This is the fourth part of a series of articles about pregnancy by YinOva Acupuncturist and Obstetric Nurse, Laura Scheurer, You can read other articles in this series by clicking here.

Even very early in pregnancy your body begins to transform to accommodate and prepare for childbirth. Your pelvic girdle shifts to support a growing fetus and as pregnancy advances, weight is redistributed sometimes stressing musculoskeletal structures as they shift, adjust, and realign. This causes a change in your center of gravity.

Some of the hormones of pregnancy, such as progesterone and relaxin, soften ligaments and cartilaginous attachments stretching the connections between the joints and muscle to the bone. It’s no wonder that one of the most common complaints our pregnant patients have is muscular pain. OB’s generally regarded mild aches and pains as ‘normal’, reflecting the way your body changes to accommodate your growing baby. However the experience can vary, with some women experiencing a time-limited, inconvenience, whilst for other women, it can be a debilitating experience.

Depending on your particular problem area and severity, your doctor or midwife may advise rest, specific exercises, physical therapy, medication, complete bed rest, or, on occasion, hospitalization.

From a traditional Chinese medicine point of view, musculoskeletal pain is seen as a disruption to the flow of Qi and Blood through the channels passing through a specific area. A disruption can occur due to trauma, overuse, poor body mechanics, the invasion of a pathogenic factor (wind, cold, damp and heat), or an internal imbalance, expressed through a channel pathway. During pregnancy, there is an adjustment in the flow of Qi and Blood in preference to supporting pregnancy, sometimes depriving sufficient flow to tendons, ligaments, muscle and bone.

Practitioners of Chinese medicine look for patterns of disharmony as we create a plan of treatment tailored to your needs. We often see a mix of both pain along the channel pathway indicating a stagnation of Qi and Blood, and an internal disharmony expressing itself along a channel. The most common channel appears along the midline of the body, affecting the neck, mid to low back and pelvic structures, or the sides of the body affecting hips, ribs and shoulders.

The two most common internal disharmonies involve the Liver and the Kidneys. The role of the Liver is to direct and provide for the flow of  Qi which in turn, leads the flow of Blood. When there is an interruption or blockage in this flow, there is pain. The tendons and ligaments are nourished by Liver blood. The sides of the body are the channels for the Gallbladder meridian, which is related to the physical and energetic activity of the Liver.

On a very deep level, the Kidney is intimately related to fertility, conception, and passing on constitutional information to the next generation. The bone and marrow are also under the influence of the Kidney. The Kidneys, located in the mid-back region, are paired with the Bladder organ and its channel pathway, which covers the entire rear aspect of the body.

Using this knowledge, as well as the information we collect from you about your specific condition, we select acupuncture points to free the flow of Qi and Blood to relieve your pain. Together, we can identify areas in your daily activity that may require some modification.

As a former labor and delivery nurse, I am so rewarded by the fact that we, at the YinOva Center, can offer a safe, effective intervention to relieve pain in all its manifestations, particularly for those who cannot take medication, or for whom medication is not effective or ill-advised. The beauty of Chinese medicine is that there are 5 branches: acupuncture, herbal remedies, massage, food as medicine, and meditation. Within this paradigm we can formulate a treatment plan that is most effective and realistic for you.

The segment that follows, addresses specific musculoskeletal discomforts associated with pregnancy, some self-help suggestions to help relieve your discomfort, prevent exacerbation of symptoms and limit their duration.

Pain affecting the Neck, Mid and Lower Back

Neck and upper back pain are often conditions that already exists. Some of us hold all our tension in our neck and shoulder area or we work long hours at a computer. Carrying backpacks, laptops, children or any unevenly distributed weight, can cause musculoskeletal misalignments. Add to these preexisting conditions increasing breast weight and postural adjustments from the added belly weight, and it is no wonder we see a rise of aches and pains.

Low back pain, and sometimes sciatica, is common during the last few months of pregnancy. These can be caused by the extra weight of your baby and the fact that joints and ligaments soften in pregnancy. Sometimes a sharp pain traveling down the back and leg can indicate pressure on the sciatic nerve.

It is important to address your neck and upper back pain early on, especially if you are planning on breastfeeding. A minor discomfort can turn into a major pain if ignored. Acupuncture is effective in treating musculoskeletal pain because it interrupts the pain pathway to the brain; it also stimulates the release of endorphins, the body’s natural pain killers.

Self Help

• Develop an awareness of those activities triggering muscle tension and pain. Pay attention to your body mechanics when sitting, using a keyboard, bending, or lifting.
• Redesign your work area to be more ergonomic and accommodating.
• Take frequent breaks, stretch, breathe, rotate all your joints to improve circulation and move areas of stagnation.
• Use support pillows for your low-back, neck, shoulders and between your knees when you are in a side lying position.
• To encourage good posture when seated, try sitting on a birthing ball.
• Comfort measures include warm baths and warm compresses to the low back, neck or shoulders.
• Prevention include keeping your neck and back out of drafts, especially if your acupuncturist identifies cold lodged in your channels.
• Regular gentle exercise (with the permission of your doctor or midwife), such as prenatal yoga or warm water aerobics, may be helpful in stretching and strengthening back muscles.
• Maternity girdles or support belts are useful to some women.

Pelvic Pain

Symphysis pubis pain presents around the pubic bone and can radiate into the lower back or the groin area. The symphisis pubis is an area of tough fibrous cartilage that joins two pubis bones together forming the pubic arch. This cartilage is softened and stretched by relaxin, a hormone of pregnancy produced by the ovaries and  placenta, increasing the flexibility of the pubic symphysis to ease delivery of your baby.

Pain often appears around the 24^th – 26^th week of pregnancy. Sudden pain and weakness is often noticeable when you are shifting your weight, for example putting on your pants, climbing stairs, getting up from a seated position or out of your car. Rest and wearing a supporting belt may be recommended to help relieve pain and stabilize the pelvis. Acupuncture can reduce your level of discomfort and prevent the pain from becoming more intense.

Self Help

• Minimize the mobilization of your pelvis. When rising from a seated position, keep your knees and ankles together as you pivot on your bottom to shift your position. Stand slowly, two feet flat on the ground, rise slowly, supporting your weight.
• Wear comfortable flat shoes.
• Rest frequently.
• Realize this condition is temporary and symptoms will resolve after the birth of your baby.

Rib Pain

Often pain is described as radiating from the upper/mid back, traveling around to the front ribs, involving one or both sides. The pain can be dull and achy or a stabbing, sharp pain, taking your breath away. Pain is attributed to the uterus rising out of the pelvic cavity, displacing internal structures, pressuring confining bony structures.

Receiving acupuncture while comfortably lying on your left side, supported by some well placed pillows can be quite helpful. Your acupuncturist may also offer ear press needles or seeds  for you to apply to appropriate points at home, enhancing your treatments between visits.

