Practicum

Tom Findley

One of my clients just became pregnant and is reluctant to continue her series because she has heard that massage in early pregnancy can release toxins harmful to the child. Needless to say, there is nothing in the medical literature. Has anyone heard of this?

Jeffrey Burch

I have been Rolfing pregnant women since 1980, the third year of my practice. No pregnant women presented themselves earlier than that in my career. Since 1980 there have usually been one or two that I am working on at any given time, so by now I have “Rolfed” lots of them. I have had no problems with this work. When the first pregnant woman asked me for Rolfing I talked it over with Ron and Annie McComb who were my mentors at that time. Annie described how she had received her first Rolfing session while pregnant. She gave advice on what to do and what not to do. Later, in an advanced class, Jan Sultan discussed this kind of work. By now I have lost track of who told me just what, and which parts I added.

Here is what I do: in the interview before work, in addition to the usual questions, I ask whether or not she is aware of any problem with the current pregnancy. If she has been pregnant before I ask if she has a history of pregnancy problems. I also ask who her Ob-Gyn and/or midwife is. If the woman doesn’t have one, she needs to get one, and be thoroughly checked out before I will work with her. If there are problems with the current pregnancy other than things that look biomechanical, I usually won’t work with her. My willingness to work with a pregnant woman with a history of problems but no known current problem depends on what the problems were. Some things are one-time events that aren’t so likely to repeat, many are continuing risk factors. Currently I am working with a woman in her fourth pregnancy. The first and third pregnancies miscarried. The problem in both miscarriages was a specific severe, uncorrectable, always fatal, heart defect. This woman is well-educated, emotionally stable and very savvy; we talked about the ins and outs of this problem in detail before we started. (Since first writing this, she carried the child to term, easy birth, beautiful baby.)

Some women have had Rolfing before becoming pregnant others have not. My plan is somewhat different for the two groups. In neither case do I do an ordinary series. The limiting factor is my reticence to work in a pregnant woman’s abdomen.

For those pregnant women who have not had previous Rolfing I often do the first three sessions of a standard series. I wouldn’t do a fourth hour until a couple of weeks before her due date, since I can’t follow through with a fifth hour until after the birth. Also I do the fourth hour only with a firm agreement that she will come back for more Rolfing soon after birth. After the first three sessions we proceed on an as-needed basis to keep the woman out of back problems. Often this means a session every two to three months. Later in pregnancy the rising fundus limits breathing capacity, pregnant women are very glad to have their breathing eased. It is often useful to make a tour of the extremities, starting with hands and feet, and working centrally. The increase in central volume in the body takes up a lot of slack in the system; relieving the ends of the system makes the whole body more comfortable and flexible. For women who have had previous Rolfing the plan is similar except that the early sessions look more like tune-ups than standard 1-3. Sessions later in pregnancy are similar to those for women without Rolfing before pregnancy.

Changes in hormone balance during pregnancy soften the ligaments of the pelvis to facilitate birth. These same changes soften the rest of the connective tissue in the body. Pregnant women usually change very easily with Rolfing. The hormone balance during lactation also makes softer connective tissue, but not as soft as during pregnancy. There have been a few women I worked on before they were pregnant who had very tough connective tissue. Later these same women became pregnant and we used this opportunity to make structural change which had not been previously possible. Bodily changes during pregnancy also produce natural analgesia, very useful for the birth process. Pregnant women are therefore less likely to register pain during Rolfing. Nevertheless, I always work with the minimal pressure that will get the job done. I take my time, not trying for huge change in any one session. I monitor autonomic arousal signs very closely. At the slightest sign of sympathetic arousal I back off. I have found piloerection to be a good early warning sign. More than about three body hairs standing up and I stop working and start asking how they are feeling.

Rolfing after giving birth is very useful to put a woman back together. After delivery I like to work as soon as the woman both has the energy to get to my office and is okay with being touched. The progressive and dramatic changes of pregnancy can leave a woman feeling quite disorganized. Putting these women back on their line is a great gift.

Structure is not the whole story with baby blues, but I believe it lessens the symptoms. After giving birth the abdomen has just been greatly stressed and is undergoing profound readjustment. I go slow, pat things back together, and don’t try for big change. Depending on how the birth was and how the new mother’s health is I let weeks and months go by and healing proceed before I try for bigger structural change. If the woman has not previously had a Ten Series we eventually get back on track. I pay attention to the hallmarks of organization expected of each stage of the basic series. Rarely can we start right in with a fourth or fifth hour. Usually we do some catch-up sessions, sometimes even starting from zero with a first hour, sometimes even earlier with pre-one groundwork. Rolfing is a great boon to pregnant women and new mothers.

About the first trimester issue: the first trimester is the most likely time for spontaneous abortions. Things that go seriously wrong with development in the first trimester can easily be bad enough to result in fetal death. Problems later tend to be more specific and local within the fetus and somewhat less likely to cause death. As I see it, the real risk of first trimester Rolfing is legal. If the woman has a miscarriage she could blame it on the Rolfer. I routinely work on women in the first trimester. Over the years, two have miscarried. This is probably less than the average first trimester miscarriage rate. Neither miscarriage was within three days of a Rolfing session. Neither mother expressed any belief that the Rolfing had caused the miscarriage. Communication is the key. Talk about it before it happens. Occasionally a woman has told me she is now pregnant in the middle of a session, in the middle of series. Whenever it comes up, stop and talk.

Jennifer Albrecht

I’ve worked with many pregnant women, women trying to get pregnant, and women who experienced a miscarriage before starting Rolfing. To me, the best scenario is the woman who has been through the Ten-session series, and wants work during the second and third trimester to keep things open and comfortable. This happens about 2% of the time!

