by marikare | Jul 4, 2023 | Acupuncture, birth, body wisdom, doula, Friends, mental wellbeing, nervous system, postpartum, resilience, Self-Love |
” Rest is not only an act of self-care but of reclamation, rememberance and resistance.”
I began writing this at 31 weeks into my second pregnancy and it has taken me over a year to finish it. It is on a topic that has been on my mind for a long time, especially since experiencing pregnancy and being a mom and it is around our ideas of Rest. What does it mean to truly rest and why is it so hard for so many of us to do? Why do so many suffer from chronic fatigue? Why do most of my patients, especially the mamas come to me exhausted, stressed and still pushing themselves? Why is it that when someone is sick or injured they go back to work the minute they can. If anything I would have hoped Covid would have taught us to slow down and really wait till we are better before we go back to work, but alas it seems that now we just work from our homes and continue to push ourselves.
Ever since having my daughter four year ago I have felt tired on some level or another, there were moments before that, of course, while busy trying to study and work or when ill or injured but nothing quite like trying to be a working mother. Add another pregnancy and a second job and it was hard to function without multiple naps. I certainly am better at allowing myself to rest these days, as I know how trying to rush back to things leads to more illness and exhaustion, and yet I still feel that pressure from somewhere deep inside myself, a seed planted, a family icon calling to me that I should be doing more, I should be better by now, I should be able to get up and go like I used to.
As I see it there are many factors that affect this, One of the most insidious of these runs back to the origins of North American colonization, that of the Protestant Ethic. An idea that the work we did was what made us worthy under the eyes of God and the harder we worked the more “holy” we were. This can easily be seen playing out in the “American Dream” and the idea that we can create anything from our hardwork, no matter who we were born to or our status in society. This powerful messaging has been carried forth by our culture and our families. My Father’s family who came to North America very early on has this story woven into our DNA, I saw it in the way my grandfather, father and uncle worked so hard, and how they indulged in booze, food and marijuana to make them feel better in their lives and I have seen it in myself, how i push myself to achieve more or take on more things than I can handle.
This history of hard work and no rest that is woven into our culture has caused many to feel like failures, sinking into some form of addiction to numb the voice of disapproval or manifesting some illness that will not allow them to work hard anymore. The body or mind demanding the rest that is so desperately needed. This has been a recurring theme for myself and many I know, taking on too much and then either becoming ill, getting injured or having to cancel a commitment that you made because it is all too much. The sense of failure leads many to some form of addiction or self-beratement that pulls us further down the spiral of having to work harder.
Then there is the need to survive in this reality we have created, rising food costs and rent, mortgages and childcare. I recently discovered that Canada has one of the highest housing to income costs in the world. In the face of the cost of living I understand why people don’t rest when they need to and yet as a society and a country that is evidently one of the best to live in in the world we don’t take very good care of our people.
But there is another way, a way our ancient ancestors knew and a way that many are starting to find and that is to move more slowly, to recognize these stories within ourselves and our culture and resist them, to allow ourselves to fully rest when we need to. At one point in time the Estimated Due Date (EDD) for a woman was known as the Estimated Date of Confinement (EDC) and it was not the date when baby was expected to arrive but the period of time she would remove herself from the world to care for herself, to nap and walk in nature, to eat many small nourishing meals, to nest and move into the deeper delta waves of the brain that are needed to birth and care for an infant. It was also common practice that a mother and babe would be left alone in the quiet and dark of their birthing space for weeks to allow for the full healing of the mother’s body and the gentle welcoming of the baby into the world. At birth we are blown open and our babies are just entering into a whole new world, still half in the realms of spirit they need time to settle into their bodies and become aware of the world around them. It is up to us to reclaim this practice of rest and care and support each other in it.
So what can we do? Firstly, we can honour our need to rest and when our bodies feel exhausted we can lie down or take a nap. Set boundaries around your time and capacity so you can nourish yourself first in order to give back to the world. Secondly, we can look to our friends and family and recognize when they are in need of an extra hand. When visiting a new mom bring her food and offer to do some laundry or wash some dishes. When a friend is ill or had surgery check in and see if you could pick up their groceries or medications or bring them some soup you lovingly made or bought. Offer to watch your friends kids for an hour or two and let them go and do whatever it is they most desire to do; nap, watch a movie, get a massage,….. It is only through caring for ourselves and then those we love that this will ripple out into our communities and eventually out into society at large.
