Health beyond pregnancy: The postpartum period

In some traditional cultures including the Chinese, the postpartum period consists of a month of special care designed to allow the new mother to concentrate on recovering from pregnancy and childbirth, and on breastfeeding her baby. During this month, close relatives, usually the maternal mother or other senior female members of the family, will either organise daily visits or stay in the new mother’s home to undertake all domestic tasks and ensure that both mother and baby enjoy proper nutrition and rest. In contrast, in many Western countries women have little or no support during the first weeks after childbirth, which may prevent or delay their recovery. In addition, women often have to go back to work well before they are back to full strength putting an enormous burden on their energy and health.

Understandably, many of the concerns and preventative measures during the third trimester of pregnancy relate to labour and childbirth. However, the importance of health during the postpartum period tends to be somewhat overlooked and as a result women may feel isolated, depressed, and unable to cope with their new situation. This can be a very difficult time especially for first-time mothers who may have little idea what to expect or unrealistic expectations of their new role, and can find themselves physically unable to perform some of the tasks they could easily undertake before childbirth.

 TCM views of postpartum symptoms

After labour is over it's time to rest and recover

According to TCM, a great deal of Blood and Qi are used up during pregnancy, labour, and childbirth; inevitably resulting in the deficiency of these substances. In addition, TCM regards breast milk as an extension of the mother’s Blood, and restoring the blood lost during childbirth is seen as an essential requirement to produce not only enough milk but milk that is rich enough to provide all the essential nutrients to the baby. Interestingly, periods may return sooner for mothers who choose not to breastfeed (1), which establishes a connection between breast feeding and menstrual blood.

When Qi and Blood are severely deficient or have been deficient during the pregnancy, stagnation may also occur as the body struggles to continue functioning without enough resources. Stagnation of Qi and Blood may also occur when there have been complications during the pregnancy or the mother has over-exercised or not followed a suitable life-style. The table below shows how the most common postpartum symptoms can reflect the TCM patterns of Qi deficiency, Blood deficiency and Qi and Blood stagnation:

TCM patterns	Possible post-partum symptoms
Blood deficiency (Liver or Heart)	Insufficient lactation Insomnia Anxiety Depression
Qi Deficiency (Spleen or Kidney)	Exhaustion Frequent urination Low appetite Indigestion Bloating after eating Loose stools Incontinence
Qi/Blood stagnation (Liver or uterus)	Hormonal imbalance Abdominal pain Blocked milk ducts Painful breasts

While deficiencies of Qi and Blood are a natural consequence of pregnancy and childbirth, leaving them unchecked can cause many of the symptoms associated with the postpartum period. Because of this, having a month to rest and recover may prove essential for the health of both mother and child. This may need a mental shift in Western societies, where new mothers feel they should go back to a normal level of activity and of physical fitness as soon as possible. This contributes to a decline in general health that is often attributed to lack of sleep but which is in fact a result of never recovering properly from the pregnancy.
 

Self help techniques that involve an adequate diet and rest are often enought to provide relief to mild symptoms during the postpartum period. Where symptoms are severe or involve pain, inflammation, bleeding or a high temperature a health practitioner or midwife needs to be contacted immediately. 

A qualified TCM practitioner can offer individual advice regarding diet and supplementation. Acupuncture and Chinese herbal medicine can also be used to strengthen the Qi and Blood and relieve symptoms such as mastitis, difficult lactation, insomnia, anxiety, depression, pain, digestive problems, and incontinence. 

What you can do

Plan ahead, is all in the preparation!

Cooking help is essential after childbirth

In order to support good health after pregnancy steps need to be taken from the third trimester to ensure that you will be able to obtain proper rest and nutrition during the first month following childbirth. Without this, you may end up with deep exhaustion and depression as a result of lack of rest and feeling isolated and overwhelmed. 

