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Herbal Medicines in Pregnancy: What’s Safe & What’s Not

herbal medicines in pregnancy

Updated April 26, 2016: You can also go here to listen to an episode of my podcast, Natural MD Radio, that accompanies this article.

So eight days late, huh,? You must be getting a little uncomfortable? . . . If you’re anxious there are a few ways to help things along . . . actually there are things you can do…just some home remedies . . . .I’ve found that some of them are very effective . . . .there’s an herbal tea you can drink . . . .”

– Obstetrician in Friends, “The One Where Rachel is Late”

The past century has vastly improved many outcomes in high-risk pregnancies and births, yet with these improvements has come the omnipresence of technology in nearly all aspects of normal pregnancy and birth. Since at least 2000, Cesarean section has been the most common hospital surgical procedure performed in the US, accounting for more than 34% of all US births. As a midwife and MD with a specialty in obstetrics, I’m grateful for the technology when it’s needed.

Unfortunately, technology is far too overused in pregnancy and birth in the US. In spite of spending more money and using more technologies on obstetric care than any other country in the world, the United States consistently ranks poorly in birth outcome and infant mortality world-wide, often below many less modernized countries.

Additionally, the use of pharmaceuticals in pregnancy is excessive, and not without risks. While the horrors of thalidomide are behind us, women in their 40s, and men too, whose mothers took DES during pregnancy in the 1960s and 1970s are still dealing with the repercussions in the forms of increased reproductive cancers (and genital deformities), and new studies continue to reveal hidden harms, though perhaps less extreme, of pharmaceuticals currently in use, including what we’ve all been told is safe until recently – Tylenol. And yet another recently study has demonstrated that the most common medication given in pregnancy for yeast infections increases miscarriage.

Shocking statistics have been coming out about the dispensing of prescription drugs, including narcotics, to pregnant women in the U.S. One recent study looked at the pattern of prescription drugs (other than vitamins) dispensed to over one million women enrolled in Medicaid for at least 3 months before and then throughout pregnancy from 2002 to 2007. Almost 83% of these women were dispensed at least one medication; half of these were antibiotics.

Another study found that the rate of narcotics dispensed to pregnant women who were enrolled in Medicaid in these same years increased from 18.5% to 22.8% with rates exceeding 30% in five states. Among women of reproductive age generally in the United States from 2008 to 2012, almost 40% of Medicaid-enrolled women and 28% of commercially insured women filed claims for narcotics.

Against this backdrop, the use of herbs in pregnancy seems rather benign. Yet it’s important to be aware of the safety issues when using herbs in pregnancy, because not everything that’s natural is safe for pregnant moms.

The desire to avoid unnecessary – and potentially unsafe – medical interventions, and an inclination toward natural approaches has led many pregnant women to seek alternatives. It’s why I began studying them over 30 years ago, and why I continue to incorporate them as my first “go-to” in my medical practice whenever possible.

The use of herbs for the treatment of common pregnancy symptoms is very common. Studies and surveys estimate that up to 45% of women use an herbal therapy at some point during pregnancy.  For better or worse, there are a lot of “experts” on the internet “wild-west” giving advice that may not always be accurate, so it’s important to get your information from reliable sources that you can trust.

I hope this article gives you a glimpse into the potential benefits of herbs in pregnancy. If you’re seriously interested in learning more about herbs in pregnancy, my course Herbal Medicine for Women is a great place to look if you’re a health practitioner. For mommas, a natural medicine in pregnancy course is in the works for you, but won’t be out until 2016. In the meanwhile, The Natural Pregnancy Book is a great resource.

Herbs in Pregnancy: Are They Safe?

Herbs have been used for the treatment of discomforts and common problems arising during pregnancy and childbirth dating at least back to ancient Egypt.

Little is known scientifically about the safety of most herbs during pregnancy, as most have not been formally evaluated and ethical considerations limit human clinical investigation during pregnancy. However, much the same can be said for the use of many pharmaceuticals during pregnancy, most of which have not been tested or proven safe in pregnancy. Even medications previously thought to be safe in pregnancy, including Tylenol, have now been found to cause potential problems for baby. And as many as 90% of all pregnant women will be prescribed some medication during pregnancy!

Most of what is currently known about botanical use during pregnancy is based on a significant body of historical, empirical, and observational evidence, with some pharmacologic and animal studies. Overall, most herbs have a high safety profile with little evidence of harm. Pregnant mommas commonly experience minor symptoms and discomforts for which the use of natural remedies may be gentler and safer than over-the-counter (OTC) and prescription pharmaceuticals.

Few reported adverse events have occurred, and those that have typically involved the consumption of known toxic herbs, adulterations, or inappropriate use or dosage of botanical therapies.  However, lack of proof of harm is not synonymous with proof of safety. Some of the harmful effects of herbs may not be readily apparent until after use has been discontinued, or may only occur with cumulative use, so it’s important to be smart and safe and use only those herbs in pregnancy with a proven track record and a good safety profile.

Schools of thought differ on whether herbs should be used during pregnancy. Some believe that since most herbs are not proven safe during pregnancy, they should be entirely avoided, while others see certain herbs more as foods that can provide an additional source of nutrition during pregnancy, or as tonics which can encourage and support optimal pregnancy health and uterine function.

