Touch in the Midwifery Arts
The midwife greets the mother and sits down in front of her. She lifts the mother’s dress and begins to firmly massage and palpate the abdomen. She assesses the position and health of the fetus, feels the lie of the uterus and aligns the energy flow through the abdomen. During the prenatal massage the mother and midwife talk about the expected baby, the woman’s health and her family. The midwife will perform a massage at every prenatal visit, during the birth and at postpartum visits. The mother’s mother may also massage her, as will her mother-in-law. The mother will then massage the new child. This dynamic web of touch has been played out all over the world, connecting midwives, mothers and massage, for thousands of years.
Before Western medical practices displaced traditional midwifery, the touch and massage of a midwife or birth attendant was a central component of prenatal care around the world. In the absence of obstetrical tools and gadgets, a midwife had her eyes, ears and hands to diagnose and assist pregnant women. Honed by constant practice, the midwife’s senses of observation and intuition were finely tuned. Today, traditional healers and midwives skillfully integrate the ancient healing arts of massage and midwifery, as they have for thousands of years.
Prenatal massage and compassionate touch during the childbearing year are more than a primitive practice or luxurious pampering; they are an essential and vital part of holistic maternity care. The medical model of birth ignores and trivializes the therapeutic value of touch during pregnancy and childbirth. In the medical model, childbearing is analyzed from a pathological and intellectual perspective. Obstetrical and gynecological practices support the deprivation of human touch, pathologize the female body, increase childbearing morbidity and place women in a subservient role to the institution. However, pregnancy is not a pathological event or an intellectual construct; it is a healthy, primal and life-giving process. Compassionate touch of the mother during pregnancy and childbirth is essential for the development of maternal touching of the infant. Tactile stimulation of the newborn is necessary for healthy development and immunological resistance.
Traditional midwives serve birth through their touch and intuition, holistic ways of learning that respect and nurture the ecology of birth. Interventions, questions and exams induce neocortical activity and the production of catecholamines (stress hormones) that interrupt the labor process. Intuitive touch and massage allows for midwife and mother to communicate without stimulating the neocortex and intervening in the natural rhythm of birth. Touch is the primal language of life; the language that speaks to the deep mind of a laboring woman and the awakening senses of an infant. Massage and healing touch enhance the body’s natural ability to sustain health and give birth. The integrity of midwifery care depends upon compassionate communication that respects the primal process of birth and women’s autonomy.
Traditional Midwives and Intuitive Touch
Traditional midwives and wise women were often the “barefoot doctors” of their tribe or village. The traditional midwife is a holistic practitioner integrating knowledge of herbs, massage techniques, spiritual healing and maternal health care. Examining the practices of massage by traditional midwives can guide us in integrating healing touch into our contemporary childbirth practices.
Every culture has beliefs, mythology, traditions and rituals regarding massage and childbearing. Traditional midwives of Jamaica have elaborate massage routines for every stage of labor. The Jamaican midwife may rub the woman’s abdomen with toona leaves, massage the body with olive oil and ease transition pains by patting the belly with a warm, damp rag. Zapotec midwives of southwest Mexico accurately detect the position of the fetus against the spine through massaging the pregnant mother’s legs and evaluating tension and vital energy flow. Mayan uterine massage, practiced by granny healers and midwives, encourages reproductive health and enhances childbearing. The Yucatan midwife gives a routine sobada (massage) during each visit with the mother. The majority of business to be had at a prenatal or postpartum visit occurs during the sobada: discussion, counseling, recommendations and diagnosis.
Seventeenth-century English midwives used oil of lilies to massage laboring women. Malaysian mothers massage their navels with coconut oil to encourage the baby to descend. Japanese midwives practice acupressure, shiatsu and foot and leg massage during labor. Samba, the traditional Japanese word for “midwife,” translates as “the elderly women who massages.” Modern midwives and doulas use sacral counterpressure and pelvic presses to ease low back pain and open the pelvis during labor.
