What is my position on the WAC Chapter 246-830, breast massage section? The real question is, "Which version do you support? A or B?" Right now the Board of Massage is asking the public to submit their opinions on which version they prefer.
Well, I wrote Version B, so I’m a little biased toward that. It was kind of a fluke and completely unexpected. After attending Board of Massage meetings for over a YEAR (and getting nowhere), I was exceedingly frustrated with the public policy process. I couldn’t read the words of the current draft (Version A) without my brain turning somersaults.
So I tore it apart, threw out the parts my colleagues and I didn’t like, added the parts that we did, and re-ordered it so it wasn’t cross-referring to other sections in a way that, well, required mental somersaults. Voila! I sent my re-write to the Board of Massage and crossed my fingers.
It turned out the Board thought it was pretty good, but they didn’t agree with all of it. They decided to put their version and my version out to the public, as is, for a “vote”. This experience was kind of like turning in an assignment in school and the teacher publishes it in the school paper. I was completely unprepared for this and my inner critic has been driving me insane since the meeting on July 8th.
My major problem with “Version A” (beside it being confusing as hell) is it requires that a client have a diagnosed medical condition for breast massage. Because I can’t diagnose as a massage therapist, all my clients would have to go to a doctor to get a “diagnosis” before receiving breast massage. What if they don’t have a “condition”? Why do they need a diagnosis to practice preventive care for themselves?
This is a deal breaker for me. If I can get my nipple pierced or my chest exfoliated without a “diagnosis”, I can get a therapeutic breast massage. I think I just might be grown up enough to decide that for myself. AND I'm not paying a copay or deductible to see my doctor to obtain said diagnosis or referral. What a waste of resources!
The other controversy has to do with allowing massage of the nipples and areola. We are nipple phobic in this country. I can wear a dress with a neckline cut down to my navel, as long as my nipples don’t show? I find this a fairly arbitrary way to decide if something is pornographic or not. In health care, the nipple and the areola are simply a part of the breast.
But why does this matter to you? Due to the high incidence of breast tumors occurring deep to the nipple, and the breast reconstruction surgeries approached along the line of the areola, there can be scar tissue at the nipple and areola. Lactating mothers may need help clearing blocked ducts behind the nipple. Sometimes there are naturally occurring fascial restrictions in this area.
Guess what? Scar tissue and blocked ducts hurt sometimes and the breast pain can be naturally reduced with massage therapy. This is not a difficult concept for logical humans. However, I believe the wording “massage to the nipples” puts a weird image in people’s minds about sexual gratification that just isn’t involved AT ALL. You may not need access to this treatment in this moment, or think it is "weird", but maybe your new-mommy neighbor or breast-cancer-survivor friend does need this help.
My colleague Barbara Helynn Heard has created a more neutral term that is actually closer to the truth of treatment. Let’s discuss “breast and chest massage that includes the nipple and areola”. Ahh, that feels better. There is less of an edge to these words. So I submit that the wording in Sub-section 3 of the Breast Massage section be changed to say “breast and chest massage that includes the nipple and areola” rather than “massage to the nipple” (see? doesn't that sound more creepy??).
There is a second issue with my Version B. There is a requirement for a separate, written consent form prior to breast massage. But not everybody reads words well. (Hence the popularity of podcasts and videos.) So it is necessary for the therapist to obtain written AND verbal consent, so there are no tricks or misunderstandings. Thus, I submit in Sub-section 1, to include a sub-sub-section B to say, “…must orally review the written consent with the client AND obtain verbal consent from the client that they understand the purpose of breast massage and can discontinue the treatment at any time for any reason.”
Here is a link to my revised Version B so you can see all these words in context (and paste them into your email). I hope you will join me in writing to the Board of Massage to express your encouragement that they keep unfettered access to breast massage for the public. If you aren't sure what to say, here is a copy of the letter I sent that you are welcome to plagiarize.
Now hurry over to your email and copy-paste your letter to MassageRulesComments@doh.wa.gov because you CAN make a difference. If I can become a public health policy writer over night, so can you! You are welcome to BCC me on your "Version B is Better" email via info@BreastRemedySeattle.com - just to let me know you love me ;-)