During my recent "Shiatsu for midwives" course, I was teaching the section on optimal foetal positioning. I saw it more as a revision section on different antenatal exercises, as so many midwives are now aware of Jean Sutton’s excellent work. As the session went on, I began to realise that many of the things which I have integrated into my work with pregnant mums were unfamiliar to the midwives. They encouraged me to write an article - so here it is.

One of the keys to my work is emphasising the importance of the all fours position. Not only working with the cat stretch and other pelvic tilting and circling movements, with which you are probably familiar, but also crawling. Crawling is a fundamental part of training to be a shiatsu practitioner because in crawling you are moving from the abdomen. In Shiatsu this is a vital energy centre known as the hara. It is important when working with someone to be making contact with pressure, which is a key part of shiatsu work, by leaning in from your hara and not your shoulders. This way your body is more relaxed, you feel less tired and the person you are working on, experiences it as a much deeper and yet more comfortable kind of pressure. I always vividly recall one of my early training weekends, when we spent hours crawling around. It was a very powerful exercise, seeming to open up memories and different ways of experiencing things. We crawled forward and backwards and side to side, on our own and with other people, crawling over people, crawling up to objects. I felt like a small baby again, exploring the world for the first time.

This is what makes crawling important - cross patterned crawling, moving one arm and the opposite leg, which is the natural and relaxed way to crawl, actually integrates right and left brain functioning. It is an important developmental stage for a baby to do through as it patterns the brain in a particular way. In modern culture, we tend to over-emphasise the use of the left side of the brain, which deals with intellectual things and under-use the right side. It is useful for anyone to re-integrate both sides of the brain, but particularly in pregnancy when so many changes are occurring, on physical and emotional levels, over which our rational brain has little control. These days when antenatal care emphasises the aspects of pregnancy which are measurable, focusing on the rational side of the brain, it is often in itself anxiety producing. Women need to have support to focus in on themselves, to connect with their more intuitive sides in simple tangible ways. In labour, the crawling position offers an opportunity to contact the primitive aspects of the brain, and allow the mother to open up to the process of birth.

In our cultures it seems extremely odd to be crawling around, used as we are to sitting at desks. Nothing we do in our day to day lives involves this position any more. At least in the past women were scrubbing floors - but upright hoovers and mops have eliminated this. I encourage women to begin to spend time each day in the all fours position from as soon as I first meet them in their pregnancy, so they have time in which to learn to be comfortable in it. It is also beneficial for the back and the abdominal muscles - and is a safe position for most women. I have only occasionally known women not be comfortable in all fours after a little practise - and that was 2 women who had extremely severe and debilitating diastis symphis pubis - one was confined to bed for the last 3 months of her pregnancy and could only move on walking sticks. If women are suffering from diastisis symphysis pubis, then they do need to be careful to keep their knees close together and not to do any rocking back ward movements which open the hips, but otherwise it is usually comfortable and safe. Women with mild carpal tunnel syndrome may find they need to keep easing their wrists or rest over the side of a chair on their forearms, but in fact the gentle stretching of the wrists which occurs during crawling in small amounts, sometimes eases mild carpal tunnel syndrome. I suggest that mums explore crawling - going forwards and backwards, doing some rocking movements and pelvic tilting, as well as resting over a chair or beanbag, each day. If they start early in pregnancy it becomes part of their routine.

I find if I explain to them the importance of this position, both for helping their baby to settle in the anterior position and for their backs and abdominal muscles they are more than happy to do this. Especially as their pregnancy progresses and they may begin to experience some back aches, they soon find it is eased by these movements and they are motivated to continue. I find introducing it early on, means that the baby is much less likely to settle into the posterior position. I explain that it is sitting and especially sitting in car seats that encourage the baby to settle posteriorly and so if they do a lot of these activities they need to definitely spend time each day in the all fours position. If from 28 weeks they find their baby is posterior, and I encourage them to be aware of the kind of fetal movements they would experience as well as checking with their midwives, to get into all fours 2-3 times a day for as long as they feel comfortable, but ideally at least 5 minutes each time. If they have been using this position from early pregnancy, it is quite comfortable for them. The cat stretch is the most effective, but crawling around on all fours can also be effective. Some women prefer to crawl backwards, and it lengthens the spine in a different way from forward crawling. If they are really uncomfortable, or get tired easily, then they can simply rest over a chair, or beanbag.

