Botanical Treatment For Miscarriage: Threatened And Habitual
This section provides botanical strategies for miscarriage prevention in the event of threatened miscarriage (Table Botanical Treatment Strategies for Miscarriage Prevention in the Event of Threatened Miscarriage and Habitual Abortion), and basic support for habitual abortion when resulting from progesterone insufficiency. If fetal demise has been confirmed by ultrasound, readers may follow the protocol in the example in the case history at the end of the chapter. When there is incomplete or missed abortion, special attention needs to be given to the risk of infection and subsequent coagulopathy. Women who miscarry are at some increased risk for post-miscarriage anxiety and depression. Emotional support during and after a miscarriage, as well as during a subsequent pregnancy, is often necessary. Botanical treatments for postpartum depression can be extrapolated for use when needed.
Botanical Treatment Strategies for Miscarriage Prevention in the Event of Threatened Miscarriage and Habitual Abortion
|Therapeutic Goal||Therapeutic Activity||Botanical Name||Common Name|
|Relieve uterine contractions||Uterine antispasmodic||Viburnum opulus||Cramp bark|
|Viburnum prunifolium||Black haw|
|Dioscorea villosa||Wild yam|
|Increase progesterone||Progesterogenic||Vitex agnus-castus||Chaste berry|
|Improve uterine tone||Uterine tonics||Chamaelirium luteum||False unicorn|
|Mitchella repens||Partridge berry|
Warning: Appropriate treatment / prevention of miscarriage requires specialized obstetric knowledge and may require hospitalization, particularly if there is cervical length shortening or cervical dilatation when the fetus is close to a viable age, or if there is excessive bleeding. Miscarriage can lead to maternal hemorrhage, and if left incomplete, maternal infection. The care of an obstetrician or midwife should be sought in conjunction with botanical care for the treatment or prevention of miscarriage.
Herbalist / Midwife Protocol for Habitual Miscarriage
This formulae is to be begun 3 months prior to conception and continued until at least 2 weeks past the latest week’s gestation of previous miscarriages (e.g., if a previous miscarriage occurred at 8 weeks, continue the formula until at least 10 weeks).
|Chaste berry||(Vitex agnus castus)||50 mL|
|Cramp bark||(Viburnum opulus)||30 mL|
|Partridge berry||(Mitchella repens)||20 mL|
Total: 100 mL
Dose: 5 mL twice daily
Herbalist / Midwife Protocol for Threatened Miscarriage with Cramping as the Primary Symptom
|Cramp bark*||(Viburnum opulus)||70 mL|
|Wild yam||(Dioscorea villosa)||30 mL|
Total: 100 mL
Dose: 3 to 5 mL every 30 to 60 minutes for up to 4 hours depending upon severity and regularity of cramping. This protocol can be repeated up to twice daily for three consecutive days.
*Black haw (Viburnum prunifolium) may be used interchangeably with cramp bark.
Whenever possible in the prevention of habitual miscarriage, the practitioner will want to try to establish an etiology. When it is not possible to establish an etiology for recurrent miscarriage, a thorough personal and medical history often provide clues to the direction the practitioner will take in establishing an herbal protocol. Both the etiology and botanical treatment of habitual miscarriage are often complex. Unfortunately, emerging theories and understanding of the immunologic, endocrine, and thrombopathic bases of miscarriage are often more advanced than can be matched by current research on botanicals. Most current protocol for miscarriage are based on traditional uses. This section highlights miscarriage prevention with uterine irritability and progesterone insufficiency, which is treated with long-term use of chaste berry (Vitex agnus-castus) begun several months prior to conception and continued until several weeks past the time of prior miscarriage, and accompanied by cramp bark or black haw, and wild yam once pregnancy is established to prevent cramping. Uterine tonic herbs, particularly partridge berry (Mitchella repens) and false unicorn root (Chamaelirium luteum), are commonly included in formulae as well. False unicorn is an endangered herb, therefore, it is recommended to use only cultivated sources. Traditional Chinese medicine can play an important role in miscarriage prevention when there is habitual abortion, as its constitutional diagnostic model and corresponding herbal and dietary protocol can be specifically tailored to a woman’s constitution and imbalances.
In case of threatened miscarriage, the Western herbal practitioner will need to address commonly overlooked factors, such as overwhelming stress, dehydration, or malnutrition. Urinary tract infection (or other infection) should be ruled out, and if present, treated. Women should attempt to achieve an optimal body weight prior to conception with underweight women, particularly trying to bring their weight to within a normal body mass index to ensure adequate hormone production. Herbs can be used primarily to reduce uterine contractions associated with threatened miscarriage. The most commonly used herbs include cramp bark, black haw, and wild yam, either alone or in combination.
Black Haw, Cramp Bark, and Wild Yam
When there is uterine cramping in the absence of cervical dilatation, cramp bark (Viburnum opulus) and black haw (Viburnum prunifolium) are used to arrest uterine spasm. These herbs, which can be used interchangeably or together for this purpose, have a long history of use as spasmolytics during pregnancy, especially for miscarriage, dating back well over a hundred years by Western herbalists, and even longer by Native American tribes. Black haw was official in the United States Pharmacopoeia in 1882, its uses as an antispasmodic and preventative for miscarriage popularized by the Eclectic physicians. Cramp bark is included in the British Herbal Pharmacopoeia and is used by herbalists in the United Kingdom for miscarriage prevention. The active principles are unknown; however, it is thought that at least four active substances, including scopoletin and aesculetin, which have been identified, have uterine spasmolytic activity.
Another herb with a long history of use for relieving uterine contractions is wild yam (Dioscorea villosa). Although this herb has developed the erroneous reputation for use as a progesterone supplement, wild yam in fact contains no progesterone, nor can it be converted by the body into progestogenic substances. However, this does not preclude its efficacy and reliability as a uterine antispasmodic, combining well both cramp bark and black haw; although, no research was identified that either supports or refutes its traditional uses.
Chaste tree (Vitex agnus-castus) is used by midwives and herbalists to prevent miscarriage associated with low progesterone, where it may exert its effects via enhancing corpus luteum function. Although researchers are still uncertain as to the exact mechanism of action of vitex it appears to having a regulatory effect on luteinizing hormone (luteinizing hormone), follicle-stimulating hormone (follicle-stimulating hormone), and progesterone, as well as the ability to reduce elevated prolactin levels via dopaminergic activity, and has shown positive effects in improving premenstrual syndrome symptoms and luteal phase defects. It is used alone and in conjunction with topical USP progesterone when the latter is prescribed by an obstetrician or midwife for miscarriage prevention. Placebo-controlled studies for teratogenicity and mutagenicity were conducted in rats, and even when the animals were administered 74 times the dose typically consumed by humans, no toxicity nor aberrations in fetal development were seen. Although it is sometimes given acutely, for the herb to have efficacy as a miscarriage preventative, it is ideally given for at least 3 months prior to conception and continued well into the first trimester to maintain stable progesterone levels. The most recent edition of the Botanical Safety Handbook provides no contraindications to use during pregnancy.