Stroke is the condition where the blood supply to the brain is interrupted because of some reasons that may cause many health problems.27 It usually occurs due to blood vessels ruptures. Many patients have tried reflexology as the alternative therapy in order to recover from strokes. The practitioners believe that pressure that they exerted on a particular point on reflex areas may induce a positive outcome and physical changes to the body.28
Many people confuse reflexology with massage, Reiki, or acupuncture, but there are essential differences between these therapies.  Massage therapists manipulate larger areas of soft tissue in the body while reflexologists apply pressure to specific points on the feet, hands, and ears.  Unlike either massage or reflexology, Reiki does not involve any physical manipulation or pressure, but instead uses light touch to work with the subtle vibrational field thought to surround the body. Finally, while acupuncture and acupressure, like reflexology, use reflex points on the body to influence other parts of the body, the points are not the same and acupuncture uses points over the entire body.

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“Many athletes and weekend warriors put themselves under a great deal of mental stress in preparation for a competition,” says Pietrunti. “For many amateur athletes, this is exacerbated by other day-to-day stressors from their jobs, families and life. Sometimes, just setting aside an hour to relax and unwind can be a huge step towards better performance and quality of life.”

Referred pain basically just makes trigger point stimulation feel bigger, more important. Press on a small spot … feel it down your entire arm. Wow! Impressive! Even though it’s just a thumb on a trigger point, it feels as though that “itch” is being scratched throughout an entire region. Referred pain amplifies the good pain effect — or the bad pain effect, if the pressure is too intense!
For instance, I tried a new young massage therapist. He introduced a pain scale right away, and asked me to use it to define an intensity I was comfortable with — a 5 out 10, say — and then actually used that scale to check with me quite a few times throughout an hour treatment. He also responded with clear adjustments to his technique when I reported that we were under or over the target I’d set. Great work! BACK TO TEXT

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A statistic has showed that there are more than 5000 registered reflexology centres in Malaysia. Currently, reflexology is a big industry in Malaysia with a huge unexploited potential for tourism and human capital, especially for disabled people. Owing to that, Ministry of Health has published the good practice guidelines for reflexology in 2011 to strengthen and govern its operations.2 Different use of reflexology and the effect of reflexology are listed below:

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aging air anger anxiety art arthritis asthma aura baby beauty beliefs bladder body brain breathing chakras change chart children communication compassion cough dance dare death depression digestion ear Earth emotions exercise eye face fatigue fear fever fire freedom gall bladder happiness hara heart intestine jaws joy karma kidneys laugh law of attraction letting go life liver love lungs manipulation mantra massage meditation menopause metal mind mood muscles music nature neck obesity pain plants positive thinking quantum quotes reiki rejuvenation relaxation sacrum season self-confidence serenity shoulders skin sleep song spleen stomach stress struggle tale talent teeth therapy third eye time trauma vampire violence visualisation vital energy water weight women work yoga

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During most full-body massages the expectation is you’ll be undressed. Your massage therapist will ask you to undress for your massage while they wait outside. It’s up to you whether or not to keep your underwear on. Your massage therapist will drape a sheet over your body, which they will pull back and adjust as they work their way around. You will be covered most of the time.

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Reflexologists work from maps of predefined pressure points that are located on the hands and feet. These pressure points are reputed to connect directly through the nervous system and affect the bodily organs and glands. The reflexologist manipulates the pressure points according to specific techniques of reflexology therapy. By means of this touching therapy, any part of the body that is the source of pain, illness, or potential debility can be strengthened through the application of pressure at the respective foot or hand location.

