TCM Placenta Recipe History

July 13th, 2014

Li Shi-Zhen published placenta (zi he chi) as a medicine in materia medica in 1578. However, it was not used in midwifery until 1984, when Raven Lang presented her recipe at a MANA convention. Today, hers seems to be by far the most commonly used TCM recipe today.

I think there is a confusion around this. The general (mis?)conception is that the lemon/ginger/pepper recipe comes from a long history of TCM use. Perhaps it is the “t” in TCM—“the TCM method” implies that the recipe itself is traditional, in accordance with generations of Chinese herbalists. Rather, the TCM method of placenta preparation is a modern recipe created in accordance with TCM principles.

However, it seems that Raven Lang’s lemon/ginger/pepper recipe is her interpretation of TCM theory, specifically that postpartum clients need warming treatments, and raw placenta is cooling. As a TCM practitioner and a midwife, she combined her knowledge to create this recipe, turning the placenta into a warming remedy, so that postpartum placenta would comply with the tenets of TCM.

In other words, when we say “TCM Method,” this means the principles are traditional, the use of placenta is traditional, but the method and recipe themselves are not. This partly explains why the peppers most encapsulators use is a jalepeño, which is certainly not listed amongst the known Chinese herbs. Neither is lemon. However, these herbs are easily accessible to Western midwives.

In fact, there is no TCM history of placenta as a postpartum remedy at all! Though human placenta has many historical uses in TCM, I wasn’t able to find any evidence for historical use during the childbearing cycle.

[Insert list of indications later]

This is not to say that TCM would consider placenta contraindicated during the postpartum. Many of placenta’s properties do fit nicely with TCM’s interpretation of what a postpartum client needs.

[Add Properties vs Needs?]

Welcome Sibyl!

August 31st, 2013

I am thrilled to say that my kid has made her outside-the-womb debut!

Sibyl was born at her Nana’s house, surrounded by people who already loved her. I had my first contraction at 9pm and told Susan she might not want to drive back to McMinnville that night. So she agreed to sleep at my place and I pretty much went straight to bed. Labor started out intense, possibly because her head was very low already, so I was vocalizing with every contraction nearly as soon as I woke up at 2am. This was emotionally difficult for me because, as a midwife and a curious human, I kept checking my cervix. “How can things be so intense but still only at 1 and a half centimeters?!” And I had thought we might get to go on walks or play cards in early labor! I took a little bath and tried to go back to bed for a while, and rested between contractions though I could not sleep. Then I entered a phase of being dizzy and nauseous, which was no fun until I got some miso soup down and started to feel better. I wanted to get in the tub, but it was too cold outside still to try the clawfoot we set up in the back yard, so my lovely support team filled the inflatable birth tub. The contractions had gotten to a point where about half were intense but manageable, and the other half peaked a bit higher than manageable. I wouldn’t say it was back labor, per se, because the pain was not present between contractions, but I did largely feel contractions in my sacrum and I really appreciated counter-pressure at this time. I decided I needed “something else,” and since the morning had warmed up perfectly, and my team filled the clawfoot so I could go outside. It was a gorgeous August Saturday, and I would have loved to have a baby under the apple tree, but the tub ended up being barely too shallow. I was putting myself hands-and-knees for nearly every contraction, and the water wasn’t deep enough to cover over my lower back. Around this time, I started breaking my moms’ hearts by saying things very typical of transition. I was pretty pitiful and there was nothing they could do to make things better. I also still really wanted the counter-pressure, but it felt as if it was just increasing the total pressure, and was too much to handle. So again, “something else.” The team was draining the inflatable tub so they could bring it outside as well, which sounded a perfect solution. In the meanwhile, I opted for the shower, which was exactly the kind of pressure/ not pressure I needed for my lower back. I stayed in there a while, and then hit a point where I knew that if I did not get out of the shower now, I would not be able to get out at all and would have a baby there. This would have been suboptimal as it was rather enclosed, with pebble floor, and the hot water was going to run out someday. So despite the inflatable tub being not-yet-drained, I reversed the orders and had my lovely people fill it back up where it was. Once back in the tub, I missed the spray of the shower but was glad not to be kneeling on wet towels or the pebble floor. Contractions got very intense and gave me no breaks in between, with the exception of when I threw up. And then I could push! And then, nearly immediately, I couldn’t NOT push. I also couldn’t not scream, which was kind of cool. This wasn’t pained victim screaming, but screaming my power down, helping the push. I am definitely one of the folks who prefers pushing to not pushing: once there was something I could DO, the panicking and whining were gone. These loud pushes alternated with whispery silent pushes, and between the two, she came quickly. As she was crowning, I could feel I was going to tear, so I tried to wait and let things stretch but my uterus and my daughter had other ideas. I was leaning back and then her head was out and I could immediately feel her wriggle one shoulder out, then the other, and pull out her hands. She was born to her middle and turned face up. She was looking around under the water and I grabbed her under her armpits and pulled her up. It was 338pm and she wailed right away.

