Shiatsu: Another Tool for Keeping Birth Normal
by Suzanne Yates
[Editor's note: This article was originally printed in MIDIRS, 12/98, and appeared in Midwifery Today Issue 61, Spring 2002.]
Anything that enables women to have more confidence in their bodies is vital in these days of hi-tech living and hi-tech birth. There is now an increasing acceptance of complementary therapies in midwifery. Yet the number of ultrasound scans, other forms of screening and cesareans continues to rise. As the "birth machine" (Marsden Wagner) continues to grow, so do we also need to keep developing support for women simply to enable them to connect with their own bodies and their own wisdom.
As a shiatsu practitioner and childbirth educator, I feel that shiatsu offers one form of that support. In some parts of the world it has become relatively popular and well known as a form of healing through touch based on the meridian system-"acupuncture without needles." In other places, people still think of the Shitsu dog! As far as midwifery practice and birth support goes, it is relatively unknown and certainly extremely underused as a tool in supporting women and their families. Many midwives have embraced massage and aromatherapy into their practices, but shiatsu has not really caught on in the same kind of way. I feel this is a shame, since it has so much to offer that is different from and complementary to other forms of massage.
I wonder if this is simply because a full massage training is six months or less, whereas the full shiatsu training is usually three years. I believe it is possible to teach people the essence of shiatsu in considerably less time than that and to focus on particular aspects of shiatsu knowledge relevant for particular groups of people. I was surprised how effectively my partner, who is not a shiatsu practitioner, was able to use some shiatsu points and techniques on me to get me into labour when I was threatened with induction after my waters had broken. I was also impressed at how effectively he was able to use shiatsu for pain relief during labour. He and I have been teaching regular classes to women and their birth partners since 1990, where they learn how to use shiatsu in labour, also extremely effectively after just a one-day course. They mostly use it for pain relief, but have also used it to help turn breech or posterior babies, to speed up slow labour, to get second stage moving, even to expel placentas, with no ill effects. It is possible for midwives to learn these skills and more, and integrate shiatsu into their practice, without having to reduce other aspects of the care.
What is Shiatsu?
Shiatsu is in essence very simple: It is a particular way of touching a body. It is similar in some ways to massage, aromatherapy and reflexology, yet it is also profoundly different, as it draws on the Eastern traditions of yin/yang, meridians, elements and Zen. It includes work with muscles, ligaments and skin, releasing physical tension and promoting relaxation. It also works with the energetic pathways (meridians) and encompasses work on the emotions, the psyche and the spirit. It is a form of communication-reaching beyond the physical and tangible form to touch the essence of life itself, which is invisible.
The main difference between the experienced practitioner and the novice is the ability to interpret the information received through touching in this way. Many of the essential aspects of this way of touch, this form of communication, can be accessed after relatively little training. In this respect it is different from acupuncture and herbalism, which view the body and its energy in similar ways. Obviously you need to train for several years to be able to insert needles into the body, and you need to have a thorough understanding of Chinese herbs to begin to prescribe them safely.
The more spiritual Zen aspects of shiatsu may be the attraction for us here in the West. Some teachers in the U.K. do work more with the physical aspects of shiatsu. They may have trained as physiotherapists, or osteopaths. Others focus more on the spiritual; they may have lived in meditation centres and studied with monks. Shiatsu has the gift of being able to work with and transcend both systems, both ways of seeing the world. It can include both the spiritual and physical and can be adapted according to the needs of the person.
In Japan, an informal style of shiatsu has been handed down for thousands of years, through the traditional birth attendants or "sambas." Unfortunately, with the Japanese defeat in 1945 the "sambas" virtually disappeared as birth shifted from the birth houses to the hospitals. Only a handful remain and I have been lucky enough to have worked with a Japanese midwife living in London whose grandmother was one of these attendants and who has written about her work. From her, I have learned some useful additional techniques and feel connected to an ancient tradition. Today the most common use of shiatsu in Japan in the maternity period is postnatally, doing breast work to promote breastfeeding and prevent problems such as mastitis.
The Benefits for Birthing Women
In practical terms, a session offered by a practitioner of shiatsu usually lasts from one to one and one-fourth hours. It involves some time spent talking, assessing through listening and observation diagnosis. Then there is about 40 to 50 minutes of work with the person lying down fully clothed on a futon (light cotton mattress). A key feature of shiatsu is the use of pressure, which is usually experienced as calm and relaxing even though it works deeply on the body. The practitioner uses the hands, especially the thumbs and palms, to apply pressure all over the body. Stretches as well as techniques more similar to massage, such as stroking and kneading are included. Afterwards, some time is given to relaxation and then feedback. Shiatsu is not simply about "having a massage" but about guiding the client in the process of both becoming more aware of the energy in their body and of self-development. This is an important part of shiatsu. Sometimes people don't want to do much of the work themselves, and that is fine. But the more they are able to take responsibility for their own health, the more benefits they will receive.
