Birth is one of the most physically taxing, emotionally depleting but simultaneously invigorating and spiritually rewarding things a human being can accomplish. But despite having birthed for thousands of years, most of us prepare for labor in completely the wrong way.
We decorate our nurseries, pack our bags, and sit and wait (because that’s what we’re told to do). And when our pregnancy ticks past the 40-week mark we throw every folk induction method we can find on Pinterest at it with hit and miss results.
But what if I told you that the fundamental error that we’re all making is waiting? That you can and should make diet and lifestyle changes in the months before birth? And that if you make these changes, studies have shown that:
- You’ll have an earlier spontaneous onset of labor
- You will have a shorter labor
- You will have a more comfortable labor
- You will have a more comfortable postpartum recovery
- And you will have more balanced hormones in the postpartum period
All it takes to get these benefits is shifting how we talk about the marathon of birth and take our focus off of the race and put our effort into the proper training.
When I was a massage student, I volunteered to do a post-run sports massage event at Grandma’s Marathon in Duluth, MN.
At 3 am we stumbled down to Canal Park to set up our tables, our cleaning stations, and our supplies and prepared for a marathon of our own. Around 6 am the first elite runners began trickling in and we began to do our work – helping the runners with muscle spasms, cramps, and other issues that can arise from endurance events.
We went until well after lunchtime, singing along with my massage teacher’s high energy Oldie but Goldie mix while we cycled through runners 20 minutes at a time. The energy of the massage tent is something I don’t think I’ll ever have the opportunity to experience again.
And the conversations! Friends, people from around the world run Grandma’s. I met people from Duluth to Denmark. It was the weirdest hodge-podge of fitness fanatics it has ever been my pleasure to encounter.
And then came a runner I would never forget. I never got her name, so for the sake of this post, we’re going to call her Jennifer.
The Last Minute Marathon
Jennifer looked like you or me – standard Midwestern stock. She grew up in Duluth watching Grandma’s marathon every year and thinking to herself, “One day, I’m going to do that.”
But Jennifer was cut from a different cloth than I am. Because it was only one week before the marathon that she decided that this was going to be the year she ran it.
She had no regular running habit.
No established fitness routine.
She had an active job where she was on her feet for most of it, but that was the closest she came to regular exercise. And she just up and decided, “I’m going to run that marathon.”
So she did! Her time wasn’t great, but she was just looking to finish and she met her goal. She was so proud and she should be. I know I couldn’t do that. There is no way I’m running a marathon next week. You’d be lucky to get a mile out of me.
But all that pride came with a massive reality check.
The Brutal Reality of Bones
When you train for endurance runs, a small part of it is cardio and the muscular capability to get from point A to point B. That’s what I learned when I first did the c25k program back in the early 2000s; you’re training your ligaments and joints to take the physical pounding of step after step after step.
In other words, it’s not so much your muscles that need the training; it’s your bones.
Jennifer did no such training and as a result, she was in severe pain.
There I was as a newbie massage therapist without the confidence or words to tell her how much worse it was going to get before it got better. She may have a life long injury from that day. I’ll never know because I’ll probably never see her again.
I know exactly what I would tell her now, because I see this same “I’m going to run a marathon next week” mentality in a completely different context, and that context is birth.
Birth is a marathon, prepare for labor accordingly
We often hear that “birth is a marathon and not a sprint.” Usually, we’re hearing that in the context of not hurrying the birth. “Take your time, breathe through the surges, your baby is coming.”
But we don’t compare the months leading up to the birth to marathon training though, and that’s a little funny. Birth professionals will talk about the physical ordeal that you’re about to put your body through and then say, “Well, good luck! I’ll see you at 41 weeks if you need me!”
To me, having someone come into my clinic asking for labor induction at 41 weeks with no preparation for the labor itself is exactly the same as Jennifer deciding to run the marathon the week before the race.
Ultimately, when labor starts is never up to us. It’s up to the baby. But there is a lot we can do from 30 to 40 weeks that has been shown to:
- Shorten mean labor duration
- Reduce pain during labor
- Lower stress prior to labor
- And help the baby into the optimal position so that when the baby decides to come they can do so much more efficiently
But in order to prepare for this race, we have to take a look at the path we’re going to run.
