CHAPTER 6. Eastern approach to labour
Our birth is but a sleep and a forgetting: The Soul that rises with us, our life’s Star, Hath elsewhere its setting, And cometh from afar: Not in entire forgetfulness, and not in utter nakedness, But trailing clouds of glory do we come
(William Wordsworth, Ode, Intimations of Immortality from Recollections of Early Childhood, 1807)
You are assisting at someone else’s birth. Do well without show or fuss. Facilitate what is happening rather than what you think ought to be happening. When the baby is born, the mother will rightly say: we did it by ourselves
(Lao Tzu, The Tao of Leadership, 5th century bc)
Introduction
There is not so much written about supporting a mother during birth in Chinese medicine. More attention was paid to the moment of the baby’s arrival and to ensuring a calm atmosphere. This extends to the support people as well as the mother herself and the environment. Maybe this is because birth was in the female domain and most of the ancient writers were men. The type of conditions which were addressed were more to do with ensuring the safe delivery of the baby than with providing pain relief or supporting the process for the mother. Shiatsu and acupuncture have only been written about in terms of pain relief since the 1970s, although traditional midwives in China and Japan probably have always supported women with touch.
Difficult or delayed labour was a major concern as this was the main cause of maternal or fetal death. There was minimal surgical intervention during birth, so it is a realm which has changed considerably. Working alongside a western medical approach to birth has become a necessity for anyone in the field and it is important to understand the energetics not only of physiological birth but also of the effects of interventions on the process for both mother and baby.
Much of the theory in this section has come from my own experience of working in the field since 1990. Lea Papworth and Jacky Bloemraad-de Boer have also kindly contributed comments.
Traditionally during the time leading up to birth, a woman was apart from her husband so that the feminine connection could be built up. Old advice to the mother approaching labour includes:
• Sleeping in a separate room from her husband.
• Washing hair regularly in the last month to avoid breech births – an interesting link to the Water energy.
• Avoiding the presence of people in mourning or those who are emotionally disturbed in any way.
False labour was considered the baby playing and so was not necessarily seen as of concern. ‘This is probably referring to the increased intensity of Braxton Hicks contractions occurring towards term, or niggling pre-labour, rather than true premature labour’ (Lea Papworth).
Although the birth process was considered to be a journey for the mother, the Chinese particularly emphasised those aspects of the journey for the baby: ‘Waking up from a dream, the child is capable of rotating their body, opening up the envelope and finding their path. They follow the amniotic fluid and descend’ (Xu Chun Fu, from Ming period, quoted in Eyssalet 1990).
If the baby is not breathing well at birth, then it was considered that they had not woken up from their dream. The first cry and the first gestures of the baby were taken seriously. The music master who had accompanied the mother in the last few months would determine the note of the cry. The cook would work out which of the five tastes would correspond to the baby. The time of the moment of birth and the placement of the stars would help identify the Nature of the child (Xing) and their line of destiny (Ming). Modern distortions of this include women planning their caesareans to coincide with what they consider to be an auspicious time.
The main pattern of energy in labour is the movement from Yin to Yang; the movement from Water to Wood. This is the five element movement and is followed by Fire, the energy of bonding.
It is important to have an understanding of the energy of the different phases of labour, so that any work can be geared individually to the mother and her response to these patterns. Work can be done on the meridians and approaches which are most relevant to her. It is important not to have preconceived ideas. Sometimes the changes in energy can be surprising.– For example a very Yin woman may move without difficulty into Yang energy. Furthermore the process of labour is different for different women. A ‘quick’ 10-hour labour for one woman may seem a slow labour for a woman who labours in 2 hours. For another woman a 2 hour labour can feel quite shocking.
6.1. Main energy changes during birth: mother
Yin and Yang: the fundamental shift
Birth is a movement of energy from Yin, the state of pregnancy with the fetus on the inside in water, to Yang, bringing the baby out into the world. The most Yin energy is Water and the most Yang is Fire. To move from Yin to Yang, following the five phase movement of elements, means to move into the season of spring, to the Wood energy of growth and transformation. Wood is the movement of energy in the second stage of labour.
With the beginning of labour, there is a Yang, active impetus, caused by changes in the Governing Vessel. From a western perspective this represents the hormonal shifts. The Yin to Yang shift continues to build. The first stage of labour is more Yin in relation to second stage. The more Yin type person will tend to find the first stage of labour easier as Yin energy still predominates. As labour progresses to second stage she may find this shift more difficult to assimilate. It is the opposite for the Yang type person, who tends to find first stage of labour more difficult than second stage.
This correlates to the Western approach: a woman who is more able to shift into connecting with the primitive brain, the hind-brain, is generally a Yin type of person and tends to ease into labour whereas someone who stays in the neo-cortex mode is more Yang and will struggle to move into the first phase of labour.
