How to have a healthy pregnancy: Second trimester

This post focuses on the second trimester of pregnancy and is the second in the series dedicated to pregnancy health. The first and third trimesters are discussed in separate posts.

Baby growth during the second trimester

The second trimester of pregnancy encompasses from the 4^th to the 7^th month of pregnancy (weeks 13 to 27 in the UK). The beginning of this period is often clearly marked by the sudden disappearance of morning sickness and an increase in energy levels. In terms of foetal development, the baby can grow from about 61mm to triple this size during this stage of pregnancy. The sex of the baby is revealed from around week 14, and the urinary system, bones and hearing develop, while hair and finger nails start to grow.  The expecting mum undergoes the most dramatic physical changes at this time with larger breasts, skin decolouration due to increase blood supply, and of course a growing abdomen. As the pregnancy is safer from miscarriages at this time, anxiety about this will subside but there may be other sources of anxiety related to changes in body shape, or fears about the future.

 In terms of TCM, the urinary system, bones, and hearing are all directly related to the Kidney energy, while healthy hair and nails are associated with plentiful Blood. Because of this, and the fact that all foetal development is rooted in the Kidney Essence of the mother, the growth of the baby at this stage takes a toll on Kidney and Blood resources of the expecting mother. In addition, as the Yang energy necessary to perform all this growing gathers and collects in the womb, too much heat may be generated causing fluids and Yin to dry up.

The most common symptoms that may appear at this time thus reflect the following TCM patterns:

• Blood deficiency: anaemia, insomnia, palpitations, anxiety, dizziness, leg cramps, absentmindedness, forgetfulness

• Kidney Yin deficiency: restlessness, night sweating, palpitations, anxiety, headaches, and high blood pressure.

• Excess internal heat: heartburn, feeling constantly hot, constipation with dry stools, nasal and gum bleeding, urinary tract infections

Women who did too much physical work during the first trimester, or who already had a tendency towards Yang deficiency prior to pregnancy, may present other symptoms that reflect the weakness of Yang energy such as feeling constantly cold and tired, oedema (water retention) in legs and feet, lower back ache, vaginal discharge, frequent urination, urinary tract infections, and shortness of breath.

Second trimester essentials:

While in the first trimester building up the Yang energy is most important in order to maintain the pregnancy, during the second trimester Yin and Blood need to be nourished and supported so that they do not become depleted from nourishing and sustaining foetal growth.

Nourishing Blood and Yin during pregnancy involves:

Enough rest: Although you may be feeling less tired than a few weeks ago, pushing yourself is not recommended. You can benefit from moderate exercise in the form of walks, gentle swims and/or pregnancy yoga classes provided you are not feeling exhausted. Afternoon naps are allowed if you can fit them into your routine and feel the need to have them. Remember your energy requirements go beyond yourself and the more energy you save at this stage, the more there will be for your baby to be strong and healthy!

Restful sleep can help restore the Blood and Yin

Restful sleep: Restorative sleep gives a chance for deep energies to gather and recover from the daily growth happening in the womb. When the Blood or Yin are depleted or out of balance, a common occurrence during the second trimester of pregnancy, our ability to sink into deep sleep may be compromised leading to restless and disturbed sleep, excessive dreaming, night sweating or feeling hot in bed, insomnia, etc. Paradoxically, good sleep allows the Yin and Blood to be restored and support healthy foetal development. Promoting good sleep is thus important for the mother and baby’s health at this stage. Self-help techniques include:

• Avoid the intake of stimulants including all types of caffeine, refined sugar, alcohol, drugs, and nicotine.

• Try to start winding down long before bed time. For this it may be a good idea to have a hot bath with calming essential oils such as chamomile or lavender. You could also burn these oils around you and listen to calming music for some time before bedtime. If you can, avoid watching TV, or being at computers right up to bedtime as this can prevent you from “switching off”.  Relaxation tapes may be useful to help you drift off if you find it difficult.

• Drink calming teas such as chamomile, hops, lime flowers or passion flower tea half an hour before bedtime.

Acupuncture, especially when combined with Reiki, can promote relaxation and help restore sleep patterns in those who find self-help techniques ineffective.

Reducing stress: The same tips given for improving sleep apply here as stress levels can rise as a result of poor sleep and low energy levels. In addition, avoiding upsetting books or newspapers, films, and conflict in general may contribute to your emotional balance and your ability to cope with stressful situations.