Perhaps the most reasonable approach to herb safety is a “risk: benefit” one that takes into consideration the safety of the individual herb, the severity of the symptom or condition and comparing this to the safety of the corresponding conventional medical approach.

Certain signs and symptoms arising during pregnancy always warrant medical attention, and should not be treated with herbs. These include:

  • Persistent vaginal bleeding
  • Initial outbreak of herpes blisters during the first trimester
  • Severe pelvic or abdominal pain
  • Persistent, severe mid-back pain
  • Edema of the hands and face
  • Severe headaches, blurry vision, or epigastric pain
  • Rupture of membranes prior to 37 weeks pregnancy
  • Regular uterine contractions prior to 37 weeks pregnancy
  • Cessation of fetal movement

Using Herbs During Pregnancy

The safest approach to the use of herbs during pregnancy is to avoid herbs during the first trimester unless medically indicated when there is not a more effective or safer medical option (i.e., nausea and vomiting of pregnancy-NVP, threatened miscarriage) and after this to use herbs that are known either scientifically or historically to be safe during pregnancy.

Beverage and nutritive teas that are known to be safe in moderate amounts (i.e., red raspberry, spearmint, chamomile, lemon balm, nettles, rose hips) can be considered reasonable for regular use in pregnancy. Using normal amounts of cooking spices is considered safe as well.

There are a number of herbs whose constituents (chemical composition) are mostly gentle, nutritious substances such as carbohydrates vitamins, and minerals and which can be used safely in pregnancy as basic daily tonics, for example, nettles (Urtica dioica), milky oats (Avena sativa), and red raspberry leaf (Rubus idaeus). Several herbs have also been scientifically proven to be safe during pregnancy. These are presented in the first chart, below.

An herbalist, midwife, or naturopathic or integrative physician trained in the use of botanicals during pregnancy should be consulted when using herbs medically – that is, to treat a specific symptom or medical condition beyond those described in this article.

In addition to common pregnancy symptoms, when we’re pregnant and nursing we also get the same run of the mill mild illnesses everyone else gets – colds, indigestion, headache, etc.,  for which herbs can be helpful and even safer than OTC meds. Many of these problems can be addressed safely and gently with mild herbs such as echinacea, ginger, or chamomile respectively.

The following chart provides an overview of a number of herbs that have been demonstrated to be safe for use during pregnancy through clinical trials or scientific evaluation of safety.

Herbs Considered Safe in Pregnancy

Herbs in pregnancy

Herbs to Definitely Avoid

While a number of herbs are known to be safe in pregnancy, there are numerous herbs that should be avoided. Somewhere between these categories are herbs whose use is not appropriate for daily, routine intake, but which can be used if necessary for brief or more extended periods of time for specific conditions.

Licorice is an example of such an herb. Used short term for a sore throat, for example, for no greater than one week, it may be entirely safe and appropriate, however, it is contraindicated in patients with hypertension, and long-term use of even licorice candy containing actual licorice extract has been associated with preterm birth.

The herbs listed under each category are representative examples and are not exhaustive, but should definitely be avoided in pregnancy. Additional herbs may fall into any of these categories.

Herbs in pregnancy

Topical applications, including vaginal use (i.e., for the treatment of vaginal infections), of most herbs is considered safe, however, some herbs, for example, poke root, pennyroyal oil, and thuja, which are known to be toxic, should be avoided internally and topically.

Note that when you see sorghum on the list of herbs to avoid – don’t freak out if you’re eating it – that’s fine – it’s concentrated use of certain species in huge amounts that’s the problem!

* Avoid internal use; external use may be acceptable under the guidance of an experienced botanical medicine practitioner. Note that sorghum in normal food use is considered safe.

Common Conditions During Pregnancy and Herbs for Treatment: An Overview

The herbs cited in the medical literature as most frequently used for pregnancy concerns varies slightly among studies, but includes: echinacea, St John’s wort, ephedra; peppermint, spearmint, ginger root, raspberry leaf, fennel, wild yam, meadowsweet; blue cohosh, black cohosh, red raspberry leaf, castor oil, evening primrose, garlic, aloe, chamomile, peppermint, ginger, echinacea, pumpkin seeds, and ginseng.

In one study, women reported lower GI problems, anxiety, nausea and vomiting, and urinary tract problems as the most common reasons for using complementary therapies in pregnancy. Midwives most frequently recommend herbs for nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation.

The Chart below, Herbal Treatment of Common Pregnancy Concerns, provides guidelines for commonly used botanical treatments for several pregnancy problems, and provides a brief discussion of the safety of the herbs presented.

Herbal Treatment of Common Pregnancy  Concerns

common preg problem

[Note that an infusion  is a strong tea, so if making with tea bags, use 2 per cup; an extract is the same as a tincture. The amount of alcohol in herbal tinctures is negligible and is considered safe in pregnancy within recommended typical use of the herbal product.]

Getting Ready for Birth: A Word about “Partus Preparators”

Partus preparators are herbs sometimes used during the last weeks of pregnancy to tone and prepare the uterus for labor. They have historically been used to facilitate a rapid and easy delivery. Herbs commonly used as partus preparators include blue cohosh (Caulophyllum thalictroides),black cohosh (Cimicifuga racemosa), partridge berry (Mitchella repens), and spikenard (Aralia racemosa), among others.

