As every pregnant woman approaches the last weeks of pregnancy they can’t help but start thinking of ways to bring on labour and get the chance to meet their baby sooner.

A pregnancy is considered full term at 37 weeks and the techniques discussed in this article should not be started until after this point.  Some women choose to wait until 40 weeks, or their due date to begin trying to naturally induce labour.

Below are suggestions for natural labour induction methods that can be attempted at home and also those that should only be administered by a qualified Naturopathic Doctor.

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Techniques for Natural Labour Induction at Home

1.     Sexual intercourse

One of the simplest methods of inducing labour (if you’re up for it!)  The prostaglandins in semen can help with the dilating and effacing (thinning) of the cervix.  If you are able to achieve orgasm this can further open the cervix.  Additionally, sex can trigger the release of oxytocin, the ‘contraction’ hormone.  Sex, even this late in pregnancy, is perfectly safe for both the mother and baby.

2.     Nipple stimulation

Stimulating the nipples (manually or with a breast pump) can lead to increased frequency and strength of contractions.  Stimulating the nipples causes the release of oxytocin, the same hormone that is responsible for uterine contraction.  This technique is best done if you are already experiencing infrequent contractions, labour has stalled or you are several days past your due date.  There are several methods that are suggested:

i.   firm pressure of nipple with fingers for 2 minutes, rest for 3 minutes.  Repeat for 20 minutes.

ii.  15 minutes of firm nipple (including the areola) stimulation (alternating breasts midway through) each hour for several hours in a row.

3.     Exercise

Sometimes the best technique for inducing labour is encouraging the baby to assume the best position for labour and delivery.  Exercise, such as walking, swimming, belly dancing, or some yoga movements can help descend a baby into the pelvis and apply the necessary pressure on the cervix for dilation to occur.

4.     Pineapple

Fresh pineapple is a rich source of bromelain, an enzyme that some people think can encourage ripening of the cervix and bring on labour.  Eat fresh pineapple daily, juicing and canning pineapple destroys the bromelain.  Caution: large amounts of pineapple can contribute to heart burn or diarrhea in some people.

5.     Castor Oil

One of the oldest methods of bringing on labour, it is one that I don’t personally recommend unless you are past your due date.  Castor oil works by irritating the digestive tract and having purgative (vomiting) and laxative (diarrhea) effects.  This over-stimulation of the digestive tract also results in stimulation of the uterus and can be effective in bringing on labour.  However, many women would prefer not to be experiencing diarrhea or vomiting in their early labour.  If you choose to use castor oil start with smaller amounts (1-2 tablespoons) and mix with a nut butter (such as almond butter) to provide  some fat and protein to lessen the negative effects of the castor oil.

6.     Evening Primrose Oil

Evening primrose oil is a rich source of prostaglandins and can support the thinning and dilation of the cervix.  Gel caps are easily available in health food stores.  Insert 3 capsules as close to the cervix as possible each night at bedtime (wear a pad to bed in case there is a slight discharge.)

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Techniques for Labour Induction Provided by a Naturopathic Doctor

7.     Red raspberry leaf tea

A botanical that is well known for it’s uterine tonifying properties.  It promotes stronger contractions of the uterus and is often used throughout the entire third trimester to ‘work out’ the uterus and get it ready for labour and delivery.  It is unlikely to induce labour on its own, but when used in combination with other methods it can speed up the progression of labour and promote strong, healthy contractions.

8.     Botanicals – blue cohosh and black cohosh

Blue cohosh (Caulophyllum thalictroides) and black cohosh (Cimicifuga racemosa) are uterine tonifying herbs.  They are known to cause contraction of the uterus and are thus contraindicated for use in early pregnancy.   They may be used in certain circumstances to stimulate labour and promote strong and regular contractions.  These herbs should never be taken without proper medical supervision from a qualified Naturopathic Doctor, midwife or obstetrician.

9.     Homeopathic Remedies

Homeopathic remedies are small doses of more potent substances and, as a result, are very safe for use during pregnancy, labour and delivery.  They are considered much safer than botanical remedies – no published studies exist showing any harm to the mother or fetus after use of homeopathics in pregnancy and labour.

The most common homeopathic remedies used to induce labour are pulsatilla, caulophyllum and cimicifuga.  Homeopathic remedies are taken by mouth at regular intervals to induce labour.  Dosages vary – contact your Naturopathic Doctor for an individualized plan.

10. Acupuncture

Acupuncture has been used for centuries to treat conditions associated with pregnancy (such as heart burn, nausea, and carpal tunnel syndrome) as well as for inducing labour.  Acupuncture to stimulate labour can be begun after 37 weeks gestation and is administered from once per week to once per day, depending on the desired outcome.  When performed after the due date, acupuncture has been shown in studies to have a success rate of up to 88% in starting labour.

Specific points are used to stimulate and strengthen uterine contractions, promote proper fetus positioning and encourage the downward movement of Qi (energy) which can bring on labour.

All published studies have shown acupuncture to be safe for both mother and fetus when applied by a qualified practitioner.  Be sure to find someone who is experienced in perinatal acupuncture protocols and techniques.

Your Naturopathic Doctor can also teach you proper acupressure techniques for you, or your birth partner, to administer to induce labour or manage pain during labour and delivery.

Remember, although most of these methods are safe and can be effective in encouraging labour in full-term pregnancies, it is important to make sure your primary health care provider (e.g. midwife or obstetrician) has given you the go-ahead for trying to induce labour.  There are some instances where waiting is the best approach for both mother and baby.

Also be sure any practitioners (Naturopathic Doctors, homeopaths, herbalists, acupuncturists, etc.) are fully qualified and knowledgable in pregnancy and labour.  Not all practitioners have the same level of experience – ask questions and only work with practitioners you have confidence in.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

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Every pregnancy is different.  Sometimes VERY different!  When I was pregnant with my first child I had few symptoms (aside from some swelling in my third trimester) and felt vital and healthy for the entire 9 months.  This time around, things are different – and uncomfortable!  I have been having heartburn.

What is heartburn?

