Ronan's Birth Story

It has been two days since I attended the birth of Jasmine and Leo’s son as their acupuncturist and doula, and I am still waking up smiling at the vision I have of Ronan entering into the world. From a traditional Chinese medicine (TCM) perspective, childbirth is considered the transition from the accumulation of ‘yin’ to the movement of ‘yang’. An expecting mother spends nine months growing and nurturing a new life, a lovely bundle of ‘yin,’ until finally, the bundle is ready to burst forth during the very ‘yang’ activity of labor. The moment of delivery is when yang expels yin. Childbirth, the steady and rhythmic opening of the pelvic floor and gradual descent of the child, may very well be one of the most ‘yang’ activities a woman ever experiences in her life.

As a doula, I am trained to offer a mother and her partner continuous emotional and physical support during labor and birth. As a traditional Chinese medicine practitioner, I can assess how each mother and each labor may need distinct forms of care and then provide appropriate support. Some mothers are said to be ‘qi stagnant’ and present with an abundance of energy, but the heightened emotional state or concern for a safe and comfortable labor may cause her difficulty in the relaxation of the pelvic floor muscles, the lowering of the baby into position or the dilation of the cervix. Some mothers may be more ‘qi and blood deficient’ and are weakened or exhausted by prolonged labor or other contributing factors. Jasmine’s labor falls into the latter category for her labor proved to get off to a rocky start.

Six days before Jasmine went into labor and at 38.5 weeks, she had come into my office for an acupuncture labor induction treatment. These treatments are usually scheduled between week 37 and 42 of a pregnancy to help build energy, relax the pelvic floor muscles (and the mother!), lower the baby into place, and soften and dilate the cervix. Just hours after the treatment, she noticed some spotting. Her midwife informed her that her mucus plug was beginning to slowly release. A great sign that her body was preparing for labor! Over the course of the following six days, she continued to have mild spotting as the plug loosened up. Throughout her third trimester, Jasmine had also experienced intermittent Braxton-Hicks contractions. But when she woke up three days ago, she knew something was different. The hormones of labor affected Jasmine very strongly and she felt nauseas during the onset of early labor. She attempted to eat and drink but over the course of the day she had vomited several times. She had also noticed that the usual Braxton Hicks contractions were beginning to become more intense and more frequent although irregular in length and rhythm.

I gave her an acupuncture treatment to help with the nausea and fatigue (PC6, ST36 and pole moxa ST36) and made her some warm congee (rice porridge) with ginger. I left her with some ear tacks at PC6 and KD1 to direct her qi downward. I suggested she try to rest as much as possible since the vomiting and subsequent dehydration took a toll on her energy. The treatment seemed to abate the vomiting and she was able to take in some food but after consuming the congee rather enthusiastically, she vomited again a few hours later. Seven hours after the acupuncture treatment, and more than 12 hours after she began to feel contractions, her contractions were 3-6 minutes apart and lasted 30-40 seconds. Her midwife suggested she come to the hospital.

The previous ear tacks removed, I added tacks at LI4, SP6, UB31, UB32, and ear shenmen, uterus, and endocrine, for the transfer to the hospital. The change in environment from the comforts of one’s home to the cold, rainy city streets, bumpy car ride, and unfamiliar hospital ward, can often disrupt the steady flow of labor contractions. Hence, ear tacks are used to help assuage the transition and regulate the nervous and endocrine systems. At the hospital, Jasmine was nearly 80% effaced and at station -2, but only 2 cm dilated. She was given fluids intravenously to counter the dehydration. Although the contractions were increasing in strength as her labor progressed, the frequency of contractions diminished to about every 6-10 minutes as she became more hydrated. It is interesting to note that dehydration is an added stressor that can ‘falsely’ increase the frequency of contractions. We returned to their home where Jasmine was encouraged to rest as much as possible.

By this point, it was clear that what Jasmine needed most was to refuel and recharge. She had already been in labor for more than 18 hours in which time she slept little, kept very little food or water down and was dehydrated. While at home for the following four hours, Jasmine was able to sleep between contractions even as they increased in regularity, strength and duration. Her husband and I supported her through each contraction with comfort measures such as massage, hip and lower back counter-pressure, warm and cold compresses, emotional support, and verbal coaching, as well as by assuring that she ate or drank a little and rested between contractions. It was very clear that Jasmine was exhausted and engaged in a very inward and personal journey. After an hour long bath where Jasmine was able to sleep between contractions, her water broke. Her contractions had increased to a minute in length and 3-4 minutes apart. It was time to go to the hospital!

At the hospital, Jasmine was 8cm dilated, and at station -1. Within an hour of arriving at the hospital and after only 5 minutes of pushing, Jasmine gave birth naturally to a beautiful, healthy baby boy.

This birth is a wonderful example of the best that Western medicine, Eastern medicine and doula support can offer to a couple during labor and delivery. Both the midwife and nurse were exceptional in their support, breadth of knowledge and skill, and the IV fluids were important in rehydrating the mother and regulating contractions. I believe that Jasmine’s sheer exhaustion coupled with her deep, even, and diaphragmatic breathes during each contraction (she is a flutist and vocalist by trade), allowed her body to completely relax into each contraction, making them more effective at softening and dilating the cervix and lowering the baby into place. While my traditional Chinese medicine training and experience inform me that needling so and so acupuncture point may be good at increasing the mother’s strength and endurance during labor, needling can also disperse an already low supply of qi (or energy). Childbirth is such an intense and dynamic experience, as the caregiver, it is important to judge in the moment what support to provide. TCM wisdom includes the knowledge that emotional and physical support, food, water, and rest can be just as nourishing as a tonifying acupuncture treatment. But this didn’t stop me from applying acupressure at SP6 during contractions and ST36 between them!