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DTM can be useful to those that are recovering from an injury (once the client/patient is out of the acute phase), for athletes, for people with postural strains, or people with chronic pain. Typically there is an area or a few areas where this type of work is needed. For example, a person who has chronic postural pain/tightness from sitting at a computer, might need DTM to their shoulders, chest, and upper back/neck. They likely, do not need DTM on their whole body. Some therapists might disagree with me here, but I rarely think a full-body, DTM, is needed. It can simply be too much. I would rather see a client more often, for less-intense sessions. It is simply more effective. It is the same as Physical Therapy- it is more effective to do it regularly.
Headaches. Severe headaches and migraines are the second most common pain conditions in the U.S. (15 percent) according to the AAPM, and Everhart says that massage therapy can oftentimes help in these cases. The Migraine Relief Center (MRC) indicates that the reason this modality works is that it eases muscle spasms, improves blood flow and circulation, relieves tension, and increases relaxation. The MRC shares that it is also especially helpful when it comes to tension and vascular headaches.
 Massage therapy catered specifically to you and what your body needs. Intuitively knowing which style of massage to use from from a wide array of options such as shiatsu, deep tissue, lomilomi, Swedish, prenatal, acupressure, reflexology  and many more I am Passionate about offering the service of massage creating an integrative, therapeutic, lasting experience.
There are maps for the feet, hands and the outer ears (see Reference section). For example, in the feet, the left foot corresponds to organs on the left side of the body, while the right side of the foot corresponds to the right side of the body. More specifically, the gallbladder is on the right side of the body, and therefore the reflex point is on the right side of the foot.

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No. Bottom line, massage should never hurt if you don’t want it to. Some clients specifically say that they do not want to be in pain, and that should be respected. However, there are certain techniques that might cause discomfort. If the client and therapist communicate and agree on increased pressure, you can incorporate these deeper or more aggressive techniques into the massage. They can cause a little pain at the time, and a little bit of soreness the next day. I like to compare it to how you feel after a good workout. A good Massage Therapist will also be very skilled at warming and softening the tissue layer by layer to decrease the amount of pain felt by the client.
Trigger points or stress points may also cause muscle soreness and decreased flexibility. These points are specific spots in muscle and tendons which cause pain when pressed, and which may radiate pain to a larger area. They are not bruises, but are thought by some to be small areas of spasm. Trigger points may be caused by sudden trauma (like falling or being hit), or may develop over time from the stress and strain of heavy physical exertion or from repeated use of a particular muscle.

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According to the National Center for Complementary and Integrative Health (NCCIH), this includes individuals with bleeding disorders, low blood platelet counts, or those who are taking blood thinning medications. When these types of conditions are present, the NCCIH indicates that a sports massage with deep tissue work is generally not recommended.

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You're going to with a foot, you're going to press down just a little and come up and press down and come up, press down and come up. Now sometimes just wave the foot a little bit towards me and that will allow you to go a little deeper. As similarly, you could do finger walking. With finger walking I generally use it on the top of the foot. We could also use it on the sides of the foot. But generally not on the bottom plantar aspect. So, with that, you're just going to be doing the same kind of thing where you come down and come back up and back down again.
Friction strokes work on deeper muscles than the techniques previously described. The friction technique is a pressure stroke and is the deepest that is used in Swedish massage. The massage therapist applies pressure by placing the weight of his or her body on the flat of the hand and the pads of the thumbs, knuckles, fingers, or the back of the forearms, and then releases the pressure slowly and gently. This movement should be a continuous sliding motion or a group of alternating circular motions.

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“It is your body, your session, your outcome,” advises Rotenberger. “There’s a fine line between pain and discomfort, and it’s unique to the individual.” What’s more, deep pressure is not the same as deep tissue. It’s a common misconception, Rotenberger explains, and in reality, a therapist that is muscle-specific needs to exert little pressure to be effective. 
The physiological effects are a bit of a moot point: if the pressure doesn’t suit you, you’re not likely to continue with the therapy. The exception is the patient who is willing to put up with intense pain long enough to find out if there appears to be a therapeutic effect afterwards, which there may be. But that judgement call is often made without much knowledge of whether or not the pain is really justified. BACK TO TEXT

In this particular study, published in Studies in Health Technology and Informatics, therapeutic massage included techniques of tapping and friction, while DTM used “oblique pressure and a combination of lengthening and cross-fiber strokes.” All sessions were 30 minutes long and preformed daily, and all participants did not receive any other treatments during the course of the study. After 10 days, participants treated with DTM reported significant improvements in pain (lower back pain in this case) compared to those treated with therapeutic massage, based on scores using the Modified Oswestry Low Back Pain Disability Index, Quebec Back Pain Disability Scale and Visual Analog Scales. (4)
Massage may be an appropriate technique for helping certain sports injuries, especially muscle injuries, to heal. When treating an injury, however, it is best to seek advice from a qualified sports therapist or a specialist in sports medicine before performing any massage. Certain ligament and joint injuries that need immobilization and expert attention may be aggravated by massage.

