Shiatsu In Obstetrics & Gynaecology
By Helen Hunt
About Complementary and Alternative Medicine (CAM)
Complementary and Alternative Therapies is defined as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” (National Centre for Complementary and Alternative Medicine, 2010). CAM is becoming more popular in the United Kingdom, with the rise in the number of people accessing complementary therapies; the NHS reports that a survey carried out by the Office for National Statistics in 2001, showed that one in ten people had accessed some form of complementary medicine in the previous twelve months (NHS Careers, 2010). Sheffield University conducted a survey which showed that the number of GP practices which offer some form of CAM therapy has increased from 39% in 1995 to 49% in 2001 (Sheffield University, 2001, cited in NHS Careers, 2010). This indicates the increased interest in CAM therapies and their increased need.
Integration of Conventional Medicine and CAM
“We need to end the Berlin Wall between complementary and conventional medicine and integrate them. It is not that one is better than the other but that there can be synergy between them both” (Hain, 2004, cited in Dooley, 2006). Thomson (2005, p.6) points out that there is now emphasis on the “NHS as a health service, rather than a sickness service.” This potentially highlights the need for preventative medicine and treatments that can be offered to patients without a long list of side-effects attached. The need for integration of conventional and complementary medicine has now been recognised officially (UK. House of Lords, 2005) with recommendations for further integration from the House of Lords. As an example of integration working harmoniously, Traditional Chinese Medicine (TCM) and Western medicine are practised together in hospitals in China where “Doctors of Western medicine will often invite a TCM practitioner to consult on a particular case, and vice versa” (Zhao, 2006, p.xiii). Patients in China seek out TCM practitioners and Doctors of Western medicine for different reasons according to what their health problem is; further highlighting how Western and TCM can and do work successfully together, as can conventional and complementary medicine.
According to Lundberg (1992, p.11) Shiatsu is a Japanese word which means “finger pressure” and he summarises Shiatsu as “…hand pressure and manipulative techniques to adjust the body’s physical structure and its natural inner energies, to help ward off illness, and maintain good health.” However, Shiatsu uses a range of techniques beyond finger and hand pressure, as explained by Jarmey and Mojay (1999, p.7); a combination of stretching, holding, applying pressure through hands, feet, thumbs, forearms and knees, and “leaning body weight into various parts of the recipient’s body to improve energy flow, blood circulation, flexibility and posture.” See image 1 (The London Women’s Shiatsu Clinic, 2010) showing a Shiatsu Practitioner carrying out Shiatsu, as an example of Shiatsu in the prone position.
Shiatsu has been likened to acupuncture due to it using the same meridians and the same acupoints as in acupuncture. Beresford-Cooke (2003, p.1) explains that Shiatsu is likely to predate acupuncture “since touch is the most instinctive form of healing, we may suppose that the points and meridians were rubbed and pressed long before they were stimulated with the stone needles found at Neolithic sites in China…simple pressure on a point can and does create the same lines of sensation [as acupuncture]”. Why use Shiatsu instead of Acupuncture? Whilst using much of the same theoretical body of knowledge and philosophy as acupuncture, Shiatsu gives the added advantage of touch. Touch provides many benefits to an individual’s health and well-being which will be discussed in more depth later. There are advantages of using acupressure over acupuncture as it is “non-invasive, does not affect the integrity of the epidermis and can be applied easily” (Fassoulaki et al, 2003, cited in Agarwal et al, 2005), and acupressure can be used on individuals with needle phobia.
Shiatsu is a holistic treatment that treats all aspects of a person’s being: physical, emotional and spiritual. This is achieved through consideration and application of TCM theory. While Western conventional medicine focuses on symptoms and disease as cause and effect in terms of a linear progression, TCM regards symptoms and disease very differently; they are “mutually conditioned, arising together. They are not seen as distinct from the environment in which they occur” (Lundberg, 1992, p.13). Lundberg uses an example which illustrates clearly how the theory of TCM and Shiatsu may be used: “A headache is not just an event in the head, according to Chinese medicine, nor is it merely a pain, or something to be stopped without regard for its origins, nor treated on the same basis as someone else’s headache. Rather, it is an obstruction of Ki, related to the overall energy patterns in the whole body of the particular individual, their circumstances, and lifestyle. Treatment might involve work on the arms or legs as well as (or instead of) the head and will bring more lasting and satisfactory changes than will an attempt to block the superficial symptoms.” The difficulty in explaining TCM to Western minds is that it is a very different way of thinking than Western thought. Zhao (2006) summarises this difficulty; “Biases come into play when we seek to understand TCM through the eyes of Western medicine. The development of TCM began more than 5,000 years ago, 4,500 years before the scientific traditions of the West.” Zhao also goes on to describe how TCM has “withstood the test of time” as it is still used as mainstream healthcare in China. There are a number of key concepts that underpin TCM and Shiatsu, however, only the concepts of Ki and meridians will be discussed here to aid understanding of the content that’s presented. It can be difficult to translate these terms into English as the concepts are very different to Western medical/scientific understanding and as Kaptchuk (2000, p.43) clearly states when trying to describe Ki: “no one English word or phrase can adequately capture Qi’s meaning” (Ki is term used in Japan and Qi is the term used in China). As Beresford-Cooke (2003, p.63) attempts to translate the meaning of Ki to aid western understanding, the term ‘energy’ is used as a “Western approximation” to describe Ki. As a more comprehensive translation of Ki, Beinfield and Korngold (1991, p.30) summarises Ki as “An invisible force known only by its effects…In the human being, all functions of the body and mind are manifestations of Qi.”
