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.