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Acupuncture in Pregnancy: Effectiveness Gaps in conventional Pregnancy Care

Acupuncture in Pregnancy: Effectiveness Gaps in conventional Pregnancy Care

Introduction:

Pregnancy is a special and unique time in any woman’s life that can be full of ups and downs both personally and physically and is often marked with advice, opinions, stories and studies that can leave a woman confused and overwhelmed. The physical adaptations that the body undergoes in pregnancy is truly remarkable and can lead to discomfort in some women, though most are short lived and go untreated, some can be more serious and can lead to medical interventions that are risky to both mother and baby. My professional experience as a Doula witnessing women go through these discomforts, big and small, with little to no safe and effective treatment in standard maternity care inspired me to look at the effectiveness gaps in maternity care and the role acupuncture can play in filling these gaps.  Effectiveness gaps (EG) as first written about by Fisher P et al. 2004 are identified as an area of clinical practice where available treatments are not fully effective. Pregnancy is a time when women’s bodies and the fetuses they are growing are considered very delicate and extra caution is advised by both modern and traditional practitioners. Furthermore, due to the ethics of studying pregnant women the availability of good studies is often lacking. In this paper I hope to offer some safe and effective solutions using acupuncture for women suffering from common discomforts of pregnancy. 

Methods:

Upon thinking about this research, I began by considering my professional experience in working with pregnant women. From my experience I have seen the following issues come up during pregnancy and thought they may be deemed to be EG by midwives in my area; nausea and vomiting, heartburn, low back, sciatica, rib and pelvic pain, insomnia, anxiety/ depression, bleeding, haemorrhoids, varicose veins, edema, induction, hypertension, breech, posterior position, constipation, anemia, headaches, UTIs, pain relief in labour, itching, gestational diabetes, fatigue and exhaustion. In order to gather further information on EG, I sent invitations to participate in semi-formal interviews to the 32 midwives operating in Victoria, BC and the surrounding area. Of these I received responses from two midwives, of which one lead to a successful and enlightening interview, who for anonymity I will refer to as Sarah. It would have been ideal to interview more midwives, however the one I did speak with had over 20 years experience working in two major centres in Canada, both pre-registration and under registration of the provincial governments of Alberta and BC. The discomforts and diseases that Sarah felt were the biggest EG were: Anxiety and depression, Hypertension, sciatica pain and safe effective induction techniques for VBAC women. With these in mind, I searched the available literature and found studies and historical documents on treating the above issues with acupuncture. 

Anxiety and Depression:

Anxiety and depression are two of the leading mental health issues in the world today and women are twice as likely to encounter them throughout their lives, as the WHO’s Department of Mental Health and Substance Abuse 2012 report indicates. As Ormsby et al 2016 cite the morbid consequences of depression in pregnant women include an increased risk of obstetric complications, post-natal depression, alterations in growth, development, autonomic nervous function and mental health in children. The current treatments for anxiety and depression are psychotherapy, antidepressants, and anxiolytics, which have not been studied well in pregnancy and may lead to unwanted side effects. 

In my interview. the primary EG that Sarah saw amongst her clients, especially in Victoria is anxiety and depression. She spoke of the stresses to lead a perfect life and the lack of information  and therefore choices these women had as major causes of their anxiety and depression and in her professional experience correlated this to increased hospital births and medical interventions such as epidurals and cesareans. 

From a Chinese Medicine perspective there are several explanations as to why women suffer from twice as much depression. According to Schnyer 2001 cited in Sniezek & Siddiqui 2013, the relationship between the liver, depression and the menstrual cycle is key, as well as other diagnosis that affect the shen/mind such as kidney and/or lung qi deficiency, liver and spleen blood deficiency, liver blood stagnation, cold invasion causing qi and blood stagnation and Jing and Yuan qi deficiencies. Historically, women during pregnancy were viewed as needing extra care and protection, especially from fright, fear and agitation (Betts 2017). Peaceful sleeping places, calming neutral foods and looking at beautiful things was often recommended to women during pregnancy. In this modern day we can still offer many of these recommendations along with acupuncture to soothe the liver, calm the mind, and nourish the qi and blood. 

