Natural Pregnancy
How to Support a Natural Pregnancy
This one is for moms-to-be, dads-to-be or those who simply enjoy reading about topics surrounding acupuncture and natural medicine. Throughout this blog we will be covering all things pregnancy; from what to expect throughout the trimesters, what are some of the common side effects of pregnancy, and how to use natural methods throughout prenatal care to address things like insomnia, pain, anxiety and stress.
This is a perfect time for a shameless plug on our previous blog posts detailing all things fertility and prenatal care. The previous topics covered are male factor infertility and nutritional habits to establish to optimize fertility. Without further a do let's dive right in.
Preparing for a Healthy Pregnancy
Preparing for a healthy baby starts long before conception. Did you know that it takes approximately 120 days for an egg and 90 days for sperm to fully develop? Much like a farmer would prepare their soil months or years in advance to ensure a good crop, the same can be thought of during preconception. Preparing for preconception means optimizing both parents health prior to conception. According to the CDC, taking measures to optimize both parents health prior to conception increases the chances of a healthy baby (1). While the idea of pre-conception care may seen modern, this idea dates back to to over 3,000 years ago.
Hindu and Ayurvedic medicine covers the physical, spiritual and the mental aspects to preconception health. While spiritually is typically associated with religion, it doesn't always have to be. In the case of pregnancy and childbirth, spiritually is thought to be that "shift" one goes through on their path to becoming a parent. This idea that they are "ready" to become a parent, starts the spiritual journey. There are many questions and answers that will be discovered along this path and will ultimately lead to preparing for conception.
Pre-Conception Care
In Ayurvedic medicine, pre-conception care is a 6 month process. A 3 month cleanse of the physical, spiritual and mental, followed by a 3 month rejuvenation of the same aspects of health. It's this pathway that prepares the couple for conception. While modern medicine, didn't always accept "preconceptional" care, around 1985 there was an acute change in OBGYN health care approach. In 1985 the Institute of Medicine published Preventing Low Birthweight, which noted "multiple opportunities exist before pregnancy to reduce the incidence of low birth weight, but that they are too often overlooked in favor of interventions during pregnancy." This idea was radical at the time, and those who favored optimizing health prior to conception were elated, however this idea fizzed out as quickly as it started.
In 1995, the American College of Obstetrics and Gynecologists stated the following, "Once information is available, the patient can be informed about the certainty or limitations of available information, what the risks of pregnancy may be, and precautions that may be beneficial. After women have been informed of the increased risks pregnancy may pose to their health or the health of a fetus or both, they can accept the increased risks, choose to modify their risks or opt to avoid childbearing (p. 2).” (3). This was a definitely a stark contrast to what was stated 10 years earlier.
Optimizing Health and Lifestyle Prior to Conception
Today, the CDC has shifted recommendations back toward the idea of preconception care. They call the program "Steps to a Healthier Me and Baby-to-be" (4). The program is rooted in goal setting, and optimizing physical and mental health. Many of the ideas set forth are rooted in alternative and holistic medicine. The idea of setting goals and optimizing health should be part of everyone's life and especially a birth plan. Asking yourself what goals do I wish to accomplish, circles right back to the idea of the spiritual awakening mentioned earlier. Setting goals that you wish to accomplish individually and as a couple is one of the first steps to becoming "ready" as a parent.
First time parents are more likely to modify health and lifestyle behaviors than during their next childbirth (7). The behavior most parents modify is alcohol intake, whereas other behaviors are largely left unmodified (7). While I couldn't find a study on US couples, I suspect the following is still likely true; Austrialian couples are not changing their behaviors prior to conceiving regardless of if it's their first or second child (7). In 2016, The LIFE Study, demonstrated that couples who had "negative" preconception lifestyle factors were more often associated with pregnancy loss (5). When behavior is unmodified, it's important for couples to understand that there could be an increased risk for miscarriage, complications during pregnancy that could require medical intervention, and alternations to the epigenome that could impact generations to come (8 & 9).