Birth in Chinese Medicine
In Chinese Medicine, we say that labor begins when three things happen:
- Yang activity replaces yin material growth
- Qi flows freely and moves blood
- The door to the uterus opens
In other words,
- The baby is big enough to be outgrowing the uterus and begins to move into position for birth
- You are calm and in a parasympathetic dominant state (rest and digest) which allows the hormones of birth to properly circulate
- The pressure of the baby on the cervix and the circulating hormones cause dilation and contractions
Everything done in medical induction is to dilate the cervix or create contractions because we’re doing it at the last minute.
Everything done when we prepare for labor is everything else. We make sure that we’re building up that dense yin material as long as we can so that when baby decides they’re big enough, they trigger the labor process.
We make sure the baby is in the right position so that the energy of the labor flows smoothly.
We make sure that everyone is as calm as possible so that cortisol and epinephrine aren’t fighting oxytocin.
And the first way we can do that is with acupuncture.
What are qi, blood, yin, and yang? Get a quick refresher before moving on:
Acupuncture can absolutely help you prepare for labor, but not if you’re doing it at 41 weeks.
Acupuncture is not Pitocin. Acupuncture is not cervidil. It’s not going to work with the same immediateness as any medical intervention because acupuncture takes time to work. I tell my patients that acupuncture can take 24-48 hours before you see the peak effect. In fact, if acupuncture triggers labor immediately you were just about to go into labor on your own anyway.
But if you’re preparing for birth as a marathoner, my first appointment with you isn’t going to be at 41 weeks, it’s going to be at 36 weeks.
Start early, treat often
When a patient starts acupuncture at the beginning of the eighth month, we have time to address many of the discomforts of the third trimester. These can range from anxiety about the upcoming birth to the positioning of the baby causing low back pain or indigestion.
We can also directly address the three components of labor:
We can build yin to make sure that the baby has everything it needs in the final weeks of pregnancy.
We can make sure that you have sufficient energy reserves by optimizing digestion and helping you sleep.
We can make sure that your muscles are softening (including your cervix!) and that your pelvic bowl is changing to accommodate the baby’s downward movement.
And of course, we can make sure that you’re relaxed so that the hormones of birth can soften your cervix and eventually coordinate contractions.
Regular treatment makes for easier labor
According to a study published in Geburtshilfe Perinatol, patients who received regular* acupuncture before labor had a mean labor duration that was a full 1 hour and 26 minutes shorter than the control group.
Additionally, midwives working closely with acupuncturists have found that patients who received regular acupuncture to prepare for labor also had a reduced rate of medical intervention. In other words, these patients were more likely to stick to their optimal birth strategy and have the birth that they wanted.
*1 to 2 times per week
Acupuncture is only one pillar of Chinese Medicine. Another arguably larger pillar is herbalism.
Western herbalists and many midwives also help patients trigger labor. In the birth center I work out of*, the herb I hear the most about is castor oil.
*I do not work for or speak for the Health Foundations Birth Center
Nobody actually wants to do the castor oil smoothie. It’s a natural, last-minute alternative to being transferred to the hospital for a medical induction at 42 weeks. It’s a sort of rock-and-a-hard-place, natural induction solution.
Castor oil is effective at inducing labor. In fact, studies show that between 54 and 58% of women begin active labor within 24 hours, up to 14 times more than control groups.
But castor oil is a last-minute solution banking on fast results, and strong medicines have both strong effects and strong side effects.
The same study that showed the impressive active labor induction also showed that 100% of participants taking castor oil reported nausea. Even more, castor oil is a laxative that works by irritating the lining of the gut. This leads to abdominal cramping and diarrhea, and if prolonged, electrolyte imbalance and low blood pressure.
Basically, castor oil expels everything, baby and bowels, and comes with the risk of nausea and diarrhea during your delivery.
So, what’s the alternative?
Build yourself up
Start earlier, with more supportive herbs rather than purgative ones. Prepare for labor by helping build your baby’s yin and your own qi and blood to optimize your birth.
