Botanical Safety in Pregnancy and Lactation – July 25th, 2018

A.C.:   Hello, Cyndi. Thanks for agreeing to do an interview. I’m excited to talk to you about one of my favorite topics, botanical medicine in pre and postnatal care. Can you tell us a little bit about yourself to start?

C.G.:   Sure. I’m an ND in practice with just over 10 years experience as a clinician. I’ve also taught at the naturopathic college in Toronto for most of that time in different capacities. And I taught the second year botanical medicine course, and my early practice actually was very focused on labour, delivery, pregnancy, and newborn care. But over the years, I have shifted much more into mental health, trauma and substance use.

A.C.:   I didn’t know that about your early career! So, jumping right in, I’d like to get to know your thoughts on an area of medicine that’s really lacking with respect to research. Anybody who’s ever been pregnant or had a pregnant loved one can attest to the fact that there’s a real dearth of safety data in both conventional and naturopathic medicine, which usually extends into use in lactation and infancy. Can you explain why this is?

C.G.:   Yes. I mean, most of the reason why there isn’t much research is because it’s really difficult to formulate an ethical trial that is actually going to look at real humans as opposed to in vitro data or animal studies. And so, sometimes there is in vitro and animal study data on herbs, but as soon as there’s any even theoretical concern about safety use in pregnancy or lactation, then there’s very little likelihood that any kind of study or potential clinical study with humans is going to pass an ethics board review. And so, that’s why we see so little research on it. And oftentimes as clinicians, we have to rely on that more theoretical data or a traditional use to guide our practice.

A.C.:   And how accurate do you see that being? Relying on in vitro and animal studies in terms of how that translates in humans?

C.G.:   Well, unfortunately, what happens is that we have to err on the side of caution, especially when we’re talking about pregnancy and lactation. And so, for a lot of practitioners that means that they’re avoiding using herbs even when they might be safe because that data exists. We know from lots of other research outside of pregnancy and lactation that in vitro data doesn’t necessarily and often doesn’t frankly translate into clinical studies. Sometimes it’s that in vitro or animal studies look great and they’re really positive and they have positive outcomes. And then when we test them in humans, we don’t see those kinds of results – or the opposite, which is that things look theoretically like they’re going to be a huge problem or have a lot of safety concerns and then when the clinical studies are run on humans, we don’t see those same kinds of adverse effects or safety outcomes.

A.C.:   Right. So not super useful.

C.G.:   Yeah. Great as an early stage consideration, but doesn’t necessarily always translate.

A.C.:   Sure. And then to go further, even if we had human clinical data, how often does that extend into practice?

C.G.:   I think that that’s where there are some herbs that do have decent research that have been studied clinically in humans while pregnant or lactating – that’s the easiest and safest thing for us to use, where we know that things are safe. Ginger has been reasonably well studied. Echinacea has also been studied in pregnancy and in clinical human trials. And so, those definitely would be on what’s considered a “safe list”.

A.C.:   We’ll get back to that in just a bit. I know you have a strong background in botanical medicine as well as women’s health in particular. You are the author of many articles and have also written a book called The Essential Women’s Guide to Herbal Medicine. Congratulations for that!

C.G.:   Thanks.

A.C.:   Why did you want to write this particular book?

C.G.:   I really wanted to write that particular book because I think on one side, women and people who identify as women tend to be really interested in herbs. Although that’s changing and growing, traditionally, that’s where it comes from. I think the other piece is that herbal medicine has historically and traditionally really been the domain of women, and there is so much history and connection there. For me, my connection to plants started when I was really little, and I have strong memories of lying in the grass on my mother’s lawn – the only non-pesticide lawn in the suburbs – and eating red clover flowers and dandelions out there.

And so, that connection has been always there in my life. So, it makes sense to write about it. I’ve taught it for a long time, and even before I studied naturopathic medicine, I studied with herbalists. So, that’s been a huge part of my life. But at the same time, I think the book has pieces that are relatable – like there’s stuff on heart health and high blood pressure and diabetes that are applicable to people who aren’t women.

