Side-lying with cushion support is the standard pregnancy massage position from the second trimester onwards, giving the therapist good access to the back, hips, shoulders, legs and feet. Lying flat on your back is avoided for extended periods after around 20 weeks because the uterus can compress the inferior vena cava. Couches with a cut-out for the bump are not standard UK practice and carry their own concerns.

Key takeaways

Side-lying is the standard
Usually on your left, with cushions between the knees, supporting the bump and under the upper arm.
The cushions do the real work
Proper support means your spine stays neutral and you can genuinely relax. Poor support makes the session uncomfortable.
Flat on your back is avoided after 20 weeks
The uterus can compress the inferior vena cava, reducing blood return and causing dizziness or nausea.
Semi-reclined is used for the front
Propped at roughly 45 degrees for neck, shoulders, scalp and face, which is safe and comfortable.
Face down is not used once the bump develops
Regardless of what equipment is available.
Bump-hole couches are not standard UK practice
They can leave the abdomen unsupported and place strain on the lower back and ligaments.
Say if you are uncomfortable
Repositioning takes a minute and transforms the session. Dizziness or breathlessness means changing position immediately.

Side-lying: the standard position

From the second trimester onwards, side-lying is the accepted position for pregnancy massage in the UK. The left side is usually preferred, since it optimises blood flow through the vena cava, though the therapist will have you turn to work both sides.

The position gives excellent access to almost everything a therapist needs: the whole back, the shoulders and neck, the hips and glutes, the legs and the feet. In practice, very little is lost compared with a conventional massage, and the areas that are avoided in pregnancy, the abdomen and deep lower back, would not be worked anyway.

A typical session works one side thoroughly, then you turn over and the other side is worked. Turning takes a moment and the therapist will help.

Why the cushions matter

The cushions are not a comfort extra. They are what makes the position safe and sustainable.

  • Between the knees. Keeps the upper leg level with the hip. Without it, the leg drops forwards, the pelvis rotates and the lower back twists, creating exactly the strain you are trying to relieve.
  • Under the bump. Supports the weight of the uterus so it does not pull your spine into side flexion. Essential in the third trimester.
  • Under the head. Enough to keep the neck in line with the spine rather than dropping or craning.
  • Under the upper arm. Stops the shoulder rolling forwards and lets the upper back genuinely relax.
  • Behind the back. Some therapists add one for stability so you are not holding yourself in position.

Setting this up properly takes a minute or two at the start of a session. A therapist who spends that time is doing the job correctly, and it is worth speaking up if anything feels off, because the whole session depends on it.

Why lying flat is avoided

From around 20 weeks, extended periods lying flat on your back are avoided. The reason is mechanical: the uterus and its contents become heavy enough to compress the inferior vena cava, the large vein carrying blood from the lower body back to the heart.

When that happens, blood return to the heart falls, cardiac output drops, and you can experience dizziness, nausea, breathlessness, a racing heart or clamminess. It is known as supine hypotensive syndrome, and it resolves within a minute or two of turning onto your side.

Brief periods on your back are generally fine, and many therapists will work face up for a few minutes at a time with a wedge under the right hip to tilt you slightly left. Sustained periods are not.

This is also why sleeping on your side is advised in later pregnancy, and it is a good example of an adaptation that only a pregnancy-trained therapist will reliably make[1].

Semi-reclined and seated

For work on the neck, shoulders, upper chest, scalp and face, therapists commonly reposition you semi-reclined: propped up at roughly 45 degrees with cushions or an adjustable couch back. This is comfortable, entirely safe at any stage, and gives good access to the areas that side-lying makes awkward.

A seated position, straddling a chair with cushion support at the front, is sometimes used for the back and shoulders, particularly late in pregnancy or for shorter treatments. It is also the standard position for Indian head massage, which is a good option in the third trimester when lying down becomes tiresome.

Maternity reflexology uses a reclining chair and avoids the positioning question almost entirely, which is one of its practical advantages late on.

The bump-hole couch question

You may have seen couches or cushion systems with a cut-out allowing a pregnant woman to lie face down. They appear frequently in online images and are more common in the United States than here.

Most UK pregnancy-trained therapists avoid them, for two reasons. First, the abdomen hangs unsupported into the space, which can increase strain on the lower back and on the round ligaments, already stretched and loosened by relaxin. Second, the position becomes progressively less comfortable as pregnancy advances, and any benefit over side-lying is marginal since side-lying gives good back access anyway.

If a therapist proposes to have you face down in the second or third trimester, it is reasonable to ask why and to request side-lying instead. It is not evidence of poor practice in itself, but side-lying is the accepted UK standard and there is no reason to accept anything less comfortable.

Making it comfortable

  • Say if anything feels wrong. Repositioning takes a moment and transforms the session.
  • Ask for more cushions. There is no such thing as too many, and therapists expect the request.
  • Speak up immediately if you feel dizzy. Turning onto your left side resolves it quickly.
  • Empty your bladder beforehand. An hour is a long time in the third trimester.
  • Consider a shorter session. Forty-five minutes may suit better than 60 late on.
  • Get up slowly. Roll to your side, push up to sitting, sit for a moment, then stand with help.
  • Wear or bring something loose. Practical detail is in what to wear to a massage.

Every therapist listed on Massages Bristol is checked for relevant qualifications and public liability insurance before publication[2], and you book direct with no commission. Browse pregnancy massage in Bristol, read the full pregnancy massage guide, or search the directory.

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Frequently asked questions

Side-lying is standard from the second trimester, usually on your left side, with cushions between your knees, supporting the bump, and under your upper arm. This gives the therapist access to your back, hips, shoulders, legs and feet. For the neck, shoulders and scalp, you may be repositioned semi-reclined at roughly 45 degrees.
After around 20 weeks, the weight of the uterus can compress the inferior vena cava, the large vein returning blood from your lower body to your heart. This reduces cardiac output and can cause dizziness, nausea, breathlessness and a drop in blood pressure. Brief periods are usually fine; extended periods are avoided.
Not once the bump has developed. Even with equipment designed to accommodate it, lying face down leaves the abdomen unsupported and can place strain on the lower back and already-loosened ligaments. Side-lying provides equivalent access to the back and is considerably more comfortable.
They are not standard practice in the UK and most trained pregnancy therapists avoid them. The concern is that the abdomen hangs unsupported, which can increase strain on the lower back and the round ligaments, and the position becomes increasingly uncomfortable as pregnancy progresses. Side-lying is the accepted approach.
It keeps your upper leg level with your hip rather than dropping forwards, which prevents your pelvis rotating and your lower back twisting. Without it the position looks fine but creates sustained strain, and you cannot properly relax. It is one of the most important elements of the setup.
Tell the therapist immediately and they will help you change position, usually onto your left side, which relieves any pressure on the vena cava. Symptoms normally resolve within a minute or two. If they do not, or if you feel unwell in any other way, the session should stop and you should contact your midwife.

Further reading

References

  1. NHS. Pre-eclampsia. https://www.nhs.uk/conditions/pre-eclampsia/ (accessed 30 August 2026).
  2. Complementary and Natural Healthcare Council. CNHC accredited register. https://www.cnhc.org.uk/ (accessed 30 August 2026).

This article is researched by the Massages Bristol editorial team using NHS guidance, professional body standards and published research, and is checked against the practice of the qualified therapists listed in our Bristol directory. It is reviewed and updated when guidance or standard practice changes. It is general information, not medical advice: speak to your GP if you have a health condition that may affect treatment.