Raven Lang was a midwife before she was a practitioner of Chinese medicine. My first introduction to Raven was through an article she wrote for Mothering Magazine on “Mother Roasting”. I had considered and even pursued midwifery as a path for a while and Raven was one of my role models.
When reading this case, consider the difference between 1985 and our current times in terms of available literature and training. What really impresses me about this case is Raven’s strong intuitive knowledge of women’s physiology, the physiology of pregnancy and birth as well as the basic concepts of Chinese medicine.
AN EXAMPLE OF A THREATENED MISCARRIAGE
This story took place in the first year of my professional practice of acupuncture and herbalism, twenty two years ago and remained an archetypal case for me and one I learned much from. It happened just months after I stopped midwifing and transitioned into the practice of TCM. This case was a threatened miscarriage and was the third I had dealt with after opening my doors to practice. The first threatened miscarriage was dealt with quickly and simply, and the pregnancy progressed without difficulty or drama, the second one ended in a fetal demise at the 13th week, and this is the story of the third. I will take you through it step-by-step b/c it exemplifies the many aspects that touch all of the practice of this subject.
This woman was 36 years old, and in 1985 that was considered an elderly first time mother. I will call this woman Donna. She had no live children, but had had eight confirmed previous pregnancies. Each one had ended in miscarriage somewhere between the sixth and eighth week. For her, conception was easy, but holding onto the pregnancy seemed impossible. It was at the last miscarriage that my name was given to her. She was in hospital, having had a transfusion because she had bled out so much with the loss of that conception. The nurse who was taking care of her before her discharge, who had been a practicing midwife while I was a practicing midwife, gave Donna a piece of paper with my name written on it and told her not to try for another pregnancy before getting some serious care and replenishment, as her life had been in real jeopardy from that last loss.
I met Donna within weeks of her getting my name. When I asked that important question of her work and how many hours she spent relative to the usual 40 hour week, she looked out the window, gazed at the sky and with a smile said “between 60 and 70 hours are more like it”. She was the right hand person to a man who later became quite famous with an international product. He was just getting started and making quite a go of it, and she was right there with him, being the person behind his scene. To say she was important for the job is to underestimate the meaning of the word important, and her identity and self worth were wrapped up with his blooming success. I remember when I first met Donna that she had big dark circles under her eyes, a stooped posture, a very funny sense of humor, and a willingness to do whatever it took to have a baby. She suffered from mild asthma and was on medication for it when needed. I remember seeing a darkness about her despite the fact that she was a blue eyed hair streaked blonde. I remember that her darkness was everywhere on her face, but mainly around the eyes and the mouth. Liver and Kidney I wondered?
From a TCM perspective, Donna was cold, and the pulses on her left arm were so small that I called them fairy dust pulses. A fairy dust pulse is one that my Chinese pulse teacher Dr. Susan Chen said was not really a small pulse, nor was it diminutive, sinking, or thready. A fairy dust pulse, she said, was so tiny that one had to have imagination to find it. This is what Donna had on all the left radial pulses. Her right pulses were small and diminutive, but at least the first two positions were palpable, her kidney position on that side was also fairy dust. Her tongue was large, pale, the center was dry, and the edges had scallops.
It was many years later, when I was at the graduation of the child that resulted from this story, that I heard from the father that the evening Donna came home after her initial visit with me and after all the doctors had said she had unexplained miscarriages, I had told her with assurance, that “for a TCM practitioner it was not an unexplained condition, because without Kidney pulses, it is hard if not impossible to hold a baby.” I also told her that getting kidney pulses was not an insurmountable task to achieve, and together we made a pact to bring those pulses up and available for palpation. I asked her not to try and conceive again until her pulses were adequate for a pregnancy to go to term. I didn’t know it until this child’s high school graduation, but what Donna went home with after meeting me that night was hope, and a plan. I had given her something within her power to do. Her husband remembered her saying that when she raised those pulses to strength and harmony, that her likelihood of holding a baby to term was possible. I cannot emphasize the importance of this position. In hindsight, there have been many a mother who said that when I gave them an assignment to do, or even two assignments, that they felt this was doable, and they were no longer overwhelmed in mystery or overtaken in fate or fear.
