1. Physiology of Pregnancy

If you're an herbal practitioner who would like to better understand the physiology of pregnancy, I like Jane Coad's Anatomy and Physiology for Midwives. For a free resource, take a look at Open Stax Anatomy and Physiology, and the section on Maternal Changes During Pregnancy, Labor, and Birth.

For a wonderful overview of the hormonal cascade of physiological labor, see Sarah Buckley MD's Gentle Birth, Gentle Mothering or her report for Childbirth Connection, "Hormonal Physiology of Childbearing."

Specific Topics

Blood Volume Expansion
- Maryn Green of the podcast Taking Back Birth has an excellent overview of the connection between nutrition and blood volume expansion: "Pregnancy Nutrition Made Simple."

2. Working with Pregnant People

If you need an overview of herbalism and pregnancy safety, check out my blog post here on "Herbalism and Pregnancy: What's Safe, What's Not." If you work with pregnant people frequently, then I recommend having a copy of The Essential Guide to Herbal Safety by Simon Mills and Kerry Bone. Carefully check medication contraindications. Common contraindications include include blood thinners and medications for diabetes. You might also find the free online Physicians' Desk Reference handy.

You may find my pregnancy and postpartum resources page helpful for you and your clients as well. Scroll down to the bottom of this page and you'll find links to some of my useful Pinterest boards.

The following symptoms are not normal and if a client comes to you with them, you would want to direct them to their care provider right away.

First Trimester: Spotting with cramping, lower abdominal pain (especially if unilateral, with referred shoulder pain, or accompanied by symptoms of shock).

Second Trimester: Bleeding with or without cramping, gush of fluid, labor contractions, intense itchiness.

Third Trimester: Vaginal bleeding, preterm labor contractions, gush of fluid, cessation of fetal movement, intense itchiness, severe headaches, edema (swelling), pain under the right ribs, blurred vision, and just feeling awful.

3. Understanding Labs

If you offer labwork, great, but if not see if your clients can share their labs with you. In addition to the normal prenatal workup, recommend they have their Vitamin D levels checked. If they have a history of miscarriages, low milk supply, postpartum depression, or symptoms of hypo- or hyperthyroid, consider recommending a full thyroid panel (not just a TSH!). If you frequently work with pregnant people and run labwork, buy Anne Frye's Understanding Diagnostic Tests in the Childbearing Year: A Holistic Approach. It will serve you well! I am also a huge fan of Nell Tharpe's Clinical Practice Guidelines for Midwifery & Women's Health. It gives you both the allopathic and alternative treatments, as well as diagnostic protocols, risk factors, etc, and is a wonderful resource.

Taking Back Birth: Episode 5, on pregnancy labs and vital signs measurements
"Thyroid in Pregnancy: What You Need to Know," Aviva Romm
"Vitamin D Deficiency Effects on Pregnancy Outcomes: Who to Test, How to Treat, and Options for Supplementation," Christian Toscano, CPM, Midwifery Matters 2015 (supplementation guidelines addendum)

4. Challenges of Pregnancy and Birth

I strongly recommend grabbing a copy of Aviva Romm's The Natural Pregnancy Book (her children's health book is amazing too! I use both often), and if you're an herbal practitioner, then her textbook Botanical Medicine for Women's Health is essential. If you work with pregnant people, you will not regret that investment.

Matthew Wood has this quote regarding the wealth of specific herbal medicine for women's health from Native American peoples:

“By comparison, European, Chinese, and Ayurvedic medicine each contain less than half a dozen such species … [and] Very few of these Old World remedies are used to make pregnancy or delivery more free of pain and stress, while fully six of the Native American remedies are used in this fashion… We must ask, ‘what is the reason for this disparity?’ …. American Indian people imagined that such remedies existed, looked for them, and developed a materia medica for nearly every facet of female reproductive health, from puberty through the childbearing epoch to menopause. The modern Western herbalist is the bearer of this precious tradition and should be aware of the origin of these medicines and importance of maintaining knowledge about them in the face of racist supposition that the science of one culture is more sophisticated than that of others.” p. 328 The Earthwise Herbal Repertory: The Definitive Practitioner's Guide

