Another common reason cited for avoiding massage to the ankles is the fear of stimulating acupressure points that might trigger contractions. Again, misunderstandings abound regarding the use, locations, and methods of accessing acupoints, as well as the differences between acupressure as opposed to acupuncture prohibitions. Some acupuncture contraindications exist to prevent causing direct harm using the needling technique. These points are not necessarily contraindicated for acupressure.
Acupressure and shiatsu can be used to support the induction of labor when desired; however, in order to have any hope of encouraging uterine contractions, a different type of touch is required than is provided by general massage. Acupressure typically requires applications of direct pressure stimulating specific points over a period of hours or days in order to have a lasting and cumulative effect. Even then, many skilled practitioners are not successful in inducing contractions.
Acupoints that are often considered useful in efforts to stimulate contractions are located on the inner leg, hand, sacrum, and one adjunctive point just posterior to the lateral malleolus—Bladder 60. However, there are discrepancies in massage and acupressure texts regarding prohibited acupoints. A variety of points around the ankles are sometimes listed as contraindicated, including Kidney 3, Kidney 4, Kidney 5, Kidney 8, and Bladder 62. These points can be used to support labor, calm the mind, beneficially influence the uterus, drain heat, move blood, or relax the back. But they are not considered points that trigger contractions and are not standard contraindications during pregnancy.
Bladder 60 is the only point around the ankle that the majority (but not all) of the sources I researched referred to as contraindicated. It has properties of drawing energy downward and is often used in combination with other points when attempting to induce labor.
Acupuncture and acupressure specialists indicate that there are no blanket contraindications for acupoints and some suggested that the stimulation of acupuncture points to help induce labor or dislodge a fetus may be “way overrated.” Chad Dupois, LAc of the Chattanooga Acupuncture and Wellness Center writes, “As with all of acupuncture, nothing is ever set in stone. There are people/styles [of acupuncture] who regularly use contraindicated points during pregnancy.” An example of this is a study investigating the use of acupuncture for reducing back pain in pregnancy that used the ankle point Bladder 60 on subjects between 12–30 weeks pregnant, with no ill consequences.
Acupressure has its own rules of practice and contraindications and can be very powerful when properly applied. But the question being explored here is whether massage can stimulate these contraindicated acupoints, resulting in serious consequences. Bronwyn Whitlocke, LAc and author of Shiatsu Therapy for Pregnancy (Spinifex, 1999), says gentle massage or acupressure applied to the ankles with the intention of relieving discomfort will not cause harm or induce labor. Instead, it can help reduce edema in the feet and therefore be beneficial. She finds acupressure to be more subtle than acupuncture. When working with a woman due for labor, she stimulates points hourly with deep and continuous pressure over 2–3 days in order to affect the type of cervical changes that she might see in a shorter time span with acupuncture. One session on the ankles in an effort to promote labor will not be effective.
Debra Betts, LAc, RN, and author of The Essential Guide to Acupuncture in Pregnancy and Childbirth (Journal of Chinese Medicine, 2006) finds Bladder 60 to be stimulating to the uterus. She feels that general massage could stimulate this acupressure point and cause an undesirable result if combined with Spleen 6 (on the medial calf) and used with strong pressure over a period of time on a woman who is susceptible and sensitive to acupressure points or who is at high risk for miscarriage. The concern is greater, she states, with pregnancies earlier than 12 weeks or later than 36 weeks, when the risks of miscarriage or preterm labor are greatest. She suggests avoiding touch to this and all the contraindicated acupoints during pregnancy.
On the other hand, Suzanne Yates, bodyworker, antenatal educator, and author of Shiatsu for Midwives (Books for Midwives, 2003), says that she often gently massages around the ankles with light pressure as she connects with the mother’s womb. “I have done this kind of work for 18 years now and not had any problems. Indeed, I feel it is of benefit. In the first trimester, it is calming and supporting the flow of the jing, an important energy which nurtures the baby.”
Stephanie Halderman, EMT, director of the Eastern Holistic Center, has been instructing acupressure and massage for pregnant women for years, and says she has not learned of Bladder 60 being a contraindicated point. “B60 is not a forbidden point, so it is safe to massage. Light, gentle, full strokes [effleurage] is fine and will not induce labor around the ankles (but focused work can),” she says.
Kensen Saito, director and co-founder of the International Academy of Tokyo in Canada and author of Shiatsu-doh (Cross Media, 2004), trained under Tokujiro Namikoshi, the founder of shiatsu whose motto was, “The heart of shiatsu is like a mother’s love. Pressing the human body stimulates the fountains of life.” Saito says that safety is the key to treating clients. He works gently on the whole body with pregnant women, including the ankles in most cases. The only danger and concern Saito expresses is the improper application of pressure that may be too deep and strong. This type of intensive pressure application would be injurious to both the tissues and the emotion of the client, he says.