Heartburn (also known as indigestion, acid reflux or gastroesophageal reflux disease – GERD) is a burning sensation in the esophagus and can have a number of different associated symptoms:

• Burning sensation in the chest and throat
• Sour, acidic taste in the mouth
• Pain behind the breastbone or between the shoulder blades

Why does heartburn happen in pregnancy?

For a lot of women (me included!) heartburn is first experienced during pregnancy.   About half of all pregnant women experience heartburn.  It can occur at any stage but is most common during the second half of pregnancy.  Hormonal and physical changes both contribute to symptoms of heartburn in pregnancy.

• During pregnancy, the placenta produces the hormone progesterone which relaxes smooth muscles.  Great for the uterus, not so great for the lower esophageal sphincter (LES) – the valve that separates the esophagus from the stomach.  This relaxation allows gastric acid to reflux up into the esophagus, causing painful burning sensations.  (FYI: this progesterone increase also contributes to constipation in pregnancy.)
• Later in pregnancy, your baby grows larger and takes up more space in your abdomen.  This pushes upwards on the stomach and forces some stomach acid up into the esophagus.

What can I do about it?

There are many things you can do to manage your heartburn and decrease discomfort.  You don’t need to suffer!  Start with the lifestyle and diet changes, and if they are not effective consider trying some of the other options presented or see a Naturopathic Doctor for an individualized plan.

Dietary Changes

• Avoid known heartburn triggers.  These are different for everyone but may include carbonated drinks, chocolate, caffeine, citrus fruits, tomatoes, mustard, vinegar, mints, spicy foods, fried or fatty foods.
• Eat small meals frequently.  Avoid eating large meals and be sure to chew each bite thoroughly (allowing the digestive enzymes in your mouth to do their job.)
• Limit beverages at mealtime.  Water and other fluids can distend the stomach and force food (and acid) up into the esophagus.
• Try a sugar-free chewing gum.  This will increase saliva production which can help neutralize acid.  (Note – you may need to avoid mint gums if mint is a trigger for your heartburn.  I find this tip very helpful when heartburn strikes suddenly – and inconveniently – while I’m at work or away from home.)
• Don’t eat right before bed.   Wait two to three hours after eating before lying down.

Lifestyle Changes

• Sleep with your upper body elevated with several pillows or a sleep wedge.  This will allow gravity to do its work and keep stomach acid where it belongs.
• Gain weight sensibly.
• Wear comfortable clothing that does not constrict your waist and abdomen.
• Sit upright rather than slouching.
• Don’t smoke.  If you haven’t quit before pregnancy, book an appointment to discuss your habit with your Naturopathic Doctor now.

Medications and natural remedies for heartburn in pregnancy

For some women, lifestyle and dietary changes are not enough to manage heartburn symptoms in pregnancy.  In these instances a supplement or over-the-counter medication may provide the additional relief needed to get through the full nine months of pregnancy.

Over the Counter Medications

In general I don’t recommend over-the-counter antacids during pregnancy because they don’t address the cause of heartburn (relaxation of the lower esophageal sphincter) but rather function to neutralize stomach acid – a substance that has important digestive properties.

Additionally, some over-the-counter antacids contain aluminum or aspirin (such as Alka-Seltzer) or are high in sodium – all of which are not appropriate during pregnancy.

Generally speaking, the occasional Tums or Rolaid may be helpful – but be sure to check the label and discuss your options with your Naturopathic Doctor or Medical Doctor before taking any mediation.

Supplements and Natural Remedies

As a Naturopathic Doctor I always try to use the smallest intervention necessary to get optimal results.  I recommend starting with all of the dietary and lifestyle recommendations above before you try any of the supplements or natural heartburn remedies listed below.

• Fresh pineapple can provide quick relief of heartburn symptoms in some people.  Pineapple is a natural source of bromelain and other enzymes.  These enzymes speed digestion and can minimize inflammation.

• Slippery elm tea is an amazingly effective and safe way to decrease heartburn symptoms and prevent damage to the esophagus.  Slippery elm contains mucilage which soothes and protects the mouth, throat and stomach.  Pour two cups of boiling water over one tablespoon of slippery elm herb or powder, cover and let steep for 5 minutes.  Drink one cup three times per day or as needed.
• Deglycyrrhizinated licorice (DGL) is a safe alternative to over-the-counter antacids.  It supports proper digestion, increases mucous production in the stomach and helps tonify the lower esophageal sphincter.  Licorice is not safe in pregnancy, however in DGL the harmful glycyrrhizin has been removed, making it a safe remedy for heartburn in pregnancy.  One capsule should be chewed (it must mix with saliva to be effective) as needed.
• Homeopathic remedies are safe for pregnancy and may be used for heartburn.  Lycopodium is used for chronic indigestion, gas, bloating and heartburn.  Nux vomica for heartburn from coffee or rich foods, or heartburn associated with nausea.

When dealing with heartburn in pregnancy keep in mind that it will end.  Most cases of pregnancy heartburn resolve completely when the baby is born.  So do your best, try some of the suggestions above and look forward to the day when your baby arrives – for more reasons than one!

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Selected resources:

Public Health Agency of Canada – Healthy Pregnancy – Heartburn

Aly AM, Al-Alousi L, Salem HA. Licorice: A Possible Anti-inflammatory and Anti-ulcer Drug. AAPS PharmSciTech. 2005; 06(01): E74-E82..

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Lemon Balm

Unless you are under the care of a knowledgeable Naturopathic Doctor, herbalist or Integrative Medical Doctor, it is unadvisable to use any herbs during pregnancy.  Health Canada currently recognizes SIX herbs that can safely be consumed as teas during pregnancy.  They are:

• Ginger
• Lemon balm
• Linden flower*
• Orange peel
• Citrus peel
• Rose hip

*Not for use in women with a pre-existing heart condition

The issue with the use of herbs during pregnancy is the lack of safety information. It is unethical to do product safety studies in pregnant women so few of these studies exist.  We need to rely on other types of information in determining the safety of herbs during pregnancy.

Herbs that are considered safe in pregnancy are those that:

• Have a long safety record of traditional use in pregnancy
• Are free of poisonous and toxic biochemical components
• Do not cause uterine contractions
• Do not alter blood flow to the uterus
• Do not lead to birth defects
• Do not cause nutrient deficiencies that could negatively impact pregnancy
• Have no actions that could be harmful to either a pregnant woman or her fetus (i.e. laxative, sedative, purgative, etc.)