A.C.:   Right. Neither pregnant nor lactating.

C.G.:   Exactly.

A.C.:   So, your mother was a sort of at-home herbalist?

C.G.:   She was not an at-home herbalist at all! She just was a bit of a hippie at heart. It seemed maybe out of laziness, or… you’d have to ask her. Partially out of just not caring! The yard was full of dandelions and red clover flowers and white clover.

A.C.:   Weeds. Darn weeds.

C.G.:   Yes. She was a lover of weeds. She still is.

A.C.:   For those who haven’t read your book, is there something you feel that all pregnant, breastfeeding women should know about herbs and herb safety?

C.G.:   I think that from a clinician standpoint, and I think even from a patient standpoint, really it’s about informed choice. Really understanding what the risks are of taking stuff or not taking stuff is always the key, whether someone’s pregnant or lactating or not frankly. But especially in those times because the risks are greater. And the risks are not just to yourself but to a small growing human or developing human. And so, looking at what is the least invasive thing I can do or what is the research information out there, and having a good grasp on that can really help people make those kinds of well-informed, evidence-based choices.

A.C.:   I can honestly count on one hand the herbs that we learned in school in our naturopathic training that were definitively safe to take while pregnant. And even then we were told that new research may be putting their safety in question. Ginger is one word that comes to mind. It’s frustrating as a practitioner, I can’t imagine as a new mother wanting to be in control of your own health. And so, do you have a list of go-tos that you feel, after all of your research, after all of your clinical experience, that are safe?

C.G.:   Do I have a list? I think my list is probably the same. It is very short and on one hand, and even then, I tend to use those herbs during pregnancy, especially during pregnancy. I feel a little bit differently, and certainly there’s better data, on lactation. I use herbs as minimally as possible and for a short a time period as possible and at the lowest dose possible. So, for me that includes most of the culinary herbs in kitchen kind of amounts. And then short-term stuff: ginger being one of them; echinacea being another. I’m comfortable with red raspberry. I’m comfortable with it from a safety perspective, but the research doesn’t necessarily bear out to what it’s been traditionally used for in pregnancy.

A.C.:   So when you mentioned the kitchen herbs, are you referring to being taken as spices? I think I have a question about this coming up. But as teas only?

C.G.:   It really depends, right? So, mint or chamomile tea, chamomile being something that also has been decently studied and generally considered safe in pregnancy, those in a standard infusion at once or twice a day is really generally not going to be a problem. What I tend to encourage people to stay away from is things like extracts or concentrated versions of it. And in terms of culinary use, like putting a teaspoon of turmeric into your food isn’t really going to be a problem. It’s if you’re wanting to drink golden milk three times a day where you’re talking about a use of an herb that’s greater than what you would use in cooking.

A.C.:   And I think that question is ever present more now than anything walking into any health food store. Where you’ll come across various foods or superfoods being packaged as powders. How many packages of turmeric lattes and matcha this and maca that are available now? I know women must question whether or not those classify as foods or as concentrated medicinal products.

C.G.:   And I think that that’s where patient education is so important. Because we need to have a better understanding of how those foods were used, right? Maca’s not a culinary herb. So, definitely, if you’re taking maca in a powder form, and you’re taking it in any substantial amount, then that’s quite different than having a glass of green tea, even if it is matcha or one turmeric latte, depending on how much turmeric you’re putting in. And so, those quantities tend to make a difference. I think the other thing that makes a big difference is actually what trimester. If you look at embryological development, you understand that the first trimester is a particular time where there’s a lot of potential for teratogenicity. There’s a lot of potential for things to go wrong and even a normal risk of miscarriage. And often, when I’m talking to patients about using herbs in particular in the first trimester, say ginger even, that it’s really about somebody’s comfort zone, right? Because if somebody is going to wonder why they had a miscarriage, which is not outside of what would be considered normal, especially early on in pregnancy – if they for a second are going to worry about the two cups of coffee they had that day or the ginger pills that they were taking to try and prevent their nausea… we won’t ever be able to say definitively whether either of those things may have had an impact in that person in that moment, right? We can look at studies and say up to three cups of coffee is generally considered safe and not going to cause miscarriage. That’s what the studies say. That’s what the evidence says. But if somebody is going to have a lot of anxiety or grief or regret or shame around something that they did, then maybe that’s a choice they need to make or consider as part of their personal informed choice.

