Prenatal Edema - by admin@mcb on August 02 2018

Prenatal Edema

Prenatal Edema

Prenatal edema is a common condition, especially during the third trimester. In moderate levels, prenatal edema it is not a contraindication for prenatal massage. Massage therapists should use a lighter than normal touch with all fluid movement toward the heart. Some essential oils have shown to be beneficial for edema. These include geranium, lemon, rosemary, and patchouli. Several drops of one or a blend of these oils can be used in massage lotion or oil for pregnant clients with edema.

Massage therapists should be cautious with prenatal edema due to the fact that edema can be a sign of more serious conditions. It should be reported to the primary care provider for monitoring.

Severe Edema

Severe prenatal edema can be a sign of pre-eclampsia. This is a condition that may cause the woman’s body to stop sending oxygen and nutrients to the fetus. It is estimated to affect 3 – 5% of all pregnancies in the United States (source: WebMD), and up to 14% of pregnancies with multiples fetuses. Symptoms include an unusual and rapid weight gain from excess water retention (edema), the presence of protein in the urine, and hypertension (high blood pressure).

Click here to watch a short video titled “Seven Symptoms Every Pregnant Woman Should Know”  This is something massage therapists performing prenatal massage should watch for their own knowledge, and might want to use as a resource for pregnant clients.

If left unchecked, pre-eclampsia can lead to eclampsia (also known as toxemia). This more severe form of pre-eclampsia is life threatening to both the mother and baby. Symptoms of eclampsia include severe water retention, abnormal headaches, relentless back pain, sickness to stomach and/or vomiting, visual disturbances. It can lead to convulsions and coma. At higher risk for eclampsia are women with poor diets and high levels of stress in their lives, as well as previous history of high blood pressure, kidney problems, and diabetes.
It should be obvious that massage at this point is contraindicated and medical attention should be summoned at once.

Prenatal Edema and Massage

To learn more about prenatal edema, and other conditions and contraindications for prenatal massage, Institute of Somatic Therapy offers a certification course in prenatal massage. Click here for more details on becoming certified in prenatal massage.   We also offer a course titled Pathology – Edema that covers the anatomy, symptoms, and causes of edema.

Institute of Somatic Therapy is approved by the NCBTMB as a continuing education approved provider. Our courses are valid for most states, as well as liability insurance continuing education requirements.

Positioning for Prenatal Massage - by admin@mcb on June 01 2018

Positioning for Prenatal Massage

There are two schools of thought on client positioning for prenatal massage therapy.

  1. Some therapists prefer to keep the woman in as close to fully prone and supine as possible to provide prenatal massage in the same positions as a standard massage. This is achieve with the use any number of specialty tables and support systems to achieve this purpose.
  2. Other therapists prefer to use a sidelying and modified supine position for performing massage therapy during pregnancy.

At the Institute of Somatic Therapy, we carefully considered positioning for prenatal massage. Our decision has been to teach in the  sidelying and modified supine (semi-reclining) positions. The routine we teach focuses on the back and legs while the pregnant woman is in a sidelying position, and the abdomen, arms, neck and face when she is in a modified supine position.

Why IST Prefers Sidelying Positioning for Prenatal Massage

Image from Istockphoto
Image from Istockphoto

There are several reasons why the Institute of Somatic Therapy prefers sidelying positioning for prenatal massage rather than the use of a support system that allows for a fully prone position.

Some of our reasons for preferring the side-lying position include the following:

1. Potential Strain to Uterine Ligaments: With some prenatal massage tables, it can be difficult to get a perfect, firm fit over the abdomen, so uterine ligament strain can be caused. While the woman may not notice it during the duration of the massage, she may have some discomfort afterwards.  Other systems do not provide good support for the legs, and others only allow for prone and don’t provide a way to modify the supine position to keep the weight of the uterus off the vena cava for the supine portion of the massage.

2. Ease for Client: As the pregnancy reaches the final trimester, it can be difficult for the client to get into and out of the prone position without assistance, and it can be difficult to assist an undressed client in and out of that position without compromising her privacy.

3. Cost Efficient: Most therapists already own a standard table, and can’t afford the expense of another table when it is not absolutely necessary. The cost of the sidelying and modified supine bolsters are often less than a specialty table.

4. Comfortable: A sidelying, fetal position is a very nurturing, comfortable position, one in which most people sleep, so it is very calming physically and psychologically.

5. Effective: A sidelying position places the client in a position which makes it very easy for the therapist to access her hip, IT band, piriformis, and sciatic nerve areas. These areas of the body are often in need of special focus to relieve the strain of the pregnancy. You cannot get the same access to these trouble spots in a prone position.