A practitioner working with a pregnant woman is able to ease many of the discomforts and problems of pregnancy, ranging from nausea to backache, leg cramps to depression, anxiety and stress. It is the whole person, rather than simply the condition with which we work; but often many of the "symptoms" disappear after only one or two sessions. The very nature of shiatsu means that the woman is enabled to connect more deeply with her body and baby. She can then begin to experience aspects of herself she may not have been in contact with before. Shiatsu can continue postnatally, and again most "symptoms" can be addressed. It is also possible to work with the newborn baby. I often teach parents a form of baby massage that is shiatsu-based.
Shiatsu: Personal and Professional Tool for Midwives
Midwives, after my six-day training program, can learn techniques that can be easily incorporated into practice. You can learn different ways of touching the abdomen (in shiatsu known as the hara, an important energy centre of the body) that incorporate relaxation for the mother and working with the energy of the baby. This needn't take much more time than an abdominal palpitation and it also provides an opportunity to teach the mother, and possibly also the father, friend or sibling some simple abdominal massage techniques. This shift of emphasis encourages parents to bond with their unborn child and encourages mothers to feel more confident about their bodies. Some of you probably do some of this anyway, instinctively, or with more Western massage techniques. Shiatsu skills will add to what you do. You may even use some simple back and neck shiatsu techniques to relieve tension and promote relaxation, which can be incorporated into your ordinary antenatal appointments. You may be surprised at how effective even a little of this work can be-sometimes having worked on the back to relieve backache, you may find you have eased water retention, or improved digestion. During labour shiatsu is extremely effective, as I mentioned before, for getting labour going, for pain relief and for helping at any stage at which the mother may get stuck. Postnatally, a midwife can ease backache, promote rehabilitation of the abdomen and work with the baby, and in doing this she may also help ease postnatal depression.
Shiatsu, even when practised by a midwife with a little training, offers a chance for mothers to relax deeply and connect with their bodies. Traditionally midwives worked a lot with touch and with plants from the earth. In Eastern terms we can say that the midwives worked very much with the earth element, with its qualities of nourishing and support. Now in the 21st century midwives work much more with machines and tools, often made from metal. We can say this represents a shift toward the metal element, which can be less nurturing, more invasive, more critical. Shiatsu represents a way of introducing more of the earth element back into midwifery practice and helping midwives reconnect and update some of their more traditional skills.
Shiatsu is also powerful as a tool for personal development for midwives. Since it has developed over thousands of years and is part of a long Eastern healing tradition, developing from a "spiritual" context, it emphasizes not only the "patient" or "receiver" but the "giver." For the work to be effective the healer must come from a place of wholeness: "Physician heal thyself." A large part of the shiatsu training and the ongoing discipline of being a therapist is self-development work. It is not possible to balance other people's energy if your own is out of balance. Integral to the practice of shiatsu is continuous work on oneself to balance one's own energy. This lessens the possibility of burnout, fatigue and stress, or even absorption of any disturbed, exhausted energies from the person you are working with.
Integration into Maternity Services
I believe it is time for some of the gifts shiatsu can offer to be more fully integrated into maternity services. This is why I have decided to set up a six-day course aimed at teaching to midwives the relevant aspects of shiatsu. The focus will be very much on integrating shiatsu into the constraints of current midwifery practice, rather than simply acquiring another interesting skill. As a member of the Avon Maternity Services Liaison Committee I am only too aware of the implications of introducing complementary therapies into midwifery care. I know many midwives out there who have a skill in complementary care, which they are not often able to use.
In these days of research-based practise, there is unfortunately not much research specifically on shiatsu. There is quite a body of research on the role of acupuncture, which uses many of the same points and is easier to research. At my local hospital in Bristol one of the midwives was particularly interested in shiatsu for induction and did an audit on its use. This showed that post-term women who used shiatsu were more likely to labour spontaneously than those who did not. Of the women who had used shiatsu, 66 percent (42/66) went into spontaneous labour compared to 36 percent (26/77) of women who did not use shiatsu. The shiatsu group had a significantly lower rate of inductions and slightly fewer Caesarean sections and instrumental deliveries. We are now applying for research funding to investigate this effect with a much larger group of women and therefore contribute to increasing research on shiatsu. My hope is that as more midwives become aware of the benefits of shiatsu, some may be inspired to carry out research projects and this kind of touch and energy work can have a bigger role in supporting women.
I am excited that such ancient knowledge is being revitalised in the modern world and is still as relevant, if not more so, today than it ever was. My work is ultimately all about "supporting the wisdom of parents and babies" and I hope that more midwives will learn shiatsu as a way of doing this.
Suzanne Yates, BA(Hons), Dip HSEC, MRSS (T), APNT, is a shiatsu and massage teacher and practitioner. She studied antenatal and postnatal exercise in the U.S. with Elizabeth Noble and established Well Mother in 1990 to work with parents. Following the success of her work in Bristol U.K. she began to teach courses for professionals including midwives and shiatsu practitioners as well as massage therapists. She now runs international courses for these three groups; her ultimate aim being the integration of bodywork as a core part of 21st century maternity care. She visits the U.S. to teach once or twice a year and Midwifery Today is organising a five-day shiatsu course from August 26-30. Contact firstname.lastname@example.org. Or visit the Web site: wellmother.org
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