In Partial Fulfillment of Herbal Therapeutics Course Requirements
Pregnancy is the carrying of one or more offspring, with normal gestation being 37-42 weeks after the last normal menstrual period, or 40 weeks in a woman who normally has a cycle length of 4 weeks. The duration of pregnancy is usually termed in “Trimesters”, with the first trimester occurring until the end of week 12, the second trimester ending at the week 29, and the third trimester occurring until childbirth, or around 40 weeks.
During the first trimester, most women feel the worse, as nausea and other symptoms may be more prevalent for them during this time. This is because the pregnancy hormones, which begin to soar right away in pregnancy, are mostly manufactured by the woman’s pituitary gland. Around week 10, the placenta largely begins to takes over the manufacture of these pregnancy hormones and the pregnant woman often begins feeling much better at this point. During the first trimester is when the risk of miscarriage is the highest as well, and the chances of miscarriage begin to drastically drop off around week 10.
Also, during the last trimester of pregnancy there are a number of other symptoms/discomforts that are common, as the body gets heavier and circulation is more difficult in the body. One of these discomforts is the swelling of the feet and ankles due to more taxed circulation.
Pregnancy complaints/symptoms usually vary by the time in pregnancy, so too, herbal care during pregnancy should take account to when during pregnancy the discomfort is experienced and why. Below is an overview of some of the most common complaints or symptoms of pregnancy for which herbal care may be appropriate.
Table 1. Pregnancy Progression
Source: Wikipedia: http://en.wikipedia.org/wiki/File:Prenatal_development_table.svg
Basic Herbal Approach
Herbs should be employed carefully and consciously during pregnancy to make sure the benefit outweighs the risk, just as the use of any pharmaceutical or medical intervention in relation to a non-pregnant person. In this respect, it is best to avoid the use of herbs as therapeutic agents (or other medications) during pregnancy unless needed, especially during the first trimester. However, there are several “herbs” that are safe enough to be considered foods, and others that have a well-established (through use by midwives and pregnant women) nutritive function during pregnancy, and these can be used safely.
A Note about Herbal Research in Pregnancy
One of the most misleading aspects of choosing herbal care during pregnancy is the fact that most herbal reference texts and herbal products commonly skirt the issue of safety during pregnancy by simply stating a person should ‘consult their healthcare professional before using during pregnancy’ or they say that due to a ‘lack of research’ on a particular herb, that it is not recommended for pregnancy. This is misleading, and rather annoying, as it does not give the mother-to-be any information about why it may not be recommended, it is simply passing the responsibility on to either the healthcare professional or disregarding what could be a useful and safe alternative for herbal care during pregnancy because they have not done their homework and have no basis on which to form an opinion or educate.
That being said, there is very little research on the use of most herbs in pregnancy, and so it is important for a woman or doctor to decide if they will not use herbs just because of the lack of safety studies in pregnancy—some practitioners and women will take this viewpoint, and it is a ‘conservative’ approach, as it goes along with western medical thought. However, it may not be ‘conservative’ when viewed at what might be the alternatives that are taken by women for relief of common pregnancy discomforts. The next place people look for information on the use of herbs during pregnancy is from herbal tradition and midwives. There are a number of herbs that are commonly used during pregnancy, such as raspberry leaf tea and nettles that have very little research associated with them, but a long tradition of use by pregnant women themselves. Therefore, it is important for a woman to make up her own mind about how much assurance they want before using an herb.
Herbs have a nutritive function in pregnancy beyond their use in soothing common discomforts. Women have many needs from their nutrition when they are growing a baby, and it is well-accepted that women should take a prenatal vitamin and mineral supplement before and during pregnancy. Also very important for women is to supplement with omega-3 fatty acids, such as DHA, as there is plenty of research that links DHA with better outcomes for both baby and mother. There are herbal sources of omega-3 fatty acids, such as flax seeds that are safe to consume during pregnancy, and may be ground up and included in food.
Herbs for Iron
Iron during pregnancy is important because approximately 20% of women become deficient while pregnant. During pregnancy the body produces about 50% more blood than usual, so it is easy to understand why iron demands are so high.
Despite what many think, herbs and vegetables can be good sources of iron, it is not necessary to be eating large amounts of meat to obtain iron. Good sources for iron during pregnancy include raspberry leaf tea, nettle leaf tea, peppermint, dandelion, fennel, ginger, prunes, rosehip, and blackstrap molasses. A wonderful brand-name product that has been on the market for a long time and used by pregnant women is Floradix -Iron + Herbs. In order to increase absorption of iron, it is also important to consume enough vitamin C.
A nice herbal iron formula would be to combine the following herbs and make a nutritive vinegar with equal parts: yellow dock, nettles, dandelion root + leaf, and apricots (unsulfured).
