Deep Tissue at 26 Weeks

No prone lying. From roughly 20 weeks the gravid uterus can compress the inferior vena cava and aorta in supine/prone positions, reducing venous return and cardiac output - causing dizziness, nausea, hypotension and reduced placental perfusion. She is 26 weeks, so this applies.

Use instead:

• Left lateral (SIMS) position with a pillow under the abdomen to support the uterus, a pillow between the knees to keep hips neutral, and the lower arm forward. Left side is preferred because it avoids uterine pressure on the vena cava.
• Or semi-reclined at 30–45° with pillows under the knees, if she prefers to be more upright and the couch adjusts.
• Bolster the lumbar curve with a small towel; work the back in side-lying if she turns.

Also:

• Shorten the overall hands-on time - 60 minutes flat is long for a pregnant client. Build in a break and offer the toilet before and midway.
• She has not eaten since breakfast: hypotension risk on the couch. Offer water and a snack first, or reschedule if she feels light-headed.
• Switch the heated couch off - overheating and vasodilation aggravate faintness.

Modify:

• Abdomen: no massage.
• Deep pressure on the lumbar region: reduce from 'really hard' to firm but comfortable. Sustained heavy pressure is not inherently dangerous on the back, but she is deconditioned (no massage since conception) and the goal is relief, not bruising.
• Calves and popliteal fossa: no deep squeezing or kneading; light effleurage only. Avoid varicose veins entirely.
• Breast tissue: avoid.
• The 'headache' points she asked for - the web between thumb and forefinger and the medial ankle: apply only light pressure or omit. Evidence is weak, but these are traditionally avoided in pregnancy and there is no benefit worth arguing about with an anxious client.
• Keep the room cool and check in on her colour and comfort regularly.

The swelling: bilateral, mild, evening-dependent, new over two weeks, with no calf pain, warmth, redness or breathlessness - this is most consistent with normal physiological oedema, not an emergency. But it is new and progressing, so:

• Check both legs, compare sides, and ask about unilateral pain, sudden onset, chest symptoms.
• Refer: mention it to her midwife at the next appointment, and stop and send her for urgent medical assessment if any unilateral swelling, calf pain, warmth, redness or breathlessness appears at any point.
• Elevate the legs during the session; do not perform deep lymphatic work over the swollen area.

• Written consent for pregnancy massage, recording that the midwife has confirmed massage is acceptable (ideally a note or message on file).
• Record the modifications: side-lying/semi-reclined position used, abdomen avoided, pressure reduced, heated couch off, no deep calf work, no acupressure points worked.
• Record the oedema factually: onset, distribution, evening variation, absence of red flags, advice to raise with the midwife. Do not write a diagnosis.
• Aftercare advice: hydration, mobilise gently, expect possible post-massage tenderness, and report any calf pain, swelling of one leg, headache with visual disturbance, bleeding, or reduced fetal movement to her midwife or maternity unit immediately.
• Book shorter: 45 minutes from 30 weeks, and reassess each visit - position tolerance falls as pregnancy advances.
• If anything changes (pre-eclampsia-type symptoms, sudden swelling, raised BP noted elsewhere), decline treatment and refer. A therapist's job is not to diagnose but to spot the red flag and stop.