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The Benefits Of Traditional Chinese Medicine And Acupuncture During Pregnancy And Postpartum

Elizabeth Cullen shares the need to know about Traditional Chinese Medicine and the benefits it offers mothers and mothers-to-be.

Elizabeth Cullen is a Traditional Chinese Medicine practitioner and Acupuncturist. She is the founder and director of The Dao Health, an integrative Chinese medicine and Acupuncture women’s health clinic in the Sutherland Shire, Sydney, that supports women from preconception to postpartum.

In this conversation with THE INARRA, Elizabeth is generous with her knowledge of Traditional Chinese Medicine (TCM). She shares her insights on preconception, pregnancy and postpartum from a TCM perspective, and the importance of the ‘first forty days’, also known as the fourth trimester.

Elizabeth provides advice on preconception care – from expected timelines to preparing the mind and body for pregnancy – and the benefits of Acupuncture throughout pregnancy. She also lists eight TCM principles you can follow at home to support postpartum recovery.

 

Hello Elizabeth! Can you tell us about yourself and how you founded The Dao Health?

My name is Elizabeth Cullen and I have the honour of being a new mother to a joyous 10-month-old daughter, Harriette. I have a deep, ongoing love for women’s health, Traditional Chinese Medicine (TCM) and practising an integrative medicine model of care.

I founded The Dao Health eight years ago after finishing my final hospital placement as part of my UTS Traditional Chinese Medicine university degree in Chengdu, China. This led to subsequent trips to Beijing and Kunming in China for further clinical experience. From there, my thirst for knowledge led me to complete my master’s degree in Women’s Health Medicine at UNSW, which supported my practice in integrative medicine.

I am the principal practitioner at The Dao Health and wear many hats as the director. I also raise awareness about how traditional Chinese medicine can support women through each chapter of their health through education as a speaker at conferences and community-based events.

As part of matrescence (the transitionary period of becoming a mother), I am now deep into discovering how my two identities can intertwine as harmoniously as possible.

 

What inspired you to establish an integrative Chinese medicine and Acupuncture women’s health clinic?

Growing up, I was exposed to complementary healthcare from an early age as my mum was a chiropractor who owned her own clinic. I had the thrill of working as her receptionist in the school holidays from when I was 10 years old.

I encountered Acupuncture and TCM for the first time at 16 years old, and after experiencing the beneficial changes in my own body, I dreamt of opening a clinic where Chinese medicine could be offered to women as a primary source of healthcare.

After finishing school, I began a Medical Science degree, but it didn’t take long before I quickly shifted degrees to ‘the dark side’ (which is what complementary medicine was called back then) as I continued to see the need for complementary medicine to be offered safely in an approachable and credible environment. 

I returned to Sydney from China at 23 years old and founded The Dao Health in 2016. I was inspired to create a space that offered evidence-based healthcare that women could feel confident to use as a primary source of healthcare in an integrative, patient-centred model. 

I began encouraging shared care with patients. If they felt comfortable, I started conversations with their GPs, fertility specialists, OB/GYNs and allied health care practitioners to unpack the mysteries of TCM so that they could be reassured of the role Acupuncture and TCM play in managing their patient’s symptoms.

At the time, it was rare for Acupuncturists to work as part of a team and I knew I wanted to see The Dao Health blossom into a team of TCM practitioners who could support one another and have a shared care model for our patients.

 

How does The Dao Health support women from preconception to postpartum?

At The Dao Health, women are supported through an integrative Chinese medicine model, which means the patient will undergo conventional medicine testing (e.g. blood tests and ultrasounds) and then their diagnosis and symptoms will be discussed and treated through a Chinese medicine lens.

We meet patients at different points throughout pregnancy, from preconception to postpartum, and time is allocated towards education each step of the way. Our aim in the clinic is to support women to understand their own bodies so they can be confident to advocate for themselves and make choices that they are comfortable with. 

An individualised approach ensures that each patient receives the treatment they need and is given enough time to share their symptoms, medical history and concerns. We allocate two hours for a new patient to ensure they leave their first appointment understanding their body more than when they first arrived. 