In cultures all over the world, midwives and mothers have massaged and oiled the perineum to increase elasticity and used fundal massage to help the uterus contract during labor and after the birth of the placenta. From a simple holding of hands to an elaborate full-body massage, touch is the foundation and heart of midwifery care. Midwife is Old English for “with woman;” to be “with” means to be in contact through touch, not simply close or nearby.
Midwives and doulas report that massaging mothers during pregnancy allows birth attendants to discover techniques the mother responds to, which they can then use during labor to facilitate relaxation. Aromatherapy massage during pregnancy by a birth partner (with wise use of appropriate oils) can encourage relaxation during labor through a massage with the same aromatic oil blend used prenatally. Prenatal massage by a midwife or doula also allows the pregnant mother to become accustomed to the touch of the birth partner early on. This decreases self-consciousness and feelings of vulnerability, fostering an inner calm vital to undisturbed labor.
Effects of Massage During the Childbearing Year
Intuitively and experientially, women have known that massage and touch are valuable assets during pregnancy and birth. Contemporary scientific research now confirms this ancient wisdom. Tiffany Fields, MD, at the Touch Research Institute in Miami, Florida, has collected extensive data on the profound healing effects of touch. The Journal of Psychosomatic Obstetrics and Gynecology published a study by Fields in 1999 demonstrating that regular massage during pregnancy results in:
- Decreased anxiety
- Improved mood
- Reduced back pain
- Improved sleep patterns
- Reduced leg pain
- Reduced stress hormone levels
- Fewer complications during labor
- Fewer complications for infants following birth
The musculoskeletal system experiences enormous changes during the childbearing year: weight gain (enlargement of the breasts and uterus), muscle stretching (abdominal and perineal), muscle compression (lower back and pelvic), loosening of ligaments (pelvis and uterus) and displacement of the center of gravity. Massage therapy and bodywork are extremely effective in easing the musculoskeletal compensations of pregnancy.
Compassionate touch also nurtures psychological and emotional health. Pregnancy is a transformative event colored with deep emotions. Women’s reactions to their changing body vary greatly. Many women love the beauty and glow of pregnancy and revel in the miraculous changes within their body. Others experience great anguish over their weight gain and rounding belly. Ecstatic feelings of fulfillment may dance with insecurity and depression. Massage during the childbearing year can enhance emotional health by aiding the mother to:
- Enjoy the changing pregnant physique
- Cultivate inner awareness, necessary during labor
- Reduce stress
- Relax deeply
- Trust the birth process
Labor and birth are also greatly affected by the therapeutic massage of a practiced midwife, doula or bodyworker. The Journal of Psychosomatic Obstetrics and Gynecology also published a study by Fields in 1997 demonstrating that massage therapy during labor was highly correlated with:
- Decreased labor pain
- Decreased anxiety
- Shorter labors
Infant massage is a routine and essential part of baby care in numerous cultures. There are long histories of women massaging their babies among indigenous cultures worldwide. Dr. Fields has produced research showing that premature infants who receive gentle and regular massage grow faster and are able to leave the hospital an average of six days earlier than preemies who are not massaged. Women who experience massage during their childbearing year are also more likely to massage their infants. Infants who are massaged regularly by their parents are healthier, grow faster and are well attached to their parents.
Massage can also assist the new mother. Compassionate touch eases the transition into motherhood and the growth of a family. Postpartum massage can:
- Hasten postpartum healing
- Hasten post-cesarean healing
- Promote musculoskeletal realignment
- Prevent depression
- Ease muscle strain caused by infant care
Compassionate healing touch nurtures and supports the physical, psychological, emotional and spiritual transformations of pregnancy. Numerous modalities of massage and bodywork are adaptable to the childbearing year. Acupressure, shiatsu, reflexology, energy work, Craniosacral Therapy, Swedish massage and Esalen massage are a few of the excellent disciplines in bodywork that can enhance the childbearing journey.