For the past few weeks I’ve been saying that I wasn’t able to imagine what it would be like to love her more than any other baby, or think she’s cuter than any other baby. I’ve seen lots of cute babies, and loved many children who aren’t mine, and though I knew it would happen, I couldn’t picture having such a superlative reaction to her existence. But I did. Sibyl is the greatest thing ever. She is alert and likes to look around at everything, often scowling skeptically. She is a Goldilocks perfectionist when it comes to her latch. She possesses an inner calm and prehensile monkey toes. She is a terrific snuggler. And she is very, very loved.

Fertility App Comparison

February 25th, 2013

To assist with fertility charting, I wanted a great app to make recording and interpreting data easier.  I tried a LOT of them, and it occurred to me that someone else might appreciate my insights.

Droid Apps

When I had my old phone, a droid something-or-other, I had what I considered the perfect fertility app: OvuView.  This app seriously had it all: looks, functionality, ease of use…I couldn’t ask for more.  The calendar view lets you see basic patterns of bleeding and fertility.  The chart view shows temperature lined up with other fertility signs, like fluid and cervical position, as well as custom cues, like headaches or mittelschmerz.  The home screen tells which day of your cycle you’re on, how fertile you might be, and when you can expect to bleed.  You can choose which fertility rules you want it to use for calculating.  And, what’s that?  Oh yeah, it’s FREE.  The pro version gives you access to even more features, but even the free version blows all the others out of the water.  My only gripe?  They don’t make it for my new phone, which happens to be an iPhone.  I’m not even going to bother reviewing the other droid apps, although I probably tried them all, because there’s just no point.

iPhone Apps

I switched to the iPhone for ease of integration with my computer, specifically iCal.  And I might get kicked out of the Apple club for saying it, but there are some things I seriously miss about my Android phone.  Number one being OvuView.  I had expected to just go get it for my new phone, and then the hard part would be transferring my history.  Alas, no.  They don’t make OvuView for iPhone, and have announced that they don’t have time or money for development on iPhone.  So I had to go back to the drawing board, and this time, because there was no stand-out winner, I took notes.  Some of my requirements were the ability to record information about cervical fluid and position, viability for those with long and irregular cycles (like me), ease of viewing patterns across cycles, and a stable program with relative ease of use.  Pretty is nice, but form follows function, baby.