Gentle deep breathing, pregnancy yoga, and meditation techniques can also provide you with tools to cope with everyday life stress. When things get too difficult, Reiki and Acupuncture can provide a space for relaxation and provide relief to emotional stress.

Eating nutritious food: Like in the first trimester, spices, stimulants, refined sugar, and toxins (from food preservatives and additives, alcohol, drugs, etc.) should be avoided throughout the second trimester of pregnancy as they can contribute to the symptoms of heat likely to happen at this time, and can harm the baby and destabilise the pregnancy. 

As I shared in a previous post on TCM healthy eating, consuming well-cooked and warm foods supports the digestive system and is therefore considered the best way to obtain energy from food. During the second trimester of pregnancy however, there may be a build-up of heat and it may be suitable to have a more cooling diet.  When symptoms such as heartburn and acid reflux, constipation, constant hunger, and generally feeling hot are present it is recommended to avoid deep-fried, roasted and barbequed foods and instead favour steaming and a moderate amount of raw salads. Peppermint and spearmint tea can really help cool down the digestive system and relieve the acidity, as does avoiding refined sugar, spices, stimulants, and rich/heavy foods.

Foods that nourish the Yin tend to be cooling and sweet in nature and are recommended for this stage of pregnancy. Particularly good ones include: Eggs, Tofu (from non-GM beans), white fish, aduki/turtle/kidney and black soya beans, coconut milk, sesame seeds, all dark green vegetables, , barley, quinoa, brown rice, and all sweet fleshy fruits such as mango, pear, and watermelon.

Nourishing the Blood is also important as Blood deficiency and anaemia can easily develop at this time. Yin nourishing foods will also contribute to nourish the Blood, while plenty of protein of either vegetable or animal origin, dark rich foods such as beetroot, molasses, dates, figs and unsulfured apricots should be part of your daily diet. It may be worth checking your iron levels if you are feeling exhausted and suffering from insomnia, constipation and/or cramps which could be signs of anaemia. Chinese herbal remedies or natural iron supplements can be taken at this time as they are more easily digestible and are less likely to produce uncomfortable side-effects such as constipation.

Meditation benefits mother and baby

 Quiet contemplation and relaxation: Many women experience deep personal changes during pregnancy. It is indeed a time where the wonder and beauty of the world can touch you as you feel part of the miracle of life.

You may feel frustrated by feeling that your brain does not work, but you may also realise that what you used to consider important now seems futile and that there are deeper, more important things that you would like to explore. Meditation and relaxation techniques, and spending time in nature, can help you connect with what goes on deeper inside you and will benefit you and the baby in many other ways as they can reduce stress and anxiety, and improve sleep and emotional balance.

Although it is less common to experience Yang deficiency symptoms during this time, some women will need to carry on following the same advice given for the first trimester. Because the growth of the baby draws on the Kidney energy of the mother, women experiencing lower back ache, coldness, swelling in legs and ankles, frequent and copious urination, heaviness and sluggish digestion, are more likely to need support from Acupuncture and moxibustion to protect the pregnancy even at this stage.

Pregnancy is not only a unique stage in the physical life of a woman, it can turn out to be a journey of self-discovery where imagination, creativity, and spiritual clarity can develop and flourish. Working on staying physically healthy during this time, will make room for the enjoyment of these other aspects of the pregnancy that could otherwise become masked by uncomfortable physical and emotional symptoms.

How to have a healthy pregnancy: First trimester

 This post focuses on the first trimester of pregnancy and is the first in the series on pregnancy health. The second and third trimesters are discussed in separate posts.

Pregnancy is a key time not just in the life of the baby but of the mother as well. I have seen the health of women being completely transformed by a pregnancy: allergies disappearing forever, skin conditions completely clearing never to come back, energy levels boosted. This is a true opportunity to get rid of toxicity and re-educate the body into a balanced state that will give you good health for years to come. Conversely, not looking after yourself during pregnancy can have the opposite effects, so it is worth thinking of how you are going to adopt a life-style that supports both your energy and the life of your baby. 

Good energy and nutrition can turn this into a healthy baby

This is particularly crucial in the first months of pregnancy when the pregnancy itself can be easily put at risk by any type of excess. Remembering that the most important baby organs start to form at this time can give you motivation to stay toxin-free and to obtain as much energy as you can from nourishment and rest. This clean, strong energy will be your personal contribution to the health of your baby.

