Topics in Pregnancy and Postpartum

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Many women find that the last few weeks of pregnancy are fraught with a myriad of discomforts. As the baby reaches his or her birth weight many moms find it more difficult to move around and function as they did before. One common complaint at this time is ankle swelling. For some women, it is a mild annoyance that shows up at the end of a busy work day, for others it is more severe. In my own pregnancies my ankles were so swollen that the only shoes I could wear were flip-flops. Thankfully, it was August and the weather warranted the footwear. When women develop swelling in the face and hands it is a more concerning sign, and they should report this to their obstetric care provider. Ankle swelling, however, does not usually cause any harm, but it can be very uncomfortable. In Traditional Chinese Medicine there is a common herbal treatment for the condition that any woman should be able to make at home. As a Westerner, the sound of it may not be very appealing, but it is actually quite good, and it works! In Chinese Medicine terms this formula fortifies the Spleen, disinhibits dampness and scatters swelling.

Li Yu Luo Bo Yin, or Carp and Radish Soup

Ingredients:

1 one-pound Carp (Li Yu), gutted and scaled, head and tail removed (or also skinned if desired)

120g (about one cup) chopped daikon radish (Luo Bo)

 

Directions:

Put the ingredients in a pot and cover with water. Bring to a boil then reduce heat and simmer covered until fish is cooked through. Drink the broth and if desired, eat the carp and radish.

 

 

I have many fertility patients who are using fertility predictor kits to track when they are likely ovulating. I find these kits, which require a woman to pee on a stick every day for many days, to be less accurate, more expensive and more inconvenient than good old fashioned BBT charts. A BBT chart tracks a woman’s Basal Body Temperature (the temperature upon first waking in the morning) and also the consistency of her cervical fluid. It allows for additional information, such as illness, insomnia, intercourse, whatever the woman wants to add. Using the chart instead of the kit, a woman learns to understand her own body, her potential fertile time, and gives her the power to determine when she is most likely to conceive. The kit, on the other hand, takes that power away from a woman’s own eyes and mind and provides information from outside of herself that is less accurate, and tells a woman nothing about her overall menstrual health.

As a TCM provider, I can also add the BBT chart to my diagnostic tools for a fertility patient.  For instance, a chart that shows a very slow-rising temperature in the luteal (post-ovulation) phase is possibly indicative of a yang or qi deficiency. Yang (which is warm) is needed for the act of ovulation and for the corpus luteum (the follicle from which the egg was released) to provide enough progesterone for conception and implantation to occur. I do not use the BBT as a sole means of diagnosis, but I do add it to my assessment.

Taking the BBT is simple, but there are some key factors to be aware of. Using a regular thermometer, a woman should take her oral (by mouth) temperature first thing upon waking from at least 5 hours of sleep. If the woman gets up, or even spends time awake in bed before taking her temperature, it will not be accurate as our temperatures do rise with activity. To be most accurate the temp should be taken after 5 hours of uninterrupted sleep, so if a woman goes to sleep at midnight, and wakes at 5am to pee, she should take her temp at 5am before getting out of bed, and not wait until she has gone back to sleep and gotten up at 7am. The number can be recorded on a piece of paper kept by the bed and then transferred to a paper BBT chart at a later time.

Even easier for some, online software can be used in which the number is simply recorded into the application, and the software creates the BBT chart based on the data provided. A nice example of this kind of software is Kindara. I prefer this one to others, as it is easy to use, is pleasing to the eye, and it does NOT try and “predict” when a woman is ovulating. Instead, it helps a woman see for herself just by looking at the chart when she is most likely ovulating. This software can be used on a computer, or on an Iphone and can also be shared online with a fertility doctor or TCM fertility specialist (or a partner!) if the woman chooses.

Cervical fluid is possibly an even more important predictor of fertility than temperature. When a woman is about to ovulate, the fluid changes in structure from a mass of crystals aimed in every which way, to straight tubes that provide a sort of “highway” for the sperm to move up through the cervix and into the uterus, hopefully to the uterine tubes where conception is most likely to occur. When the fluid is structurally tube-like, it takes on a stretchy quality that can be easily pulled/stretched between a woman’s fingers. Learning to assess when a woman’s fluid is most stretchy gives her the knowledge that she is now about to ovulate, even before the temperature rises. The 48 hours BEFORE ovulation are the best days to have sex if a woman is trying to conceive. BBT charts, including the software on Kindara, provide a place to indicate what the cervical fluid is like each day of a woman’s cycle.