Your partner or other members of your family need to be aware of the fact that you will need help with house chores and cooking during this time as you are going to need as much rest and possible. Establishing who is able to help beforehand will take a huge stress off your shoulders and will bring enormous benefit to you and your baby. Do not be shy to ask friends to sign up for checking on you and help with a few chores or even offer you a home-cooked meal at different times during the first month. If there is not family or friends around, then you and your partner need to make sure you will be able to have at least one nutritious home-cooked meal every day and that you will not be forced to perform tasks that you may not be up to. I have seen many women who waste away during this period as a result of not being able to prepare themselves proper meals because they cannot go shopping or they spend so much time nursing that there is no time or energy left to cook. To avoid going through this or having to resort to take-away food or un-wholesome pre-packed supermarket meals that are laden with salt, sugar and chemical additives you and/or your friends and family can prepare some wholesome meals to be kept in your freezer for days in which there is no help at hand.

Once the above measures are in place, you will be able to do the essential things in the postpartum  period:
 

1) Rest rest rest: 

 You may feel that you are not doing much and haven’t done since before giving birth, but it is not so. Your body has instead been heavily taxed by the growth of a baby that not only took a lot of room but used up a lot of the energy resources you would have normally had for yourself. You spent 9 months surviving on less that you would normally need to feel ok, and then went into a process in which the whole of your body went into an enormous effort to open the way and give birth to your baby. This probably lasted longer than a marathon, at the very least. 

You will undoubtedly feel exhausted after all this, and the whole of your being will be screaming for rest every time you have the opportunity. If you make a conscious effort to lie down and sleep as much as you can during the first month postpartum, you will have a lot more chances to get back to full strength sooner rather than later. Rest at this time will be the prime contributor to rebuilding your Qi which will in turn fuel the proper functioning of all your organs.

2) Eat to nourish your Qi and your Blood: 

Chicken soup helps strengthen the body

•  At this time you will benefit greatly from following the basic TCM advice regarding diet, putting particular emphasis on avoiding cold and raw foods that will take more energy than they will provide. Soups and stews seasoned with ginger and warming herbs such as fennel and basil, will provide you with the warmth and nutrition that you need at this time. Chicken soup is regarded as particularly nourishing and can be prepared onion, ginger, and vegetables. This can be prepared with tofu, miso, and sweet potatoes or pumpkin if chicken is not an option.

• Protein intake needs to be high especially for nursing mothers as they can easily become increasingly Blood deficient. Small amounts of good quality protein need to be consumed at regular intervals throughout the day. If you have little appetite, favour protein-rich snacks over carbohydrates so that you have enough sustenance.

• Foods that particularly nourish the Blood include dark green leafy vegetables such as curly kale, spinach; dark beans such as black soya beans, kidney beans, aduki beans; and naturally sweet foods such as grapes, molasses, dates, figs, and unsulfured apricots.

• Toxins in the form of alcohol, drugs and chemical additives need to be avoided completely. Not only will they go straight into your breast milk, but they will prevent your full recovery.

• Coffee should also be avoided as it can put too much stress on the adrenal glands which will have a detrimental effect on the whole body. Black tea can be taken sparingly.

3) Keep warm:
Because it is a function of Blood and Qi to warm the channels and protect the body from pathogenic factors, new mothers (especially lactating ones) are not encouraged to expose themselves to the elements. Exposing yourself to cold, dampness, excessive heat, or wind before building up your energetic resources through rest, warmth, and an appropriate diet can have a long-term detrimental effect on your health. This is also true for the new born who, having just come out into the world, has no way of fending off new influences or pathogens. 

Making a conscious effort to recover from pregnancy and childbirth through proper nourishment and rest will provide a good basis for the mother's future health and will also provide the necessary resources for abundant and nutritious mother's milk. This is also a time where the partner can feel useful through providing help and support rather than feeling redundant or left out of the close bond formed between mother and baby.

 Reference:

1. http://www.bellybelly.com.au/post-natal/your-period-and-ovulation-after-baby

The pharmaceutical industry and our health

If you have been following the news in the last few weeks, it will not be a surprise to hear that the giant pharmaceutical company GlaxoSmithKline has been fined a massive 3 billion dollars in the US for fraudulent selling of several of their drugs. Amongst these, an antipsychotic drug that had only been approved for adult use was being given to children; an antidepressant that had only been approved for this purpose was being promoted as a treatment for sexual dysfunction and weight loss, while evidence of potential heart risks of an antidiabetic drug was withheld in order to get another drug approved.  According to an article published in the Observer last Sunday (1), the firm managed to do all this by allocating a big chunk of its budget to “entertaining” physicians willing to promote and prescribe their drugs, and backhandedly motivating the publishing of fake articles that provided evidence for the use of these drugs.