A.C.:   That’s a great point. Individualizing the repercussions something might have in somebody’s personal life as well; their feelings toward it.

What about essential oils used topically in pregnancy – is there a concern? Can they cross the placental barrier? Is that something that’s a concern at all when you’re looking at anti-stretch mark ointments? Natural, yes, but usually loaded with essential oils. Mothers are always are getting told, “Oh, take a bath with lavender or rose” or whatever it is. We know that the skin is, well, we call it the largest organ…there’s a reason we use emollients and creams and things on our skin. We know there are elements that pass through the dermis. Do these oils then have any effect across the placental barrier?

C.G.:   I don’t think we really know. In general, again if you’re putting two drops of essential oil into a large bathtub full of water, is that likely to be a problem? Not really, but certainly topical direct applications, even if they’re diluted, may depend on the dilution. It’s unlikely to be causing a problem, but anytime we take herbs and we concentrate them, we’re moving outside of what’s traditional use. And so, even if we’re looking at safety data from traditional uses, there really isn’t a traditional use during pregnancy for a lot of topical essential oils when they’re that concentrated. At the same time, if you’ve got a few drops in your belly butter, it’s really unlikely to make a difference, and you’re probably not using that belly butter until your belly is getting a bit bigger. So, we’re talking second, third trimester where the risks are different. But I don’t typically use a lot of essential oils topically in a concentrated format except in very specific use cases.

A.C.:   I guess I’m thinking about what is in natural products. So when—

C.G.:   The amount in an actual product is generally considered cosmetic. Shouldn’t be a concern. When people are making their own or adding—

A.C.:   That’s the thing. Somebody is trying to go natural, right? And they think, okay, well my stuff doesn’t have any harmful ingredients versus something from the pharmacy. And you’ve got somebody who’s made their own beeswax and oil body butter that’s got X amount of drops of essential oil.

C.G.:   I just stick to less than 10 drops per 4 ounces, and you’re really pretty diluted. Then you’re just getting the nice smell. Because really as long as what you’re trying to achieve is a calming scent from the lavender or something as opposed to the actual topical application because the beeswax and calendula oil, that’s what’s actually helping to prevent things. If somebody is looking to prevent things like stress, it’s more of the infused oils that are doing that job.

A.C.:   Yes. Great Point. What about herbs that are safe while breastfeeding?

C.G.:   Definitely, the list gets a bit bigger. So, that’s kind of nice. There are a lot more options, and there’s certainly a lot of herbs that got classified as galactagogues around the world that can be used, again, relatively safely. And that’s not to say that there’s anything really that’s not ever without concern. Herbs have adverse effects in everybody as a potential. There’s actually a shocking number of people who are allergic to chamomile. Even though we consider it to be generally safer. And so, again, it’s really just about informing patients about what those possibilities are and what to do if they have a response. But certainly in lactation, there’s a lot more herbs that are available, and things like adrenal tonics and blood tonics have been used around the world very traditionally for centuries or more to assist during lactation.

A.C.:   Can you give some examples?

C.G.:   Herbs like shatavari in the Ayurvedic tradition has been that way. Vitex has been used both to increase and decrease lactation, and because of the pituitary effects, again, that’s something that we know may have positive or negative outcomes, depending. But it has been used traditionally. Herbs like dong quai in Traditional Chinese medicine have been used postpartum, or polygonum, he shou wu, to prevent and replenish from blood deficiency of delivery.

