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Holistic Maternity Care
Integrating Shiatsu and Massage

By Suzanne Yates

Originally published in Massage Bodywork magazine, April/May 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


Shiatsu may sound exotic, but it has a long tradition in Western massage. Indeed one of the first books that influenced the growth of the modern massage movement in 19th century Europe was the translation of an ancient Chinese massage text, The Cong Fu of Tao-Tse. Shiatsu evolved over thousands of years, influenced by massage in China. More recent developments include muscle energy techniques correlated with acupuncture points.1 Now many massage books include a chapter on Eastern methodologies or at least refer to shiatsu and/or acupuncture points.2 Within the literature on massage and pregnancy, massage therapists Elaine Stillerman3 and Carole Osborne-Sheets4 write about the use of acupuncture points during pregnancy and in labor, and refer to certain points that may be contraindicated.

However, shiatsu is often simplified in the form of "press this or that point for this amount of time." This implies a lack of understanding of how this fabulous system works. It has a far greater application than simply being used for specific symptomatic conditions, although this can also be very effective. Through its practical applications, shiatsu includes not only the use of specific points but also numerous ways of applying pressure, working on meridian pathways, stretching and stroking. Through its theory, shiatsu offers practitioners a way of understanding the energetic changes that happen in the body.

As we all know, pregnancy is a time of great change. In the first trimester these changes are mainly hormonal, rather than visibly physical, culminating in the establishment of the support systems for the baby -- namely the placenta and amniotic sac. The baby develops at an incredible rate during these first 12 weeks and all the main organ systems are established, although the baby is still only 2 inches long. We are aware of the anatomical and physiological explanations for these changes and adapt our massage work accordingly. The mother may be feeling extremely nauseous and the practitioner needs to be careful not to do anything to trigger the nausea. Practitioners may have learned some acupuncture points, most notably PC6, which they include in the massage. This point has been quite well-researched in its effectiveness in treating nausea.5 However, often women in the first trimester experience very low energy levels, so low that they're too tired to move their bodies. Practitioners may feel confident doing some breathing and relaxation techniques with these clients. They may just want to hold her, resting at various points on her body. But there is an opportunity for more, enabling the mother to connect with her body and her baby -- and begin to come to terms with the changes inherent in pregnancy.


Understanding Shiatsu
An understanding of the mother's and baby's energy systems can add an extra dimension to your work. Using the Eastern concepts of meridians, especially the core body systems of the conception vessel and governing vessel, can help us understand how to work with the mother and baby in safe and effective ways throughout the pregnancy.

You may already be familiar with the concept of meridians -- these are the pathways that transmit energy from the organs through the body. Common meridians include the heart protector or pericardium, lung, stomach or spleen. These form a portion of the 12 meridians that move qi (or energy) through the body. This is where you get the qi of reiki, tai chi or qigong. This is our daily energy -- which we get mainly from breathing (air qi) and eating (food qi), and flows in our body in 24-hour cycles.

The main regulator of this daily energy is the circuit of the governing vessel (GV) and conception vessel (CV), also known as the du mai and ren mai. These meridians form the two halves of the cell and are the first meridians to form in the fetus. The conception vessel runs up the front midline of the body -- from CV 1 in the center of the perineum, right up through the center of the symphysis pubis, right through the midline of the abdomen and chest ending in CV 24 below the mouth where it enters the body. In women, it has an internal pathway that flows down to the kidneys and the uterus. The other half of this circuit is the governing vessel which begins at GV 1 midway between the tip of the coccyx and the anus, and flows up the midline of the spine, through the center of the sacrum, the lumbar, thoracic and cervical vertebrae, rising up the center of the skull, to the top of the head to GV 20 and then over the center of the forehead, over the nose to GV 28 above the lip where it then follows the same internal pathway as the conception vessel. There is in fact another branch to this circuit that is called the penetrating vessel which links the two, flowing to each side of the conception vessel at the front and flowing up to lumbar 3 along with the GV.

