By Karrie Mowen, Editor
photos by Susan Goddard

Pregnancy - It's a frightening, albeit exciting time, even more so for first-time moms. Will the baby be healthy? Will I be a good mother? Can I make it through labor without drugs? The questions are endless. Add to that the pressures a working mom faces with the other questions: Will I return to work?
When? How will I manage the priorities of motherhood and work? While no one can answer these questions for the expectant mother, listening to those who've gone before can prove invaluable. That's even more true for the pregnant massage therapist whose professional demands are highly unique. What follows are two women's accounts of the pregnancy journey and the medical advice of Dr. John Larsen. We hope their input helps as you begin to answer your own journey's questions.

One of the first steps to integrating your pregnancy with your practice is to heighten screening procedures. You already do a comprehensive intake for new clients, but there is more at risk now and more things you need to know about your clients.

While a cold or flu is something you don't want to be exposed to during this time, these are not the things Dr. John Larsen, Ob/Gyn Department Chair at George Washington University (Washington, D.C.) would inquire about first. Tuberculosis, however, sits high on his list.
"It's a reasonable thing to ask someone flat out," he said. "Ask, 'Do you have any contagious diseases of which you are aware?' Then be specific: 'Do you have TB or associate with someone who does?' If they have been around someone with TB, then you must ask, 'Have you ever been tested?'" Larsen said TB is likely not prevalent on a massage therapist's standard intake form, so it's important to add it now.

Hepatitis is another condition Larsen said to take very seriously. "Ask, 'Have you had a contagious disease?' Then, 'Have you had hepatitis or yellow eyes, or been in close association with someone with yellow eyes?'" Larsen recommends all MTs get the Hepatitis B shot, and redouble the emphasis of this when they are thinking of becoming pregnant.

Pregnant therapists also need to carefully screen for chickenpox, Larsen warns. Even if the client doesn't have chickenpox themselves, the disease spreads from skin shedding off the lesions. A mother caring for her sick child at home can certainly be carrying the disease. "You don't want someone like that in your place of business," he said. "It can come in on their clothing. That's why doctors routinely try to keep chickenpox patients at home."

Chickenpox can lead to pneumonia for the mother and, if it's transmitted to the unborn child during certain developmental stages, the fetus is at risk of deformities or even death. "There's no fooling around about this," Larsen said. He advises receiving the chickenpox vaccine if you have even the slightest inkling of getting pregnant. "If you had it as a child, you are immune. There is a miniscule, but not zero, chance of getting it twice. If you've never had chickenpox, go get the vaccine."

While more common ailments like the cold and flu aren't first on Larsen's screening list, they shouldn't be forgotten. "I don't think a respiratory illness like a cold would be more alarming to a massage therapist than to anyone else who works with fairly close patient contact. The general feeling is you go out into the world and are exposed to viruses; that's part of the burden of being alive. It is alright, however, for someone who is particularly susceptible to have a flu shot when she's pregnant. It's something a hands-on therapist might think about."

Outside of figuring out how to adjust your own body mechanics and learning how to maneuver around your pregnant belly, Larsen said some other areas to consider during this time include knowing what topicals or hormonal medications your clients might be using. Things like Minoxidil can be very dangerous for the pregnant therapist who incorporates any form of scalp massage into her routine. Potent hormonal creams can be just as dangerous, Larsen said. "You have to use your judgement, but the caution would certainly be that if there was any rational, reasonable chance there is a residue there, don't work on this client."
Throughout this time in a therapist's life, Larsen said to take heed of Hippocrates and the wise words he bestowed: "First, do no harm..." If that means turning clients away, so be it.

