Contents

1. Introduction

2. Birth process - yin needs

3. Obstacles to the process - Wood energy

4. Muscular tension
muscle and resting tone
how feeling states influence resting tone
muscle and memory

5. Yang environments
merchant bank
hospital

6. Muscle tension and emotional states
anger
anxiety
motivated
at ease

7. Some ways of letting go
Breathing
Movement
Touch

8. Conclusion

9. References

1. Introduction

During the 'Well Mother' course, I've understood that birth complications often come out of an inability to let go of tension. Difficulties like exhaustion and inability to dilate can turn low-risk births into caesarian operations. If a mother was able to trust her physical and intuitive sensation of what is happening, and not work against it by tensing up, the physiology of the birth process could 'flow' as it should and she could direct her effort more effectively. But this requires familiarity with different body feelings and experience of listening internally to what feels 'right'.

Most of my shiatsu clients work in a merchant bank and have forgotten how to do this. They are used to relating to their body from the outside, often ignoring it except when it hurts. Aside from accidents they often don't know why it's hurting - sometimes they feel it's tense, but sometimes they are unaware of even extreme tension. If something needs to change, they expect it to be done from the outside and to be the work of someone who knows more about their body than they do, like a drug company, a doctor, or an osteopath. Their working lifestyle and their hospital experiences in pregnancy and labour contribute to this separation from the body. In a shiatsu or on-site massage they need coaxing into picking up body sensations before they can let go.

This paper looks first briefly at the birth process and how it can be blocked by tension. It describes how muscle tension is built up. Knowing something of the physiology can explain why relaxation techniques, especially supportive touch, can help to 'let go'. I describe how the Yang kind of lifestyle led by my clients can raise their level of tension and encourages them to forget their body, and how this is reinforced by the hospital environment. Then I discuss some of the ways in which these obstacles can be overcome. Throughout I am referring to fairly ordinary muscular tension, resulting from a mixture of emotions, posture, reactions to external stress … something which is so much a part of day to day life that people tend not to pay it much attention. The examples I give are more sketches than detailed studies. I'm also generally referring to women who'd be classified as 'low risk' by a hospital. I think that first time mothers in particular underestimate the influence of their muscle tension because they don't realise what physiological complications it can create, and that they are already much more tense than they think they are. Their overall attitude to their body is important in how easily they can let go.

2. Birth process

Birth is one of the elementary body processes that function at the level of hormonal release, motor reflexes and instinct. It is rooted in the brainstem and nervous systems at a deep Yin level and is shared with other mammals. It therefore functions best when a woman can work with it, 'being' it, rather than being outside of it. A Yin environment, like those developed by Frederick Leboyer and Michel Odent, would encourage the connection with this part of the brain, a Yang environment tends to discourage it.

Five Elements
There is a lovely progression through the Shen cycle from pregnancy to motherhood. Pregnancy is a Water state of physical and emotional of change. Birth itself is the transition from Water to Wood. If Wood energy flows smoothly, the cervix can dilate, and the power of contractions can be focused into the downward movement of the baby into the birth canal. After birth is the time of bonding with the baby, in unconditional love, the most positive aspect of Fire energy.

Client K said that in the first few weeks after birth she'd look at her new baby and just cry, she was so full of love for her.

Loving and nurturing the baby with milk, touch and bodily contact, grows into the period where Earth dominates. As the baby becomes more of an observable personality, with its own boundaries, there is an awareness that mother and baby are no longer the same, (Metal) and a healthy separation between mother and baby develops.

Pregnancy and birth can be seen in the cosmological cycle as a movement through the central axis from Water, through the centre of Earth, to Fire and the same unconditional love. The flow of both these cycles fits with the flow of birth, which naturally begins in the night, moves to birth in early morning, and to bonding and nourishing in the day.

3. Obstacles to the process - Wood energy

All the five element energies are adversely affected by the constriction of a high amount of tension. Flow of body fluids (Water) and circulation of blood (Fire) is reduced. Muscles and tendons (Earth, Wood) are deprived of energy and accumulate waste. Digestion suffers. The lungs don't expand sufficiently and respiration at a cellular level (Metal) is restricted. Imbalances can result and negative emotions can be created. Wood energy is particularly susceptible to being thrown off balance by influences that affect the free flow of Ki.