Self Help

• Rest may be your best ally during these episodes of rib pain. Finding a comfortable reclined or semi-reclined position, elevate the right side of your body slightly, prop with an adequate number of pillows, this will enhance an unobstructed flow of blood returning to the heart and lungs for oxygenation.
• Pace yourself. Don’t overdo anything. Moderation in all things rule.
• Try some gentle breathing exercises. Rib pain sometimes makes it difficult to take a deep breath but oxygenation is really important. Obstruct one nostril, inhale slowly, as deeply as is comfortable, briefly hold, then, switch nostrils, slowly and gently exhale.
• Recognize that there is competition for space in your abdomen. Try eating smaller, more frequent meals. Light broths, especially those starting with a stock of bones and marrow, are high in protein, easily digested, can be sipped throughout the day and nourishes the energy of the Kidney and Liver Blood.
• Weightless exercise, such as floating and gently stretching in a heated pool, can be therapeutic. For a more aerobic exercise try walking in the pool – it’s low impact, provides gentle resistance to improve muscle tone, and it will increase your heart rate and lung capacity. There is something quite therapeutic about water energy.

Hand Pain Numbness and Tingling

Usually occurring later in pregnancy, pain, numbness, burning and tingling of the hands and fingers, is thought to be due to an accumulation of fluid (edema), locally affecting the joint spaces of the wrist and placing pressure on the median nerve. The small bones of the wrist form a very small tunnel through which the median nerve and blood vessels pass to supply the small bones of the hand (metacarpals) and fingers (carpals) with innervation, blood and oxygen. This process allows for the fine, precise, coordinated motor movement of the hand. Symptoms vary, from mild, transient episodes to severe. If symptoms are more pronounced and prolonged, impairing your ability to turn a door knob, hold your tooth-brush or make a fist, your doctor may give a diagnosis of Carpal Tunnel Syndrome.

Acupuncture can help by relieving both local and systemic fluid accumulation and inflammation (Stagnation; Dampness; Heat). Certainly a trial of acupuncture (4-8 treatments) is preferred especially since pharmaceutical analgesics and non-steroidal anti-inflammatories are ill-advised at this time.

Self Help

• Body mechanics and ergonomic design are important in your work environment to minimize undue and prolonged stress on your neck, upper back and shoulders.
• While working at a keyboard, provide for right angle support to your shoulders and elbows, so your wrists and fingers are in alignment. Wrist rests while typing are sometimes very helpful.
• Hand braces and over the counter wrist supports are available at a variety of commercial pharmacies. When applied, they provide a resting support for those numerous fine bones.
• Support forearms, wrist and hand on pillows when in bed,  as close to the level of your heart as possible. This encourages a free flow of Qi and Blood – you will feel the difference.
• A warm compress is helpful and comforting.

Leg Cramps

Leg cramps where the leg muscles go into painful spasms, are common in pregnancy, particularly at night and may be due to the pressure of the uterus on pelvic nerves. This usually resolves once you are out of bed using the muscles. However, if the pain does not recede, and there is any reddening or swelling of the leg, you need to  promptly notify your doctor or midwife to rule out any clot formation.

Self Help

• Make sure you are drinking enough water.
• Get the blood moving in your lower extremities. Try gentle leg and ankle stretches, circling your feet and wiggling your toes before you go to bed.
• Daily gentle exercise like walking or swimming can help.
• Ask your partner to massage your feet and lower legs.
• Make sure your diet includes calcium, magnesium and potassium rich foods  like green leafy vegetables, bananas, apricot, avocado and whole grain.

Feel free to call our center and talk to an acupuncturist if you would like more information about using Chinese medicine to treat pain in pregnancy.

You can schedule an appointment at the YinOva Center by clicking here

YinOva Pilates Instructor and Front Desk Manager Sarah Lehman blogs regularly about exercise. You can read more of her blogs here.

The benefits of exercising throughout your pregnancy are plentiful.  Not only will it help limit weight gain, but mid-intensity work-outs, such as Pilates, have been shown to ease symptoms of pregnancy (i.e. back pain, morning sickness, fatigue), help shorten the labor, and reduce the time it takes to get your body to bounce back after you’ve given birth.  Also, the strengthening and functional exercises will help prepare you for the lifting, playing, and running around you’ll be doing once you have a newborn in the house.

Many women also find the breathing techniques of Pilates to be helpful in preparing for labor.  The devotion to scheduled exercise time can be great for keeping a positive outlook during the pregnancy and a healthy mindset during a period of tremendous changes to your body.

There is a lot of contradictory information floating around about exercising while you are pregnant.  The reason for this is that in the not so far past, doctors treated pregnancy as if it were an “illness.”  What recent research is showing however, is that moderate exercise will help make the pregnancy easier.  The body is incredible.  It has an amazing ability to adjust to all the new changes taking place.  While resting is important to remain healthy, exercising decreases the feeling of exhaustion and actually helps the placenta grow more efficiently.  The more efficient the placenta, the better the baby is able to absorb nutrients and oxygen from the mother.

If you listen to your body, I believe it will give you signals.  This is not a time to push your boundaries.  Start small, especially if you are a beginner to exercise.  If you are professional or recreational athlete you can continue, within reason, your normal routine but talk to your doctor or an exercise specialist for modifications and warning signs to look out for.

If you plan on working out on your own, remember to keep hydrated, fueled (eat a small snack before and after exercise) and always warm-up for about five minutes before you really get going. Due to changes in the vascular system, it is important to give your body a fair warning that you are beginning a workout.  Save high intensity workouts for after the baby has been delivered.  Stay in a range of 5-8 on the perceived exertion scale which means in the highest intensity you are slightly tired but you can speak a full sentence while you are exercising.  If for any reason you feel light-headed, fatigued, or have abdominal area cramping stop immediately and talk to your health care professional.

It is true that the body is under a lot of stress and many changes take place in a relatively short amount of time.  However, keeping the mother’s body active and healthy is incredibly important for a healthy labor and a healthy baby.  Think about it in terms of preparing your body for labor and delivery, an intense biological marathon.  It is especially important to do a lot of core/abdominal strengthening in the first trimester before the muscles begin stretching.  It is harder for them to continue to strengthen after that point and you are going to need them for the final pushing.

Pilates is a perfect compliment to any prenatal aerobic regimen.  It will primarily work on building that core strength as well as toning the arms, legs and back.  The functionality of the exercises will be beneficial to all the bending, reaching, lifting and squatting you will be doing with your new bundle of joy.  To keep sessions interesting, I like to incorporate a couple different props such as an exercise ball, resistance bands and foam rollers to keep the movements flowing and to keep you safe.

This is the third part of a series of articles about pregnancy by YinOva Acupuncturist and Obstetric Nurse, LAURA SCHEURER.You can read other articles in this series by clicking HERE.

My last blog in this series covered changes and self-help suggestions for problems arising in the upper gastrointestinal tract namely morning sickness and heartburn. Today we move south through the gastrointestinal tract to the other end, which may present some issues as well.

Changes in regularity are thought to be caused by a number of factors:

• Hormones of pregnancy contribute to a relaxation of smooth muscles including those of the large intestine.
• Some iron supplements can cause constipation as a side effect.
• Lack of dietary fiber.
• Drink less water than optimal, causing stools to become dry and difficult to pass.
• During the third trimester, your growing baby causes the uterus to rise out of the pelvic cavity, displacing organs and putting pressure on the colon which slows down movement through the bowels.
• After delivery of your baby, your bowels may be sluggish as your abdominal muscles, having been stretched during pregnancy, exert less pressure while moving your bowels.
• If you have stitches to the perineum after delivery or a small hemorrhoid, you may feel uncomfortable and anxious about opening your bowels. Resisting your body’s natural urge only adds to the problem of constipation.

