Hyperemesis (extreme sickness) in pregnancy -
how to work with shiatsu and massage..
One of my online students, Sariah Boyer who is studying my “Supporting pregnancy with massage, shiatsu and more” course is suffering from extreme hyperemesis. She contacted me because her husband is also a massage therapist and she wondered if I might be willing to make a video of a treatment that he could do to support her. I thought I could take the opportunity to make a video for anyone who would like to know more about how to work with hyperemesis. The techniques shown in the video are also helpful for women suffering from sickness at any stage of pregnancy. Sariah had requested a combination of some static pressure and point work (shiatsu) along with some direct work on the skin with oil (massage) and so this video shows how the 2 styles can be combined.
Hyperemesis gravidarium is the name given to vomiting and sickness which is more severe than the “normal “pregnancy nausea and sickness. It is estimated that up to 3% of women suffer from it. It is often accompanied by excess production of salvia (ptyalism). The care giver needs to exclude that it is not related to another complication such as appendicitis, gastroenteritis or hepatitis. If not, the main issue is that, with such high levels of sickness, many women can’t even keep fluids down and lose a lot of weight. I have on a few occasions worked with clients who had to be hospitalised and put on IV fluids to keep them nourished.
There is not a drug based treatment which stops it, although treatments, such as Zofran, may be offered to reduce symptoms. This creates complex choices since Zofran is used as a drug during cancer treatments to reduce nausea and hasn’t been approved in pregnancy. Any medication carries a potential risk for the baby. Massage and shiatsu can help promote relaxation without any adverse effects and offers many other positive benefits. (Small study of 10 hospitalised women in 2006 showed this -Agren and Berg Tactile massage and severe nausea and vomiting during pregnancy - women’s experiences Scand. J. Caring Sci 20 (2) 169 -176).
From my perspective, drawing on Traditional Chinese medicine (TCM), I have often noted that the Kidney energy is weak. This can relate to a physical issue with the organs, or, since our Kidneys store our Essence (vital energy), it can be more of an underlying energy weakness, a trauma, or something linked to our genetics. Kidneys then fail to support the Penetrating Vessel which tends to rise up the chest, creating feelings of nausea and sickness, heat rising or emotional instability, anxiety, sleeplessness, bloating in the abdomen and breasts. It takes time to change our Essence. It flows in 7 year cycles for women and regulates deep cycles. For deeper rooted patterns, it takes time to shift, and the echoes of trauma, although patterns can change, its echoes may remain even to the end of our life.
For more on Penetrating Vessel (PV) see my You Tube video
For now be aware that PV controls the Blood. It can become unstable in pregnancy because of the huge changes in both flow and volume of blood. What I find is with mild nausea is that often the Stomach energy is weak. Stomach is how we take in nourishment and how we ground, but is quite linked to the present. It can often be rebalanced by resting, and eating small amounts. Since with hyperemesis it is more due to weak Kidneys, it may even be aggravated by eating and even drinking.
Sariah is 10 weeks into her second pregnancy, and she suffered with hyperemesis and ptyalism in her first pregnancy all the way through to 7 months. The ptyalism continued to 3 months postnatally. Her daughter Sally is now 2 and half. In her first pregnancy she was experiencing some nauseas, migraines, bloating and an altered sense of smell by her second week. By her 5th week she was constantly throwing up, experiencing excess salivation and had to quit her job. As she said, her world came tumbling down. She starting losing weight because she could only drink water and eat crackers. By the end of the first trimester she had lost 20lb (9kg). She took Zofran but it only stopped her throwing up. She still couldn’t eat. Her daughter grew well despite all this and partly because of this, Sariah felt her situation wasn’t taken as seriously as it could have been. This time round her symptoms began in week one and she also experienced breast tenderness as well as womb cramps. She felt better prepared emotionally and took some magnesium which helped a little for the first few weeks. Now she can’t drink water, only apple juice but she can sometimes eat beef, although no vegetables.
She was interested when I mentioned Kidneys and potentially family and ancestral trauma because this is her situation. Her relationship with her mother has always been difficult. Her mother has mental health issues and her dad left them when she was only 7. She experienced sexual abuse as a young child and has UTI’s all her life. When she was 18 she experienced Kidney infections. In her family women were not valued and seen as weak and stupid, as also the men. She is now in a happy loving marriage and has chosen not to see her mother for now, but she recognises the deep imprinting that trauma leaves. It takes time to heal and always leaves its echoes.
