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!