Red Raspberry Leaf Tea
After 34 weeks and under the direction of your midwife, consider a single cup of red raspberry leaf tea per day. Many patients start slamming huge quantities of red raspberry leaf tea around 39 or 40 weeks and this is far too late for the best benefits to have time to manifest. To continue our marathon metaphor, this is like hitting the gym and slamming protein shakes the week before the marathon hoping you’ll build the necessary muscles in time for the race.
If we incorporate red raspberry leaf tea into our routine months before the birth, it’s more like eating a balanced and healthy meal plan to gradually and safely build muscle tone and energy. In fact, starting red raspberry leaf tea earlier in pregnancy is associated with:
- More efficient contractions (so less work for you)
- Reduced pain during labor
- Reduced pain during postpartum recovery
- Improved uterine tonicity and strength (which makes it excellent for VBACs)
- More rapid hormonal rebalancing in the postpartum period
For more information, check out Mama Natural’s in-depth dive into Red Raspberry Leaf Tea during pregnancy.
Also, check out these post on Red Raspberry leaf tea:
Slippery Baby Powder
Another option is to visit a trained Chinese herbalist. All Chinese herbalists should be aware of which herbal formulas are appropriate during pregnancy and breastfeeding, especially Oriental Medicine diplomates of the NCCAOM. However, a smaller subset has taken specific training to be absolutely sure that the herbal formulas they prescribe are safe for both birther and baby.
By using herbs throughout the pregnancy, we can treat pattern imbalances as they arise. If these imbalances are addressed before the end of the third trimester, we can drastically limit the likelihood they will negatively impact labor.
Acupuncture is an effective way to do this, but herbs prescribed appropriately will provide a much more consistent treatment than a weekly or semi-weekly acupuncture appointment.
The one formula that is given to the vast majority of patients is called ‘Slippery Baby Powder’. This can be started at 36 weeks but is often taken daily after 38 weeks (provided the birthing person isn’t showing any contraindications or reasons to avoid the herbs).
Slippery Baby Powder doesn’t induce labor. Rather, it helps regulate emotions and strengthens qi and blood (a requirement for labor, remember!) to help both birther and baby have sufficient resources for the birth to come.
Slippery Baby powder is not available commercially so you will have to find a qualified acupuncturist and herbalist to prepare or order it for you. You can read more about Slippery Baby Powder and how to prepare for labor herbally in 7 Times a Woman by Dr. Lia Andrews. (affiliate link)
Want another herb related way to prepare for birth? Check out Flower Essences for Birth Preparation and Labor
Another pillar of healthy and holistic lifestyles is exercise and it should come as no surprise that preparing for something as physical as birth requires physical preparation.
Many birthers I encounter talk about how much they are walking with respect to labor induction. That’s great. Walking does help gravity pull the heaviest part of the baby down, but it’s not enough to induce labor by itself, especially if you’re only starting your walking regimen at 39 weeks.
Walking every day throughout your entire pregnancy will not only keep you active (what we call “moving qi and blood” in the biz) but it also keeps you fit and prepared for your upcoming physical exertion.
Forward Leaning Inversion
Another technique is one you can do at home, and it is called the “Forward Leaning Inversion.” The forward leaning inversion is one of those techniques that is very useful and seems very easy but should be demonstrated by a trained professional before it’s attempted.
This exercise can help with the optimal position of the baby and late pregnancy low back pain. It’s worth finding someone knowledgeable in Spinning Baby techniques because an optimally positioned baby puts pressure on the cervix.
Pressure on the cervix releases prostaglandins. Prostaglandins soften the cervix which triggers contractions. Coordinated contractions start labor. And then the optimally positioned baby is able to efficiently work their way out into the world.
Using the forward leaning inversion regularly throughout pregnancy increases the likelihood that your baby will be in the optimal position.
One of the ways to make sure your pelvic bowl is open is with full-body stretches. Your pelvic bowl is composed of your hip bones and the muscles lining the inside of the cavity they create. When the muscles of your pelvic bowl are tight, your baby has a hard time descending.
We loosen these muscles by doing pelvic tilts, hip openers, psoas releases, lunges, and deep squats. But our pelvic bowl is affected by muscle and connective tissue chains throughout the body making it important to address your neck, shoulders, upper back, hamstrings, calves, and IT band as well.