Modalities we use range from Acupuncture, Chinese herbal medicine, supplementation, Chinese dietary therapy and lifestyle advice. The shared care model between the woman’s care providers is ideal here to optimally support one’s experience through each chapter.

 

In what ways does traditional Chinese medicine play a role in women’s health?

TCM has played a role in gynaecology and obstetrics for thousands of years. Interestingly, obstetrics was first mentioned in the Ming dynasty in 1368.

TCM supports women’s health from menarche (first menstruation) to post-menopause. The treatment approach of TCM aims to restore the body to harmonious balance through specific modalities such as Acupuncture, Chinese herbal medicine and Chinese dietary therapy. 

The TCM philosophy of balance can be applied to women’s health by acknowledging the difference between Yang (male) energy and Yin (female) energy and how the female body should be looked after throughout the seasons of the menstrual cycle and seasons of life.

Each menstrual cycle is a monthly health report and when there is balance in the female body, optimal hormonal function will be present. This can be seen in the body as a healthy, regular menstrual cycle between 28–35 days where a cherry-like blood flow is present, there will be no menstrual pain, and efficient ovulation will occur between days 12–21 of the cycle.

In today’s Western culture of busyness, the female body tends to have an excess of Yang, which depletes our Yin and Blood and, as a result, affects our hormones and menstrual cycles. This, alongside imbalances in the energetic organs, is when symptoms can arise in menstrual health and fertility, and during pregnancy, postpartum and menopause.

We must ensure there is a balance of Yin and Blood in the body and support the balance of the energetic organs, in particular the Kidney, Spleen, Liver and Heart.

Blood, known as Xue in Chinese medicine, is one of the most vital substances in the body and needs to be nourished through each chapter of a woman’s menstrual cycle, especially during preconception care, pregnancy and postpartum.

 

What aspects of Traditional Chinese Medicine resonate most with women seeking holistic health solutions?

The growing awareness of TCM means it has earned a seat at the table when considering a multi-modality approach to health. TCM and acupuncture resonate with women looking for a less invasive and more gentle approach to various conditions, such as:

  • Amenorrhea (the absence of menstruation)
  • Hypothalamic amenorrhea (the absence of a regular menstrual period)
  • Post-oral contraceptive pill cessation cycle support
  • Endometriosis and pain management 
  • Pelvic pain
  • Menstrual conditions, including painful periods and irregular periods
  • Polycystic ovary syndrome (PCOS)
  • Fertility support
  • Preconception care
  • IVF support 
  • Pregnancy support
  • Postpartum
  • Digestive support
  • Mental Health

 

What is the importance of preconception care from a Traditional Chinese Medicine perspective?

Timeline-wise, preconception care is ideally a minimum of four months to support egg quality, which takes 90–120 days and, if in a heterosexual relationship, sperm quality, which takes 72–90 days.

Ideally, I recommend patients begin preconception care one year before being open to conceiving to prepare their body and lifestyle by making space for a baby. From a body perspective, this includes supporting regular ovulation between days 12–21 to support a 28–35 day cycle, a healthy menstrual flow with minimal symptoms and getting to confidently know the seasons of their menstrual cycle. For some women, this may mean finishing contraception one year before wanting to conceive, so they can learn their cycles without the pressure of trying for a baby. 

From a lifestyle perspective, one year gives women (and if coupled, their partners) time to adjust their lifestyle to make healthier options from a nutrition perspective and decrease alcohol intake. This also allows time to learn how to slow down and physically make space for a baby in their schedules, which helps to smooth the transition into parenthood.

From a TCM perspective, preconception care is viewed as preparing the soil and nourishing the seed to prepare for implantation, pregnancy and a healthy baby at birth. Preparing the soil means supporting the uterus, also known as ‘The Child Palace’. This is done so by warming the womb and ensuring there is a smooth flow of Qi (vital energy and life force) and Blood in the body, particularly in the Ren Mai, also known as the ‘Conception Channel’, and ‘Bao Mai Channel’, the channel which connects the heart to the uterus.

Preconception care also involves ensuring there is internal balance with the organs. When we look at the energetic organs that are supported in preconception care, the Kidney, Yin, Jing (life essence and vitality) and Yang support our reproductive health and are strengthened and nourished to support egg-quality pregnancy. The Spleen’s role is to produce the Blood and to support holding the pregnancy to full term. The Heart houses our Shen, which is our spirit. We must calm the spirit through this period, which in turn soothes the central nervous system.