The Spectrum of Touch in Maternity Care
Sheila Kitzinger, a social anthropologist of birth, differentiates the types of touch used in childbirth: comforting, therapeutic, blessing, greeting (of the newborn), physically supportive, diagnostic, manipulative, restraining and punitive. This spectrum of touch encompasses the variations of touch from compassionate to invasive. The compassionate elements of touch are the foundation of traditional midwifery care all over the world.
Compassionate touch is overwhelmingly lacking in the medical model of birth, in which doctors and nurses have emphasized diagnostic, manipulative, restraining and punitive touch. Professional midwives, from the lay midwife, certified professional midwife, licensed midwife to the certified nurse-midwife, bridge the spectrum of touch in maternity care. Some professional midwives offer massage, others offer comforting or therapeutic touch during labor, and yet others offer extremely medicalized care with little compassionate touch.
The technocratic model of birth primarily utilizes touch as a diagnostic tool. Instead of the skilled palpation and massage of traditional birth attendants, the medical practitioner diagnoses through vaginal exams, measurements of the fundus, ultrasound, blood pressure checks and fetal heart tone monitors. The art of palpation and therapeutic touch is minimalized and discredited within the medical system as being subjective and therefore unable to stand up in a court of law against monitor readouts and ultrasound imaging. On the other hand, the data from electronic fetal monitoring and other obstetrical tools can be interpreted in a myriad of ways, thus providing unclear and non-objective information that is disconnected from the actual mother and fetus. Obstetrical diagnostic tools have not been proven safer than traditional midwives’ diagnoses through hands-on observation.
Manipulative touch may manifest during the medical model of childbirth in multiple forms. Manual stretching of the cervix during labor, pulling on the infant (via hands, vacuum extractor or forceps), fingers inserted in the rectum to pull the infant down the birth canal, pressure on the fundus and external cephalic versions (manual rotations of a breech fetus) are all examples of manipulative touch. Manipulative touch may assist in a complicated labor through avoiding surgical intervention, or it may complicate a healthy labor with invasive and unnecessary interventions. Increasingly, doctors perform cesarean deliveries without attempting manual rotation of the fetus or after causing complications through unnecessary manipulative touch.
Restraining touch is still frequently employed in crowded hospitals in North and South America. Nurses and aides may restrict movements by holding back arms, legs and hands. Restraining touch can turn into punitive touch, in which nurses or obstetricians slap women’s hands away or perform invasive vaginal examinations, cervical stretching and episiotomies without a woman’s knowledge or permission. In the decades of twilight sleep in the U.S., women were restrained in the lithotomy position to hospital beds while writhing, hollering and screaming during labor. Straight jackets, straps and cuffs were used to immobilize the laboring mother. Restraining touch had transformed into restraining apparatuses. The cruel and inhumane practice of restraining pregnant and laboring women is still in practice in the U.S., particularly with prisoners.
Furthermore, in the medical model of birth, women are often left to labor alone while the nurse and obstetrician attend multiple laboring women. A professional doula or bodyworker can profoundly affect the birth experience in a technocratic setting by providing touch that is comforting, therapeutic and physically supportive. Today, in North America and Europe, the popularity of the massage therapist as labor support is growing quickly.
The traditional midwife primarily utilizes comforting touch, therapeutic touch, blessing touch, greeting touch and diagnostic touch. She is also able to manipulate in non-invasive and hands-on ways, if necessary.
Comforting touch can take place as hand holding, back rubs, a gentle touch on the forehead, hugs or massage. Therapeutic touch can be expressed through various modalities of simple touch and healing bodywork, such as energy work, massage, acupressure and reflexology. Comforting and therapeutic touch can be interchangeable; the only difference, in certain scenarios, may be intention. Together they form the cornerstone of compassionate care as a birth partner.
The greeting touch of midwifery practitioners also differs from that of medical model practitioners in its allegiance to the mother-child relationship. In holistic, mother-child centered maternity care, the infant is placed on the mother’s belly as soon as possible after the birth, except in case of life-threatening emergency. The newborn may be massaged gently to stimulate the respiratory and cardiac systems. Midwives attempt to delay measuring, weighing and examining the infant for as long as possible, so as to allow time for initial bonding. The infant exam may take place on the mother’s belly. The infant is treated carefully and gently. The cutting of the umbilical cord may be delayed until it ceases pulsing or left on, as in lotus birth. The greeting touch supported by the midwifery model of care is that of a gentle midwife, an attending partner or the mother’s own hands. It welcomes the newborn into the family and community.