The herbs listed below are considered to be generally safe for pregnancy.  However, it is best not to take any medication (herbal or otherwise) during the first trimester of pregnancy as this is the most sensitive time of development for the fetus.  Only take these herbs under the supervision and guidance of a qualified health care professional.

Herbs That Can Be Used In Moderation In Pregnancy

This list refers to plants that may be used in moderation in pregnancy.  Essential oils should be avoided.

Anise seed

Herbs To Be Used With Caution In Pregnancy

Garlic

This list refers to plants which may be used occasionally as mildly flavored beverages, teas, seasonings, or as food.  Extracts (i.e. tinctures) of all of these plants, even in small doses should be avoided.

Download an easily printable PDF here: Use of Herbs in Pregnancy

Ginger

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Resources

1. American College of Naturopathic Obstetricians: Home Obstetrical Care, A Handbook for the Practitioner.
2. Bove, Mary. “Herbs for use in pregnancy, birth and postpartum”. The Birthkit. Winter 1998. P. 3.
3. Gallo et al.  “Pregnancy outcome following gestational exposure to Echinacea”.  Arch Intern Med 2000; 160: 3141-3143.
4. Hoffman, D. The Holistic Herbal
5. Weed, S. Wise Women Herbal for the Childbearing Year. 1985
6. Weiss MD, Rundolf Fritz. Herbal Medicine.
7. G Frazer 1992.
8. PDR for Herbal Medicine. 1998.
9. Yarnell, Eric. “Botanical Medicine in Pregnancy and Lactation”.  Alternative & Complementary Therapies. April 1997. P. 93-100.

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Those who take medicine and neglect their diet waste the skill of the physician
~ Chinese proverb

Eating a nutritious diet can boost your health and improve your life in many ways.  For women struggling with issues of fertility, eating properly can boost your fertility and increase the chances of becoming pregnant.

The recommendations below incorporate traditional Chinese medicine and groundbreaking research from the Nurses Health

Study which examined the impact of lifestyle and diet on the health of nearly 20 000 female nurses.  Traditional Chinese medicine (TCM) focuses on bringing the body into balance.  When in balance a woman’s body is naturally fertile and able to nourish both her own body and her fetus.

Fertility Diet Tips

1. Consume a Whole Foods Diet

Whole foods are minimally processed and provide maximum nutrients, fiber, enzymes, antixoidants and taste without added artificial flavours, colours, preservatives, sweeteners or trans fats.

2. Focus on Slow Carbs

Slow carbohydrates are slowly digested causing a slower and more gradual rise in blood sugar after being eaten.  They include beans, peas, lentils, whole grains (such as brown rice, barley, millet and quinoa) and vegetables.  Slow carbs minimize insulin resistance, regulate blood sugar, improve fertility and prevent gestational diabetes. Eliminate all white carbs – white flour, white pasta, white rice, white potatoes and white bread.

3. Eat Primarily Plant Based Foods

Plant based foods include a rainbow of high fiber, high antioxidant fruits and vegetables, legumes, nuts, seeds and whole grains.  A plant based diet means that most (but not necessarily all) of the diet is based on plant foods.  This diet is eaten around the world and is associated with health promotion, disease prevention and longevity.

4. High Antioxidant Foods

A diet high in plant based foods will be naturally high in antioxidant foods.  Fruits, vegetables, herbs and spices decrease oxidative stress and cellular inflammation associated with decreased fertility.  Select primarily organic produce – it has been shown in multiple studies to be higher in antioxidants (and free of hormone-disrupting pesticides!)

5. Consume Healthy Fats and Avoid Trans Fats

Healthy fats combat inflammation and improve hormone sensitivity.  Healthy fats and oils include coconut oil, nuts, seeds, avocados, olives, raw (uncooked) olive oil, and fats found in wild cold-water fish.  Trans fast (also known as hydrogenated or partially hydrogenated fat) – typically found in commercially prepared baked goods, fried foods, and processed snack can disrupt with normal ovulation by interfering with a cell receptor that controls inflammation, glucose metabolism, and insulin sensitivity.

6. Eat Only High Quality Dairy Products

Small amounts of full-fat dairy products daily, such as live culture yoghurt, kefir, and high quality organic goat and cow cheeses have been shown to enhance fertility.

7. Eat Mindfully

Slow down and tune into the nutritive properties of food.  Allow mealtime to be a time when you focus on nourishing your mind, body and spirit.  Mindfulness has been shown to help decrease stress, lower blood sugar and blood pressure, decrease anxiety and depression and enhance well-being.

8. Eat For Balance

In TCM all health concerns are based on an imbalance in the body.  This may be an excess or a deficiency of one of the vital substances or a blockage of energy flow in one of the organ systems of the body.  Your Naturopathic Doctor can help you determine your imbalance and give you recommendations for foods to promote balance (e.g. foods to boost yin or clear heat).

9. Take Supplements Appropriately

Supplements can be used to enhance a healthy diet but should not be used as a replacement for a healthy, balanced diet.  A prenatal multivitamin with iron, calcium, antioxidant nutrients (A, C, E, selenium and zinc), probiotics, fish oils and others may be used to enhance fertility and support a healthy pregnancy for both mother and child.

Click here for an easily printable PDF copy of the Fertility Diet

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select resources:

Chavarro J, Willett W.  The Fertility Diet.  Harvard Health Publications.  2008.
Lewis R.  The Infertility Cure.  Little Brown and Company.  2004.

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One of the first questions many pregnant women have is “can I still drink coffee and tea?”  The facts on caffeine and pregnancy aren’t always clear.  Read on to find out the current research and recommendations for caffeine intake during pregnancy.

Is Caffeine Safe during Pregnancy?

Yes.  Pregnant woman can safely consume caffeine during pregnancy.

Health Canada has produced guidelines that recommend pregnant women to consume no more than 300mg of caffeine daily.  Several recent studies have suggested that pregnant women limit their intake of caffeine to 200mg daily.  I recommend that pregnant women exercise caution and consume no more than 200mg of caffeine from all sources daily.