There are a number of things about unbalanced Wood energy that are potential obstacles to the birth process. First, it has a tendency to become stuck. The Liver meridian passes through the uterus and cervix, which are very much affected by the flow of Liver energy. Under stress, if Liver energy sticks, the cervix cannot dilate. This prolongs the first stage of labour and exhausts the energy available, which is still predominantly Water. If Water energy is blocked or runs out, exhaustion can set in and the woman can lose the will and drive to continue. She gets stuck in transition and cannot access the expulsive power of Wood energy (Client L). A sudden release of Liver energy later in birth could damage soft tissue, as in tearing, and trapped Liver energy can damage ligaments, as in damage to the coccyx if it is held too tightly to move with the baby (Client A).

Second, it naturally tends to rise. Excess rising Liver energy (Liver Yang) encourages a focus in the mind instead of the body. This upward movement also goes against the downward flow needed in labour. If it rises too strongly, it takes with it other energy from the hara, and can be difficult for an individual to stay centred because everything else has been thrown off balance. Rising Liver energy is often associated with impatience and frustration that can turn into anger. "Anger is considered the most damaging of the five emotions as it permeates all levels of the energy system functions" (Ridolfi). I believe this is because it interferes with the Liver's ability to ensure the smooth flow of Ki, creating stagnation and tension. It's interesting that Sheila Kitzinger quotes an African tradition of telling the mother to get rid of all her anger because it's felt that anger prevents labour from progressing.

There is a strong connection between Liver energy, tendons and ligaments. There are particularly important ligaments in the horizontal planes of shoulders and hips, and tension across here would provide another obstacle to the downward flow of birth. It is also an obstacle to expansion, in that the ligaments hold the limbs in to the body.

These examples show how tension can interfere with all stages of the reproductive process.

Conception
Radiologist had tried IVF three times without success. She worked full time seeing cancer patients and felt that the stressfulness of her work - the X-rays, the patients who were often terminally ill, or in distress - was a factor in this. She took six months off work, and in that time she had another IVF, which was successful. She did not return to work until after the birth of the baby. I did not treat this person, but think she illustrates how the energy of conception could be blocked by emotional and physical tension.

Overdue
Client S came for shiatsu because she was overdue and wanted to avoid being artificially induced. She was worried that she had lost contact with the baby, who was very 'out front' and no longer seemed to move 'with' her. She had had difficulties with her own mother and was worried that she and the baby were already not getting on. Her shoulders were quite tense, and although her hip rotations were smooth, there was a great deal of energy in her sacrum, pelvis and lumbar area. (Now I wonder if this was energy of the baby - felt like a plane ready for take-off! I was sure labour would start if she could get over her fear and stop holding on. Did strong work around GB and hips, KD and SP, and talked with her about how much positive energy I was picking up from her. She found this very reassuring, and labour did begin, very slowly, late that evening..

Dilation
Client L - came for onsite massage before pregnancy, and for 6 half-hour shiatsus during second half of pregnancy. Had very bad morning sickness. Held a great deal of tension in shoulder, neck and upper arms - her upper arm muscles would feel solid to me. In on-site massage her arms would float out and backwards. Yang meridians in upper body were jitsu, although the energy would partially release in a session. Her hip movements were OK. I always suggested that she do shoulder rotations and gentle arm swings whenever she could during the day, but don't think she did. She was very happy in her pregnancy once the morning sickness stopped. She had some oedema but her Kidney energy seemed strong. I was more concerned about her Spleen energy, and that under stress she would tense up again. She took 7 weeks leave before birth, was always a little over-weight, and not very fit. Attended ante-natal yoga. Had a long first stage of labour and did not dilate beyond about 4 cm. She became exhausted to the point of giving up and had a caesarian.

4. Muscular tension

Tension manifests as extreme muscular or emotional rigidity. This is felt in a rotation when there is stickiness in the movement, or clicks in the tendons, or the client 'takes over'. There may be no weight in the arm, or the arm floats out to the side, because it is being held so tightly by muscles in the shoulder socket and neck, and in the deeper muscles underneath the scapula. This can happen when the person is to all appearances 'relaxed'.