The use of such herbs to prepare women for labor begs the question of why one would use an herbal preparation to prepare the body for something it naturally knows how to do. Furthermore, the safety of these herbs prior to the onset of labor is questionable. Case reports have appeared in the literature suggesting an association between blue cohosh and profound ischemic episodes or myocardial infarction in the neonate.

Blue cohosh contains a number of potent alkaloids including methylcystine and anagyrine, the latter, which is known to have an effect on cardiac muscle activity. Other side effects of blue cohosh include maternal headache and nausea. Yet the use blue cohosh represents one of the one widely applied botanical medicines by midwives, including CNMs, and one of those most commonly included in late pregnancy formulas self-prescribed by pregnant mothers. Much of this is due to medical pressure for induction of labor by 40 weeks of pregnancy.

The risks associated with extended third trimester ingestion of blue cohosh specifically suggest that it should be avoided as a partus preparator.

Red raspberry leaf tea, 2 cups daily, on the other hand, is know to be safe in pregnancy, and several studies have now shown that taking it regularly in the last trimester can make labor easier, reduces the need for medical interventions in labor, and makes baby less likely to need any resuscitation. I’d say that this makes it a great herb to use for getting ready for birth! 

Summary

Herbs can provide substantial relief for common symptoms and concerns that arise during pregnancy and childbirth. The power of herbs should be respected during pregnancy, and therefore, they should be used with caution. However, many herbs may be contraindicated on the basis of very limited findings, erroneous reports, or by association with a problem rather than a proven causal effect.

Many herbs that have not been evaluated may, nonetheless, offer simple, safe, gentle, and effective solutions for many common pregnancy problems ranging from anemia to vaginitis.

Good diet and nutrition, exercise, and healthful lifestyle including a positive outlook and strong social support are the cornerstones of an optimal childbearing experience.

References

Ailes EC, et al. Centers for Disease Control and Prevention (CDC). Opioid prescription claims among women of reproductive age—US 2008–2012. MMWR Morb Mortal Wkly Rep 2015; 64:37–41.

Allaire A, et al. “Complementary and alternative medicine in pregnancy: asurvey of North Carolina certified nurse-midwives,” Obstetrics and Gynecology 95 (2000): 19-23.

Beal M. “Women’s use of complementary and alternative therapies in reproductive health care,” Journal of Nurse Midwifery 43, 3 (1998): 224-234.

Blumenthal M, et al., The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicine (Boston, MA: American Botanical Council, 1998).

Chez R and Jonas W. “Complementary and alternative medicine. Part I: Clinical studies in obstetrics,” Obstetrical & Gynecological Survey 52, 11 (1997 November): 704-708.

Desai RJ, et al. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol 2014; 123:997–1002.

Ernst E. “Herbal medicinal products during pregnancy: are they safe?,” BJOG 109 (2002 March): 227-235.

Ernst E and Schmidt K. “Health risks over the internet: Advise offered by “medical herbalists” to a pregnant woman,” Wien Med Wschr 152 (2002):190-192.

Fischer-Rasmussen W, et al. “Ginger treatment of hyperemesis gravidarum,” Eur J Obstet Gyn Reprod Biol 38, 1 (1990): 19-24.

Gallo M, et al., “Pregnancy outcome following exposure to echinacea: A prospective controlled study,” Archives of Internal
Medicine 160 (2000); 3141-3143.

Gibson P. “Herbal and alternative medicine use during pregnancy: A cross-sectional survey,” Obstetrics and Gynecology 97, 4 Suppl. (2001 April): 44.

Hardy M. “Herbs of special interest to women,” Journal of the American Pharmaceutical Association 40, 2 (2000 March/April): 234-239.

Hepner D, et al. “Herbal medicine use in parturients,” Anesth Analg 94 (2002): 690-693.

Jones T and Lawson B. “Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication,” Journal of Pediatrics 132 (2003 March):1323.

Low Dog T. Women’s Health in Complementary and Integrative Medicine: A Clinical Guide (St Louis, MO: Elsevier, 2004).

Mølgaard-Nielsen, D. et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58-67

Palmsten K, et al. The most commonly dispensed prescription medications among pregnant women enrolled in the United States Medicaid program. Obstet Gynecol 2015;126:465–73.

Parsons M, et al. “Raspberry leaf and its effect on labor: safety and efficacy,” Aust Coll Midwives J 12 (1999): 20-25.

Pinn G and Pallett L. “Herbal medicine in pregnancy,” Complementary Therapies in Nursing and Midwifery 8 (2002): 77-80.

Ranzini A. “Use of complementary medicines and therapies among obstetric patients,” Obstetrics and Gynecology 97, 4 Suppl. (2001 April): 46.

Strandberg T, et al. “Preterm birth and licorice consumption during pregnancy,” American Journal of Epidemiology
156, 9 (2002): 803-805.

Simpson M, et al. “Raspberry leaf in pregnancy: its safety and efficacy in labor,” Journal of Midwifery & Women’s Health 46 (2001): 51-59.

Upton R. Uva ursi leaf: Arctostaphylos uva ursi (Scotts Valley, CA: American Herbal Pharmacopoeia, 2007).

Vutyavanich T, et al. “Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial,” Obstet Gynecol 97, 4 (2001): 577-582.

Weed S. Wise Woman Herbal for the Childbearing Years (Woodstock, NY: Ash Tree Publishing, 1986).

Wichtl M. 4th ed., Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis (Stuttgart, Germany: Medpharm, 2004).