My patients that have made the switch from the “pee sticks” to BBT charting all have a renewed sense of control over their fertility potential. They are more confident and feel a sense of pride about their bodies. In my experience, this is the BEST possible way to enter pregnancy and allows a woman to feel that she understand her body and later, she is generally more comfortable making decisions for her body, such as how she wants to deliver her baby.

Understanding our fertility is our right as women, and I honestly believe that charting our cycles during our fertile years is empowering.

Many of my readers are very familiar with the work that doulas do, some of them are doulas themselves. For those of you who are not familiar, I wanted to say a few things about the role of the doula. Before the advent of technological, hospital birthing, women gave birth at home. They weren’t expected to do this alone, they were typically attended by many women, usually family members, and also a midwife. A woman’s mother, sisters, aunts, grandmother, would all assist the birthing woman in whatever way was needed. Providing emotional support and encouragement, offering water and food, gathering wet washclothes, just being there. As birthing moved into hospitals that role moved to the attending nurse, and family members were not present, including the woman’s partner. Eventually, the husband was allowed to be there for the birth of his child, but as technology advanced, the role of the nurse moved more towared monitoring the machines attached the the laboring mother, and away from a supportive role.

The need for female, non-medical support during labor needed to be filled. The doula is a woman (typically, although there may be a male doula out there that I have yet to meet) who is committed to filling that role. She is a person trained in normal labor progress, as well as the interventions that may or may not be required during the course of labor and delivery. She typically knows the risks and benefits of medical intervention as well as having a “bag of tricks” for helping a labor proceed as best as possible. During a woman’s labor she is able to offer support, encouragement, suggestions for different positions or techniques when labor stalls, or becomes rather difficult, or the laboring woman is feeling discouraged or fearful. The doula also acts as an advocate for the woman, helping her understand any medical interventions that are being offered, and any risks associated with accepting or denying those interventions.

During my own labor with my first daughter, my doula (Jennifer Hampton Head, now a midwife in Oregon) was vital. She came to my home when I felt I needed some support during early labor. She helped me to stay focused on the task and when I became scared of the pain and overwhelmed by the seemingly endless process, she took my hands, and looked me in the eye in a way that told me it was all going to be just fine. She rode with me through my entire labor, and later in the hospital, when medical intervention did become necessary, she helped my husband and I understand our options clearly. All of the decisions we made were well-informed because of her. Even the ultimate decision to have my daughter enter this world via cesarean was made from a place of empowerment, not defeat, because of the amazing support of my doula. My midwife was very instrumental in that as well, and I was fortunate that my doula was allowed to be with us during the c-section. Even more atypical, my midwife was given the honor of bringing my very poorly positioned daughter out of me, thanks to a wonderful Obstetrician. Because of the incredible work my doula did, I know that my cesarean was not one of those unnecessary surgical births, but rather the only option left after attempting every concievable option.

During my second labor, my doula was instrumental in my ability to have an unmedicated vaginal delivery. Her awe at my progress gave me faith in myself to continue, and her whispers of “this is normal, this is what it’s supposed to be like” in my ear during transition got me through. Her suggestions for better pushing positions allowed me to push my daughter out in 30 minutes. Two very contrasting labors and births, but in both instances, a doula was extremely important in both progress of the labors, and also in my perception of myself and my ability to give birth.

Doula’s fill a very important role whether women are birthing in a hospital, in a birth center, or at home. There are plenty of statistics available on the lowered intervention rate when doula’s are present. There are even statistics on shorter labors when a doula is present. Right now I want to put statistics aside and just honor what doula’s are. They are women who are passionate about helping women during quite possibly, the more transformative moment of her life, when she becomes a mother, or a mother again. They are women who understand that a woman’s view of herself and her world will be altered in some way during that process, and they are committed to having that alteration be positive. What we experience during our labors can shape how we feel for the rest of our lives. Doulas know that society as a whole is more healthy when women feel supported during their births and they are there to do it tirelessly.

Thank you to all the doula’s out there. Your work is important and I honor it. May every woman be given the opportunity to birth with a doula.

To learn more:

www.dona.org

www.palsdoulas.org

www.openarmsps.org

 

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Chinese dietary therapy often recommends that people limit or eliminate dairy products from their diet. In Traditional Chinese Medicine, dairy is considered a cold food that leads to damp accumulation, particularly in people who have a weakness in their Spleen energy. Symptoms of dampness include lethargy, loose stools, feelings of heaviness, cloudy thinking, excess sputum(particularly in the sinuses), certain types of headaches, and accumulations such as cysts and tumors. The concern for some who want to follow this dietary advice, is whether they will be able to get adequate amounts of calcium from a dairy-free diet. This is certainly a concern as most adults require around 1,000 mg of calcium a day to maintain bone, muscular, vascular and hormonal health. There is disagreement about the exact quantities of calcium in foods, but if a person were avoiding milk, increasing the amounts of the following foods should provide enough calcium for most individuals.