During your pregnancy your midwife or Doctor may suggest a bulk forming stool softener as laxatives are not recommended at this time.

From a traditional Chinese medicine perspective, we seek out your particular underlying pattern while taking into consideration pregnancy induced changes occurring in your body that lead to constipation.  There are about four frequently seen patterns that emerge contributing to sluggish bowel function.  After a brief description of each energetic pattern, self-help suggestions follow.

1. Blood Deficiency – there will be dry stools that are difficult to pass, as well as pale lips and complexion.
2. Kidney Yin Deficiency – in addition to dry stools that are difficult to pass, you might experience dry mouth and sensations of heat that are worse in the evening, or night sweats.
3. Liver Qi Stagnation – the stool may not be dry, but stools will be pebble shaped or thin ribbons.  You may also be feeling bloated, cranky, irritable or depressed.
4. Stomach Fire Blazing – there are dry stools, thirst for cold drinks and constant hunger.

Self-help suggestions:

Acupuncture is a gentle and effective way of promoting a bowel movement, so seeing your acupuncturist may be helpful in getting things going.  If you are experiencing morning sickness or heartburn, these issues need to be addressed first.  After that, the primary focus is on your diet.

Some suggestions:

• Increase your daily intake of fresh and dried fruits (apples, raisins, figs, apricots or bananas) and vegetables.
• Incorporate flax seeds, sunflower seeds, and nuts into your daily routine. Sprinkle them over cereal and salads, or carry a mix of raisins and nuts to snack on during the day.
• Drink ½ your body weight in ounces of water daily. In other words, if your weight is 130 lbs. your daily intake of water should be 65 oz.  Sufficient water is necessary to soften stool and will help create bulk if you are adding nuts and seeds to your diet. Warm or room temperature water is best, especially first thing in the morning.
• Take a cup of warm prune juice or lemon in hot water ½ hour before meals.
• Take 1 tablespoon of blackstrap molasses before bed.
• 4 oz. each of freshly juiced carrot and spinach.
• Remember to take time to eat your meals in a relaxed nurturing environment. Thoroughly chew your food as digestion begins in your mouth.
• Get daily gentle exercise. Long walks after meals, swimming and prenatal yoga all encourage the smooth flow of Qi which in turn will encourage smooth movements.

We think these  gentle, natural suggestions will be helpful to you not only during your pregnancy but at any time when constipation is an issue.

This is the second part in a series of articles about pregnancy by YinOva Acupuncturist and Obstetric Nurse, Laura Scheurer.You can read other articles in this series by clicking here.

Morning sickness, one of the most common of complaints in pregnancy, can vary widely from person to person.  One might experience a mild aversion to aromas that previously were perceived as pleasant and not much more.  In another, the mere thought of food can induce a wave of nausea accompanied by dry retching and or vomiting.  It may not come as a surprise to hear that “morning sickness” can occur at any time of the day.  For some it is first thing in the morning only, for others it may be present constantly, even waking some women during the night.

Although no one is really clear as to the cause of nausea during pregnancy, it is thought to be due in part to an increase in estrogen levels and human chorionic gonadotropin (hCG), a hormone produced by the developing embryo after conception and later by the placenta.  Theories about other contributing factors include high stress levels and fatigue before conception and in early pregnancy.  Some believe emotional factors play a part as well.

Regardless of the cause, it is considered a “normal” side effect of pregnancy that is generally time-limited and will pass by the 12^th to 14^th week.  Conventional treatment usually involves reassurance and possibly an anti-emetic (medicine to stop the nausea and vomiting).

From a Chinese medicine perspective, there are very dramatic and profound changes occurring  during pregnancy as the Conception Vessel and the Penetrating Vessel are now redirected from supporting a menstrual cycle to nourishing a growing fetus.  These extraordinary vessels traverse the front and center of the body.  The Penetrating Vessel (the sea of Blood) communicates with both the uterus and the Stomach.  It is said that when the Penetrating Vessel is disordered, it interferes with the descending action of the Stomach, causing a rebellious rising of Qi, leading to nausea and vomiting.

Acupuncture has been used effectively offering great results in the treatment of morning sickness, providing a real alternative to just putting up with feeling sick all the time.

Treatment with Chinese medicine recognizes nausea and vomiting to be caused by one of a number of imbalances.  Some may sound familiar to you such as Stomach Qi deficiency, or Stomach cold, Spleen Qi deficiency, accumulation of phlegm or Liver Qi stagnation invading the Stomach.  These differential diagnosis, assist your acupuncturist in devising a treatment plan specific to your particular imbalance.

Once you have received acupuncture and are on the road to recovery, we have some very helpful self-care suggestions that will help keep those nauseating episodes at bay.

Fluids

• Avoid dehydration, even mild dehydration can make any nausea worse.  Dry lips, feeling thirsty, and decreased urinary output with dark concentrated urine are signs that your fluid intake is inadequate.
• Suitable fluids start with water, water, water.
• Teas, such a chamomile, peppermint or ginger tea are settling to the stomach.  For ginger tea, shave a thumbnail size of ginger into your cup, pour hot water over the ginger, add honey to taste, let steep for 10 minutes.  Limit the ginger tea to no more than 2 cups a day so as to not create heat in the Stomach.
• Ginger ale, is helpful for those who feel some relief after burping.
• Mineral water with lemon is refreshing and hydrating.
• Some women find that a teaspoon of apple cider vinegar in a cup of hot water with a bit of honey to taste, settles an upset stomach.
• If there are no symptoms of cold, ice pops and watery fruits like watermelon will keep you hydrated, and may be all you can tolerate for the time being.
• Soups and broths are a great way to maintain hydration and supply some nutrients.  Potato soup, miso soup, chicken broth are all nourishing, in addition to providing hydration.

Foods

• When thinking about what you can eat, think of what you would feed a 9-month old baby – bland, easy to digest foods.
• Baby rice, porridge, potato, pasta, yogurt, peaches and pears, go down easily and are not difficult to digest.
• Frequent, small meals encourage blood sugar levels to remain stable.
• Avoid sweet, sugary treats as they will cause blood sugar levels to fluctuate contributing to nausea.
• High protein snacks throughout the day and before bed, and a carb based breakfast may be helpful during this time.

Smells

• Sometimes just a whiff of an odor or an aroma that was previously inoffensive, now triggers a wave of nausea.
• A little essential oil on a hankie can save the day.  Try peppermint, lemon, or vanilla.

Acupressure Bands

• Worn on both wrists, pressure is applied to an acupuncture point known as PC-6 or Neiguan (inner gate) as it is the empirical point for the treatment of nausea.

Heartburn

It is thought that the rising hormone levels of estrogen and progesterone during pregnancy, relax the smooth muscle of the sphincter between the esophagus and the stomach causing acid to counter-flow from the stomach into the esophagus.  Acid reflux, or heartburn can occur at any time during pregnancy, but most often at the end, in the last trimester when the gravid uterus rises up into the diaphragm.  The degree of discomfort can vary from very mild to severe pain with vomiting.  It is usually worse when in a reclined position and better when sitting upright.

A Chinese medicine differential diagnosis may include Stomach Fire Blazing with strong thirst for cold drinks, or Food Stagnation, with a sensation of abdominal distention and belching.

