscles, which extend from your mid back, travel through your respiratory diaphragm, and attach at the front of your hips and inner thighs (iliopsoas challenges can lead to symptoms ranging from severe low back pain to trouble breathing). Your abdomen also carries blood and lymph circulation to your upper and lower extremities. As if that wasn’t enough, your gut has its very own nervous system, the enteric nervous system, and has been found to play a significant role in the regulation of emotion.

TL;DR-Your abdomen connects to every major metabolic, reproductive, and nervous system function in your body, from the top of your brain to the tips of your toes!

Connection to Cycles, Fertility, and Transition

Whether you’re trying to get pregnant, never plan to be pregnant, or are going through transition to menopause, abdominal massage still has life-changing benefits.  Part of living in a patriarchal society means that people socialized as girls are given messages from even before puberty that they are insufficient, faulty, and need to be controlled.  It’s no surprise then that when people have painful menses, missed or changeable cycles, endometriosis, or fibroids the immediate answer they are often given is to take strong hormonal medications or to have surgery. While there are absolutely times when these forms of medicine make sense, they are often pushed on people without first providing adequate education and agency.

Hormonal differences, blood and lymph stagnation, and varying uterine position can all contribute to symptoms of infertility or cycle irregularities, as well as increased symptoms during life transitions.  Rather than pathologizing the person, abdominal massage works to support the entire system. By gently bringing circulation and metabolic activity to the cells of the reproductive and digestive organs, these symptoms—even something as severe as large fibroids—can be reduced and sometimes even eliminated.  Did you know that a uterus moved slightly to the back can cause menstrual cramps, constant yeast infections, and low back pain? Or that tight fascia around the intestines can lead to IBS? While the pain can be severe, the healing can be quite simple, and easy to access through self-care. For people who have had or who find they need or desire surgery and medication, massage can be an extremely supportive modality, and help a person connect to their bodies more deeply and increase the healing capacity of the other modalities they are engaging.  

Massage During Pregnancy

During pregnancy, the entire body goes through amazing changes.  As tendons and ligaments loosen to allow the bones to separate to accommodate a growing baby and a birth, our skeletal muscles might get tight to compensate and make sure we don’t fall forward or backwards.  In addition, the 5 ligaments that hold the uterus in place have to move and stretch, most notably the infamous round ligament, which attaches from the top of the uterus to the outer labia (no, you are not imaging that your labia hurt!There’s a reason!) and grows from just a few centimeters to up to 14 inches during pregnancy.  In addition, as your belly grows, even just a small amount, it changes the relationship to your intestines, stomach, liver, bladder, and lungs. Depending on the position of your uterus before and during pregnancy, even small changes can cause digestive, urinary, and respiratory symptoms as early as 5-6 weeks.

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In addition to changes in your abdomen, the growth of your uterus and the influx of hormones in your body can lead to pain and discomfort in your hips and back.  Most pregnant people (or anyone around pregnant people!) are familiar with the phenomenon of sciatic nerve pain--severe pain and numbness in the hips, low back, and legs. While many people find relief from releasing gluteal muscles, pain along the sciatic nerve can also be caused by the shifting of weight into the front of your body, and pressure on the nervous and blood circulation to your legs.  Similarly, leg cramps (charlie horses), numbness, and swelling can be caused by a restriction of blood and lymph to the lower extremities as pressure in the abdomen and pelvis increase. Pressure in the top of the abdomen can lead to shortness of breath, but also digestive challenges as the stomach, spleen, and liver change shape and the esophagus musculature becomes more lax. Finally, many pregnant people suffer from extreme pain in the pubic bone and groin, incontinence, and constipation.  While some people might be told their hips are “too small” or their babies “too big” this is almost never true. What is more often the case is that the uterus is in a position where the baby is pushing on the pubic bone, cervix, rectum, bladder, or intestines.

Abdominal massage can address all of these issues and more.  Before 20 weeks of gestation, abdominal massage is indicated for the upper abdomen only, and can help the liver process the large increase in hormones, the stomach move through difficult constipation and nausea, the diaphragm expand to accommodate easier breathing, and the relax tissue around the esophagus to ease acid reflux.  After 20 weeks, abdominal massage on the lower abdomen focuses not on moving the baby, but instead on the ligaments, muscles, and circulation surrounding the uterus. The principal is to provide more circulation and space for the uterus to do its important work, and more room for the baby to move into a comfortable position for you and them.  Abdominal massage can even help a breach or posterior baby turn!

Post-Pregnancy and Beyond

Fortunately there has been a significant increase in the amount of attention paid to birth giving people after labor over the past several years thanks to the hard work of birthworkers and advocates.  However, many still find a lot of isolation, pain, and lack of information following delivery. Difficult births, unplanned cesareans, epidurals, and other occurrences during labor and birth can be traumatic, with many people being pushed into feelings of shame or embarrassment if things did not go as they planned, or as family or community wanted.  Terminations and losses of pregnancy carry their own complex emotions, and people often are not given room to process these complexities. Conversely, people who have “easy” births can feel their own sense of shame for not having the same experience as their peers, and might feel unjustified in talking about their own discomfort, emotional challenges, and fears.  

Massage following a pregnancy can release both physical and emotional pain, and can help people deeply connect to a part of their bodies they may have felt cut off from, or simply have felt changed.  Massage for any type of incision after it has healed can cause a dramatic reduction in scar tissue. Abdominal massage when there hasn’t been an incision can help the uterus tone and be situated in the pelvis, and can help heal pelvic floor challenges such as prolapse, hemorrhoids, post-partum incontinence, and diastasis.

People often ask “Am I still post partum after...1 year...5 years...40 years?” My answer is absolutely yes!  You are post partum as long as you feel that way. While you are not defined by your pregnancies, they can also have a lasting impact, and it is never too late to care for yourself.

And finally, people without uteruses can benefit from abdominal massage as well! Whether you used to have a uterus (or more than one), or never had a uterus, the abdomen is still home to all of your other crucial organs and is still a spiritual home for creativity and self-actualization.

Cindy Samantha. Cindy is a certified prenatal massage therapist, cranio-sacral therapist, and a certified practitioner of the Arvigo Techniques of Abdominal Therapy ®.

*This post was written with a certain population in mind, particularly, people who at some point have or had uteruses, for the purpose of describing symptoms particular to that anatomy.  However, many of these principles can be applied to any one, with any type of body and regardless of gender identity, gender expression, coercively assigned sex at birth, hormone therapy, or surgery (affirmation or otherwise). Other treatment principles are specific to people with prostates, and with a range of anatomies.

**This is a general description of abdominal anatomy.  Not everyone’s internal organs are arranged in this way, and not everyone has all of these organs.  The pictures similarly are meant to provide a suggestion and framework for understanding abdominal anatomy, and do not reflect a universal, correct, or “normal” abdomen since there is no such thing.