First trimester with its magic, fatigue, and morning sickness

From my years of working with people on their fertility and pregnancy journeys and my own studies of gynecology from a Classical Chinese Medicine perspective, I thought that I had many tools to deal with my first trimester. Yet, I have to admit that I had a very very hard time especially week 8 - week 13. It is unique for each pregnant person but there are also very common discomforts that come with the first trimester; fatigue, nausea, vomiting, and loss of appetite, and I had them all. I know some of my patients had minimal discomfort, I even had a patient who told me that she had not known about her first pregnancy till she was 3.5 months pregnant!!!

For me, the first few weeks were just as regular as before. I was still feeling energetic, practicing Aikido, and surfing, just leaving my life as usual till I hit week 8. Since I found out that I was pregnant, I was trying to pay more attention to my sleep, and making sure to get adequate rest after exercise. I started to take prenatal vitamins in pill forms, and I even started to eat fish once or twice a week.

When week 8 came along, that Saturday I vividly remember feeling a type of fatigue that I had never experienced in my life. Sleeping 9- 10 hours a day did not touch it. I was still able to see patients at the clinic but during each lunch break after eating my lunch I would go to one of the treatment rooms and I would needle Stomach Qi points based on Kiiko Matsumoto style, and add happy baby point Kidney 9.

Week 8 and 9 hit me so hard and unexpectedly that I spent all of my time after work hours lying horizontal and doing nothing. I did not even think about going to Aikido or surfing or my dance jams. I had zero motivation or energy to do anything, and that made me feel very depressed. Here I am wanting to have a baby and feeling awful about my situation. I reached out to one of my Chinese Herbal Medicine teachers Dr. Eran Even, at that point I had also started to have some night sweats and feeling overall warmer. With his suggestion, I started taking two simple formula combinations: Gan Mai Da Zao Tang and Zhi Mu Bai He Tang. The formula helped my mood but the fatigue was very severe still.

Week 10, I started to have morning sickness (which can happen at any time of the day, for me it was in the evening) which plummeted my appetite. If the morning sickness and nausea persist throughout the pregnancy or if it gets really bad, that is called hyperemesis gravidarum. It can require hospitalization and treatment with IV fluids and anti-nausea medications.

Let’s look at how Chinese Medicine looks at morning sickness, loss of appetite, and fatigue during the first trimester.

In Chinese Medicine, there are multiple channel systems that might be challenged during the first few months of pregnancy, such as the Liver, stomach, spleen channels, and Chong mai /penetrating vessel.

The Chong mai / penetrating vessel channel is interesting because it is located deep inside the body and doesn’t have any acupuncture points on the surface of the skin. This channel functions as a reservoir for blood and qi, two of the body’s most vital substances.

Every month a woman’s chong mai fills up with so much blood that it overflows into the uterus, which is what causes menstruation. But when she gets pregnant this stops since the extra blood is instead redirected to nourish the developing baby. These changes in the Chong Mai are the reason for morning sickness.

Chong Mai is closely connected with the uterus and the stomach. The qi of the stomach should normally flow downwards, allowing digested food to move into the intestines. When the Chong mai becomes imbalanced, this can cause the Stomach’s qi to move upwards in a condition known as “rebellious qi. ” From a TCM perspective, this is the cause of morning sickness.

There are also other, more subtle factors in TCM that can contribute to morning sickness. For example, a woman who is experiencing nausea and vomiting as well as the sensation of fullness in the central abdomen and a lack of appetite (although food and drink may offer temporary relief) may be suffering from weakness or excess cold in the Stomach. Women who have similar symptoms but also feel weak, fatigued, have heavy limbs or sweat easily could be suffering from a deficiency of the Spleen, another vital digestive organ in TCM. Women who vomit right after eating and are constantly thirsty may have too much heat in their Stomach. Women who suffer from belching, a sour taste in the mouth, irritability, or depression may be suffering from a Liver imbalance.

I tried salt crackers which did not do much for me, eating small, simple flavors (my favorite Indian cuisine was not an option, I could not even stand the smell of curry). Snacking on nuts and ginger candies was not very helpful either. Freshly ground ginger tea with a touch of honey and lemon juice seemed to work better.

I was forcing myself to eat more protein from fish, but I was not able to keep the food down. I switched to taking prenatal gummies because I could not stand the taste or the smell of the prenatal vitamins. My blood test showed vitamin D deficiency so I added vitamin D supplements and also DHA/EPA since It was really hard for my system to accept fish. As a vegetarian, I had always told myself that if I craved any type of meat, I was not going to restrict my diet due to my belief system, but that was not the case for me, I never had cravings for meat.