Wright I. “Neonatal effects of maternal blue cohosh consumption,” Journal of Pediatrics 134, 3 (1999 March): 384.

Comments

  1. Could you comment about the use of valerian in pregnancy, specifically for preexisting postpartum depression/insomnia? I was not able to find much information in your book on botanicals for women’s health.

    • Hi Bethany, please see my blog on postpartum depression and depression in pregnancy for what’s safe. Best wishes to you!
      Aviva

  2. Gwyn MacDonald says:

    Hi Aviva!
    Great article, as always. Wondering if you have a recommendation for some good info/reading on holy basil during pregnancy? Many thanks!

    • Hi Gwyn
      See comment above to another lovely reader….
      There’s really no good data on adaptogens in pregnancy, and some physiologic evidence that suggests best not to use them other than as a tea here or there…
      Aviva

      • Brittany says:

        I have taken Maca during pregnancy, which I believe is an adaptogen, mainly by adding a teaspoon of powder to oatmeal. Is there any evidence of harm to taking Maca after conception? I had been taking it as a nutritive, fertility-promoting supplement and simply never discontinued it.

        • I don’t know of any harm, and it is used during pregnancy in Peru, but I don’t personally recommend adaptogens in pregnancy. Best wishes! Aviva

  3. Thank you so much Aviva! What a great resource!!! I really appreciate this.

  4. Hi Aviva,

    Thank You for your wisdom! I wonder if you could enlighten me about Tulsi tea? I know that it is a wonderful tea and good for the female reproductive and hormone system, but I also heard that it can effect estrogen production, so it might not be safe in pregnancy. Please let me know if this information is correct or not.
    Thank You!
    Ilka

    • Hi Ilka,
      Love that tulsi! But aside from a pleasant cup of tea here or there, I don’t recommend any herbs in the adaptogen class during pregnancy….
      Best, Aviva

  5. Audrey M says:

    Why are peppermint, thyme, sage & oregano not safe essential oils while pregnant? My father keeps insisting they are safe for common pregnancy symptoms, I’d like to be properly educated 🙂
    -Audrey

    • Essential oils taken internally in pregnancy can cause miscarriage (sage is well known for this), are potential neurologic agents in baby if they get across the placenta, and have potential hormonal effects. They are VERY concentrated so it doesn’t take much. Best, aviva

  6. Christine says:

    With peppermint under the “essential and volatile oils” category, is this primarily in reference to concentrated forms of peppermint such as peppermint EO, or are you also concerned about the volatile oils released in peppermint leaf tea? I generally use the AHPA’s Botanical Safety Handbook to determine herb safety and although there isn’t much research with peppermint leaf during pregnancy, there don’t seem to be any known concerns listed there. The essential oil, on the other hand, is cautioned. I just wondered if you have found different information. I like using peppermint leaf to help give a little flavor to pregnancy teas made with red raspberry, oatstraw, and nettles.

    • Hi Christine, SUPER LARGE amounts of peppermint tea might not be advisable — the idea is to not get a ton of the volatile oils to baby. But normal amounts of peppermint tea in pregnancy, likewise spearmint, are totally fine. However, peppermint can make reflux (GERD/heartburn) worse…
      Aviva

      • Caroline says:

        hello aviva , thank you for this great article, what do you think of topical use of peppermint oil for migraine on the temple?

        • Love it! 1 drop neet or diluted. Can cause eye burning even just from the vapors so don’t usually recommend for kiddos.

  7. Christine Harris says:

    Hi Aviva,
    My friend’s blood thickens when she get’s pregnant.
    She cannot carry a baby past 8 weeks because of it.
    The first herb I thought of was red clover.
    I see in your e-mail that it is not considered safe when
    pregnant. What would you recommend?
    She is 39 and has had 2 miscarriages in the past 2 years.
    Thanks,
    Christine

    • Hi Christine. She likely has Factor V leiden or a phospholipid antibody. This requires medical treatment — the gentle herbs would be safe as teas but herbs wouldn’t be appropriate to treat her condition. Best, Aviva

  8. Thank you for this research summary, as always well-developed and balanced, as well as very well referenced. As a midwife advising clients on herbal teas, I was wondering about oatstraw (as opposed to milky oats) and about your recommendation to avoid Red Clover. Both of those I’ve seen in pregnancy tea mixtures. Any specific resources you think would be helpful to look up the details of both of these herbs in pregnancy?

    • Hi Jenni
      Milky oats are also safe in pregnancy and are certainly the more effective form. Since many pregnancy nutritive formulas contain it, I mentioned it. As for the red clover, LOL, I think that herb got included in so many pregnancy teas because of me. That is, I put out a little handbook that circulated amongst midwives in the mid 1980s and then again, included in my earlier book editions and it just caught on. Over the years I stopped including it. I’m not sure it adds that much value as a dried herb, and though it’s not likely harmful at all, it raises red flags for OBs because it is wrongly associated with increased risk of bleeding or estrogenic activity. In reality, neither is likely from the herb in any form. My textbook Botanical Medicine for Women’s Health is probably the best resource on herbs in pregnancy — it’s the only comprehensive evidence based resource; and then there’s also the Botanical Safety Handbook which is the most current and accurate safety guide to botanicals. Warmly, Aviva

  9. Thanks for this post – it is so hard to find good information about herbs, especially during pregnancy. One that I didn’t see mentioned is evening primrose oil. I see it recommended during the last few weeks of pregnancy as a way to prepare for labor – used vaginally and orally and sometimes in large doses. Any thoughts on that one?

