A Compassionate & Holistic Approach to Pregnancy Loss

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Fertility and women’s health is a very popular specialty for many acupuncturists and herbalists. Success stories permeate medical journals, mom groups and amongst the general public, giving hope to those who wish to become pregnant and have had difficulty in the past. These successes are wonderful, and in some cases one may say even miraculous. Patients love the stories of how one person went from never getting pregnant to finally carrying to term with the thanks of a special tea; so much so this storyline is written into TV shows and movies alike. The truth of the matter, however, is that not every patient has this success story, not every patient gets pregnant, not every IVF round is a success and not every pregnancy will carry to term.

It is estimated that miscarriage affects as many as 26% of all pregnancies, some of which may be before the patient knows they are pregnant and some occur after, perhaps weeks or months along. For these people the loss of a pregnancy may be devastating, and it brings about questions of all kinds - am I worthy of parenthood? Am I dysfunctional or broken? Why can my friend get pregnant but I can’t? What if I did something to cause this? What if I'm never meant to have a child? And the list can go on and on. It’s in this moment that deep support, understanding and care are needed, and can be found not only with a therapist, friends or family but also with an acupuncturist and herbalist.

Support in the process of shock, loss and grief can be profound within the spectrum of Chinese medicine. Treatment that utilizes the interplay of emotions, the Five Element cycles and Chinese medicine theory is something that I find to be deeply helpful with patients who are working through the hurdles that life throws at us. In particular with pregnancy loss we may see almost any emotion, but we often see a predominance of grief, anger and shame.

Grief - Release and Renew

When working with grief we have a two-fold intention; the first one to allow and encourage the patients to truly feel the grief they are experiencing, and second to coach and support them through that grief so that they don’t get stuck there, avoiding underlying emotions like shame or anger. Grief is represented by the Metal element, the Lungs and Large Intestine, and calls upon our ability to receive the new and to release and let go of the old. In many cases crying is a release of old, and often letting go of hope and expectation. I find with grief, the primary intention of a treatment is to create a safe enough container that the patient is able to tap into that deeply vulnerable space of grief they are experiencing. This isn’t a treatment strategy of turning to the textbook for the right point, but rather an opportunity to truly see the person in front of us, pain and all, and simply treat them as they are. You’re not changing anything, you are simply creating space to allow what is already there to bubble up and outwards.

Pericardium 8 - Palace of Weariness

This point is the safe haven for the Emperor to go when he needs to rest and feel his pain without the judgements or responsibilities of ruling the kingdom. It’s a safe space to feel your feelings, whatever they may be, but particularly an excellent space to find grief. I think the location of this point and the pain experienced from needling it also aids in this effect. Sometimes the pinch of the needle helps to bring a somewhat dissociated or numbed out person back into their body.

Large Intestine 18 - Support and Rush Out

A Window of the Sky point, this point helps us with that bridge between the heavens and earth, our spirit and body. Support and Rush Out is appropriate for the times in our life when we are holding too much, but feel too disempowered or not supported enough to go through the process of releasing.

Gan Mai Da Zao Tang, or Serene Spirit formula

This is a personal favorite, and is essential for the processing of loss and grief. In school we thought of this formula as a nice “herbal hug” and it truly is. But what this formula does is to nourish the Heart Qi so that we can really sink into the pain and hurt we are experiencing. It allows us to be with what is. That hug releases us from our resistance, and in turn we can feel into those emotions that are hiding under the surface.

Shame - the Great Stagnator

Shame isn’t referenced in ancient texts or in general acupuncture education as an emotion related to the Five Elements or Chinese medicine theory. This is of course, a shame, because it’s one of the most pervasive and important emotions we experience. Shame is within the Earth element. When we look at the associations with the Yi spirit; worry, overthinking and sympathy, it becomes clear how shame is a natural extension of this family of emotions and experience. The Yi spirit helps us to be centered within ourselves, to digest and assimilate experiences and to make sense of what’s happened. It also gives us the courage to step forward, set intentions and make our inner thoughts match our outer actions. Shame develops when we don’t have the ability to do this, or when we want to change or do something but we can’t make and hold the intention to actualize it. If we want some aspect of our life to be a certain way, and it isn’t, we may experience shame because we feel that it is a fault, failure, or deficit of ourselves that it isn’t working. Shame is guilt turned inward, it doesn’t say ‘I did the bad thing’, it says ‘I am the bad thing.’

When a person experiences the loss of a pregnancy, shame can be a natural and deeply pervasive experience. This may look like blaming oneself for the loss of the pregnancy; ‘if only I didn’t eat that piece of fish’, ‘if only I knew earlier, I wouldn’t have gone running,’ and wondering if their body is inherently flawed or faulty; ‘I am just a flawed person,’ ‘my body is unacceptable and broken.’ These are all deeply unsettling thoughts and beliefs, and while the patient may know intellectually that they are not true, it doesn’t stop them from experiencing the deep pain of this experience.

Shame is a very detrimental emotion that can actually block us from feeling our other emotions as they arise. In that sense, it's a ‘great stagnator’ and the job of shame is to make you stop, keep you stuck, and prevent change. When we are working with shame, there always needs to be an element of movement involved in the treatment principle; we have to shake things up, and offer a new vantage point to help the patient move out of the sludge of shame. We also need to help the patient center back into their body, to be fully present and in the body, not only in the mind.

Stomach 25 - Celestial Pivot

This is a go to point for help with the Yi, it’s the bridge of the midway point of the body connecting above and below. This point can help someone feel more centered and grounded and be present in their body. For any patient with an Earth constitution, or with a Yi disturbance, or who is experiencing overwhelm, shame, or worry, they will benefit from this point.

