Shiatsu Treatment for Postpartum Women

In the fall of 2020, I delivered twins at 32 weeks in New York, far from my family, during the COVID-19 pandemic. Despite the circumstances, I received unwavering support and love from my partner.

During pregnancy, my body underwent remarkable changes as I created not one life, but two. These transformations included structural shifts in my pelvis and ribcage, significant weight-bearing challenges, lower back pain, unprecedented breast enlargement, and edema in my legs and feet, among other changes.

Post-delivery, beyond the emotional adjustments, I struggled to feel at ease in my body due to the physical void left after pregnancy and the accompanying musculoskeletal changes. Despite my decade-long background in Pilates and yoga, including pre-natal and postpartum exercise training, experiencing these changes firsthand provided an entirely new perspective. Nothing could have fully prepared me for the physical reality of pregnancy and postpartum recovery.

I gradually initiated my recovery with pelvic floor exercises, beginning with Kegel exercises. As my strength returned, I incorporated abdominal strengthening exercises and specific stretches designed to restore joint mobility and help my body transition from its pregnancy state. While I didn't experience severe discomfort, I noticed persistent discomfort in my pelvic bones and ribcage that lasted several months.

Approximately one year postpartum, I began studying Shiatsu and discovered alternative approaches to supporting the muscular system, ligaments, and connective tissues.

In this article, I will explore the orthopedic changes and common pathologies experienced by postpartum women, both as a direct result of pregnancy and due to the postural adaptations required in caring for a newborn. I will also address how factors such as sleep deprivation and nutritional challenges impact these changes, offering relevant recommendations.

Pregnancy and Postpartum Physical Changes

During pregnancy, alongside hormonal and emotional transitions, a woman's body undergoes extensive modifications to support fetal development. These changes significantly impact the musculoskeletal system. A primary factor is the production of relaxin and progesterone hormones, which soften tendons and ligaments to accommodate fetal growth and ultimately facilitate delivery through the birth canal. This softening affects all soft tissues, potentially weakening stabilizing muscles at a time when the body requires increased strength and stability. This disparity often leads to common orthopedic conditions that may persist postpartum.

Birth-Related Changes

During vaginal delivery, many women opt for epidural anesthesia for pain management, which can sometimes result in residual back or leg pain. The delivery process stretches the pelvic floor muscles, occasionally causing tears. In some cases, an episiotomy may be performed to prevent anal tears, necessitating perineal sutures postpartum.

For caesarean deliveries, the procedure involves incisions in the lower abdominal muscles along the bikini line and in the uterus, requiring postoperative sutures. Like any surgery, recovery is extended and necessitates specific rehabilitation of the abdominal muscles.

Postpartum Lifestyle Adaptations

The transition to motherhood introduces new postural challenges:

- Carrying an infant in various positions

- Nursing or bottle-feeding positions

- Stroller navigation

- Baby-wearing

- Interrupted sleep patterns, sometimes while nursing

These adaptations can lead to discomfort in multiple areas:

- Cervical spine

- Shoulder girdle

- Wrists

- Lower back

- Rectus abdominis muscles

- Latissimus dorsi muscles

- Pelvic region

Common Meridian Pathologies in Postpartum Women

Kidney Qi

Pregnancy and childbirth can deplete Kidney Qi through:

- Fetal development demands

- Blood and fluid loss during delivery

- Increased stress on the lower back and perineum during pregnancy

These factors often result in weakness in the lower back and pelvic region.

Spleen Qi

The Spleen Qi, responsible for organ positioning, typically experiences the greatest impact during late

pregnancy. The growing fetus can create qi stagnation in the middle heater, potentially leading to:

- Compromised qi flow

- Spleen deficiency

- Fluid retention

Liver Qi

Kidney qi deficiency may trigger:

- Increased liver yang

- Liver qi stagnation

Leading to:

- Tendon and ligament issues

- Emotional instability

- Cervical tension

- Migraines

Special Meridians

Pregnancy and childbirth can deplete yin and blood through:

- Maternal resources supporting fetal development

- Blood loss during delivery

This affects several meridians:

- CV meridian (yin regulation)

- Spleen meridian (postnatal blood production)

- CHONG meridian (blood supply and circulation)

Common postpartum syndromes include:

- Yin or blood deficiency

- Qi stagnation

- Dampness and phlegm in the CV, KID, SP, LIV, and CHONG meridians

Clinical manifestations often include discomfort in:

- Pelvic floor

- Pelvic girdle

- Lower back

- Neckline

- Shoulders

- Wrists (carpal tunnel syndrome)

- Diastasis recti

Treatment Approach

Postpartum treatment requires a long-term perspective, emphasizing:

- Nutritional support for substance-level strengthening

- Flexibility in treatment delivery, sometimes accommodating the presence of the newborn

- Focus on the Earth element to restore centeredness and stability

Treatment is customized based on individual complaints while maintaining the foundational Earth element support. The orthopedic approach is gentle, primarily strengthening organ function where deficient. Various pathologies often interconnect; for example, pelvic floor weakness may correlate with abdominal muscle weakness, while cervical tension may affect the shoulder girdle and wrist, or vice versa.

Optimal results are achieved through:

- Concurrent herbal nutritional support

- Integration of movement and breathing practices

- Early intervention for maximum effectiveness

This period presents a unique opportunity for therapeutic support, offering:

- Rest and recuperation time

- Self-care opportunities

- Personal reflection space

*Note: In Traditional Chinese Medicine, meridians are energy pathways connecting to internal organs. Each organ's function and influence may differ from Western medical perspectives. For example, kidney qi deficiency doesn't necessarily indicate Western kidney pathology.

References

- West, Z. "Acupuncture in Pregnancy and Childbirth"

- Sela, K., Seslov, Y., Binyamin, T., & Shreibom, N. "The Clinical Guide to Gynecology in Traditional

Chinese Medicine"