Muscles and Resting Tone:
Muscles are designed to perform movement with the minimum effort required to produce the action. There are sensory organs in muscle tendons (Golgi tendon organs) and sensory cells in the muscle itself that constantly monitor the required degree of contraction or lengthening of the muscle and how that fits in to the position of the body as a whole in relation to external forces like gravity, and to the amount of resistance encountered in, say, picking up an object. When a muscle is not actively contracting or lengthening and is at rest, it is not completely flaccid. It maintains a resting 'tone', where some, but not all of the muscle cells are active. If all cells were active, the muscle would be completely rigid. This activity consumes a great deal of energy and the constriction it creates restricts the muscle's supply of fresh energy and its removal of waste. The muscle has a sliding scale of resting tone - the higher the tone, the more muscle motor cells are active. At any time, different areas of the body will have a different resting tone, depending on what activity the body is involved in.

How Feeling States Influence Resting Tone:
This monitoring activity and tone setting takes place below our level of conscious awareness in the brainstem. The way in which something is done, or the 'decision' on how much tension is required to do it, is controlled by neural impulses descending from the higher brain cortex and interacting with the monitoring impulses. Life experiences, emotions associated with experiences, taught beliefs, memories and current emotions are all registered in the cortex and can influence that decision. So for example, enthusiasm can create a setting that might allow muscles to be strained, and embarassment can create a setting where muscle movement is inhibited or hesitant. In 'Job's Body', Deane Juhan says: "… objects pull on my muscles from the outside, and my emotions pull on my muscles from the inside; a pull from either vantage point increases the tension on the muscle."
In a stressful environment, a person's sense of what is normal for their muscles can be distorted by emotion. They may feel physically or emotionally threatened, and tense up as part of their reaction to this. Their local muscle tone settings are tightened up. A perceived threat can also activate basic withdrawal and a crossed-extensor reflex, which contract and twists the body away from a threat. There is also the hormonal stimulus of the stress response, preparing physiologically for escape. Humans draw their back muscles together in preparation to stand up and fight with their arms. These are subconscious reflexes, which happen almost before we are consciously aware of the threat. They can be activated by imaginary and psychological as well as physical threats. This tightening raises muscle resting tone. Perhaps that is part of the association of anger, Wood energy and tendons.

Muscle and Memory
The human brain has a huge capacity for learning and refining skills throughout life. Most skills involve muscle activity and are learned by registering the sensation of the movement involved. This is based on the information provided by the sensory organs in the muscle fibres and tendons. It becomes a kinetic template of how it normally feels to perform the activity, and is stored below the level of consciousness. The template, or memory of the movement is called a sensory engram. As well as the sensory sensations of the movement, emotional associations that were present as it was being learned, are also part of the engram. There's no physiological distinction between mind and body, everything is one. This is how people can develop a 'cringing' posture, or a 'swaggering gait', associated with particular emotional states. Calling up the emotional state can also call up a muscular state:

Oliver Sacks describes how, after an accident, he learned to walk freely again as he heard a piece of music. The emotional state that went with his memory of the music was 'Joy, life, intoxicating movement', and as he felt that state, he was able to walk 'easily - joyfully, with the music'.

This is similar to the experience of Client K, and shows how pleasant emotional associations, either physical (real), or remembered (imaginary) can encourage someone to expand and open.

Client K was very aware of the need to relax and open in the first stage of labour, and she tried to think of a time when she'd been most relaxed. Her husband suggested the tropical beach from their honeymoon, and as soon as she thought of that, she felt her body relaxing. So he described the beach, and K visualized it, especially on the out-breath. She had been very cautious about her ability to cope with labour, saying she would not be 'a martyr' but she was able to cope well throughout the first stage without pain relief, with sacral massage, using sacral massage, breathing and visualizing the beach.

I've found that for my clients, letting go of tension is a skill that has to be learned or re-learned.

Client J had not had shiatsu before coming for 12 weekly treatments in her second pregnancy. She carried a lot of tension in her neck and shoulders, and there would always be some point in the session where her shoulder rotation would become jerky.. At some point in each session I drew her attention to how her shoulders/neck were feeling. We talked about the connection between the neck and the cervix. Early on in labour, when she was alone in hospital overnight, she found a position where she could lean forwards and extend her neck, to counteract her tendency to tighten there, and persevered with that. Her first stage was shorter than before, she was far less tired, and had less gas and air, and felt that she had better strategies for coping with contractions.

