Pregnancy Care

2011

Pregnancy Care And Prenatal Wellness

The state of a woman’s health is indeed completely tied up with the culture in which she lives and her position in it, as well as in the way she lives her life as an individual. We cannot hope to reclaim our bodily wisdom and inherent ability to create health without first understanding the influence of our society on how we think and care for our bodies.

Dr. Christiane Northrup, obstetrician / gynecologist

The past decades have tremendously improved the outcomes of high-risk pregnancies and birth, yet with these improvements have come the ubiquitous presence of technological intervention in nearly all aspects of normal childbearing as well. Yet, the safety and efficacy of the routine use of many interventions is not clear, with a striking lack of an evidence base for many. Nonetheless, the number and frequency of interventions has risen steadily since the 1950s. Since 2003, cesarean section has been the most common hospital surgical procedure performed in the United States, with 1.2 million of these major abdominal surgeries each year, accounting for more than 25% of all US births at a national cost $14.6 billion in total charges. In spite of spending more money and using more technologies on obstetric care than any other country in the world, the United States ranks only 25th in birth outcome and infant mortality worldwide. Dr. Marsden Wagner, former Director of the World Health Organization’s (WHO) European Regional Office, remarked at an international medical conference that hospital births “endanger mothers and babies — primarily because of the impersonal procedures and overuse of technology and drugs.”

The desire to avoid excessive technology and an inclination toward natural approaches to health, combined with many women’s perceptions that obstetric care is grossly impersonal, has led women to seek alternatives to conventional obstetric care. Homebirth has become an increasingly popular option because of its astounding safety record and the intimate prenatal, birth, and postnatal care experience it offers women. Many choose to self-medicate with alternative therapies, such as herbs, and turn to sources that may not be reliable for information. Although the treatment of common pregnancy complaints with gentle herbs and simple home remedies has generally proved safe, women are increasingly seeking advice through the Internet, books, and alternative practitioners for potentially serious problems than can arise during the childbearing cycle. Thus, it is essential for practitioners to become knowledgeable about natural therapies and willing to have an open dialog with their clients about their concerns and preferences in order to help pregnant women access intelligent and accurate information about the safety and efficacy of such therapies during the childbearing cycle, and to avoid harmful therapies and obtain appropriate medical care as needed.

Diet, Nutrition, Exercise, Lifestyle And Psychoemotional Health: Central To Optimal Childbearing Health

Health education and preventative care through diet and nutrition, exercise, and healthful lifestyle are the cornerstones of an optimal childbearing experience that may play the most pivotal roles, outside of genetics, in shaping pregnancy health, and as a result, significantly influencing the health of the baby. In addition to routine prenatal care, attention should be given to the psychoemotional wellness of the emerging mother, her changing identity as a woman, and her changing family status. Although a presentation of diet, nutrition, exercise, and lifestyle approaches to prenatal health is beyond the scope of this edition, as is a discussion of the psychological and emotional factors that support a healthy pregnancy, the importance of these factors cannot be overstated.

Herbs As Part Of Pregnancy Wellness

Schools of thought differ on whether herbs should be used routinely — or at all — during pregnancy. Some ascribe to the belief that because most herbs have not been proven safe for use during pregnancy, they should be entirely avoided, whereas others see certain herbs more as foods that can provide an additional source of nutrition during pregnancy, or as tonics that can encourage and support optimal pregnancy health and uterine function. Many consider the choice of whether herbs are appropriate for use during pregnancy to be circumstantial, for example, dependent upon the nature of the condition being treated and the risk benefit of herbs compared with medical intervention for that particular condition. Certain conditions are beyond the scope of herbal treatment, and practitioners should be keenly aware of the symptoms that herald such conditions and indicate the absolute need for medical care (Warning / Danger Signs during Pregnancy).

Warning / Danger Signs during Pregnancy

The following signs at any stage of pregnancy suggest that there may be a problem requiring medical treatment and are beyond the scope of what botanical care can treat. A patient with any of these signs should be referred immediately to an obstetrician or midwife for assessment and appropriate medical intervention. Warning signs:

• Vaginal bleeding

• Initial outbreak of herpes blisters during the pregnancy

• Severe pelvic or abdominal pain

• Persistent, severe mid-back pain

Edema of the hands and face

• Severe headaches, blurry vision, or epigastric pain

• Rupture of membranes prior to 37 weeks pregnancy

• Regular uterine contractions prior to 37 weeks pregnancy

• Cessation of fetal movement

It can be useful to see herbs on a continuum between food and medicine. There are many herbs whose constituents are mostly benign, nutritive substances such as carbohydrates vitamins, and minerals (Table Herbs Demonstrated as Safe for General Use in Pregnancy Based on Clinical Studies). Herbs such as nettles (Urtica dioica), milky oats (Avena sativa), and red raspberry leaf (Rubus idaeus) are examples. On the other hand, there are numerous herbs whose use in pregnancy is entirely contraindicated for safety reasons. Somewhere between these categories are herbs not appropriate for daily, routine intake, but which can be used if necessary for brief or more extended periods of time for specific conditions. In addition to common complaints of pregnancy, pregnant and lactat-ing women are also subject to the run of the mill complaints and illnesses we all face — colds, indigestion, headache, etc. — for which they may seek herbal care. Many of these problems can be addressed safely and gently with the herbs listed in the following or discussed in subsections of this site.

Herbs Demonstrated as Safe for General Use in Pregnancy Based on Clinical Studies

Common Name Botanical Name Reason For Use Clinical Trials In Pregnancy Typical Daily Dose Comments
Red raspberry leaf Rubus idaeus Mineral-rich nutritive tonic, uterine tonic to promote an expedient labor with minimal bleeding. Can also be used as an astringent in diarrhea. Positive 1.5-5 g / day in tea or infusion Highly astringent herbs can theoretically interfere with intestinal nutrient absorption
Echinacea Echinacea spp. Reduce duration, recurrence of colds and URI Positive 5-20 mL tincture The dose listed here and considered safe by herbalists is higher than that used in the study by Gallo et al.
Ginger Zingiber officinalis Antinauseant,

antiemetic for nausea and vomiting of pregnancy, hyperemesis gravidarum, and generally nausea

Positive Up to 1 g dried powder / day Higher doses of ginger are traditionally considered emmenagogic

Untreated hyperemesis gravidarum in pregnancy can cause serious adverse outcomes

Cranberry Vaccinium macrocarpon Prevent and relieve UTI None identified 16-32 floz of juice / day Untreated UTI in pregnancy can cause serious adverse outcomes
Chamomile Matricaria recutita Promote general relaxation, treat insomnia, treat flatulence None identified 1-5 g / day in tea No reasonable contraindications17

Table Herbs Demonstrated as Safe for General Use in Pregnancy Based on Clinical Studies provides an overview of a number of herbs that are generally considered safe for general use during pregnancy, reasons for use, and dose. The remainder of this chapter is dedicated to common pregnancy complaints and problems, and the herbs that are often used in their treatment.