Sarah Tewhey
Forum Replies Created
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I agree with Carmen that gestational age is important. A second trimester loss really needs medical monitoring due to the increased risk of bleeding.
This is what I do for missed miscarriage in the first trimester when people want to avoid a d&c. I’ve always talked with the primary provider prior to doing this protocol.
I generally provide a root treatment based on differential diagnosis and then often Li4, Sp6, GB21. Agree that both qi xu or qi yu is super common and I add points or moxa accordingly. I tack points after the treatment.
Because I am a Western herbalist, I use a Western herbal protocol that involves a couple days of Evening Primrose oil, followed by a very specifically dosed protocol of Black Cohosh and Blue Cohosh over five days. Again, this is ALWAYS with prior communication with their primary provider. I also give an SOS formula that includes herbs like Angelica (Angelica archangelica, not Angelica sinensis), Yarrow and Shepherd’s Purse to stem excessive bleeding – I explain that the formula is to be used EN ROUTE to getting medical care, not In LIEU of medical care if they are bleeding too much. Its an important distinction. I do alot of education on when to go to the ER for bleeding, pain, fever or other signs of infection. Again this is for a missed miscarriage – not for someone who wants to end a pregnancy that is still viable.
In terms of assisting with a termination, I personally don’t do anything with acupuncture or herbs to help end a pregnancy. As Claudia mentioned, in some cases the doses required of abortifacient herbs are so high that they can be dangerous to the pregnant person unless you really, really know what you are doing. The medications available are both safe and effective – but access is increasingly an issue here in the US. I happen to live in an area with good access to care.
What I have done is supported many people through a termination by providing support as a doula as well as acupuncture and herbs to help support their bodies and minds through the process of ending a pregnancy. People are often so grateful for this type of help and a safe place to openly talk things through and receive supportive treatment. I’ve had people come in YEARS after their abortion to get some acupuncture to help with closure because they had no one to tell or support them when they were going through it. Its a population that just isn’t receiving enough care, for sure.
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I would bet money she is a marathoner. 😉
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Hi All,
Micaela had sent this case to me as an email and I encouraged her to post it here, because it is an excellent case. Below is my opinion….I hope others will chime in as well!
Micaela you are giving really thoughtful care and thinking ahead…well done!!!
Her baby will likely turn, and my opinion is that if her cervix is just more prone to bleeding (some just are) and not thinning, dilating or showing other signs of pre-term labor, then trying to turn her baby would be fine. UB67 does cause minor contractions, so if you have someone at 32-33 weeks with a cervix that is bleeding, thinning, dilating, etc…you wouldn’t want to add contractions into the mix. A closed and thick cervix that is simply sensitive is less concerning. Some people I’ve worked with bleed for weeks and their pregnancies are perfectly fine.
If you are feeling unsure when the time comes, you might try doing things like cupping and body points from 32-35 weeks and start with UB67 only closer to term (36-37 weeks).
I’m personally increasingly of the opinion that we maybe don’t need to be trying to turn babies with acu/moxa at all until 36-37 weeks anyway (more on that in the Breech module), so you have LOTS of time.
***I do want to edit to add that there are other situations of vaginal bleeding in the 3rd trimester (like a partial placental abruption, placenta previa, etc) where trying to turn the baby would be totally contraindicated.
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Hi Micaela,
So many thoughts.
I am an aunt to twins (and treated my SIL through her pregnancy), so twins have a special place in my heart! At this stage I agree with Claudia and Cally that the real focus is on maintaining nourishment of the qi and blood – both for the pregnancy and for the intensity of postpartum with two newborns! And that drain on the system really starts to ramp up after 20-24 weeks, so you are unlikely to be seeing it yet. I do find that twin parents do often get more stagnation and more heat (even here in Maine)…so I think your approach of nourishing while also keeping things gently (so gently) moving is wise. Treat what you see in order to keep good quality blood.