These meridians regulate the flow of qi in the main meridian system, especially in times of change or shock. The governing vessel is the ultimate regulator of the yang energy of the body and the conception vessel the main regulator of yin energy. The Chinese character for yin and yang represents the shady and sunny sides of the mountain. These two concepts represent a movement of energy from day to night as opposed to two opposite forces -- one cannot exist without the other. They relate to both physical and emotional qualities within the body. Yin relates to the inside of the body and to slower changes. Yang relates to the outside of the body and faster reactions like nervous system response. At conception, yin is the egg and yang is the sperm. Emotionally, yin is the inward reflective space -- the ultimate yin is expressed through the element of water. Water can be the energy behind will power and ambition, driving us forward like a river breaking through its banks. It can also get stuck in a negative, depressive state like a stagnant pond. Pregnancy is the ultimate state of yin -- hidden growth in a watery environment. In our culture we are encouraged to be more yang, to be outwardly active. To do so we need to support the yin qualities of pregnancy. Birth is the movement from yin to yang, from the inside to the outside -- new life and growth represented by the energy of wood. Learning to tune into these different energies in pregnancy helps the mother process the emotional and physical challenges of pregnancy and labor.


Ancient Energy
The CV and GV vessels have another important function. They circulate the essence or jing -- our ancestral energy. We inherit essence from our parents at the time of conception -- and the quality of our essence, our constitutional/genetic inheritance is influenced by the energy of our parents' parents and their parents, too. It is this energy that underlines organic change and growth and governs the reproductive system. In women it is said to represent in energetic terms the hypothalamus, pituitary (governed by the governing vessel) and ovarian (regulated by the CV) axis. It flows in seven-year cycles for women and eight-year cycles for men.

During pregnancy there are many demands made on this circuit, especially with the conception vessel, which has a close relationship with the reproductive organs and the recti muscles. The linea negra, the skin darkening on the abdominal midline common in pregnancy, is indicative of these changes. Physical changes in the spine due to the adaptations the mother has to make as the baby grows and her body shape changes are regulated by the governing vessel.

This system provides the ultimate support for the pregnancy. If this system is not operating smoothly, the pregnancy may be inhibited through infertility or miscarriage. There may be problems with the pubic bone (symphysis pubis diastasis), extreme separation of the recti muscles (abdomini recti diastasis), backaches, exhaustion or lack of connection with the baby, to name but a few. By considering this system in our work we have a route into these core changes for both mother and baby during pregnancy.

Much of this type of work involves holding points along the pathways of the meridians, stroking the meridians, soft palming and deep tissue techniques, the use of breathing and visualization. There are techniques for working with the kidneys and the uterus -- which include the placenta and the baby. These don't feel invasive for mother or baby. Indeed it often helps them to switch into a space of deep relaxation. From this space, many "problems" dissolve.

The techniques for turning breech or posterior babies (notably, the use of BL 67, BL 60 and sacral work)6 can be combined with core meridian work to increase their effectiveness. Some-times I think the baby turns because it feels reassured by this energetic connection. Sometimes mother or baby has to make an emotional shift at a profound level. I know of babies who have turned into a breech position at the same time the mother experienced a sudden shock (like her mother or partner dying or maybe simply she is afraid of giving birth). The baby senses this stress and also feels afraid and turns away from the birth canal. The Chinese say that a breech baby is holding on to the mother's heart. Working the bladder channel helps address the fear; fear and shock are often processed by the governing and conception vessels which link closely with the kidneys.


Using Pressure
Much of shiatsu's focus is the use of pressure -- sometimes this can involve deep pressure, as in the use of deep sacral work in the final trimester for alleviating backaches, shifting the baby's position or for pain relief during labor. Sometimes this pressure is physically light, but energetically deep. It is very much about making connections in the right kind of way -- which is why simply finding points, counting and holding is not the most effective use of this tool. Individual bodies respond very differently -- for one person, 10 seconds of holding may be too long and for another half an hour may not be long enough. There are many different styles of shiatsu that emphasize slightly different aspects. In the tradition in which I work, it is important to follow the principle of using two hands -- a mother hand (yin balancing hand) and working hand (yang balancing hand). The practitioner needs to work from a connection with their center, their hara (abdomen), in order to make energetic connections with their pregnant clients. This involves focusing with the breath and connecting deeply to the internal organs.

