Pregnancy Risk Factors and Release

Physician Pregnancy Referral

Please review this information prior to scheduling your prenatal pregnancy massage

Pregnancy Massage — Prenatal Risk Factors

Pregnancy massage has a great many benefits for both mother and in utero baby. We are very careful to ensure that we perform our sessions with consideration for each of our client’s specific needs and situation. In order to ensure that we deliver the best massage and provide a safe and effective session, there are a few factors that need to be taken into account. Please review the following information regarding your particular pregnancy. If any of the factors listed below exist, we will need to obtain a release from your primary care physician who is supervising your pregnancy. We can modify your session based on your unique factors as long as we obtain a release. A release only applies if high risk factors exist. Typical pregnancies do not need a release.


Risk Factor List

Within first trimester of pregnancy

Alcohol or drug use

Younger than 17 or older than 35

Multiple pregnancy birth (twins, triplets…)

Three or more previous miscarriages

Baby has a genetic condition such as 

  • Down syndrome
  • Heart, lung, or kidney problem

Past pregnancy issues

  • Preterm labor
  • Preeclampsia or seizures (eclampsia)
  • Having a baby with a genetic condition

Presence of infection such as

  • HIV
  • Hepatitis C
  • Cytomegalovirus (CMV)
  • Chickenpox
  • Rubella
  • Toxoplasmosis
  • Syphilis

Taking medications such as

  • Lithium
  • Phenytoin (Dilantin)
  • Valproic acid (Depakene)
  • Carbamazepine (Tegretol)

Other health problems such as

  • Heart valve issues
  • Sickle cell disease
  • Asthma
  • Lupus
  • Rheumatoid arthritis
  • Spotting or vaginal bleeding

If any of the above listed factors exist, please see our Physician Release form (downloadable form below). We will need this form received at our office either when you arrive or prior to your session via fax or email.

Physician Permission for Pregnancy Massage

If any of the above risk factors apply to your pregnancy, you will need to obtain a release from your Physician. Any questions, please feel free to contact us.  

Physician Permission Form (pdf)