What are the Concerns with Excess Caffeine Intake during Pregnancy?

Caffeine has the ability to cross the placental barrier and impact the fetus directly.  The fetal liver is unable to efficiently process methylxanthines (such as caffeine) and may experience effects of caffeine – such as increased heart rate, alertness and nervous stimulation or tremors for a longer time than the pregnant mother.  Excess caffeine also puts additional strain on the maternal liver, which is busy processing pregnancy hormones.  Additionally, caffeine constricts blood vessels and may reduce blood flow to the placenta.

Initial concerns over caffeine in pregnancy surrounded the potential that it may lead to low birth weight or miscarriage.  It was found by a team of researchers from Yale University that drinking 600mg of caffeine per day or more (approximately 6 cups of coffee) resulted in lower birth weights.

A Danish study found that drinking 8 cups or more of coffee per day (equivalent to 12-20 cups of tea) can increase the risk of miscarriage or stillbirth by 60% compared to women consuming no caffeine.  Moderate consumption of caffeine (200-300mg per day) does not pose a significant risk.

A seven year study of 1500 women found that less than 200 mg of caffeine consumed daily during pregnancy had no effect on birth weight, birth length or head circumference.  Follow-up examinations at ages 8 months, four and seven years also found no negative effects of maternal caffeine consumption on a child’s motor development or intelligence.

The negative effects of excessive caffeine don’t end at birth.  Research has shown that newborns whose mothers consumed more than 500mg of caffeine daily had faster heart and breathing rates and spent more time awake in the first days after birth.

Interestingly, tea seems to be supportive for women attempting to conceive.  A study out of Northern California found that drinking one-half or more cups of tea daily approximately doubled the chance of conception each cycle.

What are Common Sources of Caffeine?

If you are going to continue to consume caffeine safely during pregnancy it is important to understand how much caffeine is present in common foods and beverages.  The chart below will give you a good overview of the caffeine content of select foods and drinks.  Remember to consider portion size when you are calculating your personal caffeine intake.

If you are interested in further reducing your caffeine intake from tea, steep your tea leaves for a shorter period of time.  Steeping for 1 minute decreases caffeine content by 50% compared to steeping for 3 minutes.

Chart is available here as a pdf for you to download and print: Caffeine Content of Common Foods and Beverages

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select references

American Academy of Pediatrics’ Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics, 108(3):776-789, Sep 2001.

American College of Obstetricians and Gynecologists.  2010.  Committee Opinion No. 462; Moderate Caffeine Consumption During Pregnancy.  Obstet Gynecol 116 (2): 467-68.

Armstrong, BG, McDonald, AD, and Sloan, M. Cigarette, alcohol, and coffee consumption and spontaneous abortion. American Journal of Public Health, 82:85-90, 1992.

Barr, HM, and Streissguth, AP. Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicology and Teratology, 13:441-448, 1991.

Caan, B, Quesenberry, CP, Coats, AO. Differences in fertility associated with caffeinated beverage consumption. American Journal of Public Health, 88(2):270-274. 1998. Caffeine, Coffee and Health. S. Garattini (ed). New York: Raven Press, 1993.

Clausson, B, and Granath, F, et al. Effect of caffeine exposure during pregnancy on birthweight and gestational age. American Journal of Epidemiology, 155:429-436, 2002.

Cnattinguis, S, Signorello, L, Anneren, G, et al. Caffeine intake and the risk of first-trimester spontaneous abortion. New England Journal of Medicine, 343:1839-1849, 2000.

Differences in Fertility Associated with Caffeinated Beverage Consumption.  B Caan, C Quesenberry, AO Coates.  American Journal of Public Health.  1998; 88: 270-274.

Effects of Caffeine on Human Health, P. Nawrot, S. Jordan, J. Eastwood, J. Rotstein, A. Hugenholtz and M. Feeley, Food Additives and Contaminants, 2003, Vol. 20, No. 1, pg. 1-30.

Fenster L, Hubbard AE, Swan SH, et al. Caffeinated beverages, decaff coffee, and spontaneous abortion. Epidemiology, 8(5):515-522, 1997.

Grosso LM, Rosenberg LD, Belanger K, Saftlas AF, Leaderer B, Bracken MB. Maternal caffeine intake and intrauterine growth retardation. Epidemiology, 12(4):447-55, Jul 2001.

Health Canada.  Fact Sheets – Food and Nutrition – Caffeine in Food.  Available online at: http://www.hc-sc.gc.ca/fn-an/securit/addit/caf/food-caf-aliments-eng.php

Maternal caffeine intake and risk of selected birth defects in the National Birth Defects Prevention Study.  Birth Defects Research. Part A, Clinical and Molecular Teratology.  Birth Defects Res A Clin Mol Teratol 2011 Feb; Vol. 91 (2), pp. 93-101.

Maslova E, Bhattacharya S, Lin SW, Michels KB.  Caffeine consumption during pregnancy and risk of preterm birth: a meta-analysis.  Am J Clin Nutr, 92 (5): 1120-1132, Nov 2010.

Methylxanthines during pregnancy and early postnatal life.  Aden U.  Handbook of Experimental Pharmacology [Handb Exp Pharmacol] 2011; Vol 200, pp. 373-89.

Nehlig, A and Debry, G. Consequences on the newborn of chronic maternal consumption of coffee during gestation and lactation: a review. Journal of the American College of Nutrition, 13(1):6-21, 1994.

Tim Hortons Canada.  Tim Hortons Caffeine Content.  Available online at: http://www.timhortons.com/ca/pdf/CaffeinceContentEN.pdf

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Is Naturopathic Medicine safe during pregnancy?

Absolutely!  Naturopathic Medicine is an ideal treatment option during pregnancy.  Although not all Naturopathic treatments are safe during pregnancy, a large majority of Naturopathic treatments are both safe and effective for the common and uncommon health concerns of pregnancy.
Being under the care of a Naturopathic Doctor during pregnancy does not replace the prenatal care offered by a midwife or obstetrician.  Naturopathic care should be used in addition to these services.  Naturopathic Medicine can offer guidance and treatments above and beyond what is offered by your prenatal health care team and can contribute to a happy and healthy pregnancy for both mother and child.