Shiatsu is traditionally done on a clothed client, but it doesn't have to be. With the application of the correct principles, it can be done as effectively directly on the skin using oils. Practiced in this way, it blends in well with massage and the practitioner can employ shiatsu as part of a massage session. However, sometimes working through the clothes or towels can be useful for women who feel vulnerable. It can sometimes be useful during certain stages of labor as well.

Traditionally, shiatsu is done on the floor on a cotton futon. Again this need not be the case -- it can be done equally well on a table. However, working on the floor can be a useful practical technique with pregnant clients. Heavily pregnant women may find it difficult to get up on the table and get comfortable. Lying on the floor offers another option. She can also sit in a chair, but she can't relax as much as if she was lying down. Using the futon, all massage techniques can be done on the floor, integrating some great passive movements for legs, back and arms. This also gives the therapist an opportunity to work with the mother in the all-fours position, which is excellent for backaches and helping encourage the baby to settle in the anterior position. Some simple exercises, such as pelvic tilting, can be integrated as part of the massage session when the mother gets restless.

An added benefit of working on the floor and through the clothes is the client's partner and/or the baby's father can support the mother and be part of this circuit of energy. After the baby arrives, it allows the mother to cuddle up with the baby, even breast feed, while the therapist works.


The Way Forward
I would argue that all forms of bodywork have a common tradition, evolving from societies where people lived intimately influenced by the forces of nature and in which touch played a crucial role, not only in healing, but also in how people related to each other. Over the centuries different ways of explaining and codifying these systems of touch evolved. Today, we are more aware of these different traditions and how each one has developed its own rules of practice and training. I feel the way forward is to reintegrate the traditions, especially when it concerns integrating Eastern energy systems with Western anatomy and physiology. There is so much that shiatsu can offer the massage practitioner, particularly in pregnancy when many of our more physical techniques are less appropriate and when we do need ways of being able to work with the baby as well as the mother to address the emotional aspects.

The pregnant body as a marvelous integration of the physical and emotional whole which includes the baby. We need to work with a holistic understanding of the body, appreciating how all systems are interlinked and work not with fear, but with marvel of the wisdom of the body, helping women to be more in touch with themselves and their babies.


Suzanne Yates, B.A.(Hons), Dip H.S.E.C., M.R.S.S.(T), A.P.N.T., began studying massage in 1982 and shiatsu in 1983, completing a three-year practitioner diploma course in 1988. When she became pregnant in 1989 with her first child, she became interested in the potential of bodywork in the maternity period and integrating a physical understanding of the body with an energetic one. She studied antenatal and postnatal exercise in the United States with Elizabeth Noble and established her company Well Mother in 1990 to work with parents. Following the success of her work in Bristol, United Kingdom, she began to teach courses internationally. Contact suzanne@wellmother.org or visit her website www.wellmother.org.

References
1. Travell, J.G., and Sminons, D. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 2 Baltimore: Williams and Wikins, 1992, 5. Weinntraub, M. Shiatsu, Swedish massage and trigger point suppression in spinal pain syndrome. American Journal of Pain Management 1992 April; 2 (2): 74-78.
2. Cash, M., and Greetham, A.N., Sport and Remedial Massage. Ebury Press; 1996. 226-243.
3. Stillerman, E., Mother Massage, Dell Publishing Co.; 1992.
4. Osborne-Sheets, C. Pre- and perinatal massage therapy. Body Therapy Associates; 1999.
5. Steele, N.M., French J., Gatherer-Boyles J., et al. Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy, Journal of Obstetric, Gynecologic, and NeoNatal Nursing 2001; 30 (1): 61-70.
6. Cardini, F., Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. Journal of the American Medical Association 1998 Nov. 11; 280 (18): 1580-4.




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