That being said, we realize this is a personal choice, and do not require our students to adopt this position if they have strong feelings about the prone positioning. Most of the techniques we teach are easily adapted into a prone position if that is what you and your client prefer.

Becoming Certified as a Prenatal Massage Therapist

To learn more about becoming certified as a prenatal massage therapist with Institute of Somatic Therapy, click here.

Institute of Somatic Therapy  is approved by the NCBTMB (Provider #280672-00) as a continuing education Approved Provider. Institute of Somatic Therapy is also approved by Florida (#MCE-326), and New York (#0019). Our courses are  valid for AMTA, ABMP, and most individual states.


What it Means to Be a Massage Doula - by admin@mcb on May 01 2018

What it Means to Be a Massage Doula

A doula has a special relationship with an expecting mother. Having a familiarity with massage can help make that bond even stronger. ©
A doula has a special relationship with an expecting mother. Having a familiarity with massage can help make that bond even stronger. ©

A massage doula is a certified massage therapist trained to provide support during the birthing process. The three-pronged definition of a doula is one who provides: 1) emotional support, 2) physical comfort, and 3) information. The doula is there specifically to meet the mother’s needs. A birthing women benefits from a doula by receiving focused care that  primary medical providers may be unable to provide.

Doulas have a unique opportunity to serve women during childbirth. Many times the mother depends on her doula more than the doctors and nurses in the room for support and advice. This is where a background in massage therapy is beneficial for doulas. As a massage therapist you understand the benefits of relaxation and can help a mother feel calm and focused during the birth. This is especially enhanced if you have been working with her by providing prenatal massage therapy for several months leading up to labor.

Becoming a Certified Massage Doula

Our team at the Institute of Somatic Therapy has developed a certified massage doula program. This online three-part course trains massage therapists to perform prenatal massage, doula labor support, and postpartum massage. The doula portion of the course teaches many topics. It focuses on how to provide physical comfort, explain the medical benefits of a doula, and. provide pre-labor and labor coaching. You will learn a variety of laboring positions and their purposes and benefits, and how to support your client through potential labor complications.

At the Institute of Somatic Therapy we also offer a variety of additional online massage therapy courses for all of your continuing education goals. Visit us online today to learn more.

Manitoba Massage Continuing Education Approval - by admin@mcb on April 19 2018

Manitoba Massage Continuing Education Approval

Massage Therapy Association of Manitoba Approval

Attention Manitoba massage therapists: The Institute of Somatic Therapy is pleased to announce that we have received another approval for our massage continuing education. Effective April 3, 2018, Institute of Somatic Therapy has several courses approved by the Massage Therapy Association of Manitoba (MTAM) for continuing education. The MTAM is a not-for-profit association of over 1150 professional massage therapists in Manitoba. We look forward to serving Manitoba massage therapists with their continuing education needs. We are committed to providing the best online home study continuing education courses available to massage therapists.

Manitoba Massage Continuing Education Requirements

Massage Therapy Association of Manitoba members are required to complete 24 continuing education credits in a 2 year cycle due every other August 31. CE credits needed are as follows:

  • 18 CECs from Primary/Core Competency activities, and
  • up to 6 CECs from Secondary/Complementary activities.

All CECs can be from Primary/Core Competency coursers. Approved online course work is acceptable.

Manitoba Massage CE Course Approvals

The MTAM has approved the following online courses offered by the Institute of Somatic Therapy through 4/3/2020. (Click each title to go to course information page.)

Prenatal Massage Fundamentals – 12 primary/core competency credits.
Prenatal Massage Techniques – 12 primary/core competency credits.
Infant Massage – 16 primary/core competency credits.
Massage Doula Support – 21 primary/core competency credits.

Institute of Somatic Therapy plans to seek Massage Therapy Association of Manitoba approval for more of our courses in the near future. If you are a Manitoba massage therapist and are interested in more of our courses, please contact us. Let us know which courses you would like us to submit for approval next.

(MTAM Disclaimer: The approval of these courses for continuing competency credits by the MTAM Education and Competency Committee does not represent an endorsement of the course or any products or services promoted within the course.)

Additional Canadian Massage Therapy Continuing Education

Several other Canadian associations currently accept Institute of Somatic Therapy courses for continuing education. Our courses meet the criteria for College of Massage Therapists of Ontario (CMTO) and Natural Health Practitioners of Canada (NHPC). We also have course approvals pending with the College of Massage Therapists of British Columbia.