By week 11, the fatigue was not as bad but the morning sickness and vomiting persisted so I started to take Xiao Chai Hu Tang, also used a gold magnet and pynex stickers on my wrist on Pericardium 6 acupuncture points. During my lunch-break self-acupuncture sessions, I needled pericardium 6 with spleen 4 acupuncture points as well as stomach qi and added yin tang for overall relaxation.

When I woke up the morning of week 13, a beautiful Saturday morning, I knew something was different. I had way more energy and as the day progressed I did not have any nausea. I was finally experiencing the Golden / Second Trimester. The very next week I took my very first Aikido class after a month and a couple of days later I had a surf session. I was feeling so much better when I saw my acupuncturist that he was surprised that I did not call him and ask for help while I was at my worst. This made me realize the state of mind I was in that I did not even think about reaching out to him for help. I promised myself and him that I would call him whenever I needed help instead of trying to treat myself, I got my first prenatal massage session with Susi Galloso, I was very excited about the Golden Trimester and then the universe had another plan for me; I got covid!

I will be talking about how I dealt with my COVID symptoms and experiences and maybe some advice about the second trimester in next month’s blog post.

I would like to summarize the recommendations to deal with morning sickness but as I explained in detail above, some did work on me, and some did not. You can try them and see what works for you!

-Eat plain, “bland,” warm foods. Avoid anything that is spicy, salty, fatty, fried, or cold.

-Eat smaller meals/snacks at regular intervals throughout the day, so as to avoid the stomach being empty or too full, and to keep blood sugar levels steady.

-you can make fresh ground ginger tea, with lemon juice and honey, some prefer ginger candies, for some people, ginger can be too warming and spicy, instead, you can try peppermint tea which is cooling and soothing.

-you can have an acupressure wristband on pericardium 6 acupuncture points

-if taking your prenatal vitamins makes you nauseous, you can try switching to the gummy form

-take as much as rest you need

-if you have enough appetite, eating congee with white rice is a great way to nourish your stomach and spleen. You can use bone broth vegetable broth or just water, you can make it sweet by adding goji berries, walnuts, and honey. You can sprinkle some ginger powder and you can also alternate rice with oatmeal. For the savory version, you can use egg, bone broth, mushroom, or green vegetables that you like, you can add butter ghee, or sesame oil.

-try to eliminate stress from your life, this could include not reading the news or watching movies that include violence and stressful images. Surround your environment with beauty and things that give you a sense of calm.

-you might have heard the saying “eating for two,” but don’t feel stressed or worry about not nourishing the fetus. Your midwife or doctor might have already told you too, that you don’t need to have more calories than your usual amount during the first trimester. Your body is going through a tremendous change and working very hard so be kind to yourself.

-you can work with an acupuncturist and herbalist who has additional training for prenatal care. As practitioners, we tend to not give herbs during pregnancy and recommend dietary advice and food-grade herbs but if your condition is severe and you need more support, an experienced herbalist can prepare a custom-made formula that is safe for you and for your baby.

Here are some key studies and findings related to the use of P6 acupuncture/acupressure for morning sickness:

1. Meta-Analyses and Systematic Reviews:

• A systematic review and meta-analysis published in the Journal of Clinical Acupuncture and Moxibustion in 2019 analyzed 16 randomized controlled trials (RCTs) involving 1,163 pregnant women. The review concluded that acupuncture at P6 significantly reduced the severity of nausea and vomiting compared to control groups.

2. Individual RCTs:

• A randomized controlled trial published in Obstetrics & Gynecology in 2004 found that wrist acupressure, specifically at the P6 point, was effective in reducing nausea and vomiting in pregnant women. The study concluded that acupressure was more effective than a placebo wristband.

• Another RCT published in the American Journal of Obstetrics and Gynecology in 2009 showed that acupuncture at P6 was effective in reducing nausea and vomiting during pregnancy. The study reported that acupuncture significantly reduced the frequency and severity of morning sickness

3. Cochrane Review:

• A Cochrane systematic review published in 2015 examined 27 RCTs involving 4,861 pregnant women. While the review did not focus exclusively on P6, it found that acupuncture and acupressure at various points, including P6, were effective in reducing nausea and vomiting during pregnancy.

4 Neurophysiological Studies:

• Some studies have attempted to elucidate the mechanism of action behind P6 acupuncture/acupressure for nausea. Neurophysiological research has suggested that stimulating P6 may affect the autonomic nervous system and modulate the body's response to nausea-inducing stimuli.