by marikare | Sep 22, 2022 | birth, body wisdom, doula, family, midwifery, postpartum, resilience, Ritual, Soul wisdom, traditions |
Birth begins before we realize
Aisla’s journey into this world began on May 23rd. I had just finished what i has intended as my last week of work and was feeling good though tired and sore. We went to the Highland games and in the warm sun we watched men and women prove their strength and skill at dance and the heavy games just like my ancestors once did. It felt a bit like stepping back in time and the combination of the heat, remembering something in my bones and being on my feet helped things get rolling. By the time we got home i was exhausted, hot, sore and was having some fairly intense braxton hicks contractions. The first that felt more than just a tightening of my belly. At that moment i knew I was done being busy and it was time to dive into rest mode and prepare for this baby. So i cancel any plans i had made and the few clients I had let slip past my end of work date.
I felt quite different at the end of this pregnancy than i had with Ayana. I was having more pain in both my SI and PS joints, I didnt have the same energy and I wanted to be alone and quiet, choosing who was allowed to be near me at this time. I felt done with being pregnant this time round and so hoped that she would not be two weeks late like her sister was. At the same time I love being pregnant, the way my body looks, the ripeness and fullness of my flesh that can grown life within it. Despite the aches and fatigue, heartburn and carpal tunnel I knew my body was made for this. I was made for this. Finishing work and cancelling plans helped shift things, listening to my body, relaxing, play with Ayana, spending time with Adam felt good, felt right deep within me. This was what I was supposed to do, this was what I needed to bring my baby earth side.
About a week later I woke up and went upstairs for my morning ritual and my body and mind felt different. I had been having braxton hicks since the night before and as I rocked and rolled my pelvis on the birth ball sinking into and connecting with my body, a sense of elation embraced me and i dropped down into a delta wave trance and I was immediately connected to the universe, I could feel all life around and the web that connects us all. I was the great mother preparing to give life to all existence. As I allowed this feeling to be apart of me I knew this was the next step in bringing this baby forth and I wondered if this was the day she would come. And so as i was bathed in this ecstacy I started to blow up the birth pool and make the bed and gather supplies, caught between the realities of what needed to be done for this birth and the dreamy universe calling to me. This bliss held me though my contractions never intensified and when it came time to go to my midwive’s appt I knew she wasn’t coming today and with the travel outside my home the state receded. But once again I moved more deeply inward and decided I would no longer go out except to the midwife or walk in nature and I would only allow people around me who made me feel safe, revered and loved. This prolonged preparation for labour felt juicy and sweet, I knew I could wait until the time came, I knew my boundaries, I knew what I needed and what this body needed. So I moved slower, lounging, taking ambling walks, taking naps and getting rubs and it was delicious.
Several days later another day came where the braxton hicks felt more like contractions and I thought once gain she might come but it wasn’t time yet and so I let go of trying to figure it out and opened further to the universe and the great unknown. It is quite a thing to wait for a baby, the anticipation and excitement, the moments of being uncomfortable and tired and wanting them to come and the movements of feeling them move and the complete awe and amazement of being so full with child and wanting it not to end. I am so grateful that I got to experience it three times in unique and beautiful ways.
Then June 12th rolled around and I was awoken by what I thought were bowel cramps and so I got up to the go to the bathroom but nothing came and I went back to bed. An hour later more cramps woke me and this time I got up and went upstairs with my tea and granola and sat down to read my book. By this time I had given up on questioning, is this it? and so I read and ate and sent texts to some friends and family, wishing other’s a happy birthday. Then contractions slowly intensified but I didn’t think it would be today, exactly 38 weeks from when we conceived. Eventually I thought well if this is it I better get a shower in and as I got up and started to walk, gravity pulled on my body and my baby and the contractions started to speed up. As I got the shower ready I started to time them and they were at 30-45 sec every 2-3 mins and I realized this was very like last time, short contractions close together. In the shower I decided to give things a boost and get the oxytocin flowing with an orgasm and from that point on I had to stop and focus through each contraction, using the water to ease the growing pain in my low back. By the time I was out of the shower my contractions were a 45-1 min long every two mins. My body doesn’t mess around or move slow once it’s in labour.