The ideal result from preconception care from a TCM perspective is for the woman to enter into pregnancy in a physical place of abundance with balance and strength. This supports the embryo’s growth into a fetus and a smoother pregnancy, birth and postpartum.

I believe it is always important to emphasise that when being open to conceiving without assisted reproductive technologies, a one-year benchmark is a helpful timeline for falling pregnant. Most importantly, it is imperative to remember that even with the most perfectly executed preconception care and timing, there are factors that are out of your control. It is also never too late to begin preconception care when trying to conceive, both unassisted and assisted.

How does TCM benefit the emotional and physical well-being of women during pregnancy?

TCM supports the growth of the baby whilst also supporting the mother by ensuring they are nourished. This involves nourishing organs including the Kidney, Spleen and Heart meridian, soothing the Liver meridian, and calming the Shen, the spirit, which is housed in the Heart. In TCM, when the pregnant mother is deficient, symptoms can manifest in the body that can be physical and/or emotional.

TCM treatment in pregnancy involves the use of Acupuncture. Acupuncture is a low-risk intervention that can support women through each trimester of pregnancy.

The benefits of Acupuncture throughout pregnancy

Trimester One

  • Reduces the frequency and intensity of the following pregnancy symptoms:
    • Nausea and vomiting
    • Hyperemesis gravidarum (severe nausea and vomiting during pregnancy)
    • Fatigue
    • Insomnia
    • Anxiety
    • Stress

Trimester Two & Three

  • Reduces the frequency and intensity of the following pregnancy symptoms:
    • Pubic symphysis pain & symphysis pubis dysfunction (SPD)
    • Lower back pain
    • Sciatica
    • Carpal Tunnel Syndrome
    • Heartburn, reflux
    • Anxiety, stress
    • Insomnia
    • Sciatica
    • Oedema
    • Sinusitis
    • Pregnancy-induced hypertension (PIH)

Labour Preparation for Vaginal Birth

Labour Preparation for C-Section:

    • Supporting optimal position for baby
    • Preparing the body for C-section
    • Preparing the body for postpartum 
    • Softening the muscles, tendons and ligaments
    • Calming the central nervous system


Important: When considering Acupuncture throughout pregnancy, ensure your chosen practitioner is an AHPRA-registered Acupuncturist trained in pregnancy and women’s health. There are Acupuncture points that are contraindicated in pregnancy, which are recommended to avoid using in patients during their luteal phase when open to conceiving. During your luteal phase when trying to conceive and in early pregnancy, ensure you let your practitioner who practices dry needling know and check if they are trained to treat with dry needling during pregnancy before receiving treatment.

 

What is the significance of the ‘first forty days’, commonly known as the ‘fourth trimester’, in Chinese medicine?

The ‘first forty days’ in TCM is one of the three golden opportunities, along with menarche and menopause, for women to be cared for and supported to heal and actively improve their long-term health in regards to future fertility, menstrual cycles and menopause. The first forty days are crucial for the immediate and future health of both mother and baby. It is a time to rest, recuperate and be supported. 

The practice is traditionally known as ‘sitting the month’, also known as Zuo Yue Zi. Originally, sitting for a month was what a mother in China would do post-birth. She would be confined inside her home, away from the wind and cold, limiting socialising and encouraged to rest. 

Traditionally, the new mother would be supported 24 hours a day with meals, massage and abundant support with the baby. Her mother or mother-in-law would observe her to ensure she is following these guidelines and therefore ensure her recovery and future longevity. Sitting the month is still encouraged culturally in China, with fourth-trimester support available in a confinement hotel.

From a TCM perspective, childbirth causes significant depletion in a mother’s body with a loss of Qi, Blood and Jing. The body and mind need time to be cared for, to enable healing and replenish what has been lost. Breastmilk in TCM comes from the foundation of Blood and Qi responsible for breastmilk to flow smoothly and to function efficiently. When there is not enough Qi or if the Qi is unable to circulate properly, breastfeeding will be affected.