In hospitals, the bonding process is only partially supported, at best. After cesarean surgery, and frequently during normal births, the newborn is rushed away from the mother to be inspected, measured, weighed and swaddled before the mother can hold her child. Medical practices of greeting the newborn include immediate cutting of the cord, slapping or startling to initiate breath and isolating the child in a nursery where she is deprived of physical human contact and stimulation. Newborns in hospitals frequently experience their first touch in the form of a vacuum extractor, forceps and/or an internal fetal monitor screwed into the baby’s head. Mechanical touching of the newborn in the medical model of care ritualizes the infant as a product of the institution.
Traditional midwives trained in healing touch can diagnose and manipulate without mechanical tools. The ability to receive and interpret information through touch is profound. Awareness of tension, movements, vibrations and warmth can provide information on the state of health in the body. Through pressure on the fundus, compresses on the perineum, pelvic rocking and external rotation of the fetus, traditional birth attendants are able to perform hands-on manipulations. Traditional birth attendants’ hands-on skills integrate valuable health care techniques with compassionate touch.
Physical support may be offered as a lap or shoulder to lean on. The Navajo midwife supports the mother from behind while massaging her belly or back; she is known as “she who holds.” A midwife, doula or partner may physically support the mother in labor while walking, dancing, sitting or squatting. Global birth customs have incorporated ropes, scarves, chairs and tree branches for women to hold on to during contractions. In the hospital, if a woman needs support, she may have a birth partner or be able to use a squatting bar; usually she will be administered pain medication.
The blessing touch of the midwife often takes the form of a “laying on of the hands” or prayer. The midwife does not simply catch the baby, but provides care that aligns with and supports the social and spiritual orientation of the mother. Since the beginning of history, birth has been a spiritual experience for the mother, baby and community.
During the witch hunts of the Middle Ages, thousands of women healers and midwives were killed. A leading witch hunter wrote that the “blessing witch,” she who saved, delivered and healed for good, deserved death most of all. Historically, women healers who integrate spirituality and healing have been oppressed for not supporting the patriarchal medical and religious institutions. This continues today, as midwives are persecuted for practicing “medicine without a license” and attending women in childbirth at home.
Rejuvenating the Touch of Midwifery
Maternity care in the twenty-first century has developed an extreme dependency upon technology. Traditional midwifery arts are being cast aside, particularly the core practice of touch. Verny’s First Law of Psychotechnology in Labor says: “The quantity of technological devices in the labor room is inversely proportional to the amount of human contact between staff and patient.” In order to reclaim the midwifery arts, excess technological dependence in childbearing must be reduced and compassionate touch rejuvenated.
Every woman and labor is unique. Some women desire constant touch and massage throughout the entire labor, others only during specific stages or times, and other women desire to labor alone without touch. Each woman’s preference must be respected, and laboring mothers may change their minds. However, the knowledge that healing touch is available, should they so choose, is a vital assurance and benefit to mothers.
The art of massage is an ancient tradition of health care that is compassionate, empowering and holistic. Midwives, doulas and other birth attendants who massage mothers reap the benefits of increased comfort, closeness and communication with their clients. A calm, soothing, female touch during the intense challenge of labor assures that women’s bodies are sources of strength and power. It is not necessary to be a professional massage therapist to reach out and touch compassionately.
- Field, T., et al. 1999. Pregnant Women Benefit From Massage Therapy. J Psychosom Obstet Gynaecol 19: 31–38.
- Kitzinger, Sheila. 2000. Rediscovering Birth. New York: Simon & Schuster.
- Verny, MD, Thomas R. 1986, Spring. The Psycho-Technology of Pregnancy and Labor. Pre- and Perinatal Psychology Journal 1(1).