The Meridians can be seen as channels or pathways that transport Ki around the body; “they comprise an invisible lattice that links together all the fundamental textures and Organs…these channels are unseen but are thought to embody a kind of informational network” according to Kaptchuk (2000, p.105).
Shiatsu is a very versatile treatment in that it can be performed in a variation of environments and modalities, the most common being: on a futon/mat at floor level; lying on a massage couch; or seated in a chair. However, it can be adapted potentially for any position the client is in making it very useful for those who may be bed-ridden or those who need to move around a lot (in the case of pain or when in labour for example). An aspect which makes Shiatsu accessible to most people is that it is performed through clothes, so there is no need for the client to expose any areas of their body during a treatment. Loose clothes are however needed so that the body can be moved easily and freely.
Shiatsu as a therapy was recognised in Japan in the 20th Century, with the incorporation of newer Western medical knowledge of anatomy and physiology with several older forms of treatment (Shiatsu Society, 2010). Some of these older forms of treatment are Anma (from Japan) and Tuina (from China), both of which are forms of bodywork. Beresford-Cooke (2003) outlines that there are three different sources of Shiatsu theory, which are: Five Element theory, TCM (TCM) and Zen Shiatsu. Although there are three different theories underpinning Shiatsu, all of them are based on the fundamentals TCM (Shiatsu Society, 2010). Kaptchuk (2000, p.2) describes TCM as “a coherent and independent system of thought and practice that has been developed over two millennia. Based on ancient texts, it is the result of a continuous process of critical thinking, as well as extensive clinical observation and testing.”
Aside from the theory that underpins Shiatsu, the other component of Shiatsu touch. Touch is used very little in conventional medicine aside from examinations for a range of reasons including the fear of accusations of inappropriate touch. Touch, which is respectful and caring can have profound effects on people’s health. To illustrate the importance of human touch and the many benefits that touch alone can bring, we look at how premature newborn infants rely on human touch for survival, with a study carried out by Lawn et al (2010) which highlights how skin-to-skin contact “substantially reduces neonatal mortality amongst pre-term babies.”
The power of touch has many positive effects such as: alleviating depression; facilitating weight gain in pre-term infants; enhancing attentiveness; reducing pain; reduce stress hormones; improve immune function (The Touch Research Institute, 2010). Conventional medicine is slowly starting to become aware of the beneficial effects of touch as indicated by Dobson (2006): “Touch, a key component of traditional healing, is being increasingly studied in mainstream medicine, with some trials showing symptom benefits in a number of areas.”
When thinking of the basics of human touch, we all know what touch has the potential to communicate. It can communicate a range of messages including: love; safety; confirming that you’ve been heard; reassurance; encouragement; and kindness. All of these messages are important if someone is to flourish on any level (physically, emotionally and spiritually); and what happens on one level effects all the others, according to TCM.
Shiatsu in Obstetrics and Gynaecology
Why focus solely on Shiatsu? Shiatsu is one of the oldest forms of medicine; healing with hands (Lundberg, 1992), and with the increasing advances in technology within the medical world and more specifically within Obstetrics and Gynaecology, Shiatsu can maintain the balance and the humanness of medicine, keeping what the essence of healing is alive. Shiatsu isn’t solely the administering of physical techniques; Jarmey and Mojay (1991) present another aspect of Shiatsu stating that “the spirit of Shiatsu is one of communication through touch. Shiatsu which is responsive to the recipient’s needs cannot be achieved by technical skill and intellectual study alone. To be effective, it requires sensitivity in order to feel and positively influence the quality of vitality within the recipient. Vitality is the basis of health, and reflects the strength and harmony of Ki circulation. Shiatsu which is sensitive and supportive both tonifies and corrects the flow of Ki, thereby helping to restore vitality and prevent disease.” Whilst technological and pharmacological advances within this speciality are necessary and positive in the diagnosis and treatment of the conditions which effect women, in order to keep medicine and healthcare personal and grounded, a modality such as Shiatsu can bring both a healing system with its foundations in TCM but also provide care in its most simplistic form: touch, something which today is overlooked in medicine.
