CHAPTER 15. Professional issues
Introduction
While maternity bodywork is an exciting and expanding field in which to work, there are specific issues which need to be considered for the therapist. The potential role of the maternity bodyworker can cover more than simply one-to-one work with a client and the therapist needs to consider which aspects of it they wish to specialise in. Once they have undertaken a personal evaluation of the type of work they want to include in their practice, the next issue is to evaluate and access appropriate training and then begin to build one’s practice. They need to identify the specific needs of the maternity client group and to take into account that this is one of the few times in life when healthy clients are under the care of a primary care provider.
15.1. Setting up a maternity-focused bodywork practice
Qualities needed to be a maternity bodyworker
Commonly asked questions
• Do I have to have had children to work with pregnancy and birth?
• Can a male practitioner successfully work in this area?
• What other qualities do I need?
Do I have to have had children to work with pregnancy?
Often one of the first questions that bodyworkers ponder is whether they have to have had children to work effectively with pregnant clients. Essentially the answer is ‘no’. A bodyworker does not necessarily have to have had the experience of their clients. For example, it is possible to work with cancer patients without having had cancer. Furthermore, even if therapists have had children, the different range of experiences of pregnancy, birth and parenting vary enormously from woman to woman and from culture to culture. Furthermore:
Whether we ever choose pregnancy, every one of us has encoded in our cells the knowledge of what it is to conceive, gestate and give birth to something that grows out of our own substance. You don’t have to have a baby to learn how to labour. Labour, whether physical or metaphorical, teaches us not to fight the process of giving birth, not matter what we’re giving birth to, even when it hurts and we want to quit
(Northrup 1998: 416–417)
The most important aspect is for the therapist not to be carrying unresolved issues around pregnancy and birth which may impede their judgement and ability to support their client. Bodyworkers with children are sometimes drawn to specialise in the maternity field either because they have wonderful experiences which they want to share, or dreadful experiences which they want to ‘save’ other women from experiencing. For bodyworkers with no children, they may have issues with miscarriage and fertility or other issues and they need to be careful not to live out unfulfilled desires through their clients.
Suzanne (who has two children)
In some ways it has helped me to empathise with my clients through having experienced pregnancy first hand. It was this which motivated me to learn more about bodywork in pregnancy and certainly I felt more able to ‘experiment’ with different techniques on myself. During both my pregnancies I used bodywork as a major source of support. I had extremely positive experiences of pregnancy and birth and did not really suffer from any ailments; indeed I felt well and healthy throughout and they were positive times in my life. How much that was due to bodywork or from my hereditary patterning I do not know. However, I did support my health and I did trust my body. I have no experience of many of the ailments women suffer from, such as symphysis pubis problems, heartburn, carpal tunnel syndrome. I have never had a miscarriage or undergone a termination, so I cannot personally identify with those experiences, although I work a lot with women at those times in their lives. So while I feel that my own experiences gave me a foundation on which to build, it has been primarily through my work with women over the years that I have built up my knowledge of other conditions, situations and issues.
Cindy (who has no children)
I feel anyone interested in helping families have a positive birthing experience is an asset in the field. Many massage therapists I know attended their first birth as a result of being invited by their clients. That first experience whetted the appetite for attending more births and gaining additional training.
The key elements are passion for the work and an ability to work from a client-centred framework. I think professionals in the field should be mindful of their attitude towards practitioners who do not have children since I have heard unintentionally hurtful comments towards childless practitioners. For me, the bottom line is if you love this work then you have an important contribution to make.
Can the male practitioner work effectively with the maternity client?
Some people believe that pregnancy and birth is very much ‘women’s business’ and it is not appropriate for men to be involved. It is true that in traditional cultures it was ‘women’s business’ but male and female relationships were completely different and in many cultures men and women did not have much connection with each other. Modern culture has tended to value ‘experts’ who may often be male and many feminists see the rise of the male obstetrician in childbirth as a sign of male control over women. There is some truth in this. However, it is wise to remember that sometimes female obstetricians can be less sympathetic to women than male obstetricians.
Again, one of the main considerations is clarity, empathy and enthusiasm. Men have the experience of their own birth and many male practitioners are drawn to the field because of experiences they may have had with their partners during pregnancy and birth. The male practitioner does need to be sensitive to the fact that some women may not want to have a male practitioner, although some women may prefer a male practitioner. Working with the breasts and abdomen is likely to be more of an issue for the male therapist and they need to make sure that they provide a safe space and adequate draping for the client to feel comfortable.
What qualities do I need?
As pregnancy, birth and becoming a mother are such life-changing experiences, therapists need to be self-aware and not impose their own values and judgements on the client. Being able to support a client to learn to connect with her own knowledge and way of processing the experience is essential. It is vital to respect the choices that clients make, especially if they are different from the choices the therapist would make. Creating a safe space for the client to express herself and be heard is key. It is also important to recognise the limitations of one’s role and know what other services and support the pregnant woman may need to access. The ability to reflect on one’s work is fundamental.