Part 2: Itch, Itch, Scratch, Scratch: 3 Allergy Cases

(Note: This entry is a continuation of the previous entry. Best to read in order for full effect!)

What compelled each patient to seek out Chinese medicine care was the very insufferable and at times incapacitating symptom of itchy skin, or pruritis. As someone with a history of hay fever since a child, complete with ceaseless itchy eyes and nose, I can empathize completely. According to traditional Chinese medicine, the symptom of itchy skin is generally thought to be caused by ‘wind’. Traditional Chinese medicine categorizes external pathogenic agents into wind, heat, cold, damp, and dryness. Each one of these agents has a particular nature and acts in specific ways in the body. As Nigel Wiseman states in Fundamentals of Chinese Medicine, the nature of wind as a pathogenic agent in the body is similar to our understanding of “the meteorological phenomenon from which the name is derived: it comes and goes quickly, moves swiftly, blows intermittently.” Itchy skin travels around the body, appears and disappears, intensifies and calms down without warning.

In the three cases outlined in the previous entry, we see that there are, in fact, a multitude of contributing factors—environmental, emotional, physical, genetic, and lifestyle-related—that coalesce to cause the chief complaint of itchy skin. Many of my patients tell me, for example, that they have had allergy tests or they have eliminated certain foods or that it doesn’t run in the family, but they still do not know what one thing is causing these symptoms. What I have found is that there is no one thing but rather it is the combination of multiple factors over time that has led to their hypersensitivity.

We cannot ignore the global changes that challenge our immune systems on a daily basis—especially for those of us who live in urban or industrial areas. Air, water, and food pollutants are becoming more potent and the global temperature is rising at an alarming rate. Together these conditions create a toxic environment that sets the stage for bacterial and viral epidemics and infections. In Case 1, the patient’s prolonged exposure to direct environmental pollutants at his workplace may have overwhelmed an otherwise healthy constitution.

In addition to the mounting strength of environmental stressors and pollutants, our demanding lifestyles also wears us down and prevents us from eating regular, home-cooked meals, getting adequate sleep and ample downtime. All three patients are professionals with very demanding jobs that often require long workdays.

Other lifestyle stressors also include overindulgence in certain recreational activities. Although the patient from Case 2 exercises regularly, she has a ten-year history of smoking, social drinking and coffee intake. Over time, these habits create heat in her system. Rather than be released properly from the bowels, urethra and through the pores, the heat is trapped inside.

Our emotional health is also a contributing factor to the health of our skin. The patient in Case 2 experienced emotional ‘stagnation’ due to unfulfilled desires and feeling ‘stuck’ or frustrated in her life. These feelings are not simply metaphors for what is physically and energetically occurring in the body but actually prevents the free circulation of qi and blood in her body. This impeded circulation further traps the mounting heat in her system. Her cold hands and feet, yet warm torso is indicative of this impeded circulation. Poor circulation and trapped heat only need small triggers like increased physical activity to cause skin outbreaks on her torso.

The patient in Case 3 presents differently from the other two in that there is a good deal of qi deficiency, or overall weakness, of her physical functioning. This may be due to her genetic make-up or from long-term weakness stemming from her childhood. This patient has a childhood history of eczema, asthma, and seasonal allergies—all signs of immune, respiratory and digestive compromise. The patient’s difficulty in warming up, reduced appetite and low energy are indicative of her body’s hypo-functioning. In this case, part of her treatment plan includes building up her internal strength so that the body can begin to self-regulate and become less susceptible to external pathogens.

Thus, in all three cases we see examples of external pathological agents mixing with existing internal imbalances. Each case is unique but each presents with the same symptom of itchy skin. In all three cases, I used a modification of the formula Xiao Feng San, or Eliminate Wind Powder. This formula combines wind dispersing, heat clearing, dampness eliminating and blood cooling medicinals. With skin disharmonies, it is often important to treat the blood because the quality of the blood and smooth circulation of blood is important to healthy skin. The blood must be nutrient rich so it can nourish the skin and tissues. And the blood must be able to reach and circulate to the outer layers of skin. Hence, blood cooling herbs reduce toxicity in the blood. Other herbs are also added to improve the quality of the blood and to invigorate its movement.

This formula was amended to suit the specific needs of each patient. In Case 1, strong toxicity reducing herbs were added to the formula to combat the invading external pathogens. In Case 2, general constitutional heat clearing, qi moving and spirit calming herbs were added to address the other presenting disharmonies that contributed to the itchy skin. And in Case 3, qi supplementing herbs were added to strengthen her core energy so that the body slowly learned to heal itself.

Hence, we see that treating the symptom of itchy skin is not enough. Each person’s presentation, constitution and health history is unique and require custom-tailored care. As a Chinese medicine practitioner, I must uncover the overall disharmony in the whole person and strategically find ways to best relieve the presenting itchiness, treat the root cause of the imbalance, and strengthen and nurture the body so that it can continue to stay strong and healthy.