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by Patti Saha, Community Midwife, London

(from Well Mother Newsletter July 2000)

Midwife Patti Saha, working in London, attended one of my 6 day shiatsu courses for midwives recently. Her story illustrates how safely, easily and effectively shiatsu skills can be integrated into midwifery practice. Patti had just attended 2 of the 6 days when she encountered the following opportunity to apply some of her skills and is now building them more and more into her

I am a community midwife working in a team of six, providing total care to a caseload of women throughout their confinement. I was on-call when Hatty paged to say that she was in labour, first baby, term plus 6.Her labour had started 2 days ago with irregular contractions. However, her contractions had become regular and painful for the past 2 hours and she was thinking of having some form of pain relief as she was getting tired.

I met Hatty and her partner Mike in the delivery suite. I had already met Hatty during her pregnancy twice and
spoken on the phone a couple times, so knew her a little. On admission Hatty’s vital signs and baby’s heart tracing was within the norm expected. On internal examination her cervix was 4 cm dilated and the presenting part engaged. The membranes ruptured spontaneously during the examination.

Hatty had a birth plan which included an epidural for pain relief so I thought she wouldn’t be amenable to
complementary therapy to ease her labour, but she said that she will try to manage for as long as she can. Her contractions had become irregular and less strong following admission so I encouraged Hatty to mobilize to allow the presenting part to descend and stimulate contractions but Hatty declined as she felt tired and wanted to rest.

I suggested a foot massage to help Hatty relax and worked some shiatsu points. I am not sure if it was the
massage / acupressure or just nature taking its course, but Hatty’s contractions became regular and within an hour she was requesting an epidural. However, the anaesthetist was busy in the operating theatre with an emergency caesarean section and so meanwhile I commenced Hatty on Entonox and suggested she turn on ‘all fours’ to alleviate back discomfort. It would also enable me to massage her back.

© Jules Selmes Beautiful Birth

Alternative pain relief was offered, but Hatty declined. The top of the bed was raised and I positioned a bean bag for Hatty to lean over. Mike was supporting her in the front and I encouraged him to massage Hatty’s shoulders as she was all hunched up. I remembered gall bladder 21 points on the top of the shoulders which is suppose to have a descending effect and got Mike to massage the shoulder area while I began giving light massage to Hatty’s sacral area. Her pain was mainly in the suprapubic area and as labour progressed I also
applied thumb pressure to the sacral grooves, alternating with leaning with my palms down on the sacral area. Hatty said it felt good to have pressure on that area. Previously, I would instinctively massage but now after learning more about Shiatsu, I now think in terms of chi flowing through meridians which when stagnate (jitsu) or deficient (kyo) could cause problems in a person’s wellbeing. The flow of chi is encouraged by the application of pressure to meridian points to ‘move’ the stagnation or ‘tonify’ the deficiency to bring relief.

The anaesthetist was still unavailable due to another emergency and it was over an hour since Hatty had first
requested an epidural. Luckily she was still coping with her labour, but I felt I was failing to give her what she had planned. I compensated by giving all my energy to do what I could to ease her pain. As she was still kneeling over the head of the bed, I realised that her ankles were neatly propped up and I could work on them. I remembered that there were points around the malleolus that would help with pain relief and taught Mike to continue the sacral massage whilst I concentrated on the new area.

I organised the siting of an intravenous drip in anticipation for the anaesthetist but she was still busy!!
Anyway, I realised that labour may be progressing well as Hatty was beginning to breathe differently and making some grunting noises. It was at this stage that the anaesthetist became available. I thought I had better examine Hatty prior to any intervention and, lo and behold I couldn’t believe it, Hatty was nearly fully dilated and the baby’s head had descended well into the pelvis. Hatty felt she was really ‘going somewhere’ and we said ‘no thank you’ to the epidural. It had only taken 3 hours for Hatty to reach this stage. A baby boy weighing 7lbs 8oz was delivered after 35 minutes of second stage. Hatty and Mike were jubilant and couldn’t believe
that she had a literal ‘drug free’ labour. Not by choice! But it turned out so well.

I must admit that my experience in using complementary therapies as part of the care to the women I look after
is limited at present. However, this case has given me confidence to realise that labour can be managed differently. I just can’t wait for my next case!

I saw Hatty on the postnatal ward the following day and we had a chance to debrief. I was worried that Hatty
may be upset that she did not have an epidural as she had wanted. Hatty said she felt that the contractions were painful but it was bearable. She said that the work I was doing on her back was comforting and the fact that I was there beside her was important.

Hatty is really pleased with her care and she said she felt very proud of herself for coping with her labour
without drugs. That is EMPOWERMENT!!

I am very excited that I can offer alternative care to women in childbirth. I feel that though childbirth is
very much medicalised it can work ‘hand in hand’ with complementary therapies to enable the women to have the best of both worlds.

Patti Saha, Community Midwife, London

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