Business is business

This outrageous behaviour poses a whole load of questions on the quality of our health care for, even though this happened in America, it is easy to believe that this kind of practice is if not company policy, then of common occurrence. Let’s not forget that the pharmaceutical industry consists of enormous organisations such as GSK that are in no way charitable. They are businesses and, like many other businesses, are prepared to go to great lengths to sell their products. Whatever the reason a doctor may have to agree to prescribe a drug for symptoms it has not been approved for, it is doubtful that it will be for the patient’s benefit. Even though it is hard to imagine that all doctors can be this irresponsible, the fact that some of them can be so easily strayed from their Hippocratic oath of “first do no harm” immediately makes us doubt all their colleagues as there will be no way of telling one from the other.

It is the role of our governments and regulatory bodies to get their act together to protect us from illegal practices like this, and it is our role to be critical and demand health care that provides just that.

Our future health

So what happens now? In whose hands are we going to put ourselves when confronted with illness?

Are these making you healthy?

Before answering these questions, let us consider this first: illness may be the absence of health but health is by no means the absence of illness. In fact, the bulk of people who resort to Complementary and Alternative therapies belong to the category of "not ill but not healthy either". Many of us pursue what we consider a fairly sensible life-style but still suffer from lack of sleep, fatigue, recurrent infections, anxiety, digestive problems, just to name a few. The doctors may not provide you with a label for an illness, but this does not make you automatically "healthy", you are merely "not ill enough".

Health is a state of physical, mental, and spiritual well-being that allows us to live our lives fully. The business of pharmaceutical companies has all to do with illness and little to do with the promotion of health, or else they would be selling us organic vegetables and wholesome diets instead of anti-cholesterol/diabetic/you-name-it drugs. As a business, the pharmaceutical industry works in terms of supply and demand. So by pairing up with willing physicians, and publishing false studies proving fictitious health benefits, it is ensuring that the demand is there even if it is not real. The more of their drugs we “need”, the more that can be given to us, and the more money and power pharmaceutical companies get to have. Chronic illnesses are a godsend for this industry as their complexity makes it easier to constantly market new drugs for each possible symptom than to investigate the causes and disease mechanisms involved in them.

Many a cynic conspiracy theorist may even claim that pharmaceutical companies work alongside the food industry in order to make us ill by putting high levels of salt, sugar, fat, and chemical additives into our food so that we will need their drugs on a long-term basis. Whether this is true or not is actually beside the point as ultimately the choice is ours.

So to answer the above questions, what happens now is that we need to assume total responsibility for our health for it is to a great extent down to each of us to be in a state of illness or health. We may be mis-sold unhealthy products branded as healthy but we cannot solely blame the seller for what we ourselves are choosing to buy. We all have the notion that in order to enjoy good physical health we need to eat healthily, not smoke, drink less, and do some moderate exercise; but we still choose to do the opposite. Yes it is outrageous that the pharma business is taking advantage of us by profiting from our pain and I hope that they are thoroughly investigated and made accountable for betraying everybody's trust and for causing suffering to so many people. Yet I also think there is something to be learnt from this. The other side of this coin is that to an extent we have given them the power to betray us by not assuming responsibility for our health.