Laws can and do change, and your associations will hold you responsible for knowing the laws that apply to you. Please note that we provide this information as a courtesy, but cannot guarantee its accuracy because laws are continually subject to change.

United States Massage CE Approvals

Institute of Somatic Therapy (Judith Koch) is approved by the NCBTMB (Provider #280672-00) as a continuing education Approved Provider. Institute of Somatic Therapy is approved by Florida (#MCE-326), and New York (#0019). Our courses are also valid for AMTA, ABMP, and most individual states. Some states limit how many hours can be done online or by home study. Please refer to our State Guidelines section for specific information about your state.


Prenatal Massage and HELLP Syndrome - by admin@mcb on February 13 2018

Prenatal Massage and HELLP Syndrome

Prenatal Massage and HELLP Syndrome

Prenatal massage therapists need to have an understanding of complications of pregnancy that could contraindicate massage in their clients. One of the most severe conditions that may affect pregnant women is called HELLP Syndrome.

HELLP syndrome is a serious, but rare, complication of pregnancy. Chances are if a prenatal massage client has HELLP, she is too sick to come for a massage, so it is very unlikely that a prenatal massage therapist is going to encounter it during a massage session. However, if you suspect that your prenatal client has any serious complication, do not perform massage, and if necessary, call 911 or secure other help for your client.

What is HELLP Syndrome?

HELLP syndrome is extremely rare, occurring in only 2 out of 1,000 pregnancies. Approximately 20% of women who develop preeclampsia or eclampsia go on to develop HELLP Syndrome. HELLP can develop during the pregnancy or after giving birth. It is named for the following blood and liver conditions:

H–Hemolysis, a condition where red blood cells rupture, leading to a reduction in oxygen delivery throughout the body.
EL–Elevated liver enzymes, which are indicative of a problem in the liver.
LP–Low platelet count, which interferes with the ability of blood clotting.

Symptoms include:

  • Visual disturbances (blurriness)
  • Lethargy/Tiredness
  • Rapid onset of edema/water weight gain
  • Headache
  • Nausea
  • Nosebleed, or other bleeding, that persists without quickly clotting
  • Seizures
  • Abdominal pain, most often on the upper right side

HELLP syndrome can become life threatening for both the mother and the baby, so it usually leads to an emergency induction or C-Section, even if the baby must be born prematurely.

Prenatal Massage Certification

Massage therapists who wish to become certified in prenatal massage can do so through the Institute of Somatic Therapy. We offer a variety of options, including prenatal massage certification, doula certification, infant massage certification, and fertility massage certification. To see these, as well as many other massage therapy online continuing education courses, visit

Institute of Somatic Therapy is approved by the NCBTMB as a conatinuing education approved provider, #280672-00. Our courses are valid for NCBTMB, AMTA, ABMP, and most states.

Antidepressants Lead to Autism - by admin@mcb on August 22 2017

Antidepressants Lead to Autism

Antidepressant Drugs in Pregnancy Lead to Autism

Recent studies show that the use of antidepressant drugs during pregnancy lead to a significant increase in autism in children. The April 2017 article in the Journal of the American Medical Association was titled “Association Between Serotonergic Antidepressant Use During Pregnancy and Autism Spectrum Disorder in Children.” The study analyzed 2,837 children of mothers who, during their pregnancy, took two or more consecutive prescriptions of the most common types of antidepressant drugs.

Those children were compared to women who did not take antidepressant drugs during their pregnancies. The article reported that children whose mothers took antidepressants had a 216% increase in autism (“4.51 per 1,000 person-years compared to 2.03 per 1,000 person-years”).

This study confirmed the results of previous studies which also found a similar 200% increase of autism in children whose mothers took antidepressant drugs during pregnancy.

Antidepressant Drugs No More Effective Than Placebos

What makes this all the more troublesome is that several studies have shown that antidepressant drugs are not statically significantly more effective than a placebo for patients experiencing mild to moderate depression. (Example:

By taking the drugs, patients are taking significant risks for a very small chance of benefit. There are far safer alternatives, including massage therapy.

Massage Therapy Alleviates Depression

Research has repeatedly proven that massage therapy for depressed pregnant women has a positive impact, by increasing levels of dopamine and serotonin, and decreasing levels of cortisol and norepinephrine. More importantly, massage therapy during pregnancy carries none of the risks that antidepressant drugs do.