Acupuncture points on the foot, lower leg, wrist or mid-abdomen can be helpful to redirect the flow of digestive juices to their proper place.  Sometimes we can send our patients home with ear press needles to be applied to the webbed area between the 2^nd and 3^rd toe as an adjunct to weekly treatments.

Self-help suggestions

• Small frequent meals as opposed to fewer larger meals makes more sense for you now.  As your baby grows, your internal organs are displaced smaller meals are processed easier than a large meal, especially when space is limited.

• Learn to recognize and avoid the foods that trigger heartburn.  Some common culprits are highly seasoned rich foods, fried or fatty foods, processed meats, chocolate, coffee, alcohol and often times commercially prepared yeast containing products.

• Antacids are generally safe to take, but avoid sodium bicarbonate since the sodium is absorbed into the blood stream causing a potential for other issues.

• A safer alternative is an herbal antacid, hai piao xiao, or cuttlefish bone is a simple formula that also contains gan cao (licorice).

• Read our blog for more detail on what foods to eat and what to avoid during pregnancy.

We think you will find these suggestions easy to incorporate into your daily routine and quite effective.

Please see Part I of Laura’s series, Conquering Pregnancy Fatigue.

This is the first in a series of articles about pregnancy by YinOva Acupuncturist and Obstetric Nurse, Laura Scheurer.

What an exciting time it is anticipating the birth of your baby, whether it is your first or a new addition to your growing family.  We can say with confidence, there are few experiences in life that top the moment your pregnancy is confirmed.

At the YinOva Center we offer acupuncture, herbal remedies, massage and holistic support for you as you prepare for a healthy pregnancy.  Happily we see many of you transition from this “premester” preparatory phase, to your first trimester.  When that time comes, we often hear, “We’re pregnant, now what?”  We can continue to work together as your body adjusts to the various changes of pregnancy.  Guided by the principles of Chinese medicine and our philosophy of “traditional wisdom for modern families,”  I have been inspired to start a blog series offering safe, simple self-help suggestions for the common side-effects of pregnancy.  Topics will include everything from the first trimester through to preparing for labor and finally, the postpartum period.

“Why am I always so tired?”

Fatigue is a common complaint in the early stages of pregnancy, with a sudden loss of energy as your body gets used to the all the changes.  Your body is adjusting to the extra workload of the developing placenta as well as hormonal changes.  This fatigue often lasts throughout the first trimester, with a sense of renewed energy starting at about week 13.  Toward the end of your pregnancy, in your last trimester, fatigue is often linked to the additional 20 – 30 lbs. gained, lack of sleep due to frequent bathroom visits or the station of the baby, making it hard to find a comfortable sleeping position.

Your Doctor or midwife may suggest an iron supplement early in your pregnancy to improve your hemoglobin levels, which will improve overall oxygenation to your cells and thereby improving your energy.

Based on the result of an involved questionnaire, we can find different patterns that emerge.  Your acupuncturist will then select a course of treatment best suited for you particular presentation.  You may recognize the names of some of the more common patterns if you have been receiving acupuncture for a while, if not, this may be an introduction.  Either way, I’d love to explore the Chinese perspective with you.  They include:

• Qi deficiency: fatigue that is worse after exertion and better with rest.

• Yang deficiency: includes some of the signs of Qi deficiency plus sensations of feeling cold.

• Yin deficiency: fatigue, restlessness and heat signs, like warm flushes or night sweats.

• Liver Qi stagnation: fatigue that is worse with inactivity and stress.

• Liver Blood deficiency: fatigue, weakness, dry skin, pale lips and poor memory.

Acupuncture is useful at any stage of your pregnancy.  If there are obvious reasons for your fatigue, like nausea, anemia or musculoskeletal pain, those issues will be addressed first.  We would advise you to listen to your body and slow down if needed.  This is not the time to push the envelope on your energy reserves.  Small, simple lifestyle or nutritional changes will correspond to increased energy.

Self help suggestions:

• For those of you taking an iron supplement, choose an easily absorbed liquid formula, like Floradix.

• Incorporate iron rich foods into your diet, like organic eggs, grass-fed red meats, spinach, blackstrap molasses and dried fruits.

For those presenting with patterns such as Qi deficiency or Yang deficiency:

• Think about how you can reduce your workload.
• Dress warmly.
• Start work later in the morning if possible.
• Go to bed earlier.
• Pay attention to your sleep hygiene: keep your room dark; remove electronics like TV’s and laptops from your bedroom; if outside noise is an issue, use a white noise device.
• Your diet should incorporate Qi and Yang tonifying foods and preparations: limit the consumption of cold and raw foods; lightly steam or roast veggies with rosemary, add a little garlic or ginger to stir-fry;  add cinnamon, or cloves to fruit compotes or rice congee.

Yin deficient women need to support and conserve their Yin energy:

• Seek out activities that are calming as opposed to stimulating, i.e., gentle moving meditations, Tai Chi or prenatal yoga help to center and ground your energy reserves.
• Avoid foods that are too stimulating like caffeinated drinks, pick-me-up snacks with too much sugar.
• Incorporate Yin nourishing foods like banana, mango, dairy, legumes, fish and pork.
• Small frequent meals, rather than less frequent, large meals, keep blood sugar levels stable, minimizing those after meal or mid-day energy slumps.
• Try different kinds of milk to make fruit smoothies, such as almond, rice, hemp or coconut milk as these are less mucus producing, and nourish the Yin energy.

Liver Qi stagnation fatigue requires us to focus our attention on promoting the smooth flow of Qi.  Possibly you are one of those ladies, who, prior to your pregnancy found regular, strenuous work-outs like running suited you best.  Now that you are pregnant those work-outs may not be advisable.  If you feel the need to release some of that pent up energy and doing nothing makes you feel more tired a brisk daily walk and/or lane swimming  are good alternatives.  They are both gentle enough and active enough to move the energetic Qi of the Liver, calm irritability, and energize you at the same time!

Liver Blood deficiency ladies need to build Blood (of course we are primarily speaking of the energetics of Blood, through the eyes of Chinese medicine, we are not suggesting there is anything wrong with your blood – using upper case ‘B’ for Chinese medicine and lower case ’b’ for what is commonly thought of as blood).

• Dietary suggestions include already mentioned iron rich foods.
• Other suggestions: beetroot, avocado, dark leafy green vegetables, kidney beans.
• Smaller, more frequent meals.
• Include plenty of plant based proteins, like quinoa or whole grain buckwheat.
• Wheat grass shots are a nice addition to your routine.
• Don’t forget your fluid intake.  Always start with water, water, water.
• Another option, pure, clear and clean broths to sip on throughout the day.

Daily waking activities need to include some down time.  Most likely you will find it is after lunch between 1 and 3 pm, you may feel,  as my mother would say, “too pooped to pop.”  Energetically, in terms of Chinese medicine, this is the time when the Liver energy is at its weakest (peak time is 1 – 3 am while you’re body is resting & rebuilding Liver Blood).  A nap would be ideal, but often not possible for many working women.  Please listen to your body’s needs.  Put yourself first for now.  Schedule a daily 20 minute catnap.  Close the eyes, get into a no fly zone space to replenish your energy reserves.

