Prospects of using RSL sculpting procedure to reduce anxiety and depression in pregnant women

Prevention of pre- and postnatal depression is of great importance due to its high prevalence and severe consequences both for the mother and the baby [1–5]. Approximately one fifth of pregnant women suffer from anxiety and/or depression [6–9]. Some of the factors that are considered to contribute to the development of anxiety and depression are the first pregnancy, unwanted pregnancy, higher anticipated risk of complications for the mother and her baby [10–12]. Mental disorders are treated with pharmacological intervention, however, some specialists are concerned about the lack of evidence of the safety of such medicinal products during pregnancy and about their possible teratogenic effects [13, 14]. Thus, there is a need to study and research supplementary methods of treating prenatal anxiety and depression.

Massage can become an alternative method for treating prenatal anxiety and prenatal depression, as well as an affordable method for preventing postnatal depression in some women without the risks associated with pharmacological intervention.

“Research on the efficacy of massage therapy for mental health continues to show great promise,” says Michaele Colizza, President of the American Massage Therapy Association (AMTA). “Actually, more and more customers choose massage as part of an integrated approach to their mental health care and wellbeing” [15].

There is a growing body of work that shows that manual and mechanical massage therapy is effective as a method of preventing postpartum complications and depression in pregnant women. According to the results of the Cochrane Systematic Review that included 11 studies with a total of 833 participants, relaxation methods can reduce stress and anxiety in mothers, reduce C-section frequency, and increase infant birth weight [16, 17]. A number of small-scale studies on the effect of massage on the condition of pregnant women with clinical depression was also conducted in North America. The women receiving massage therapy had fewer symptoms of depression and fewer postpartum complications. Although the sample of the study was small (n = 27), treatment fidelity was rather high. Almost all women completed the study and reported that they would recommend massage as a method of improving mental health of women during pregnancy [16, 17]. These studies reporting reduced anxiety, stress, and depression in pregnant women who receive massage therapy are in line with the other studies on the effect of massage on pregnant women. For example, one study has shown that women who received a series of 20-minute prenatal massage treatments demonstrated significant reduction in indicators of depression and anxiety compared to women who received standard care [16, 17]. Thus, all these studies prove that massage is a suitable and effective method to reduce prenatal symptoms of anxiety, depression, and stress.

It is worth noting that manual massage is significantly less effective than mechanical massage techniques as it cannot guarantee an even and deep pressure and has a demerit related to the "human factor" as people can get tired. The RSL sculpting procedure performed with the Beautylizer device is one of the most advanced, effective, and safe mechanical massage procedures that can be indicated to pregnant women for prevention of postpartum complications and depression. The procedure combines effects of vibrocompression with spheres and of 650 nm red light (LED therapy) [18]. Due to several physical factors that were proved to be effective, processes that have a beneficial effect on skin, subcutaneous fat, and muscles are launched in the tissues [19]. Advantages of the procedure include its physiological nature, good compatibility with other therapeutic agents, and possibility of using the physical factors in various therapeutic regimens, its painlessness, and lack of toxicity and allergic reactions.

The procedure can significantly reduce stress on both psychological and physiological levels by stimulating the parasympathetic nervous system, which is the main mechanism of body relaxation [20]. In addition, various studies have shown the effect of massage techniques on the levels of the stress hormones cortisol and norepinephrine in pregnant women. T. Field et al. have shown in their study that the level of noradrenaline in urine of pregnant women who regularly received massage had significantly decreased compared to the control group [21]. Another research studied the effects of repeated massage, relaxation therapy, or regular treatment on 84 pregnant female participants with depression. The results have demonstrated that women who received repeated massage treatment reported lower anxiety and less depressed mood by the end of the study compared to women in other groups [22].

One of the important merits of the procedure is the fact that it demonstrates an antidepressant effect faster than when treating depression with medications (antidepressants, neuroleptics). Antidepressants and neuroleptics usually begin to work in 1–3 weeks, and the maximum effect does not occur until after 4–8 weeks.

RSL sculpting can also be successfully used in pregnant women for:

• Eliminating pain and swelling in the lower limbs;
• Preventing calf cramps;
• Preventing stretch marks (striae) in the abdominal and thigh area.

Thus, the RSL sculpting procedure, as a relaxation method, can become an affordable and effective way of improving not only mental but also somatic health during pregnancy, as well as a method of preventing postpartum complications and depression. It should be taken into account that there are nuances in different gestational periods that need to be considered when planning procedures.

Most doctors do not recommend performing the procedure in the first trimester (1st–3rd month of pregnancy), as during this period, all systems and organs begin to work in a completely different mode. This period is statistically marked by a higher risk of spontaneous abortion, especially before 12 weeks. The autonomic nervous system is also undergoing changes. The shift toward parasympathetic responses explains some of the symptoms of early gestosis, such as morning nausea, vomiting, and dizziness. Excitability and functional activity of the nervous reflex connections are changing, so any intervention “in the wrong place and with the wrong force” can cause adverse consequences [23–26].