How often do I see my Naturopathic Doctor during pregnancy?

Naturopathic Medicine is an individualized treatment and frequency of visits will be determined based on your current health, changes in your health, personal health goals, and stage of pregnancy.  In general visits occur less frequently in early pregnancy (unless specific concerns such as nausea, nutrient deficiencies, muscle cramps, or insomnia are present) and more frequently in the later stages of pregnancy.

First visit:

The first visit typically occurs prior to pregnancy (during conception planning) or in the first 4-8 weeks of pregnancy.  During the first visit a comprehensive intake and health history will be completed and a nutritional assessment and recommendations are made.

First trimester visits:

The second visit varies, for some women occurring 2-3 weeks after the first visit depending on recommendations made in the first visit.  For the majority of women the second visit is between weeks 8-12 and is the final visit for the first trimester.  Changes to nutritional requirements are discussed and a diet diary is given to track caloric intake for three days. Naturopathic treatments for nausea, appetite changes, swelling, sleep disturbances, or other concerns may be prescribed as needed.

Second trimester visits:

The second trimester is often the easiest for pregnant women.  It is important to maintain regular visits with your Naturopathic Doctor during this stage of pregnancy to ensure continuing health throughout the remainder of the pregnancy.  A visit is recommended around 18-20 weeks and again at 24 weeks.  Between 24 and 28 weeks a glucose tolerance test is performed by your midwife or obstetrician.  You should see your Naturopathic Doctor in the weeks before this test to learn ways to properly prepare for this test.

Third trimester visits:

During the final trimester you may see your Naturopathic Doctor more frequently.  Preparation for the Group B Streptococcus test, treatments for health concerns that arise more frequently during the third trimester as well as acupuncture and herbal teas to prepare the body for labour and delivery are all addressed during the third trimester.

After due-date visits:

Your Naturopathic Doctor will be available to you if you go past-due with your baby.  Acupuncture and moxa (an herb that is applied to warm acupuncture points) as well as homeopathy can be helpful in promoting labour.

Post-natal care:

After the baby is born it is recommended that you and the baby continue to see your Naturopathic Doctor as needed.  Naturopathic Medicine is safe during lactation and for common health concerns in infants.  Your ND can also offer guidance on infant food introduction and appropriate nutritional supplements to support the tremendous growth your child will experience in their first year of life.

Your Naturopathic Doctor may be consulted at any time during the pregnancy if a health concern arises.  Your ND will tailor your pregnancy treatment to your individual pregnancy.  No two pregnancies are alike!  The visit schedule outlined above is just a general guideline.  Your Naturopathic Doctor will recommend a visit schedule that will meet your needs and support your physical, mental, and emotional health, and the health of your baby throughout pregnancy.

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Pregnancy is a time of growth – growth of a baby, growth of a mother’s belly and growth of a family.  And in pregnancy, as in life, sometimes there are growing pains!  Acupuncture and Traditional Chinese Medicine provide mothers with a safe and natural form of health care that can effectively manage the growth and ‘pains’ of pregnancy.

Acupuncture during Pregnancy

Many physical, emotional, and spiritual changes occur throughout a pregnancy and some of these changes can bring with them uncomfortable symptoms.  Since most conventional pharmaceutical medications are not safe for use in pregnancy many women suffer with these symptoms not realizing there are safe and effective alternatives available.  Acupuncture can be used safely in pregnancy to relieve negative symptoms and increase overall health and wellbeing.

When applied by a licensed and qualified Naturopathic Doctor, acupuncture is ideally suited to treat the following conditions associated with pregnancy:

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.

• Threatened miscarriage
• Nausea and vomiting (“Morning sickness”)
• Heartburn
• Insomnia
• Fatigue
• Migraine
• Back pain, pelvic pain, sciatica
• Swelling/ edema
• Leg cramps
• Carpal tunnel syndrome
• Premature labour
• Breech presentation
• Labour induction

Acupuncture in the first trimester

One of the most researched uses of acupuncture during pregnancy is for the treatment of morning sickness and hyperemesis gravidarum^1,2 (severe nausea and vomiting lasting beyond the first 12 weeks of pregnancy).  Over 1100 women have participated in studies assessing the effectiveness of acupuncture for pregnancy³.  A majority have found that acupuncture decreases the symptoms of nausea and vomiting and encourages a healthy appetite during pregnancy.

It is best to start acupuncture treatments at the first signs of morning sickness in pregnancy (often around the six or seven week mark) and to have treatments once a week.  More severe cases may need to be seen more often – your Naturopathic Doctor will individualize your treatment plan to meet your needs.  You should know after three visits if acupuncture will be an effective treatment for your morning sickness.

Acupuncture in the second trimester

For some women the second trimester is a welcome break from the nausea of the first trimester and the aches and pains of the third trimester.  But unpleasant symptoms do develop in this time for many pregnant women.  Insomnia, anxiety and depression often develop in the second trimester and can greatly impact a woman’s ability to function in her day-to-day life.

Acupuncture is one of the few effective methods of treating insomnia that are safe in pregnancy – a time when most pharmaceutical drugs should be avoided.  Insomnia affects a large majority of pregnant women (up to 88% in one study)⁴ and tends to worsen as pregnancy progresses.  Acupuncture has been shown to be more effective than sleep hygiene techniques for insomnia in women in their second and third trimesters of pregnancy in a small study⁵.  Weekly acupuncture visits over an eight week period resulted in a greater than 50% improvement in insomnia symptoms in a majority (75%) of women studied.

According to a 2007 study published in the Acupuncture in Medicine journal, acupuncture is an effective treatment for irritability, anxiety and depression⁶.  Depression affects as many as 1 in 5 pregnant women, and anxiety affects 1 in 7 pregnant women.  Acupuncture safely treats these emotional complaints and improves quality of life measures – including sleep quality, mood, relationships, social activities, and joy of living.  Acupuncture also offers the mother-to-be a chance to relax and time to enjoy her treatment (yes – many people do find acupuncture to be a relaxing experience!)

