Pre-conception Care and Pregnancy

This topic is representative of the work I do in my Sydney based naturopathic clinic. A large part of my client base have or had fertility problems and maybe also be participating in some form of artificial reproductive technique concurrently. It is still the exception in practice that I would treat a healthy couple who have not tried to conceive prior to seeing me. However, with declining birth rates, greater acceptance of natural therapies and an older maternal age of first time mothers in Australia, the trend towards preconception care and healthy pregnancies with a minimal amount of medicalisation is growing. In practice I don’t do any bodywork so my aromatherapy treatments are usually internal or I will ask the patient to apply an essential oil formula to him or herself cutaneously, as is practiced in aromatic medicine.

Introduction

Preconception is a comprehensive approach for those wishing to conceive and involves both partners. It embraces diet, lifestyle, environmental issues and at the same time treating pre-existing health problems. However some health care professionals still see preconception care as being relevant only in cases where there is evidence that the couple may pass on some genetic abnormality or a pregnancy may risk the health of the mother or baby. (Wille et al, 2004). By maximising the health of the couple before consciously conceiving minimises complications of pregnancy and produces a healthy wanted baby.

Most healthy pregnant women enjoy their pregnancies and apart from the physical discomfort as the due date approaches they maintain wellness and often express that they have never felt better. However, acute infections and inflammatory conditions can be irritating and I find using essential oils a safe and expedient method of treatment.

Why bother with preconception care?

Preconception care is a responsible approach that a couple makes prior to trying to consciously conceive. When healthy couples fall pregnant they tend to have healthy babies that are carried to full term and are usually delivered without medical intervention. For the mother an optimum postnatal experience with the risk factors for postnatal depression minimized as the pregnancy is planned and wanted. (Naish & Roberts, 2000). Underpinning the protocol for initiating preconception care is a healthy baby. Planned pregnancies are still the exception rather the rule with an average of 50% occurring in adult women. It is not to say that they are not wanted, it’s just that with conscious conception there are likely to be better health outcomes. (Gottesman, 2004).

What’s involved?

� Detailed case history of both partners - medical, dietary, lifestyle and environmental health.
� Medical tests – semen analysis, genital swabs for infections are the starting point
� Naturopathic tests – hair mineral analysis; check mineral status + heavy metal load (Inter Clinical Laboratories, 2004)
� Treat pre-existing health problems
� Dietary (Fowles, 2004)
� Lifestyle - remove social drugs & caffeine (Gottesman, 2004)
� Environmental & occupational hazards – eg. A spray painter married to an acrylic nail artist
� Loose or gain weight, look at exercise
� Anatomy & Physiology lesson with diagrams – many women are unaware of when & why they ovulate
� Symto-thermal charting of menstrual cycle – see ovulation pattern
� Aromatic medicine – using essential oils for broad spectrum infections & infestations
� Herbal protocols – hormone balancing and other more chronic problems
� Vitamin & mineral therapy (Naish & Roberts, 2000)
� Bodywork – yoga, massage, stress, osteopathy or an appropriate therapy

� How long will it take?

When you look at the average menstrual cycle, the fertile days account for 15% of the cycle, in reality the window of opportunity to fall pregnant is about 4 days in the month. Coupled with the age of the women will depend on how quickly she will fall pregnant, in Australia the median age of a first time mother is 29.7years (Australian Bureau of Statistics, 2002). With delayed childbearing comes the increased risk of infertility, twinning, chromosomal abnormalities, miscarriage and complications in pregnancy (Wille, 2004). Also the health problems the couple share and time it may take to treat and compliance to the treatment plan will impact on the time it will take to conceive.

Because my practice is located in the city it is not always the most convenient for the patient to drop in & collect medicines so I have an efficient mail order system where the patient phones or e-mails & goods are delivered the next day. I enforce this thinking from the first consultation because natural therapies work very well if the patient has easy access to them.

A good practitioner will know when to refer the patient to other practitioners; I have never lost a patient because I referred them to the right person for appropriate treatment.

They’re Pregnant!

I schedule 3 future appointments to track the mother’s progress. This she finds reassuring because she may have been in my care for some time and don’t forget you often know more intimate details about this couple than anybody else. When she has been tracking her cycle with the sympto - thermal chart she is recording when she ovulates and timing intercourse accordingly, so you have formed quite a bond with the couple by the time she is pregnant. Scheduling theses appointments eases the transition from trying to conceive to achieved pregnancy and birth of the baby.

� 1st Appointment:�� End of 1st trimester - check her nutritional status, general health & make sure she has access to child birth education

� 2nd Appointment:�� End of 2nd Trimester - possible essential oils and herbs for birthing.

� 3rd Appointment:�� 8 weeks post natal - meet baby, check nutritional status, ask how she is coping and supported

Rational for treating a pregnant woman

I do not treat a pregnant woman medicinally unless there is a reason for the treatment. Lisa Basso (2004) laments in a paper in the International Journal of Aromatherapy, about the lack of scientific research as far as aromatherapy is concerned. The work with pregnant women is largely documented in labour and birthing (Simkin et al, 2004) using massage techniques with essential oils. I have developed my own protocol adhering to the following rational with excellent results.

