Prenatal Massage Contraindications

Massage therapy during pregnancy has been shown to be beneficial for a number of common complaints such as fatigue, musculoskeletal pain, sciatica, edema, and many others. However, there are risks associated with specific conditions that may occur during pregnancy.

 

You must inform your massage therapist/practitioner if you have or have had in the past any of the following conditions or symptoms which may make massage therapy during pregnancy contraindicated or may require your therapist/practitioner to alter the massage.

 

History of miscarriage	Preeclampsia
Gestational Diabetes	History of any high-risk pregnancy
Cardiac, pulmonary, liver, or renal disorders	Drug exposure
Multiples	Hypertension
Pitting edema	Genetic abnormalities
Epilepsy or other convulsive disorders	Placental or cervical dysfunction
Fetal growth retardation	Bloody discharge
Abdominal pain	Leaking of amniotic fluid
Sudden weight gain	Diarrhea
Severe nausea or vomiting	Decrease in fetal movement over a 24-hour period
Sudden edema/swelling	Severe headaches
Fever

I,_________________, have read the aforementioned conditions and symptoms which make massage therapy during pregnancy contraindicated. The massage therapist/practitioner has discussed this information with me and provided an opportunity for any questions. I have disclosed all the high-risk factors of my pregnancy.

 

I have discussed with my prenatal healthcare provider/physician any health concerns that I had about receiving massage therapy. I agree that my healthcare provider/physician has given me clearance to receive massage therapy.

 

I understand the information contained on this form and confirm that (1) I am receiving medical care including regular check-ups with a licensed healthcare provider. (2) I have not experienced any of the listed symptoms, conditions, or complications. (3) I am not currently experiencing any of the listed symptoms, conditions, or complications. (4) I am experiencing a low-risk pregnancy.

 

 I understand that I will be receiving massage therapy as an adjunct form of healthcare only and that this therapy is not meant to replace appropriate medical care. I release the massage therapist/practitioner of all liability for any harm that may unintentionally occur during my treatment(s