Spleen 1 - Retired White

This point helps us step forward on a path of breakthrough. I find that any point that can be more painful to needle is a great point to help get things moving, and also reconnect us with our body, in a way that pain of the needle is a big reminder that you actually have a body in the first place. This point helps us take all of what we have learned, all the work we’ve done, assimilate it and move forward. It’s about moving through our own personal glass ceiling and stepping into something new and more aligned for us.

Bu Zhong Yi Qi Tang

This formula gives us the Qi movement we need while simultaneously supporting the center. It’s like the friend who will come to your house, pick you up, take you out for a hike then buy you lunch and listen to your life’s problems. It helps you get out and shake off whatever is weighing you down, while also being nourished through the process. The support we need while working through shame (along with any other emotions) is to have enough Qi to be able to process in the first place, while also staying grounded in the body. Bu Zhong Yi Qi Tang helps by tonifying the center, and raising the Yang Qi so that we can be uplifted and motivated to dive a little deeper, and so that we have that acceleration force within us to move through shame or other emotions that can bog us down.

Anger - Growth and Expansion

One of our most transformational emotions is anger. Anger isn’t just rage and hatred, it’s also the motivation to commit to a plan, set boundaries and hold them, and to have passion and drive in our lives. The ability to ‘do’ is often fueled by the emotion of anger. Anger is so misunderstood and pushed away in our society that it can be very difficult for people to feel anger, particularly those who are female presenting. Women in our society are taught to hide and repress anger at all costs, and instead it’s often acted out through other emotions along the five element cycles. If anger isn’t expressed, it can bubble up through the generating cycle into anxiety (Fire). When we want to express anger but can’t or don’t feel safe, it often comes out as crying through the controlling cycle (Metal controlling Fire), and when shame (Earth) is a pervasive emotion in our lives, it stifles our ability to use our anger in a healthy way through the insulting (Wu) cycle.

What’s the solution?

Plain and simple: boundaries, healthy boundaries.

By setting and holding healthy boundaries we are learning to channel that anger energy into a positive force in our lives. It helps protect us from people and situations that don’t serve us and allows us to be more aligned with who we truly are and where we want to go. In the case of pregnancy loss, healthy boundaries may look like choosing to limit interactions with friends or family members who further induce our pain or shame us for our choices, or perhaps it’s finding a new doctor who is more compassionate and has better listening skills. Boundaries are all about tuning into what we need and want for ourselves and then adjusting who or what we interact with, which helps us stay in that alignment versus pulling us farther away from it. Boundaries are not telling another person what they can or cannot do, it’s about deciding what is acceptable for you to be around and then moving yourself closer or farther away based on what your needs are.

It’s important to help our patients also truly feel the anger that is present, and this is the classic anger and rage we’re speaking about. It doesn’t help us to ignore it or stuff it down, we do need to feel it and process it as it arises. This might look like holding space for them to talk about it, doing some somatic movement like grunting, shaking, punching a pillow, etc. As a practitioner, when you can see the anger but the patient can’t or won’t look at it, it’s okay to ask more questions to coach them into looking at it and to help them feel it, it can’t be skipped over. When following the generating cycle, under anger (Wood) is always fear (Water), and this is an excellent place from which to encourage a patient once they’ve tapped into the anger they feel.

Gallbladder 15 and 41 - Head and Foot Overlooking Tears

These points help us get to the top of the proverbial mountain so that we can see clearly what’s ahead. When someone is lost in their emotions, particularly if they are stuck in frustration and can’t see outside of it, these points can be very useful. GB 41 in particular can be very grounding, and helps us be in our body while also connecting with our higher self so that we can see outside of all the difficulties we are currently faced with.

Liver 5 - Insect Ditch

This point is for the person who is irritated by everything, they may be acting out that irritation or simply experiencing it internally, but either way they aren’t able to see clearly or move forward because of it. There are bugs everywhere and they’re laser focused on each and every one, missing the big picture.. It’s a similar function to GB 15 and 41 in that it helps give us more clarity, to see what’s going on and see where we are going.

Yue Ju Wan, or Escape Restraint Pill

While not traditionally indicated for mental or emotional issues, Yue Ju Wan is an amazing formula to work with depression and to help patients move through stagnation that’s preventing them from accessing emotions. The name of this formula says it all, ‘Escape Restraint Pill,’ and while I originally learned this formula to help with the physical manifestations of stagnation, it can be profound for working with the mental and emotional manifestations of stagnation. When our emotions feel stuck, we feel numb, or are repressing emotions, we need to relieve this stagnation. With emotional stagnation it may not be very clear which aspect of ourselves is stagnated so Yue Ju Wan, by releasing all five types of stagnation (Qi, Blood, Phlegm, Fire, Food and Dampness) can really help to start to clear things and provide that opening.

Support, Listen and Hold Space

If you’re feeling lost as to how to support a patient through the loss of a pregnancy; keep it simple. There truly isn’t anything you can do that can magically erase the pain, or change the outcome. Emotions need to be felt, seen, and heard. Your job in this process is to be there. Simply, be there. The acupuncture and herbal treatments are secondary to the experience of simply being listened to and witnessed by another person. By allowing and encouraging the patient to truly feel into the experience they are having, no matter how painful it is, you’re helping them to truly heal. I define healing as returning to your original intention by finding and staying true to yourself regardless of the situation or outcome. When we think of healing in this way, it becomes accessible to anyone and everyone, because it doesn’t hinge on the patient getting better or being cured. The outcome doesn’t necessarily need to change for them to experience this. We can guide them toward a shift in perspective, which allows the patient to grow and change, and eventually re-approach whatever it is they are working with (if they choose to) from a new state of being, a new state of consciousness and awareness.

References

• Dugas, C., Slane, V. "Miscarriage," https://www.ncbi.nlm.nih.gov/books/NBK532992/.