My favorite, and one of the  two apps I ultimately used to get pregnant, is Lily Pro.  This app had most of the features I needed, and it’s really pretty.  However, it took me for-ev-er to input all my older data because you have to go through and choose the specific date for every day in history.  (Some other apps allow you to swipe to the next or previous day, making the process much quicker.)  The chart view only shows BBT, cervical fluid and cervical position, which is useful and better than many others, but paled compared with OvuView’s chart showing whatever I told it to.  Lily DOES have a place to input information from a fertility monitor or ovulation predictor sticks, which is super awesome for those of us trying to optimize conception.  However, they dropped the ball a little bit on single folks and queer families, in that when I did an insemination, I had to record it under “intercourse.”  Does my fertility app really need to remind me that I’m not actually getting laid?!  Trying to conceive is stressful enough.  And for many families, having sex and applying sperm are two completely different things.  This complaint is actually common to many of the apps, and for me ended up being less important than functionality.  Even though it cost me ($7 currently), Lily was my favorite app.  *UPDATE* Lily has recently undergone a complete overhaul.  Since I’m already pregnant, I haven’t had a chance to use it yet, but it’s still really pretty.

Fertility Friend
The other app I used in conjunction with Lily is Fertility Friend.  This is a great fertility website offering all sorts of features, like forums and lessons in charting, and they happen to have apps for iPhone and Android.  With my droid, I pretty much wrote off Fertility Friend because I was comparing it to OvuView, but it’s one of the strongest contenders for iPhone.  Now, especially if you’re also looking at Lily, Fertility Friend is kinda awkward, both aesthetically and functionally.  The calendar view counts cycle days and shows bleeding days and intercourse/insemination days.  That’s right: FF calls it “intercourse/insemination”!  Yay, them!  Inputting data is pretty easy, as you can easily move from one day to the next, and you can record all sorts of data, grouped by category.  But their chart view doesn’t show any fertility signs other than BBT, which is suboptimal.  BBT shows whether you ovulated and when, but does not predict ovulation in advance, so the ability to see cervical fluid patterns is crucial for planning conception (or avoiding it, for that matter).  But the thing that totally makes FF awesome is the fertility analyzer tab.  I swear I stared at this thing all day when I was in my two-week wait.  It tells you which of your most fertile days you intercoursed/inseminated on, and whether your timing was good.  THEN, it looks at all the symptoms you’ve reported and compares them to other charts that ended up pregnant and non-pregnant!  So darned cool.  You can get even better analysis if you want to pay them for their membership.  You can probably see why I ended up double-charting using both Lily and FF, but if you only wanted one app that’s free, I’d absolutely recommend Fertility Friend.

The Others
The rest of these apps will just be listed alphabetically.  Since I deemed them all unacceptable for my purposes, there’s no ranking amongst them.  I’m also not linking to them, since I’m not endorsing them.  If someone is interested in period tracking without fertility signs, some of these might be great.

  • FemCal Lite: You can only see the current cycle, none of your previous cycles, which is a major oversight.  There’s a place to record cervical firmness, but not height or openness, which is insufficient.  The navigation is also really awkward.  This lite version wasn’t good enough for me to spend money on the paid version, but it could theoretically be awesome.
  • Hera: It’s pretty cool, but works more like a period tracker than a fertility tracker, as there’s nowhere to record cervical fluid or position at all.  Navigates well but not thorough enough for my purposes.  Oh–and it’s a buck.
  • Kindara: It’s nice looking, but there’s no cervical position options and cervical fluid is limited to only choosing between “clear” and “thick”!  So it’s insufficient.  It’s also difficult to scroll through results or input older data, and there’s no calendar view.
  • MyFertility: Cervical position can only be recorded as one item, as opposed to the standard three (height, firmness, openness), which makes it not accurate enough.  In addition, it was slow and crashy.
  • Sympto: This one was so buggy I couldn’t get it to stay open.
  • Woman Calendar: This one does have cervical fluid and position options, but doesn’t work for me because the chart only shows the first 36 days!  This could be a good option for someone with regular cycles that never go longer than that, but some of my cycles have been 6 months long, so this limitation really killed it for me.  It’s also sort of awkward to use.

There were a few others out there that I didn’t even try because they seemed more like period trackers than fertility charting tools.  Hopefully my experimenting can save you a bit of time.  Good luck and happy charting!