Trimesters
Action Phase of Pregnancy
Once couples have accomplished goal setting and optimized health and lifestyle factors the preparation period is complete. It's onto the action phase of the transtheoretical model. Ideally, during the preparation period, women should keep track of their menstrual cycle, as this will provide value information when in the action phase. Tracking a menstrual cycle can be accomplished in a number of ways, but the easiest is either a calendar or smart phone app. A 2019 study showed that by tracking menstrual cycles, there becomes an increased likelihood of conceiving within 2 menstrual cycles (6).
Tracking menstrual cycles gives women and couples clues as to when to start "trying". While sperm can live up to 5 days in the uterus, an egg has approximately 24 hours. The 5 days leading up to the egg being released from the Fallopian tube is referred to as the fertile window. Since a woman can only become pregnant during her fertile window, it's important to time sex around this period to increase the chances of becoming pregnant.
1st Trimester & Early Signs of Pregnancy
After approximately 2 weeks, a woman will menstruate or become pregnant. While it's likely too early to tell if a woman is pregnant via an "at-home pregnancy test", due to low hCG levels, a missed period is often the first sign. After approximately another 10-14 days, a woman's body will to ramp up hCG production and an "at-home pregnancy test" will detect a positive pregnancy result. At this point, it's important to contact your professional medical provider to establish prenatal care.
Pregnant women typically have a myriad of symptoms and side effects of pregnancy. However, there is typically one that stands out to most, morning sickness. Morning sickness affects 8 out of 10 pregnant women. And, while referred to as morning sickness it can happen at any time of the day. Typically, morning sickness lasts until weeks 12-14, so that raises the question of what can be done to address these symptoms.
Combating Morning Sickness
Acupuncture
If you have ever been on a cruise you may be familiar with the "sea wristbands", well those infamous bands, are placed over an acupuncture point, PC6, which is known for for reducing nausea and vomiting. So, you may have guessed it, acupuncture has a long standing history for treating nausea and vomiting. A randomized control trial (RCT) published in 2002 in Birth, found that weekly acupuncture was able to reduce nausea and vomiting when compared to the non-acupuncture group (10). Another RCT demonstrated that acupuncture, specifically at PC6 was able to resolve hyperemesis gravidarum( severe vomiting which affects 1-2% of pregnant women) faster than the non-acupuncture group. Enough about acupuncture, let's talk about additional research backed modalities for morning sickness.
Ginger
Ginger has long been used as natural remedy to combat gastrointestinal issues. Research has demonstrated that up to 1 gram of ginger has been demonstrated to be safe during pregnancy (11). Another study illustrated that 1 gram of encapsculated ginger daily was able to reduce nausea and vomiting in early pregnancy (12). While all research on ginger has been shown to be safe, it's always recommended to consult your health care professional prior to beginning any new protocol as your situation may be unique and require a different approach.
Vitamin B6
B6 is a water soluble vitamin. Although the body does not store B6 in its tissues, it is important to watch your supplement intake and never exceed 200mg daily - as excess can cause temporary nerve damage. While B6 will not reduce vomiting, it can reduce nausea. For those who are not expecting food aversion during pregnancy, whole food natural sources of vitamin B6 are sunflower seeds, poultry, walnuts, pecans, avocados and spinach. For those who can't stomach food, typical protocol is 10-25mg 3 times day (13). As previously mentioned it's always recommended to consult your health care professional prior to beginning any new protocol as you situation may be unique and require a different approach.
Additionally, it's recommended to eat smaller meals, drink more water between meals, eat a bland meal, and avoid spicy, heavy, rich meals, and avoid foods and smells that are nausea triggers. Nausea is most common during the first trimester, and typically affects pregnant woman less as they progress through pregnancy.