(Jacky Bloemraad-de Boer)
Once the baby is born, they begin to form relationships with people other than the mother and this is more to do with Fire, the most Yang energy. The mother also has to draw on her Fire to relate to the baby in a different way and on her Metal to let go of the identity she had formed of her baby and relate to it as a separate person.
Yang wood energy – the spiritual aspect of the Hun
This movement to Yang is linked with a movement of Wood energy. Wood is about birth, new life and the baby coming into the world and beginning its journey. Hun resides in the Liver. It is to do with the word, imagination, Yang energy and the spirit, and to some extent the breath.
Changes in flow of Qi, Blood and Jing
All of these energies change dramatically over a short period of time. As well as CV and GV being important, PV and the other five Extraordinary Vessels play a role. Any blockage during labour for mother or baby can ultimately be caused by any of the energies in the body being out of balance.
Qi
There is a big movement of Qi with the baby moving from being inside the mother to outside. The biggest movement is at the moment of birth when there is a large surge of the mother’s Qi.
This is seen when an exhausted mother makes the final push that delivers the baby, and she takes her child in her arms.At this point, her Shen reignites. Considering the digestive functions slow to minimal activity in labour, a women relies on her reserve (Pre-Heaven) Qi as well as her Jing.
(Lea Papworth)
Blood
This is important throughout the labour as the baby needs to keep receiving nourishment, especially during the contractions when Blood flow is restricted. If the labour is long, maternal position will be important to ensure good Blood flow. For a woman lying on her back, even in the semi-recumbent position which is often favoured now, the free flow of breath, Qi and Blood tends to be blocked. At the moment of birth there are huge changes in Blood as the placenta stops providing the Blood to the baby and the baby has to start producing its own Blood. For the mother also there are big changes in the flow of Blood as the placenta detaches and the blood vessels start healing over.
Jing
This supports the whole process with changes in hormonal energy initiating labour for both mother and baby and the changes in the early postnatal period. As the flow of Qi slows then Jing and Yuan Qi are drawn upon to provide the energy to support the birth process.
Stages of labour: the movement of the five elements
All elements are present, supporting each other, but the overall movement is from Water to Wood.
First stage: water Yin to Yang, opening up and letting go
This is the first stage of the movement from Yin to Yang. It involves a shift from the Yin to the Yang aspect of Water, from Kidney Yin to Kidney Yang and then to Bladder. As the first stage progresses women often connect with images and visualisations of water, and may even want to get into water. The image of the wave gets stronger as the contractions become more intense. As the first stage culminates with transition many women exhibit fear or anger. This indicates the emotions connected with the shift from Water (fear) to Wood (anger) which the mother is passing through.
I often ask a mother who is struggling during the latent phase if there is any ‘stuck’ anger in her. This very strange question almost always results in a resounding YES and a dam of anger bursting. Once this has happened the mother usually moves right along into good latent and then active labour! I have to mention though that I usually have a close relationship to these clients and choose the moment very carefully.
(Jacky Bloemraad-de Boer)
The latent phase is Kidney Yin and during the active phase there is a shift to Kidney Yang and Bladder.
Opening up Metal and CV/GV
This is expressive of LI/LU energy: the movement of the out-breath and letting go both emotionally and physically. There is an interesting connection between the jaw being open and the cervix being open. The mouth to anus connection represents the beginning and end of Metal energy as well as the basic GV/CV circuit. Often women experience sickness or diarrhoea before or during labour and LI 4 is a point which can reduce these symptoms and enable this energy to support the opening up process.
When supporting a woman in labour take note of her lips. A woman pursing her lips is tensing with her contractions, particularly tensing her abdominal muscles, often pulling up her shoulders as well. Encouraging her to let go assists her to relax and seems to increase the effectiveness of natural painkillers – endorphins.
(Lea Papworth)
Going with the flow – Water
With the onset of labour there is a Yang impetus as energy shifts from Kidney to Bladder. Often BL and KD points are used to support first stage, for example BL 67 and BL 60, KI 1, sacral BL points and KD 6 and BL 62. It is well accepted that fear increases pain. KD 1 helps calm fear.
Muscular contractions – Earth
The uterine muscles contract but they also need to relax. The process of retraction means that the upper uterine muscle contracts and then partially relaxes resulting in their bulking and shortening. The lower uterine muscles and cervix relax and lengthen. Spleen/Earth (SP 6, ST 36) supports this process. If the mother uses too much muscular contraction in other parts of her body and does not nourish herself adequately she can get tired and this can lead to tiredness in the uterus and ineffective contractions, thus tending to prolonged labour.