Another reason why Shiatsu has a place specifically in Obstetrics and Gynaecology is that Obstetrics and Gynaecology is a fairly unique speciality, in that it encompasses the normal life transitions of women; for example the transition from childhood to womanhood with the onset of menses, the transition from womanhood to motherhood with pregnancy and childbirth and the transition which the menopause creates later in life. Unlike other branches of medicine, which specialise in organ systems only when there is disease present, much of Obstetrics and Gynaecology is based on the normal development of women and how these transitions in life are managed. Part of Shiatsu’s role is enhancing the natural life cycles of women, supporting women through these various life transitions.
Shiatsu is a treatment that is non-invasive and allows for a gentle approach in treating conditions concerning an intimate part of the body. For example, dysmenorrhoea (painful menstruation) is commonly treated by Shiatsu Practitioners using specific acupoints of the Liver and Spleen meridians according to Ridolfi and Franzen (1996). Whilst some of the acupressure points of these meridians are located over the lower abdomen (a site where pain may be localised in dysmenorrhoea), many of the points which are commonly used are located elsewhere on the body, such as on the legs, hands and feet. Diagnosis and treatment of many gynaecological conditions in conventional medicine involve exposure of the most intimate part of a woman’s body, her genitals, during the gynaecological examination and this can cause a range of problems for women such as anxiety, embarrassment, pain, and feelings of vulnerability and loss of control as reported by Szymoniak et al (2009). It was found that 41.8% of women were embarrassed about undressing and exposing themselves for gynaecological examination according to Yanikkerem et al (2009). Shiatsu practitioners can use acupressure points and techniques away from areas of pain or areas that may cause embarrassment or which may feel invasive or intrusive of an individual’s personal space. For the less severe gynaecological problems where an examination can be delayed, Shiatsu can be used to treat the disharmonies initially, and if unsuccessful, then conventional treatment can commence. This may encourage more women to access treatment for gynaecological disorders if they know they will not have the worry of the gynaecological examination.
An additional reason why Shiatsu should be considered seriously in Obstetrics and Gynaecology is that many of the acupressure points used in a Shiatsu treatment can be taught to patients so that they can self-manage their own care. Patient’s managing their own treatment has many benefits such as: a greater sense of independence; greater sense of control; more autonomy; and increased effectiveness of treatment as patients are more likely to have greater self-awareness around treatment outcomes.
Shiatsu in Obstetrics
Obstetrics is defined by The Oxford Concise Medical Dictionary (2007, p.498) as “the branch of medical science concerned with the care of women during pregnancy, childbirth, and the period of about six weeks following the birth, when the reproductive organs are recovering.”
Not all women fall under the care of obstetricians during their pregnancy; often their care is provided by midwives and there is little or no need for medical intervention. Therefore, when considering Shiatsu’s role in Obstetrics, this needs to be extended to maternity services outside the medical speciality of Obstetrics.
There are four main areas to be considered when looking at Shiatsu’s role within Obstetrics; antenatal care, labour, post-natal care and working with complications. For the pregnant woman, it can be increasingly difficult to find a position that is comfortable, especially towards the end of the pregnancy where her increasing size interferes with mobility and limits what positions the woman can adopt. Shiatsu can be carried out in a variety of positions: sitting; lying in the side position; lying in supine with the support of cushions and bolsters; on all fours using an exercise ball; or sitting in a massage chair. Shiatsu offers women a treatment which is likely to meet their comfort needs.
Shiatsu in antenatal care and labour
Shiatsu’s role in antenatal care is varied and extensive. In the first trimester, Yates (2010) points out the benefits that Shiatsu can provide: stress reduction; relaxation; alleviation of early pregnancy symptoms; encouragement of early pre-natal bonding; encouraging and supporting self-awareness; encouraging working and connecting with the breath, and promoting well-being Engaging with a Shiatsu Practitioner also provides the opportunity for fears, concerns and doubts to be expressed and to explore these worries (Well Mother, 2009). As the pregnancy progresses, through to the second trimester, Shiatsu continues to take on a similar role as in the first trimester but there is greater focus on: preventing conditions arising; encouraging good body posture; and encouraging involvement of the partner (Yates, 2010). Shiatsu in the third trimester focuses on: supporting optimal fetal positioning; supporting increasing tiredness; alleviating anxieties surrounding birth and motherhood; advising women on self-care strategies for birth readiness; and involving the partner in birth preparation (Yates, 2010).