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People with serious and long-term medical problems are urged to seek the advice of a physician. Diabetes patients in particular are urged to approach this therapy cautiously. Likewise pregnant women are cautioned emphatically to avoid reflexology during the early phases of pregnancy altogether, as accidentally induced labor and subsequent premature delivery can result from reflexology treatment.

The first study I know of was supervised by William T. Jarvis, Ph.D., a professor who taught research methods to graduate students at Loma Linda University. Using questionnaires, 70 subjects were asked to state whether they had had health problems during the previous two years in any of 43 anatomical areas. These data were then compared with the findings of a reflexologist as recorded on a report form. The results did not differ from what would be expected by blind guessing. To prevent the reflexologist from asking questions or observing subtle clues, the experimental subjects were asked to remain silent and a curtain was placed so that their feet were the only part of their body visible to the reflexologist [12].

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Reflexology practitioners and the professional association have advocated that reflexology is effective for general well-being maintenance and treatment of chronic diseases such as strokes, musculoskeletal disorders, and stress. Due to its soothing massage and non-drug complementary nature, reflexology is widely accepted by general public. Yet, numerous systematic reviews confirmed that strong evidence of the positive effects of reflexology postintervention are lacking despite plenty reported small-scale trial and anecdotal evidence of reflexology for some common ailments. Adequate training of practitioners and reflexology programme accreditation are to ensure correct and consistent services are provided.

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So what do you expect to happen after foot reflexology? Just like most of the people which have reviewed it, reflexology makes them feel calm and composed. You will definitely feel refreshed and energized after getting foot reflexology done. That said, there are some people who are sensitive; they get nausea or become tearful, but you need not worry as these are just causal and normal feelings. Instead, therapists consider that these feelings are actually a sign of the healing process. Additionally, you must always consult your doctor if you are sensitive, pregnant or have some other problem so that things do not get complicated.
In recent times, Sir Henry Head first investigated the concepts underlying reflexology in England in the 1890s. Therapists in Germany and Russia were researching similar notions at approximately the same time, although with a different focus. Less than two decades later, a physician named William H. Fitzgerald presented a similar concept that he called zone analgesia or zone therapy. Fitzgerald's zone analgesia was a method of relieving pain through the application of pressure to specific locations throughout the entire body. Fitzgerald divided the body into 10 vertical zones, five on each side, that extended from the head to the fingertips and toes, and from front toback. Every aspect of the human body appears in one of these 10 zones, and each zone has a reflex area on the hands and feet. Fitzgerald and his colleague, Dr. Edwin Bowers, demonstrated that by applying pressure on one area of the body, they could anesthetize or reduce pain in a corresponding part. In 1917, Fitzgerald and Bowers published Relieving Pain at Home, an explanation of zone therapy.
While the majority of people tend to get professional reflexology sessions for their feet, the hands can be just as effective. In the self-help reflexology segment I did on the show, I explained what to look for on your palms to get to know your own body better. Here’s a recap for you to try for yourself. Of course, this is not a substitute for medical care; always be sure to consult with the appropriate health practitioner in case of any medical condition.
Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).
Pumping - The stroking movements in massage suck fluid through blood vessels and lymph vessels. By increasing the pressure in front of the stroke, a vacuum is created behind. This is especially important in tight or damaged muscle tissue as a tight muscle will squeeze blood out like a sponge, depriving the tissues of vital nutrients and energy to repair.

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The foundation course provides the student with comprehensive training to begin working as a Professional Reflexologist. Dedicated students wishing to extend their skills are recommended to continue their studies with our Advanced Reflexology course. The advanced course will expand your knowledge in the specialised areas of this truly effective therapy.

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Beyond the feel-good effects of the treatment, the practice and purpose go deeper than the skin and muscles by taking specific reflex points on the foot to induce a healing response in corresponding organs and areas of the body, as seen in the chart to the left. Kneading the soft fleshy ball of the foot, pulling on the toes, tracing around the heel and pushing deep into the arch are just a few of the many small, intense movements you’ll experience during a reflexology treatment.