To date there have been three studies done on acupuncture to treat anxiety and/or depression in pregnancy. As cited in Ormsby et al 2016, In the first RCT conducted by Manber et al 2004 compared 12 treatments over 8 weeks of individualized acupuncture with sham acupuncture and a massage control in 61 pregnant women with major depression. They reported a 69% improvement in the acupuncture group over 32% in the massage group (p=0.031) and 47% in the sham acupuncture group. The acupuncture group also demonstrated a significantly higher average rate of reduction in depression scores in the first month of treatment when compared with the control (p=0.047). In the second RCT lead by Manber et al in 2010, they utilized a larger population of 150 women and found that the acupuncture group demonstrated significantly decreased severity in symptoms when compared with the combined results of the massage control and the sham acupuncture groups (p<0.05) The third study in 2007, lead by Bosco Guerreiro da Silva compared 51 women quasi-randomized into a pre-programmed acupuncture group and a non-treatment group. They reported a reduction of symptom severity of up to 50% in 15 out of the 25 acupuncture subjects vs 5 of the 19 control subjects (p=0.013). They also found that the acupuncture group experienced a significant reduction in 3 out of 5 life disturbance categories (p<0.05).  These studies with their limitations provide good groundwork revealing that acupuncture can provide safe and effective treatment from women suffering from anxiety and depression during pregnancy. More studies are needed and currently Ormsby et al. 2016 are recruiting for a major RCT that will take into account the limitations that affect these three studies; small sample size, quasi-randomization, lack of equivalent care control, unclear randomization generation and concealment, unclear assessor blinding and incomplete baseline and outcome data. 

Hypertension and Preeclampsia 

The American congress of Ostetricians and Gynaecologists 2015 define Preeclampsia as a disorder specific to pregnancy, where gestational hypertension is seen together with proteinuria or other risk factors such as thrombocytopenia, impaired liver function, renal impairment, pulmonary oedema or new-onset cerebral or pulmonary disturbances. According to the Maternal Hypertension in Canada ( Public Health Agency of Canada, 2010/11) report the rate of gestational hypertension without proteinuria was 46.2%, the rate of preeclampsia was 11.5% and the rate of eclampsia was 0.8%. Zeng et al 2016 cite Steegers et al. 2010 as stating that Preeclampsia remains a leading cause of maternal and perinatal mortality and morbidity and complicates 2-8% of all pregnancies. Preeclampsia can lead to various complications including eclampsia, renal failure, placental abruption and preterm birth. Normal treatment with antihypertensives throughout pregnancy can have many side effects including fetal growth restriction, fetal renal impairment and reduced placental perfusion, as cited by Zeng et al. 2016.  

In my interview Sarah mentioned the need for ways to lower maternal blood pressure before it leads to preeclampsia and other issues. In Chinese Medicine, Hypertension can refer to TCM patterns of headache. dizziness, tinnitus and palpitations (Shi & Zeng 2011). These are often connected to the liver, which is easily affected by stress and stagnation that can increase in pregnancy.

In my research I found one study on the effects of acupuncture on preeclampsia in Chinese Women (Zeng et al 2015). In it the authors reference two observational studies looking at acupuncture for treating pregnancy-induced hypertension in which both studies found acupuncture to be safe and effective but lacked control groups to draw any comparisons. In the 2015 study by Zeng et al they compared an acupuncture group (n=11) and a control group (n=11) both receiving standard care at baseline, following treatment, 24 hrs before delivery and 1 day postpartum. They found that though mean differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not found immediately following treatment, the mean differences 24 hrs before delivery and 1 day postpartum were significantly lower in the acupuncture group and that the individual change in BP from baseline was significantly lower in the acupuncture group for both SBP (p=0.007) and DBP (p=0.013). They also found no statistical difference in perinatal outcomes between either group. They do outline two limitations, one that there was no sham acupuncture given to the control group, thereby there is no way to rule out placebo. The second was the very small sample size. Overall, the study does seem to show that acupuncture can safely lower blood pressure in women with preeclampsia alongside standard care. 

Low back and Pelvic Pain

Low Back and Pelvic Pain (LBPP) is a common complaint of pregnant women, with loosening ligaments, changes in lumbar curvature and balance due to a growing belly and increased weight, a decreased ability to exercise in the last trimester and often days filled with sitting at a desk, the low back and pelvis structures can stretch, pull, pinch and compress. According to the 2013 Cochrane Review on Interventions for treating and preventing pelvic and back pain in Pregnancy they report several studies (Greenwood 2001; Mousavi 2007; Skaggs 2007) finding that approximately two-thirds of women experience low back pain and one-fifth of women experience pelvic pain and nearly 50% of women receive very little to no treatment at all. The Review also references studies (Van De Pol 2007; Kalus 2007; Mogren 2007; Skaggs 2007) that found for many women, pain interferes with their daily activities, their work, their sleep and leads to increases in depressive symptoms. Common interventions that have been used and that were looked at by the Review are exercise, manual therapy, acupuncture, pelvic belts and pillows and multi-modal approaches each having varying degrees of effectiveness. 