From a physiological perspective, a female will experience the most significant changes hormonally and physically from birth into the postpartum period. As the body adjusts to restore to a pre-pregnancy state, rest is vital to ensure she feels supported through this time to heal.

During the phase from childbirth to postpartum, the new mother will experience the highest levels of the hormone oxytocin, which is produced for a prolonged period. Creating an oxytocin-rich environment through nurturing and caring for the new mother provides space for her to rest, heal, and connect with the baby through spending time together and through breastfeeding or bottle feeding. 

 

How can mothers realistically implement TCM practices in the first forty days to prevent postnatal depletion?

As with all great traditions, TCM has evolved with the times. It is promising to see that in Western culture today, the fourth trimester is being encompassed and implemented in a mother’s recovery from pregnancy.

Depending on whether you have the guidance of your TCM practitioner or not, the basic principles of good care to support the new mother during the first forty days can be easily followed (see below).

 

8 traditional Chinese medicine principles for postpartum you can follow at home

1. Make an Acupuncture appointment for postpartum support

If you are receiving Acupuncture throughout your pregnancy or considering Acupuncture for labour preparation, I recommend scheduling your postpartum Acupuncture treatment before giving birth. An ideal appointment time is 7–14 days post-birth after settling back at home if you have birthed in a hospital.

In your postpartum Acupuncture treatment at The Dao Health, we unpack your birth story and support the new mother with Acupuncture tailored for post-birth recovery, calming the central nervous system and supporting breastmilk supply if breastfeeding.

‘Mother warming’ is practised in this treatment to support warming the uterus post-vaginal birth. For mothers post-caesarean section, treatment supports the local c-section site area to promote scar tissue to heal. This is often the mother’s first time away from the baby and it is a sacred moment of rest to reflect on the last 10 months of nurturing, growing and birthing her baby. Check with your Acupuncturist on how they can support you postpartum

Tip: Schedule an appointment in the middle of the day and bring your partner/birth support person to take the baby for a walk while you have your treatment.

2. Mother warming

Mother warming’ is a treatment using moxibustion to support the new mother post-birth. This treatment is focused on the lower abdomen area where the moxibustion, in the form of a stick, is used about two fingerbreadths above the skin to provide a warming sensation on the conception channel meridian, specifically from the pubic symphysis to the navel. 

The purpose of mother warming treatment is to warm the local uterus area and support the Blood and Qi flow in the local area to encourage circulation and reduce any pain. Mother warming is a calming treatment which also supports the central nervous system.

At The Dao Health, the mother warming technique is used as part of the postpartum Acupuncture treatment, although it can also be done at home following specific instructions from a Chinese medicine practitioner. 

Important: The mother warming technique on the local abdomen area should be avoided at home for a mother who has had a c-section during the first forty days and alternative Acupuncture points can be used to support recovery.

3. Chinese dietary therapy

A practical way to implement TCM to reduce postnatal depletion is to follow the postpartum Chinese dietary therapy principles to replenish the mother post-birth by strengthening Qi and building Blood.

This includes considering the way that the food is prepared, and consuming warm, cooked foods to support digestion and blood circulation to keep the body temperature warm and strengthen Qi to support recovery. 

In postpartum reality, this can be slow-cooked, boiled and roasted foods and soups, adding cinnamon and goji berries to your oats, eating regularly and avoiding frozen foods. An 80/20 rule works well here – support yourself with a plate of 80% cooked foods and 20% raw foods.

Tip: I recommend The Dinner Ladies for easy, nourishing meals during postpartum.

4. Traditional Chinese herbal medicine postpartum soup

The Dao Health’s postpartum soup supports the mother’s recovery from birth, either vaginal or C-section, and supports the breast milk supply by restoring Blood, Qi and Yin that has been lost from birth and pregnancy through the use of traditional Chinese herbs.

I recommend portioning the postpartum soup into a storage container and freezing it. Begin to have one portion of soup from the day of birth and remember to take enough portions for each day you will be in hospital.

All herbs are to be removed other than the Da Zao (red dates) before consumption. The postpartum soup is not advised to be consumed throughout pregnancy. Find the recipe for the postpartum soup here.