Combating Fatigue
Typically a pregnant woman feels a bit fatigued throughout the first trimester. While not quite as unpleasant as morning sickness, it can definitely cause a feeling as though feet are dragging behind. If caffeine use was discontinued, there may be additional fatigue and headaches. The good news is that small amounts of caffeine have been shown to be safe. The Committee on Obstetric Practice stance on caffeine is stated below;
"Moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a correlation between high caffeine intake and miscarriage."
The original cause for concern was that due to the fact, caffeine crosses the placenta (14) and increases maternal catecholamine levels. This caused concern about the potential relationship between caffeine exposure and the incidence of spontaneous miscarriage. The committee has found the studies to be non-reliable, as those studies have small sample size and the retrospective collection of data influenced by recall bias, particularly in patients interviewed after pregnancy loss (15, 16).
This raises the question, what can be done to combat fatigue.
Physical Activity
While, physical activity might not be at the top of your list - studies have shown regular physical activity during pregnancy has a myriad of health benefits (20) such as lowering the risk of the following:
Excessive gestational weight gain
Gestational diabetes mellitus
Gestational hypertensive disorders
Preterm birth
Cesarean birth
Lower birth weight
Additionally, physical activity can provide that "pick me up feeling", that is much needed during pregnancy. For an added benefit try exercising outdoors- it has been shown that a walk outside or even the simple act of being outside, around plants and/or fresh air—boosted energy in participants (20). That's a win, win, in my book!
Sleep
Sleep is one of the pillars to optimal health and during pregnancy there is no exception. Unfortunately, 78% of pregnant women will report at least 1 night of sleep disturbances and for many those nights are much greater (21). University of California-San Francisco researchers found that women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries. Fatigue was unrelated to labor outcomes (22). As such, it was recommended that women received at least 8 hours of sleep daily. While not confirmed, it been suggested that if hours are not met during the nighttime, a daytime nap could be helpful. A previous blog post on all things sleep and natural sleep remedies can be found here.
Sleep Position
Sleeping positions are often discussed amongst pregnant women. While left side sleeping is the most widely recommended, for those women who are not used to left side sleeping, there may be a reduction in sleep duration (23). While left side is the most often recommended, right side has also been demonstrated to be equally safe (24). The one position that should be avoided to reduce risk of a stillbirth would be a supine going-to-sleep position. In fact, supine going-to-sleep position, has been demonstrated multiple times to increase the risk of stillbirth (24, 25, 26). If you aren't already a side sleeper, it's recommended to use lots of pillows to achieve optimal sleeping position as well as to increase comfort while sleeping.
2nd Trimester
The 2nd trimester is often the most enjoyable of the trio. Morning sickness has likely passed, energy levels have increased and the first signs of your baby-to-be are seen (ultrasound & teeny-tiny belly bump) and heard (doppler). At this point in the pregnancy, attention is often turned toward natural pain management for low back, hip, pelvic, headache and migraines pain. Options such as acupuncture, prenatal yoga, heat, chiropractic care, and arnica gel are often utilized as part of natural prenatal care.
Low Back,Hip and Pelvic Pain
A 2008 observational study of 167 pregnant women demonstrated that acupuncture was effective at reducing pain of the hips and back (27). Acupuncture has also shown to alleviate low back and pelvic pain during pregnancy as well as increase the capacity for physical activities. (28) This could provide a potential gateway to other activities such as swimming, walking, strength training that could help to manage pain, promote better sleep, manage high blood pressure, gestational diabetes and excess gestational weight gain.
It's often suggested the pregnant women receive 20-30 minutes of physical activity per day. While physical activity is often one of the last thoughts an individual will have while experiencing low back pain, physical activity could definitely help. A 2018 meta-analysis of RCTs, concluded that "exercise appears to reduce the risk of low back pain in pregnant women, and sick leave because of lumbopelvic pain" (29). Further benefits of exercise are a reduction of insomnia. In fact, a RCT of 30 females and 11 males, demonstrated significant reduction of insomnia from just 150 minutes of moderate exercise per week (30). While 150 minutes may seem like a far reach, scheduling yourself for just 21 minutes per day will allow you to achieve the 150 minutes. Those 21 minutes, could save you countless hours, counting sheep! As always, it's important to talk to your health care professional to ensure you don't any contraindications that would prevent you from engaging in physical activity. If you don't, what are you waiting for, your walking shoes await you!