The importance of minimising stress levels was highlighted in a UK population based case control study which identified the risk-factors for first-trimester miscarriage (Maconochi et al, 2007). The Royal College of Obstetricians and Gynaecologists recognise links between stress and adverse birth outcomes, such as: stillbirths; physiological effects on the maternal body; and effects on fetal development (RCOG, 2008). Also, Yates (2010, p.370) explains how Gilbert and Harmon (1986, 1993, 2002) repeatedly state stress and anxiety as “contributing factors to some of the issues resulting in a higher-risk pregnancy.” Northrup advises that increased rest and care during pregnancy is important in limiting stress (Northrup, 2006) as “suboptimal conditions in utero set the stage for adult diseases such as high blood pressure, heart disease and diabetes” (Nathanielsz, 1999, cited in Norhtrup, 2006). If stress is high and there has not been enough rest and care throughout the pregnancy, increased fatigue may be experienced and there is increased risk of premature labour and toxaemia (Muylder et al, 1992., and Newton and Hunt, 1984., cited in Northrup, 2006). When looking at the efficacy of Shiatsu in symptom management, Long (2007) found “the greatest reduction was for symptoms of ‘tension or stress’,” indicating that Shiatsu is a very efficient treatment for stress-reduction. This provides a safe option considering that there is little that conventional medicine can offer for stress management during pregnancy as stress is usually managed using pharmaceuticals which are recommended to be kept to a minimum during pregnancy.
Alleviation of early pregnancy symptoms such as nausea and vomiting can be addressed through Shiatsu. One of the components of Shiatsu is the use of acupressure. There has been research conducted which identifies the benefits of using acupressure on point P6 which is located on the forearm (Arsenault, 2002, and Can Gurkan, 2008, cited by Ebrahimi, 2010). Hyde (1989) in a controlled clinical trial found that acupressure therapy resulted in statistically significant reductions in nausea and Dundee et al (1988) found acupressure point P6 was shown to have a “specific therapeutic effect.”
Encouraging self-awareness is an aspect of care which is often overlooked in conventional medicine since pregnancy and birth has become increasingly medicalised. Shiatsu has a unique role when working with women in promoting this aspect of their care as there are many techniques that encourage self-awareness and promote a ‘tuning-in’ to help women trust their own bodies. By developing self-awareness, women are able to birth instinctively and with less risk of obstetric intervention allowing for reduced risks to mother and baby. Ina May Gaskin, midwife and author, uses an approach which is based on birth being instinctive and uses an approach that inspires self-confidence in women to connect to themselves during the birth process to allow birth to take a natural course. Statistics that Gaskin (2002) has collated from her midwifery practice in America between 1970 and 2000, based on 2028 births shows a caesarean rate of 1.4% whilst the national average in the United States during 2000 was 23% for caesarean section (Centres for Disease Control and Prevention, 2010). Zhao (2006, p.148) in her practice, states that for all the pregnant women she has seen, “their emotional state and their attitudes towards having a baby and what this means to them as woman had a deep impact on the nature of their pregnancies.” Shiatsu encourages women to ‘listen’ to their bodies increasing their self-awareness.
Promotion of good body posture and awareness prepares women for the third trimester where greater demands are placed on the body affecting posture and structural alignment. Backache is common in pregnancy with approximately 70% of women suffering with back pain usually from the fifth month onwards as reported by Yates (2010). In 1990, Fast et al accounted back pain in pregnancy to be the result of either postural changes or muscle spasm (Yates, 2010). Several studies have shown that Shiatsu treatment can have a significant effect on backache as shown in Brady et al (2001), (Field et al, 1999, cited in Well mother, 2009) and Long (2007).
Shiatsu to prepare for labour and provide support during labour has many benefits (Well Mother, 2009) and may include: shorter labour (Lee et al, 2004); less need for medical intervention; a reduction in pain (Hjelmstedt et al, 2010 and Lee et al, 2004) and increased capabilities in managing pain; reduced anxiety; increased in breastfeeding initiation and a number of postpartum benefits such as reduced depression and greater sensitivity of the mother to her child’s needs. Shiatsu during transition can support women in releasing tension in their upper body as “often women pull away from the intensity of feeling in the perineum” and tension then arises in the neck, shoulders and upper back (Yates, 2010, p.295). Shiatsu can also support the delivery of the placenta in the third stage of labour using acupressure and encouraging the woman to remain relaxed and focused (Yates, 2010).