Herbs for Vitamin C
Vitamin C is important for several essential functions for you and your baby, including tissue repair, wound healing, bone growth and repair, healthy skin, and helping the body to fight infection. There are several good herbal sources of vitamin C, including rose hips, camu camu, acerola, alfalfa, peppermint, horsetail and raspberry leaf. It is easy to obtain the vitamin C you need in foods and herbs, so it is not necessary to supplement separately with it.
Red Raspberry Leaf
Some call red raspberry leaf tea the supreme herb for pregnancy. It is thought to strengthen the uterine wall, relax smooth muscle, and help to make delivery easier and speedier by helping the uterus contract more efficiently. Red raspberry leaf tea also contains a number of nutrients that are helpful for pregnancy, including calcium, iron and B vitamins.
Some medical professionals make reference to a possibility of red raspberry leaf bringing on miscarriage. This is due to a study back in the 1950’s where fractions of the raspberry leaf were isolated and tested in vitro to the uterine tissues of guinea pigs and frogs. Spasmolytic and uterine contractions were caused by separate fractions. However, this is common for studies on purified fractions of herbs to find contraindications that may not be a problem in the whole plant. A newer study (from 2010) found that the ability of red raspberry leaf preparations to augment uterine contraction was variable and dependant on the type of herbal preparation used, and they concluded that their results do not support the hypothesis that red raspberry leaf augments labor by a direct effect on uterine contractility. Some women prone to miscarriage and due to this research (the first more cited study) choose not to consume red raspberry leaf until later in the pregnancy or after the first trimester.  
Nettle Leaf Tea
Nettle contains vitamins A, K and C, as well as calcium, iron and potassium. It is best used in dried form and made into a nutritive tea for use during pregnancy. Nettle is another one of the herbs for which there is confusion or misinformation passed around about whether or not it might have a uterine contracting effect during pregnancy, so many doctors will not recommend it do this. However, it should be clarified that it seems to be the dried nettle that is used in pregnancy for its nutritive effect, not the fresh plant, as the fresh plant may have concerns on stimulating uterine contractions (but yet this is also not certain). The American Pregnancy Association explains that many herbalists and midwives use and recommend stinging nettle tea for its vitamins and minerals, yet the Natural Medicines Database gives it a rating as possibly unsafe.
Common Discomforts/Conditions of Pregnancy & Herbs
Nausea is the most common (experienced by up to 90% of women) during the first trimester as the pregnant woman’s body is getting used to the hormones produced in the body, and while the pituitary gland is producing the hormones. It is thought that nausea is more commonly experienced by some women especially while they are low in blood sugar, or after a period of fasting, such as in the morning (after sleeping all night and not eating). Therefore, one of the common suggestions for nausea is for women to eat something, especially something that will not upset their stomach, first thing in the morning (like a saltine cracker), perhaps before even getting out of bed.
One of the most famous herbs for nausea in general is ginger. This is one of the herbs that is safe and could be classified as food, as well, and can be useful during pregnancy. Another wonderful thing about ginger is that it comes in so many useful forms. It may be used as a warming herbal tea (just decocting ginger in water), it may be eaten as a food (eg. Candied ginger is great for this), and it may also be used in essential oil form. When using as an essential oil, a woman may only need to sniff the ginger scent to help her to hold back her nausea. In some stores, ginger is available in an herbal nasal inhaler form, which can be a very portable and safe way for a woman to have it ready for use at any time.  If ginger seems not to do the trick, peppermint or peachleaf tea can be tried.
Swelling in the extremities—especially in the feet and ankles—is a very common symptom of pregnancy, which usually is experienced and gets worse during the third trimester. Minor swelling during pregnancy is considered normal. Most of the first actions to take while combating prenatal swelling are physical: avoid standing for long periods of time; avoid going out during hot climate conditions; don’t wear too tight pants or socks (esp. socks with bands), as these inhibit circulation; change positions while sleeping frequently; go out and get some exercise, as circulation is improved with exercise. If the hands or face swell, or if swelling is more on one side of the body than the other, it is recommended to notify the health care professional, as it could be a sign of preeclampsia or another condition.
A couple Ayurvedic recipes involve the use of safe kitchen spices: 1- a few tablespoons of coriander in two cups water (boiled to one cup, and taken throughout the day, if desired with sugar and milk); 2- tea of fennel and palm sugar (2 cups water, 1 tsp palm sugar, 2 tsp fennel seeds; boiled until one cup remains) taken throughout the day.
Although there is not much research on the use of Poria mushroom for use in pregnancy, it is a common herb used in Traditional Chinese Medicine (TCM) for reducing edema, and is often used in pregnancy.
Other suggestions involve eating bitters, such as dandelion greens, which help the body metabolize fluids, eating extra garlic and onions, as it is known to promote good circulation, and eating foods that are natural gentle diuretics, such as celery, artichokes, parsley, and grapes.