I put my tens machine on my back and slowly walked downstairs taking time to stop at each contraction until I reached our bedroom and woke Adam and Ayana telling them it was time. A little dazed and surprised they got up and Adam got himself together, while I made peyote tea and labour aide and Ayana held my hand and shook my arm through each contraction, asking me “does this feel good mommy”. By the time we were all upstairs, Adam really took things in as contractions quickly swept over me and he realized things were happening much faster than he realized and he began to fill the pool and call our Doula, photographer and midwife. After not being able to get a hold of our doula and the midwives call backs going straight to message I thought perhaps it would just be Adam, Ayana and myself as I had dreamed. But I did not have long to contemplate as my contractions drew me deep into myself and I rocked on my birth ball, roaring with each contraction and clawing the carpet through each contraction. It took all I had to focus, to breath, to roar. The roaring felt so good, it rumbled deep in my belly and some how blended with the contraction to ease it, while tapping into that primal part of myself that was born to birth. By the time our doula Jennifer arrived, Adam was trying to squeeze my hips but just couldn’t get the right spot and I had begun internally thinking I don’t know if I can do this while simultaneously reassuring myself that it would be over very soon. Jennifer swooped in and took over the hip squeezes, finding that perfect spot and giving just the right amount of pressure, while Adam came to my front and held my hands pressing on LI4 and telling me how amazing I was doing. This is what got me through transition.
I had had several dreams of a swift labour, some with only Adam, Ayana and I present, others with just our midwife or just our doula and so I knew this was going to be a very fast labour. As I moved through transition Adam kept reminding me that I had really wanted to get in the pool but as each contraction passed and I started to rise another would come. Finally, I gathered up my strength and got up and stepped into the pool and it was utter bliss. I had hoped it would be and as I sat there leaning against the pool my body melted and I had what seemed a deliciously long time to just be and between each contraction I found I could relax my body more completely, allowing things to open that last little bit and just as our midwife, Jane arrived and I began to feel the urge to push. She came over and told me to open my throat more as I had still been roaring and on the next contraction as I opened into an AH instead of a roar, transforming from a lion to an open vessel, my waters broke and I remember seeing the vernix and amniotic fluid swirl in the water. I moved onto my hands and knees and then onto my side and gave every thing with each push. With Ayana’s birth I had been so blown away by the fetal ejection reflex, there was nothing that could stop my body from pushing this baby out but this time though the urge to push was there I felt much more involved in it. I pushed with all my might! I wanted this baby out! I wanted the pain and intensity to be over and to hold my baby. And so only in what seemed a few contractions I pushed her out. On the final contraction as I felt her head slip out and I still had more contraction I pushed the rest of her out. As i turned onto my back and held my baby to my chest, elation, joy, gratitude and relief that she was here and it was over washed over me. I did it! Another little being grown and birthed through this body. How amazing!!!!
After a time contractions ramped up again and i pushed out the placenta out all on my own, no synthetic oxytocin needed. A full, plump, juicy placenta slithered from my body, one last push needed. After the placenta was born they helped me from the pool and my shook from all the adrenaline and effort of birthing a baby in a mere three hours. I laid down on the mattress Ayana was born on snuggling with my girls, wrapped up in blankets as Jane stitched me up. I had torn once again, through the skin all the way from my vagina to my rectum and slightly deeper on my vaginal side. I stared into this amazing beings eyes as they stitched trying to keeo my legs open and relaxed. When they finished and I was wrapped up again and Jennifer brought me that first bite of food it was absolutely the most delicious thing I had eaten (since I last gave birth). My heart, my mind and my belly were so full snuggled up with Adam, Ayana and our baby. We did it! Though others were there to help this was our birth as a family. No other family members or friends were there, we did it together, each giving our own energy and medicine to the process. As a family we grew exponentially that day. Our fourth member here completing and solidifying our family into four solid pillars of support and love.
Lessons, Insights and Reflections
- In this second birth experience I was much more confident in my own truth and knowing what I could do. With Ayana’s birth I felt much more pressure and the need to meet my health practitioners part way but after her successful home birth I knew alot of the fears were unneccesary. So this time there was not the same pressure to people please. I opted out of the syntocin, vitamin k and vaccines with trust in my truth and my knowing what was best for my baby.
- You create a relationship with your midwife and other supports and they want to be there at this moment with you. They want it to turn out the way you do. They want you to have your dream birth and have to navigate the possibilities that it may not turn out that way with you.
- Allowing the Man/partner to really show up is sexy and empowering for him and the whole family. With Adam being my primary support and the one who had to get things together when I went into labour and care for me after the birth, he grew enormously, as did we as a couple. He stepped into the King role and made me feel like a Queen. As Whapio says He was the perfect intimate advocate!!