Headaches & Migraines
It is estimated that 15-20% of pregnant women will experience migraines during pregnancy (31). Another 39% are estimated to experience headaches during pregnancy (32) This combines to roughly 50% of pregnanct women will experience either a migraine(s) or headache(s) during the course of pregnancy. While it's impossible to change the influx of hormones that cause headaches and migraines during pregnancy, it is possible to address other factors. Dehydration, caffeine withdrawal, low blood glucose (sugar), poor posture, stress, anxiety, and lack of sleep can all impact the risk of migraines and headaches.
Chances are cutting out coffee or tea, will result in some withdrawing symptoms such as headache, irritability, etc. As previously discussed cutting out caffeine completely may not be necessary, up to 200mg daily has been demonstrated to be safe. So, if you suspect that cutting out caffeine is the cause of your headaches, a cup of coffee or tea could be the remedy to your headache.
Now that we have our coffee or tea in hand, let's talk about dehydration. Women are recommended to consume 95 ounces of fluids daily, unfortunately less than 50% of women in 13 countries meet the recommendations set forth for daily fluid intake (33). General fluid needs increase during pregnancy in order to support fetal circulation, amniotic fluid, and a higher blood volume. (34) The current recommendation for water intake is drinking 8–10 glasses of water each day. Bear in mind, this water intake, not including any water from fruits, veggies, etc. If a pregnant woman isn't meeting the recommendation, chances are she might be suffering from constipation. While, it might be the decreased gut motility and intake of an iron supplement causing constipation. It is recommended that pregnant women increase fluid intake as a possible avenue to reduce risk of constipation.
Due to the rapid growth during the end of 2nd trimester, there is a very high likelihood that a woman will find herself carrying extra weight in the abdomen. While completely normal, the extra weight will likely to lead to postural changes that could cause headaches, migraines, and low back pain. Additionally, due to a change in the center of gravity there is an increased likelihood of falls. (35) If fall mitigation is necessary, common preventive strategies include physical activity and maternity support belts. Ideally, it is best to include core strengthening exercises prior to pregnancy, however it's not too late to "exercise". Try diaphragmatic breathing, not only can you strengthen the abdominal and pelvic muscles but you can de-stress a bit. To learn more visit a previous blog about how one can use breath to de-stress.
Headaches and migraines are more likely to occur when one is stressed. This often raises the question, what can one do to manage stress while still continuing to support their pregnancy and childbirth. Acupuncture definitely can fulfill that job. Acupuncture can help reduce stress and anxiety by stimulating the release of endorphins which allow for feelings of happiness and relaxation. In addition, acupuncture reduces sympathetic nervous system activity (the fight or flight response) which allows your body to go into its rest and digest phase (parasympathetic nervous system). The benefits of acupuncture are vast, and this is just skimming the surface - click here for more information on the benefits of acupuncture.
For those looking for something that they can achieve at home - exercise, breathwork and magnesium supplementation are safe and effective tools that can be utilized to reduce stress and anxiety. And as previously discussed, these options are also wonderful at reducing other aches and pains that can arise throughout pregnancy. When it comes to supplementing with magnesium, it's important to remember that not all supplements are created equal. While many forms of magnesium exist the bioavailability, absorption rates, and gastrointestinal tolerability do vary. We took a deep dive into the research to find a magnesium product that we would feel comfort recommending and we settled on magnesium biglycinate. We recommend magnesium biglycinate for it's bioavailability, absorption rate, and tolerability. Not to mention the amino acid, glycine, one of the main inhibitory neurotransmitters of the central nervous system. The combination of magnesium and glycine are relaxing which can lead to higher quality sleep, a reduction in stress, anxiety, and even assist with muscle tension.