We need shop around for better health choices

All around me I see people doing the necessary research when trying to upgrade to a better car, computer, iPod, ipad, etc. who would not dream of blaming the shop that sold them the goods when they decide that they are no longer good enough for their needs. If our illness is a need that requires the purchase of something from a company that makes a profit by selling it either directly to us or to our health service, then we need to “shop around” for the best available products. This does not mean that we are going to bypass our doctors or ignore their advice. What it means is that each of us needs to take our own health seriously. We need to get informed about our illnesses, their treatment, and what we can do to improve our chances of getting better. We need to ask all the necessary questions, and challenge whatever seems out of place in the approach that is being offered. Doctors are after all trained to recognise signs of illness and to treat illness when present. Their expertise is centred in illness, not health. So it is down to us to develop an expertise on our well-being. An example of this is a person with moderate Type II diabetes (of which I have known many) who instead of being told by their doctor to control their diet by avoiding refined sugars and refined carbohydrates, is given a prescription and told to eat as many cakes as s/he fancies and if the blood sugar goes haywire, then the medication can be increased. This is clearly a way to perpetuate an illness rather than work towards resolving it.  In this case, the doctor is doing his job and if the patient is not taking responsibility for her wellbeing it is really her problem not the doctor’s.

Now, more than ever, our health is in our own hands. This is about acknowledging that although doctors can save our lives in an emergency or when we suffer from an illness that imminently threatens us, they can only help us manage symptoms when we suffer from chronic, on-going and long-term conditions. If we are unlucky and get a shady doctor, we may not even get this. It is here that we need to get off our backsides and stop expecting the doctor to take away in an instant decades of illness-inducing habits without even bothering to change anything. There is a wealth of information out there available to all, and exploring the many aspects of our well-being is definitely worthwhile. Taking this responsibility is not easy but the benefits are many-fold as I explained in more detail in my previous post about being holistic. There is so much to be gained and really nothing to lose!

 

 Reference:

1 This article by Terry Macallister published in the Observer last Sunday, analyses the GSK situation 

http://www.guardian.co.uk/business/2012/jul/08/pharma-misbehaviour-gsk-fine?newsfeed=true

How to have a healthy pregnancy- Third trimester

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


In the third trimester of pregnancy (weeks 28 to 40 in the UK), most women experience incredible growth in their wombs. During this period, the baby will go from about 40cm to 60cm in length; and from about 1kg to between 2 and 4 Kg in weight. The fully formed body of your baby will spend the last few weeks of pregnancy growing in size and strength, and refining its functioning.  The highlights of baby developments at this time include the baby’s bone marrow starting to produce its own blood supply, the liver starting to store iron sourced from the mother, the production of a special fatty tissue that will provide the baby with warmth after birth, the strengthening of the immune system by drawing antibodies from the mother, and the mastering of the sucking and swallowing reflexes ready for breast-feeding.

Third trimester growth

The mother in the meantime may not be having such a good time. The huge amount of baby growth not only may result in an uncomfortably big belly that can give you an aching back and legs, but may also leave little room for your own digestive system and bladder causing frequent urination, indigestion, and heartburn, amongst other things. Uncomfortable sensations may also be felt in the lower abdomen and groin areas as the baby gets into position, and this may become more acute once the baby’s head engages at some point between weeks 36 and 40.

TCM views of third trimester symptoms

Some of the symptoms commonly experienced during the third trimester are purely consequences of the physical pressure exerted by the baby on the mother’s organs. However, an increased severity in these symptoms can reflect imbalances in the mother’s energy. Common third trimester symptoms may fall into the following TCM categories:

• Qi/Yang deficiency (of Spleen/Kidneys): Indigestion, loss of appetite, constipation, haemorrhoids, varicose veins, oedema (water retention), frequent and copious urination, lower back ache, vaginal discharge.

• Blood deficiency: Insomnia, anxiety, cramps, carpal tunnel syndrome, anaemia, constipation.

• Yin deficiency: Feeling hot, night sweating, excessive “Braxton hicks” (false contractions), insomnia, anxiety, high blood pressure, gestational diabetes.

Acupuncture combined with gentle massage can help relieve some of the uncomfortable aches, carpal tunnel syndrome, and water retention. Other symptoms such as digestive problems, insomnia and anxiety, cramps, and sensations of heat can also be relieved by Acupuncture and personalised advice from your TCM practitioner. Your Acupuncturist can also help you manage high blood pressure and gestational diabetes.