I feel totally comfortable doing sessions 710 if a woman gets pregnant after session 6 or so. If they get pregnant early on, I discuss the pros and cons of Rolfing as previously mentioned in a few posts, and usually they’re interested in some modified work to address the changes that will be occurring. Sessions become gentler, more Rolf Movement-oriented, and with less involvement with the pelvic area.

If a woman is trying to get pregnant, it’s pretty much, go on with the sessions. If she’s not pregnant, we progress to the next session. (I ask them to do a pregnancy test before sessions 4 and 5). I’m pretty meticulous with integrating each session in a way that if we had to stop there for a while, it would work for the client.

I had one client miscarry during a break we had taken until she was done with the first trimester, and, when she came back, she complained that she just didn’t feel like herself; like she was in a state of limbo. Okay, here’s all the wu-wu stuff… in working with her (very tenderly and gently), it was as if the fetus and the mom hadn’t energetically disconnected. We did a beautiful session around allowing the fetus to go on, and allowing the mom to come back into herself. She was so much better after the session. You never know.

One other thing I think is important to be aware of: when working with a pregnant woman, you’re working with two energy fields- the mom’s and the baby’s. I always check in with the fetus to see if it’s “okay” for me to be working with it while I work with the mom, and if I get a strong sense it’s not, we punt. I also explain that to the mom, and, as happened in one session, we worked only on the mom’s feet and neck/ head, and she said it was one of the best sessions she’d ever had. Go figure!

One other story. Four years ago I had a woman call and say she’d heard that Rolfing could help her get pregnant, and when could she start? I told her how Rolfing worked and that I couldn’t guarantee anything, but was willing to give it a try. Two years later she had a beautiful baby girl, whom she named Anna Grace. After delivering, she said to her doc “I told you I was going to get “Rolfed” and get pregnant!”

I just treated her adorable daughter last week. What a blessing.

Louis Schultz

I have “Rolfed” several women throughout their pregnancies. In the late stages, it certainly helps to get the rib cage off the abdomen, lengthen the back and hamstrings. I was told that close to birth, work on the adductors is especially helpful. Women said that they felt work in that area made the delivery much easier.

Clay Cox

I have worked on ten women throughout their pregnancies. Assisted in seven. I am reluctant to do much work past the third hour of traditional Rolfing taught in the 1970’s. I do supportive work and integrative work to help the expectant mother adapt to the rapid changes in her structure, especially during the last of the second and all of the third trimesters. I use traditional 8-9-10 approaches. When asked to do so after 38 weeks, I have also worked the adductors at least half a dozen times with no observable effect whatsoever.

On the outside chance that it is possible to induce labor by mechanical means such as bodywork, I never work 4-5-6 lines on pregnant women.

Cherie Lyon

No pelvis work at ANY time?

How can one help a pregnant woman with severe sciatica? A friend has had it for three years since her first labor and is now in her first trimester with her second child. She has not been “Rolfed” and I have been wondering how I can help her later in her pregnancy.

Clay Cox

I use the Body Cushion System for just about all prone work and always with pregnant women who in the last trimester really appreciate a little time on their stomachs. A significant amount of relief from low back tightness can be easily provided. Some say they would come just to lie on the cushions for an hour.

I also do osseous work with pregnant women to facilitate their accommodating the fetus. As the SI joints spread they rarely do it symmetrically. One hangs up, the left more often than not. Mobilizing the sacrum with trochanter work can facilitate the accommodation with greater ease. I also work the gluteals, rotators, quadriceps, hamstrings, and all general pelvic-related musculature, but always with a superficial approach. Read: No core work or core-evoking work. The best help I can give is often to facilitate the accommodation that the pelvis and low back have to do in the later stages of pregnancy and through delivery.

I guess I should have stated “no intra-pelvic work,” but it is important not to stir up any core stuff. I shift my intention from a sixth hour piriformis approach to a more integrative, inviting, flow-and-glow style of posterior pelvic work from mid-dorsal functional hinge to popliteal fossa to create space and bring ease to the patient.

My suggestion regarding your case in particular is to do a little diagnostic work to safely help your friend. Sciatica is an irritation of the sciatic nerve. Two causes for sciatica often present themselves in my practice. One is generated from dorsal root compression in the L3-4-5 region and radiating down toward the knee. The other is caused by a contracture of the piriformis muscle which puts pressure on the sciatic nerve body itself. Some texts state that as many as 60% of women have the sciatic nerve actually passing through the body of the piriformis itself. (On a side note, this is another piece of the puzzling question of why women have a tendency to carry excess weight in the posterior pelvic region. It may serve to cushion an entrapped and chronically irritated sciatic nerve.)

A rotated lumbar vertebra or a displaced SI joint will often be part of the first scenario. These issues are more easily addressed and more readily resolved the earlier in pregnancy that they are addressed. If the osseous work is not something that you are very comfortable with, this is not the situation to learn in. Refer out, but work with whoever is doing the bone work. Your job is to release everything connected to the area that is going to be adjusted. Follow up the adjustment with additional soft tissue work to help her integrate the change from a three-year-old pattern.

If the sciatica goes unaddressed, there will be a lot more strain on this mother and the fetus as a result. The last trimester will not go well. Neither will deliver as well as they could. Now I have seen delivery straighten out a broken coccyx and settle displaced SI joints, but it is always a hope and a gamble to head in this direction. You have the training, tools and skill to head off a lot of pain and trouble. Use it.

Tom Findley

I might add that about 5% of all pregnancies end in spontaneous abortions. Most people are unaware that the rate is so high, as it often happens early before the woman knows she is pregnant. So we are only aware of the mostly successful pregnancies. But any time a particular group of people is surveyed, this seemingly high rate is found.