Swedish massage is the most popular type of massage in the United States. It involves the use of hands, forearms or elbows to manipulate the superficial layers of the muscles to improve mental and physical health. Active or passive movement of the joints may also be part of the massage. The benefits of Swedish massage include increased blood circulation, mental and physical relaxation , decreased stress and muscle tension, and improved range of motion.


Reflexology careers have been gaining in popularity for the past 25 years and continue to grow today. With the current wellness boom in the United States, reflexology has earned a place at the forefront of alternative therapies for its effectiveness in reducing stress and relieving a number of common health problems, including chronic pain, allergies and digestive issues.
DTM can be useful to those that are recovering from an injury (once the client/patient is out of the acute phase), for athletes, for people with postural strains, or people with chronic pain. Typically there is an area or a few areas where this type of work is needed. For example, a person who has chronic postural pain/tightness from sitting at a computer, might need DTM to their shoulders, chest, and upper back/neck. They likely, do not need DTM on their whole body. Some therapists might disagree with me here, but I rarely think a full-body, DTM, is needed. It can simply be too much. I would rather see a client more often, for less-intense sessions. It is simply more effective. It is the same as Physical Therapy- it is more effective to do it regularly.
To be effective, a reflexology practitioner must be certified and understand the meridians related to each pressure point. Most spas offer reflexology, and the treatment typically lasts approximately 30 minutes. It’s important to have a conversation with your reflexologist beforehand to discuss your “issues,” whether it is constipation, a tension headache or trouble sleeping.

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During most full-body massages the expectation is you’ll be undressed. Your massage therapist will ask you to undress for your massage while they wait outside. It’s up to you whether or not to keep your underwear on. Your massage therapist will drape a sheet over your body, which they will pull back and adjust as they work their way around. You will be covered most of the time.
The recognition of reflexology as a specific type of treatment began with Zone Theory, in which the body is divided into 10 vertical zones. Each zone corresponds to fingers and toes all the way up to the top of the head. For example, if you are standing up with your hands on your thighs (palms facing down) the thumbs and great toe would be zone 1. On either side of the body, the index finger and second toe would be zone 2, etc.
Hydration is key to a good deep tissue massage. Drink plenty of water at least two hours before you arrive. You should also drink water after your massage to flush out the toxins from your body. The massage breaks up the toxins in your muscles, and now they’re ready to exit the body. If you don’t drink enough water, then the toxins will find a new home in another part of your body, and the effectiveness of the massage will be limited. 

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Hi, my name is Renee French and I'm here at Practical Massage Therapy in Nashville, Tennessee, and I'm going to be talking about massage therapy. Swedish massage is the most commonly offered technique of massage therapy, and it's usually the basis of most of the massages that you will receive in the United States. It involves the use of 5 strokes that include long gliding strokes, kneading, tapping, friction, and vibration. So Swedish massage is one of the basic techniques that most massage therapists will use to build other techniques on. There are lots of things, different combinations that you can use on the body. With the cross-fiber friction, you can get some nice warming of the muscles, and getting the connective tissue to start to release. With the long gliding strokes, you can apply the massage oil and the cream, and that's also really great for warming up the muscles. And kind of getting that person in a relaxed state to start receiving massage, and to get their breathing nice and even flowing. It's a nice technique for opening and closing the massage. You can the end the massage. And one of my favorite things to do is to end the massage with the tapping. And it's kind of like a percussion drumming on the belly of the muscle. Kind of the thicker part of the muscle. you want to make sure and stay away from the bones, as this could be really uncomfortable. But if you do some tapping on the muscles, it can just really get the muscles to release any tension that might still be kind of stuck in the muscle tissue.
One risk is clearly neurological and complex: some people are basically sitting ducks for the well-documented and nasty phenomenon of “central sensitization,” and indeed may already be in pain and seeking help because of it. A strong massage can severely aggravate that situation, with long term and extremely unfortunate consequences. It’s rare, but it happens. The typical clinical scenario here is a gung-ho under-trained therapist over-treating someone in, say, the early stages of fibromyalgia. Bad, bad, bad.
Foot Reflexology massage can be a deeply relaxing and therapeutic modality for those suffering from plantar fasciitis, ankle injuries or even everyday work and play. At Massage Envy, your massage therapist will apply traditional Swedish and sports massage techniques to the foot, calf and upper leg. This will not only help relieve toe pain, ankle pain, plantar fasciitis and common forms of arthritis, but can also decrease stress and anxiety in the entire body. In addition, a variety of stretches can be beneficial. With pain and sensitivity in the foot, heel and calf areas, be sure to communicate your pain levels with your massage therapist during your treatment. It is also a good idea to rest after receiving the reflexology massage.
While a foot massage may feel the same as a reflexology treatment, a reflexologist will work on areas to promote a healing response in the corresponding organs. A massage therapist giving a foot massage will manipulate muscles and other soft tissues to improve circulation, relieve pain, and heal injuries in the area or to induce overall relaxation.
Deep tissue technique uses very little to no lubricant so that the muscles can be hooked or grabbed, thereby stretching and lengthening them, and to separate adhered muscle compartments. Strokes will be considerably slower and possibly shorter as the therapist waits for a slow release of tension. Some areas may be skipped so more time can be spent on specific areas of need. Doing this provides better alignment of the muscles and less restriction in the joints, thereby improving their movement and function. It is a massage in which the primary goal is less about general relaxation and more about promoting change in the actual structure of the body.
In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; reflexology was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.[5] Accordingly In 2017 the Australian government named reflexology as a practice that would not qualify for insurance subsidy, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence".[6]
A couple’s massage is a massage that you do with your partner, friend, or family member in the same room. It brings all the benefits of a regular massage and sometimes provides you with access to the spa’s hot tubs, saunas, and other facilities. Other treatments such as pedicures, facials, and body scrubs are sometimes offered as part of a package.

