Presenters Bio
Claudia Citkovitz
Forum Replies Created
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Thank you Anisa for this important and yet very sensitive question.
Overall, the uterus’ mechanism for expulsion is contraction, so I think of LI4 and SP6 as go-to points, but with the same differential diagnosis we’d do for dysfunctional labor – in particular, it’s quite often that the uterus isn’t contracting strongly enough due to Qi deficiency in which case I’d moxa ST36 and SP3 with supplementing needle on Li4 and SP6. Local moxa is important if they’re cold, and Qi stagnation is super common so you’d add LV3 for 4 gates, plus LV2 if a lot of heat/constraint. This is also how I approach persistent uterine bleeding after birth, miscarriage or termination.
For herbs for incomplete abortion, gui zhi fu ling wan rather than tao hong si wu tang is the baseline formula I most frequently use (and this is often the right formula for persistent bleeding). ‘Masses in pregnancy’ can easily be interpreted as ‘something in the uterus that needs to be moved out at a time when your body still appears to be pregnant’. It’s really perfect for that, with the gui zhi and bai shao regulating the pushing out/holding in functions, while the mu dan pi and tao ren move blood. That said, it’s important to do a really good differential diagnosis, modify as needed, and discontinue as soon as symptoms improve — switching to a more restorative formula. You’d use chi shao of course if there’s more heat/more stasis.
As to the question of us initiating the expulsion, acupuncture most definitely has been used that way but I spoke to someone who had experienced that long ago and she said it was brutal — 2x 45 minutes very strong estim, like for acu anesthesia. From who came into the hospital when I was there it was also clear there was a local herbalist using contraction inducing herbs, and there were some really horrible outcomes including multiple uterine ruptures. It’s hard not to think about these things in the present US political climate, but I don’t think it makes sense to experiment with alternatives at this point, as the drugs properly prescribed are safe and effective, and the main issue is access.
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Hi Lori! I’m so glad to see you online — and hope to see you in person in November again! :- )
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Welcome Julia! I look forward to getting to know you better :- )
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So very great to see you back Kenna!
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Hi Micaela,
Such a rich question, thank you! I want to leave space for everyone else’s input so I’ll just start with one important difference — the drain on Mom’s qi and blood!!!
What else? Recent experiences?
Warmly
Claudia
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Thanks so much for posting this Cally!
Kate and also Sandro Graca are much more up on the endo literature than I am, but here are a few quick thoughts –
– Any significant result at all for endo is a big win, it’s been really hard to demonstrate efficacy
– This is the kind of tightly controlled efficacy trial that most docs and institutions like (and ask us to repeat the protocol for better or worse). As practitioners of an individual medicine we tend to prefer more pragmatic approaches that look at the effectiveness of what will really happen if real patients get acupuncture. However, there can be a value in knowing that there’s a protocol for something really difficult that mostly worked for most people.
– That value may be undermined somewhat by the frequency of treatment in the protocol (it’s under ‘Intervention’). I’d love to hear from people if they think it would be feasible to reproduce that in their clinics, given that there’s no need to diagnose but just put in needles and let them rest.
– It’s interesting to me that the results are better at 12 weeks than 24. I have an urge to suggest that indeed needling the same points over and over will lose effectiveness….
I look forward to discussing! Let me also put in a good word for Lisa Conboy’s Research Study Group on White Pine Circle https://www.whitepinecommunity.org/welcome. It can be a really good adjunct to MAMPS, for those really interested in research.
Warmly
Claudia
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Hi All!
Thanks for this great conversation. I think it’s in my lecture and book, but for sure let me also emphasize and agree with Sarah here, PROM can be assumed to be positional until you have reason to think otherwise, and OP is the most common culprit. If I can’t see someone I will often tell them to at least try Right side lying along with jiggling, acupressure etc, as ROP is way more common than LOP.
My experience is also consistent with Sarah’s that 24 hours is the longest anyone in my US circle has been comfortable with, though if active labor is going well at the 24 hour mark that’s not itself a reason for transfer. Midwives in Europe have told me they will go more like 48.
Cally, to your point about Yang deficiency, I have long thought both that it’s the job of Yang to enter the Yin and push the babe into right position which is why moxa at the Taiyang channel point Zhiyin is so effective. And, my favorite metaphor for how to spot an OP or other malposition labor early is that the baby head on the cervix is like the terminal of a battery allowing the Yang qi to flow through the labor. So a malposition labor *acts* like Yang deficiency (contractions are like a yang deficient pulse — slow, irregular) *whether or not the patient is Yang deficient*. For sure, if the quality of the labor/contractions does not match the quality of the pulse, this is a sign to me that the position needs to be checked.
Hope that’s a help!
Claudia
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Hi Sarah!
Welcome welcome to MAMPS — and huge congratulations on becoming a mom! <3
100% agreed that the pregnant and postpartum person is often underserved, even marginalized, right in plain sight. We have our work cut out for us!!!
I look forward to seeing you on the Zoom sessions…
Claudia
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Hi Brittin!
What a joy to welcome you to the MAMPS club! I think you’ll find it a super supportive environment for growing one’s pregnancy practice comfort zone, with a safety net of folx to check in with… also the more you are interested/willing to share about your own journey as it’s relevant, the more it helps bring it to life for others.
Warmest wishes and look forward to meeting you!
Clauida
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Hi Micaela, welcome!
How great that you’re in PA, there are some really good people for women’s health there but I don’t know anyone doing pregnancy and birth. I look forward to meeting you and supporting you in bringing your practice back home.
Very warmest wishes
CLaudia
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Hi Julie! Welcome to MAMPS, I’m happy we have a number of Canadians this year :- ). I think you’ll find your personal labor journey is also an important part of the conversation as you move through the material — and I really look forward to meeting you personally. Very warmest wishes, Claudia
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Oh my goodness what important and exciting work for acupuncture! I’m so very happy to welcome you to the program and really look forward to learning more, as well as supporting you as you build the program. Very warmest wishes, Claudia
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Hello Audrey!
What a pleasure to welcome you into the program. I so agree about the outsize impact of getting a pregnancy going right — and helping parents to understand just how powerful our gentle, nonpharmacalogic approach can be!
I look forward to meeting you in the upcoming Q&A sessions.
Warmly
Claudia
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Hi Emma, welcome! Yo San is a great program for women’s health, I look forward to all of the discussions! Warmest wishes and see you soon, Claudia
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Hi Courtney, welcome! I am sure we will all learn from each other and I’m very curious about your experience with homeopathy as well as East Asian Medicine. I read a book ages ago — Robert Moskowitz maybe? — that had the most interesting cases…
We look forward to meeting you in real time
Claudia