During my interview with Sarah, she particularly spoke of the need for effective treatment for Sciatica pain that some of her clients experienced. She stated that she has had good results treating hip pain with a homeopathic dose of Hypericum Perforatum. In Chinese Medicine, Pain is most often associated with Stagnation of Qi or Blood in a channel that can arise from invasion of a pathogenic factor (wind, cold, damp, heat), injury or an internal organ disharmony affecting a channel (Betts 2006). According to Betts 2006, LBPP is most commonly seen as tenderness and pain along the bladder and gall bladder channels with an internal organ disharmony of either kidney deficiency or Liver qi stagnation. 

In the Cochrane Review 2013 they cite three studies that looked into the use of Acupuncture in treating Pelvic Girdle Pain and Four studies that looked at treating LBPP with Acupuncture. The first, a study by Elden 2008, looked at 108 participants with Pelvic Girdle Pain, the results they found were mixed. The overall pain relief from usual care plus acupuncture vs usual care plus sham acupuncture was insignificant (p=0.483), however there was a significant improvement in daily living in the acupuncture group (p=0.001). Another study by Elden 2005, also looking at pelvic girdle pain amongst 330 participants who received either usual care, stabilizing exercises or acupuncture, found that the usual care group experienced much more severe evening pain then the acupuncture (p=<0.001) and stabilizing exercises (p=0.0245) groups and that the acupuncture group experienced more evening pain relief than the stabilizing exercises group (p=0.0130). The third study by Lund 2006, compared the use of Deep vs superficial acupuncture to treat pelvic girdle pain in 47 participants, though no significant differences were found between the two techniques, 68% of the women receiving superficial acupuncture found improvement in their evening pain and 72% of women receiving deep acupuncture found improvement in their evening pain. 

Of the studies that were included looking at women who suffered both low back and pelvic pain, all four found improvement in pain and function, though they were all deemed low quality by the review. Ekdahl 2010 looked at 32 women who began treatment at either 20 weeks or 26 weeks gestation, they found that the group that started at 26 weeks saw a greater improvement in pain relief. In the study by Kvorning 2004 that looked at 72 women either receiving acupuncture plus usual care or acupuncture alone, found that only 14% of women receiving usual care found improvement in their pain vs 60% of the women receiving acupuncture. In the third study, Wang 2009a looked at 152 women who receive either ear acupuncture, sham ear acupuncture or were on a wait list control. They found that all women reported an improvement in pain, with the acupuncture group reporting significant improvement in pain relief and function compared with the sham group (p=0.02) and the wait list group (p<0.001). Wedenberg 2000 compared 46 women receiving either acupuncture or physiotherapy, while all women experienced improvement in evening pain and disability the acupuncture group reported significantly less intense pain (p<0.01) and disability scores than the physiotherapy group. All of these studies were deemed safe with few mind adverse effects (bleeding and pain at site of insertion) they were all classified as low quality evidence, except Elden 2005 which was considered moderate quality. The review calls for more studies to further illustrate the effectiveness of acupuncture in treating LBPP. 

Discussion:

Overall, though limited by time, funding and a limited number of studies, the findings of this research show that acupuncture is a safe and effective tool for treating the EG of pregnancy that Sarah pointed out in our interview. In future research I would like to interview more midwives regionally, nationally and even internationally to see if different EG exist within different regions, countries and amongst practitioners themselves, as well asking doctors, obstetricians and gynaecologists what EG they found in their practice would be interesting to compare with the midwives results. It is evident from the research that more studies on acupuncture in pregnancy are needed, including studies into whether cervical ripening acupuncture would improve outcomes for VBAC mothers and if acupuncture can help with gestational diabetes as these were EG that Sarah identified that I could not find any research on. With particular consideration of the unique treatment that acupuncture uses and the many limitations of these studies (small size, quasi-randomization, lack of equivalent care control), more studies with a better system of comparison needs to be utilized by researchers, such as The Stricta (2010) (standards for reporting interventions in controlled trials of acupuncture) protocol developed in conjunction with the CONSORT group. There is also much wisdom that is offered in the historical and modern texts and experiences of practitioners that could shed more light on the use and effectiveness of acupuncture. 

