Mention the words “herbal medicine” and “pregnancy” in the same breath, and many physicians blanche in terror. This is an unfortunate reaction, because in reality, judicious use of botanical medicines can provide safe and effective relief for many common ailments affecting pregnant and lactating women, said Paul Richard Saunders, PhD, ND.

Herbs like Viburnum, Mitchella, Rubus, Aletris, Melissa, Gelsemium, Capsella, and Geranium have long histories of safe use during or immediately following pregnancy. They can prevent or ameliorate problems like miscarriage, abdominal pain, prolonged labor, ineffective uterine contractions, post-partum pain, hemorrhoids, emotional stress and difficulty with lactation.

While it is important to maintain the level of caution one would have when considering drug therapies for pregnant women, conventional medicine’s categorical dismissal of herbal therapies during pregnancy betrays ignorance about herbs far more than it reflects genuine risk.

“I use these plants all the time in my clinic. They are very safe, if you are careful,” said Dr. Saunders who is Chair of Materia Medica and Professor of Clinical Medicine, Canadian College of Naturopathic medicine. Dr. Saunders also holds a PhD in plant ecology from Duke University.

In the US, much knowledge about the use of herbs during and after pregnancy comes from Native Americans. Their herbal lore was preserved by the so-called “Eclectic” physicians in the early 20th century, who then passed it down into modern naturopathic practice. Dr. Saunders strongly recommended Dr. Francis Brinker’s, “Herb and Drug Contraindications and Interactions,” 3rd Edition, as a valuable resource. “It’s a great source. I use this book all the time.”

Preventing Miscarriage

“Roughly 50% of all pregnancies end in miscarriage, only most of the time the patient is unaware,” said Dr. Saunders. Several herbs can help women with histories of miscarriage or complicated pregnancies. Mitchella repens (Partridgeberry), used widely by Cherokee, Delaware, Iroquois and Menominee people for centuries, is his first choice. It contains saponins, glycosides, and tannins, and is excellent for strengthening and tonifying the uterus. The herb is effective in both hot water decoction or alcohol extract forms. Dr. Saunders usually recommends patients take up to 60 drops of a standardized alcohol extract, twice or thrice daily, or 2–4 oz of a water decoction, twice or thrice daily.

Viburnum prunifolium (Black Haw) is another valuable ally for these patients, especially in acute situations. It is a strong uterine sedative and antispasmodic. He recommends one dram 4–5 times daily. This herb has a reputation as an anticoagulant and blood thinner, because it contains scopoletin. “But the truth is, unless it is fermented, this herb does not cause coagulation problems.”

In cases where an intrauterine fetal death has occurred, but the fetus has not been expelled, Caulophyllum thalictroides (Blue Cohosh) can be a big help. Dr. Saunders described a recent case in his clinic. “There was a spontaneous abortion, but after 2 weeks, the patient still had not delivered the fetus. It was causing her great pain. I gave the recommended 15 drops of Caulophyllum, and the contractions began after one day.”

Preparing for Delivery (Partus Preparatus)

“As a pregnancy progresses we can really help patients prepare for delivery.” Herbs in the Rubus (Blackberry) family (R. villosus, R. idaeus, and others) are tannin-rich plants that tonify and strengthen the uterus. Dr. Saunders advises patients to make Rubus tea, 1 teaspoon of leaves per large mug, and drink it 3–4 times per day. “Infusion works better than alcohol extracts. You can start this early in pregnancy. I’ve never seen a problem with it.”

Viburnum opulus, Aletris farinose (Colicroot or Stargrass), Actaea racemosa (aka Cimicifuga racemosa or Black Cohosh), and Mitchella repens, are also helpful in helping women prepare for labor. Dr. Saunders combines these herbs in equal parts into a single Partus Preparatus formula, and recommends that patients take 15 drops twice or thrice daily during the last 2 months of pregnancy. “The nice thing is you can adjust the mixture depending on a patient’s symptoms. If she’s having a lot of painful contractions, increase the Mitchella. If she’s got leg cramps, increase the Viburnum. During the last month of pregnancy, I sometimes add Caulophyllum thalactroides.“

Aletris, a member of the lilac family widely used in Germany, has oxytocic effects, and is good for treating women with uterine hyperactivity or uterine weakness.