We are an interesting brood of people. We study the consequence of stress on the body, or fear, or anxiety, or anger, or grief, or denial, but we fail to focus nearly as much on the aspects that involve faith, hope, nature, and the extraordinary experience of those states of being. In looking at so many threatened miscarriages since that particular one, I only now realize that what I first reach for when working with a woman with a history such as this, is that aspect of faith, and the courage and commitment to walk into it with arms open wide.
Getting to a more practical level, I remember telling Donna that it was going to take approximately a year to build her up enough so that she could hold a conception. I don’t know why I said that particular time frame, b/c I was such a new practitioner that I still didn’t tell people to come back to see me, or give them direction on that front. But that day, I said it would be a year of work. She agreed, and she promised not to conceive again until there was enough strength for her to do it. Knowing myself these many years later, that first day I probably gave her quite a lesson in Qi so that she could understand some of what we were going to be discussing in the following weeks and months. I remember showing her the character, teaching her the functions of Qi, and discussing how important it was in the concept of “holding things in place”.
As we spoke and I described some of the TCM concepts and how they manifest in us, she recognized certain aspects of herself in the examples, and even quickly saw how her Qi was also connected to other strengths or weakness, such as her breath. I tried very hard to convince her to work less, talking about how the Qi taken by her job was robbing her of what she needed it for personally. That was the single hardest thing for her to hear, because she was a main player in the financial scheme of her married life, and they had only recently bought a house and were making mortgage payments.
Donna easily met all the other issues I asked of her. Her diet was changed, her play-time was changed, she stopped her vodka tonic each night and she quit smoking on the dime at that very moment and never again resumed the habit. She began taking herbs and she received needles and lessons each week for several months. She was one of the only people that I worked with at this frequency, and it took five or six months before she began to have some palpable kidney and qi pulses. During those months she read a few books on nutrition and was busy helping to make wonderful meals alongside her husband who was the main cook and who adored her. I remember learning from Donna that her husband was excited about the work we were embarking on together. He was relieved, b/c now someone was going to help her and guide her to be proactive in their desire for a child. It wasn’t long before I met her husband, because she wanted the two of us to meet.
During those months, Donna charted her menstrual cycle, and it was apparent that the yang aspect of her cycle was by far the weaker of the two, and that she did not reach a consistent level of heat to achieve a uterine incubator for the embryo. So we worked on building her fire. She learned not to waste the little fire she had on ridiculous things such as smoothies for breakfast and salad for lunch, and when her fire ran out by the end of the day, she rested instead of doing her usual false fire fix of a cigarette and some form of sugar. On each treatment she received moxa, either on the Dan Tien or the Ming Men, and points such as Zu San Li, Pi Shu, Shen Shu, and Bai Hui were all moxa’d at each meeting.
The first real shift came when her asthma, which was a mild form of asthma with a small amount of inhalent each month, began to just go away. She found herself going out for periods of time and forgetting to carry her inhaler, which would have been unusual for her to do previously. We spoke again and again of the holding aspects of yang, of true fire, and of conserving her Qi.
Another shift came when she noticed that her menses came without any lingering delays or pre-spotting, had a good amount of rich blood, and ended with the turning off of the cycle, instead of the many days of post-menstrual spotting. We talked about the soil she was to create for this coming conception in her endometrium and she took herbal formulas such as Dang Gwai Shao Yao Wan during her follicular phase to make sure the soil was rich and would remain moist. At the same time she did this, she planted and nurtured a few seeds in her garden to remind her what she was doing on an internal level. She made her intention and commitment a kinesthetic experience with the caring of these seeds.
I remember looking forward to her treatment each week, because Donna was a delight of a person who was by nature funny enough to always insure that I would have at least one or two hearty laughs. We appreciated each other, and the relationship grew into one of ease, trust, inquiry, insight and continual evaluation. By the end of a year of work together her asthma was gone, her darkness had almost completely gone, each one of her pulses was soft and palpable, her luteal phase had risen high enough to make her uterus a reliable incubator until the hormones of pregnancy took over, and I remember feeling that it was time to try again. She did too.
It took her only two cycles before she conceived. The one remaining difference we had regarding her health was the amount of work she was still doing and simply was not letting go of. She had at least reduced the hours from approximately 60 or 70 per week to a mere 45 or 50. However, she promised herself and me that when she conceived, she would reduce it further.