• DAYNA KLEIN
Starting Over
by Danya Klein
In April 1999, my husband Jim and I found out I was pregnant with my first child. In nine months I learned a lot about myself, as well as discovering a new dimension to managing my massage business. I would like to share those insights with you with the thought that should you too find yourself expecting a baby, they may be helpful.
First, a bit of history. I have been a massage therapist since 1993. In 1994, I conceived, then miscarried eight weeks later. Subsequent health changes ensued and sometime later I was diagnosed with Graves Disease, a disease of the thyroid gland resulting in a hyperactive metabolism and imbalanced hormones, making it difficult, if not impossible, to conceive.

Being a firm believer in natural medicine, I sought out an acupuncturist, along with several endocrinologists, who all had different advice regarding my treatment. All I wanted was to get pregnant as soon as possible. My options were medication which controlled the thyroid's output of thyroxin, (too much thyroxin taxes the heart), radioactive iodine or surgical removal of the thyroid gland with lifelong supplementation of synthetic thyroxin. I was put on the medication while deciding my options. I did not like the feeling of having the drugs course through me. The radiation option had three strong negatives: you could not try to get pregnant for up to 18 months, the thyroid could act up again, and I did not like the idea of putting radioactive anything in my body. And even though I am sure we all get a good dose of radiation from many sources, including the sun, I did not wish to voluntarily contribute to it. The third option didn't seem so appealing either - cutting my throat. Yet, when weighed with the other options, the latter was the choice I elected.

I had the operation and things went much smoother than I thought. However, it did take another year for my body to regulate and receive the correct amount of synthroid (synthetic thyroxin). As soon as it was regulated, my husband moved out to Denver to start a new job, and I soon followed after selling our home. After a year in Denver, I found out I was expecting. Today we have a little boy who is such an incredible gift - healthy, laughing and smiling. He was worth the wait.

Making Changes
After selling a successful practice in New Jersey, I started all over again in a little town west of Denver. My clientele grew fairly quickly as I enjoyed working part time in an upscale day spa and out of my home office. Becoming pregnant at age 36, or at any age for that matter, represents some changes in lifestyle. I was thrilled to be expecting, but at the same time, petrified. How was I going to fit a baby into my lifestyle? I was going to be a mom, but how much of myself and my business would be left intact. It was a scary thought. Being both driven and business-minded, I thought, "How will I juggle all of this?" A stranger offered this bit of wisdom that I held on to: "That is why it takes nine months to create a baby - to have the baby grow and develop, yes, but more importantly, to have mom move into the place she needs to be emotionally when the baby arrives." How true. Any moments of panic I experienced those first few weeks quickly dissolved and were replaced with feelings of hope, joy and sheer delight. And yes, the occasional cry of "help."

The First Trimester
Ah, those first three months. Luckily for me, I experienced no morning sickness, so my morning routine remained intact - up and out to the gym, (of course, I monitored my exercises accordingly). Unfortunately, I had afternoon/evening malaise that hung like a lead balloon in my belly and usually presented itself when I was working on my clients. This lovely feeling was usually accompanied with extreme afternoon fatigue. So what's a pregnant woman to do? Examine her workload. I left the day spa because the pace of doing one massage right after the other was too taxing. It turns out I was still quite busy at my home office, but at least I was able to book clients with enough time for rest and a snack in between. I had to remain positive that I would replace my income from the spa with clients at home, and that visualization became true.

I was never one to take naps before, but now it was simply a necessity. My body was no longer just for me, it was home to this miracle inside me and it was working hard at its creation. The fatigue factor was extremely high those first few months, but a 30-minute "power nap" worked wonders. I could usually tell myself to wake up at a specific time and amazingly I would. There were still exceptions. One time I woke up to a knock on the door; my client had arrived and I had overslept. I felt so groggy as I stumbled around getting her to the table. It was a trite bit embarrassing, but she too was pregnant and was very understanding. I was off the hook with that one. Another time I was just so nauseous that I had to re-schedule an appointment. I am glad I only had to do this once, because even though people are happy for you when you tell them your "news," they still want a massage and you have a business to run. Cancel too many times and you're out of business. That's a fact of life.