Later in the second trimester, heartburn, hemorrhoids and edema (swelling) often develop.  A study out of Brazil found that weekly acupuncture treatments decreased symptoms, increased appetite, improved sleep and less use of medications to control heart burn in a majority of pregnant women⁷.  Acupuncture, especially when combined with other safe Naturopathic treatments, can greatly decrease the discomfort of these symptoms and increase the enjoyment of being pregnant.

Acupuncture in the third trimester

As a mother enters her third trimester all thoughts turn towards preparing her body, and her baby, for labour and delivery.  Between 32 and 35 weeks acupuncture and moxibustion (holding a warming stick of the herb mugwort – “moxa” – over different acupuncture points on the body) have been shown to be effective in encouraging breech babies to turn into the preferred head-down position.  Several large studies have been done that support these traditional acupuncture techniques to turn a baby and reduce the incidence of caesarean section^8,9,10.  Moxibustion techniques combined with acupuncture are considered safe for both the mother and fetus when applied correctly¹¹.

From 36 weeks to delivery (at approximately 40 weeks), acupuncture can be used to soften the cervix, and prepare the body for labour and delivery¹².  Once you have reached 40 weeks labour induction acupuncture can be used to help initiate labour and decrease the potential for medical intervention.  Women who receive acupuncture in preparation for labour are more likely to enter labour spontaneously (without medical induction), have shorter labours (up to 21 hours faster to delivery) and have fewer caesarean sections^13,14,15.

Backache, pelvic pain, sciatica, carpal tunnel syndrome are most severe during the final trimester as the baby continues to gain weight and put increased pressure on the mother’s nerves, ligaments and joints^16,17,18,19.  Acupuncture can bring much-needed relief from these aches and pains and make those final weeks of waiting much easier to endure!

Acupuncture after delivery

In the weeks following delivery a mother’s body is recovering from labour and delivery, as well as bonding with her new baby and growing family.  However, some symptoms may persist from her pregnancy or may develop in the weeks after delivery.  Acupuncture can help to restore balance in a woman’s body and can effectively treat the following post-natal conditions:

• Postpartum depression and anxiety
• Insufficient milk flow
• Blocked breast ducts/ mastitis
• Hemorrhoids
• Carpal tunnel syndrome
• Urinary incontinence
• Recovery from Caesarean section

The best way to determine if acupuncture is the best treatment for you in your pregnancy is to schedule a consultation with a qualified Naturopathic Doctor.  They will be able to answer your questions and offer guidance as to whether acupuncture has been proven to be an effective treatment for your pregnancy symptoms.

References:

1.       Shin HS, Young AS, Seo S.  Effect of Nei-Guan (P6) acupressure on ketonuria levels, nausea and vomiting in women with hyperemesis gravidarum.  Journal of Advanced Nursing 59(5), 510–519

2.       Carlsson C, et al. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. Journal of Pain and Symptom Management October 2000;20(4):273-279.

3.       Ezzo J, Streitberger K, Schneider A.  Cochrane Systematic Reviews Examine P6 Acupuncture-Point Stimulation for Nausea and Vomiting.  The Journal of Alternative and Complementary Medicine.  2006; 12(5): 489-495.

4.       Suzuki S, Dennerstein I, Greenwood KM, Armstrong SM, Satohisa E.  Sleeping patterns during pregnancy in Japanese women.  J Psychosom Obstet Gynaecol 1994; 15(1): 19-26.

5.       Da Silva JBG, Nakamura MU, Cordeiro LK, Kulay L Jr.  Acupuncture for insomnia in pregnancy: a prospective, quasi-randomized, controlled study.  Acupunct Med 2005; 23(2): 47-51.

6.       Da Silva JBG.  Acupuncture for mild to moderate emotional complaints in pregnancy: a prospective, quasi-randomized, controlled study.  Acupunct Med 2007;25(3): 65-71.

7.       Da Silva JBG, Nakamura MU, Cordeiro LK Jr, Saidah R.  Acupuncture for dyspepsia in pregnancy: a prospective, randomized, controlled study.  Acupunct Med 2009; 27: 50-53.

8.       Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C.  Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.  The Journal of Maternal-Fetal and Neonatal Medicine 2004; 15: 247-252.

9.       Neri I, De Pace V, Venturini P, Facchinetti F.  Effects of three different stimulations (Acupuncture, Moxibustion, Acupuncture plus Moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation.  Am J Chin Med 2007; 35(1); 27-33.

10.   Smith CA, Cochrane S.  Does acupuncture have a place as an adjunct treatment during pregnancy?  A review of randomized controlled trials and systematic reviews.  Birth.  September 2009.  36: 3.

11.   Guittier M-J, Klein TJ, Dong H, Andreoli N, Irion O, Voulvain M.  Side-effects of moxibustion for cephalic version of breech presentation.  The Journal of Alternative and Complementary Medicine.  2009; 14(10): 1231-1233.

12. Tremeau ML, Fontanie-Ravier P, Teurnier F, Demouzon J.  Acupuncture for Cervical Maturation.  Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 1992, 21(4):375-80.

13.   Betts D.  The Use of Acupuncture as a Routine Pre-Birth Treatment.  Journal of Chinese Medicine; 2004; 76: 5-8.

14.   Harper TC, Coeytaux RR, Chen W, Campbell K, Kaufman JS, Moise KJ Jr., Thorp JM Jr.  A randomized controlled trial of acupuncture for induction of labor in nulliparous women.  The Journal of Maternal-Fetal and Neonatal Medicine 2006; 19(8): 465-470.

15.   Smith CA, Crowther CA.  Acupuncture for induction of labour (review).  2009. The Cochrane Collaboration.  Published by John Wiley & Sons Ltd.

16.   Elden H, Ladfors L, Fagevik Olsen M, Ostgaard H-C, Hagberg M.  Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomized single blind controlled trial.  British Medical Journal 2005; 330: 761.  doi:10.1136/bmj.38397.507014.E0 (published 18 March 2005).

17.   Kvorning N, Holmberg C, Grennert L, Anders A, Akeson J.  Acupuncture relieves pelvic and low-back pain in late pregnancy.  Acta Obstet Gynecol Scand 2004: 83; 246-250.