Nausea & Vomiting of Pregnancy (NVP)

Experienced by most pregnant people
A positive indication of a healthy pregnancy
Severe form is Hyperemesis Gravidarum, requires medical care
Consider prenatal vitamin as possible factor, recommend food based prenatal vitamin. It's okay if people skip taking it if they're feeling sick, and start taking again in 2nd trimester.
Dandelion: 1-15 drops neat or in water, added to ginger tea or ginger all, or added to lemon water
Ginger: Tea, candies, capsules or ginger ale. Add 20-30 drops of wild yam tincture if ginger alone isn't working
Cannabis: Smallest possible dose that brings relief and stimulates appetite, as infrequently as possible

Anemia

Review blood volume expansion and nutritional considerations. This is really important!
Excellent nutrition is a must. Heme iron (red meat, pastured liver) is easily assimilable. Non-heme iron is less assimilable but also critical (dark leafy greens, dried fruits, sea vegetables).
Combine iron-rich foods with Vitamin C and avoid sources of Calcium within two hours of meals (ie. Tums!)
Non-food based iron supplements may cause constipation and are harder for the body to assimilate than food-based.
Dandelion & Yellow Dock Tonic:
- 1/2 ounce dried dandelion root
- 1/2 ounce dried yellow dock root
- 1/2 cup blackstrap molasses
- Put the roots in a quart jar and cover with boiling water. Let sit 4-8 hours or so. Strain into a pot and simmer off until you’re left with 1 cup of liquid. Add blackstrap molasses while still heating, then remove from heat. Store in the refrigerator. Dose is 1-2 TBS daily. Take it with 250 mg Vitamin C for best absorption. This preparation will keep refrigerated for at least several weeks. Avoid if you have blood sugar regulation issues.
Overnight infusions of nettles and/or alfalfa in a quart size jar using 1/2 cup loose herb, drink throughout the day. Add milky oats or oatstraw, red raspberry leaf, and a little spearmint for a lovely pregnancy tonic.
Supplements: Floradix, liquid chlorophyll, Megafoods Blood Builder,

Constipation

Consider synthetic iron supplement, diet (fiber? fruits and veggies?), hydration, exercise, Squatty Potty
Dandelion & Yellow Dock tinctures or tonic under Anemia
Liquid Calcium-Magnesium Citrate in PM before bed
Probiotics
Herbal laxatives are contraindicated in pregnancy! Bulk laxatives such as psyllium husk and flaxseeds are safe and effective, take with lots of water.

Heartburn

Consider digestion, posture (refer for chiropractic care), trigger foods, low stomach acidity
Commercial Antacids (Tums) contain calcium carbonate, which is poorly assimilated in the body and is deposited as calcifications in the placenta. If taken with meals, the calcium inhibits absorption of iron and other nutrients.
Papaya: Eat fresh fruit with meals or take papaya enzyme tablets with meals and bedtime
Apple Cider Vinegar: When there is low stomach acidity, add 1 tsp in 8 oz water, between meals
Slippery Elm: Thayer's lozenges, 2-4 per dose, up to 3 doses daily
Raw Almonds: Eat as snack or after meals, chewing slowly
Activated Charcoal: For occasional really bad heartburn, two capsules

Anxiety

Consider history of trauma (potentially undisclosed), history of miscarriage, negative messaging around childbirth and parenting
Consider digestion (probiotics), lack of dietary calcium and magnesium
I generally recommend tinctures instead of teas to cut down on PM bathroom trips
Nervines: Passionflower, valerian, chamomile, lemon balm, lavender
Liquid Calcium-Magnesium Citrate in PM before bed
Skullcap: 15 drops of up to 4x daily or twice before bed with a 15 minute interval between doses
Milky Oats: Drink regularly as part of a pregnancy tonic, or 1/2 tsp tincture in pm
Mitchella (Partridge Berry): Traditional partus preparator that eases anxiety. Use in third trimester. One cup of tea daily (1 tsp herb steeped 10 minutes in boiling water).
Epsom Salt Baths with lavender oil