Relaxation of the sinew and tendons – Wood
The cervix relaxing is related to the Wood energy of the sinews. GB 34 is often used to relax a tight or scarred cervix and points such as GB 30, LV 3, GB 21 help the Wood to flow.
Shoulders being pulled up is a sign of Liver Qi stagnation (Gall Bladder 21) and so in relation to that shift from Water to Wood it is important to ensure a woman relaxes her shoulders during and between contractions
(Jacky Bloemraad-de Boer).
Transition – the movement from Yang Water to Wood
The mother may get stuck here. How she gets stuck reflects the balance of the elements within her. It could express itself as either a physical or emotional block.
It could be Earth not moving, a phase of withdrawal expressing through tiredness and lack of energy, feelings of being stuck, or feelings of lack of nourishment, either physical or emotional.
It could be Wood not flowing, in which case there is often a lot of anger and physical holding on, especially in the jaw and shoulders.
It could be Water not flowing. Water could be Bladder or Kidney energy but it could also be Extraordinary Vessel energy. The mother may go to sleep, switch off, or simply pause at the pivotal moment of the shift between the Water and Wood. There could be trembling, tiredness and exhaustion. The mother could feel very fearful.
If Metal is not flowing there can be feelings of sickness or holding on emotionally or expressed physically through being constipated.
If Fire is not flowing there can be panic or emotional disconnection. The mother could feel very cold.
Second stage – Water to Wood and the moment of birth
The predominant energy here is of Yang energy rising. This is Wood. It is a much shorter phase relative to first stage involving a more dynamic physical shift of Qi.
The contractions change in their energy flow from dilating to expulsion so there is a strong downward movement of energy as the baby moves down the birth canal. Governing Vessel as overall regulator of Yang predominates at this phase. The Chinese advised against pushing too strongly. The most important thing was to allow Wood to flow like a general marshalling his troops. It is difficult to assess what ‘too strongly’ is as it is different for different women and is probably related to cultural traditions. Mediterranean women are known for vocalising in their labours and asking them to breathe out quietly and bear down gently can inhibit and annoy them or make them feel ashamed of their need to express. Amish women in North America, by contrast, often make no sound at all. The main principle is to assess that Wood energy is flowing and that the bearing down is not full of tension. If the mother is tense, she may think she is bearing down but the energy is often stuck in the upper body and her mouth and jaw are likely to be tight. GB 21 is a powerful point to release this energy and allow it to flow to the cervix to facilitate productive bearing down. At the moment of the actual delivery the mother may feel that she is breathing the baby out. At this stage women sometimes open their eyes to bring more of an outward energetic focus to the process.
Blocks to the flow of Wood
Blocks in the flow of Qi in any element or meridian will block the flow of Wood.
It can be hard for the Wood to flow if the Water is exhausted because Water is the mother energy of Wood. If first stage has gone well then there is more likely to be a natural flow into Wood. Stuck Water could be indicated by a full bladder which can block the process of the second stage. It is interesting that often physiologically the amniotic sac (waters) break at the beginning of the second stage of labour, facilitating the movement into Wood. If Water is not flowing the mother may be afraid of the pressure on the perineum and hold back through fear.
Metal can block the movement of Wood by not allowing it to flow. If the mother is unable to open her jaw, relax, soften her shoulders, open the cervix and let go both physically and emotionally, then Wood can become blocked. She may be slightly constipated. Again it is interesting that often at this stage women feel the urge to defecate and indeed sometimes small amounts of faeces are released. If Metal is over-controlling Wood it is usually expressed as tension in the neck and shoulders and unproductive pushing utilising the upper body rather than allowing the energy to flow down. The mother may feel quite angry. GB 21 and release work to the shoulders can often unblock this pattern but LI 4 can also be useful.
If the Earth energy is exhausted then the mother may not have the energy for second stage, or it may be that the baby is exhausted.
Lack of Fire could lead to emotional exhaustion.
Third to fourth stage – Wood to Fire and bonding
Fire is the predominant energy here as the mother begins to bond with her baby outside the womb and the baby begins to make new relationships.
The third stage has very similar energy to the second stage but is less intense. It is still about the downward movement of Wood to deliver the placenta. If this does not happen, then the placenta may be retained. However, there is already a shift of movement from Wood to Fire which happened with the birth of the baby, and the mother’s and baby’s energy is more expansive. This is the energy of the fourth stage – the beginning of the bonding process between the mother and her baby.
It also correlates to keeping a woman warm (Fire) after the second stage so that high amounts of adrenaline (needed for the “fetal ejection reflex”) can drop. Otherwise the production of oxytocin needed to release the placenta is blocked’.
(Jacky Bloemraad-de Boer).
