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It is estimated that over 80% of expectant mothers now use natural remedies.[Hall et al 2011] British-born women view the self-administration of herbal, homeopathic and other remedies as empowering, enabling them to regain control over medicalized childbirth. However, Britain is a multicultural society, with the proportion of immigrants set to rise to 20% by 2051.[BBC News 2010] Indeed, over 25% of births in England and Wales are to mothers from outside the UK.[Office for National Statistics 2011] For many of these women, the use of herbal remedies or traditional medicine (TM) is often strongly embedded in their culture, particularly for those from Asia, South America and Africa.

Indigenous plants may be the only accessible alternative to biomedicine in many countries, especially in remote areas. There is, however, growing concern about the effects of migration both within and from developing countries. Urbanization, and emigration to westernized nations increases the availability of conventional medical facilities to those who hitherto relied on TM. Adverse effects of TMs are often precipitated by combining them with prescribed pharmaceuticals or other herbs with similar pharmacological properties, or by excessively high or prolonged doses.

Further, medicinally-active plant constituents are increasingly being extrapolated by western scientists and applied in a reductionist manner to individual conditions. For example, kava kava, is a TM used to treat a range of conditions in countries such as Fiji, where traditional ceremonies are held at which yaqona, a drink containing kava, is dispensed. However, when Western scientists recognized its sedative and anxiolytic properties and began administering kava, several cases of hepatotoxicity occurred, which eventually led to it being banned in Germany, the UK, Canada and Australia. Later investigations concluded that the constituent most likely to cause liver problems is found in the stems and leaves of the plant, whereas the therapeutic constituent is found in the roots.[Beresford (2010] It appears that it is the bringing together of two distinctly different cultural approaches, in which neither side fully understands the other, which is responsible for the rise in adverse reactions to medicinal plants.

This is especially worrying when natural remedies are used by expectant, labouring or breastfeeding mothers, as both the woman and her baby are exposed to potential dangers. We know very little about the teratogenic or abortifacient properties of European herbs, and even less about indigenous plants from other continents. Research studies are almost impossible since ethical clearance would not be granted, and knowledge of adverse effects is generally gathered from reports of reactions experienced by individuals. Moreover, contemporary medical research methodology requires the isolation of single therapeutic constituents, which would result in the TM being used out of context.

Many cultures from around the world use plant remedies aimed at preparing the mother for birth, nourishing the foetus and strengthening the uterine muscle. In South Africa, for example, Zulu women drink a concoction called Isihlambezo, thought to contain up to 55 different plant extracts, with several having strong contractile effects on the uterus.[Brookes 2004]  Unfortunately, access to information - and mis-information - via the Internet has meant that westerners often make leaps of assumption about the effectiveness of particular remedies and their application to pregnancy and childbirth. An example of this is the supposition by UK women that TMs used to procure an abortion in some cultures can be used as natural methods of induction of labour. Even remedies commonly used in the UK, such as raspberry leaf, are taken inappropriately by many women because they do not understand the mechanism of action, the correct dosage and any relevant precautions.[see Tiran 2012]

In UK maternity units with a high proportion of mothers from ethnic minority groups, many women resort to TMs antenatally, to prepare for the birth, and during labour to aid progress. Often the women do not inform their caregivers, and occasionally refuse to impart information about remedies being openly-used. One midwife witnessed a labouring Asian woman drinking a glass of liquid in which a flower was floating; every time the mother took a sip, the uterine contractions became so strong that foetal distress ensued. Despite imploring the mother (and her mother-in-law who had given her the drink) to tell her what it contained, they refused to share the information or to discontinue its use. The foetus subsequently developed distress which resulted in the mother requiring an emergency Caesarean section.[personal communications with midwives]

Whilst there may be legitimate indications for using TMs to aid childbirth, problems arise when women self-administer natural remedies inappropriately. There is, for example, a current trend for British women to use clary sage essential oil, either in the bath or as a massage oil, to induce contractions. Indeed, midwives who are trained to use aromatherapy in their practice often administer clary sage in labour if contractions slow down.[Burns et al 2000] It is, however, totally inappropriate to use this oil regularly from 30 weeks of pregnancy, as one woman was found by her midwife to be doing recently. On discussion, it was surmised that the expectant mother had confused clary sage oil with raspberry leaf - which can be introduced around this gestation to prepare for labour.[personal communications with midwives] Similarly, it is unsafe in many cases for women to be taking TMs at the same time as other medications, notably those used to induce or increase contractions.

The issue here is the need for education - of expectant mothers and of their caregivers. Unfortunately, if midwives, therapists and other professionals do not have sufficient depth of information to advise women comprehensively about the safety of natural remedies and TMs, pregnant women will be unaware that they may need to be cautious with a particular remedy. At the very least, all health professionals should advise women to inform their midwives or doctors if they are using any TMs. Whilst the maternity professionals may not be familiar with the specific remedy, it can alert them to the potential for risks, especially when combined with medically-prescribed drugs. Complementary therapists can play a part here if they regularly treat pregnant women, urging them to inform the midwife if a mother wishes to use natural remedies during pregnancy, birth or breast feeding. 

In addition, there is an urgent need for professionals to have access to high calibre continuing professional development courses which ensure that they understand the safety issues. The inclusion of the subject of “complementary therapies and natural remedies” within pre-registration midwifery education, doula training courses and the preparation of antenatal teachers who provide ‘preparation for birth’ classes would provide an overview on which maternity carers could build.

The next generation of maternity professionals and carers needs to be better equipped to deal with the increasing diversity of populations and their cultural needs.  We can no longer ignore the wide range of natural remedies being used by different ethnic groups, including those born and raised in the UK. We have an obligation to be more aware and more accepting of individuals’ rights to administer TMs to themselves, whilst finding ways to ensure that they do so safely.

References

BBC News. Census shows rise in foreign born. Viewed online at www.bbc.co.uk/news/uk-20677321  2012.

Beresford R. Traditional medicines in the Pacific In Kayne SB (ed) 2010 Traditional Medicine Chapter 10, pp 270-292. Pharmaceutical Press London. 2010.

Brookes K.  Chemical investigation of isihlambezo or traditional pregnancy-related medicines PhD Thesis. 2004.

Burns E, Blamey C, Ersser SJ, Lloyd AJ, Barnetson. The use of aromatherapy in intrapartum midwifery practice an observational study. Complement Ther Nurs Midwifery  6(1):33-4. 2000.

Department of Physiology, Faculty of Medicine, University of Kwa-Zulu Natal, South Africa

Hall HG, Griffiths DL, McKenna LG.  The use of complementary and alternative medicine by pregnant women: a literature review. Midwifery 27(6):817-24. 2011.

Kayne S. Introduction to traditional medicine IN Kayne SB (ed) 2010 Traditional Medicine Chapter 1, pp 1-24 Pharmaceutical Press London. 2010.

Office for National Statistics 2011 Statistical Bulletin: Births in England and Wales by parents' country of birth. Viewed online at www.ons.gov.uk/ons/dcp171778_230307.pdf   2010.

Scott G. Traditional medical practice in Africa IN Kayne SB (ed) 2010 Traditional Medicine Chapter 5, pp 82-118 Pharmaceutical Press London. 2010.

Tiran D.  Raspberry leaf tea in pregnancy Expectancy - available via Amazon in e-book format. 2012.