Remember how incredible your body is.  Enjoy, marvel and embrace the changes your body is going through and bringing forth!

Stay tuned for the next topic in our series: ‘Morning Sickness.’

Susan was a long-term fertility patient who was overjoyed to find out that she was pregnant. “Should I still come and see you every week?”, she asked me.

The answer is only if you want to. If you find acupuncture relaxing and useful, feel free to visit us here at the YinOva Center as much as you like. However, most pregnant women visit us only when they need us and I encourage them to use us as a resource coming in when they are uncomfortable.

Pregnancy is not an illness and most women do not need regular ongoing treatment. However acupuncture can be an excellent choice to address common pregnancy ailments in a safe, gentle, drug-free manner. The needles we use a small and hair-like, the treatment is relatively painless and there are no adverse side effects for either you or your baby.

The First Trimester

• Fatigue
• Morning Sickness
• Constipation
• Headaches and nausea

I end up seeing my patients quite a lot in the first trimester. Many women struggle with fatigue and nausea at this time. Usually they haven’t told friends and colleagues about their pregnancy yet so they struggle to act as if everything is normal whilst feeling strange and off-kilter. It can feel like a bit of a battle. Acupuncture can help with the fatigue and has been shown in clinical trials to be effective for nausea and vomiting.

A study of women who had been hospitalized for severe pregnancy vomiting showed that acupuncture was a useful treatment. Researchers randomly assigned 33 women to acupuncture treatments at a specific point (PC6) on the underside of the wrist, or to sham treatments at a different spot. After two days, all treatments were stopped for two days to allow any effects to dissipate. Then the groups were reversed for two more days of treatment. Before treatment all women were vomiting. On day three, only seven out of seventeen women (41 percent) receiving active acupuncture were still vomiting compared with 12 out of 16 (75 percent) receiving sham treatment. After the active and sham groups were switched, more of the women receiving active treatment stopped vomiting. Women also reported experiencing less nausea. (1)

I needle a variety of points for patients with morning sickness and then send them home with a tiny magnet taped to their wrist at a special nausea point. For many women this magnet is a bit of a lifeline. I once arrived at my office early one morning to find an unscheduled pregnant patient sitting on the floor outside waiting for me. Her magnet had fallen off and she had started to feel nauseous again. She was determined to get a new one put on before work and had decided to camp out until I arrived.

Some women also suffer from headaches and migraines at this stage and find acupuncture to be a useful way of addressing them. The other common problem that women complain of is constipation. There are acupuncture points to help this although I’m also a big believer in prune juice (if you can stomach it).

The Second Trimester

• Heartburn
• Edema
• Excessive weight gain
• Hemorrhoids
• Back pain
• High blood pressure

The list above makes this trimester sound like an ordeal but the truth is most women feel happy and healthy in the 2nd trimester and I end up seeing my patients the least at this time.

As your bump grows, however, you may start to feel the strain on your back. If so, please come on in and see us at the YinOva Center.  Acupuncture has been shown in several clinical trials to be a safe and effective way of relieving pregnancy related back pain.

A study published in Acta Obstetricia et Gynecologica Scandinavica looked at pelvic and low back pain in pregnant women, and concluded that acupuncture it is a safe and effective method of reducing pain without producing any serious side-effects.

In the study, 72 pregnant women with pelvic or low back pain were randomized, during weeks 24-37 of their pregnancies, to either an acupuncture group or a control group. Women in the acupuncture group received needling at traditional acupuncture points and “local tender points” based on their individual pain patterns, and were treated once or twice a week until the child was delivered. Women in the control group were given no stimulation.

Throughout the study, patients in both groups were asked to rate their pain weekly on a visual analog scale, and to rate their pain on a three-point scale during various activities.

Over time, visual analog pain intensity scores decreased in 60 percent of the women given acupuncture, but in only 14 percent of the women in the control group. Additionally, 43 percent of the acupuncture patients reported a decrease in pain during activity, compared with only 9 percent of the control patients.

No serious adverse effects were observed in the women receiving acupuncture, and no adverse effects of any kind were noticed in the babies born to women in the acupuncture group. (2)

We have a soothing herbal balm for hemorrhoids and can treat edema and heart burn. Along with your doctor we can help you with high blood pressure and also give you acupuncture to slow down excessive weight gain.

The Third Trimester

• Back pain
• Pelvic pain
• Breech position
• Induction of labor

It is in this trimester that acupuncture’s ability to gently relieve pain comes into its own. I always caution my patients to look after their back at this time and not to lift anything heavy. The combination of your ligaments softening in preparation for labor and your center of gravity being pulled off by a big bump makes you susceptible to back injury. If you are suffering please come in and see us. As shown in the study described above, acupuncture is a great way of relieving your discomfort without having to resort to pharmaceuticals.

If your baby is breech it is worth coming in for moxibustion. There is a proven technique that involves burning an herb above the small toe that has been shown in trails such as this one to be an effective method of turning breech babies. In some clinical trials it has been found to be effective 67% of the time. Here is a link to an article on our YinOva Blog about using acupuncture to turn a breech baby and here is a one of our patients blogging about her own experience.

I’m often asked how this works and it’s important to note that the techniques does not miraculously pivot the baby. What it does is relax the uterine walls a little so that the baby has more room to move. Some babies follow their instinct and use this space to move head downwards and some don’t. Personally I have found it hard to get the desired effect after the 37th week.

Many OB’s here in New York send their overdue pregnant women to us for acupuncture induction. We use elector-stimulation to stimulate contractions and in many cases this gets a sluggish labor started without the need for a chemical induction.

I always tell my patients to come in and see me in the last month of their pregnancy so that I can prepare them for labor. I do acupuncture to relax the pelvic muscles and near the big day I needle acupuncture points that help dilate the cervix. Labor is an unpredictable event so I can’t promise anything but patients that we have prepared do, on the whole, seem to have shorter and easier labors. Our lovely YinOva acupuncturist Laurel Axen Carroll blogged here about using acupuncture to prepare for labor.

Birth

In 2004 I worked as an acupuncturist at Lutheran Hospital in Brooklyn. At the time I was teaching students in the hospital and one of our main focuses was pain relief in labor. I had the opportunity to attend many births and was so impressed by how helpful the acupuncture could be. We started a clinical trial investigating the use of acupuncture to relieve pain during labor and delivery – a study that is still ongoing.

Postpartum

• Poor milk supply
• Anxiety
• Fatigue
• Depression
• Pelvic and low back pain

After birth acupuncture can help restore balance in your reproductive hormones and deal with any residual aches and pains from labor. It’s also a useful way of addressing the anxiety and fatigue that many new Moms feel. If you are suffering from depression we encourage you to talk to your doctor but we also have very good herbal formulas, which may be useful to you at this time.

If you find that your milk supply is weak or inconsistent, acupuncture can help with flow and nourishing herbs can help with supply.

At the YinOva center we love taking care of women through all their transitions and it is our pleasure to support you at such an exciting time. I am delighted that most of our patients find pregnancy to be a rewarding and creative time. We love meeting your babies and cherish the many pictures you send us. I am so thrilled that so many of you take the time to drop by with your little ones and share with us your joy at becoming a Mom.