The concern with treating pregnant women is always the effect the treatment will have on the fetus and rightly so. Drugs only cause 2-3% of fetal congenital malformations; most deformities are related to genetic or environmental causes. The effect the drug has on the fetus is determined by the age of the fetus, potency and dose. Before the 20th day, after fertilization, they have an all-or-nothing effect, killing the embryo or not affecting it. Teratogenesis is not likely to happen. However, between the 3rd and the 8th week (organogenesis) when the major organs are developing the fetus is most vulnerable during this period, commonly effected are the heart, central nervous system, palate and ear. Drugs given after organogenesis are unlikely to be teratogenic. Maternal and fetal blood do not merge, solutes in maternal blood must cross the epithelial cells and connective tissue of the villi and then the endothelium of the fetal capillaries. The placental veins, which converge into the umbilical vein, then carry the agent to the fetus. (The Merck Manual, 1999).

The more sedating or intoxicating an agent for example alcohol, more likely it is to cross the placenta. The lower the molecular weight less than < 500 g/mol, the more easily an agent will cross the placental barrier. (Seibert, 2001) The more lipophillic (agents that dissolve or absorb lipids) and the longer the agent remains in the circulation the higher the probability that the agent will eventually cross the placental barrier. The longer the agent remains in circulation, the high the probability that it will cross the placental barrier. (Seibert, 2001) For the above reasons, I do not treat in the 1st trimester at this stage of organ development.

Treatments during pregnancy

In pregnancy I treat acute conditions because the chronic complaints should have been remedied in preconception phase. The type of conditions I would commonly treat are listed below. Essential oils have antibacterial, antiviral and antifungal properties that antibiotics do not have. (Schnebelen et al, 2004) (Pauli, 2001).

Infections:�� respiratory -colds/sinusitis

Vaginal:�� candida / thrush

Inflammation:�� respiratory - bronchitis vaginal - vaginitis haemorroids

Viral:�� influenza - genital herpes

Treatment Protocol

Work through pre-conception issues

Don’t treat in first trimester

2nd trimester onwards, only if there is a reason

Terpenes, alcohols, esters & oxides

Work within your professional limits

If in doubt, do without

Conclusion.

Preconception is a comprehensive approach for those wishing to conceive and involves both partners. It embraces diet, lifestyle, environmental issues and at the same time treating pre-existing health problems. A study 200,000 women in the Netherlands were counseled to stop smoking (50% stopped smoking) & take folic acid (75% took folic acid) to prevent, neural tube defects, low birth weight, very low birth weight and perinatal death because of smoking. It was estimated that 5.1 million dollars in smoking related and 7.2 million dollars in neural tube related health costs were saved. (de Weerd et al, 2004) Imagine the lifetime costs saved and a healthy child cannot be expressed in terms of cost alone our national health systems should all look towards comprehensive preconception care as the first step to a healthy pregnancy and baby.

Pregnant women are usually healthy robust women and the choice of taking an essential oil remedy as opposed to an antibiotic for a non-life threatening illness is usually something they are not offered. I think the thought of treating pregnant women in aromatherapy circles needs more exposure and aromatherapist should not be frightened by further learning opportunities.

References

Arnal-Schnebelen, B. Hadji-Minaglou, F. Peroteau, J.F. ribeyre, F. & Billerbeck, V.G. (2004) Essential Oils in Infectious Gynaecological Disease: a statistical study of 658 cases. International Journal of Aromatherapy Volume 14(4): 192 - 197

Australian Bureau of Statistics (2002) Population Births. http://www.abs.gov.au

Basso, L. (2004) Aromatherapy and Scientific Research: the current status of aromatherapy in relation to scientific research methodology. International Journal of Aromatherapy 14(4): 175-178.

Borrelli et al (2005) Effectiveness and Safety of Ginger in the Treatment of Pregnancy Induced Nausea. Journal of Obstetrics & Gynaecology 105: 849-856

Bowles, J.E. (2003) The Chemistry of Aromatherapeutic Oils. Allen & Unwin, Australia.

de Weerd, S. Polder, J.J. Cohen-Overbeek, T.E. Zimmerman, L.J.I. Steegers, E.A.P. (2004) Preconception Care: preliminary estimates of costs and effect of smoking cessation and folic acid supplementation. Journal of Reproductive Medicine 49(5): 338-344.

Fowles, E.R. (2004) Prenatal Nutrition and Birth Outcomes. Journal of Obstetrics, Gynaecology & neonatal Nursing. 33, 809-822.

Gottesman, M.M. (2003) Preconception Care, Care for the Future. Journal of Paediatric Health Care 18(1):40-44.

Guba, R. (1996) Aromatic Medicine Course Notes. The Centre of Aromatic Medicine. Melbourne.

Inter Clinical Laboratories (2004) Tissue Mineral Analysis:Bringing the Body into Balance. Practitioners Reference Manual. Interclinical Laboratories Pty Ltd. Australia.

Naish, F. & Roberts, J. (2000) The Natural Way to Better Babies. Adelaide: Griffin Press.

Pauli, A.(2001) Antimicrobial Properties of Essential Oil Constituents. The International Journal of Aromatherapy 11(3): 126-133

Simkin, P. & Bolding A. (2004) Update on Nonpharmacological Approaches to relieve labor pain & Prevent suffering. Journal of Midwifery & Women’s Health 49(6) 480-504

The Merck Manual of Diagnosis and Therapy. (1999) 17th edition Merck & Co. Inc. USA

Tisserand, R. & Balacs T. (1995) Essential Oil Safety A Guide for Health Professionals. Churchill Livingstone, New York

Wille, C. Weitz, B. Kerper, P. & Frazier, S. (2004) Advances in Preconception Genetic Counselling The Journal of Perinatal & Neonatal Nursing 18(1): 28-40.

Posted by Wendy Williams on Aug 14 2006 at 5:29 PM