18.   Lund I, Lundeberg T, Lonnberg L, Svennson E.  Decrease of pregnant women’s pelvic pain after acupuncture: A randomized controlled single-blind study.  Acta Obstetricia et Gynecologica.  2006; 85: 12-19.

19.   Wang S-M, DeZinno P, Fermo L, William K, Caldwell-Andrews AA, Bravemen F, Kain ZN.  Complementary and Alternative Medicine for Low-Back Pain in Pregnancy: A Cross-Sectional Survey.  The Journal of Alternative and Complementary Medicine 2005; 11(3): 459-464.

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Nutrients to Avoid in Excess During Pregnancy

Vitamins and minerals are vital in supporting a healthy pregnancy.  However, some nutrients can cause problems when taking in excess amounts during pregnancy.  Make sure you are not over-doing it with these nutrients during pregnancy.

Some nutrients should be avoided in large doses during pregnancy

Vitamin A

Birth defects are associated with vitamin A intake over 10 000IU per day.  Birth defects associated with excess vitamin A include malformation of the urinary and genital tract, skull and facial bones and heart.

These defects occur within the first 6 weeks of pregnancy, so avoid consuming more than 5000IU of vitamin A if there is a chance you may become pregnant.

Vitamin C

Vitamin C is safe during pregnancy, but consuming high levels during pregnancy may result in a rebound vitamin C deficiency in your baby following delivery.  Avoid taking more than 1000-4000mg daily to avoid this effect.

Vitamin D

Vitamin D is essential for proper bone and teeth development.  However, excess levels (greater than 1000IU daily) can lead to hypercalcemia which can cause placental calcification and fetal arterial stenosis.

From 20 weeks onward 1000-1200IU daily is recommended to promote optimal bone development of the skull and other bones.  Research shows that this amount also promotes optimal bone mass later in the child’s life.

Proper supplementation is especially important if the third trimester occurs during winter months when inadequate sunlight reaches Canada for skin production of vitamin D.

Vitamin E

Vitamin E can inhibit proper coagulation of the blood and should not be taken in high amounts close to delivery.  Avoid taking more than 800IU per day from week 36 onward to decrease the risk of excess bleeding during and after delivery.

Calcium

Calcium is important for both mother’s and baby’s health during pregnancy.  Supplementation can help to prevent pregnancy-induced hypertension and pre-term labour.

However, excess amounts can increase the risk of kidney stones for the mother and can lead to hypercalcemia (excess calcium) of the fetus and placenta.  Avoid taking more than 1200IU daily.

Also avoid dolomite, bone meal and oyster-shell sources of calcium as these may be contaminated with lead.  Instead use professional quality supplements or consume more broccoli, almonds, dark green leafy vegetables, canned salmon (with bones), sesame seeds and enriched soy milk.

Pregnancy is a great time to learn more about nutrients and how they support our health (and the health of our babies).  Naturopathic Medicine is a perfect complement to a natural, healthy pregnancy.  Book a free 15 minute consultation with Dr. Lisa Watson to learn more about how Naturopathic Medicine can support you, your body, and your baby during pregnancy.

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Naturopathic Medicine is an integrative health care philosophy that recognizes the importance of health during conception, pregnancy, labour and birth.  Naturopathic Doctors work with your health care team (family doctor, midwife and/or obstetrician) to provide care to both the pregnant mother and unborn baby.

Naturopathic Medicine is a BABY FRIENDLY alternative

Naturopathic Medicine isn’t just for moms.  It’s for babies too.  During pregnancy and infancy Naturopathic Medicine can help your baby reach it’s full potential – for growth, intelligence and health.  It can also help prevent common childhood conditions, such as eczema, asthma and allergies.

Naturopathy SUPPORTS PREGNANCY

There is no better time to see a Naturopath than during pregnancy.  Your body is changing.  Your nutritional needs are changing.  You may be experiencing health concerns you have never had before.  Naturopathic Medicine supports your body, and your baby, with gentle, safe and effective medicine.

Conditions that Naturopathic Medicine can treat during pregnancy include:

• • • • • • • • • • Morning sickness
                  • Heart burn
                  • Fatigue
                  • Insomnia
                  • Anxiety and depression
                  • Constipation
                  • Hemorrhoids
                  • Fluid retention and swelling
                  • Lowered immune system
                  • Nutrient deficiency
                  • Leg and foot cramps
                  • Stretch marks
                  • Gestational diabetes

.

Natural Therapies used by Naturopathic Doctors during Pregnancy

NUTRITION

Build nutritional foundations for a healthy pregnancy.  Guidance on selecting
pre-natal vitamins and additional supplements.  Support for vegan, vegetarian and special diets.  Food and teas as medicine for heart burn, morning sickness, water retention, insomnia and more.

ACUPUNCTURE

Acupuncture can relieve back pain, anxiety and stress during pregnancy.  Acupressure is effective for treating nausea and morning sickness.  Acupuncture has also been used to effectively help rotate a breech baby, and for labour induction in post-date pregnancies.

HOMEOPATHY

A safe and effective treatment during all stages of pregnancy, labour and
post-natal care.  It is used to treat any number of conditions and provides pain management during labour and delivery and is equally effective in uncomplicated labour, difficult labour and caesarean sections.

MASSAGE

Massage therapy is a pregnant mother’s best friend.  It can provide physical and emotional relaxation, ease cramps, treat lower back and hip pain.  It can also lower blood pressure and increase blood flow to internal organs and the placenta.  It is very effective in reducing swelling and fluid retention during pregnancy.

CHIROPRACTIC MANIPULATION*

Maintaining a healthy spine and nervous system during pregnancy can prevent further postural problems that might occur during and after childbirth.  Chiropractic care reduces back pain and pelvic pain during pregnancy, labour and delivery.
*Although Naturopathic Doctors are trained in manipulation, Dr. Watson does not perform manipulation in her practice.  Dr. Watson refers patients to a chiropractor at 360 Health Care who is well-versed in pregnancy care.