The following are the taboo zones for the procedure in the first trimester:

• Lumbosacral area;
• Buttocks area;
• Inner thigh area;
• Tailbone;
• Heel cord;
• Heel and base of the thumb.

During the second trimester (4th–7th month of pregnancy), weight gain puts additional strain on the back and leg muscles. As breasts and belly grow bigger, the center of gravity of the body shifts, leading to increased lordosis (lumbar curvature of the spine), which in turn causes muscle tension in the cervical collar and the thoracic region, headaches, and stress even in a normal pregnancy. Due to the increase in body weight, the load on the feet increases (foot pain appears), and the increase in fetal weight and volume of circulating blood leads to the appearance of pastosity and swelling of the feet and lower legs, and leg cramps [23–27].

All the changes in the body and sensations of a pregnant woman are due to a powerful change in the endocrine profile of the body. The pregnancy hormone progesterone ensures the normal course of pregnancy, but it also contributes to fluid retention in the body, which can cause a tendency toward swelling. Progesterone causes relaxation of smooth muscles of internal organs and vessel walls. This leads to the inclusion of superficial and deep arterio-venous anastomoses into the blood circulation to ensure adequate blood supply and delivery of oxygen and all necessary substances to the growing fetus. The load on the vascular bed can cause an increase in blood pressure, headache, and bruises may appear more easily. During this period, deep modalities are excluded, and special attention is paid to lymphatic drainage techniques [23–27].

In the third trimester (7th–9th months of pregnancy), general weakness, rapidly developing fatigue, back pain, neck pain, and other symptoms described above appear for the first time or continue to bother. The hormone relaxin, which acts on ligaments and joints, makes them softer, pliable, and flexible, starts to be produced. At the same time, pain in the sacroiliac joints, tailbone, and pubic symphysis may bother. Legs require special attention during this period. Women often experience heavy legs, swelling, cramps in the calf and foot muscles. Less often, vascular spiders and varicose veins of lower extremities develop. These symptoms are caused by increasing body weight (during pregnancy, average weight gain is 11–16 kg), a shift in the center of gravity, manifestations of venous insufficiency in the legs, and hypocalcemia. In addition, the venous return from the inferior vena cava decreases due to the intensively increasing growth of the uterus and fetus. Women may experience pain in the feet caused by increased weight and a shift of the center of balance from the center of the arch of the foot towards the base of the toes, which, together with the malleability of the ligaments, can lead to deformation of the foot. Therefore, at this stage, a relaxing foot massage is indicated, provided the uncomplicated course of pregnancy; it is especially worth paying attention to the presence of hypertonia [23–27].

During pregnancy, the procedure may be performed as a general or local massage. Anti-cellulite massage is not recommended for pregnant women due to the high intensity of treatment.

In the case of normal pregnancy, it is possible to perform the procedure as a general treatment with a frequency of about 2 times per week and a gradual increase in duration to 40–60 minutes. A local exposure involves treatment in the cervical collar area, in the extremities, especially the lower ones. Such 15–20-minute treatments can be performed every other day or even daily. The onset of signs of early and late pregnancy toxicosis is the basis for the inclusion of methods of specific exposure. The course of treatment includes 5–10 procedures.

RSL sculpting procedure is performed while a patient lies on the side, the lower leg is straight, and the upper leg is bent at the knee. A special bolster is placed under it to make the position as comfortable as possible and cause relaxation of all of the muscle groups. The position on the back after 24 weeks of pregnancy poses a threat of inferior vena cava syndrome, when the uterus squeezes the inferior vena cava, which leads to worsening of blood supply to the brain and may even cause loss of consciousness in a pregnant woman. If there is soreness in the projection of the mammary glands, it is advisable to put a bolster or small pillows under the subclavian areas. Sometimes another pillow is required under the stomach for more relaxation. The lower hand is bent at the elbow and placed under the head or lies next to it, and the other hand is freely positioned in front of the mammary glands in a comfortable position.

It is prohibited to perform the procedure in the stomach and lumbosacral areas as it can cause an increase in uterine tone and provoke the threat of termination of pregnancy or premature birth. The procedure is not performed in the area of the inner surface of the lower legs and thighs as they are highly sensitive. The procedure is also not performed in the areas of feet and palms as there are a lot of biologically active points and reflexogenic zones.

It is prohibited to use oils with warming or cooling effects (containing camphor, mint, citrus fruits, pepper extracts) to perform the procedure in pregnant women. It is possible to use olive, peach oil containing extracts of horsetail, ivy, and pine needles. There are also special lines of oils for pregnant women. But it is best to use neutral oils for the procedure.

The importance and relevance of the integral approach to diagnostics, prevention, and treatment of psychoemotional disorders in women during the perinatal period determine the aims for the development of an interdisciplinary algorithm for the cooperation of obstetricians and gynecologists, perinatal psychologists, and physiatrists. As traditional treatment of depression in pregnant women is sometimes unsatisfactory, not immediately available, or not applicable due to contraindications to the use of specialized medications, RSL sculpting may become a perfect non-drug alternative. To implement the application of this procedure in obstetrics, closer cooperation between the above-mentioned healthcare specialties and training of those specialists who will perform this procedure is required.