The standard type of massage offered in most clinics, gyms, spas, and wellness centers, Swedish massage is virtually synonymous with massage therapy. Swedish massage is based on the Western concepts of anatomy and physiology, compared to the energy-centric style more common in Asian forms of massage. Using lotion or oil, massage therapists typically begin with broad general strokes and then transition to specific strokes to address problem areas.
During the 1990s, I observed at least seven foot reflexologists at work during health expositions. In most cases, the process appeared to be an ordinary prolonged foot massage with little communication between the practitioners and their clients. But at one exhibit, the practitioners claimed that they could reduce stress, cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. On another occasion, I underwent a 15-minute session in which the practitioner felt my foot for diagnostic purposes and then massaged it for "therapeutic" purposes. During the previous year, I had had severe shoulder pain caused by an inflamed tendon that was rubbing against a bony surface inside my left shoulder joint. Thorough medical evaluation had determined that the appropriate treatment was arthroscopic surgery in which a drill is used to shave the bony area that was impinging on the tendon. The reflexologist claimed that he could detect the shoulder problem by feeling my left foot, that it was caused by stress, and that pressing on my foot—perhaps for a few sessions—could solve the problem. His "treatment," which lasted about 10 minutes, consisted of massaging the foot and from time to time, pressing hard on the ball of my foot, a procedure that was quite painful. The "treatment," of course, did absolutely nothing to help my shoulder. A few months later, I had the surgery, which cured the problem immediately and permanently.
Using a wide variety of tools including bands, combs, electricity, hooks, light energy, probes and stainless steel instruments to stimulate various pain-killing responses in the hands and feet, FitzGerald’s work was first brought to the public by Edwin Bowers in his 1915 article, “To stop that toothache, squeeze your toe,” which was published in Everybody’s Magazine. (15)

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Learn about qi and other conceptsAnother theory that may also explain how reflexology can produce pain relief is the gate control theory, or, more recently, the neuromatrix theory of pain. This theory suggests that pain is a subjective experience created by your brain. The brain does this in response to the sensory experience of pain, but it can also work independently of sensory input and create pain in response to emotional or cognitive factors. Thus things that influence the brain, such as your mood or external factors like stress can also affect your experience of pain. According to this theory, reflexology may reduce pain by reducing stress and improving mood.