5. Yang Environments

A merchant bank
My bank clients spend most of their time at work, and in commuting to work, and they are noticeably less tense when they've had a few days' leave. Sometimes they are tense to the extent that I really doubt their ability to have a natural birth. It has made me wonder if there are just too many external influences in their lives (apart from whatever personal issues they may have) that are opposed to relaxing and letting go, and opposed to focusing on and listening to the physical side of their own bodies.

A merchant bank is a Yang environment - ambitious, impatient, competitive. Staff work long hours (Client T was working a twelve hour day, for a while, two months before her due date) and their posture suffers. People often eat at their desk. They enjoy their work, and the facilities, the salary and the 'buzz'. Information has to be absorbed very quickly - traders have five monitors to watch on their desk, most people have one or two. It's a sedentary existence where there is no need to breathe deeply or move very much. Their tension settles in the horizontal planes of the occiput, neck/shoulders, diaphragm and hips, especially shoulders. Those who can afford it might go to the gym. Men have more outlets for physical exercise than women, in football and other sports teams. Most staff are young and their constitutions can absorb many damaging influences. However, when the women also have to deal with the physical and emotional changes of their first pregnancy, they sometimes become 'wiped out' with tiredness early on, suggesting this environment has been sapping their intake of post-natal ki and taxing their Kidney and Spleen energy.

Client K worked in 'line management' where she was responsible for a team of people. This involved training and disciplining them, and making sure their work met the requirements of those further up the line. She worked long hours, enjoyed her work, found the people management the most stressful side and felt the demands most in early pregnancy when she worked long hours to the point of exhaustion: she would begin to shake and spend the weekend asleep. She was normally able to contain her emotions but became tearful. Her doctor signed her off for two weeks' rest for nervous exhaustion and over-work, and when she came back, her job was changed to shorter hours - 9.00 - 6.00 - and no line management, which helped. Early in pregnancy she would be 'wiped out' on some days and too tired to come into work. She felt this tiredness especially in her muscles, as if her limbs were too heavy to move.

Commuting is another strain. As well as being tiring and frustrating, being squashed in busy public transport can feel like a 'threat' when pregnant.

Client E (strong Liver energy) shouted at a man on the station platform "For God's sake, stop pushing, can't you see I'm pregnant?" She said she'd felt she had to protect her baby.
There are also things in the work environment that can make people forget their body (relating to others via telephone, screen, doing nothing that involves physical effort or the lower brain, always tasks that involve the higher brain). This separation can be so marked that it's impossible for them to experience their body internally. It's as if they are operating only at the level of mind (Yang, Fire) and have lost touch with the grounding force of Earth and Water (Yin) as far as they themselves are concerned, as far as work is concerned they are very focused and practical.

Hospital environment
This separation can be reinforced in ante-natal visits and in hospital, where what is felt internally is less important than what is 'really' happening on a monitor screen or felt by someone else in an examination.
Hospital staff told one mother repeatedly that according to their monitors she was not in labour, although her waters had broken and she'd had contractions for most of the day. On examination they found that she was about 7 cm dilated.
Most hospitals are also very Yang environments which depend upon higher brain activity: comparing statistics, writing notes, taking personal details, measurements, questions, seeing rather than experiencing. They are also impatient and can be unwilling to wait for someone whose birth is naturally taking longer than their range of time says is acceptable.
Michel Odent lists three basic aspects of the hospital environment that work directly against birth physiology:
Bright lights - stimulate activity in the higher brain
Conversation - spoken language is a higher brain activity, especially recalling practical details for form-filling
Being observed - the presence of monitors and people observing mother and baby is felt as a lack of privacy and inhibiting influences from the higher brain interfere with freedom of expression and movement, creating tension.

I'd expect this fundamental conflict between environment and physiological needs to create tension at a very deep level in the mother. There is also the element of stress hormones. Adrenalin is the antagonist of oxytocin, and oxytocin stimulates contractions, so activation of the stress response in early labour slows contractions. This explains why contractions frequently disappear on arrival in hospital and have to be artificially started again. The factor more likely than any other to raise stress hormones is a perceived lack of control (Sapolsky). It's common for women to feel that they have no control over what happens in hospital, especially first-time mothers, who say afterwards that they would have liked to move more but felt unable to ask, they would have liked to have the monitor belt taken off but didn't like to ask. In their second pregnancy three mothers told me the first thing they want is more control. I would expect these feelings to increase their level of stress hormones, and also to increase their level of muscle tension because of the conflict between wanting to move and not actually moving.