Preparing a Twin Placenta

February 24th, 2013

Here are the pictures I took of a gorgeous twin placenta I encapsulated.  They are posted with permission from Jenny, the mama who birthed it.  The babies were determined prenatally to be mono-chorionic, di-amniotic twins, which is the most common type of identical twins.  This means that the original zygote started the process of creating a single placenta, and then split so each of the twins creates a separate amniotic sac.  Twins who divide sooner can have separate placentas and those who divide later can share an amniotic sac or even a forked umbilical cord!

twin chorion
Here you can see the chorionic membrane, the outer of the two membrane layers, which is considered part of the placenta.  Because Oscar and Atticus were mono-chorionic, this membrane surrounded both of them and their separate amniotic sacs.  Note the two cords curled up inside: it’s common for the first baby out to have a single clamp on the cord, and the second baby to have two clamps.

twin amnion
This is the amniotic membrane, or rather, the septum formed by both amniotic membranes pressing together.  Because they are di-amniotic, Oscar and Atticus each had his own amniotic sac.  So these membranes were between them until they were born, though many twins have been seen on ultrasound touching and interacting with one another through the membranes.

twin cords
After I have removed the membranes, we can see the umbilical cords and their separate vascular trees.  Sometimes the vessels will interconnect and the babies share blood.

twin cleaned
After I removed the cords, drained and rinsed.  It’s ready for steaming!  You can still see the diagonal line where the division was.

twin maternal
This is the (rinsed-clean) maternal side of the placenta, where it attached to the uterus.  From the maternal side, looks like a (large) singleton placenta!  It’s not uncommon for two placentas to grow together, but because they were mono-chorionic, these guys always shared their placenta.

Thank you for letting me share, Jenny!

Switching Roles

February 1st, 2013

So I’m ready to publicly, officially let you all know that I’m pregnant.  Due August 2013.  Now I’m moving from the midwife role to the midwifery client role, which is so much fun, and provides a lot of insight for me clinically.

I started by asking my best friend to be my sperm donor.  We’d discussed it theoretically many times over the years, while I was single and while I had a girlfriend, so it wasn’t a huge surprise.  We cobbled together a donor agreement using pieces we liked from other agreements we’d found, and came up with something that works well for us both.  In the meanwhile, I spent a few months preparing my body for conception.  Because I had very irregular cycles, averaging 3 months long and generally anovulatory, I took a multi-pronged approach: thorough charting, acupuncture, herbs, pelvic floor work, fertility yoga, lots of supplements, Mayan abdominal massage…I can’t even remember all I did.  I also made sure I got a pap smear.  And I’m not sure what did it (maybe all of it?), but my cycles shortened down to 40-ish days, and the cycle before my first insemination, I ovulated for the first time in six months!

I was expecting that it might take a while to conceive, given my own crazy cycles and my mom’s struggles with infertility.  I myself am a Clomid baby, and she tried for years to have another baby, but it never happened, and I’m her only child.  So I had emotionally prepared myself for it to take 6 months, or a year, and that I might end up getting some fancy expensive doctors involved.

So my first cycle of insemination, I was telling myself it was the practice run, learning the logistics.  I was just proud of myself that I nailed the timing, and that I did in fact ovulate at all!  Once I got my temp spike, things shifted from thinking and doing to just waiting.  The two week wait is ridiculous.  Torturous and crazy-making.  My boobs are kinda sore–is it only because I’m squeezing them all the time to see if they’re sore?!  In the end, I couldn’t even wait the whole two weeks, and 12 days post ovulation, I peed on a stick without telling anyone because it was too early.

It was positive.  Faintly, but unmistakable.

I was shocked.  It’s not common to get pregnant the first try, and I was certainly expecting to be on the other end of the spectrum, taking a long time and possibly some interventions.  I spent the first few weeks thinking that even if I miscarry, this is still helpful information, because it means my ovaries work well enough, and that my donor isn’t shooting blanks, and that I have a decent grasp of charting and timing.  I was waiting for the other shoe to drop, but it hasn’t yet.