Conclusions:

Acupuncture is a safe treatment in pregnancy and seems to offer effective alternative or complementary care for pregnant women with anxiety and/or depression, hypertension, preeclampsia, low back and/or pelvic pain. With Pregnancy being a time of care and caution and being surrounded by a system that is largely adverse to risk, acupuncturists have an important role to providing care to pregnant women when their regular care providers have little to no safe or effective treatments. Many women are told to watch and wait or that it is just part of pregnancy and are often not assisted by their practitioners unless it is deemed critical when interventions are sometimes dangerous, in this acupuncturists can offer women relief from persistent and troubling discomforts in their daily lives and allow for a healthy and happier pregnancy. 

References:

Betts, D. (2006) The Essential Guide to Acupuncture in Pregnancy and Childbirth. East Sussex, The Journal of Chinese Medicine Ltd. 

Betts, D. (2017). Maternity Acupuncture: Pregnancy, Labour and Postpartum. [Lecture] Pacific Rim College, April, 2017.

Department of Mental Health and Substance Dependence. (2012) Gender Disparities in Mental Health. World Health Organization. Available from: http://www.who.int/mental_health/media/en/242.pdf 

Fisher, P., Van Haselen, R., Hardy, K., Berkovitz, S. & McCarney, R. (2004) Effectiveness Gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine. Journal of Alternative and Complementary Medicine. 10(4), 627-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15353018 

Ormsby, S.M., Smith, A.S., Dahlen, H.G., Hay, P.J. & Lind, J.M. (2016) Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): Study protocol for a pragmatic randomized control trial. Trials. 17(93). Available from: 10.1186/s13063-016-1204-9 

Pennick, L. & Liddle, S.D. (2013) Interventions for preventing and treating low back and pelvic pain in pregnancy (review). The Cochrane Library. 8. Available from: http://uir.ulster.ac.uk/26553/1/LBPP_in_pregnancy_Cochrane_review_2013.pdf

Public Health Agency of Canada. (2010/11). Maternal Hypetension in Canada. Available from: https://www.canada.ca/content/dam/canada/health-canada/migration/healthy-canadians/publications/healthy-living-vie-saine/maternal-hypertension-maternelle/alt/maternal-hypertension-maternelle-eng.pdf 

Shi, A. & Zeng, D. (2011) Essentials of Chinese Medicine Internal Medicine. Second Edition. California, Bridge Publishing Group.

Sniezek, D.P. & Siddiqui I.J. (2013) Acupuncture for treating Anxiety and Depression in Women: A Clinical Systemic Review. Medical Acupuncture. 25(3), 164-172. Available from: 10.1089/acu.2012.0900

Stricta (2010) Checklist for Stricta 2010. Available from: http://www.stricta.info/checklist.html 

Task Force on Hypertension in Pregnancy. (2013) Hypertension in Pregnancy. American Congress of Obstetricians and Gynecologists. Available from: https://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy 

Zeng, Y., Liu, B., Luo T., Chen, Y., Chen, G. & Chen D. (2015) Effects of Acupuncture on preeclampsia in Chinese Women: A Pilot Prospective Cohort Study. Acupuncture in Medicine. 2016(34), 144-148. Available from: 10.1136/acupmed-2015-010893 

Acupuncture for Birth: Pre-birth vs induction

Acupuncture for Birth: Pre-birth vs induction

In Traditional Chinese Medicine it is said that there are three factors that are needed to start labour; a) activity (yang) Replace growth (yin) b) qi must move freely and move blood c) the uterus must open. I would add a fouth, the baby’s spirit must be ready.

After all Babies come in their own time. But there are so many factors that can make us feel like they aren’t coming at the right time, our nervousness about labour, our desire to meet our babies, our sore achy bodies, medical practitioners talking about big babies and the risks of going overdue, family and friends saying “are you still pregnant, when is that baby coming, wow you look huge”

So how do we help these three factors come together and promote a healthy natural start to labour? Prebirth Acupuncture (aka cervical ripening Acupuncture). Prebirth Acupuncture begins at 36-37 weeks gestation and continues each week until labour begins. In each treatment we discuss how the birthing person is feeling, addressing their concerns, hopes, fears, dreams and desires and based on this a unique combination of points is developed with the help of some special points that move qi and blood, ripen the cervix, relax the tendons and strengthen the body. This time spent each week allows mom to prepare herself, her body and her baby. I am a big advocate of talking to your body and baby and this is a great time to do it. Fears are released, anxiety dissolves, worries disappear, resilience and strength are built and trust in our power and knowledge is developed. All of these things help make stronger mamas and babies and promote more effective labour and birth. It strongly helps mitigate the need to medical interventions and if an induction is required it can make it that much more effective.

