Shonnie Carson: Would you discuss your thoughts on when and how it is appropriate to do Rolfing Structural Integration (SI) for a client who is pregnant, what work is appropriate and what is not, and what things practitioners should be cautious about?

Pilar Martin: I think of Rolfing SI with adults as more of a refinement process of development and embodiment. I do not feel it is appropriate to do any series work during pregnancy, as the body is going through such enormous changes. I apply the midwifery approach to pregnancy, which is you don’t do anything that is not necessary. I tell my pregnant ladies, “If you are having any pain or problems come and see me. Otherwise just have your pregnancy but for sure come and see me after your delivery to make sure everything comes back to where it should be.” I tell them, if they have no problems, come and see me about a month after the pregnancy. If they have problems with pain or incontinence, then call me and I usually go to their house. Sometimes during birth the symphysis pubis gets dislocated and it is very painful. It is very easy to normalize when you work with it early as opposed to much later.

You do not want to do work on or relating to the pelvis during the first three months of pregnancy. This is not because it would pose a particular risk, but rather because the highest incidence of miscarriage is during the first trimester (three months), and you would not want a woman to think the miscarriage resulted from your manipulations. It is for your protection as a practitioner.

SC: I often see questions on practitioner forums like, “I have a new client who is pregnant and wants to do the Ten Series,” or “I have a client who has had the first two sessions and has discovered she is pregnant; what should I do?” How would you respond to those questions?

PM: I always tell women who want to have the Ten Series that is it not appropriate to do that work during pregnancy. The purpose of the Series is to help the person orient more successfully to gravity. You cannot do the series work on a person who is shifting in shape and volume and has a constantly changing relationship with gravity. If you wish to do some symptomatic relief work on the neck, shoulder girdle, ribs, or lower back, that would be appropriate to help her body accommodate to the changes. After the seventh month, any work should be done in sidelying position.

SC: Are there any other precautions you would like to mention?

PM: Yes, you know often there are discussions about manipulating the perineum just before birth. Unless you have had specialized training (and have appropriate licensure) you should not be doing this. The perineal tissues are very enlarged and thinned and full of fluids and you could really make a mess. If you do a lot of manipulation you could create more swelling. So, if you are not a midwife and know exactly how to do it, you should not do it.

SC: What kinds of activity do you recommend postpartum?

PM: Walking is great, swimming if you like to swim, and Pilates is excellent.

SC: The only thing I caution people about with Pilates is to not be tucking their tail under all the time.

PM: Absolutely. You have to find a really good Pilates instructor. I also recommend The Gyrotonic Expansion System® Method, that is great. I usually have a team of people I can refer to like a good movement person, Pilates, Gyrotonics, a good pediatrician, and others I can refer mothers to for specific help.

SC: What other things would you like to address?

PM: Teach them how to carry the baby. In the front in the beginning and then in the back. Use one of those carry slings for both.

SC: Great! What else?

PM: I teach them to keep a sense of their internal ‘Line’ and posture while breastfeeding. Using pillows, finding a good position in bed, etc., will help with this. If the mother is comfortable, the baby will be more comfortable. Remember, the first experience of gravity for the baby is through the hands of the mother, so this is important.

SC: Oh, that is such a beautiful thing to say.

PM: So, if the mom is breastfeeding in a position that is not balanced in gravity, it will transmit that to the nervous system of the baby. Other animals get their first experience of gravity through the legs by standing, but we get it from the mother holding us.

SC: That is just a great statement. What kinds of activities do you recommend for mothers after a C-section or tears of the vagina, perineum, rectum, those kinds of anatomical disruptions?

PM: In the first few months just walking, because they will not like to do anything else. This is not the right time to push. When they start to indicate they are feeling better, then that is the time to start increasing activity. You have to use common sense and pay attention to the mother.

SC: What do you recommend in cases of postpartum depression?

PM: Whew, that’s an interesting one. Well, first they need to have their hormonal levels checked. If the hormones are dropping too fast the woman will go into depression and may need help regulating hormone levels. This is something for the physician to address. Check the position of the coccyx. It may have been displaced by the baby’s head and that affects the craniosacral system and may result in depression. So, check the coccyx and the balance of the craniosacral system. Of course, there could be other reasons such as the conditioning of the mother and other factors, but the two most primary ones are hormonal levels and the balance of the craniosacral system.