    • The data from the Cochrane Database actually shows that it probably doesn’t do that much. I only use it in late pregnancy if someone is going way overdue, as part of a larger plan to get labor going. The idea is that the prostaglandins help to ripen the cervix. Large doses shouldn’t be needed….See more in my book Botanical Medicines for Women’s Health. Warm wishes, Aviva

  10. Hi Aviva,
    You always write such incredibly thorough and helpful articles and I just want to thank you for offering so much of yourself. It is so appreciated! <3 -C

  11. Rebecca says:

    Thank you for the great info. I was wondering if elderberries were safe during pregnancy?

    • Elderberry syrup is considered by herbalists to be safe in pregnancy for use during a cold or flu, though there isn’t a ton of scientific data on pregnancy, elderberries, and safety. I do use it. Best wishes, Aviva

  12. Melissa says:

    Hi Aviva,
    I’m confused about Prunus spps as teratogens. What species exactly are you referring to here and in what forms? I would think that Rosaceae family herbs would likely be safe and can’t imagine that cherries, peaches, apricots and plums would be unhealthy in pregnancy! I would appreciate clarification.
    Thanks!

  13. Hi Dr Aviva,
    I was wondering if you were familiar with this study on Red Raspberry Leaf tea and if so, if you had any thoughts on it?
    http://www.ncbi.nlm.nih.gov/pubmed/19276407
    Sometimes I am so confused by traditional use of herbs vs what I read on Pub Med. For instance, I’m breastfeeding and my acupuncturist would like to me to use Dong Quai, but then I’ve read elsewhere that it may be carcinogenic. So hard to know what to believe.

    • hi rachel,
      good for you for reading the literature! this study was on rats; not all of it was statistically significant; a strange association is made with problems with ginger extract in pregnancy, and yet all other data and historical use has found both to be safe in pregnancy. also, there is no data on study quality. so overall, although i wouldn’t ignore it, i don’t give it any major weight and would absolutely continue to rely on the data that demonstrates it’s safe in pregnancy. best, aviva

  14. Hi Aviva,
    Are there herbs that are safe to use for pain management during labor?

    • Hi Jeanne,
      This will have to be a blog! Or check out my textbook, Botanical Medicine for Women’s Health. Warmly, Aviva

  15. I’ll share this with my mom, a 20-year childbirth educator for low income, Spanish speaking women with high risk pregnancies. She attends their labors in hospitals with largely English-speaking-only doctors, so graciously and powerfully, and is so loved has like 800 Godchildren by now. 😉 Thanks for your brilliance.

  16. Thank you for this well researched article! 🙂 What do you think about green and black tea during pregnancy?
    Anna

  17. Karen S. says:

    Hi Aviva – I just heard about you through a podcast on Jennifer Fugo’s website and so excited to see the best of both worlds with midwife and doctor experience! I wanted to be sure I understood your article. Are you saying that no herbs (even the ones that are considered safe for pregnancy, such as red raspberry leaf) should be taken during the first trimester? It wasn’t exactly clear and I’ve been wondering if it is OK to consume the raspberry leaf tea throughout a pregnancy or just waiting till the last trimester. Thank you kindly.

  18. Hi Aviva! Thank you so much for this wonderful information. I had a miscarriage 2 months ago and I’ve recently started taking a supplement blend that include herbs such as rhodiola and ashwaganda to help support my adrenal health. Is it okay to take herbs and use essential oils until I find out I’m pregnant again or can I harm the pregnancy that early along? (I would take home pregnancy tests ASAP each month). Thanks in advance!!

    • Hi Katey,
      I don’t usually recommend oral internal oils, but I do put many of my patients on adaptogens to support fertility – and then I discontinue once conception has taken place…

      • Thank you so much for your reply, Aviva! I’m so glad to hear that it’s acceptable to just discontinue the adaptogens once pregnant. This way I don’t have to choose one or the other 🙂 I’m so very grateful to have discovered you – thank you for sharing your perspectives with us all! (P.S. I also choose not to take oils internally)

  19. Hi Aviva,
    I’m 42 and pregnant for the first time after not being able to conceive for years.
    I have pcos and I cut out soy, wheat, and cut back on sugar and dairy I finally got pregnant but now I have another concern. I’m 17 weeks right now and I’ve had bv for several years. After taking metronidazole several times in the past it kept reoccurring and I finally gave up. Now, I’m pregnant and still had gardnerella (bv) come up in my culture. I’ve been prescribed metronidazole orally but after much research and an overall gut feeling I’m very afraid to take it while pregnant. I’ve been trying to do research and found a lot of different advice on what to do but I’m very overwhelmed and worried about a possible miscarriage if I do nothing. It was suggested that I should use a boric acid capsule vaginally as a possible form of treatment but again after doing a bit of research I’m conflicted. Some say it’s very dangerous and other things I’ve read say it’s safe. Any advice would be so much appreciated as I feel the life of my unborn baby depends on me making a move soon. Please, I’m very worried and unsure what the safest possible approach would be. Thank you in advance for any thoughts on this.