Sometimes Inductions happen and hopefully it is for an important reason. Acupuncture is one tool amongst many that can be used for induction or help medical inductions be more effective and prevent further interventions. However, if baby isn’t ready or the three factors that start labour aren’t completed then acupuncture or any other natural induction method will not work. In those cases, only medical interventions will get that baby out, so that mom and baby are both healthy and safe.

Studies show that those women who receive pre birth acupuncture had a shortened labour(1), improved cervical ripening(2,3), a 35% reduction in medical inductions (43%. For first baby), 31% reduction in epidurals and 32% reduction in emergency c-sections(4). While the 2013 Cochrane review of acupuncture for labour induction only found some evidence of cervical maturation in those who received acupuncture(5).

Book Now at Mothering Touch or call 587-581-5081

References:

1 Kubista E Kucera H. 1974. Geburtshilfe Perinatol; 178 224-9

2 Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P.  2001. Acupuncture for cervical ripening and induction of labour at term – a randomised controlled trail. Wien Klin Wochenschr; 113 (23-24): 942-6

3 ​Tempfer C, Zeisler H, Mayerhofe Kr, Barrada M Husslein P. 1998. Influence of acupuncture on duration of labour Gynecol Obstet Invest; 46:22-5

4 Betts D, Lennox S. 2006. Acupuncture for prebirth treatment: An observational study of its use in midwifery practice. Medical acupuncture May; 17(3):17-20

5 Smith Ca. Crowther CA. Grant SJ. 2013. Acupuncture for induction of labour. Cochrane Database System Review.

 

Flower Essences: Nature’s vibrational Medicine

Flower Essences: Nature’s vibrational Medicine

I love Flower Essences! They are one of my favourite tools for creating mental, emotional and spiritual transformation and connecting in with the seasons and cycles of nature. You can purchase many different essences online and in health food stores but they are so easy to make and allow you to connect with the plants that are growing in your community.

What are flower essences?

They are vibrational remedies preserved in alcohol that tap into the different energetic levels of your being. Each individual essence has captured the energetic imprint of a flower into water and then they are further diluted with alcohol and water. Like Dr. Masaru Emoto’s work in “The Hidden Message of Water” Water takes on the energy of the flower as it can take on the energy of our words.

Which Flower Essence is best for me?

Each flower has its own unique vibration and medicine to offer to us. Some are good for all people while others are good for just some people. You can read about different essences and see which resonate with you. My favourite list is here.

My favourite way to determine which essences are best is to go for a walk in your neighbourhood and see which flowers call out to you. It could be with their smell, their colour or just their vibration calling to you. That’s where making your own essences is so great. Once you have made your essence you can try it and identify what it is that it helps with through your experience with it.

How to make your own Flower essences?

First, find the flowers that call to you and the best place to pick them. I like to pick mine with the new or full moon but any time will do.

Prepare yourself a dish or jar and fill it with purified water, 1 cup/250ml is lots.

Go to the plant you have chosen and introduce yourself. Ask it to share its medicine with you.

Once you have asked harvest one flower head and place it in the water.

Place it in the sun or under the moon for a few hours or up to one day.

Strain the water into a sealable jar, flask or dropper bottle and top with 1 cup/250 ml brandy. Label with flower, date and any astrological info. This is your mother essences.

To make into an essence to carry with you or give a friend or family member.

Grab a dropper bottle and fill it 3/4 with half water and half brandy. Then add seven drops of each flower essence you wish to add to it. I usually add a maximum of 5 essences to a bottle. Label again with flowers and date made.

To use:

Take four drops under the tongue or in a beverage as often as needed. For chronic or deep work, once a day is good. For acute work like grief, stress, anxiety, as much as needed. Ideally taking a moment to take your essence allowing it to work its magic as you breath is best.

 

The Ancient Art of Mother Roasting

The Ancient Art of Mother Roasting

As most people wonder when I begin to speak about mother roasting, I imagine you are also wondering, what could mother roasting be? Is it publicly roasting mothers with our words or could it be cooking them in a human sized roasting pan? Fortunately, I can reassure you it is neither, well no quite! Mother Roasting is an ancient form of caring for a mother after birth. As SacredPregnancy.com so beautifully puts it “Mother Roasters are CAREGIVERS that nurture new mothers after BIRTH while supporting their RECOVERY + JOURNEY into motherhood; as EVERY woman deserves to be welcomed into MOTHERHOOD through GENTLE + LOVING + CARE*.