The history of her past pregnancies had been that each time she arrived at six or seven weeks from LMP, she would begin to bleed, and within days miscarry. Or she would spot, stop, and then miscarry within a week or two after the bleeding. Each time this happened, both she and her husband suffered the devastation and the loss. And each time it happened, she did not think to change her health state, but instead vowed to conceive again and again until one stayed. One might say that the bleed out she had was a blessing in disguise, because it led her into the office of an acupuncturist and herbalist.
This time, the plan was to do it differently. Once we were sure that there was a pregnancy, I did my best to talk Donna into conserving her Qi at every possible moment. She rested three or four times a day at the work place, even if it was only for a ten-minute window. For the first month of her pregnancy she was on Bu Zhong Yi Qi Tong, or You Gui Wan/Replenishing the Right pills, and by the second month Da Bu Yin Wan in the morning and Bu Zhong in the evening. Her pulses were soft and slippery, and both sides were easily palpated. Her tongue was a normal size, pink, moist, and her scallops had gone away. She was abstaining from sexual encounters so she would not stimulate the release of oxytocin and cause unwanted contractions. All external physical activities were put on hold.
At six weeks, like clockwork, Donna spotted. She was devastated, as was her husband. I was challenged. Her pulses were still full and slippery. I was aware that there was a threat going on, but did not believe that the embryo was yet lost. This outrageous deficiency had surprisingly arisen once again, right out of a deep cavern that I thought we had already climbed out of. It was at that moment I told Donna, in no uncertain terms, that if she wanted to keep this pregnancy she had to stop every minute of her work, and that this boss of hers was going to become famous and rich without her, even if she took full disability for the remainder of her pregnancy. I reminded her that this decision was hers, and that it represented a choice in her life. It didn’t take her beyond the end of that session before she agreed to speak with her boss that day and begin a three-month disability upon tomorrow’s rising sun. We agreed that three months might be the way to begin, and I have to say that giving her this finite window of time allowed her to even consider this. Had I said that she might have to take the remainder of her pregnancy off, she might not have been able to see that as a possibility. In the final analysis, Donna didn’t return to work for the remainder of her pregnancy.
As soon as I knew there was spotting, I added an indigenous American herb called Black Haw to her herbal regime. This is an herb that the midwives have used and I had used it in that profession for at least ten years, seeing its amazing properties. This is an herb that stops contractions, cramping, spotting, and menorrhagia, and it has historically been a chief and extremely effective herb for stopping threatened miscarriages. I gave her a full dose of black haw and the spotting stopped within days, but within another four or five days, it returned. It was at this time that I called a colleague and friend who is an obstetrician, asking if he would see her to give her a prescription of progesterone and also I wanted him to have a record of her in his office in case we needed instant medical contact.
I accompanied Donna to the visit several days later, and during a moment I had alone with the doctor, after Donna had explained that she did not want an ultrasound and that she believed she was still carrying a life within her, I re-iterated her desire to forego the ultrasound, and told him that I, too, believed that the embryo was not yet lost. I believed this because I pay attention to a woman’s self-knowledge and also, to confirm this belief, her pulses remained full and slippery. I told the doctor that Donna and I were simply there to ask for his help. The doctor insisted on listening for a fetal heart tone with a vaginal Doppler, which is also ultrasound, because that was the only way he could diagnose a quick assessment of whether or not there was life. I asked him to order hCG levels instead of the ultrasound, but he felt it was already too late based upon her history and the present spotting. Under the doctor’s pressure Donna finally consented to a vaginal Doppler and though he tried to get some pulse of life, he could not. He was positive that the pregnancy had ended and suggested that she go in within the next few days for a D&C and that they could now make an appointment for that at the front desk. Donna was stunned, and again said that she did not think that the baby had died and that she didn’t want to schedule a D&C. Long story short, the doctor wouldn’t prescribe progesterone and hadn’t ordered blood work. We left with bad news and no help.
Meanwhile I decided to write a special formula for Donna which I now call HOLD BABY FORMULA and it consisted of herbs to tonify the kidney yang, raise the qi, nourish and calm the embryo, benefit the essence, nourish the yin, generate fluid, lift the uterus, strengthen weakness and lower back, nourish tendons, and regulate the qi. She was chilled, so I gave her moxa and sent her home with a moxa pot that she gave herself on the Ming Men during the next few afternoons.