Heartburn is another common discomfort during late pregnancy, as the internal organs, including the stomach, have less space due to the large developing fetus, and because the pregnancy hormones slow down digestion. It can be experienced earlier in pregnancy, but as the hormone levels rise and pressure on the stomach increases, usually so does the incidence of heartburn. Heartburn is just another term for indigestion, usually experienced as a burning sensation that starts in stomach and rises to the throat.
Common sense treatments include eating smaller meals throughout the day instead of three large meals; eating slowly, not lying down directly after eating; avoiding eating fried, spicy or rich foods, and avoiding mixing fatty and sweet foods together during meals. Conventional treatments include antacid heartburn relievers, such as Tums, Maalox, Titralac, Mylanta, Riopan, and Gaviscon.
A tea of chamomile or peppermint is useful in decreasing acid and soothing the digestive system, and is commonly thought to be safe during pregnancy. Prune juice (a small cup morning and night) is a safe and effective way to get the digestive system functioning, and can help heartburn if intestinal motility is a factor in the mother-to-be’s heartburn symptoms. Other dietary approaches for heartburn include eating carrots, apples, and lemon juice, which contain vegetable acids that can help to neutralize stomach acid.
Sensitive Teeth + bleeding gums
Another common symptom during pregnancy is sensitive teeth and the bleeding of the gums. It is important that if there is excessive gum bleeding that the mother-to-be visits the dentist or doctor about this problem, as it could affect the health of the baby and delivery. However, it is normal that as circulation and the supply of certain hormones increase in the body that there may be tenderness, swelling and bleeding of the gums.
The use of a soft toothbrush and toothpaste for sensitive teeth are often first measures to take with sensitive teeth. It is also good to eat foods high in vitamin C, such as lemons, oranges, limes, kiwis, and mangos. Camu camu is a ‘super fruit’ from the Amazonian regions that is one of the highest sources of vitamin C. Camu camu can be taken in supplement form, or as a food, such as a beverage.
Fatigue is another common symptom of pregnancy that often hits women starting in the first trimester, and can endure throughout the pregnancy. A certain amount of fatigue is normal and to be expected during pregnancy, as growing a baby takes extra energy and may make the mother-to-be feel tired! As getting enough rest and sleep is important at any time for our health, it becomes mandatory for a good pregnancy and to care for the growing baby. Regular exercise is also important during pregnancy, as it can help reduce the risk of developing discomforts and problems during the pregnancy.
When fatigue becomes severe, it is important to visit a doctor to find out if anemia is present. Normally, prenatal care includes a normal program of testing the blood for presence of anemia (low iron in the blood). If anemia is not present in the beginning of the pregnancy, this does not mean that it will not become a problem later, and normally if it does show up during the pregnancy it usually happens by around the end of the second trimester. If anemia is present, or simply to prevent fatigue, it is possible to increase the intake of foods and herbs that are high in iron (see nutritive recommendations above).
Difficulty Sleeping/ Insomnia
Finding a comfortable sleeping position may become difficult in later pregnancy. It is generally not recommended that women lie on their backs during mid-late pregnancy, as this can result in decreased circulation to the mother and baby. Sleeping on the left side of the body, supported by pillows, is thought to be the optimal sleeping position.
It is not recommended for mothers-to-be to take sleep medication. A little warm milk may be all that is needed before bedtime to help induce sleepiness. Teas of chamomile, lemon balm, oat straw and marjoram may have a relaxing effect on the mother, and are safe during pregnancy. Essential oils may also aid in relaxation and sleep, such as lavender placed on an herbal pillow.
Hormones as well as taking certain vitamin supplements, such as iron, may cause constipation. Pressure on the rectum by the uterus may also cause constipation. Another factor is that some women who are regular consumers of coffee or caffeine-containing beverages may find that they have become somewhat dependent on their caffeine-consuming rituals for regular bowel function, and may result in constipation if this ‘ritual’ is stopped or altered, as most feel it is important to cut back on caffeine consumption during pregnancy.
Doctors generally now are saying a low level of caffeine intake during pregnancy is ok (like one cup daily), so if a disruption of caffeine consumption is causing constipation, then perhaps continuing with decaf coffee or a small amount in the morning could be enough to get the bowels moving. Preferably, it is best to decrease or eliminate caffeine and to adopt other strategies for helping digestive motility, such as: adding more fiber to the diet, drinking plenty of fluids, and drinking warm liquids in the morning, exercising daily. A safe natural laxative is a small cup of prune juice in the morning and evening, and this could be enough to make the system regular. Psyllium fiber is also thought to be safe during pregnancy.