Click here for more articles about pregnancy from our YinOva Blog

References:

(1) Carlsson CP et al. Manual acupuncture reduces hyperemesis gravidarum. A placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000;20(4):273-79.
(2) Kvorning N, Holmberg C, Grennert L, et al. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstetricia et Gynecologica Scandinavica, March 2004;83(3):246-50.

Patient’s often ask me what the early signs of pregnancy are. It is useful to look out for them even though they can be a little confusing. Realistically, the only conclusive way of knowing that you are pregnant is a positive pregnancy test however the signs outlined below may give you a hint. Our book Making Babies: A Proven 3-Month Program for Maximum Fertility gives more information about this.

These are the symptoms I tell my patients to look out for.

Digestive Changes

Feeling nauseous or vomiting is one of the most common signs of early pregnancy. Gas, constipation or abdominal bloating are also common because digestion slows down in pregnant women.

Breast Tenderness

Extreme breast tenderness or itchy nipples are also a sign of early pregnancy.

BBT Chart

A BBT chart that goes up at ovulation and then goes up again about 4-6 days later, especially if the temperatures stay high.

Mild Spotting

As the fertilized egg implants into the uterine lining this can cause some very light bleeding. Women experience this as very light spotting a few days after ovulation. Heavy bleeding could be a sign of something more serious and should be flagged up to your health care provider.

Cramping

This feels like a mild menstrual cramp and is often the first sign of pregnancy for many women

Extreme Fatigue

In early pregnancy a lot of your body’s energy is diverted to the developing fetus. My pregnant patients are often surprised to feel as tired as they do.

If you are feeling these symptoms regularly but your pregnancy tests are negative you may be experiencing chemical pregnancies. If you are a patient at The YinOva Center we would like to know about this as this effects the treatment plan we draw up for you. We also advise you to tell your OB/GYN or RE as it will help them with their diagnosis.

You can find out more about our work with women trying to conceive here and with pregnant women here.

“Is it safe to exercise during pregnancy?”

I get this question a lot from new moms and the answer is that for most women it is perfectly safe as long as they keep a few common sense guidelines in mind. In fact not only is it safe but it’s a good idea to stay physically active throughout your pregnancy as a recent study in the American Journal of Epidemiology showed. This study looked at moms-to-be who take regular exercise in the first six months of pregnancy and found that they had half the risk of having a premature baby when compared to inactive moms.

Exercise boosts energy, relieves stress, helps with posture, promotes blood circulation and gets your body in good shape for labor. If you have been following an exercise program before your pregnancy you should be able to maintain your fitness by adapting it to your new circumstances. If you have not exercised regularly it’s important that you start very slowly and don’t overdo it.

Here is the advice we give our YinOva Center patients.

Check with your OB

For most healthy, pregnant women, exercise is encouraged but there are exceptions so run your exercise regimen by your OB to make sure that you are not putting your baby’s health at risk.

Don’t get too hot

Now is not the time to take up Bikram yoga! It’s OK to sweat a bit but try not to get too overheated as this can lead to dehydration, raised blood pressure and edema. Pregnant women overheat easily because of their progesterone levels. For this reason its best to avoid saunas, steam rooms and hot tubs too.

Don’t overstretch

Pregnant women release a hormone called relaxin which relaxes muscles and ligaments to make labor and delivery easier. This means that your muscles are extra pliable especially in the second and third trimester. You should be careful not to injure yourself by stretching too much. We usually tell our patients not to hold a stretch for more than 10 seconds.

Don’t overdo it

Its OK to exercise to the point where you are breathing a little heavier, sweating a bit and getting warm but you should still be able to hold a conversation. Exercising to the point of breathlessness means that both you and your baby are not getting the oxygen you need.

Avoid high impact activities and contact sports

Generally we suggest that you don’t jog after the first trimester because the impact puts unnecessary stress on ligaments and can affect the pelvic floor muscles. Swapping jogging for power walking is one way to get the cardiovascular benefits without the impact. Clearly contact sports are a bit of a no-no, so if you like to wrestle or play rugby you may have to take a break. You should also avoid any sport where you could fall such as horse riding or mountain biking.

Avoid exercises that involve laying on your back after the first trimester

This position puts pressure on the vena cava and can affect blood flow to the uterus.

Wear the right kit

Loose, breathable clothes are important to stop you overheating and its a good idea to invest in a well fitting sports bra that will support your breasts and stop your breast ligaments from over-stretching.

Listen to your body

If you do this you will know when you are overdoing it. Do not push through pain or exhaustion. Take plenty of breaks and replenish fluids.

Swimming is a great exercise for pregnant women because the resistance of the water increases the intensity of the exercise without increasing impact and the water supports the uterus. We also suggest finding a good prenatal yoga class. Yoga with an instructor who is trained to work with pregnant women combines relaxation, with deep breathing and gentle stretches which prepare the body for labor. It can also be a good way of meeting other pregnant women.

This post was first published in 2006 but we decided to repost it because the question of whether and how to exercise during pregnancy is one that we get asked all the time.

Blogging today – YinOva Acupuncturist and Herbalist Laurel Axen Carol. Laurel specializes in using Chinese medicine to treat female reproductive issues, a subject she currently teaches at graduate level.

Laurel says – Getting a diagnosis of a breech presentation is not fun. I have had two myself, one frank and one transverse, so I am no stranger to the news. I have done everything under the sun to get a baby to turn and both did ultimately-but with two totally different births.

It’s healthy to encourage a baby to turn but there is a point when we need to TRUST that some things are beyond our understanding.

There are so many suggestions for turning a breech baby:

• Laying inverted on an ironing board (this can become really uncomfortable fast)
• Hanging around the house on all fours doing continuous cat/cows (yoga moves where you gently rock your pelvis)
• Frozen peas on the top of your abdomen or wherever the babies head is.
• Playing music into your pubic bone with head phones etc.
• Moxibustion, otherwise known as mugwort, burned over the mother’s small toe.
• Chiropractic -namely the Webtser technique.
• Clothes pins on the baby toes.
• Handstands in the pool.
• Visualization.
• Meditation.
• Homeopathic remedy pulsatilla
• External cephalic version.

As an acupuncturist I use moxibustion and acupuncture to help turn babies. I am always honest when dealing with a woman with a breech. Sometimes there are reasons way beyond our understanding that lead to a baby’s postion.

My treatment usually consists of a systemic treatment to help address what is going on with mom. This could include; stress (obviously), reflux, back pain, sciatica, tight muscles, insomnia. I often open the Dai Mai which is a meridian called “the Girdle Vessel”. This extraordinary meridian runs transverse across the belly and its main function is to hold up the other meridians. Opening the Dai Mai can often help the baby find a little room to flip drop down.

A lot of times I find that babies are breech because the hip-flexors and pelvic floor needs to loosen up. Some tight ladies include runners, pilates aficionados, athletes etc suffer from this. Other times babies are breech because the mom has too much water or the uterus is stretched and weak and isn’t holding the baby as tightly at term. In this case I use treatments to help strengthen her Qi.

I do burn the moxa of the little toe in a few different ways. Occasionally I use warming needle (moxa attached to a needle) and other times direct moxa placed on cream and other times I use pole moxa. I provide mom with moxa sticks and tell her to go home and continue treatment for ten consecutive days. If baby has not turned by then to come back for another treatment. No one really understands why moxa over the little toe works? One Western explanation may be that the little toe is the dermatome for the sacrum. One thing is for sure moms report (and I experienced) a lot of fetal movement during the moxa treatments.