 Although most of the above symptoms can be classified as normal, bear in mind that when they become severe they may present risks to the pregnancy. Close contact with your health practitioner or midwife at this time is essential and any severe or unusual symptoms should be notified to them immediately.

Third trimester essentials 

 

This is the time when all your efforts to be healthy during the pregnancy will pay! If you have managed to maintain yourself well-nourished, rested, strong, and flexible, you will be more able to enjoy this time. 

In the first trimester of pregnancy the focus was on maintaining a strong Yang energy and a healthy supply of Blood, while in the second trimester Yin and Blood became the main substances to be nourished. In the third trimester, the mother’s Qi needs to be tonified and supported, while continuing to nourish the Blood. Where signs of Yang or Yin deficiency have been present in the previous trimesters, these substances need attention too. For this you can follow the same advice given for the first and second trimesters, respectively.

To nourish Qi and Blood we need to focus on the following:

Diet: Following the basic rules for a healthy diet accordingto TCM is recommended during this stage of pregnancy. As in previous trimesters, stay clear of stimulants and toxins as much as possible: alcohol, drugs, tobacco, black tea and coffee, refined sugar and chemical additives and preservatives. In addition there is some specific advice that can be followed at this time:

• Unless you are feeling very hot and suffering from constant heartburn, herbs and spices with gentle warming properties such as ginger, basil, thyme, cumin, and garlic can be used in small amounts . Heavier spices need to be avoided as there pungent flavour strongle moves the Qi and Blood which can result in premature labour. They can also create internal heat that can make you and the baby restless and uncomfortable.

• If you suffer from constant heartburn and feel very warm all the time, you will need to avoid all herbs and spices and consume cooler foods such as melons, cucumber, salad vegetables, steamed vegetables, plenty of water (at room temperature), and drink mint tea after every meal.

• If you feel full easily due to lack of space in your belly, try to eat little and often, making sure you have nutritious snacks rather than sugar-filled foods or an excess of refined carbohydrates which will make you feel full quickly but provide little in terms on nutrition. Favour fruit, vegetables and small amounts of wholemeal grains and protein-rich foods (good quality meat/fish, nuts, seeds, sprouted beans, beans and pulses, etc.).

In addition, as Calcium and Iron requirements increase at this time, foods rich in these minerals need to be increased in your diet. 

• Iron: Blackstrap molasses, unsulfured dry fruit such as dates, apricots, and figs, beetroot, dark leafy vegetables, and red meat. Making sure there is an adequate amount of protein in the diet is also regarded as essential to nourish the Blood in TCM, as is to avoid pushing yourself when you feel tired.

• Calcium: Bony fish, small amounts of seaweed, soya beans and soya products such as soya milk and yogurt, tempeh and tofu (make sure they are non-GM products), kale, collard greens, almonds, sesame seeds, and blackstrap molasses. Dairy products such as cottage cheese and low-fat yogurt can also be included. However, and excess of dairy products needs to be avoided particularly if your digestion is sluggish as they trigger the production of mucus in the digestive system and, according to TCM, this can block the channels and delay labour.

Acupuncture can be effectively used for symptoms such as indigestion, sluggish digestion, constipation, and heartburn. Often, some individual adjustments to the diet can make an immediate difference to these symptoms.

Pregnancy yoga classes help flexibility and relaxation

Exercise:  You will need a certain amount of “fitness” for labour not to be too hard on your body. This is a very different type of fitness from the one you can get in the gym. First you will need to be well-rested so that you feel you have energy. This can only be achieved by resting enough and eating the right foods for you.  You then will be able to build up some strength and stamina which can be achieved by gentle walking and swimming (breast stroke is best!). This is not competitive exercise or calorie-burning stuff, so you do not need to push yourself hard.

Pregnancy yoga can also give you tools to achieve relaxation through breathing, and help you maintain flexibility in the right places.

If fatigue prevents you from exercising, it is possible that you will benefit more from resting than from making yourself exercise. Acupuncture can help increase energy levels and improve sleep. A TCM practitioner can help you adjust your diet so that you can obtain more energy from food and sleep.