Fourth stage – Fire and bonding
This is postnatal energy and is about the relationship between Fire and Metal as the bonding is closely linked with the process of separation of mother and infant. There is the continuation of the hormonal changes and changes in the flow of Blood and Qi which need to happen for both mother and baby.
6.2. Main energy changes during birth: baby
Yin and Yang: moving from Water to Wood and Earth
The process of the birth for the baby is about moving from the Yin Water environment of the womb to the Earth outside and from being dependent on the mother’s Qi, Blood and Essence for nourishment to making the transition to producing its own energies. The circuit of the Extraordinary Vessels is important in regulating this process of change. In the fetal position, the Governing Vessel surrounds the Conception and Penetrating Vessels. During labour, they are stimulated through compression and then undergoes changes at birth as the baby’s spine is extended and the head and shoulders rotate. At birth there is a gradual opening and unfolding which continues in the early days and weeks as the baby opens up its body and the Yin channels come into more direct contact with the outside and become the front as opposed to the inside of the body.
The baby is considered to be vulnerable in the early days. The Shen is open. To protect the Shen, the baby is in immediate and direct contact with the mother’s abdomen. To protect the Jing of the baby, birth would be in a darkened room and strong voices and shocks and contact with metal would be avoided where possible.
In old China, and indeed in many traditional cultures, there were some traditions where the baby would pass the first 3 days of life on the ground on their abdomen without food so that they can connect with the Earth. There would be rites of purification before the infant would have first milk. This is an example of a traditional practice which is not helpful and underlies the importance of not slavishly following ancient writings. It can be understood energetically but skin-to-skin contact and breastfeeding are better ways of supporting the Earth. The pre-milk, colostrum, contains important minerals and immunological properties so it is important for the baby to feed from the breast as soon as it can. Feeding also encourages involution of the uterus. Energetically the mother has been the infant’s Earth for 9 months and continues to provide that continuity of support. In some cultures the mother would hold the baby for most of the first 6 months.
Another eastern view (Kushi 1979; see Ch. 5) sees birth as representing the occurrences on earth about 400 million years ago. As land masses formed and creatures moved from the sea to the land there were repeated catastrophes in land formation and large scale flooding. This is like the baby moving from water to earth. In order to adapt to the new expanded atmospheric environment the baby must first experience contraction by being compressed through the birth canal and breathing out excessive substances through the contraction of the lungs. Babies who are born by caesarean miss out on this process of contraction and may need additional support to make the transition.
Changes in flow of Qi and Blood and Jing
As with the mother there are big changes in all these energies.
Qi
There is a big shift in Qi as the baby makes the journey down the birth canal through the process of movement involving various twists and turns. The Qi and limbs are compressed. The moment of birth represents the movement when the baby starts making its own Qi, separate from the mother’s. The first breath opens the lungs and Air Qi comes directly into the baby’s body. Shortly afterwards the baby will suckle, taking in Food Qi. In this way the organs each become activated as they start to assume their functioning outside the womb.
Blood
There is a need for an adequate supply of Blood, particularly during the contractions themselves as Blood flow is restricted. At birth it is important that the flow of Blood continues. It was considered important not to cut the cord and thus allow Blood to continue to flow while the baby makes the transition to form its own Blood. If there is not a good flow of Blood then the baby can become emotionally distressed and disturbed.
Jing
The mother’s Jing continues to support the baby during labour and there are hormonal shifts for the baby. The baby is connecting with the will of the earth and coming into the realisation of his/her destiny. After birth the Jing is vulnerable and it is important to continue to support the baby’s Jing through the breast milk and colostrum. This is one of the reasons why the baby and mother would remain in a quiet, stress-free environment for some time after birth.
Stages of labour: the movement of the five elements
First stage – Yang Water
The baby is moving from Water propelled by the Yang energy of the mother. Sometimes the waters break before labour begins, sometimes during labour and sometimes not at all. These differences show how different babies relate differently to Water. The change of energies is less dramatic when the waters break later in labour or the baby is born into water. Water is also about the hormonal changes which the baby is going through. The hormonal changes for the baby are more on the adrenal level, which is related to the Yang aspect of the Kidneys. However, there is a fine line between Yang stimulation and stress and fear. Sometimes the baby can go into an unbalanced as opposed to a supporting stress response and this is when it can become ‘compromised’.
Earth
The baby feels the energy of contractions around its body. These muscular forces represent the strong containment of Earth. However, they are gradually moving the baby away from the womb home towards a new experience of Earth. The mother’s Earth which contained them is now the very force which is propelling them out from their home. The baby may resist this emotionally or even on a physical level if they have poor muscle tone. They may want to stay in the womb home and not move on. This can slow down or block the process of labour.
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