The one thing I feel that I must urge continuously is that you must TRUST that the baby and your body know what to do. Let go, relax and try not to become obsessive. This may be your first interaction with the will of your little one!

I have found the greatest success is before 36 weeks but many babies still turn past then. I have even seen a baby flip at 41 weeks.

A good online resource is Spinning Babies

Other YinOva Blog articles on this subject
Can Acupuncture Help to Turn a Breech Baby
Turning a Breech Baby – A Patient’s Story

YinOva acupuncturist Laurel Axen Carroll blogs about acupuncture before labor.

I have had really great success treating pregnant women and helping them to go into labor “on-time”. These days not many doctors will allow their patients to carry past 41 weeks. Unfortunately, babies do not always know the time line which, leads to anxious moms worrying  about pitocin, cervadil or a scheduled C-section. Stressed out moms make for tight muscles and a tense cervix which, is less than optimal if you are trying to go into labor.

I’ve been lucky enough to work with many pregnant women and have had a lot of success using a pre-labor protocol that was created by Debra Betts, a renowned midwife and acupuncturist from New Zealand. Most of the women who get this treatment go into labor “on time” usually by 40-41weeks, and have had relatively short (less than 12 hours which is short in my book) and often unmedicated labors. First time mothers may go past 40 weeks but in my practice I have had very few Mom’s who have been induced medically.

The treatment commences at about 36-37 weeks gestation and ends at the onset of labor. Treatment consists of a core group of acu-points that help facilitate muscle relaxation, a softening of the cervix and relaxation for the mind. During treatment I also addresses other issues that may be affecting the woman. This could be reflux, insomnia, back pain etc…

A recent study showed a 35% reduction in the number of inductions, (for first-time mothers this was a 43% reduction) and a 31% reduction in the epidural rate. When compared to a local midwifery practice (with no acupuncture) there was 32 % reduction in emergency Cesarean Sections and a 9% increase in normal vaginal births. Read the full study here.

This week’s blog is written by New York massage therapist Nicole Kruck. Nicole specializes in fertility massage as well as pre and postnatal massage. We often get asked questions about prenatal massage and decided to put some of these questions to Nicole. Below are her answers. You can book an appointment with Nicole online by clicking here.

“What is prenatal massage?”

It is just like a regular massage: it loosens the muscles and joints, improves the circulation to you and your baby, and relieves fatigue.

The difference is prenatal massage is performed by a New York certified prenatal massage specialist who is able to target the unique needs of mothers-to-be in each trimester. These therapists are adept at working with specific conditions that can occur during pregnancy such as pelvic pain, digestive and elimination issues to bring you safe relief.

The length of your prenatal massage can range from sixty minutes to two hours depending on your specific needs. Several techniques are employed such as Swedish massage, myofascial, stretching & range of motion, and other modalities to relax and soothe the body, treat and ease tensions. At the end of the session you are left feeling restored, relaxed and comfortable in your happy body. You will also get tips on how to sleep better, foods that support pregnancy, relaxation techniques and exercise to support you during this time of added stress.

As your pregnancy progresses you will find each trimester will hold it’s own focus for your body’s needs.

“How is prenatal massage different in the first trimester?”

This is when we create the foundation for your pregnancy.

As weight in your belly begins to increases your center of gravity shifts adding stress and strain to weaker areas. This is your opportunity to concentrate on muscles, ligaments, and postural problems to create a stronger structural foundation.

The focus of your first trimester is to address any pre-existing conditions that would include chronic issues: back, neck, shoulder or pelvic pain, sciatica, or other recurring problems. Immediately attending to these issues will support your body’s ability to more easily distribute the added weight as your baby grows. Along with physical support massage at this time also reduces emotional anxieties which are important to a healthy foundation.

“What about the second trimester? Does the massage differ?”

In some ways this is your baby’s first massage

At this stage the pregnancy is settled in and it is time to focus on uterine support. As your uterus increases in size( 4 oz to 13 lb..) it is easy to over stress the 13 ligaments which give it support. Keeping the ligaments toned easily prevents many debilitating symptoms such as pelvic or back pain, premature delivery, and back labor. However, most importantly massage is a wonderful way to connect to your baby. You will be taught your own self care massage for home play.

“And in the third trimester?”

This is when we start to prepare you for labor.

So many internal and external events are taking place in preparation for your labor and birth. As strain to ligaments increase due to weight and increased hormones simple movements can induce pain until the muscles around them are releases. Also uterine pressure to your legs can cause excessive swelling along with blockages to digestion and elimination. Not only does prenatal massage on a regular basis help combat these symptoms but it will also relax your body in preparation for an easier labor, delivery and recovery.

“Should our Yinova Moms still be coming in for massage post-partum?”

Yes indeed. I like to say that we are returning a wandering womb

Your body has been put under tremendous stress. Especially in the abdominal and pelvic area where there are many new physical and emotional demands. These experiences – recovering from your pregnancy, delivery (especially with cesarean section) and now caring for your newborn are all individually major transitions. Postnatal massage supports recovery of all these stages in a gentle and effective way.

One major overlooked problem in postpartum recovery are the uterine ligaments. These ligaments are meant to easily expand to accommodate pregnancy however, recovery can many times create complications. One uterine massage after birth will not usually repair the nine months they have endured under great pressure. Especially if there was some type of trauma during delivery (such back labor, cesarean, extended pushing, improper care). These ligaments have a hard time recovering just like the over stretched elastic in your waist band. If they are not properly healed the uterus can not return to it’s proper positioning and many can complications occur. Some complications are incontinence, uterine, bladder or rectal prolapse, constipation, scar tissue especially with caesarean fallopian tube blockages and future fertility issues.

Getting regular massage and learning to do your own “Self-Care Massage” will assist not only the uterine ligaments and uterus to return to proper place but, will support the harmony of all healing.

You can start Postpartum Massage one week after a normal vaginal delivery, six weeks after a normal cesarean and after release of doctors care from any other complications.

“So how would you sum up the benefits of prenatal massage?”

The health of your uterus and it’s ligaments will assist you in avoiding common complications such as incontinence, prolapse, scar tissue (especially with caesarean) and future fertility issues. Prenatal massage does more than benefit the mother. Everything a pregnant woman does from her diet and fitness to her relaxation and relative state of contentment – also directly affects the child she is carrying. Study after study has proven that calmness in the mother leads to healthier baby development.

According to a study¹ receiving regular prenatal massage benefits labor by:

• 25% shorter delivery time

• 30%reduction in all pain medications

• 50% fewer cesarean births

• 60% less request for epidurals

Prenatal massage:

• promotes relaxation

• reduces edema

• reduces blood pressure & relieves varicose veins

• improves blood circulation & lymph circulation

• facilitates support for respiratory, digestive & elimination

• releases neck, back and and other joint pain

• relieves muscle spasms and cramps

• reduces mental strain, fatigue and depression & anxiety

1. Touch Study Support for Pregnancy by Marshall Klaus, MD

This week I was interested to read a new study in the American Journal of Obstetrics and Gynecology which showed that ear acupuncture can significantly reduce low back and pelvic pain in pregnant women. You can read the full text of the study here. This is not the first research study to look at this. In fact in 2005 I was interviewed by ABC news about a previous study in the British Medical Journal that also showed acupuncture can help with pregnancy back pain. You can watch that clip here.

