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.
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 |
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.
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.
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.
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.
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.
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Shi, A. & Zeng, D. (2011) Essentials of Chinese Medicine Internal Medicine. Second Edition. California, Bridge Publishing Group.
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Stricta (2010) Checklist for Stricta 2010. Available from: http://www.stricta.info/checklist.html
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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