Becoming a Certified Prenatal Massage Therapist

The Institute of Somatic Therapy offers online continuing education courses in prenatal massage, as well as doula training, infant massage, and fertility massage. Institute of Somatic Therapy is approved by the NCBTMB (National Certification Board for Therapeutic Massage and Bodywork) as a continuing education approved provider. Our courses are valid for AMTA, ABMP, and most states. Please refer to the state guidelines section of our website for specific information about your state.

Maternal Migraines, Colic Linked - by admin@mcb on May 20 2017

Maternal Migraines, Colic Linked

Maternal Migraines, Colic Linked

Women with a history of migraines have a 50% greater chance of having a baby with colic, a new survey found. Fathers with a history of migraines, however, had a statistically insignificant lower chance of having a baby with colic (29%) compared to father without a history of migraines (31%). The study, conducted in February and March 2017, studied 1010 participants. Colic was defined as the baby crying for at least 3 hours per day for at least 3 days during the prior week. Fussy crying times were most common between 4:00 p.m. and midnight, with the heaviest crying between 8:00 p.m. and midnight.

Parents rated babies with colic as having increased sensitivity to loud noises and strong smells —traits often associated with migraine. Infants with a history of colic are also more likely to experience migraines in their adolescent and adult years.

Lead author Amy Gelfand, MD, director of pediatric headache at the University of California, San Francisco (UCSF), spoke at the American Headache Society (AHS) 2017 Annual Meeting. She stated that these results should be of interest to obstetricians and pediatricians. “For obstetricians, it’s worth counseling pregnant women with a history of migraine that they are more likely to have a baby with colic — and to let them know that colic is a time-limited phenomenon that isn’t their fault. For primary-care pediatricians, if you’re seeing a colicky baby with a family history of migraine, keep it in the back of your mind that these children may be coming back with headache or migraine at the age of 7 or 8 years old.”

Help for Migraines, Colic

Techniques that the parents reported as having a calming effect to the colicky infants included feeding, gentle rocking, making shushing sounds, and adding white noise.

Because increased colic is linked to maternal migraine, anything to mitigate migraines in pregnant women and mothers may be helpful. Massage therapy, both during pregnancy and postpartum, should help. Infant massage techniques can also be helpful to calm a colicky baby.

Massage Continuing Education Courses

The Institute of Somatic Therapy offers courses in prenatal massage certification and infant massage certification. Institute of Somatic Therapy is approved by the NCBTMB as a continuing education approved provider. #280672-00. Our courses are valid for most states. Click for information on becoming a Certified Prenatal Massage Therapist and/or a Certified Infant Massage Therapist/Instructor. For both certifications, see our package discount here.

A Day in the Life of a Massage Doula - by admin@mcb on April 25 2017

A Day in the Life of a Massage Doula

Ring…Ring. Yawn. Shake off the sleep. Ring…Ring. “My phone! Mary (pseudonym) must be having her baby. Time to kick into action as a massage doula. What time is it?” 4:15 a.m. Good, I think, I’ve gotten most of a full night’s sleep. I jump out of bed, throw some cold water on my face, brush my teeth, put on the carefully laid out clothes that have been waiting for just this moment, and off to the hospital I go. Such starts my favorite kind of day as a massage doula.

Make no mistake, getting up at 4:15 is not high on my list of things to do, but there is something calming and quieting about the wee morning hours when I know within a few hours, I will be witnessing the miracle of birth.

My interest in prenatal massage began early in my massage career. I earned my initial massage certification in 1991, and in early 1993, I became certified as a prenatal massage therapist. I immediately dove in, started working on pregnant women, and started attending labors, although at that time, I had only learned four strategies in my labor support repertoire, one of which I quickly abandoned because everyone told me to stop because it hurt.

Within in a few years, I started hearing about doulas. I had no idea what they were doing that I was not, but I thought if I only learned one new thing, it would be worth it. I got certified with Doulas of North America, and also took advanced doula training from Penny Simkin. It was after this training that I coined the term “massage doula” to refer to a certified prenatal massage therapist who is also certified as a massage doula support person.

Armed with a wide range of new techniques, I assisted over eighty births before retiring my private practice a few years ago to focus on teaching and to take on the role of Director of Education with the Institute of Somatic Therapy. With all of those births, my moms averaged under five hours of labor, only two needed C-Sections, and the vast majority birthed entirely drug free. My star client had three babies, with the total labor time from all three births only 4.5 hours (2.5 hours the first baby, 1.5 hours the second, and only 30 minutes the third).

As a doula, I could share many stories, some funny, some harrowing. I know that I will treasure my doula years forever. Not having any children of my own, I feel lucky to have been able to have so many through the experiences with my clients. I have said many times how grateful I was to have been able to watch miracles happen for a living.