Shiatsu in Post-natal care
According to Yates (2010), Shiatsu can support a woman postnatally in a variety of ways: supporting the restoration of pre-pregnancy physiology; support with back pain; prevent and support in postnatal depression; relieve stress and birth trauma; Shiatsu for baby and showing the Mother how to give Shiatsu to her baby; promotes sleep; support around breastfeeding; and can help with energy levels, improving circulation and allows for opportunity to encourage the woman to start pelvic-floor exercises. Shiatsu supports the readjustments and changes that are taking place on all levels.
Many of the complications that are experienced by women during pregnancy, labour and the postnatal period can be treated with some involvement of Shiatsu; either as a stand-alone treatment in some cases or as a treatment in conjunction with conventional medicine. It needs to be emphasised that even complications which can be treated solely by Shiatsu always need to be assessed by a medical professional and calls even more so for an integrated approach. Yates (2010, p.370) emphasises that complementary practitioners are to “work in close collaboration with the primary care provider…always ensure that the client is receiving appropriate medical care for their condition.”
Firstly, before exploring the specific complications, it is important to look at the more general role Shiatsu has when working with women who are facing complications. Facing complications during pregnancy and during labour brings added worry, stress and anxiety, all of which can have negative effects for mother and baby; Yates (2010, p.370) sees stress reduction as “a primary component of care”. As previously explored, Shiatsu can aid relaxation, reduce stress and can provide an environment for the woman to explore fears, concerns and anxieties. Talking plays a large part of the Shiatsu consultation (duration varying between practitioners) and offers women the opportunity to explore areas of concern.
Shiatsu can be used as an effective treatment for post-term women as shown in studies by Ingram et (2005): “-term women who used shiatsu were significantly more likely to labour spontaneously than those who did not (p=0.038). Of those who had used shiatsu, % more went into spontaneous labour compared to those who were not taught shiatsu.” According to NICE guidelines (2008), options available in conventional medicine for induction of labour are pharmacological interventions (prostaglandins), non-armacological interventions (membrane sweeping) and surgical interventions (amniotomy which is the deliberate rupture of membranes). All of the conventional options for inducing labour have side-effects and are invasive, leading to possible adverse effects for mother and child. Buckley (2009) cites a number of studies which look at the effects of obstetric intervention for post-term induction; In 2007, Battista et alfound that the majority of women who are induced require some form of pain relief, “with more induced women using epidurals, which…further increase the risks of labour complications for mother and baby” (Buckley, 2009, p.71). Buckley (2009) cites three studies which suggest induction may increase chances of a longer second stage of labour and instrumental delivery (Cammu et al, 2002., van Gemund et al, 2003., and Parry et al, 1998, all cited in Buckley, 2009). Buckley (2009, p.72) explains how studies by Phillip et al (2004), Gilbert et (1987) and Stones et al (1993) show that induced labour can increase the risk of postpartum haemorrhage. As a summary, post-term induction carries various risks according to Buckley (2009, p.70) including: “precipitate labour; lack of blood and oxygen for the baby; increased maternal pain and need for pain relief; increased maternal risk of uterine rupture, postpartum haemorrhage, and caesarean;…infection, stress on baby’s skull bones, and possible bleeding in the brain;…cord prolapse and amniotic embolism.” Shiatsu allows for a more gentle, non-invasive and safe option for increasing the chances of spontaneous labour; as reported by Long (2007, p.9): “the findings confirm the safety of shiatsu”.
Assisted delivery in the form of: episiotomy; forceps and ventouse; and caesarean can all be supported by Shiatsu and sometimes prevented. In the case of episiotomy, Shiatsu may help to prevent an episiotomy from happening by helping the woman to relax and take her time with labour. When episiotomy is necessary, the role of the Shiatsu practitioner is to support the woman with relaxation and offer post-natal recommendations such as pelvic-floor exercises and perineal massage. Shiatsu can support healing of the area postnatally (Yates, 2010). Shiatsu can aid with prevention of assisted birth techniques by doing “downward focus work” (Yates, 2010) such as the labour-focus points. The use of forceps and ventouse in labour can be supported by Shiatsu with the continuation of downward focus work and labour -focus points, and post-natal support in recovering from bruising and pain (Yates, 2010, p.362). Caesarean can be planned or carried out as an emergency. Shiatsu’s role in caesarean is focused around making the surgery as special as possible as the mother is still going to give birth to her baby. A focus needs to be around relaxation and encouraging that the mother maintains her connection with the baby (Yates, 2010). The use of acupressure has shown to reduce nausea and vomiting during and after spinal anaesthesia for caesarean section from 53% to 23% compared to placebo (Harmon et al, ). -natal support by the Shiatsu practitioner following a caesarean is crucial as a great deal of healing is required to take place. The focus is on: encouraging energy flow through the abdomen and uterus; encouraging gentle exercises to minimise Ki stagnation; Shiatsu to support exhaustion and blood deficiency; and encouraging ambulation of legs to reduce risk of thrombosis (Yates, 2010). Shiatsu can also support wound healing for the caesarean scar (Yates, 2010).