6. Muscle tension and emotional states

Most of the clients, men and women, in the bank suffer from discomfort arising from muscular tension, but there are different emotional qualities which seem to make it difficult or easy for them to let it go.

Anger
A very few want 'it' to go away without any involvement on their part, are not open to new ideas, usually with a big Liver imbalance, with very rigid ligaments. I'd expect them to get stuck in labour, but it's possible that the force of their excess Liver energy would carry them through.

Client A was on her back for most of her first labour and delivery. A few days after the birth her upper back went into spasm and she was unable to move. 27 weeks into the second pregnancy she came for shiatsu because of wandering (Liver related?) pain in the lower back, coccyx and groin (not in symphisis pubis) which was worse on getting out of bed. A physiotherapist had given her a support belt, but said they could not help with the groin pain. Did not appear to know about SPD. She seemed very jitsu in upper body. I sensed anger and inflexibility. There was strong energy in her sacrum and legs, but not in arm meridians, and GV seemed blocked around T8 - 12, which was where her back had seized up. Hip and shoulder sockets would not rotate more than an inch without resisting (Liver). She'd not noticed any tension there before, was unaware of any discomfort or that she was resisting. She had no difficulty lying in supine (legs propped up) or side, but got up very stiffly off the floor, said it felt like getting out of bed. Phoned later in week to see how she was and suggest she come for upper body shiatsu, (sitting), as it would help her tension. She said 'What's the point? It's my back that hurts.' I think she damaged her coccyx in the first labour, through being on her back and probably not letting go.

Anxiety
More clients are open to new ideas and able to make connections between mind and body. They are more anxious, unwilling to make time for themselves, as if they are less important than their work (Earth). One pregnant employee, in an anxious, stressed state, said she felt better at the end of the session, but she really could not take the time off again from her desk. She was a PA to a 'workaholic' boss. The anxious clients are usually tense all over, but less rigid - more muscle than ligament.

Client T also had a great deal of tension in her shoulders and hips. Before pregnancy she went to yoga classes and enjoyed aromatherapy massage, but stopped because of tiredness in first trimester. She'd seen an osteopath for low back pain and a physio for a stiff left shoulder. She did not have the structural problems of client A but in pregnancy had constant low back-ache.
She could only come every three weeks and was very dominated by immediate, work concerns. Her meridian energy was strong; GB and LV meridians were very always very tight in thighs, SP/ST weaker. Back-ache was eased by shiatsu and by spending time on all-fours. She would often try to 'help' in rotations, which were sticky. With prompting she was able to give over some control of a limb and to focus her attention in her body, as she had in yoga. For instance, on the outbreath she created a really smooth release of tension in her hip joint and was able to feel the difference and the lengthening. I felt a release of energy along ST meridian as we did this. She'd already learned how to use the out-breath in yoga, and I suggested that she spend ten minutes a day on this kind of visualization at home, and see the aromatherapist agains, felt she needed to nurture Earth, including her self-image. Unfortunately she was diagnosed with diabetes, requiring injections of insulin. I saw her for a treatment six weeks later and asked if she'd done any 'relaxing' visualizations or exercises - no. In January she'd been working until 10 pm. Her husband now drove her to work, and she dozed in the car. She said she had no energy to spare for anything except managing the diabetes and continuing to work until maternity leave in mid-February, two weeks before the caesarian.

Motivated
Some clients' tension is more neutral, and localised, reflecting physical demands on their posture at work and at home. They are open to new ideas and prepared to make time for themselves. Their local tension releases to some degree in a session.