- I am deeply appreciative of having a large birth team at Ayana’s birth, but the energies of family and old friends can change the dynamic. Having this birth just being Adam, Ayana and I as a family and the key supports was just the medicine we needed at this time.
- Having a separate sacred space for me to birth and then for Aisla and I to be in our own energy for the first weeks/month was so deeply nourishing and allowed for healing and connection on so many levels.
- Can we really prepare for birth? Learning to trust yourself, face your fears and create little rituals to channel the mind can help enormously as it is only you and this baby at the end of the day. So you must believe in yourself!!
by marikare | Oct 25, 2019 | Acupuncture, birth, body wisdom, chinese medicine, doula, Flower Essences, grief, midwifery, postpartum, traditions |
It is believed in Chinese Medicine that proper healing in the postpartum period can lead to a graceful menopause, greater health overall and even recovery from previous illness and chronic dis-ease. The body, mind and spirit go through tremendous changes in pregnancy and these changes don’t stop once baby is in the outer world. We must grieve our lives from before, we must learn to communicate and support a whole new human who is utterly dependent on us, we must find a new rhythm and our bodies must find a new normal. This takes time, lots of patience and support from our greater village and can lead to amazing, almost magical transformation in our bodies, beliefs and perceptions.
While most put lots of emphasis on the birth plan and what the nursery will look like, not many think about those tender weeks, months and first year of recovery and transformation, love and grief, confusion and joy. It truly takes a village to support a new family in this period of time and I encourage all my clients to sit down and make a plan in advance. Asking friends and family to help cook food, do chores, run errands and give a family space to find their new groove.
In many traditional practices including traditional Chinese medicine, the mother and baby were left from one moon cycle up to 6 weeks to recover and build their bond. Family and friends would bring food, clean, keep mom and baby warm and away from cold, wind and the outer world, in order to protect the new family from illness, over exertion and emotional overwhelm. In some cases the mother was not even allowed to bath. Her only job was to eat, rest and learn the language of her new baby. In our modern world we know it is good to bath on occasion and getting some gentle exercise is very important to help in both physical healing and mental wellbeing. But the general principles behind these practice are still important to keep both moms and babies healthy, encourage recovery and bonding and lead to long term health outcomes.
In this article I am going to go through some of the key elements to work with postpartum that I have learned in my studies, practice and life.
Building up the blood and yin
“Qi is the commander of blood and blood is the mother of qi”
It takes Yin, Qi and Blood to make a child. Yin the material form of all life gives rise to the anatomy of the body; its organs, tissues, muscle, skin…. Qi the energetic form of all life gives rise to the physiology of the body; digesting food, breathing, thinking, moving,… Blood, a yin substance connects the mother and baby, nourishing the fetus in the womb and then turning into breastmilk after the baby is born. Labour requires an extraordinary amount of qi to birth our babies and with the birth mothers lose some blood and with it more qi. Thus it is essential to build up the yin and blood to restore mama to her full strength and to make the milk that baby requires.
The best way to build up yin and blood is through the food and drink that we consume. Bone broths, liver, red meat and red fruits and vegetables are the best for building the blood. Whole grains, nuts, seeds and spices help build up the milk. Warmly cooked and neutral foods are easiest to digest. Here are a list of foods that are great to give a new mama.
Bone broths (my favourite recipe)
Red Meats and Liver to replace Iron
Beets and Red fruits esp. Chinese red dates aka jujubes, goji berries, raspberries, strawberries and cherries to build the blood
Oats, Barley, Peas, Legumes, walnuts, almonds, sunflower, flax, pumpkin and hemp seeds to nourish the milk
Fennel, anise, dill, coriander, caraway and cardamom to aid digest and increase breast milk.
Keeping the body warm aka mother roasting
All that qi and blood that gets used in labour can leave one feeling chilled and more vulnerable to invading pathogens like wind and cold. Thus it is essential to keep both mom and babe (who can’t regulate their temperature yet) nice and warm. There are several ways to do this.
- Wrap mom and babe in warm clothes and blankets
- keep windows closed, especially if there is a cold wind.
- Feed mom warm teas and foods
- Moxa!! An amazing medicine in my tool kit. Moxabustion is made of Chinese Mugwort, one of the only ways to increase qi and Yang (heat) from an external source. I give all of my postpartum clients a moxa stick to use three days after birth (six weeks after a cesarean) The stick is lit and held over the womb space and slowly moved over the abdomen in circles, spirals or figure eights until the skin becomes slightly red and warm. This feeds the qi, warms the body, moves the blood to prevent stagnation and clotting and generally feels amazing!