A.C.:   We sort of touched on this before, but to discuss the importance of understanding the form and dosage for the herbs that we’ve been discussing; would therapeutic amounts in capsule form still be safe?

C.G.:   Out of those, again, it’s relatively safe but not necessarily very well studied. So, there is some minimal research, say on Shatavari or asparagus racemosus, in lactation, about safety but very minimal research. You’re kind of banking on that traditional use in a lot of cases. And that’s where we have to talk to patients about what the rationale is for using it but also what the risks are around it or what’s known about it…or not known about it.

A.C.:   The art and the science… I’ve read very conflicting ideas about food amounts of these herbs being by and large safe in any situation, pregnancy and postnatal periods included. So, for example, spearmint, peppermint…I’ve heard that as long as it’s something that you’re consuming as a food, as long as it’s tea, who cares? It’s not a considered a ‘medicine’ – though we know that we do use infusions as medicines – but it’s not a tincture or a capsule. So, I know many pregnant women taking peppermint tea twice a day. I’ve also read that peppermint and spearmint can decrease milk supply, for example, when breastfeeding. What’s your opinion in terms of food amounts of these herbs?

C.G.:   Yeah, my opinion is generally like most, if it is a food – so peppermint, spearmint, generally consumed as food. I think that there is a line. Where that line is is not necessarily the same for everyone, and that’s where it gets to be a bit tricky. But a standard infusion for therapeutic use—that’s like one teaspoon or more three times a day—is definitely not a food amount. Like very few people are consuming that much as food. Some people might be, and they might have done that for a long time and then maybe that’s a bit different. But certainly, even some people two cups of peppermint tea a day is going to cause them reflux while they’re pregnant or might be enough to decrease their milk supply a little bit, and for other people, it won’t be. And so, that’s where individualized care really has to come in, and as the practitioner, it’s your job to think about whether or not that might be a factor. If someone’s coming and saying, “My milk supply is low,” then maybe it’s worth cutting out the peppermint tea or switching them to something else, switching them to fennel tea, or fenugreek. And then you might even use that tea drinking as a way to boost supply.

A.C.:   And just to clarify, you were talking about one teaspoon of dry herb.

C.G.:   Yes, exactly.

A.C.:   And the same could be said for sage tea, correct? Sage being well-known to decrease milk supply.

C.G.:   Oh, sure. But if you think about how much sage you use in cooking… it’s a tiny amount to get a lot of flavor out of sage. And so, most people aren’t even using a teaspoon of dried sage except, like, in a whole turkey.

A.C.:   Which you’re not consuming on your own anyway!

C.G.:   Which you’re not consuming the whole thing on your own, and it’s cooked, and there’s all sorts of other factors. And so, for a lot of people, sage is more potent than something like chamomile or peppermint, and we would use a lot more mint in general cooking amounts then we would sage. And so that relative amount makes a difference as well. Certainly, there aren’t that many people drinking sage on its own as a tea for culinary purposes, but if somebody were doing that, then that could definitely be enough- even at one teaspoon – to decrease supply.

A.C.:   Absolutely. And in pregnancy to potentially cause miscarriage. I don’t know if in tea form, but I know that if somebody is taking—

C.G.:   A capsule, certainly. Yeah, absolutely. Most essential oils in capsule form are enough to be considered either emmenagogues or even abortifacients.

A.C.:   Many herbal products, unfortunately, are adulterated. Meaning what’s inside may be different than what’s on the label, right? They’re changed in some way. How can someone ensure they’re buying pure and clean botanicals? Can they? Are there brands or certifications that one should look for?