In terms of Chinese medicine, this is a time when the Blood and Yin need to be plentiful to provide nourishment and moisture to the embryo via the uterine lining and, later on, the placenta. Yang also needs to be strong to fuel the transformation of a fertilised egg into a ball of cells and later into layers of tissue that will become the spine, the skin and each of the organs of the baby. Because they are the root of Yin and Yang and the organs of reproduction and development, keeping the Kidneys healthy and their energy strong is essential during pregnancy. This can be done by supporting Yin and Yang. The nourishment of Yin is achieved through avoiding excessive activity, having a supportive diet and staying as stress-free as possible, while Yang is strengthened by having enough rest and keeping warm inside and out.

First trimester essentials

The four most important things to bear in mind during the first few months of pregnancy are:

1. Rest up, no need to push yourself:  Many women feel that they should carry on “as normal” during the first months of pregnancy. Contrary to this idea, in the first months of pregnancy rest should be taken really seriously.  As I mentioned, above the energy requirements on the part of the expecting mother during this time are enormous. It may not feel like much is happening, but cell division and the formation of tissues and organs are not small tasks. 

Heavy exercise especially running and cycling long distances can actually affect the health of the foetus, and in cases may result in miscarriages (1).  Many women actually feel too tired to do any exercise during the first months of pregnancy. This is normal and may be an indication that you need to rest. Pushing yourself at this time is not advisable. If you have energy for exercise, try swimming, walking in the open air (but not long distances), and gentle yoga.

2. Reduce your stress levels: needless to say, stress can have a detrimental effect on pregnancy and can impair foetal development (2). Often there is little that can be done to avoid stressful situations and the hormonal surges occurring during pregnancy may not make it easy to deal with them. 

However, you can build up on resources can help you cope better.

• Avoid stimulants: coffee and tea should be banned from your diet, especially if you are prone to feel stressed. If you love chocolate, try to reduce your intake, not only it contains caffeine but its high sugar contents could contribute to pregnancy-related diabetes (gestational diabetes).

• Meditation can give you tools that you can use to keep calm during stressful moments

• Avoid things that upset you: this may include certain people, violent/horror films and books, conflict, watching the news or anything else that makes your blood boil.

• Surround yourself with relaxation-inducing objects, people, and music. Lavender flowers can induce a calm state and promote sleep, while drinking camomile, lime flower or passion flower tea can help you keep calm.

If applying self-help techniques is either difficult or ineffective, Acupuncture can be very effective at reducing stress and anxiety levels, improving sleep, increasing energy, and generally promoting a more relaxed attitude.

3. Eat to maintain two people healthy: The idea that we need to “eat for two” is not really an excuse to stuff ourselves with cakes and chocolates during pregnancy.  In fact, it is becoming increasingly clear that what we need to do is eat “twice as healthily” rather than “twice as much”.  It is not just a question of logic that eating junk or other unhealthy food during pregnancy will affect the baby, it is a fact. Studies are now showing that what women put in their mouths during pregnancy can change the DNA of the baby and can serve as the base to a host of future health problems (3).

Apart from making an effort to follow a balanced diet there are some additional tips for the first few months of pregnancy:

• Avoid spicy food and stimulants such as black tea and coffee: in TCM spices such as chili and black pepper, and stimulants have a strong moving effect on the Qi and Blood of the body. This is definitely not wanted during the first months of pregnancy as it can result in bleeding especially if the mother’s energy is already low.

• Ban alcohol, tobacco, and drugs: the toxicity of these substances will end up in your liver and in your baby’s too.

• Keep the sugar down: Refined sugar and refined carbs create acidity in the body and can contribute to indigestion, heartburn, and pregnancy-related diabetes. You will be doing a favour to your baby if you switch to wholemeal carbs and unrefined sugars such as honey and molasses.

• Increase your protein intake: Protein can provide you with energy and nourish the Blood and Yin. Good quality eggs and chicken are good options for meat eaters. Vegetarians need to be careful with the protein intake as there is high demand of Yin and Blood especially during the first months of pregnancy. Eating plenty of pulses and adding moderate amounts of nuts and seeds to your meals is essential.

• Avoid eating excessive amounts of cold and raw foods as this may rob your Yang energy of the power it needs to hold the pregnancy and encourage foetal growth. Eating warm and well-cooked foods and adding small amounts of fresh ginger can help warm the body and keep the digestive system strong. For more on this click here.

 Eating well also promotes energy but when the digestive system is unable to extract nutrients from the food we eat, help may be needed. Acupuncture can be used to strengthen the digestive system and, combined with specific dietary advice, can help relieve morning sickness, heartburn, indigestion and constipation which may be preventing the proper absorption of nutrients.