In order to work out the most appropriate treatment for my clients, I feel it’s important to ask what they would like, especially in terms of position and type of strokes. Sariah is most comfortable in side lying, although if she has acid reflux then she needs to sit upright. She would like some direct skin to skin contact. In some styles of shiatsu, like with massage, work is done directly on the skin with oil. Sariah said she would prefer a more static touch, or slow deeper strokes, which is what we tend to use a lot in shiatsu. I find fairly often with women suffering from any kind of nausea or sickness that it is this kind of touch that they prefer. Her husband has been working reflexology points on her feet, as well as using some slow strokes on her legs and she finds this calming.
Without having my touch assessment tools, I have to be guided by our conversation. This has all led me to sense that what would be most appropriate for her is indeed the Penetrating Vessel. This is the Vessel of Bonding and the archetype of the mother. Working offers a possibility of shifting some of her past trauma as well as supporting her current energy. This Vessel has some important branches and points in the legs and feet, areas which we already know Sariah finds calming. I will first focus on these branches. PV also has branches in the chest and upper body, and I will show a few connections here, although it may be possible that this is too much for Sariah.
Since I am in France and Sariah is the US, I kindly enlisted the support of Marisol, who is 4 months into her pregnancy. She is comfortable in the side and sitting positions. I begin with some work in the sitting position. Since Marisol also has some nausea, she finds it more suitable to sit on a chair with a fit disc, which gives gentle release to the pelvis, rather than a ball. The ball is great to get some more mobility as the baby grows, but only if the mother is not feeling nauseous. I sit on the ball to show how it can be beneficial.
I feel it is important to start with the feet and then work down the legs. This brings in the grounding qualities of the PV. I include points on the foot, KD6 and BL62 each side of the ankle bone, the heels and round the feet. Then I connected with Mari Sol’s knees, where there are also some important grounding, earthing points, like ST36, which is also a point on the Penetrating Vessel. I work slowly down the legs, both at the same time and then one at a time. I put some oil as Sariah wanted skin to skin contact, and with a firm whole hand stroke I work slowly down her legs to her feet. I repeat a few times so I can cover the front and side and the backs as well always ending in the feet. Then I connected with Marisol’s hands where there are also important points. One of these is fairly well known HP6 ( 3 finger width from the wrist fold) and the other I find sometimes works even better is HP8 in the centre of the palm. HP8 is wonderful for calming emotions and Marisol breathed deeply at this point. Then we connected Marie Sol’s hands to her abdomen to connect with her baby, as around 16 weeks early movements are becoming more noticeable, and the womb has started to rise above the pubic bone. I connect with the lower back, especially around second and third lumbar vertebrae, GV4 Ming Men or Gate of Life. This supports the Kidneys on a deep level as well as connecting with the ancestors. I then connect with Marie Sol’s heart and her brain.
Marie Sol was very relaxed after this and felt more connected with her pregnancy and baby. Before lying down in the side position, we paused a moment in sitting where I showed the leg connections again. This time I provide the earth anchoring by placing my knees against the soles of her feet, connecting with KD1 which is nourishing for the Kidneys, and being the most Yin point in the body, a grounding connection. As her shoulders felt a little tight, I worked the area of GB21 which can help relax the shoulders as well as sending energy down which can be helpful for nausea. She felt she was more able to welcome her baby and more at peace with herself.
In the side lying position, well supported with cushions, I worked again on Marisol’s legs. First connecting with both feet and then working one leg at a time in a similar way to what I did in the sitting position - a slow stroke. I also show working with the forearm. Sometimes it feels helpful to connect with the Kidney area in the lower back.
Then I connected with her head and did some palming down the spine, which is the Governing Vessel and regulates all the organs. It also links with the chakra system. A Marisol’s shoulders are tight, I did some holding work to release tension down. Then I worked each side of the spine, in the erectae spinae muscles which is the Bladder line. Like with the Governing Vessel, points along this line connect with all the organs in the body and also work here helps calm the nervous system.
I finish with a sacral head hold. I don’t feel I want to hold the top of the head but invite in space. After Mariesol rests a little she turns on her side and opens her heart. This reminds me that I didn’t show the Heart Protector points in the arms and so I work these again to show how to work in the side.
Marisol felt very rested, calm and connected with her baby, and felt that perhaps her nausea was a response of not having taken the time/space to connect with the pregnancy and digest all the changes in her body.
Next I sent the video to Sariah so that her husband, Jonathon, could try out the work on her. It took a little time before they were able to find the time and space, as they have a toddler and also while waiting for me to edit the video, Sariah’s sickness got much worse. Jonathon wanted to know what he was doing and have a quiet, calm space. After they were able to do it, we had another chat and Sariah was able to say how much she found it really helpful and calming. Jonathon said he enjoyed doing it and it was calming and soothing for him. This is really important and was great feedback. The person doing any kind of touch work also needs to feel calm and relaxed so that they can communicate calmness and relaxation.
I found the whole process fascinating and hope to do some more videos like this soon.