I would strongly recommend that you go away and practice crawling and other all fours movements. The midwives on my course, had not really explored these movements for themselves and were reluctant initially to spend much time in them. As we kept going back to them, they became more relaxed. I think until they had fully experienced the benefits for themselves, some were half heartedly recommending these positions. In my experience, if women adopt all fours positions from early on in pregnancy and work with them more if their baby is posterior, the baby will turn in about 99% of cases. Midwives on my course had a much lower rate of success. I think this is also partly due to women only going into all fours when their baby had already been settled into the posterior position for some time.

I also suggest these positions to women with transverse babies, and find that again, in most cases, the baby will move. One key feature of the way I work is to encourage the mums to be aware of the baby in this process - to be aware themselves of the position their baby is in and also when the baby is moving or not. Success is greatly increased if the mum gets into these positions when the baby is moving. I am a firm believer that the body tries its best to get the baby in the best position for birth (i.e. LOA) and also that the baby is working with the mum. Encouraging this 2 way communication in whatever way is most comfortable for the mum greatly enhances the success. The baby is not a passive recipient of care, but an active participant. Some mums become more aware of their baby through physical things, like movements and massaging their abdomen, or breathing deeply and letting the movement of breath in the abdomen surround their baby. Some mums find simple visualisations helpful. - picturing their baby, imagining what they are feeling. It is important to find things which each mum can relate to and encourage them to find their own ways.

I work a lot with including the babies, and some midwives on the course, initially found my thoughts in this a bit strange. Gradually through sharing some of their own experiences of pregnancy, or those of friends, they began to realise how much midwifery care can sometimes neglect the baby as a living, feeling, responding person, by all its measuring and monitoring. In Eastern cultures, from where Shiatsu has evolved, it is considered that life in the womb represents the evolution of humans as a species in the ocean of the earth, until the time of the rising of land, a biological period of 2.8 billion years. This means that each day in the womb represents 10 million years of evolution. The baby is incredibly sensitive to all sorts of influences - the mother was meant to spend her pregnancy being peaceful and relaxed. This idealised view is not always possible in busy modern living with many mums working - but I believe that by considering the baby as a person and communicating with them as such, the baby can assimilate its womb experiences better and the bonding process is begun in the womb, not just after birth.

I apply these same ideas to turning a breech baby. Most midwives are aware of the knee to chest positions for turning a breech. Some years ago when I had suggested this position to a mum, she reported back that her baby had been awake when she’d done it and she had felt the baby moving around from breech to cephalic. I thought about this and realised that a baby is not likely to be sound asleep and then wake up because the mum is in the knee to chest position and then turn. Ever since then, I have told mums to adopt the knee to chest position when their baby is awake, Unfortunately many babies have their most active time in the middle of the night. Mums don’t seem to mind too much getting onto all fours on their bed if it means their baby is more likely to turn. This has greatly increased the success I have had from the knee to chest position. Many mums since then have also told me they felt their baby move from breech to cephalic.

With breech babies, I always tell mums not to squat if they know that their baby is breech as this is going to encourage the baby to settle more into the breech position. However as soon as they know definitely that their baby is cephalic, I encourage them to do as much squatting as they feel comfortable with, as this will encourage the baby’s head to go deeper in the pelvis and make it less likely that the baby will turn back to breech again.

There are also various acupuncture points, some of which you may have heard of, which are the same ones we use as shiatsu practitioners to encourage babies to move. I work with these as well, but I do find what really makes the difference is actively involving the mum and the baby, as I have described above.