pregnancy

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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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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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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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Near the end of pregnancy, when the due date begins to loom, most babies will position themselves head down and facing the mother’s back. This is the ideal position for labor and delivery. When a baby is in this position the head descends and puts pressure on the mother’s cervix which helps initiate labor and leads to effective, productive contractions during labor. This position is also ideal for the descent of the baby through the birth canal and out into the world.

While turning head down is the norm, not all babies move into this position on their own. Giving birth to a breech baby who is butt down or feet down is possible, but it carries a higher risk to the baby and mother and most care providers are not willing to do it.

There are two choices in Western medicine when it comes to breech babies. One is to attempt a manual version from the outside. The midwife or OB will use their hands on the outside of the mother’s abdomen to try and turn the baby into the ideal position. This is done with the aid of an ultrasound machine while the heart rate of both baby and mother are monitored closely. It is not without risk and not all practitioners are willing to perform this technique. Some women find it to be painful and opt out of trying it. The second choice, when manual version is not an option, or is undesired, is to schedule a cesarean section.

Chinese medicine offers another option. 

There is a simple technique that can be quite successful if applied correctly and daily within a specific time period.

Moxibustion is applied to the point Zhiyin (BL-67) on both feet for 15 minutes every day.

A practitioner of Chinese Medicine can perform the technique once, showing the woman and a partner how it is done, and then the woman can have it done at home every day for up to 5 days. After 5 days, the pregnant woman should be checked to see if the baby has in fact turned. If not, another 5 days of moxa can be applied.

The ideal week of gestation for applying moxa is week 34, but anywhere between 30 and 38 can be done. If it is applied too early, the baby may turn back into the breech position, while attempting too late may not be successful if the baby doesn’t have enough amniotic fluid or room to make the move.

There have been several studies performed testing the efficacy of this technique. The success rates vary from 60% to 80% success, depending on the study. Most of these studies also conclude that the 34th week of pregnancy is the ideal time to perform moxibustion for turning breech babies.

I have personally seen this technique succeed and feel that it is usually worth trying when cesarean section is the only other option.

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