Supporting Women with Shiatsu
- another tool for keeping birth normal

This article was first published in MIDIRS midwifery digest Vol.8 No.4 (December 1998)

Anything that can enable women to have more confidence in their bodies is vital in these days of high tech living and high tech birth. There is now an increasing acceptance of complementary therapies in midwifery. Yet the number of ultrasound scans, other forms of screening and Caesareans continues to rise. As the 'birth machine' (Marsden Wagner) continues to grow, so we also need to keep developing support for women simply to anable to connect with their own bodies and their own wisdom.

As a Shiatsu practitioner and childbirth educator, I feel Shiatsu one form of 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 under-used as a tool in supporting women and their families. Many midwives have embraced massage and aromatherapy into their practice, 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 which is different from and complementary to other forms of massage.

I wonder if this is simply because a full massage training is 6 months or less, whereas the full Shiatsu training is usually 3 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 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, skin, releasing physical tension and promoting relaxation It also works with the energetic pathways (meridians) and encompasses work on the emotions, the psyche, 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.

Shiatsu was rationalised in Japan at the beginning of this century - but has its origins thousands of years In Japan today, there tends to be more emphasis in Shiatsu on a style which relies a lot on anatomy and physiology, and muscoskeletal work partly as a result of the strong Western influences in culture and in medicine, with their scientific, material based viewpoint.

It is by contrast, the more spiritual Zen aspects of Shiatsu which may be more attractive to us in the West. Some teachers in the UK do work more with the physical aspects of Shiatsu - they may have trained as physiotherapists, or osteopaths. Others focus more with 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.

The benefits for women from a qualified Shiatsu practitioner

In practical terms, a Shiatsu session offered by a practitioner of Shiatsu usually lasts from 1-1/4 hours. It involves some time spent talking, assessing through listening and observation diagnosis, then about 40-50 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 mainly their hands, especially the thumbs and palms to apply pressure all over the body. Stretches and also techniques more similar to massage like stroking and kneading are included. Afterwards some time is give to relaxation and then feedback. Shiatsu is not simply about 'having a massage' but about guiding the client in the process of become more aware of the energy in their body and self-development is an important part of that. Sometimes people don't want to do much 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 back ache, leg cramps though to depression, anxiety, stress. It is the whole person rather than simply the condition with which we work but often many of the 'symptoms' disappear after only 1 or 2 sessions. The very nature of Shiatsu means that the woman is enabled to connect more deeply with her body and baby, and begin to experience aspects of herself she may not have been in contact with before. Postnatally work can continue, and again most 'symptoms' can be addressed. It is also possible to work with the new-born baby, and I often teach parents a form of baby massage which is Shiatsu based.

The benefits for women cared for by a midwife trained in Shiatsu work

Midwives, after a few days training, can learn techniques which can easily be built into your practice. You can learn different ways of touching the abdomen (in Shiatsu known as the Hara - an important energy centre of the body) which 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 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 mothers to feel more confident about their body. 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 how effective even a little of this work can be - sometimes having worked on the back to relieve back ache, 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 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 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 20th 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 as a tool for personal development of midwives

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, then it emphasises 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 on-going discipline of being a therapist is self development work. It is not possible to re-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 ones own energy. This lessens the possibility of getting 'burn out', fatigue and stress, or even absorb any disturbed, exhausted energies of the person you are working with.

The way forward and integration into the Maternity Services

I believe that 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 6 day course aimed at teaching the relevant aspects of Shiatsu to midwives. The focus will be very much at 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 how many midwives are 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 more easily able to be researched. 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.

copyright © Suzanne Yates October 1998