The needles that I was giving her were Stomach 36, Kidney 9, Governing 20, Yin Tang, PC 6, and then turning her over and giving her needles and moxa at Shen Shu, Pi Shu, and Ming Men. I still felt that she didn’t have enough progesterone for this window of the pregnancy, so I made another phone call to a doctor who specialized in endocrine disorders, especially as they relate to women in their many reproductive changes. When I called, an FNP colleague of mine answered the phone and said to come right over. She didn’t think there would be any problem getting a prescription for progesterone. I called Donna and she and her husband then went to this office with a shining glimmer of hope in their spirits. At this doctor’s visit, Donna was assessed again. “the baby is dead”, said the doctor, and since I have a three o’clock cancel tomorrow, if you return then I can give you a D&C. I was told that Donna collapsed at that moment, and her husband said to the doctor, “we came here for progesterone, and if this isn’t going to hurt Donna, then will you give it to us”? The doctor acquiesced and gave them a strong prescription of it in the form of vaginal suppositories. She had worked extensively with it for other patients and for other reasons, and had a pharmacy in town that made bio-identical progesterone. Meanwhile, the doctor ordered a quantative Hcg level that day with a repeat within two days. Donna and her husband immediately went to the lab for the blood draw and then went to get the progesterone. Within hours after taking the first suppository, Donna was actually feeling the loss of anxiety and fear, the return of hope, and got back to bed to continue “holding” this wanted child. This is one of the delightful side effects of adequate progesterone in a pregnant body.
This part of the story is one example of why anyone working in this field needs to befriend a physician who will work with you as a practitioner, giving the woman the best of the two medical disciplines, east and west. Donna went home with progesterone suppositories in her vagina, bitter Chinese tea waiting for her as she re-entered home, and moxa given to her by her husband or herself. She was cloaked in pro-activity and hope. She begged this child to stay. She was already in love with the possibility of this child.
Within a day the first results from the blood test had returned and the levels were normal for gestational age. Within another two days the test was repeated and the levels were climbing exponentially, as they should. “I knew it all along” she said, “this baby is still with me”. She did nothing during the days and seemed to soak every restful hour in a well of fatigue that she had created in her living.
I worked to save this pregnancy, she worked to save it, and her husband did, too. It was a team effort and Donna was supported in ways that she had never thought possible while remembering her past losses.
She made it over the first trimester, and when she got to 14 weeks she went in for an ultrasound. Now, she thought, I will have one. Now the baby’s organs are fully formed, and the baby is here to stay. A perfect heart tone was heard and she saw the pulsations of the life within her for just a few seconds when she knew it was enough and asked the doctor to stop. She did not receive another for the remainder of her pregnancy. “My intuition was correct,” she thought. This gave her an internal belief and knowing about herself. She wore that pride in self-knowledge like a badge of womanly wisdom. This early experience of the first trimester was like a bearing wall in the architecture of her mothering and was the beginning of her learning how to take on the overwhelming tasks of being a parent, when so many important decisions need to be made for the child, and intuition and faith have to be woven into the making of those informed decisions.
During the 9th to the 13th week Donna had a touch of morning sickness and it was dealt with simply with the use of a few needles and some dietary instruction. She had some low back involvement, experiencing some weakness during the days that she stressed in fear, didn’t sleep, or remembered her past losses. I encouraged her to remain positive and create a stress free environment for herself and the growing child. We talked about how the adrenals are connected to the reproductive state and how we wanted to reduce her cortisol output. By six months into the pregnancy, she was round, happier than she had ever been in her life, and her pulses were strong. From the very start her baby was available to feel as she grew, and I taught Donna to feel and monitor the growth. This was one woman whom I think didn’t miss out on one minute of her pregnancy, except when she was sleeping. At that time she resumed living life, but did not return back to work. Her boss was becoming nationally famous without her and she saw that that his life went on just fine despite her absence. Her priorities were to grow a full term baby. She loved coming to my clinic during these months, because she got to be the pregnant woman, and she got to give encouragement to those who followed in her footsteps with past miscarriages and hopes for a full belly such as she had. As she once appeared stooped with darkness, she now seemed swollen with light and laughter. Everyone she touched with her success or her jokes was given a shot of positivity. I watched her strength and spirit grow with her body and her baby.