 

The history of Mother Roasting can be drawn back to nearly every culture around the world and today it is still practiced in many Asian, Middle Eastern, Latin and Indigenous Cultures. All of these cultures recognize the great care a mother needs after birth in order for her to be able to give back to her family. By sealing up the gateways of birth, returning the organs and bones to their normal places, protecting and supporting her back, keeping wind and cold from entering her body, nourishing her with rich, healing, milk-enhancing foods and teas and giving her permission to take care of herself, a mother is able to take the time to heal, integrate motherhood, bond with her baby and seal her story of birth. The different practices vary from culture to culture from sleeping on warm furs beside the hearth to having moxa sticks heat your womb and back, having your belly bound with a bengkung (Malaysia), Haramaki (Japan) or a Faja (latin America) to having your pelvis and womb massaged by a skilled practitioner, but all of these practices are meant to allow the mother to heal, transition and bond with her baby.

Here are two examples of how a mother may be supported if she lives in Malaysia or Thailand:

In Malaysia, The Pantang/exclusion period lasts for 40 days during which the mother’s belly is massaged and bound every day for a minimum of 3 days up to 40. This is done to allow the organs and bones to return to their original places. A week after the birth a stone or metal ball is heated in the fire and then wrapped in a cloth and rolled along the mother’s body. In Malaysian culture, the mother is thought to enter a cold phase after birth, thus she eats only foods that will heat her up and her body is warmed with massage and wrapped to restore her to her normal temperature.

In Thailand, during the pregnancy, the father will collect special smokeless firewood. After the birth the father will create a fire for his wife to sit near or he may place a special bed over the fire. The fire keeps her body warm while the smoke purifies her and keeps evil spirits away. The Thai recognize that after birth the mother is weak and exhausted and her uterus is still filled with harmful fluids, therefore they warm up her body to help recover her energy and to push out the fluids. Her body is not only warmed by the fire but also with hot water that she bathes in and drinks and basic warm foods and traditional medicines that she eats.

In the West, I often see mothers who feel the pressure to be continuously productive and bounce right back from birth like nothing ever happened. I have heard many say that it is their jobs as mothers to serve and there is no time for self-care. I think this is one of the greatest misfortunes of our Western perspective, how are we to raise our children to our greatest ability and their greatest success if we are not giving back to ourselves. One of my wishes for all mothers is the opportunity to honour the babymoon and the transition they have gone through, to ask for and receive the support they need from family, friends and community and to take time for themselves. I know 40 days may sound like a long time but even a week or a few hours a day to enter into a sanctuary with your baby and take time to relax, nurture, heal and honour can make the greatest difference in a mother’s life, her baby’s and her whole family’s.

 

References

*http://www.sacredpregnancy.com/sacred-pregnancy-training/mother-roasting-retreats/#sthash.UZDTUqqi.dpuf.

Priya, Jacqueline Vincent. Birth Traditions and Modern Pregnancy Care. 1992. Element books ltd. Longmead, Shaftesbury, Dorset, UK. Pg. 108-116.

Johnson, Deborah. With Child: Wisdom and Traditions for pregnancy, birth and motherhood. 1999. Chronicle Books. USA. Pg. 70-73.

Body Shop Team, Mamatoto. 1991. Virago Press ltd. London, UK. Pg. 120-129.

Originally published in Birthing Magazine Spring 2015

For more info on Mother Roasting Treatments and packages http://marikareidhall.com/wp/birth-medicine/

Walking with Death: A Reflection on death, dying and grief

“Sorrow is part of the earth’s great cycles, flowing into
the night like co0l air sinking down a river course.
To feel sorry is to float on the pulse of the heart, the
surge from living to dying, from coming to being
to ceasing to exist. Maybe this is why the earth has the
power over time to wash sorrow into a deeper pool,
cold and shadowed. And maybe this is why, even
though sorrow never disappears, it can make a deeper
connection to the currents of life and so connect
somehow, to sources of wonder and solace.”
-kathleen Dean Moore

