Is massage safe during pregnancy?

Short answer: yes, with conditions.

If you are past 13 weeks, your pregnancy is progressing normally, and nobody has told you it is high risk, massage is generally considered safe and I can treat you.

The longer answer is more interesting, because the rule everybody has heard — no massage in the first trimester — is a professional precaution rather than evidence that massage is dangerous. Almost nothing online says that plainly, so let me.

If you are reading this after a miscarriage

I want to deal with this first, because people do search this question afterwards looking for a reason.

Miscarriage is common. The Miscarriage Association puts it at around one in five pregnancies (opens in a new tab), and is direct about the cause: “Miscarriage is very unlikely to have been caused by anything you did or didn’t do.” Where a cause is identified it is often a genetic change meaning the pregnancy could not develop as it should. Frequently no cause is found at all.

That applies to massage as much as to anything else you did or did not do. Nothing on this page should be read as suggesting otherwise.

So why do therapists avoid the first trimester?

Two separate facts sit behind the rule, and it helps to take them one at a time.

There is no published clinical evidence that massage causes miscarriage. The largest systematic review of massage in pregnancy (opens in a new tab) found side effects that were minor and transient, and set out precautions by position and pressure rather than by trimester. One caveat worth stating plainly: the trials it reviewed started at 11 to 12 weeks, so the first trimester is under-studied rather than studied and found risky.

Separately, most miscarriages happen early. NHS patient information (opens in a new tab) puts it at around 80 in 100 occurring before 12 weeks.

Those two facts are not connected to each other, but together they explain the convention. Early pregnancy is when loss is most likely and when the most is changing in your body — so for your peace of mind as much as anything else, massage is best left until the first 13 weeks have passed. It is a precaution, not a warning.

What this means in practice: in your first 13 weeks I will need approval from your GP or midwife before treating you. That is not negotiable, and knowing the reason behind it does not change it. Not because I think you are fragile — because it is a short conversation at an appointment you are already attending, and it means neither of us is guessing.

What “high risk” actually means

Why some pregnancies are called high risk

It sounds like a verdict on you. It isn’t. It is a decision about who coordinates your care.

At your booking appointment your midwife works out whether your pregnancy is straightforward enough to be looked after by the community midwifery team, or whether an obstetrician should be involved too. If nothing is flagged, you stay under midwife-led care (opens in a new tab). If something is — an existing medical condition, something that happened in a previous pregnancy, expecting more than one baby, or a complication that develops along the way — you are referred to consultant-led care instead.

“High risk” is the shorthand for that second group. It does not mean something is going wrong. Plenty of consultant-led pregnancies are entirely uneventful; it means someone wanted another pair of eyes, which is the system working rather than failing.

For a massage therapist it matters for one practical reason. If a clinician has already decided your pregnancy needs closer watching, they are the right person to say whether hands-on treatment fits with everything else going on — not me, and not you having to guess.

The bit about being over 35

Here the training material gets it wrong, and it is worth saying so.

A definition still taught on pregnancy massage courses — the course I did included — counts maternal age over 35 as high risk in its own right. It comes from an American obstetric list of risk factors, where it sits alongside things like cardiac conditions and placental complications.

Taken literally, that would mean asking a very large share of women having babies in London to go and fetch a note for a pregnancy nobody has raised a single concern about. That is not care, it is paperwork, and it would tell you something alarming about yourself that your own midwife has not told you.

So I don’t apply it. Your age, by itself, is not the question. If being over 35 has actually led to extra monitoring, your midwife will have said so — and then it is the monitoring that matters, not the birthday.

What it means in practice

If a clinician has classified your pregnancy as high risk, or you are under consultant-led care, I will need approval from your GP or midwife before treating you.

You will know if this applies. It is not a judgement I make by looking at you or reading your intake form — it is a term your midwife or consultant will have used with you directly, and consultant appointments are hard to miss.

If you are genuinely unsure, ask at your next appointment. And either way, please mention it when you book rather than on the day, so nobody has a wasted journey.

What is actually different about the massage

Three things.

Position. You will not be face-down, and you will not be flat on your back. From around 22 weeks you will be side-lying, propped with pillows and bolsters under your head, bump and knees. This matters: lying flat on your back in later pregnancy lets the weight of the uterus press on the major blood vessels running behind it. NICE antenatal care guidance advises avoiding going to sleep on your back after 28 weeks (opens in a new tab) for related reasons. Side-lying from 22 weeks is deliberately more cautious than that.

If side-lying is uncomfortable — with reflux, sinus congestion, or pelvic girdle pain it often is — we can work seated instead.

Pressure. Lighter and slower than a sports massage. Your ligaments are more mobile during pregnancy, so joints move further than they usually would, and deep work is neither necessary nor sensible.

Expectations. Massage will not change why your back hurts. Your centre of gravity has shifted forward, the curve in your lower back has increased and your hips have widened to compensate. What massage can do is ease the muscular tension that builds up around all that, help with heavy legs, and give you an hour where nothing is asked of you.

One thing you have probably read that isn’t quite right

A great deal of pregnancy content claims that rising relaxin levels are what make late pregnancy ache. It is a tidy story and it is not well supported.

A 2025 prospective cohort study (opens in a new tab) measuring hormones across all three trimesters found that relaxin is actually highest in the first trimester and declines through the second and third — and found no significant association between relaxin levels and clinical pain. The authors concluded the changes were driven mostly by increased weight during pregnancy rather than by hormones.

Your joints really are more mobile, and that really does mean lighter work. But the aches in your third trimester are largely load and posture, not a hormone surge — which is part of why hands-on work helps at all.

When not to book, and when to ring your midwife instead

Please contact your midwife the same day, rather than booking a massage, if you have:

• Any unusual bleeding or discharge
• Severe or persistent headaches, visual disturbances, or sudden swelling of the hands and face
• Reduced or absent movement from your baby
• Abdominal pain or cramping you cannot explain
• Raised or unstable blood pressure

A massage is not the right response to any of those. Your midwife needs to know.

I also cannot treat you within seven days of an amniocentesis, a CVS (chorionic villus sampling) or a similar procedure.

After the birth

After a straightforward birth, wait until after your six-week check and until your midwife or GP has given you the all-clear.

After a caesarean, longer — I would suggest three to six months, and I will need approval from your GP or midwife. A caesarean is major abdominal surgery, and the layers underneath take considerably longer to heal than the scar on the surface suggests. The same applies if you had other complications.

Babies are welcome at appointments if there is nobody to leave them with. It is a home practice, not a clinic.

A note on what this page is

I am a sports massage therapist with a certificate in pregnancy and postnatal massage, not a midwife. The NHS is clear (opens in a new tab) that complementary therapies cannot replace conventional antenatal care, and that you should tell your midwife about any therapy you are using. Both of those are right. Keep going to your appointments, and mention that you are having massage.

If you have read this far and you are still unsure, the answer is to ask your midwife. It costs you one question at an appointment you are already going to.

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If you would like to know more about how the treatments work, what they cost, and how to book, there is a full page on pregnancy and postnatal massage.