Stretching, walking, and forward leaning inversions can be done throughout most of your pregnancy but always check with your midwife and find someone who can properly demonstrate necessary techniques before adding them to your routine.
Address position earlier in pregnancy
One of the weirdest and coolest treatments in an acupuncturist’s toolbox is the treatment of breech positioning with moxibustion. Moxibustion is the combustion (burning) of the herb ai ye, known as mugwort here in the west.
When done on both pinkie toes for 20 minutes a day for 10 days, using techniques demonstrated by your acupuncturist and under their direction, the birther’s fascia and muscles will release and open sufficiently. The baby then has the room to move down and often decides that head down is the most comfortable position to be in.
This technique is so effective that an Italian study found that 75.4% of babies turned head down with moxibustion compared to 47.7% in the control group.*
A different Chinese study found that 81% of babies turned head down with treatment compared to 49% in the control group.*
Moxa is incredibly effective at encouraging optimal positional, but it is far more effective when partnered with its ultimate ally: time.
* both studies found in Debra Bett’s The Essential Guide to Acupuncture in Pregnancy and Childbirth (affiliate link)
Timing the turn
Most people address their baby’s position far too late in pregnancy. The vast majority of turning inquiries I get are between 38 and 41 weeks of pregnancy. It’s always a hard conversation to have because I have to be honest: this technique had a chance of being 75-80% effective 4 weeks ago. Now, it’s a coin flip.
The best time to come for turning assistance is at 34 weeks. Babies start to move head down around 28 weeks. Most breech babies will flip by 30 weeks. And 50% of all breech babies will flip by 36 weeks. (Betts, affiliate link)
But there’s a lot we can do between 34 and 36 weeks to give you that extra 25-30% chance of turning for one simple reason: there is still a ton of room for baby to move around.
At 39 weeks, the baby has run out of room to turn. While there is still some chance of success turning this late in the game, it’s not common and is more likely in people who have given birth before.
So, get to it early! Your baby’s position is a key component to efficient labor and it’s worth addressing as early as possible.
Dates get a category all their own. While technically a food (and I’ll be getting to dietary changes in a minute) they have such a noted and positive impact on labor they can also be considered an herb.
Medjool dates are strong qi and blood tonfiers for both you and your baby. In fact, the Journal of Obstetrics and Gynecology published a study in 2011 that showed that participants who ate 6 dates a day from 36 weeks forward had:
- Higher mean cervical dilation
- Higher rates of spontaneous labor
- And a shorter first stage of labor
This is the power of feeding the three requirements of labor. You’re not just creating contractions, you’re making the entire process easier. You’re not just running a race, you’re building a body capable of an elite endurance event.
Of course, you can’t just eat dates for the last four weeks of pregnancy. So, we partner dates with other qi, blood, and yin tonifying foods.
Changing your diet
When it comes to preparing for labor, most of us think of spicy foods, pineapple, and papaya enzymes. But the results of eating these foods to induce labor are hit and miss because, in my clinical experience, we’re trying to use low therapeutic effect foods like a high therapeutic effect herb. In other words, we’re expecting more from food than it can possibly give in the amount of time we’re giving it to work.
Food and dietary therapy is slow medicine; it takes time to work. It’s way more effective to make proper dietary changes at the beginning of the third trimester (or even better, before the pregnancy even begins) to build your qi, blood, and yin.
I recommend my patients make these changes, with the approval of their midwife, of course:
In general, Chinese medical providers want pregnant people to be eating meat. To be frank, you need flesh to create flesh.
Poultry and fish are the easiest to digest. Personally, I like my patients eating cold-water fatty fish like herring because they are lower on the food chain than salmon, and therefore lower in mercury. But, they’re still rich in protein, omega 3 fatty acids, calcium, and vitamin D.
Congee or oatmeal
Rice and oats are a great source of qi and blood. My recipe for lactation boosting oatmeal is worth considering because it’s great for anyone needing to boost qi and blood (lactating or not!). It’s also a great vehicle for all the dates you should be eating that last month of pregnancy.