The day my father died, I clearly remember wondering if I truly wanted to be at his bedside when he finally passed on. That evening I had sat on the phone with my partner during a break from the smells and sounds of the hospital and had expressed this confusion in my mind, was it the right thing to do, would it be better if I slept and took care of myself, would I regret it if I wan’t there? I decided to go. After showering and recentering myself with prayers I walked back to the hospital just as the sun was setting. As I entered into the outer room to dress in a gown and gloves my father’s girlfriend called out to me, I arrived just in time. I hurried in forgoing the protective gear and we sat holding each of his hands, wishing him a safe passage as his breathes became more and more spaced. With each one we thought it was his last but it took time and when he finally went I was ever so grateful that I was there. Death is something none of us will get out of, we will see those we love die and eventually it will be our turn. From this experience I have learned that to be fully present and engaged can be the greatest gift we give our loved ones, in their deaths, our deaths and each day of our lives. In this reflection I hope to offer a glimpse of the beauty, grief, love and loss that accompanies death and how vital it is for us as a society to want a good death for those we love and ourselves. A revolution in death is coming as we remember our place in the nature of things and we all need to be apart of it.

It was a Sunday when I received the call at work that my father’s situation had once again changed. He had been refused his transplant and within 24 hours of getting the news his body had begun to internally bleed. My father was always a strong man, full of energy and activity and as I got that call I knew he had made the choice that sitting and waiting to die was not something he desired to do. So I flew to Edmonton the next morning to find him an even weaker and paler version of himself than I had seen two weeks previous, in and out of sleep he knew who I was but no longer had the sparkle of life in his eyes. I knew that part of my purpose in going was to let this decision he had made be honoured and so, my brother, my dad’s girlfriend and I discussed the options with the doctor and after many tears were shed we all agreed it was time to take him off his transfusions and accept that this was his time. The next two days we sat at his bedside holding his hands, telling stories and singing him songs while friends and family came to say farewell. Sometimes it was calm and peaceful, all you could hear was the rattle in his breath as he slept conserving his energy to be able to smile and say hi to the next visitor, but as death came closer and the veil began to open there were moments of fear and confusion. Watching his once strong body and clear mind, fumble over words and thoughts, unable to rise by himself to go to the washroom, his skin sagging, pale and waxy with purple petechiae dappled over it, this was life and it was incredibly hard! There is one moment that remains seared in my mind, we had helped him to the washroom and were trying to see if he wanted to go outside, his favourite place his whole life, but he didn’t understand or just couldn’t express what he wanted and so he stood trembling with our support as he called out for help over and over again until the nurse came and gave him another dose of morphine. My once powerful father had turned into an old man and at that moment it struck me how these liminal spaces at the time of birth and death when the veil between worlds opens are not like any other experience. They are beautiful and raw, hard and scary and oh so magical, if we let them be.

When my father finally did pass the struggle that had followed him in that last day and in the many hard years he had experienced at the end of his life were erased and his body was at peace. After many tears were shed and the nurse and doctor confirmed his death we slowly began to say good bye to his body. I gathered up warm water and clothes and to the water I added aqua de florida, a powerful and beautiful flower mixture that I use in Shamanic healing. Slowly we undressed him, surprised by the shear weight of his uninhabited body and then we took turns washing each part of his body, thanking it for the work it had done throughout his life. For it’s keen intellect and sharp senses, for the strength to build houses and canoe mighty rivers, for the children it had helped to produce, for the smoothness and grace it had exhibited on the dance floor and the sports field. When we finished clearing, thanking and sealing up his body, we dressed him and said our final goodbyes and then we left the room shaken and exhausted, but knowing we had sent him off right.

On reflecting upon this experience there are so many emotions and thoughts that bubble up to the surface, gratitude for being there for all of it, fear when I sat alone with him as his breathing changed and I wondered if this was it, aggravation at my family and how they kept trying to talk to him or feed him despite the obvious shutting down of his systems, anger at how the system had dragged him around for so long and how is doctors were unable of being genuine or candid enough to speak about the realities of his situation, grief as the little girl inside who had lost her father many year before had only just recently finally found him again, beauty in the love all around and ease in the never-ending cycles of life and death. Despite all of this I was most amazed at how I just knew what to do, when I sat present to all of this it came naturally to me, sing this song, hold space, pray, call in the guides and angels. My training as a birth doula and a shamanic practitioner came to the fore and I was able to weave together my own presence with the skills and tools of these trades. There is nothing I regret in my experience or actions in those two days, but there are two things I wish I had done after he passed; the first to have spent more time with my family and the second to have taken more time off work and school to fully reflect and convalesce from this momentous experience. I recognize I lost my presence when fatigue, grief and daily life came back into the fold and the weight of responsibility began to be felt again. I understand I can not always be in complete presence and by doing my work and utilizing my tools I can achieve more and more presence in my own life, ready to face all the beauty, loss, grief and joy it sends my way. This is what my father’s death taught me.