Hemorrhoids are swollen veins that are like painful lumps on the anus. They are a frequent symptom of pregnancy due to increased circulation and pressure on the rectum and vagina due to the growing baby. One of the fist things that should be avoided when hemorrhoids are a concern is constipation, as constipation can cause hemorrhoids and also make them more painful. Other things to avoid is sitting or standing for long periods of time, straining during bowel movements. Ice packs can be used on the area to help with the pain, or a warm bath may also provide relieve. It is also recommended to avoid wearing tight-fitting underwear, pants or pantyhose.
Herbal treatments like above may help with relieving constipation and therefore hemorrhoids. Longer term use of other herbs, such as those high in bioflavonoids (like bilberry) and other antioxidants, can help increase general vein health and therefore prevent conditions such as hemorrhoids and varicose veins. For relief of the pain and swelling of hemorrhoids during pregnancy, aloe gel applied topically can sooth the sore rectum, as well as the use of homeopathic calendula ointment, or a calendula salve.
Leg cramps during pregnancy are another common complaint and can occur due to both the increasing pressure of the growing uterus, as well as imbalances or deficiencies of certain minerals like calcium and potassium.
There are some physical measures that can be taken to reduce the potential for leg cramps: wear comfortable shoes, elevate the legs when possible, exercise daily, stretch the legs before going to bed, avoid lying on the back, massage on the legs and feet, foot and leg warm baths or hot water bottles. Secondly, it is important to consume foods rich in calcium, such as milk, broccoli or cheese.
Red raspberry leaf is a long-used herb in pregnancy as a nutritive and tonic for the female system. It also is a good source of calcium—even when consumed as a tea. A tea made of any of the following herbs is reported to contain 250-300 mg of calcium per cup (1 ounce of dried herbs steep in 1 quart of water for 4 hours): Raspberry leaf (Rubus idaeus), nettle (Urtica dioica), oatstraw (Avena sativa) and chickweed (Stellaria media).
Pregnancy definitely makes the skin of the body stretch to proportions that it is not normally used to, and the result for some women is stretch marks. They are a type of scar tissue that forms when the skin’s normal elasticity is not enough for the stretching that is required of the skin—they can normally appear on the abdomen, breasts, buttocks or thighs, and although they normally will not disappear completely, they will fade after delivery. According the conventional theories, they occur to the surface under the skin and so they are usually not preventable. However, there are a number of herbs and oils that can help to deeply moisturize the skin, such as aloe vera gel, shea butter, and cocoa butter. Additionally, including in the diet vitamins and minerals that nourish the skin can be important, such as vitamin A, vitamin C and vitamin E. Herbs such as nettle and horsetail are known to be nutritive to the skin and can be taken in tea form or supplements.
Stretch marks are a type of scar tissue that forms when the skin’s normal elasticity is not enough for the stretching required during pregnancy. They usually appear on the abdomen and can also appear on the breasts, buttocks or thighs. While they won’t disappear completely, stretch marks will fade after delivery. Stretch marks affect the surface under the skin and are usually not preventable.
Just as there are 3 phases of pregnancy—the three trimesters—and there are also 3 stages of labor: the first stage is when the cervix is ripening, the second stage is from full dilation through the pushing and delivery of the baby, and the third stage of labor is the delivery of the placenta.
Leading up to the delivery, a formula can be taken to help ready the woman’s body for a smooth childbirth. This formula is called a “parchuriant formula” and the below example should be taken in the amount of ½ tsp, 3 times a day starting at about 36 weeks of pregnancy.
3 parts- Michella (Partridge berry)
2 parts- Viburnum prunifolium
1 part- Cimicifuga
In early labor a formula may be taken to help tonify the women’s uterus and act as nerviness as well: 1 part raspberry leaf, 1 part Mitchella, 2 parts chamomile, and 3 parts passionflower.
After the delivery of the baby to help expel the placenta, goldenseal may be taken, or some midwives recommend a simple glass of red wine. After the delivery a soothing and astringent herbal sitz bath with rose petals can help the mother to heal.
Another formula may be taken after the birth to help normalize the hormones, protect against postpartum depression, stabilize the pituitary gland and ease transitions, which is 1 part Vitex, 1 part Melissa, 2 parts Crataegus, and ¼ part fennel.
Herbal care during pregnancy is a broad topic, yet there are many simple and gentle herbal approaches that can ease the common discomforts of pregnancy and help nourish the body and growing baby.
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 Jing Zheng, Pistilli MJ, Holloway AC, Crankshaw DJ. The effects of commercial preparations of red raspberry leaf on the contractility of the rat’s uterus in vitro. Reprod Sci. 2010 May;17(5):494-501. Epub 2010 Mar 10.
 Ebrahimi N, Maltepe C, Einarson A.Optimal management of nausea and vomiting of pregnancy. Int J Womens Health. 2010 Aug 4;2:241-8.