Yin Tonfiying Water
Because a huge component of healthy and efficient labor is sufficient yin and birthing people need increased hydration, most of my patients end up drinking yin tonifying water at least once a day. There are some cautions with this so be sure to check out the whole article and check with your own acupuncturist.
Talk with your midwife and a trained acupuncturist to flesh out an ideal meal plan for you. There are foods you can add that are appropriate for your condition and pattern diagnosis that can make your pregnancy more enjoyable and properly prepare you for birth.
The last recommendation I have to prepare for labor is counseling.
Individual counseling can help you cope with perinatal anxiety or depression, fears you have about your upcoming labor, and set you up for success for the postpartum period. A calmer mind and lush support system will absolutely help labor go more smoothly. Labor happens more efficiently when we’re relaxed.
I also recommend couples counseling. Even if you and your partner already have children, each additional child changes the dynamic of your household. Not only can you discuss how your partner can best support you during your pregnancy, but you can also make a postpartum plan together. You’re partners. This is a partnership. Couples counseling supports that partnership.
Having an established individual and couples counselor (which should be separate counselors) will make it easier to sort through issues during pregnancy and ensure that you have established and continued support through the postpartum period.
Tying it all together
How you prepare for labor determines how efficiently your labor goes and also how easily you recover. And preparing for labor isn’t just about making labor happen sooner. Labor is naturally happening sooner because we’re getting everything aligned in the weeks and months before it begins. Doing this means our bodies don’t have to scrape together a quality birth from poor nutrition, a stressed-out nervous system, a sympathetic dominant endocrine system, and tight muscles.
And have you noticed a theme? Starting interventions earlier in pregnancy was not only associated with earlier spontaneous onset of labor, but it was also associated with less pain, shorter labor duration, and reduced need for intervention across the board.
Acupuncture, herbs, exercise, diet therapy, and counseling are all tools that you can use to build yourself a plan that suits your needs. Take the time to take care of yourself now so that you have more time to enjoy your new life with your new little one.
If you enjoyed this blog post, make sure to sign up for the newsletter where I share more tips on reproductive health and tie the seasons and the natural world into your holistic health picture.
Hey, it’s that time of year again!
I’m planting the seeds of a regular qi gong practice, better hydration, and less debt.
I’ve heard from some of you and you’re planting the seeds of:
- a gratitude practice
- an intentional diet
But I need to plant seeds for Reverie, too. I might be the only one behind the scenes on the business side but I really like to think that we’re a community. Your input matters to me because it’s how I adjust where Reverie is heading.
Just last year you told me you wanted massage in clinic and I made it happen.
So if you have 9 minutes – I’m not even asking for 10 minutes, my friend – please fill out the 2020 survey.
Couch to 5k endurance race plan
Evidence Based Birth – Castor Oil
Mama Natural – Red Raspberry Leaf Tea
NCCAOM – Find a Practitioner
Dr. Lia Andrews – 7 Times a Woman (affiliate link)
Spinning Babies – Forward Leaning Inversion
Spinning Babies – Daily Exercises
Shiva Rea – Prenatal Yoga (affiliate link)
Blooma – St Paul
Spinning Babies – When should baby be in position
Betts – The Essential Guide to Acupuncture in Pregnancy and Childbirth (affiliate link)
Journal of Obstetrics and Gynecology, 2011 – The effect of late pregnancy consumption of date fruit on labour and delivery
Evidence based labor – Pineapple
Disclaimer: I am an acupuncturist in the state of Minnesota, and the information falls within my scope of practice in my state. However, unless I have directed you here as your homework I am probably not your acupuncturist. The information in this post is for general purposes only and does not constitute medical advice. As always, check with your own acupuncturist or primary care provider before making any lifestyle changes. This post does not create a patient-practitioner relationship and I am not liable for any losses or damages resulting or relating to the content in this post.
Jessica Gustafson is a licensed acupuncturist in St Paul and White Bear Lake, MN specializing in women’s health and fertility. She loves working with patients through the Health Foundations Birth Center on Grand Avenue in St Paul, Naturally Well in White Bear Lake, and doing home visits in the Twin Cities area. Check out the services page for more information!
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