C.G.:   It’s really on a case by case basis. Contamination and adulteration is a huge issue in the industry, and I don’t think one that’s been adequately addressed. Even most of the bulk herb companies, even if you’re ordering in bulk, to get a certificate of analysis that proves that herb is what it says it is is extraordinarily difficult, and usually, you have to pay for that. So, using a company that even does that kind of check, it is probably the best thing that you can do. But again, without having that certificate of analysis, you’re less likely to be 100 percent sure. And adulteration can be as simple as that there’s a little bit of some other herb mixed in, which often happens, like in harvesting. If you look through your cilantro that you bought at the grocery store, you’ll see that there might be a little bit of something that’s not quite a cilantro leaf. That does happen in cooking sense, and it’s certainly going to happen or has the potential to happen in the herb world as well as much as companies take a lot of care in working to avoid that kind of contamination or adulteration.

A.C.:   So, somebody just walking through a grocery store or health food store, how can they know whether, first of all, an herbal company, a brand, carries out that third party testing? Whether their certification is one that’s legitimate? What are they looking for?

C.G.:   There isn’t really one single certification body to my knowledge that does exactly what we’re talking about. Certainly, I’d advise anybody buying herbs, pregnant or breastfeeding or not, to look for having that good manufacturing process, having a natural product number, so that they have at least gone through the Health Canada process. That doesn’t avoid what we’re talking about, but at least decreases the likelihood of it, and there is some rigor in the process. And certainly, buying things that have that number does bring some level of protection. Unfortunately, it’s still possible in Canada to buy things that aren’t registered within the natural health products database, especially online, and there is a much greater risk of contamination buying things that don’t have those numbers, manufactured and produced outside of Canada.

A.C.:   Absolutely. Potentially, one could go to the website and check. I’m sure they can. If a company has carried this testing out, it would—

C.G.:   It would be on the website. Absolutely. And so, going and looking at what the brand or the manufacturer has online in terms of what their standards of practice are can be helpful. There’s other kinds of contamination. So, I know that in general, there are certainly some herbs that are widely produced and have pesticides on them. And so, you might want something that’s certified organic. Again, there’s multiple certification bodies, and nothing is really guaranteed. But at least you’re minimizing the likelihood of pesticides or chemical fertilizers being present in the herb. The other thing with herbs is that certain herbs like raspberry leaf – actually being one of the main ones used during pregnancy and lactation for a lot of people – that is an herb that actually draws a lot of minerals from the soil, which is one of the reasons why it’s used as a nutritive is because it draws those minerals from the soil. There is, unfortunately, evidence that those herbs, like nettles (also safe in pregnancy generally and widely used)…that both raspberry leaf and nettles have the capacity to pull heavy metals out of the ground as well. And so, the kind of soil quality or where they’re grown can have a huge impact if people are thinking about that herb quality. And that’s something to talk to them about because that’s not always tested for in a dry loose herb situation.

A.C.:   Is that preventable by choosing organic?

C.G.:   It’s not preventable by choosing organic, unfortunately, because heavy metal testing of the soil is not part of most organic certification processes. It really is about the addition of chemical pesticides or fertilizers that the organic certification bodies are concerned about and not necessarily testing for heavy metal content in the soil. It’s a much bigger problem in wildcrafting; if someone were wildcrafting their nettles or raspberry leaf, which some people are doing, looking at—if you can—not picking off sites that used to be industrial sites or near a whole bunch of traffic. Again, it’s always about minimizing risk. There is never zero risk in life.

A.C.:   And less so when you’re carrying a little one or caring for a little one. My next question was actually about the safety of wildcrafting local herbs…I guess, being careful of the sites where these herbs are coming from?

C.G.:   Yeah, I think being careful of sites of where your wildcrafting, certainly. The dangers of over wildcrafting from an environmental perspective are pretty huge. And even if you follow wildcrafting guidelines of only taking 20 percent of a stand, if you take 20 percent and then the next person takes 20 percent and another person takes 20 percent and another person and so on, then very quickly nobody has any wild leeks anymore. So, certain kinds of herbs like nettles, if you’re just cutting off the aerial parts, those nettles are going to be still standing there next year and the year after and probably forevermore, but that’s not true of all of the plants that people would potentially be harvesting.