Round Two
For most pregnant women, myself included, once you get over that first trimester, life generally returns to normal. Sometimes you even have more energy than ever. Fortunately this was the case for me. As we all know, it is so important to have your energy when you are a massage therapist. I strongly believe that fitness plays an enormous role in our capabilities to give our best massage. We must nourish our bodies with proper nutrition and practice some form of exercise and breath work on a regular basis. I also believe in "mens sana en corpore sano" - strong mind in a strong body. Approaching pregnancy from this viewpoint afforded me a pain-free pregnancy and the ability to work up until two weeks before I gave birth. I practiced my yoga and breath work along with hikes, some weight lifting and cardio work.

With a client on the table I had to watch that my big belly did not bump into them. I modified my positions just slightly, bending more in the knees, or working off to the side a bit more. Breathing deeply became increasingly important to my work and helped to keep me energized and focused. One of the wonderful things about massage is that I too would relax and my baby would benefit from this state of calmness. As a certified LaStone massage therapist, I found the hot stones to be extremely meditative. If I had a busy day, I would take a stretching break between clients. Lying on the floor with my feet against the wall, knees bent, calves perpendicular to the floor, I could curl my sacrum up and down and get a terrific, invigorating stretch.
As my pregnancy progressed, some of my clients assumed I had stopped working so I sent out postcards offering a discount if they booked by a certain date. It worked. When you are self-employed and having a baby, you need to work as much as you can to cover your "maternity leave." However, I truly felt as if I was giving superior massage work all throughout my pregnancy - as if my baby was sharing that vital life energy with me.

The Real Fun Begins
My delivery went smoothly, a consequence of my yoga practice. I delivered an 8-pound baby boy 1 1/2 hours after arriving at the hospital and did so without drugs. Now the fun really began. After a few months of baby bonding, it was time to get back to work. As a member of a neighborhood mom's group, I do babysitting swaps weekly and have a few sitters to fill in at other times. I have been able to get back to work, but I still need to find the time to send out that newsletter and offer a discount to get back some of my old clients and find new ones. Yet, as I visualized success before, I know it will be perseverance, faith and a matter of time that will bring my practice back to where I would like to see it. It's no different than visualizing that baby coming into our lives five years ago.

So, if you're thinking that a baby in your life might change the way you do business, you are right. Personally, I believe the rewards of having (or adopting) a baby are much greater. While you are pregnant, I would suggest you stay as active as you can (sensibly, of course), and definitely do yoga or some form of stretching (although you need to know your limits). If you know other women in a similar situation, set up some babysitting trades and make a list of people you know who are willing to babysit. Keep your clients informed of the date you will stop working, either verbally or with a newsletter or a postcard. Get your rest and slow your workload down if you have to, especially in the beginning. You will feel better. Eat well and breathe. Once you have your baby, call your clients personally to tell them your good news and invite them back when you are ready.

My breath work and yoga were the most important things I did for myself during pregnancy. Rising early for my yoga I would see the December sunrise crystallize on the fallen snow, while the elk lumbered slowly by in the morning cold. I would practice for an hour by the fire. It was such a beautiful time for me. I had come full circle from those frantic thoughts of "How am I going to do this?" to "Hi baby, I can't wait to meet you." Now, as my baby is 6 months old, I feel like it is all coming together, albeit some days more slowly than others.
Now I look back at how hard I had worked before and compare it to how hard I laugh now, and I realize that I have been given the opportunity to appreciate a daily joy so great - one more little golden nugget of life. I am so thankful. Believe in yourself and trust life to be good.

• LINDA STEINFELDT
FIG NEWTONS & MASSAGE: What OneMother-To-Be Has Learned
by Karrie Mowen
Six months ago, Linda Steinfeldt was filled with questions. After learning she was pregnant, this 44-year-old massage therapist wanted to make sure her work wouldn't comprise the health of her or her unborn baby. "Do I need to be concerned about topicals my clients use, like Minoxidril?" "How careful should I be about seeing clients who presented with anything unusual - sniffles, rashes, anything?" "Could I injure my fingers and wrist doing bodywork as my connective tissue expands during pregnancy?" The list went on and on.