As a practitioner I wish to bring these rich gifts forward to my clients. In reading about death, grief and dying, I have learned several things that help frame my experience and give tools to share with my clients, friends and family. The first tool comes from Joan Halifax (2011) who so beautifully shares ‘Any attachment to outcome destroys our ability to be fully present and compassionate.’ Everyone has a different concept of death and dying and to honour that as practitioners we must learn from our clients what their journey looks like to them and how they wish to proceed, not holding opinions, judgements or attachments to their outcomes. This was one of the hardest parts of watching my fathers journey through diagnosis and treatment. I did not want to see him die and I disagreed with his choices in medical care, especially his out right trust for his doctors. But I quickly learned it just caused conflict to hold these attachments.

The second teaching comes from Sarah Kerr, PhD (2017) from her talk on Death Midwifery, ‘Ritual is energy medicine for the collective body’ and when each of us come to death or witness death we must create, support and maintain the proper rituals in order to heal and set the collective body back into balance. These rituals can be simple and personal, we can help guide people to find these ways of honouring a passage and releasing their grief and love as they send their loved one off. Through listening to my intuition and my training in Shamanic ritual I put together the ritual we used to support my fathers passing, helping his spirit to let go, his body to be cleansed and sealed and our own love and grief to be released meeting the collective body of all those who love and grieve.

For my third lesson I find Frank Ostaseski’s (2017) third lesson on what the dying teach the living to aptly portray my experience, ‘Bring your whole self to the experience- When we bring our whole self we can work with compassion and not judgement.’ This bringing of one’s whole self, a calling to be completely present is what I learned most in my father’s death, the gifts and healing that this suffering brought to me have out weighed all others to date and I would not have so fully experienced them if I didn’t bring my whole self to his death. Choosing to walk this path with him after having reconnected with him in the last few years created a great mending in myself and my feelings of grief of losing my father as a young girl. Though I could not prevent his leaving this time I was able to be fully present during his passage.

The fourth Teaching comes from Stephen Jenkinson (2012) in his talk for The Compassion Choices Conference, He states that ‘Death is not the end of health, but an enhancement of health and your ability to be a deeply present human being.’ I feel this is key to shifting our perspectives on death and dying, framing it currently as a lost battle or not being healthy anymore makes us feel like we have lost, but death is part of the process and if we can embrace it as such we can return to the harmony that it brings to the planet and the enrichment it adds to our lives.

Finally as Francis Weller (2005) so poetically shares ‘In truth, without some familiarity with sorrow, we do not mature as men and women. It is the broken heart, the part that knows sorrow, that is capable of genuine love.’(p.9). One of the greatest gifts I have received from my father’s death is this maturing of a maiden into a woman. I will never be the same again and I am ever so thankful for that.

As far as deaths go I believe my father had a good one. It may have been earlier than expected and his illness may have caused him much pain and worry, but ultimately when he knew there was no more hope and decided it was time he was supported in that. Death played the central role, as Stephen Jenkinson (2012) suggests it should and we his family were at his side. We were given the space to support him as we saw fit and each one of the nurses and doctors kept their distance except to aid in cleaning up or giving him more morphine to ease his pain and confusion. In coming together we knew we could do this, as he knew he could and I can not imagine a better way to go. Many cultures speak of death as crossing a river from the village of the living to the village of the ancestors, the living’s grief and love met with the joy and welcome of the ancestors help get the dead safely across, Sarah Kerr (2017). In my father’s case I know he was held the whole way and when it is my time to go he will be there to welcome me. Until that day I will continue to cultivate presence in the hardest of situations life brings and work on bringing a good death to all I know. May the future hold a good death for us all.

References
Halifax, J. (2011) Joan Halifax: Compassion and the true meaning of Empathy. Available from: https://www.youtube.com/watch?v=dQijrruP9c4&t=17s

Jenkinson, S. (2012) The Skill of Brokenheartedness: Euthanasia, Palliative Care and Power – Stephen Jenkinson. Available from: https://www.youtube.com/watch?v=6dbmXWLCaRg&t=55s

Kerr, S. (2017) An introduction to Death Midwifery with Sarah Kerr, PhD. James Bay United Church. 13/07.

Ostaseski, F. (2017) Frank Ostaseski: What the Dying teach the living. Available from:
http://longnow.org/seminars/02017/apr/10/what-dying-teach-living/

Weller, F. (2015) The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief. Berkeley, California. North Atlantic Books. pp.9.

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