Supporting Pregnancy from the Very Beginning: The Case for First Trimester Massage

For many women, the first trimester is the most emotionally intense stage of pregnancy, and yet it’s often the time when they receive the least support. Many massage therapists, and  wellness providers hesitate to work with women early in pregnancy. Even many OB’s won’t see them before 8 or 9 weeks, and others decline to offer any hands-on support until the second trimester. But at our practice, we believe there’s real value in offering skilled, nurturing bodywork from the very beginning, and we encourage you to consider it for your practice too. 

Why Stress Support Matters Most Early On

The research tells us that stress decreases as pregnancy progresses. Which means, when it comes to stress management and nervous system support, the first trimester may be when massage is needed most. Early pregnancy often brings anxiety, uncertainty, hormonal changes, and emotional shifts. It’s the time when she is wrapping her mind and her heart around her changing reality and all the ways this new baby will change her life: logistically, financially, relationally. Offering a space where a woman can feel held, acknowledged, and grounded can make a tremendous difference.

Helping Her Body Before Patterns Get Compounded

Many women come into pregnancy with pre-existing tension patterns or structural issues: shoulder tension from desk work, chronic low back tightness, or old injuries that haven’t fully (or ever) been addressed. The first trimester is a window where we can gently attend to these issues before they become compounded by the physical changes of pregnancy. As the body changes, pre-pregnancy holding patterns can intensify, and addressing them early helps set the stage for more ease throughout the rest of the journey, and into postpartum as well. 

Sometimes, We’re the First to Say "Congratulations"

It’s not uncommon for our clients to tell us: "You’re the first person to treat this like it's real." And that’s because in many settings, especially medical ones, there’s a "wait and see" approach during the first few weeks. But to the woman who just found out she’s pregnant, this is already a huge shift. Her reality has changed. And while others may hold back, we meet her right where she is, offering safe touch, emotional presence, and acknowledgment of this early milestone.

Positioning for Emotional & Physical Safety in the First Trimester: 

Let’s talk about massage positioning, because it matters—not just for safety, but for emotional comfort too. (This information is for singleton pregnancies. If she’s carrying multiples, we treat her like she’s one trimester further along, and would position her using second-trimester guidelines.)

Prone (face-down) positioning can be fine for some women in the first trimester, if assessed properly. The key question we ask is: Does her pelvis (specifically the ASIS on both sides) catch her weight in prone, or does her belly already extend beyond the protection of those bony prominences? We ask this to determine if there is any chance her uterus is being compressed between the table underneath her and the pressure from your hands on top. If the bony structures of the pelvis support her, and there’s no tenderness or risk of uterine pressure, short sessions in prone may be appropriate. But it’s a case-by-case decision.

Supine (face-up) positioning is generally considered safe until 22 weeks. From weeks 13–22, we use a wedge under her right side to prevent compression of the vena cava and ensure optimal circulation. Some therapists like to use supine to do neck work, but the wedge under the client’s right side does create a slight asymmetry which some clients will find annoying. That’s where sidelying positioning offers safety AND comfort, and with practice, delicious neck work can also occur in this position. 

Sidelying positioning, however, is our go-to in the first trimester. Not only is it the most universally safe, it also provides a deep sense of emotional nourishment. There’s no worry of creating intrauterine pressure or putting pressure on sensitive breast tissue, and it facilitates communication, as some clients will need to speak in order to unburden themselves. We don’t start conversations, but rather follow the client’s lead here. Lastly, there’s something profoundly supportive about lying in the fetal position during early pregnancy. It not only mirrors the vulnerability and newness of this phase, but is also scientifically shown to be comforting to the nervous system. With proper bolstering (which many practices fail to do), sidelying allows the body to fully relax and the nervous system to downshift.

Adjusting Our Techniques for Nausea, Tenderness, and Safety

While first trimester massage can be incredibly beneficial, we do adjust our techniques:

• We exclude all abdominal work during this time
• We avoid rocking or rhythmic techniques that may worsen nausea
• We skip deep pressure over bony parts of the sacrum
• We focus on nervous system regulation and releasing chronic tension patterns from before pregnancy

It’s a time to go gently, and listen closely, not just to what she says, but to how her body responds.

What If There’s a Loss?

This is one of the reasons many practices avoid first trimester massage. Not because massages causes harm, it doesn’t, when done thoughtfully by a well-trained therapist, but because of the fear of being perceived as linked to a loss. And yes, the risk of miscarriage is highest in the first trimester. That’s just nature.

So we approach this with care. We make sure our clients understand that our touch is safe. We acknowledge their vulnerability. And if loss does happen, we offer bereavement massage as a way to continue honoring their journey.

At the end of the day, first trimester massage is about meeting women where they are, without fear or hesitation. It’s about creating space for their bodies to soften, their minds to settle, and their hearts to be witnessed, right from the very beginning.

I hope this is helpful. As one of the 5 authorized instructors of Carole Osborne’s Pre- and Perinatal Massage Workshop, I’d love to see more therapists supporting pregnancy from the very beginning. If you’d like to study with one of us, please check out the schedule of upcoming classes. We love nothing more than to see more skilled, confident, and compassionate therapists showing up for women in every season of life.