A.C.:   For sure. Speaking of these practices, with a medical model that places double blind placebo controlled trials as the only measure to assess treatment outcome, how does traditional wisdom fair?

C.G.:   Well, if the gold standard is the double blind RCT than traditional fare doesn’t compare because the traditional medical models, or traditional use, is not an RCT. It’s never going to be. And so, I think that we have to consider both in terms of if something has been used for 3,000 or 4,000 years in this way, that still doesn’t make it 100 percent safe. But certainly, there are herbs within those traditions that would be considered completely unsafe in a pregnancy or lactation. It’s not like everything is chosen willy-nilly and just give everything to everybody. I think that there’s a lot we can learn from traditional use, in particular in lactation and the postpartum period because most of the traditional medicinal systems around the world, whether that’s Unani or Ayurveda or Traditional Chinese Medicine had a lot to say about that period and how to nourish somebody after delivery…there’s a lot that we can’t learn there. And maybe that’s where we should be focusing our research dollars, because some of the most common complaints postpartum that people see in primary care are things like hair loss, night sweats, and general fatigue and then lactation concerns around supply. And that’s where traditional medicines have a lot to say about those things and how to prevent them or how to address them when they do occur. Those don’t have to be a part of that postpartum period. We could direct research in that area, say for instance, using those traditional herbs that have already been used and are more likely to be safe than not safe.

A.C.:   Coming full circle then to the first question, the fact that it is unethical to test pregnant women and thus have answers about a drug or an herb in pregnancy…being that that model makes it so that we can’t test them… which makes sense, right? It makes ethical sense not to. Knowing that we have thousands of years of a different kind of data that has allowed—whether ethical or not—herbs to be used by just the nature of somebody’s environment, of how somebody’s grown up. The fact that they’re not relying on going to the MD to prescribe them something that has an RCT on it. Herbs have been used in pregnancy for—

C.G.:   And I think this is where so much of it comes down to consent, and some patients and some people are going to be really comfortable with having an understanding of what the potential side effects might be based on traditional use. Right? Because it’s not like that wasn’t noted or isn’t noted in the literature. But having that understanding and taking the herb based on that traditional use whereas other people are not going to be. And so, I feel like for me, my job as a practitioner is really to provide them with as much information as possible in a way that people understand so that they understand what those risks might be and what the side effects might be. How the herb has been used traditionally and what that looks like. I think in particular it’s more the partus preparators that have a lot more conflicting data on them, but they’re used. They were used. Say something like blue cohosh. Okay. It’s a very strong herb. We know in its regular use in people who aren’t pregnant, as an emmenagogue and a decently strong one, and that isn’t going to be something that necessarily has the same safety data as nettles. And we can predict that based on what we know about that herb and how we use it or how it’s been used traditionally. Likewise, something that’s been classified as a rasayana, within the Ayurvedic tradition, like a tonic, right? Or a tonic within the Traditional Chinese Medicine tradition. Generally, those herbs have been considered safe for a reason and used on a daily basis as tonics for years without fail. They’re not intended as short-term herbs. So, that understanding is really critical to how we look at those periods as well. Even from that traditional model, we have a sense of which herbs are generally safe long term and at higher doses with a wide therapeutic window, what herbs have a smaller therapeutic window and are generally used on a shorter term basis or maybe might be better used only topically during times where there’s that risk, in a powdered form or a tincture form, topically…something like an infection, like an herb that’s more anti-infective.

A.C.:   Like golden seal.

C.G.:   Golden seal. Great example. Right? Versus herbs that are already really low-dose that most people, even most herbalists or naturopaths, aren’t using except in extremely low doses.