Another issue I often see is with mothers who are very determined as athletes and have learned to be very strong willed. These are mothers who have a lot of investment into being in control. You know the whole process of pregnancy and birth and raising children is a lot about not having control all the time. They often have to learn to let go and not try to be in control. So very carefully you need to guide them in how to find support without trying to control too much. How to find well-being without having to fight too much. Trusting, you know, all that.

And then there are the mothers who feel so ‘loose’ that they start wanting to get fit and work out a lot, and you have to guide them to not overdo and hurt themselves. Many women want to know how to recover abdominal strength and tone. What many people do not realize about ‘core strength and stabilization’ is that core activation occurs through the extremities. For example, in pregnancy women spend months trying to balance the weight in their abdomen by leaning back. After pregnancy, you need to help them find their core balance through the feet. With engagement through the core of the feet, balance travels into the abdomen; then they regain abdominal tonus that is not only from control. When a woman only has tonus from control, then she only has it while she’s thinking about it. The hands are the same. Look at yoga – always pushing with the hands like downward dog, sun salutations. The moment the weight travels from the hands the movement goes directly into the core. At the moment that the hands and/or feet engage, if any of the diaphragms cut the flow, then there is no possibility of core tonus.

SC: Can you talk about your intention and purpose in your female pelvis workshops?

PM: I teach about ‘emptying’ the pelvis. I talk about the locomoting, visceral, nervous-system part of the pelvis. That many of the holdings in the pelvis are not in the tissue, but are in the ‘gesture’ in response to invasions/intrusions. Sometimes holdings are actually confusion about support and stabilization, how a woman’s feet connect and what is stability. When women start to find their embodiment and connect well to their extremities and their own space, the feminine power starts to come through very fast. When you change the soma you make changes in the psychology but there is no drama. It’s beautiful, and I really like seeing women gain their own power. It is a fluid power that is very unique and very powerful.

SC: Would you like to talk about working with the female pelvis outside of pregnancy? Such as problems with incontinence, fibroids, dyspareunia (painful sexual intercourse), vaginal or labial irritation with aging, and so on.

PM: As Rolfers we can help a lot. For example, with incontinence, with aging the bladder drops down, and engagement through the feet will help lift the bladder. With fibroids, they are often heavy, and we can help with mobilizing them so the woman can find her own space and create less compression and downward pull. Dryness and thinning of the vagina and labia can be helped with hormonal creams or different oils but is not something we can help with manipulation. With dyspareunia, it depends on the cause. If the cause is from uterine pain, that probably should be referred to a gynecologist. If that has been cleared, then again it is usually from needing to connect through the feet and learning how to relax and let go and still have the power to decide when and how through the body. The specifics are better discussed in the workshops rather than in this interview.

SC: Yes, I agree. Do you have any additional comments you would like to share?

PM: No, I think we have pretty well covered it SC: Well, Pilar, thank you so much for sharing your expertise and insights.

Pilar Martin, RN, midwife, Certified Advanced Rolfer was born in Spain. She became an RN-midwife in Spain at age twenty-two. She was introduced to Rolfing SI in 1988 by Peter Schwind’s first book on Rolfing SI, the only one translated into Spanish at that time. Her initial Rolfing sessions were with Sammy Frank in Barcelona. She trained in Munich in 1991 with Peter Melchior and Bill Smyth, and met Jean-Pierre Barral at the same time and studied extensively under his guidance for many years. Pilar has also studied with Hubert Godard, and that has been an important influence on her work. She did her Advanced Rolfing Training in 1994 in the US with Jan Sultan and Jeffrey Maitland. Pilar has a private practice in Santa Cruz, California. She works with mothers pre- and postpartum and babies, and with the craniosacral system in infants. She has been teaching workshops on the female pelvis in both Europe and the US for fifteen years. She can be contacted at [email protected] or pilarmartin.org

Shonnie Carson, RN, BS, ANP, BCSI, Certified Advanced Rolfer was trained at the Rolf Institute® in 1981. She has studied with most of Ida’s original teachers/students. She had a full-time practice in Seattle, Washington for twenty-four years and now practices in Phoenix, Arizona. She has served as a member of the Rolf Institute’s Law and Legislation Committee, a member of the IASI Board of Directors, and as Vice-Chair of the Certification Board for Structural Integration. She can be contacted at [email protected] or www.mybodyworks.com.

Pregnancy, Postpartum, and Rolfing® SI[:]