5. Avoid chilled drinks

As much as the quench of chilled water is all I dreamt of in those early postpartum days of breastfeeding, avoid chilled water and say no to adding ice cubes to fresh juices or table water at your local cafe. The focus on keeping the uterus and body warm in the first forty days extends to what you drink. This also means that iced coffees are not recommended.

6. Avoid swimming until you finish the fourth trimester

To support the uterus and the body’s warmth to aid postpartum recovery in the first forty days, swimming is not recommended, even after getting the all-clear from your midwife/ obstetrician at your 6-week check-up. The first swim after the first forty days is worth the wait.

7. Keep your feet warm 

You may have heard of this advice when trying to conceive or in an IVF cycle. In TCM, it is important to keep the feet warm to support the Kidney meridian which begins at the base of the foot. By supporting the Kidney meridian you are supporting your Jing (life essence and vitality) which supports your hormones and fertility.

8. Remember to take your supplements

If there is one thing to remember each day in the first forty days other than keeping the body warm, it is to take your supplements. Often, when adjusting to looking after a newborn, the new mother can forget to take their pregnancy supplements. The body requires ongoing support through the demanding postpartum period, breastfeeding or not. It is important to remember that just like in pregnancy, you continue to support your baby and you need the support to continue to do so. The rule of thumb is to continue taking your prenatal supplements for three months post-birth if not breastfeeding or, for three months after weaning.

Tip: From a TCM perspective, HQ Health has a supportive range of Chinese herbal medicine to support the first forty days with high-quality herbs that are safe to consume whilst breastfeeding. Other than the HQ Health range, which is safe to use whilst breastfeeding, I do not recommend taking general Chinese herbal medicine throughout this period. Find out more about HQ Health.

 

What common challenges do women face in adopting TCM practices during the postpartum period, and how can these challenges be addressed?

Firstly, we should unpack the realistic expectations of the postpartum period and allow the new mother to have permission to lift any pressure of perfectly ‘sitting the month’.

The process of matrescence is unique and different for each mother and their baby, and a piece of advice I recommended for all is to learn to surrender, to ask for help and support when you need it before birth, and to be as prepared as you can to be unprepared. 

I recommend heading into postpartum with a list of ways you would like to be supported, and discuss your boundaries around ‘sitting the month’ with family and friends. When your loved ones understand your wishes, they can support you and your baby.

Adopting TCM practices can be overwhelming at the best of times if you do not have a TCM practitioner to guide you or have access to helpful educational resources, let alone during the postpartum period. As discussed earlier, I recommend choosing between 3–5 practices listed above that you would like to implement into your first forty days and creating a plan with your partner or support person/people. 

One of the largest challenges in implementing TCM practices is the unexpected – for example, a longer stay in the hospital or a medical emergency with your newborn baby. When taking care of an unwell baby, there may be no time or emotional capacity to consider your postpartum recovery. In such scenarios, the first forty days can be put aside and healing can begin later. Focus on eating enough food and staying hydrated with room-temperature water and warming foods, if possible throughout this period to support yourself.

 

What are some misconceptions about traditional Chinese Medicine in women’s health?

TCM can seem mysterious due to a lack of education, and this creates misconceptions. Below are four common misconceptions, debunked.

4 common misconceptions about traditional Chinese medicine:

Misconception #1 – You either believe in traditional Chinese medicine or you don’t
Rather than an alternative therapy, TCM is a complementary therapy which can be used either by itself or alongside conventional medicine. Most often, when a person says they don’t believe in Acupuncture, they do not understand Acupuncture and TCM. 

Misconception #2 – Acupuncture is not safe during pregnancy

A common misconception is that Acupuncture is not safe during pregnancy. When practised by an Acupuncturist who is AHPRA-registered and trained in women’s health and pregnancy, Acupuncture is a low-risk intervention that is beneficial for labour preparation, birth and postpartum.

Misconception #3 – Postpartum ends after the 6-week check-up

It is often assumed that when a mother has her 6-week check-up post-birth with their midwife or obstetrician, the postpartum period is finished. From a traditional Chinese medicine perspective, the postpartum period spans one year to allow the body to fully heal. Being conscious of this timeline will allow a woman to pay respect to their body and listen when they need to rest.