Today, 2 1/2 months away from meeting her first, and "probably only" child, Steinfeldt has come full circle. "I found that I drove myself nuts, worrying about every little thing," Steinfeldt said worrying about things like the unknown possibility of chickenpox being transmitted to her developing baby via a client's shirt eventually became taxing. "Just do the best you can do, without becoming cavalier. Use common sense without overanalyizing. It's too easy to worry about every little thing."

What Steinfeldt did end up worrying about was her business, Discover Therapeutic Massage in Doylestown, Penn. Her plan was to find someone to take over the business, keep her clientele happy and do all the hands-on work until Steinfeldt's return. "I was planning on stopping (massage) at six months, but I had trouble finding people to replace me." So while she looked for someone she could trust with her business and clients, and dealt with all the unknowns of pregnancy, Steinfeldt continued on with her full massage schedule until 6 1/2 months and stopped altogether at seven months.
Luckily, she eventually found the right person to take over; someone willing to train to do massage the way Steinfeldt did. Acting as a contractor, this new recruit walked into a ready-made client base and is payed on a graduated scale, dependent on how many massages she performs. Steinfeldt still mans the business phone from home, keeping abreast of bookings and keeping in touch with new and old clients.

Once her baby is born, Steinfeldt plans to return to massage after four months. Instead of taking over the work at 100%, she will likely only work part time. Staying home with baby will remain her priority.
Steinfeldt knew she didn't need "all" the answers about the pregnancy, but she followed her instinct and remained cautious. With screening, she found once she put the word out about the pregnancy, clients screened themselves. "The clients were more responsible and considerate; not wanting to take the risk. They were hypervigilant for me and they saved me the delicate situation of asking them to cancel if something was wrong."

Clients were also very understanding of their massage therapist's personal needs. "I was so lucky; I had no morning sickness. But I did get nauseous if I got tired or hungry." She took care of the hunger problem by keeping crackers and fig newtons around. "They were easy to pop in my mouth." As for being tired, Steinfeldt found people were really forgiving. "They would say, 'are you up to this?' It was great to know they were okay if I was extra tired. Knowing that actually gave me the strength to do it."

Clients were also forgiving when they would find Steinfeldt asleep on her massage table. "During the first trimester, there was no way around cat naps," she said. "At 2:30 in the afternoon, I had to sleep. In the beginning I didn't realize what was happening. I continued to work those hours, and I would be ready to fall asleep during the massage." Eventually, Steinfeldt gave herself permission to nap, and even scheduled time for it.

Other work-related changes brought on by the pregnancy included a heightened sense of smell, and a sensation of "squishing" her baby. "It was hard to bend forward. I'm having a boy, and he's real low. When I would sit and lean forward to work on a client, it was hard to get comfortable. I felt like I was squishing him."
Her advice for other bodyworkers entering this journey is practical. "Make a plan early on, based on how you think the pregnancy will go for you. Mine was to quit working after six months. Make a plan and then listen to your body. Your body and your baby are much more important than the business. Start looking for replacements early if you have your own business. I placed an (employment) ad in January. I found someone finally in April. It can take a long time."

Another tip Steinfeldt offered kept her feeling of obligation to a minimum when backing off the business. "If you offer gift certificates, try to make them all expire before you quit working."
On a personal note, Steinfeldt has been receiving massage which she said has been very helpful. This will help if, or rather when, a pregnant therapist's body mechanics change. "As your belly gets heavier, your center of gravity shifts. You compensate to protect the baby," she said. The hip pain a pregnant massage therapist may experience, like Steinfeldt, might be more a result of bad body mechanics than a result of the pregnancy itself. "Therapists really need to be careful of body mechanics."

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