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Upon entering the suite, you are surrounded by aromatic therapy that will envelop you in a sense of relaxation. Our aphrodisiac oil will stimulate your sensuality and feeling of togetherness that will enhance your spiritual connection. A couple’s massage is a wonderfully relaxing, personal experience. During the session, two people receive massages at the same time and in the same room from two different therapists.
Research published in the Journal of Sports Medicine and Physical Fitness reported findings of a positive trend for deep tissue massages in regard to improved athletic recovery and performance. The most beneficial type of deep tissue massage for athletes is considered to be “sports massage,” which is commonly performed prior to athletic events to help warm the body and prevent injuries or immediately after to improve recovery.

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The underlying theory behind reflexology is that there are certain points or "reflex areas" on the feet and hands that are connected energetically to specific organs and body parts through energy channels in the body. By applying pressure to reflex areas, a reflexologist is said to remove energy blockages and promote health in the related body area.
Studies have shown that reflexology can be very beneficial for pregnant women, particularly in terms of labor lengths and their need for analgesics during labor and postpartum recovery time. Beyond that, due to many of the health benefits already outlined above, it can reduce the chances of postpartum depression and can also help a woman’s body heal itself faster and get back to its normal metabolic activity quickly.

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Headaches. Severe headaches and migraines are the second most common pain conditions in the U.S. (15 percent) according to the AAPM, and Everhart says that massage therapy can oftentimes help in these cases. The Migraine Relief Center (MRC) indicates that the reason this modality works is that it eases muscle spasms, improves blood flow and circulation, relieves tension, and increases relaxation. The MRC shares that it is also especially helpful when it comes to tension and vascular headaches.

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Although many assume Swedish massage comes from Sweden, Johan Georg Mezger (1838-1909), a Dutch man, is often credited with formalizing the system known as Swedish massage—sometimes referred to as “classic massage” in Europe. Mezger assigned French names— effleurage, petrissage, friction, and tapotement—to the specific strokes used in Swedish massage application. In English, these movements are known as stroking, kneading, rubbing (friction), and striking.
Normally, it is not a painful treatment but if you feel any sort of pain, you must inform your therapist and they will sort it out for you. The chances of pain can be because of your comfort zone; you may not be seated properly or the angle of your feet is not in its natural position. Additionally, therapist will always give more time to the parts that you have discussed about in the beginning. The painful parts are given more priority and pressure is given to the reflex points of those parts.

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Pain management. If you have a condition like sciatica or osteoarthritis and are suffering from chronic pain as a result, Swedish massage can be an effective method for managing that pain in a natural way. Notify your massage therapist about your pain points, he or she can target those areas and use a stroking motion to improve local circulation and reduce muscle tension.

Pumping - The stroking movements in massage suck fluid through blood vessels and lymph vessels. By increasing the pressure in front of the stroke, a vacuum is created behind. This is especially important in tight or damaged muscle tissue as a tight muscle will squeeze blood out like a sponge, depriving the tissues of vital nutrients and energy to repair.

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Another institute that offers a short course of reflexology is Karisma Institute which is a specialist training institute. This institute is registered with the Ministry of Human Resource and Ministry of Tourism Malaysia. This institute offers many courses that are geared towards meeting the market needs. For those who registered as participants at this institute, they are supplied with registration kits which consist of foot reflexology book, reflexology zone poster, massage cream, and towel. This institute offers 10% lecture class on theory and 90% practical session with demonstration. The overall contents of this short course are introduction to reflexology, human physiology, organs function, consultation, treatment, and entrepreneurship.16
According to research, stress and tension can be one of the huge sources of worsening your health by creating blocks in your body. Therefore, reflexology is one of the best practices that are mainly used to keep people away from worry, strain and tiredness among other things. Additionally, it also helps your body maintain a balance and make you more energetic to carry out your daily activities with more vigor and determination.
Obviously, open sores to the hands and/or feet would be a reason to avoid reflexology. Acute injuries also must be handled with care. Anyone with active blood clots should avoid rubbing near the area of the clot. Burns, wounds, gout and infections to the hands or feet should also limit the use of reflexology. Lower extremity swelling or chronic skin changes that are a result of vascular problems to the feet should also limit this form of therapy. Recent removal of a cancerous tumor or other surgical procedures, such as wart removal, also make reflexology inadvisable. There is some evidence that rubbing of the feet during pregnancy might stimulate contractions, and so should be avoided in the later stages of pregnancy.

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