Third Trimester - Preparing for Labor and Delivery
The beginning of pregnancy may seem like eons ago. And while much of the attention is turned toward the baby's due date - it's important to remember that there is still 3 months of pregnancy left. During this trimester rapid weight gain will occur resulting in sleep disruptions, pain, possible hypertension, and a few other ailments. Not the mention there may be some stress and anxiety for the pregnant woman and her family. During the final chapter of pregnancy, it'll be important to discuss both the final steps of pregnancy and the birth of the upcoming child.
Whether you are looking to have a natural birth at-home, a hospital birth, or somewhere in between let's discuss what the the final journey of pregnancy may look like.
Weight Gain
During the first trimester weight gain is pretty minimal, approximately 1-5 lbs. According to the CDC, during the 2nd and 3rd trimester pregnant women with a normal BMI should gain approximately 1 pound per week (36). While counting calories is not necessary, the idea of eating double what is normal is not recommended as medical intervention may become necessary. So throw old that old adage, "eat for 2" out the window or better yet off your plate. If you are interested in learning more about weight gain during pregnancy - click here. If you are pregnant with twins or triplets, or more - it important to consult your health care practitioner to determine what normal for you.
By the middle to end of the 3rd trimester, the rapid weight gain may be causing pain in the low back, hips, pelvic area and other musculoskeletal areas. As previously discussed and if your health care practitioner has given you clearance, continue with activities such as walking, yoga, and swimming, continue acupuncture treatments, visit your chiropractor or anything else you've used on your road to a natural childbirth.
Sleep
Without adequate sleep, sleep deprivation will result. Decreased sleep quality will cause a number of issues but most common are a decrease in physical and mental performance (37). During the 3rd trimester it's estimated that 3 out of 4 women will experience insomnia (38). Poor sleep has been demonstrated to increase risk of preterm birth (39), and preeclampsia. While ensuring a good night sleep can be easier said than done, it's important to take every measure possible to ensure the sleeping environment is more than adequate.
The easiest sleeping environment areas to address are:
Light exposure after sunset
Brightness/Darkness of bedroom
Temperature of bedroom
Noise
For a full list of areas to address click here
Taking measures to ensure a good night sleep can reduce the risk of developing gestational diabetes (40). While increasing the chances of better breastfeeding outcomes (41), decrease the risk of depression both during pregnancy and postpartum (42), and decrease the chances of a long labor and/or cesarean delivery (22). With that being said, it's important to continue good sleeping habits, if this is something that has been challenging, ask us how to establish better sleeping habits, we'd be happy to assist.
Preparing for Arrival
Finally, we've made it to the last topic that will be discussed, preparing for the arrival of your new family member. As you and your family have likely discovered pregnancy is full of unexpected twists and turns. As your due date approaches, stress and anxiety may increase with anticipation of your little one or you may have been dealing with stress and anxiety throughout all trimesters. While being anxious for the arrival of a newborn is normal, excess anxiety can cause the the situation to feel even more stressful. Taking measures to combat stress and anxiety are readily available such as meeting daily physical activity recommendations, obtaining time outdoors, and receiving adequate sleep.
At the beginning of this blog the three components of Hindu and Ayurvedic medicine were introduced; physical, spiritual, and mental. The same principles that assisted the start of the journey can be applied to labor and delivery. In fact, these principles can be applied to very aspect of life.
By setting goals, maintaining positive thinking, and embracing new challenges individuals and families can overcome obstacles that stand in their way. While this may sound cliche, there is science to back this up. (43) While pregnancy and parenthood will be filled with stressful moments, it's important to remember that those periods are finite. Remembering to relax, take time for oneself, and utilize activities that have been highlighted throughout this blog will provide you with many of tools necessary to enhance one's health and embrace life's journey.
References:
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