Shiatsu can support women who have problems such as symphysis pubis instability and weakness of the sacroiliac joint. Shiatsu can strengthen areas of weakness (abdominals, adductors, ligaments, pelvis and symphysis pubis), to “give some release to contracted/overcompensating areas” such as the gluteals, piriformis and iliotibial band (Yates, 2010, p.236).
Shiatsu in Gynaecology
Before looking at disorders and disease, it is important to consider Shiatsu’s role with women who have a normal functioning reproductive system. In TCM, women’s cycles are seen as a normal part of women’s lives. Conventional medicine has historically medicalised certain aspects of menstruation, menopause and childbirth. Shiatsu can support women in connecting with their bodies and specifically to their cycles; it is believed by TCM that the problems faced with menstruation are due to disassociating ourselves from our cycles (Zhao, 2006). Menstruation in Western culture is now seen as an inconvenience and women in the modern day do not offer much time or attention to themselves or their self-care during menstruation. Using Pre-Menstrual Syndrome (PMS) as an example, Zhao (2006) found that “in the West, the physical and emotional manifestations of imbalances in the body had been labelled a syndrome and were negatively associated with [menstruation]…by attributing our symptoms to PMS…[menstruation is] considered a nuisance and a source of much distress.” Shiatsu can serve to support women through the fluctuations that happen on all levels throughout their cycles and throughout their life cycle. Shiatsu used as a preventative measure can both celebrate good health and maintain a healthy constitution for the transitions that exist in a woman’s life.
TCM views gynaecological pathology very differently to Western conventional medicine. The Zhejiang College of TCM (1995, p.15) points out: “Gynaecological disorders are closely related to the whole constitution even though their manifestations appear in the reproductive organs.” In TCM, great importance is placed on considering all aspects of a person to diagnose and treat. TCM recognises that emotions play a significant role in gynaecological health. The Zhejiang College of TCM (1995, p.9) emphasise the role emotions play in gynaecological pathology: “Emotional disturbances are a major disease cause in gynecology”. Not only are women’s emotional states taken seriously when treating gynaecological health problems, the lifestyles women lead and their eating habits play a crucial role in their health. The Zhejiang College of TCM (1995, p.10) recognises that “loss of discipline in food and drink” can contribute to or cause menstrual abnormalities and abnormal vaginal discharge for example.
As we cannot look at an exhaustive list of all gynaecological disorders, categories of disorders will be discussed, they are: menstrual disorders; gynaecological oncology; surgery and the menopause.
Numerous aspects of a woman’s life can impact on her menstrual health. When looking at TCM, it is the Liver meridian which is closely related to menstruation and menstrual disorders (Zhao, 2006). Emotional health is paramount to healthy menstruation and as Zhao (2006) highlights, “Stagnating Liver Qi and Blood are generally a result of suppressed, unexpressed or excessive emotions.” Beresford-Cooke (2007) discusses the important role the Liver meridian plays in regulating emotions from a Zen Shiatsu perspective; imbalances arise in the Liver meridian when “emotional inconsistency, mood swings and bursts of emotional display which are swiftly controlled” manifest. Where the contraceptive pill is the conventional treatment for many menstrual disorders in conventional medicine, Shiatsu can play a vital role in helping women connect to their emotional being, according to Beresford-Cooke (2007): “since the body and the emotions are both different manifestations of Ki in action, the emotions are reharmonized as well as the body at the time of treatment.” Zhao (2006, p58) states that in TCM, the contraceptive pill is said to “cause Liver Qi Stagnation,” which is one of the disharmonies which can lead to menstrual disorders. A randomised controlled trial using acupressure point SP6 for primary dysmenorrhoea showed “Acupressure on the SP6 meridian can be an effective non-invasive nursing intervention for alleviating primary dysmenorrhea and its effects last for 3 h post-treatment” (Mirbagher-Ajorpaz et al, ). Stimulation of points such as SP6 can be taught to women so that they can manage their symptoms themselves without the need for a practitioner or pharmaceutical drugs which have an array of side-effects. The Kidney meridian also has a major part to play in menstrual disorders when imbalance in this Organ system arises; “when out of balance, [kidney] is a major cause of symptoms related to PMS”; such as backache, water retention, bloated abdomen, decreased libido and urinary tract infections (Zhao, 2006, p.60). According to Beresford-Cooke (2007) the Kidneys are related to stress and the Western lifestyle isn’t conducive to successful stress management; working long hours, increasing pressures with regards to money and security. Netdoctor (2005) reports that about one third of women in the UK suffer with PMS, indicating the extent of the problem. As we have seen already, Shiatsu proves to be a very effective treatment for stress.