Relaxation and sleep: Learning to relax becomes more important as the end of the pregnancy approaches. Regular meditation and gentle breathing will help you maintain fears and every-day stresses at bay so that they don’t build up making your mind spin out of control.

Sleep may be uncomfortable at this stage because of your body shape.  You will need to experiment using cushions and different layers of covers depending on what your specific problem is. If the problem is not being able to switch off, you can follow the same advice given for the second trimester in my last post.

If insomnia and disturbed sleep are not improved by self-help techniques, Acupuncture and Reiki can promote the relaxed state necessary to induce sleep. Often only a few sessions are required to improve sleep patterns.

Antenatal classes inform you and give you choices

Get “mentally” ready: Have you ever gone into something without knowing what to expect, and come out thinking that if you had known more about it you could have made the most of it? It could be safely said that labour has the potential of making you feel like this. We all have a deep fear of pain, but some of us are truly terrified of it. Burying your head in the sand will not however help you overcome the fear of labour. 

The first thing you need to do is find out what it’s all about. This is the function of antenatal classes, they will arm you and your partner with the knowledge of the processes involved in late pregnancy, labour and the early days of your baby.  Not only will you learn what to expect but you will be informed of a range of options available to you when the moment comes. In my opinion, the earlier into your third trimester you go to the classes, the better. The reason for this is that you will have enough time to process the information and prepare yourself by exploring ways in which you can work on your fears.  

Relaxation and breathing techniques come to life here as they are often good enough tools to prepare you and help you throughout labour, you can learn specific techniques and yoga postures to help you prepare physically in “active birth” classes. When this is not enough to curb your fear, hypno-birthing classes or individual hypnotherapy sessions may be able to help you override it.

In addition, planning ahead so that you can have enough rest and proper nutrition during at least one month after giving birth should be part of your priorities right now. Click here for some useful reading on the subject. 

Last weeks’ issues

Weekly Acupuncture sessions can be especially helpful from the 34^th or 36^th week. Acupuncture during the last month of pregnancy can help promote relaxation, increase energy levels and stamina, and is considered to enhance the softening of the cervix in preparation for labour and childbirth. These effects build up over the few weeks prior to labour giving the expecting mother increased strength and, in my experience, an easier labour.

Moxa can help turn breech babys

Breech baby:  Acupuncture and Moxibustion in specific points, are considered  safe and effective treatments for breech presentation (1). Greater effectiveness of these treatments is seen between the 34^th and 36^th weeks. One or two weekly treatments are given for one or two weeks, and moxa will be supplied for the mother to burn on specific points at home between treatments.

Overdue labour:  If you have gone over your due date, do not panic! The normal pregnancy term is different from one woman to the next and it is perfectly normal to give birth after your due date even until the 42^nd week. Unless your midwife or medical practitioner has identified possible complications, you do not need to feel pressurised to go into labour before your time.

Fear, anxiety, low energy, and a not-so-perfect diet can all contribute to delay labour so all the work that you have done to maintain yourself healthy and strong before this point should render its benefits here. Acupuncture can be used to induce labour (2) by using the Acupuncture points that are contraindicated during the rest of the pregnancy. Personalised advice as to diet, relaxation and specific points that the expecting mother can massage at home should supplement the treatment to enhance its effects.

Overall, the last trimester of pregnancy can be a challenge not just physical but also emotional particularly for first-time mothers. Making sure that you maintain your physical and mental health at this time is not only important to prepare you for labour but it will give the basis for your health in the post-partum period. As I mentioned on my first post about pregnancy, I have seen the health of women being completely transformed by pregnancy. This is an opportunity to become aware of your body and to introduce health-inducing habits into your and your baby’s life. Recruiting your partner can make the experience all the more fulfilling as you can both learn and grow together and create an environment of health and awareness that will benefit both of you and your child for years to come.

REFERENCES

1. Study shows acupuncture and moxa to be safe and effective treatmentsfor breech presentation http://www.ncbi.nlm.nih.gov/pubmed/15280133

2. Inducing labour is listed as a condition effectively treated by Acupuncture by the World Health Organisation: http://www.acupuncturetoday.com/mpacms/at/article.php?id=29001