Thirty-eight weeks, a bad hip, and a pile of cushions

She opened the door sideways. Not on purpose, I don't think. She had a hand in the small of her back and she was leading with one shoulder, and she said, before hello: I haven't slept properly in two weeks.

Thirty-eight weeks. Second baby. The hip on the right had gone, in the way hips do at the end, and she was doing the thing where you sleep for ninety minutes, wake up because the hip is burning, turn over, and start again.

Why I don't use a table with a hole in it

The first question every pregnant client asks is whether I've the table with the cut-out, so she can lie on her front.

I don't, and I wouldn't use one.

The bump is held by ligaments running down from either side of the uterus. Let it hang through a hole and the whole weight of it pulls on those ligaments, which is uncomfortable at best. Worse, to keep the bump in the hole your lower back has to arch, and the lower back is usually the thing that hurts in the first place.

The other thing I won't do is lay you flat on your back for any length of time. As the bump gets heavier it can press on the vena cava, the big vein bringing blood back up to your heart, and some women feel that as lightheadedness or nausea. Some don't feel it at all.

Worth separating two things here, because they get muddled. Being on your back for a few minutes at a check-up isn't the same as spending a night there. The guidance you'll have been given by your midwife, and the research behind it, is about the position you go to sleep in from 28 weeks: Tommy's advise going to sleep on your side in the third trimester, for naps as well as at night, because going to sleep on your back is associated with a higher risk of stillbirth. Either side is fine, and if you wake up on your back you just settle back onto your side.

My rule is simpler than any of that, because an hour is a long time to hold a position. Side lying. Every time.

The cushions are the treatment

For anybody else, setting up takes five minutes. For a pregnancy massage it can take fifteen, and that time isn't wasted, it's the whole thing.

Four cushions, usually. One under the head so the neck stays in line with the spine. One under the bump so it's carried instead of dragging the top hip forward. One between the knees so the top leg doesn't roll across and twist the pelvis. One behind the back so you can lean into something and stop holding yourself up.

That last one is the one people underestimate. Most women at thirty-eight weeks are bracing constantly without noticing. Give them something solid to lean back against and you can watch the shoulders drop two inches.

I bring my own cushions. You don't need to have a pile ready and you don't need to tidy up first.

What I actually worked on

Not the bump. I don't massage the abdomen and I don't go near it beyond resting a hand there if she wants me to.

The glutes and the hip. This is where the money is. The pelvis has been loosening for months under a hormone called relaxin, the joints move more than they used to, and the muscles around them work overtime to compensate. On her right side, gluteus medius was rock hard and tender.

The lower back. Steady and broad, not deep. A pregnant lower back doesn't want an elbow in it.

The ribs on the top side. Nobody expects this one. In the third trimester the baby pushes everything upward, the ribs flare, and the muscles between them get stiff. Working there's often what makes people say they can breathe properly for the first time in weeks.

The feet. Gently, and briefly. I keep pressure light on the lower legs because swelling is common late on and firm work on a swollen calf isn't something to do casually.

Halfway through, she cried

That happens more often than you'd think, in pregnancy massage more than anywhere else, and it isn't sadness. It's what happens when somebody who has been holding everything together for eight months gets an hour where nobody wants anything from her.

I keep going, I don't make it a thing, and I leave the tissues where she can reach them.

Sophie is a fabulous masseuse and I'm convinced she has healing hands. I love that she comes to me with her massage bed, it's so nice to be able to fully relax after your massage instead of having to get in a car and drive home.

Lyn French, on Facebook

For a pregnant client that last bit isn't a nice-to-have. Getting up off a table at thirty-eight weeks, getting dressed, getting into a car and driving home undoes a good half of what just happened.

What she told me a week later

She slept five hours straight that night. Not fixed, she was still pregnant and the hip still complained, but five hours instead of ninety minutes at a time.

I don't think an hour of massage cured anything. I think an hour of massage gave a very tired body permission to switch off, and the hip work bought her a few nights of it.

The list of things that mean no

I'll ask all of this before I come, and I'd rather you tell me and be wrong than not mention it.

• Pre-eclampsia, or blood pressure your team is watching
• Any bleeding, at any stage
• Severe or sudden swelling, especially in the hands and face
• A history of blood clots or DVT
• Reduced movements, ever, on the day
• Anything at all your midwife or consultant has flagged

If you're unsure, ask your midwife, and I'll wait for the answer. Nobody has ever lost a booking over this.

Booking

Pregnancy massage is £75 for the hour and I come to you. There's no travel charge on top. If you're past twelve weeks and having a straightforward pregnancy, that's all there's to it.

Tell me how many weeks you're and which side hurts. I'll bring the right cushions.

If you aren't pregnant but the lower back is still the problem, the hot stone massage is the one I'd put you in instead.