Shiatsu’s main role in oncology is regarding quality of life. There are many benefits of Shiatsu in gynaecological oncology, such as: support with treatment; helping to alleviate stress and anxiety; support with spiritual exploration; and enabling a number of physiological processes to be enhanced (such as immune function). Shiatsu can support a woman who is undergoing chemotherapy treatment by: reducing fatigue, nausea and vomiting; provide emotional support; and give recommendations for self-care. A 2010 study showed that “acupressure…may be effective in reducing chemotherapy-related nausea and may decrease the antiemetic use after chemotherapy” (Taspinar and Sirin, 2010). In 2004, Chevalier carried out a study to look into the effectiveness of Shiatsu in helping cancer patients overcome the side-effects brought about by chemotherapy and “almost all the side-effects were diminished, some more than others, ranging from 40% to 83% reduction…average rate of improvement for the combined side-effects of all patients was 64%” (Shiatsu Society, 2010). The side-effects ranged from hair loss, nausea and psychological fatigue to shivering, mouth problems, tinnitus and liver pain. Shiatsu’s ability to help alleviate stress and anxiety has previously been discussed and applies to Shiatsu treatments with women who have gynaecological cancer. Bailey, who has worked internationally with people with cancer summarises the many benefits Shiatsu gives people suffering with cancer: “Shiatsu allows someone to feel a genuine sense of support, to relax more deeply, to gain greater awareness of their breathing and thus greater ability to release tensions, causing relief around sites of deep pain. When the mind, body and spirit is in a more harmonious state then, the body’s own healing potential has far greater capacity to become even more effective” (The Shiatsu Society, 2010).
Gynaecological and Obstetrical Surgery
Surgery in Obstetrics and Gynaecology is a major component of diagnosis and treatment. Surgery in obstetrics consists mainly of caesarean surgery. Surgery in Gynaecology is incredibly varied; from laparoscopy (key-hole surgery) to open pelvic surgery (laparotomy). Surgery can be used as an exploratory tool and diagnostic tool as well as for treatment. Shiatsu can play a role in preparing for surgery and healing from surgery. Shiatsu aids relaxation and can specifically reduce anxiety pre-operatively; “acupressure is effective in decreasing…pre-operative anxiety” and could potentially “avoid the need for sedative premedication with its associated side-effects” (Agarwal et al, 2005). Reduced levels of anxiety has profound effects on the healing from surgery and the surgery experience (Rogers et al, 1986, cited by Huddleston, 1996). Shiatsu has been shown to reduce post-operative nausea and vomiting; a study of 410 women showed that “P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynaecological surgery” (Alkaissi et al, 2002). This could potentially reduce the dose of antiemetics used. Regarding post-operative pain, Shiatsu’s use of acupressure can play a significant role in pain reduction as seen by a study carried out by Felhendler and Bjorn (1996) where “the results indicate that pressure on acupoints can decrease postoperative pain.” Reducing pain will mean that less use of analgesics is required which lessens the side-effects such as nausea and vomiting, which can be particularly worrying for the patient having undergone pelvic surgery.
According to Northrup (2006, p.211), the menopause has usually been studied as a “deficiency disease”. Menopause in TCM is viewed more positively as a “natural effort to slow down [ageing] and bring new balance to our advancing years” (Zhao, 2006, p206). Zhao also acknowledges how a woman’s attitude has as much influence on how she experiences the transition as her biochemistry does and highlights that our attitudes “can create distress and pain in our bodies, since what we think and feel exert energetic influence on both our psyche and soma.” Shiatsu plays a major role in processing emotions and can support women in helping to create this transitional time into a joyful, inspiring and empowering time in their lives.
Women have a variety of different experiences with the menopause. Women can experience a number of different symptoms: sweating and hot flushes; sleep disturbances; thinning of skin; vaginal dryness; changes in libido and intensity of orgasms; increased frequency of bladder emptying; osteoporosis and increased risk of heart disease and stroke (Netdoctor, 2010). A study by Yang et al (2008) found that “meridian massage was effective in improving menopausal symptoms.”