Acupuncture and moxa can warm the Yang during pregnancy

4. Keep warm: The Kidney channel runs along the lower abdomen into the inner part of the leg down to the inner ankles and feet. The Kidneys themselves are found in the lumbar region of the back and their energy governs the whole of the lower back area. These areas are most susceptible to cold and wind and as they are regarded to be directly connected to the Kidneys, their exposure to the elements can have a detrimental effect on the Kidney Yang. 

Because the strength of Kidney Yang is important to maintain the pregnancy and support foetal development during the first months of pregnancy, it is considered essential to always keep the lower back and abdomen, and the lower legs and feet covered and warm.

If the Yang of the Kidneys was weak prior to pregnancy, symptoms such as feeling constantly cold and exhausted, frequent urination, sluggish digestion, and heaviness in the limbs and lower abdomen can occur during the first months of pregnancy. In these cases both Acupuncture and moxibustion may be needed to re-ignite the fire of the Kidneys and strengthen the Yang energy so that the pregnancy can be protected.

Pregnancy can be used as an opportunity to promote long-term health in both mother and baby. Fathers-to-be can also take advantage of this time to strengthen their own energy and health so that they can fully take part in the production of a healthy family.  Although this may sound daunting, understanding and assuming this responsibility at the right time could be the key to the joy and health of the whole family for years to come.

References:
1. http://news.bbc.co.uk/1/hi/health/7014828.stm

2. http://www.guardian.co.uk/science/2007/may/31/childrensservices.medicineandhealth 

3. http://www.bbc.co.uk/news/health-13119545 

Improving fertility with Chinese Medicine

According to Chinese Medicine theory, the normality of all bodily functions depends on the balance between Yin and Yang and the subsequent unrestricted flow of Qi and Blood. Fertility is not an exception, the only difference being that as there are two people involved in the process. Thus, the success of fertilisation and implantation depends on balance in both male and female.

Fertility: not just about sperm and eggs

The process of conception goes well beyond specific ovarian, menstrual or sperm issues, which are just a reflection of the general state of health of the couple: The female body needs to be free of blockages and have plenty of Qi, Blood, and body fluids to release and ripen an egg, the male body needs to be sufficiently nurtured and be free of blockages to produce sperm that is fast, well-formed, and strong enough to survive the passage through the female reproductive organs to fertilise the egg, the womb needs to be sufficiently thick and at the right temperature to nurture the fertilised egg or else it will not be able to survive.

TCM understands that the reproductive system is not isolated from the rest of the body. As a result, TCM fertility treatment is not solely concerned with conception but with the balance and well-being of the person as a whole.

TCM Treatment:

The first step in female fertility treatment is to regulate the menstrual cycle by the strategic use of Acupuncture and Chinese herbal medicines that provide support for each stage of the cycle. This is monitored during regular sessions and by the use of a Basal Body Temperature chart. 

If blockages are suspected, they will be cleared first with specific Chinese herbal remedies and Acupuncture points, and conception will not be encouraged during the first few months of treatment. Symptoms of blockage generally involve pain at any stage of the cycle, menstrual clotting, dysfunctional bleeding, and emotional instability.

As blockages impeding the proper flow of Qi and Blood in the reproductive system are cleared, this gives room for working on the strengthening and balancing of Yin and Yang. These two energies are strongly reflected at different times during the cycle and provide the basis for ovulation, thickening of the uterine lining to provide nourishment to a fertilised egg, and the energy that maintains the pregnancy once conception has occurred. 

 At the same time, the male's Yin and Yang should be balanced and strengthened to provide enough nutrients to support healthy sperm (Yin) and enough energy to maintain the libido and provide strength and sperm motility (Yang).

There are modern tools to identify more detailed problems in reproductive functions and it is common for couples to arrive at the TCM clinic with a clear idea of what the difficulty conceiving consists of. This is helpful for the TCM practitioner but is nevertheless not essential as TCM provides us with tools to identify imbalances between Yin and Yang in the different stages of the menstrual cycle and the reproductive process, and the presence of blockages in the flow of Qi and Blood by examining the general health of the couple.