Nuts and Seeds

Sesame seeds (most sources list the calcium content of 1 oz of these to contain more calcium than one 8oz glass of milk)

Sunflower seeds (also high in iron)

Almonds

Soybeans

Brazilnuts

Pecans

Sesame tahini

Legumes

Beans (garbonzo, pinto, soy, canellini)

Tofu (especially calcium-treated)

Dark Leafy Greens

kale

collards

turnip greens

dandelion greens

mustard greens

arugula

chard

chicory (curly endive)

Vegetables

Broccoli

Bok Choy

Acorn squash

Fruit

Figs, dried

Orange juice, calcium-fortified

Kiwi

Grains

Cereal (calcium-fortified)

Amaranth

Brown rice

Oatmeal

Corn tortillas

Fish and Seafood

Oysters, raw

Salmon (canned with bones)

Sardines (canned with bones)

Mackerel

Other

Blackstrap Molasses (also high in iron)

Greek yogurt (although dairy, this is not considered a damp-producing food)

 

 

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I have a fertility-turned-obstetric patient who just emailed me to cancel her appointment for this morning. She was in labor and wouldn’t be needing an induction treatment as we had planned. This is someone who had faithfully come in for treatment throughout her pregnancy, and to whom we applied pre-birth acupuncture from week 36 on. She went into labor 5 days after her due date.

This is typical of primigravidas (first time moms). Having pre-birth acupuncture most typically results in babies that come during the 40th-41st weeks. Rarely do I see those who come in weekly for this treatment get to week 42. The protocol is simple, and the hour spent in session gives the mom some much needed self-care time. Not only is the pre-birth acupuncture helpful for getting labor going in due time, but it has also been shown to reduce the overall time in early labor by an average of 2 hours. 2 hours might not sound like a lot, but believe me, to a woman in labor it is significant. In addition, there is strong anecdotal evidence that women who receive pre-birth acupuncture require less medical intervention during labor than women who do not. I encourage all of my obstetric patients to come in once a week from week 36 to week 41. Once we pass week 41, we can apply a stronger induction-style treatment 3 times in a week as these moms may be facing a decision to medically induce with Pitocin should they reach week 42. I do not actively induce moms before their due dates, and I find that those who receive pre-birth treatment rarely require it.

For acupuncturists interested in incorporating the pre-birth protocol into their obstetric practice, I use the following points as a base of treatment, and add any points that I feel will benefit the particular patient depending on other symptoms present and using a differential diagnosis.

Weesk 36-38: (using no stimulation) GB34, ST36, Sp6 (if there is a history of rapid uncontrolled labor, substitue with Ki8), Bl62, yin tang. If the baby’s position is not optimal, add Bl67 and Bl60

Weeks 38-40: (using no stimulation) GB34, St36, Sp6, Bl62 (again, add Bl67 and Bl60 if needed), yin tang, GB21

Week 41: (using strong stimulation) GB34, St36, Sp6, Bl62 Bl60,, Bl67, yin tang, GB21, LI4 Bl31, Bl32

These points can all be needled bilaterally in a seated position, or unilaterally in a side-lying position. I favor side-lying as many moms become quite relaxed and meditative.

 

 

 

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When I was in my last semester of acupuncture school, I was pregnant with my first daughter. Once that fact became obvious to my teachers and classmates, my two Chinese instructors insisted that I needed to needle Kidney 9 regularly. It is thought that this point will produce a beautiful baby when needled throughout the pregnancy. I thought it was humorous at the time, but I have since come to rely on this point with all of my pregnant patients, as it is one of the most useful for securing a pregnancy and preventing miscarriage. I joke with my patients that we are needling the “beautiful baby” point, but in truth, I am using it to be sure that the uterine environment is as healthy as possible for the growing embryo and fetus.

From the book Acupuncture in Midwifery (which I highly recommend to acupuncturists focusing on Obstetrics) by Yelland:

“Kidney 9 is said to produce a child with particularly luminous complexion who would sleep at night, laugh in the daytime, be virtually immune to diseases or if he/she did catch a disease would heal quickly, be sane in mind, morals and body.”

 

Interesting note: Peter Deadman’s A Manual of Acupuncture, which is the main text used in American acupuncture schools, does not include miscarriage prevention or “beautiful baby” as indications for this point. The name of the point, however, translates to Guest House. To me, this sounds as though it is for the uterus while it is “housing” a guest, aka, a baby.