Though not usually considered botanical medicine, per se, Dr. Saunders added that moxibustion—the Chinese practice of burning small amounts of mugwort atop acupuncture needles at specific meridian points—can actually help correct breech positioning. A study in the Journal of the American Medical Association in 1998, showed moxibustion could induce cephalic presentation in breech fetuses.

Labor & Delivery: Easing the Passage

Gelsemium sempervirens (False Jasmine or Wild Woodbine) is among Dr. Saunders’ favorite herbs for helping women through labor. It is useful for nervous, anxious or fearful patients with a rigid, non-dilating os and ineffective contractions. He usually doses it on the low side, diluting 5–15 drops of a standardized extract in 4 oz of hot water, and gives one teaspoon periodically during labor. Don’t start too early or give it too frequently, or it can slow the labor process and delay placental delivery. In higher doses, it can also make the woman drowsy.

Traditional Chinese medicine includes a rich store of knowledge on herbs during labor, much of which aimed at supporting the woman’s overall energy level or “nourishing the yin,” and attenuating pain during the process. Rhemannia glutinosa (Chinese Foxglove), Paeonia lactiflora (Peony), Cyperus rotundus (Nutgrass), and Fritillaria cirrhosa are commonly used TCM herbs in this context.

Post-Partum Relief

Members of the Salix (willow) family are excellent herbs for relieving post-partum pain and hemorrhage. “The Native Americans used this a lot. They would make a poultice of the Salix bark and use it like a vaginal poultice. It works very well this way,” said Dr. Saunders.

Capsella bursa-pastoris (Shepherd’s Purse) is a useful plant for persistent post-partum uterine bleeding, especially of the cystic variety. He recommended the tincture form, and usually treats patients with 1–2 drams every 2–3 hours if bleeding is frequent. For less frequent, less severe bleeding, use 15–60 drops, twice or thrice daily.

Galactogogic Herbs for Inducing Lactation

Many women have difficulty lactating; in Canada, approximately 15% of women at breastfeeding clinics have insufficient milk, according to a 2003 study. “Though the mechanisms are not really well-understood, there are a number of galatogogic herbs that can help promote lactation, induce relaxation, and increase milk flow. “Lowering stress is really important. Women who are stressed do not lactate as well as those who are relaxed.”

For proactive patients who like a hands-on approach to herbal medicine, Ricinus communis (Castor) is an excellent lactogogic herb. It is best used as a topically applied oil. Patients who don’t want to use store-bought castor oil can easily prepare their own oil. The process is to take a handful of the leaves, and then boil them first in water until white, followed by a second boiling in a light base oil. The patient can then apply the oil to her breasts between feedings. Ricinus reduces mastitis and increases milk flow. However, it is important that patients wash the oil off their breasts before feeding. Phytolacca americana (American Pokeweed) is another good topical herb. Patients can simply crush a few leaves and rub the bruised leaves on their breasts. Again, they should wash their breasts before feeding.

The seeds of Foeniculum vulgare, aka Fennel, also contain galactogogic compounds. A daily dose of 10–30 grams of powdered fennel seed daily will help women having difficulty lactating. Widely used in Europe but little known in the US, Galega officinalis (Goat’s Rue) contains compounds that increase milk volume and also increase the solid protein components of breast milk.

Adequate sleep is a prerequisite for optimal lactation. Unfortunately, many new mothers have great difficulty in this department. Dr. Sanders noted that many common herbs like lavender (Lavandula officinalis), peppermint (Mentha piperita) and Catnip (Nepeta cataria) will help women sleep and often increase lactation. They can be taken as teas or infused into bath water.

Hops (Humulus lupulus) contain compounds that induce transcription in estrogen responsive cells. Hence hops can be a good lactogogic, not to mention a mild sedative. A dram of a liquid extract daily is usually sufficient, but Dr. Saunders noted that women can get the same effect from a good beer. He added that barley (Hordeum vulgare), the other key component in beer, increases peripheral circulation, reduces local inflammation, and often promotes lactation. “I recommend microbrews,” he joked.

At the other end of the lactation spectrum, women who want to stop breastfeeding will find an ally in Salvia officinalis (Sage). Taken as an infusion 3 or 4 times per day, Salvia is excellent for checking the flow of milk and reducing breast swelling.

Dr. Saunders noted that for most women in the world, including many low-income women in the US, herbs are a primary source of medicine, as they have been for thousands of years. Rather than fearing botanical medicines during pregnancy, modern physicians ought to investigate what they have to offer. “This is a real opportunity for good research.”