    • Hi Ava, Unfortunately, I can’t give direct personal health advice here on my blog. But my textbook, Botanical Medicine for Women’s Health does have natural information for BV. Best, Aviva

  20. Hi! Thanks for this fabulous resource!
    I’ve been advised to take oregon grape and a probiotic to try to ward off GSB. Both on the bottle and in your article it say do NOT take Oregon grape. Can you elaborate? Is it ok to take for a short time (10 days until the swab and I’m 35 weeks pregnant). Any help is appreciated. 🙂

    • Hi Elisa, Yes, Oregon grape is NOT intended to be used by mouth in pregnancy. Even for a short time, nope, not to be taken by mouth. It is used vaginally much like goldenseal, but check with your midwife, first! Best with baby! Aviva

  21. I am so thrilled I found your website!! Wish I would have found this years ago with my other pregnancies! Thank you for your insight. Do you have thoughts on garlic supplements and Rosemary? I know you mentioned garlic suppositories- but I found some fabulous garlic supplements that I love and am interested in your opinion!

  22. Mary Francell-Sharfstein says:

    Hi Aviva!

    Do you have a blog on the safety of herbs while breastfeeding? I have Sheila Humphrey’s book, but it’s over ten years old. Is there a chapter on breastfeeding in your textbook?

    Mary

    • Megan Liebmann says:

      Hi Mary,

      This is Megan from Dr. Aviva’s team. I highly recommend checking out Aviva’s book Natural Health After Birth, and yes, Chapter 18 of Dr. Romm’s text book is all about breastfeeding and botanical medicine!

      Megan- Dr. Aviva Romm Nutritionist

  23. What do you know about Shepherd’s Purse? My last midwife had me drink a tea for the last few weeks of my pregnancy to prevent hemmorage. I was amazed at how little bleeding I had after the birth. My lochia was so much lighter and was GONE in about 5 days (with my first, it lasted 6 weeks). I haven’t been able to find much information on Shepherd’s Purse in pregnancy, though it seems common to use for heavy periods.

  24. Great article! I’m 35 weeks pregnant and I’ve started drinking a lot of red raspberry leaf tea. I just bought some that is combined with hibiscus tea. Is hibiscus tea safe in third trimester? There is a lot of contracting information about it.

  25. Jessica G says:

    This is a great post! I would love to hear your opinions about Vitex during the 1st trimester in terms of safety.

    Thanks!!

    • The data suggests that it is safe in first trimester (Botanical Safety Handbook) and I have used it for over 25 years in first trimester mommmas (see Botanical Medicine for Women’s Health). Best on your pregnancy!

  26. Hi – I see that sorghum is listed? I bake a lot of gluten free things with sorghum flour, and never knew it could be a problem. Now I’m very concerned about what effect that may have had on my baby (I’m currently in 3rd trimester). What are the dangers of cooking with sorghum?

  27. Lauren says:

    As always Aviva, thank you for the awesome resource you provide!! I’m a new, practicing clinical herbalist and you demystify a lot of pregnancy/BF’ing subjects for me. Thank you!

  28. Hi, Aviva!
    I am a CNM working at a birth center in Maryland where a lot of our clientele uses herbs and natural remedies. I saw a client today that was wondering about the safety of Rhodiola, aka Golden Root. Do you know anything about this? Thank you in advance!

    -Liza

  29. I’m about 7 weeks pregnant. It is safe to drink the Pregnancy Tea made by Traditional Medicinals this early in my pregnancy? In your blog I read this tea is normally for later the later trimesters. I’m not drinking it to cure any symptoms, just wanting to be healthy and enjoy tea that can promote a healthy pregnancy.

  30. I’m pregnant with my first child and planning on a natural birth. I was just recently told of Dr. Christopher’s birth-prep formula. A friend of mine used it with her first, and felt that really helped her natural birth go quickly, without tearing, and a fast recovery. However, after reading your post here, I notice there are some of the Partus preparators in the blend. The ingredient list is: Blessed Thistle herb, wildcrafted black cohosh root, false unicorn root, organic red raspberry leaf, wildcrafted lobella herb, wildcrafted sqaw vine herb, and pennyroyal herb. Would you consider it safe to start taking after 34 wks, or would the red raspberry leaf be adequate enough? Thank you so much!

    • Hi Abby,
      Great question! I don’t generally recommend birth prep herbs unless there’s a need to (a woman’s not gone into labor in past pregnancies without induction, for example). First, I trust your body to know what to do, and second, some contain an herb called blue cohosh which has some risks, especially if taken often, such as for weeks at a time. Also, false unicorn is an endangered species, and very hard to grow, so I generally avoid products that contain it. The red raspberry is perfectly safe and very effective, so I recommend sticking with that, 1-2 nice strong cups per day. Keep us posted on baby’s arrival and best wishes!!!

  31. Hi Aviva,
    Thank you so much for sharing your expertise and knowledge. I have recently been looking more and more into herbs as an alternative to conventional medicines, treatments etc. and i have had great difficulty finding much info about safe uses in pregnancy. I have been on the hunt for a natural bug repellant ( that works for ticks especially) to use on myself ( trying to conceive) as well as on my 2 year old. I recently came across a recipe that soaks herbs in vinegar for several weeks and then is cut in half with water before applying. The recipe however, includes sage, wormwood and tansy( all of which are included here on your list to avoid). I have seen others that use both sage, thyme and peppermint. If prepared in the manner indicated are these big repellents unsafe to use
    a) before, during and after pregnancy (bfing) either on the skin directly or just on clothing and
    b) on a 2 year old.
    If indeed they are unsafe, can you recommend something that is safe to use – especially for repelling ticks?

