Massage & Bodywork

September/October 2009

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Stephanie Halderman, EMT, director of the Eastern Holistic Center, has been instructing acupressure and massage for pregnant women for years, and says she has not learned of Bladder 60 being a contraindicated point. "B60 is not a forbidden point, so it is safe to massage. Light, gentle, full strokes [effleurage] is fine and will not induce labor around the ankles (but focused work can)," she says. Kensen Saito, director and co- founder of the International Academy of Tokyo in Canada and author of Shiatsu-doh (Cross Media, 2004), trained under Tokujiro Namikoshi, the founder of shiatsu whose motto was, "The heart of shiatsu is like a mother's love. Pressing the human body stimulates the fountains of life." Saito says that safety is the key to treating clients. He works gently on the whole body with pregnant women, including the ankles in most cases. The only danger and concern Saito expresses is the improper application of pressure that may be too deep and strong. This type of intensive pressure application would be injurious to both the tissues and the emotion of the client, he says. IN THE END Ultimately, the ankle massage warning seems to refer to stimulation of acupoint Bladder 60. The other ankle points that pregnancy massage sources have labeled with concern do not have properties that bring on contractions, and may actually support a pregnancy. So the question remains: what is the likelihood of causing significant or dangerous contractions by stimulating Bladder 60 with stroking and squeezing along the Achilles tendon for a few moments during a foot massage? The likelihood seems remote for several reasons: massage therapists typically do not repetitively massage one specific spot posterior to the ankle for extended periods; general effleurage does not have the same effects as acupressure; and Bladder 60 is not generally used alone or as a primary contraction stimulator. This is not to say that one should rub the Achilles tendon with gusto for hours on end. Nurturing, gentle touch is always expected and appropriate during pregnancy. Clarifying contraindications can reduce both therapist and client's fears about the delicacy of pregnancy and improve awareness about the prevalence of miscarriages unrelated to external forces. If we have concern about stimulating Bladder 60 with effleurage and want to avoid it, then to be consistent, we must, as Betts says, also avoid massage to areas of all the prohibited points. Ironically, the more powerful contraindicated acupoints on the hand (Large Intestine 4), inner calf (Spleen 6), and sacrum (Bladder 32) have not formerly elicited massage contraindications. Alternatively, we can offer nurturing gentle massage that includes those areas, while following more critical and relevant guidelines for safety in positioning, pressure, and observation for thrombosis and varicose veins. And we can educate the public on the benefits and safety of prenatal massage along the way. massage specialist, doula, writer, and hospice nurse. She has taught perinatal bodywork at the Oregon School of Massage since 1993, initiating the 60-hour Maternity Massage certification program in 2007. She is the author of Nurturing Massage for Pregnancy: A Practical Guide to Bodywork for the Perinatal Cycle (Lippincott Williams & Wilkins, 2009) and the instructor on the DVD, Mastering Pregnancy Massage. Her other DVDs, Mothertouch: Nurturing Touch for Birth and the upcoming Touch Techniques for Birth, are based on her experience attending hundreds of hospital and home births. Reach her at touch4birth@gmail.com. Leslie Stager, RN, LMT, is a perinatal NOTES 1. Colleen Moriarty, "Soft Touch," Fit Pregnancy. Available at www.fitpregnancy.com/ style/113?subsection=beauty& (accessed July 2009). 2. Online discussion. Available at http://forums. online-sweepstakes.com/showthread. php?t=639959 (accessed July 2009). 3. Ibid. 4. Ibid. 5. The Merck Manual of Medical Information, 2nd ed., ed. M.H. Beers (Whitehouse Station, N.J.: Merck & Co., 2004-2005). 6. Early Pregnancy Loss: Miscarriage and Molar Pregnancy, ACOG Education Pamphlet Item #AP090 (American College of Obstetricians and Gynecologists, 2002). 7. R. Rai and L. Regan, "Recurrent Miscarriage," Lancet 368, (2006): 601-11. 8. S. Ventura et al. "Estimated Pregnancy Rates for the United States. 1990-2000: An Update." National Vital Statistics Report from the U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, 52, no. 23 (June 15, 2004). 9. A.J. Wilcox et al. "Early Loss of Pregnancy," New England Journal of Medicine 319, no. 4, (1988): 189–94. 10. K. Kleinhaus et al. "Paternal Age and Spontaneous Abortion," Obstetrics & Gynecology, 108, no. 2, (2006):369-77. 11. R. Slama et al. "Influence of Paternal Age on the Risk of Spontaneous Abortion." American Journal of Epidemiology,161, no. 9 (2005): 816-23. 12. "Report to the NACHHD Council," National Institute of Child Health and Human Development, NIH, DHHS. Division of Epidemiology, Statistics, and Prevention Research (DESPR), NICHD. (Washington, DC: U.S. Government Printing Office, 2001). Available at www.nichd.nih.gov/publications/pubs_details. cfm?from=&pubs_id=128 (accessed September 2007). 13. Elaine Stillerman. Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork (St. Louis: Mosby Publishing, 2008). 14. Carole Osborne. Pre and Perinatal Massage Therapy (San Diego: Body Therapy Associates,1998). 15. Bette L. Waters. Massage During Pregnancy, 2nd ed. (Mesilla, NM: Blue Water Press). 16. N. Kvorning et al. "Acupuncture Relieves Pelvic and Low-back Pain in Late Pregnancy," Acta Obstetricia et Gynecologica Scandinavica, 83 (2004): 246-50. connect with your colleagues on massageprofessionals.com 75

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