Up to 1 in 5 women suffer from back and pelvic girdle pain in pregnancy. Usually our patients complain of pain in the low back and buttocks although some patients also feel discomfort at the front of their pelvic area. Some women also experience radiating pain down one or both of their legs. Most women tell us that the pain gets worse if they have to stand for a long time. In 7% of women the pain continues after they have given birth becoming a chronic lower back issue.

At the YinOva Center many of our pregnant patients are keen to avoid medication, if possible, and so they choose acupuncture as a gentle and safe way to treat their pain. We usually use a combination of ear acupuncture as described in this recent study and local acupuncture as outlined in the previous study. The local acupuncture works in three ways – the needles act on the nervous system to interrupt the pain signal, the combination of needles causes the body to release chemicals which act as natural pain killers and by needling the spasms we get the knots in the muscles to release.

In the recent study the patients only received ear acupuncture which has a long history of efficacy in China and has been found in clinical research to initiate an endorphin release. 152 women, in late pregnancy, were divided into three groups one of which had small acupuncture needles held in place by tape and retained in three ear acupoints for one week. Another group received sham acupuncture and the final group acted as a control and received no acupuncture at all although they were instructed to rest and take painkillers if necessary.  81% of women in the ear acupuncture group reported a significant reduction in pain as oppose to 59% of the women in the sham acupuncture group and 47% of the women in the control group.

Acupuncture is a time-tested therapy for pain relief and because it has few side effects is one of the safest ways of releiving pain in pregnant women. Most of our patients get relief from the combination of ear and body acupuncture and usually feel much better after 2 or 3 treatments. Other helpful treatments include gentle stretching exercises as well as massage by a qualified prenatal massage therapist and we usually suggest that women do one of these in conjunction with their acupuncture treatment.

I recently wrote a blog entry that was all about influencing the sex of your baby. All that talk about X and Y chromosomes prompted one of my patients to ask me about Fragile X syndrome. She had just been diagnosed as a carrier for this disorder and wanted me to help her sort through her options.

What is Fragile X Syndrome?

Fragile X is a genetic disorder and is the most common cause of inherited mental impairment and cognitive problems including some forms of autism. It is caused by a mutation of the FMR1 gene on the X chromosome. The mutation turns off the production of the FMR1 protein which in turn affects brain development. People with Fragile X suffer from mental impairment which can take the form of anything from very minor learning difficulties to severe cognitive problems. They may be hyperactive or over sensitive to stimuli and they may have short attention spans. Physically people with Fragile X may have a long narrow face, prominent ears, enlarged testicles and loose joints. Approximately 1 in 2000 boys suffer some kind of mental impairment due to Fragile X. The disorder also affects girls but the incidence is lower and the symptoms tend to be milder. This is because girls have 2 copies of the X chromosome whereas boys only have one. This means that girls have 2 copies of the FMR1 gene so if one is mutated a girl has another copy of the gene to fall back on. Boys only have one X chromosome.

What does it mean to be a carrier of Fragile X?

Fragile X syndrome is carried on the X chromosome. Since men (XY) and women (XX) each have at least one X chromosome, both parents can be carriers.

If a father is a carrier, he can only pass the gene defect to his daughters, since he transmits a Y chromosome to his sons. All of his daughters will inherit the gene, but as far as anyone knows this inherited defect will be in the premutation stage which means that if a daughter inherits Fragile X from her father she will not be symptomatic although she can pass the disorder on to her children.

If a mother is the carrier, she can pass the gene defect to either her sons or her daughters, since she contributes an X chromosome to each. If, as a woman, you are a carrier you have a 50% chance of passing the gene on because you have two X chromosomes and only one of them is affected. So if you are a carrier you may not pass on the defect at all or you may just pass on the premutation or your child could inherit the full syndrome. Sons who have fragile X are at high risk of intellectual disability but daughters who receive the fragile X gene may appear normal because the have two X chromosomes and only one is affected.

If you are a carrier how is risk assessed.

A simple blood test can establish if you are a carrier of Fragile X and the degree to which this mutation is likely to cause problems for your child. Geneticists classify the gene mutation into three categories based on the number of repeats of a pattern of DNA called CGG repeats. Individuals with less than 60 CGG repeats have a normal gene. Individuals with 60-200 CGG repeats have a premutation which means they do have a small risk of their child suffering from Fragile X syndrome and that risk is directly related to the number of CGG repeats. Parents with over 200 repeats have a full mutation which causes fragile X syndrome.

As for my patient. She fell into the middle ground in that she had the premutation and so was at a small risk of passing on Fragile X. Fortunately we live in a time when we have access to good genetic testing and advice. Her doctor was able to reassure her that, because the number of CGG repeats was low her risk of passing this disorder on to her child was minimal. An amniocentesis at 16 weeks was able to confirm her doctor’s prediction and she was relieved to hear that her baby was just fine.

Although it’s scary to find out that you are a carrier for a genetic disorder such as Fragile X, it’s important to find out more about your own situation. You may find that with a combination of genetic and prenatal testing you , like my patient, receive reassuring news.

I enjoyed this video by Alice Eve Jones performing an extract from her book, What I Thought I Knew. In it she describes how, after a long struggle with infertility, she was told she was in menopause, only to find out that she was pregnant. Recently Dr. David and I were consulted by a patient in her mid-thirties who was told she was menopausal and that she should give up all hope of bearing her own child. She’s now four months pregnant. Miracles do happen. In fact they happen all the time.

Thanks to Njemile Carol Jones, an fabulous acupuncturist in Maryland for sending me this link. Njemile specializes in OB/GYN with a particular specialty in treating infertility. So if you are looking for an acupuncturist in the MD or DC area she would be an excellent choice.

Todays blog is written by YinOva Acupuncturist Margaret Sikowitz.

I’m very excited today. It is my daughter’s 7th birthday so there is an air of festivity abounding AND I just learned that one of our overdue pregnant mothers-to-be just gave birth. However, the patient in question was a bit disappointed. First she missed the cut off set by her hospital’s birthing center by going too far past her due date, then her doctor diagnosed her with low amniotic fluid and she had to be induced. (She responded beautifully to pitocin, labored for a few hours and gave birth to a healthy baby girl!)

I can relate. I am truly blessed with two healthy children. Still, neither wanted to come out and needed a fair bit of coaxing. Here at the YinOva Center we often get asked about our own experience of labor, especially by the soon-to-be moms. I’m happy to volunteer that mine were not easy, and that both needed an epidural and pitocin. While it wasn’t what I wished for or envisioned, it seemed the right move at the time and I definitely got the prizes in the end. I think the acupuncture treatments I had before labor definitely helped and I have no doubt that the ones I managed to squeeze in after aided my recovery (and my post-partum depression, more on that later.)

In Chinese medicine, female life cycles occur every 7 years (it’s 8 years for boys, they’re always a little slower…) So today I celebrate the birth of this new baby, the first cycle of my daughter and more importantly, the unpredictability of life! Toward this end, here’s a gem I often ponder, given to me by one of my first Chinese medicine teachers:

Be flexible like the tree and you can withstand all the changes of the seasons.