Blood Sugar Dysregulation

Blood sugar is tested at 28 weeks after consumption of sugary dextrose beverage. Checks for proper pancreatic function. If blood sugar is > 135, diagnostic testing is the next step.
Gestational diabetes (GD) is a abnormal blood sugar imbalance caused by placental hormones and may require insulin treatment.
Consider previous history of GD, familial history of GD or diabetes, diet rich in carbohydrates, exercise, BMI, Vitamin D deficiency
Be cautious or avoid using herbs if someone is on medications for diabetes, they may bring blood sugar too low.
Dandelion (tincture, not molasses tonic!)
Gymnema: 1/2 tsp fluid extract daily
Ceylon Cinnamon: 1/4-1/2 tsp powder daily
Apple Cider Vinegar: 1-3 tsp in water before bed, start with lower dosage and move up as needed. Helps to reduce fasting blood sugar (article).

Varicosities & Hemorrhoids

Consider nutrition
Recommend Vitamin C with bioflavonoids and foods containing rutin, especially berries, topical arnica on legs
Bilberry Extract: Also helpful for hypertension. 3 doses of 160-340 mg daily.
Nettles as part of pregnancy tonic

Hypertension

High blood pressure in pregnancy (> 140/90 represents a serious medical condition and requires medical treatment.
Herbal support is especially useful where there is a history of hypertension in pregnancy and/or when blood pressure starts to creep up.
Foods: Watermelon, cucumber, parsley, raw onions, garlic, olive oil, flaxseed oil, fish oil, berries, cacao
Consider nervines and liver support
Liquid Calcium-Magnesium Citrate in PM before bed
Bilberry Extract: 3 doses of 160-340 mg daily.

Post-Dates Pregnancy

Medical induction of labor is common, and people feel pressured by providers to induce.
There are some good medical reasons to induce labor before term (pre-eclampsia, for example)
Bishop Score - Quantitative assessment of cervical ripeness
Evidence Based Birth: "Evidence on: Due Dates"
Evidence Based Birth: "Evidence on Using Castor Oil for Labor Induction"
Evidence Based Birth: "Natural Labor Induction Series: Eating Dates"
Consider: anxiety, inaccurate due dates, hx of PCOS or other hormonal disregulation
Cotton Root Bark: This should be administered by a qualified midwife who can listen to the baby.
- Augustine Colebrook, CPM: For induction of labor 10 mL CRB (2 dropperfuls) q30 mins twice, then 5 mL CRB q30 for a total of 7 hours, monitoring q60 until ctrx start, then q30, then q20 with active labor. Discontinue in 2nd stage.
- For the important history of Cotton Root Bark as an abortifacient, and to learn more about the history of medicine of enslaved people in the United States, read Karen Culpepper: "Deep Medicine: Cotton Root Bark and Reproductive Justice" and "Gossypium app (Cotton Root Bark): A Symbol of Herbal Resistance"
- Also useful as a galactagogue to promote milk letdown

Postpartum Hemorrhage

Angelica: For retained placenta, 1-2 dropperfuls (5-10 mL) under the tongue or in 1 oz water
Cotton Root Bark: For retained placenta or PPH, 1 dropperful (5 mL) under the tongue or in 1 oz water
Shepherd's Purse: For PPH, 1 dropperful under the tongue or in 1 oz water. Some recommend not using it before the placenta comes, to avoid forming large clots that may contribute to bleeding.

There are lots of other topics that I didn't cover, from miscarriage to Group B Streptococcus. For more information on topics that interest you specifically, please refer to the texts I mention throughout the notes, but especially Aviva Romm's Botanical Medicine for Women's Health.

Midwives' Medicine Basket

Krystina Friedlander, June 3rd, 2018