Client J had not had shiatsu or massage but I felt that she already knew before coming for shiatsu that she needed to find a way of going 'inside' her body and experiencing and responding to the demands of labour from there. She had no major discomforts in pregnancy (her second) but she thought she didn't sit well at work, and at home she lifted and carried her small son around, which created shoulder and neck tension. She came weekly for shiatsu and inbetween practiced crawling and the cat, which relieved any backache. Shortly before her due date there was a possibility that the baby was breech and she was booked for external version. She spent the weekend on all fours, knees to chest, and massaging BL67, whenever the baby was active, which her family found very amusing, but on the Monday the baby was definitely not breech. Client J was very motivated to find out about new things and to use whatever she could find to prepare for labour, because in her first labour she hadn't felt in control. She was naturally very focused, with strong Earth energy and she had support from her husband and family even though they didn't understand what she was doing..

At Ease
There are a very few people in the bank who are familiar with and enjoy massage, only some of whom have an interest in alternative therapies. They already know how to release their tension quickly during a session, with a sense of relief and familiarity.

Client E had done a course in aromatherapy and uses oils for people and horses. Her sister is an anaesthetist and acupuncturist. She was familiar with shiatsu and would relax and doze within five minutes. She enjoyed her work at the bank but found commuting very stressful when pregnant. Used a birth ball for back bends until late in pregnancy and enjoyed all stretches. She had a lot of liver energy that needed expression in movement and hated delays. Although she had this Liver energy, she had ways of releasing it, and her musculature was not tight. She tended to Spleen deficiency. Her placenta had attached low down, ( poor Spleen energy?) but did not grow towards the cervix. Although she was impatient outside sessions, in a treatment she enjoyed the 'comforting' Earth feel of hara gathering and holding, as well as the stretches and after the treatment was curious about 'what did you find … I felt this ".

7. Some ways of letting go and re-connecting with the body

From reading and observing, I'd describe 'letting go' as allowing and encouraging the yourself (body and attitudes) to expand from a constricted, or over-tense state imposed by the higher brain. Mostly the word 'relaxing' is used when someone is being encouraged to become un-tense, but 'letting go' gives a better suggestion of what to do. Letting go is not holding on, and if you can demonstrate to a client that they are holding on (i.e doing something) then it gives them a starting point from which to work. They can choose not to 'do' that any more. This is a large part of Alexander Technique teaching.

In shiatsu with these clients I've tried to release their Yang energy, which is holding on so tightly, by stretches and movement, and support their Yin energy with meridian work, holding the hara. It's often hard to connect along PV and CV (GV is no problem) so I try to balance upper and lower burners with holding, and working TH. I also suggest ways in which they can focus on this side of life.

Going back to muscles and memory, visualisation, movement, simple breathing techniques, being touched (energetic holding, massage, working points) and receiving strong emotional support can all enable a person to let go, because these things can create a pleasant, comfortable emotional sate. They also stimulate activity in the parasympathetic nervous system and lower brain. All require practice and repetition by the mother and birth partner, so that the brain/body becomes familiar with them and the higher brain is not involved in remembering the theory of how to 'do' them.

Breathing and the out-breath
The Liver meridian connects with the Lung meridian, so there must be a close connection here, with breathing affecting Wood energy and vice versa. This would make the out-breath very effective in influencing tension and encouraging expansion. Meditation practices focusing on the breath and on creating a sense of ease in body posture (just sitting quietly) calm the mind (Fire) and draw it down into the body. Breathing into the hara encourages an opening of the central channel, and a flow along the vertical axis of Fire, Earth, Water. This kind of activity is usually very foreign to my clients.

Client D found it hard to relax during sessions (eyes open) until she had had 3 or 4 treatments and been away for a weekend in the country. Later in pregnancy she suffered from palpitations and panic attacks. It was hard for her Heart energy to descend, because her diaphragm would tighten up, and there seemed to be a gap there in PV. I suggested that she hold Heart - Uterus before going to sleep (restless, thinking), try stretching to ease ribcage, and worked a lot with Kidney and PV; working HT meridian was most calming for her. The most effective help was to suggest she concentrate on the feel of her breath moving through her nostrils as she breathed in and out, especially the out-breath. She said that focusing on the sensation made her stop thinkng and calmed her.

Antenatal classes teach breathing techniques for coping with contractions in labour, but these are often presented as a mechanical 'coping' or 'relaxation' technique. They don't necessarily emphasize that the breathing should be in tune with the body, so that it comes out of what is happening, rather than imposed on it from the outside. Sheila Kitzinger says 'A woman … can only go with the rhythm if she can accept what is happening in her body and assent to it'. This will be very difficult for women who have not had the experience of being 'in' their body, and difficult in a state of tension

Movement
In pregnancy, crawling encourages reconnection with the ground, and a sense of the weight of the body experienced on all fours (Earth). The Wellmother exercises, especially those involving stretches of the body, would help keep energy moving. In early labour, the rhythmic movement of rocking, walking, swaying, can encourage a sinking into the body and into lower brain activity.