Donna took the formula I had written for her from the time that she bled until she was approximately six months pregnant. After that, she took it only when she felt she needed it. She remained on the progesterone suppositories until her 14th week, when she decided to wean herself from them and be watchful for any changes. Thankfully, there were none.
Her treatments were down to once every few weeks for a few months, until she got closer to term. Then they stepped up again, because she didn’t want to stress in anyway. She had a history of vaginal herpes and now wanted to avoid an outbreak, which would interfere with a vaginal delivery. Also, we were spending time preparing her for the road into the unknown journey of labor and early mothering. She was curious, excited, and game for diving in. Once she knew that this pregnancy was there for the keeping, she exercised by taking long walks and gaining strength in endurance and breath. She had lessons in TCM along with her needles and moxa, so that she could fully understand what we were doing and why. This, I find, is the greatest tool for co-operation or compliance.
Since Donna was then 37 years old, she was offered fetal testing. During the weeks that tests such as amniocentesis or a CVS would have been given, she and her husband had decided against it, so they had no idea if this baby had a problem such as Down’s. They had made this decision based upon their reading, which addressed the rare possibility of either test causing contractions and leading to eventual miscarriage. They made an informed decision to have faith in this conception and forego those tests. One evening about a month before the due date Donna’s attended one of her husband’s soccer games. One of the other pregnant wives whom she had shared her pregnancy with arrived that night with her newborn. That baby had Down’s. Deb called me shortly after she got home from the game, berating herself because she had foregone that test. I had to remind her of the reasons why she had chosen not to do that. Her husband had to remind her of how they were going on faith and instinct, “beside,” he said, “you don’t deserve that.” With those words, and the belief of her husband that he, too, did not think this would happen, she regained her strength. By the next day, she told me that if they had a baby with Down’s, she would accept that circumstance and do all that she could to develop the potential of her child. She had moved through the fear and gone back to remembering why she and her husband had made that decision months ago.
I think that by the time Donna gave birth, which was right on time, there had been no rock left unturned in her garden of pregnancy. She had chosen to work with the OB who had first seen her when we asked for progesterone and refused to give it to her. Her labor was so quick, that Donna, her husband, and the physician all hardly made it into delivery on time. I, who had promised to be her guide during labor, arrived as she was greeting her new baby. She delivered a full term seven plus pound daughter, needing nothing more than her courage and her husband’s strong hands and loving eyes. They left the hospital to return home just hours after delivery. She had no perineal tear and took to nursing like a seasoned mother.
The plan had been for Donna to return to work six weeks after delivery, but instead she had a great epiphany about that time. She came into my clinic one day while swaying her daughter in the baby pack strapped onto her and said that she had found the perfect job, and that was raising this baby. The work she had done for the entrepreneur was one type of wonderful opportunity, but that what she was doing now was the opportunity of her lifetime, and she wasn’t going to pass up any of it. She had called her boss and told him that she would not be back for months or if ever, and freed him to find another permanent employee. She actually took six full months of mothering before she decided to go back to work and then it was in a new business endeavor with her husband where they worked and parented side-by-side, laughing together and enjoying their long awaited family.
I know that this sounds like the perfect love story of a pregnancy, but it was first begun in a dark cloud of sorrow, loss, and weakness, and didn’t gain its own strength until after the first trimester was over. In fact, for some months the pregnancy and its keeping seemed to take nearly every minute and every action. During the early spotting and the visits to the obstetrician and the endocrinologist there were also moments of great shock and disappointment. Those days were surely not a piece of cake, but instead took every bit of self-belief, desire, and faith that both Donna and her husband had. And I supported them each and every step of the way. The woman who first walked into my clinic 21 months earlier was changed throughout by the time she opened the door into her birthing. At the time of delivery, she knew much more about herself, her strengths, her marriage, and of her ability to make correct decisions. As I sit and write this, the daughter who was born from this commitment is presently half way through college.
This is and can be the role of the Traditional Chinese doctor who chooses to work with pregnancy. This example shows us how we can be a guide, herbalist, acupuncturist, support person, triage with the medical team, therapist and educator, and all the while we work to keep fires burning, tissues moist, and the spirit supported. This story combines the art and the discipline of obstetrics and helps women who face problems in pregnancy to have healthy outcomes and full term healthy babies.