A.C.:   So, it’s so great to be positioned where we are, where we have both sets of data, because they’re both so instructive. And to have this bank of stories of use in pregnancy and lactation for thousands of years and to say, “Well, this is what we’ve seen. This is why these cultures use these herbs,” and then we might look at it in an animal trial and say, “Well, it looks to be potentially unsafe.” Well—

C.G.:   What does that mean, and how do we use that data? And I think that’s the critical piece, weighing all that information there. Also, how am I going to apply it? So, I’ve certainly had situations where people have been pregnant, and they’re really constipated, for instance. And there is not a great amount of safety data on the therapeutic use of dandelion root. Period, actually. Not just in pregnancy and lactation, but actually very few people have researched dandelion for constipation. There’s some more recent research on its potential use in oncology than there is on what its traditional use has been. And it’s an herb that crosses that barrier, right? Because dandelion leaves have been eaten as food and have a culinary usage and certainly would not be considered to be a problem in pregnancy. But dandelion root is not necessarily in that culinary framework. But I’ve certainly had patients who have really struggled with constipation that wasn’t resolving from dietary changes or fluid intake and fiber and the usual options where the patient did decide to use dandelion root tea because it was a bit lower risk than or less concentrated than a tincture, and on a short-term basis and just to kind of reset digestion.

A.C.:   To good result. Great. Great.

C.G.:   But that’s an example of using an herb that doesn’t have that kind of research based on it but does have some traditional use understanding and has been traditionally considered relatively safe.

A.C.:   No absolutes.

C.G.:   There’s no absolutes in medicine. Ever. Ever!

A.C.:   So, sort of to wrap up, do you have any interesting stories of herbs or practices used traditionally in childbearing, in childbearing women that we may not use or have knowledge of in Western medical practice?

C.G.:   I think in Western medical practice there’s very little use of herbs typically. So any, any herb use is really kind of unusual. I think in like second, third trimester, and I’m much more cautious during the first trimester. And the challenges in pregnancy are quite minimal relatively speaking in first trimester. Basically, you’re looking at nausea and vomiting and fatigue…to be expected. I think I’m more comfortable than most talking to people about their options, but I’ve used a lot of tonics during those times with people of various sorts or nutritive herbs during that time. And the only main questions I really have with herbs that really have a very well documented, known effect on hormones or risk of teratogenicity. So, because I’m working in mental health, we know that this is true even in the conventional medicine system. At this point, SSRIs are generally considered safe during pregnancy for the most part because the risks of depression are greater than the risks to the pregnancy. This is the other thing about risk – that it’s complicated. It’s never just one factor. I certainly have had patients who have had a history of anxiety or trauma that’s been mediated by nervine herbs like say passiflora or scutellaria that they had been using long term on a regular basis prior to pregnancy and felt very concerned about not being able to use those, even though there is little safety data on their use. Again, generally considered safe, a wide therapeutic window. There definitely have been times where I’ve had patients who made the choice to continue using those herbs through pregnancy and lactation in spite of a lack of research of their safety in terms of human trials during that time.

A.C.:   It’s never one factor. You’re dealing with a whole person with many things going on.

C.G.:   Rarely has the person who got pregnant not lived a life before that.

A.C.:   Yes, yes. So, what is the greater risk? That’s a great point. Always a conversation. I’m sure with their naturopath is a great place to have that conversation.

C.G.:   I think it goes back to some of the things that are just considered normal, like night sweats and hair loss, most I’d say most naturopathic doctors would say that’s not necessary. Most Traditional Chinese Medicine doctors, most Ayurvedic practitioners, most people outside of the conventional medical model in North America would say that doesn’t have to happen in the postpartum period. And a lot of times, herbs can be quite efficient in that time period to help prevent it.

A.C.:   Yes. It’s not necessarily an illness, right?

C.G.:   Or a necessary evil

A.C.:   Well said. Thank you so much for your informed interview, and thanks for taking the time to speak with us.

C.G.:   Thank you.