Touch
Our whole early experience comes from touching and being touched.by something 'other'. Deane Juhan says 'my sense of my own surface is very vague until I touch'. If a mother and baby are attached to monitors, with hospital staff looking at the screens, her sense of her own body, which is where all these things are happening, may become more vague than it already is. To be without boundaries when one is under stress is to be without support and substance, completely without a sense of Earth and centre, and increases anxiety and levels of tension.

Client J asked her sister to use the girdle vessel hold while she was on her side being told not to push. She said that without this encircling, supporting hold, she could not have coped. When I'd showed it to them, they'd thought they'd look 'a bit funny' using it, although Client J had said it felt very good. It turned out to be a major help to them in labour. The fact that Client J asked for it indicates how she was in tune with what her body needed. She did cope throughout labour with only some gas and air.

It's necessary to feel secure in order to be able to do nothing and let the process happen, which is why the security provided by the Earth nature of supportive touch is so effective. The presence of a doula or one midwife throughout labour is another example. Supportive touch is a contrast to the invasive procedures of internal examinations, injections and monitoring. The hospital environment tends not to acknowledge the importance of emotional states and from what I have heard, underestimates the effect that the attitude of hospital staff has on mothers. If the staff are not 'earthed' and focused, they won't inspire confidence. The environment also starves mothers of supportive touch. However, when they receive it, their system responds very quickly. Midwives describe mothers as being so 'grateful' and 'thankful' for a brief massage, emotions which go with an opening and reaching out.

One midwife reported working on an anxious, exhausted woman who was otherwise alone and not dilating in spite of severe contractions. If there was no change, she would have a caesarian. The midwife gave a few minutes' massage and worked points, and the woman fell asleep. In the time that she was asleep, she dilated very quickly and the baby was born soon afterwards.

There is the 'endorphin effect' of comforting touch, and of working points, where the body is stimulated to release its own endorphins and to let go of tension. Husbands/partners are often with the mother, but may feel inhibited about stroking and caressing her in the presence of strangers. Those who have been able to use shiatsu points and massage felt they had something 'official' to do, and that their touch made a difference.

Just feeling happy can help.

Michel Odent spoke of a mother in early labour sharing a hospital room with a woman who had given birth. This being France, the family and the expectant mother were celebrating with champagne. The mother's contractions came on strongly and her baby was born after an uncomplicated labour.

8. Conclusion

The lack of experience that my clients have of hard physical effort, their sedentary lifestyle and the stress of working long hours throughout pregnancy, make them vulnerable to exhaustion in labour. Their tendency to hold tension in rather than let it go, especially holding across horizontal planes makes them vulnerable to 'failing to progress'. Hospital staff are more and more restricted in what they can allow to happen by the narrowing of policy on what is a risk. Ranges are set because they can be pointed to on monitors and made into rules, but birth is a bodily process and each body is different - so limits are crossed and then intervention begins. It often ends in an emergency caesarian, and the impact of this on women and babies can be considerable. How considerable can depend on the hospital environment: Client K had an emergency caesarian, and felt supported throughout. Another client in a different hospital, felt traumatized. Both babies have benefited from cranial osteopathy.

Most people don't seem to notice that the Yang hospital environment is so opposed to the Yin requirements of birth physiology. Perhaps it's because the tensions are usually unseen - women often don't like to ask for what they feel they need. So an inability to relax can be attributed to just the woman, when in fact she's in a situation which is working against her ability to relax. If women are habitually very tense, they are even less able to relax. They need a great deal of support to help them let go and to stay focused and connected with their body.

Tension and inability to let go are factors which can be at the start of intervention, but they can be positively affected by various activities and treatments during pregnancy that encourage familiarity with 'feeling' rather than 'doing'. Not 'doing' is a new experience for most of my clients and they need time to get the feel of it prior to labour. The first step is often helping them to know the bodily feel of a relaxed state.