Naturopathic Medicine is SAFE in Pregnancy

Some therapies used in Naturopathy have the potential to be harmful if not used under the care of a trained Naturopathic Doctor.  Dr. Watson is here to make sure you make SAFE and HEALTHY choices for yourself, and your baby.

Diverse families are welcome.

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Every mother wants what is best for her baby.  And pregnancy is a great opportunity to start our babies on a healthy diet.

More foods can affect your health and your baby’s health than you might realize.  Understanding what foods to avoid during pregnancy is an important aspect of pregnancy nutrition.

Following these guidelines will help you make healthier choices for you and your baby.

Raw Meat: Uncooked seafood and rare or undercooked beef or poultry should be avoided because of the risk of contamination with coliform bacteria, toxoplasmosis, and salmonella.

Deli Meat and Hot Dogs: Deli meats have been known to be contaminated with listeria, which can cause miscarriage. Listeria is able to cross the placenta and may infect the baby leading to infection or blood poisoning, which may be life-threatening. If you are pregnant and you are considering eating deli meats, make certain that you reheat the meat until it is steaming.

Fish – Mercury and PCBs: Fish can be a great source of protein, iron, and omega-3 fatty acids.  The omega-3s in fish support the proper development of your baby’s brain, eyes, and nervous system.  Research suggests that complete avoidance of fish during pregnancy may contribute to poor verbal skills, behavioural problems, and other developmental issues during childhood.

However, fish that contain high levels of mercury must be avoided. Mercury consumed during pregnancy has been linked to developmental delays and brain damage.  Fish with long life spans tend to contain more mercury than smaller, younger fish.

Farm-raised fish should be avoided due to the significantly higher levels of PCBs – polychlorinated biphenyls.  PCBs can disrupt the normal development of the endocrine (hormone) system.  In addition, farm-raised fish have less nutritional value than wild fish due to the restricted diet they consume on fish farms.

High quality fish oil supplements are rigorously tested for mercury and other contaminants and are safe during pregnancy.

Use the following chart to help guide your fish consumption during pregnancy.

Smoked Seafood: Refrigerated, smoked seafood often labeled as lox, nova style, kippered, or jerky should be avoided because it could be contaminated with listeria. (These are safe to eat when they are in an ingredient in a meal that has been cooked, like a casserole.)

Raw Shellfish: The majority of seafood-borne illness is caused by undercooked shellfish, which include oysters, clams, and mussels. Cooking helps prevent some types of infection, but it does not prevent the algae-related infections that are associated with red tides. Raw shellfish pose a concern for everybody, and they should be avoided altogether during pregnancy.

Raw Eggs: Raw eggs or any foods that contain raw eggs should be avoided because of the potential exposure to salmonella. Some homemade Caesar dressings, mayonnaise, homemade ice cream or custards, and Hollandaise sauces may be made with raw eggs.  When preparing eggs at home cook them until the whites and yolk are opaque and firm.

Commercially manufactured ice cream, dressings, and eggnog are made with pasteurized eggs and do not increase the risk of salmonella.

Soft Cheeses: Imported soft cheeses may contain listeria bacteria, which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning, which can be life-threatening.

Avoid soft cheeses such as: Brie, Camembert, Roquefort, Feta, Gorgonzola and Mexican style cheeses that include queso blanco and queso fresco, unless they clearly state that they are made from pasteurized milk. All soft non-imported cheeses made with pasteurized milk are safe to eat.

Unpasteurized Milk: Unpasteurized milk may contain bacteria called listeria, which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning, which can be life-threatening. Make sure that any milk you drink is pasteurized.

Pate: Refrigerated pate or meat spreads should be avoided because they may contain the bacteria listeria. Canned pate, or shelf-safe meat spreads can be eaten.

Liver: Liver is high in vitamin A and high doses of vitamin A during pregnancy may cause birth defects.  Liver can be consumed during pregnancy, but only in small quantities and no more than once per week.

Caffeine: Although most studies show that caffeine intake in moderation is OK, there are others that show that caffeine intake may be related to miscarriages. Avoid caffeine during the first trimester to reduce the likelihood of a miscarriage.

As a general rule, caffeine should be limited to fewer than 200 mg per day during pregnancy. Caffeine is a diuretic, which means it helps eliminate fluids from the body. This can result in water and calcium loss. Some research shows that large amounts of caffeine are associated with miscarriage, premature birth, low birth weight, and withdrawal symptoms in infants. The safest thing is to refrain from consuming caffeine.

Alcohol: There is NO amount of alcohol that is known to be safe during pregnancy, and therefore alcohol should be avoided during pregnancy. Prenatal exposure to alcohol can interfere with the healthy development of the baby. Depending on the amount, timing, and pattern of use, alcohol consumption during pregnancy can lead to Fetal Alcohol Syndrome or other developmental disorders. If you consumed alcohol before you knew you were pregnant, stop drinking now. You should continue to avoid alcohol during breastfeeding. Exposure of alcohol to an infant poses harmful risks, and alcohol does reach the baby during breastfeeding.

Unwashed Fruits and Vegetables: Fruits and vegetables are safe to eat, and you should be eating a wide variety of them throughout pregnancy. However, it is essential to make sure they are washed to avoid potential exposure to toxoplasmosis. Toxoplasmosis may contaminate the soil where the vegetables were grown.  Also be sure to cut away and discard any damaged parts of the fruits and vegetables to avoid bacteria and mould growth.

Raw Sprouts: Raw sprouts – including alfalfa, clover, radish and mung bean may be contaminated with bacteria and should be avoided during pregnancy.

Artificial Sweeteners: Although the FDA considers artificial sweeteners to be safe in pregnancy I recommend they be eliminated from the diet.  Aspartame, for example, consists of three components: the amino acids phenylalanine, aspartic acid and methanol, otherwise known as wood alcohol.  Methanol is toxic in humans even when consumed in small amounts.  There are also concerns that aspartame may have a link to immune system dysfunction and neurotoxicity.  It is best to avoid all artificial sweeteners during pregnancy.

Herbal Teas: Many herbal teas are safe during pregnancy, but some are not.  Some teas are safe for consumption during the third trimester, but not the first.  Do not consume herbal teas without first seeking the advice of a Naturopathic Doctor.

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