Naturopathic Newsletter April 2010: Perinatal Care

April 2010

For the past 5 years, i have had the honor of working with numerous patients here in Ste-Anne-de-Bellevue. Many of those patients have been parents consulting with regards to perinatal care: from preconception to post partum. I have enjoyed this work tremendously! But now that I have had the honor of going through the experience myself, I do view perinatal care through a slightly different lens. I have decided to dedicate this newsletter to perinatal care to share these insights with you, hoping that it will be applicable to some readers. 

The biggest insight has come from my experience with the conventional medical system. In light of Quebec's severe doctor shortage, I am very lucky to have an OB, and I am very lucky to be giving birth in a hospital setting that is in line with a natural approach to birthing. That being said, I feel that the conventional system has a number of limitations. As I have experienced with my patients as well as first hand, many of these limitations can be fulfilled by naturopathic care.

At my first OB visit, I was so glad to hear her say that pregnancy was not a medical condition, and that she would not treat it as such. Such a statement was like music to my ears. I assumed that she would discuss a preventative approach, discussing and offering solutions to the numerous symptoms that come and go with the gestation. Needless to say that as the months unfolded, I was disappointed. She did her job very thoroughly in screening against significant medical ailments that would put myself or my baby in harms way, including diabetes, high blood pressure, etc ... However, there was very little dialogue about nutrition, exercise, sleep, supplements, and the less threatening symptoms of pregnancy, such as insomnia, anemia, and nausea. That is when I realized how lucky I was to be able to complement this information with naturopathic care, and how important it is to educate the community that these needs can be fulfilled by your local ND.

In an ideal setting, both parents have made the choice to start a family in the near future, allowing for naturopathic care of both the mother and father before conception occurs. In this situation, we have the chance to work with both parents to maximize their health, and therefore the health of their child.  

Typically, when time is permitted, we would complete a 6 week to 3 month internal "clean up", where both mom and dad to-be would follow a detox protocol tailored to their individual needs. Unfortunately, the reality today is such that infants are born testing positive to hundreds of environmental chemicals before even taking their first breath. From phthalates to bisphenols to mercury, the source of these chemicals is often the mother as they are passed on through their shared blood supply. Having a chance to remove some of this toxic burden from mom and to strengthen her detoxification function would decrease the toxic load on the fetus. 

Although the father does not share his internal environment with the fetus, the sperm carries a toxic burden as well. Therefore, putting dad through a detox protocol would not only support mom, but would also render his sperm of better quality.

During the course of the naturopathic consultation, details would be gathered with regards to the woman's menstrual history. This would include a discussion of cycle length, bleeding time, blood volume, PMS, ovarian cysts, endometriosis, cervical dysplasia, etc ... Should abnormalities or irregularities be assessed, an examination of reproductive hormone levels through the saliva would be considered. This would allow for an accurately tailored protocol of support to both the uterine tissue and the ovarian hormones.

And of course, we can not forget the need for conventional blood tests. To have a sense of the woman's baseline physiological and biochemical function can be very valuable. Aside from a general chemistry screen and a urinary analysis, I would include the following tests: an iron panel complete with ferritin, serum vitamin B12, TSH, free T4, free T3, and 25(OH) vitamin D3. Knowing these levels before hand can be very effective on a preventative level in correcting any imbalances or deficiencies prior to conception.

 

One of the main questions from expecting parents is 'what supplements should i be taking?'. The answer to this question obviously depends on the individual and their specific constitution, past medical history, and present needs.

Here is a list of supplements that I consider with the majority of my prenatal patients:

prenatal multi vitamin mineral:

this will depend on the individual's needs, their diet, and the frequency of vomiting

folic acid:

this will depend on the patient's diet

it is IMPORTANT to note dosage recommendations here, as I have seen numerous outdated recommendations given by OB/GYNs. Recent research shows that the following doses of folic acid correlate with the following decreases in neural tube defect:

0.4mg is correlated with a 36% decrease

0.8mg is correlated with a 52% decrease

4mg is correlated with a 82% decrease

5mg is correlated with a 85% decrease

omega 3 fish oils:

this has been shown in numerous studies to a) support neurological development of the fetus and thus decrease the incidence of both autisn spectrum disorder and ADHD, and b) support neurotransmitter balance in the mother and thus decrease the incidence of post partum depression

probiotics:

this has been linked in numerous studies to supporting the immune system of both mom and fetus to decrease the rates of both maternal (such as vaginitis) and infant infections.

calcium-magnesium:

this will depend on the individual's diet

 

As mentioned in the introduction, the lack of discussion around less threatening pregnancy symptoms with my OB struck a deep cord. These less threatening symptoms often significantly influence the mother's quality of life on a physical, mental and emotional level, which in turn can affect the fetus. I will list some of these symptoms below, along with some considerations to be further discussed with your local ND.

morning sickness: vitamin B6, ginger

fatigue: milk thistle, vitamin B12, iron

insomnia: magnesium, valerian, chamomille

constipation: magnesium, probiotics, increase fiber

hemorrhoids: horsechestnut, rectal suppositories

muscle aches and pains: minerals, nettle

anxiety: magnesium

depression: st john's wort

vaginitis: probiotics, garlic

water retention/swelling: dandelion, nettle, leg massage

**NOTE: specific to the individual symptoms, homeopathic remedies can offer effective, safe and fast acting solutions. Since there are thousands of homeopathic remedies to chose from, they were not mentioned in the list above, but rather are to be discussed with your local ND.

**NOTE: only a short list of herbal remedies have been substantially researched to show safety in pregnancy and lactation, thus do not start any herbal supplement without consulting your ND first.

Just a few additional notes on other ways in which naturopathic care can support perinatal needs and concerns:

promoting fertility

preventing miscarriages

assisting in addressing more complicated conditions, such as gestational diabetes, preeclampsia, UTI, etc ...

post-partum tissue and scar healing

lactation; milk production

post-partum depression

I hope this newsletter has provided useful information on how naturopathy can complement conventional care in preconception, pregnancy, birthing, and post-partum, allowing for greater health and wellness of our next generations and of their parents:)