The Big Taboo- Female Sexuality
When discussing Obstetrics and Gynaecology, one of the most obvious aspects of women’s health and well-being is rarely discussed; their sexuality. Considering it is the reproductive organs that are being discussed, little is mentioned about a woman’s relationship with her sexuality and the impact this has on her health. As we have seen both in the obstetrics section and the gynaecology section, women’s emotions have a direct impact on the health of their reproductive organs, and women’s intimate relationships and their sexuality effects their emotional well-being greatly. As Northrup (2006, p241) states “The functioning of our sexual organs and our sexual response are determined in large part by our cultural conditioning concerning sexuality.” How the body physically responds to emotions can be illustrated using an example with a woman who does not want to have sex but has been raised feeling that it is her duty to fulfil her partner’s sexual desires; women can suffer with dyspareunia (painful sexual intercourse) and according to Northrup who gives details of a study, where as many as 33.5% of women were having painful intercourse at the time of the study. Northrup (2006, p250) on discussing Ancient Taoist practices, says that “sexual energy is one of our most powerful energies for creating health.” Shiatsu is a holistic treatment which will work women’s relationships with their sexuality, on all levels; physically, emotionally and spiritually. Unlike conventional medicine, Shiatsu embraces all aspects of a person’s being and acknowledges how sexuality can impact on health.
Despite Shiatsu’s many benefits and positive effects on women’s health, there needs to be more extensive research into the field. Currently, Shiatsu along with other CAM therapies struggle to be taken seriously by Western conventional medicine. The problem that exists in research studies into Shiatsu is that Western conventional medicine seems only to respect studies which are randomised, double-blind trials. Michael Dooley in his paper on ‘Complementary therapy and obstetrics and gynaecology: a time to integrate’ presents the problems that exist in using Western conventional studies when testing the efficacy of a CAM therapy: “The randomized placebo controlled study was developed to test new drugs and is based on biomedical assumptions. In a drug trial, the elements such as talking and listening are defined as incidental (placebo) factors and separate from the characteristic drug treatment. In [CAM] the characteristics and incidental factors are intertwined.” (Paterson et al cited in Dooley, 2006).
Regulation is an important factor if Shiatsu is to be integrated with conventional medicine. There needs to be safeguards in place to protect patients from unqualified practitioners and practitioners who practice beyond their limits of competence. Shiatsu practitioners in the UK complete a three year part-time Shiatsu Diploma which qualifies them to practice as a Shiatsu Practitioner. Practitioners can then complete the postgraduate year which qualifies them as a Member on the Register of Professional Practitioners of the Shiatsu Society (MRSS). The Shiatsu Society is the UK’s professional organisation and fulfils the role of the Professional Association for Shiatsu Practitioners. It is part of the European Shiatsu Federation (The Shiatsu Society, 2010). Shiatsu Practitioners should be insured and receive regular supervision.
The practicalities need to be considered if Shiatsu is to be integrated more with conventional medicine. Obstetrics and Gynaecology concern predominately female patients (although treatment can extend to partners when considering infertility, and maternity support) which brings up questions that need considering such as: ‘what about the safety of female patients when visiting practitioners at a home clinic?’, and ‘what about the ethics of using touch-based therapies in a speciality focusing on women’s reproductive organs?’ Practitioners should undergo a CRB (Criminal Records Bureau) check which is a safeguard which goes some way in protecting patients. Using touch-based therapies in a speciality which is involved with an intimate part of the body calls for even greater need for supervision and Continuing Professional Development as emotional factors that impact on the reproductive organs (such as sexual abuse) can cause pathology in this area. There is currently an organisation which offers postgraduate training in pregnancy for Shiatsu practitioners, focusing on all aspects of pregnancy, birth and babyhood. The organisation is called Well Mother and is the main leading international organisation that offers training in this field. Shiatsu practitioners who are wanting to specialise in women’s health, need to be looking at undertaking Continuing Professional Development courses with organisations such as Well Mother.
From the evidence presented here, Shiatsu can certainly have greater involvement in the treatment of gynaecological disorders when initially presented in primary care. Due to its versatility, Shiatsu can be carried out in a number of locations: GP practices; practitioner’s home clinics; and complementary health centres. Shiatsu practitioners can be involved in specialist areas of care, such as: early pregnancy clinics; well woman clinics; surgery; gynaecological oncology; and general gynaecology. As Shiatsu is a very safe treatment for all aspects of Obstetrics and Gynaecology (on the condition that there is: good communication between both Shiatsu practitioners and conventional medical staff; practitioners operate within their limits of competency; and regular supervision is accessed), Shiatsu can provide an effective treatment in the majority of areas of this speciality enabling: a greater variety of treatment options to patients; a decrease in the medication and surgery used; enhanced patient responsibility; and improved quality of life for patients. As mentioned above, greater research is required and employers should take steps to ensure professional registration, insurance and competence of Shiatsu practitioners. Greater funding into Shiatsu and CAM in general needs to be addressed as it is difficult to prove the efficacy of a treatment if the funding doesn’t exist.
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