    • Oh how I know that dilemma having been pregnant in the Southeast with all of my babies! Yes, you are correct to be cautious about those herbs — all are considered “emmenagogues” which were classically used as abortifacients, though that is when taken internally. Nonetheless, I generally avoid those in pregnancy — except the peppermint which is fine. You could, however, spritz them, or citronella around you, or dab them on your clothes, and ditto for your 2 year old. I am not 100% confident in these herbs repelling ticks — they are more effective for mosquitos. For ticks I recommend tucking in pants, and doing regular tick checks. My blog coming out tomorrow talks about what to do if you do get a tick on you.

  32. I am currently trying to fix my adrenal issues with holy basil. I have suffered with this for over 4 years or so now, not allowing me to have any more children and suffering a miscarriage earlier this year. I also have hashimotos and other autoimmune diseases. I would like to get pregnant but I am worried that there is nothing I can take while pregnant to deal with stress. Are there any alternatives to the Adaptagens? Thanks!

    • Megan Liebmann says:

      Hi Christa,

      This is Megan from Dr. Aviva’s team. Thank you so much for writing and please know that Dr. Aviva values your questions. Unfortunately she can’t address every question and she can do much better justice to health questions in an appointment…

      Her NEW! Integrative TeleWellness Consultations may be a great option for you if you’d like to discuss your health and wellness concerns with an expert in Integrative and Functional Medicine for women and children, and you don’t have this option in your community, or if are unable to come to see her in NYC when my practice opens in late autumn (2015).

      Although she cannot diagnose you, order labs or prescriptions, or treat you without an initial in person appointment, she can provide a thorough discussion of your current health-related questions and concerns, including reviewing your health history and laboratory results, helping you to make sense of how you might bring an Integrative, Functional Wellness approach into your health and wellness goals.
      Based on your conversation and information you might provide ahead of time, Dr. Aviva can offer a set of Integrative/Functional Medicine suggestions that you can discuss with your local doctors to see whether those would fit into your current health plan.

      If you would like more information, or to schedule an appointment, please go here:
      http://avivaromm.com/integrative-telewellness-consultations

      If you would like to join her practice in the autumn, please check back on her website in late autumn for booking information.

      With warmest wishes,
      Megan- Dr. Aviva Romm Nutritionist

  33. Hi Aviva. Thanks for making all this information available on the web. What an excellent resource! I was recently was asked if wild carrot is safe to use while breast feeding. A mama was interested in trying it as a contraceptive. I couldn’t find enough information in my research. Do you have experience with this?

  34. Hi Aviva-
    I’m researching prenatals and have a question on the Honest Company prenatals as well as Rainbow Light prenatals. The Honest Co. one contains 205 mg of a “wellness blend” of organic ginger root powder extract, organic spirulina powder, organic prune fruit powder and marshmallow root powder.
    The Rainbow Light has a Gentle Prenatal Blend of 90 mg
    (equivalent to 320 mg food & herbal powder) Red Raspberry [leaf] 2:1 Extract, Ginger [rhizome] Fresh Juice 10:1 Extract, Organic Spirulina.
    I know the importance of taking a prenatal in that first trimester but I’m concerned about the marshmallow root powder, the ginger and red raspberry leaf. Would you say either one of these would be safe to take in the first trimester or not at all? If not, do you have any recommended prenatal brands that don’t include questionable herbs? Thanks!
    Kristin

    • Hi KRistin,
      While my general feeling is to avoid unnecessary herb intake in the first trimester, these are considered safe in pregnancy. So you could take one of these, or simply take methylfolate for the first trimester, then add in a prenatal vitamin after that. Warmly Aviva

  35. Hi Aviva,
    I have been taking St. John’s wort for my anxiety on and off for the past few years now I take 1-2 a day currently. It’s really the only thing I have found that gives me any relief. Do you have any recommendations for some solid information on taking it while both trying to conceive and pregnant ? I look forward to hearing back from you 🙂
    -CheriAnn

    • Hi CheriAnn
      According to the research we did for the Botanical Safety Handbook second edition and all of the research I have done, it is safe to use while TTC and during pregnancy, and better than untreated anxiety and safer than most anxiety meds. Best wishes! Aviva

  36. I’m now seeking other options for treatment*

  37. I have a sister in law that I gave some fenugreek to for aiding in lactating to nurse my 1 year old niece. She also is now 18 weeks pregnant. I sent her some fenugreek a couple weeks ago. She said she read somewhere that fenugreek can cause miscarriages because it’s inducing labor or contractions. I didn’t have alot of time today but briefly looked it up online and found an article said that it’s fine as long as it’s not taken in large doses. Can you speak into this at all? I did read at the beginning of this article to not take any herbs in the first trimester, so that is good to know! Thanks for your hep!

    • It’s not recommended in pregnancy other than perhaps if there was some in a seasoning…it’s likely got some hormonal activity that leads to breast milk production, so wouldn’t be appropriate for prenatal use.

  38. What are your thoughts about Chastetree berry (vitex) in the first trimester if used for fertility and a history of PCOS?