You can really use the second and early third trimesters to set her up well for birth and postpartum. The longer I do this work the more I realize that treatment through pregnancy dramatically cuts down on having to “manage” issues surrounding labor. Front-loading throughout pregnancy is the way to go. So, I wouldn’t be focused too much on labor or induction at this point, besides the understanding that in most multiple pregnancies birth happens earlier than with singleton pregnancies. So you might want to think about starting pre-birth treatments a week or two earlier (34-35 weeks vs. 36-37). In most pregnancies we think of pre-birth treatments as helping to prep the body to get baby out…depending on what is happening with the pregnancy, pre-birth treatments in parents of multiples may end up being focused on trying to keep babies IN until they are full term! You won’t know until well into the third trimester what your focus is going to need to be.
If the presenting twin is breech in the 3rd trimester and the parent is hoping for vaginal birth there are also considerations around trying to turn the presenting twin…so if Twin A ends up breech and we haven’t done the breech module yet, reach back out!
MAMPS grad Ciara McNiff is a mom of twins did a lecture for MAMPS with Debra a few years ago. The recording is in the Forum entitled “MAMPS Library”, then “Video Resources” then “2021 Video Lectures”, then “Twin Pregnancy with Debra Betts and Ciara McNiff”…..its alot of clicking to find it, so a direct link to that discussion is here:
mentorship.healthyseminars.com
Twin Pregnancy with Debra Betts and Ciara McNiff - 2021 Video Lectures - HealthySeminars Mentorship Program
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Oh thank you Cally!
We are so thrilled to have you back. You contribute so much to the program. We all look forward to seeing what you do next!
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Claudia I think this sentence is such an important point
“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*”.
I think it is so important at the very end of pregnancy and in labor to take care to remember that we always have so much more than a single EAM pattern going on. We’ve got two people to consider – one of whom has a pelvis to navigate! It takes experience to be able to see exactly what is getting hung up…I often come back to the 5 P’s of labor: Passenger, Passage, Power, Position, Psyche.
Adding the EBB signature article on PROM. 😉
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Welcome Julia! We’re glad you’re here and hope that you enjoy the program. You’re in good company as we’ve had some fantastic Australian students in the last few years.
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Hi Micaela. I’m so glad you were able to join MAMPS this year and hope you enjoy the program. Welcome!
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Hi Julie. I’m so excited that you were able to join us…I hope you love MAMPS. I look forward to hearing about your work and learning with you.
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Hi Emma. I’m so glad you’ve joined us for the 2024 cohort. Welcome!
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Welcome back to MAMPS Courtney! We’re so glad you’re here.
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Claudia is right! There is so much in the program. Many students do the program the first year and spend a second year digging in to the libraries. ;-). I hope you’ll find everything you are hoping for…it is an amazing learning community.
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Hooray for another doula in the program! I’m so glad you’re here.
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Welcome Maggie! I look forward to learning together and getting to know you.
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Hi!
In my area (rural Northeastern US), out of hospital midwives like to see good labor happening within 24-ish hours and a baby not far behind after ROM (rupture of membranes). Whether or not someone is GBS positive and if so has agreed to IV abx (which are within scope of practice for CPMs here in Maine) also influences decision making around timing. The midwives monitor closely, avoid cervical exams and make sure their clients are informed of risks, etc. Care in the hospitals in my area is similar. The willingness to wait 48 hours out of hospital would be unusual in my area.
Evidence Based Birth has a signature article on the subject…happy to attach it if you’d like to see it.
Claudia and Zena would be great to ask about patterns for PROM. In general what I see most often with PROM in an otherwise healthy pregnancy is less a EAM pattern and more an issue with baby position or pelvic fit – with OP (occiput posterior) being the most common issue.
In those labors where position/fit doesn’t seem to be the issue many of the people I’ve seen with PROM tend to be high stress/anxious individuals with Liver stagnation OR have a history of being endurance athletes/doing hard physical work like farming and haven’t had their normal level of intense physical exercise in pregnancy. This seems to leave them a bit yang xu…they get sort of pale and the tissues in general get a bit doughy. I don’t know what impact this might have on the membranes, but it certainly isn’t a good starting place for the yang required for contractions to start. We need strong and healthy yang to get contractions going in a timely way.
Interested to hear other’s thoughts and experiences.