- Get a full Mother Roasting treatment! For more info
Of course you do not want them to get to hot either, so in summer do be mindful of the ambient temperature of your rooms.
Reducing pain and inflammation
The body’s natural response to going through the hard work of labour, the stretching and sometimes tearing of tissues, the hours of squatting and pushing is to send fluid and immune cells to these tissues to repair them. This insurgence causes inflammation which causes pain. In order to reduce the pain we want to reduce the inflammation by helping the healing of tissues. Good nutrition as mentioned above is key to repairing the skin and building new vessels and cells, especially helpful is bone broth and collagen. Other helpful nutrients are vitamin A, C and zinc which are crucial to building new collagen and blood vessels, Rutin and grape seed extract are antioxidants that help vitamin c enter the cells and prevent scar tissue formation. Also taking natural anti-inflammatories like bromelain or turmeric can reduce inflammation, pain and speed healing.
One of my favourite and safest ways to speed healing, reduce inflammation and pain is with acupuncture. Acupuncture works by stimulating neurotransmitters that modulate pain, release tight muscles and helps the body find the optimum path to healing. Ideally, having acupuncture in your home three days after your delivery is best to promote healing and well being. But it can be done at any time even months after delivery to help heal scar tissue and residual aches and pains.
Homeopathics are gentle yet potent medicines that hold the vibration of the plants, animals and minerals they are made from and help the body find its return to health by itself much like acupuncture. For pain and inflammation: arnica Montana 200c, calendula officinalis 200c, staphysagria 200c and hypericum perforatum 200c are taken one tablet at a time up to every half hour.
Keeping the emotions balanced
In TCM, Our emotional well-being is controlled by the liver who is responsible for the smooth flow of all our mental, emotional and physical energy, as well as bodily fluids. So if we get stuck in a mental or emotional rut or don’t move enough our qi becomes stagnated causing the liver to become upset and stagnate further. As we know post birth there has been lots of qi and blood lost and the change in our hormones, sleep schedules and need to rest can lead to further qi stagnation and emotional imbalance.
Acupuncture excels in balancing the emotions. In fact, in Chinese medicine each emotions is associated with a different organ. Long term emotional imbalance can injure the organs as can injury to organs lead to emotional imbalance but lucky it is quite easy to help the qi move smoothly and find the correct path again, relieving anxiety, depression, worry, sadness, fear, shock, anger and over stimulation.
Some other ways to help process and balance your emotion are:
Support groups- We are never alone in our experiences, though we are each unique we also share so much especially in the world of birth and parenting. We were all born and were parented and many will go on to birth and parent themselves. Finding others who have gone through birth and parenthood or are going through it helps us to remember we are not alone and allows us to express our feelings and thoughts and hear from others perhaps gleaning some nuggets of wisdom, tools or compassion for ourselves and others.
Counselling- seeking out a trained counsellor who has experience in working with birth and parenting and can offer tools and insights can be a real game changer. I am especially fond of somatic and mindfulness based approaches.
Placenta pills are made from your placenta. The placenta is cleaned and dehydrated and then powdered and encapsulated, some also make a tincture or eat their placenta whole. The placenta is full of minerals, especially iron and hormones from pregnancy and labour. Some women find that consuming their placenta helps balance the hormones and emotions after they drop on the third day postpartum. Others find they are too sensitive to it and can’t take it. When looking for someone to encapsulate your placenta always make sure they have training in blood borne infections and proper clean technique.
Rescue remedy is a combination of five flower essences created by Dr Bach. Like homeopathics they contain the vibrational imprint of the flowers and are especially good at balancing emotions, releasing grief and trauma, reducing anxiety and fear and reconnecting the spirit withe the body. Four drops can be taken at a time as often as needed.
References
https://www.webmd.com/skin-problems-and-treatments/news/20040708/supplement-speeds-wound-healing#1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839002/
Medical Disclaimer
Information in this post and on this web site is provided for informational purposes only. The information is a result of practice experience and research by the author. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional or any information contained on or in any product label or packaging. Do not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem.
by marikare | May 30, 2019 | Acupuncture, birth, body wisdom, chinese medicine, doula, midwifery, research |
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
by marikare | May 30, 2019 | Acupuncture, birth, body wisdom, chinese medicine, doula, midwifery, research |
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.
by marikare | Oct 22, 2018 | birth, body wisdom, chinese medicine, doula, family, postpartum, Ritual, traditions |
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/birth-medicine/