Because the Kidneys are the main organs involved in reproduction, and are the root of Yin and Yang, infertility commonly involves a degree of Yin or Yang deficiency. Some of the main symptoms of these imbalances are listed below. This is by no means a comprehensive list and cannot serve for diagnosis without the assistance of a TCM practitioner who will be able to link this to symptoms in other organ systems:

 

TCM diagnosis	Systemic signs	Reproductive signs
Yin/Blood deficiency predominates	Restlessness of body/mind Anxiety Poor sleep/Insomnia Thirst Dry skin/hair Warm/Hot feelings in the afternoon and evening Hot flushes/Night sweating Lower back ache Tongue: Pale or slightly red with little coating Pulse: fine, superficial, slightly rapid	Women: Very light periods Short menstrual cycle Little or no mucus discharge Lack of vaginal lubrication Amenorrhoea Men: Premature ejaculation Sperm motility disorders Poor sperm quality Sperm viscosity disorders
Yang/Qi deficiency predominates	Feeling constantly cold Tiredness/lethargy Water retention Frequent urination Lack of motivation Lower back ache Poor appetite and digestion Tongue: Pale, flabby, possibly with a white coating Pules: Weak, deep, “hollow”, slow	Low libido Menstrual pain alleviated by warmth Menstrual lower back ache Prolonged cycle/Period Un-ovulation Excessive mucus discharge throughout cycle Men: Low libido Premature ejaculation Impotence Seminal emissions Poor sperm motility

"Family planning"

Our children's health depends on our own

Parenthood invariably comes with responsibility towards our offspring. No mother or father in their right mind would consciously choose not to provide food, shelter, or security to their child. On the contrary, they will strive to give them all possible comforts and do their best to ensure a pain-free future.

Ironically, we are oblivious of the fact that the state of our health at the time of conceiving a child will provide the basis for their inherent constitution and health for the rest of their lives.  

Despite growing awareness of the fact that our diet, life-style, and relationships affect our health, there is little said in respect of how this could affect the health of our children.

In Chinese medicine theory, there is a concept of pre-natal Essence which accounts for our constitution and genetic make-up, and provides the basis for all physical, mental, and developmental changes throughout our lives. Pre-natal Essence is produced at the time of conception and is the result of the combined Essences of the mother and the father which in turn result from their own constitution and the general state of their energy. Pre-natal Essence is limited an irreplaceable so it implies a big responsibility on the part of parents-to-be to provide their off-spring with the best possible Essence. For more on Essence read my post about the Kidneys.

Preparing the ground

Seeds need good soil to grow

Most of us know that in order for seeds to thrive, good soil is needed. We need to take time to prepare the soil, remove unwanted stuff from it, and add whatever is needed to provide the best nourishment to our seedlings. Why should it be different with our own seeds? We need to make ourselves “fit” for conception, but this is not the same kind of fitness as that needed to run a marathon, or even a 10k. The matter of having babies should not be solely for the benefit of the eager parents, the baby should be taken into account, should it not? 

As we are choosing to become parents in our late 30's and 40's when female energies are starting to decline, there needs to be some preparation prior to conception. It would be great if this was done long before wanting a family, but it is rather impractical in the time of “instant results”. Although some of this work can be done through the use of Acupuncture and Chinese herbal medicine, it is the couple's responsibility to make suitable life-style changes that support the process.

These are the main points to be considered:

• Minimise or, preferably, eliminate toxins completely from your diet: Drugs, Nicotine, Alcohol, Caffeine, chemical additives. These substances will damage your health and their toxicity will affect your baby so best to stop now! 
• Eat as healthy a diet as possible (for tips click here) 
• Moderate your exercise: Gentle exercise is essential to improve energy and fertility in women. Running and very strenuous work-outs have a detrimental effect on fertility and should be avoided from the moment you decide you are going to try for a baby. Gentle yoga, Pilates, walking, and swimming are best. Doing no exercise is not great either as you need to gently encourage the flow of Qi and Blood. 
• Encourage a good balance between rest and activity: Make an effort to get enough sleep and to have off-days. This is the time when you can recover the energy you lose on a daily basis so that your body does not resort to deeper energies (from the Essence) for day to day functioning.
  
• Check your emotions: if there is anything stressing you out or making you anxious it needs dealing with. Stress and anxiety can negatively affect the reproductive system.

I treat many women who have difficulty conceiving with both Chinese herbs and Acupuncture. This is a difficult time for women especially when they are in their late 30’s or in their 40’s. Every month that there is no pregnancy is seen as a missed opportunity, and there is much stress surrounding the subject of children and pregnancy. Encouraging women's well-being should be part of all fertility treatments as this will both make the process less stressful and more effective, and provide their baby with the best nourishment and the best chances to have optimum health when pregnancy occurs.