Be knowledgeable about resources
It is important to be able to know about specific services pregnant women can access and to work to liaise with the relevant groups and individuals so that referrals can be made as necessary. The type of groups to be aware of are:
• Pre- and postnatal classes including yoga, pilates, Aquafit.
• Home birth support groups.
• Antenatal and postpartum support groups.
• Special interest support groups such as: twins and multiple birth support, parents of children with disabilities, SANDS (still birth and neonatal death support groups).
• Other therapists specialising in maternity work, e.g. counsellors, psychotherapists and so on.
Dealing with the more difficult aspects of pregnancy
Difficult issues can include loss, death, emotional or sexual trauma. Many therapists begin by wanting to work with pregnancy because they see it as a positive time in a woman’s life. While this is true and it can be a very rewarding time to work, the maternity period is not always positive. Sexual issues often surface during pregnancy and birth, particularly if the mother has suffered from abuse. Birth and death are closely interlinked and the therapist needs to consider how they would feel if their client miscarried, or experienced stillbirth or loss in the early postnatal period. Birth itself may be a very traumatic experience for many women.
15.2. Reflective exercise
• Do you think you have the right qualities to work in the maternity period?
• Consider why you are drawn to working in the maternity field.
• What motivates you in your work?
• How would you feel if you are a big fan of home birth but your client wants to have an elective caesarean section?
• How you would you feel if your client had a miscarriage?
Appropriate training
It is important for the therapist to evaluate whether they have the relevant training and experience. Most bodywork training does not cover maternity care in sufficient depth for the therapist to be able to specialise without further training.
The quality of the maternity training required will depend on the context of the general training that the practitioner has received. This varies enormously from country to country and even between states in some countries. For example, massage therapists in Ontario receive 2200 hours of instruction over a period of 2 years. This has become the yardstick of training in other Canadian provinces and is beginning to become accepted in other countries. In the USA and the UK programmes of 1 year’s duration or less than 500–1000 hours are more common; however, most therapists will access further advanced training courses once the foundation training has been completed. Shiatsu therapist training in the UK is spread over 3 years with various residential and non-residential modules and home study and practice required. Osteopaths train for a minimum of 3 years full time.
The therapist needs to consider what specific maternity training was included as part of their course. They need to evaluate it in the context of number of hours, the content of the courses, the accuracy of the information, the experience of the trainers and the clinical practice which was offered.
In most cases, the therapist is likely to need to do a specialised course. They have to consider whether they want to specialise only in pregnancy or birth support work or postnatal work. In a way it makes sense to see the whole period as a continuum, but some therapists may prefer to work more with pregnant or postnatal women.
Length of course
It is hard to give a precise number of hours as it depends on the exact delivery of the course and how much pre- and post-course work is required as well as the therapist’s initial level of bodywork training. As a guideline we would suggest that for pregnancy work a minimum of at least 20 contact hours would be required. For birth work an additional minimum of 20 contact hours would be needed. For postnatal work, if the therapist has already done some pregnancy/birth training, which is important as many of the themes of postnatal work may arise from the birth or pregnancy experience, then an additional minimum of 10 hours is likely to be sufficient. However, if the therapist is only doing a course in postnatal work then the contact hours would need to be more.
Course content
Consider what topics are covered on the course. This would need to include some coverage of the following topics:
1. Relevant anatomy and physiology.
2. Relevant eastern theory, if the therapist works with that model.
3. An overview of the medical care offered in the country in which the course is being taught and any issues this may raise.
5. Supervised practice working with pregnant women during the course.
6. Self-reflection exercises, including reflecting on things like qualities needed, how to evaluate the work and so on.
Some ideas/support on how to set up and run a maternity practice, including: creating appropriate intake forms and client information, promotion, marketing and networking.
Course reputation
• Is the course recognised by any relevant accrediting organisations?
• Is the course recognised in the community as providing accurate, client-centred content?
• What sort of feedback has there been from other participants?
• How many participants are currently working in the maternity field?
Credentials of the educators
It is important to consider who is teaching the course and ask:
• What is their training?
• How long have they been involved in maternity work?
• What is their philosophy of care?
• What is their educational experience and training?
• Are they recognised and well respected by their peers and others in the field?
• Are they affiliated to recognised institutions, governing bodies, primary care providers?
• What ongoing CPD and clinical activities are they currently engaged in?
Post-course consolidation
• What opportunities exist for post-course consolidation?
• Is course work or case study work required?
• What is the time frame?
Ongoing support and development: training, CPD
Once the course has been completed, what opportunities are there to continue learning? What kind of post-course support is offered in building, developing and maintaining the practice? Are there any student networks? Discussion groups? CPD possibilities?
As the issues and type of care are constantly changing and skills can always be refined and developed, it is important to see the initial maternity training as only being a starting point. It is important to access continuing training, education and support in order to develop the work.
Practice management
Once the relevant training has been completed the therapist needs to consider how they are going to run their maternity practice.
Insurance cover
It is important to check that insurance cover is appropriate, as some companies will insure for all aspects of maternity work, while others may have certain exclusions such as no work in the first trimester, during labour, the first 6 weeks postnatally or with the newborn.
Appropriate cover can usually be arranged provided evidence of appropriate training for the intended activity can be provided.
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