# # #

Judith Koch is the Director of Education at the Institute of Somatic Therapy, an online continuing education provider. To earn your massage doula certification, click here.

Aromatherapy During Pregnancy - by admin@mcb on January 18 2017

Aromatherapy During Pregnancy

Aromatherapy During Pregnancy

Massage therapists performing prenatal massage should use caution with essential oils, as many essential oils are considered contraindicated for pregnancy. As such, therapists should err on the side of caution in using essential oils with their pregnant clients.

Contraindications and Substitutes

When researching various oils, it is not uncommon to see some sources list a particular oil as contraindicated in pregnancy, while other sources consider that same oil safe for prenatal use. If there is any question, you should substitute known safe oils if possible. If there is no suitable substitute, use a very small amount. An alternative is to consider the use of a floral hydrosol. Hydrosols are the water byproduct of the essential oil extraction process. As such, a hydrosol will have a more gentle effect than the essential oil from the same plant.

Points to Keep in Mind When Using Aromatherapy During Pregnancy

Essential oils should be used only if the potential benefits outweigh the possible risks.

The use of aromatherapy should be omitted entirely if the pregnancy is high risk or any contraindications are present.

Your client’s heightened sense of smell and possibility of nausea are to be considered when using essential oils during pregnancy, especially in the first trimester. Allow your pregnant client to sniff the oil to make sure that she finds it pleasant before diffusing it into the room or using it on her body.

A single oil is preferable to a customized blend, especially if the massage therapist has not taken extensive aromatherapy training and learned how to properly blend oils based on both their note (intensity and duration of scent) and type (effects such as balancing or stimulating). An exception to this might be a formula pre-blended by the oil manufacturer.

In general, all oils used in pregnancy should be diluted by 50%. If you typically use 15 – 20 drops of oil per ounce of massage lotion, reduce that to 7 – 10 drops per ounce for your pregnant clients.

Continuing Education

The Institute of Somatic Therapy offers massage therapy continuing education (CE) courses on aromatherapy and prenatal massage, along with many other topics. Institute of Somatic Therapy is approved by the NCBTMB as a continuing education approved provider, #280672-00. Our course are also valid for Florida, Georgia, New York, and most states, as well as for AMTA and ABMP.

Prenatal Depression & Fetal Brain Development - by admin@mcb on November 30 2016

Prenatal Depression & Fetal Brain Development

An article published on this week shows a negative impact of prenatal depression and postnatal depression on children’s brain development.

Researching Prenatal Depression Impact

Research was conducted under the supervision of  Catherine Lebel, PhD, University of Calgary, Alberta, Canada. She found that both prenatal depression and postpartum depression is linked to adverse cerebral cortex development in their young children.

The study looked at the depression scale readings of 52 women during all three trimesters of pregnancy and again 3 months after giving birth. Their children were given an MRI between the ages of 2.5 to 5 years old. The study revealed two types of fetal brain anomalies. Cortical thickness in two areas of the right hemisphere of the brain, and structural patterns of the white brain matter, were negatively affected by maternal depression. It was noted that most of the women did not have major depression that would have resulted in a diagnosis of depression.

“These types of changes suggest to us that the children whose mums were more depressed have a more mature pattern of brain structure. Their gray matter was thinner, and we know that with age, gray matter becomes thinner. So it looks like the kids whose mums were more depressed have this premature pattern of brain structure, almost like their brains are developing too soon,” said Dr Lebel.
“There is a lot of focus on postpartum depression, but prenatal depression exists, and it is actually quite common, and we have shown here that it is actually associated with children’s brain structures.” Dr Lebel added.

Prenatal Depression and Neurodevelopment

A related editorial was written by Amalia Londono Tobon, MD at Yale Child Study Center, New Haven, CT. She stated that current neuroscience suggests that one of the most vulnerable times for a person’s mental health is while they are in their mother’s womb. “A range of critical neurodevelopmental processes are taking place during this time… Given the complexity of this process, it is no surprise that small perturbations can lead to significant long-term consequences.” she writes.

Prenatal Massage Benefits Prenatal Depression

This adds yet another reason why massage therapy during pregnancy is so important. In addition to expected benefits like relieving muscular and skeletal aches and pains, by easing prenatal depression it also can help reduce the chance of preterm labor and improve infant brain development.

Are you ready to see your massage practice have benefits that extend to the next generation? Become a Certified Prenatal Massage Therapist through the Institute of Somatic Therapy. Click here for details and to enroll.