I also share with women that it can take a minimum of a year to build strength and fitness back to pre-pregnancy levels, depending on their birth and therefore their pelvic floor health and recovery. Whether a woman is breastfeeding can also affect recovery, as the body adapts again to hormonal changes once weaning occurs.

Misconception #4 – Placenta encapsulation is an ancient traditional Chinese medicine practice

With the rapidly growing practice of placentophagy (the process of consuming the placenta postpartum) around the world, many assume that placenta encapsulation is a healthy and traditional postpartum practice connected to TCM.

Placenta encapsulation is not a TCM practice for postpartum recovery and there are no classical Chinese sources or gynaecology texts that recommend women eating their own placenta or any animal placenta for this treatment.

Interestingly, the health claims made from consuming placenta include supporting an increase in milk production and a preventative treatment for postpartum depression. Neither claims are based on valid current research and do not make physiological sense due to the inhibitory effect progesterone has on prolactin (the hormone responsible for lactation, certain breast tissue development and milk production).

Research indicates that there is a negative effect of placenta encapsulation on milk supply. Further research is needed and this practice should not be recommended or encouraged for new mothers.

To learn more about why you should reconsider placenta encapsulation and about other ways to honour the placenta, read this article.

 

Are there any developments or initiatives around TCM in women’s health that you find particularly exciting or promising?

It is an exciting time to be a TCM practitioner as Chinese medicine continues to become more understood and is recognised as a complementary medicine to consider for treating specific conditions. Working in an integrative model of healthcare alongside gynaecologists, obstetricians, fertility specialists and GPs is particularly rewarding for the outcomes for patients. 

It is also very promising that medical doctors are accepting and suggesting Acupuncture as a modality for specific conditions, and in consultation, patients are being listened to and offered another option for management that may not have previously fit the biomedical mould.

The majority of research is currently looking at the effectiveness of Acupuncture in particular for specific conditions, and the results continue to conclude that Acupuncture should be considered a beneficial modality for specific women’s health conditions including endometriosis and endometriosis-related pelvic pain, amenorrhea, PCOS, fertility, IVF and labour preparation.

I always think it is important to note the barriers to research when it comes to Acupuncture and TCM, which include minimal commercial interest, significant numbers for sample size and the inability to rely on government grants. Hopefully, with further recognition, we will see further funding applied to more research in TCM, Acupuncture and women’s health. 

 

Looking ahead, what are your aspirations for The Dao Health and its impact on women’s health in the community?

My aspiration for The Dao Health is to broaden accessibility to treatment and education that is practical so that TCM can be approachable and an option for all. Two major factors for barriers to treatment include the issue of accessibility and cost. I aspire to see Acupuncture covered by Medicare and part of the Enhanced Primary Care plan. For example, it would be very beneficial for our endometriosis patients to be able to access Acupuncture as a form of management for chronic pain.

This year, our offerings of education will grow in the community with an emphasis on accessibility. Our team at The Dao Health will continue to raise awareness among our medical colleagues of when Acupuncture can be safely and effectively used as a modality to recommend to patients.

 

Where can women find more information about implementing TCM as part of their reproductive and postpartum care journey?

When looking for an Acupuncturist in Australia, please reach out to the team at The Dao Health and we will be happy to refer you in the right direction. You can get in touch through The Dao Health’s website or through emailing our reception team at information@thedaohealth.com.au. You can also access further education and information on our Instagram (@thedao).

I am happy to refer you to an Acupuncturist in Australia. You can get in touch with me through The Dao Health’s website and then our reception team can either answer questions or forward any specific questions to myself. You can also access information on our Instagram (@thedao). Alternatively, you can email me: information@thedaohealth.com.au

For further resources and Acupuncture research please check The Dao Does Journal. The journal is a collection of evidence-based recommendations, lifestyle advice, practical tips and inspired by the roots of TCM.

I am also a co-host of the Integrating Chinese Medicine podcast, which is an audible resource that provides an educational platform for listeners to integrate Eastern practices and philosophy into their daily lives. I particularly recommend our episode ‘What is the Fourth Trimester?’ for women looking to learn more about post-birth support. Listen on Apple Podcasts and Spotify.

 

Words by Ellie Wiseman

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