  39. Hi, I am 32 weeks pregnant and recently started suffering from allergies. Before I was pregnant I used to take Quercetin with Bromelain daily to control my sinus allergies and it helped keep them at bay. Ran into your article while trying to research if it’s safe to begin taking them again during my last months of pregnancy and possibly during breasfeeding. So far I have only found conflicting advice. Do you know if it would be safe? thanks

    • Hi Maria,
      I don’t consider quercetin > 150 mg/day safe in pregnancy — however, the freeze dried stinging nettles is considered safe in pregnancy. Other things you can do for allergies are remove dairy, use a neti pot, take a probiotic… Best, Aviva

  40. Hi, thank you for doing this blog. I have saw many websites with mixed reviews and tried to go to see if any studies have been published on certain herbs and I am not finding much firm information. Since you are a doctor it makes me feel more comfortable asking you. I just found out today I am pregnant. 2 years ago I miscarried and then miscarried again last winter. I have been taking alfalfa in a tablet form. I have read it is good for nausea and other things in pregnancy but here that it possibly unsafe in pregnancy, is this the case? Also I have a natural laxative that has senna leaf in it… heard is unsafe as well, but it isn’t on your list under laxatives. I also have been taking a high dose of folic acid, zinc and Vitamin C is this helpful with progesterone levels? I also take a probiotic which I know is fine. One last question, you mention rasberry leaf safe but to wait until 2nd trimester for all herbs, is rasberry leaf okay in first trimester?

    • Megan Liebmann says:

      H Bettina,

      It looks like this was a comment from a while ago, but I wanted to point you towards Aviva’s latest podcast on herbs in pregnancy where she takes a deep dive into working with herbs during the childbearing months!

      Warmly,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  41. Hi Aviva,
    Wondered if DGL Licorice (aware that regular licorice is not ok), Slippery Elm, Marshmallow root and Mastic gum are safe to take during pregnancy and breastfeeding for numerous digestive issues, and what the safe amounts are. Thank you very much.
    Tanya

    • Megan Liebmann says:

      Hi Tanya,

      This comment was from awhile ago, but I wanted to chime in and let you know that Aviva’s podcast on Herbs in Pregnancy is a wonderful resource as well!!

      Warmly,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  42. Aviva,
    Thank you for your information. I am a CNM and many of my clients use herbs and natural remedies. One that has come up more than once is colloidal silver..for the immune system. I know it isn’t an herb but can you speak to it’s safety in pregnancy?

    Thank you so much!

    • Hi Patty. I’m not fond of it personally – so never recommend it. I think there are safer, natural options. And I definitely wouldn’t use it in pregnancy – there’s just no safety data and silver is a heavy metal. Warm wishes, Aviva

  43. Aviva, thank you for this! I so appreciate you. One question… Is there any way to make the tables bigger? I’m having trouble reading them. Thanks, Kate (RN and doula)

    • Megan Liebmann says:

      Hi Kate,

      Depending on your computer, sometimes you have to click the pages multiple times. At first they may look smaller, but clicking again will enlarge them!

      I hope this helps!

      Megan- Dr. Aviva Romm Nutritionist

  44. I saw the reply above that Rhodiola during pregnancy is not recommended. I was taking rhodiola prior to conception for 2-3 days on 1-2 days off cycles. It in combination with vitex got me off of antidepressant wellbutrin, adderall, and anxiety medication which I had been on for years. I stopped taking rhodiola and vitex when I found out I was pregnant but I’m almost 7 weeks and am experiencing very uncomfortable anger that pops up and depression/anxiety symptoms. It is affecting my family and my peace of mind everyday. In your oppinion, would the herbs be a safer bet than antidepressants?

  45. Thank you for this article! I recently bought a supplement and it has 15 mg of licorice root in it! Is that safe to take? I’m 39 weeks pregnant.. Thanks!

    • Nope. Licorice is not for use in pregnancy. I think you’ve had baby by now though – congrats and sorry for the delayed response!

  46. Raspberry leaves (Rubus idaeus herba): Effective in suppressing nausea and morning sickness. Regular use during pregnancy helps to build strength of the uterine muscle, which promotes effective and less painful uterine contractions at birth, thus shortening its duration.

  47. What are your thoughts on daily fennel tea for IBS/constipation? I know first trimester herbs should be avoided but IBS/severe constipation is getting bad and I am trying to avoid Miralax as much as possible. Or perhaps other safe suggestions for IBS flare ups (outside of increased fiber, exercise, fruits, veggies etc.) Thanks so much.

    • Megan Liebmann says:

      Hi Amanda,

      Have you seen Aviva’s blog specifically on IBS? I would start there, beyond that, working with your midwife or doctor is best as they will know how to support your unique system through your pregnancy.

      I hope this helps and we are wishing you a comfortable and happy pregnancy!!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  48. Hi, does anyone know about the safe use of Tumeric during pregnancy for pelvic related pain? As well as the use of B-complex?

  49. Veronica says:

    Hi Aviva, continue your great work. What about horsetail tea in pregnancy?

  50. Hi Aviva – great blog! I have an irritable uterus and want to try cramp bark tincture to see if it helps. My doctor doesn’t know a lot about safety of herbs in pregnancy. Is there somewhere specific I can point her to for this?
    Thank you so very much for all your research!

    • Hi Terri,
      You’d need to refer her to the American Herbal Pharmacopoeia Monograph on Cramp Bark (can be ordered from the AHP), or my textbook, Botanical Medicine for Women’s Health. Warmly, Aviva

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