 

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There are many new books being published about fertility and Chinese Medicine. I have read most of them and find that most offer fairly accurate advice and expectations when using Chinese Medicine for fertility. I certainly think it’s helpful for women to have a basic understanding about how the medicine works, how we diagnose, basic nutritional advice. However, I think it is risky to follow advice about taking herbs or supplements from a book without seeing a professional trained in herbal or Naturopathic medicine. The author of a book has no way of knowing your particular set of circumstances and health make-up.

Here’s an example: In the book The Tao of Fertility, the author, Daoshing Ni gives a group of supplements that he recommends for women trying to get pregnant. These include high quality fish oil, B12, B6, Folic Acid and the amino acids L-carnitine and L-arginine. Now, it may be the author’s experience that most women respond well to these supplements, and I would agree that fish oil and B vitamins are essential for every woman. However, supplementing L-carnitine and L-arginine can have detrimental effects in some women including: low blood pressure, bleeding disorders, nausea and low blood sugar. These amino acids can be found in foods, and eating a well-balanced diet full of vegetables, fruit, legumes and lean meats will provide adequate quantities of both without the unnecessary risks of side effects from supplementation.

When considering any supplementation outside of a basic multi-vitamin, fish oil, and probiotics, supplements and herbs are best taken with the guidance of a Naturopath or herbalist who knows your personal health history and knows any pharmaceuticals that you are taking.  This ensures that what you are taking is tailored to what YOUR body needs, not general advice that doesn’t take your set of circumstances into account.

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This past weekend I saw 4 women in the early stages of pregnancy who were struggling with nausea and vomiting. Morning sickness is considered a normal symptom of pregnancy, and even lauded as a “good sign.” While it does indicate higher levels of progesterone necessary for maintaining pregnancy, for some women it can be debilitating. For many, it is so severe that they are unable to work and often resort to western drugs which can be effective, but are not without risks.

In the hands of an experienced acupuncturist, a woman can find significant relief for morning sickness. In my experience, the most helpful protocol is to receive treatment three or four times within a short period of 1-2 weeks, then continue once-weekly treatment through the first trimester. I will also prescribe herbs if they seem necessary, and encourage women to keep their blood sugar as stable as possible by taking bites of crackers, or other carbs throughout the day. Rest is very important in these situations, and I ask my patients to get to bed early and nap when they can. I have a very strong ginger candy that many women swear by as well.

The main points that I use are KI-27, KI-21, KI-6, P6, Ren 14, Ren 12. I will add additional points based on the woman’s current Chinese Medicine pattern. Common additions are St-36, Sp-4, Liv-3, St-44, St-19, St-40.

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Sanyinjiao translates to Three Yin Intersection. This point is unique in that the three yin channels of the leg intersect here. The Spleen, Liver and Kidney channels can all be accessed through this point making it very powerful, and very useful.

Locate sanyinjiao 3 cun (approximately 3 inches) up from the medial malleolus (the inner ankle bone) just behind the crest of the tibia, or leg bone. The point is often tender and might feel like a slight depression in the muscle tissue.

I use this point often, especially on women, as it is a lovely point for tonifying the qi of the Spleen and Stomach, thereby aiding in building blood. This has broad use, from menstrual irregularities to digestive discomfort. It resolves damp conditions and invigorates the blood, making it useful for regulating menstruation and also for inducing labor. It is therefore, contraindicated in pregnancy unless labor is desired. It is usefully for calming the spirit and rules the lower of the 3 jiao, meaning the intestines, bladder, uterus/tubes/ovaries, and the sexual organs.

Sanyinjiao is useful for any gynecological, urinary, sexual, digestive and emotional issues. Few points have so many, and such broad application, making Spleen 6 one of the most widely used acupuncture points.

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I have always had faith in the wisdom of a pregnant body. For the most part, babies come when they’re ready. Unfortunately, there are circumstances in which a medical induction with pitocin or cytotec are indicated. If a woman or baby’s health is in jeapordy, induction becomes necessary. All too often, medical caretakes do not feel comfortable with a woman who hasn’t started labor by the 41st week and induction is recommended for no other reason than being “overdue.”

When a woman is facing medical induction with drugs, I do provide acupuncture induction to start labor naturally. Contractions initiated with Pitocin are more intense than natural contractions and often lead a woman straight to an epidural, which carries with it many risks. Naturally inducing labor with acupuncture does not have the intensifying effect.

In my experience, first time moms often need up to 3 treatments to get labor going, although I have seen many cases in which 1 treatment does the trick. It is a safe protocol, and worth trying before resorting to more invasive, less safe inductions with drugs.

Interestingly, women who have done prebirth acupuncture once a week from week 36 on, usually go not require even acupuncture induction, as they generally go into labor on their own by week 41.

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