The Whole Pregnancy Handbook
An Obstetrician's Guide to Integrating Conventional and Alternative Medicine Before, During, and After Pregnancy
At last, everything you need to know about the latest in alternative and conventional healthcare before, during, and after pregnancy—in one comprehensive, jargon-free guide. Whether you embrace the philosophy that mind, body, and spirit work together to promote good health or you’re just looking for a way to have the healthiest, most comfortable pregnancy possible, The Whole Pregnancy Handbook has the information you need to make educated decisions and take charge of your prenatal care. The Whole Pregnancy Handbook featuresIntroduction
* Complementary treatments and techniques to improve your pre-conception health and fertility, such as nutritional medicine, mind-body medicine, acupuncture and herbal medicine
* Comprehensive and compassionate information about genetic and prenatal testing
* Techniques such as massage, accupressure, herbal medicine, and mind-body exercises to help you relax and feel more comfortable as your pregnancy progresses
* A fully illustrated chapter on prenatal yoga with pose variations for all three trimesters.
* How your pregnancy unfolds month by month and how you can connect with your baby while you’re expecting
* The best practices of doulas and midwives
* The pros and cons of giving birth in a hospital, birthing center, or at home
* Effective pain management for your labor—from epidurals to hypnotherapy
* Everything you need to know about inductions, assisted deliveries, and C- sections
* What happens postpartum—physically and emotionally
* Candid recollections and insights from other moms and patient stories from Dr. Evans’s practice, The Center for Women’s Health
The Whole Pregnancy Handbook is an informative and reassuring guide that will empower you to combine the best of conventional and alternative medicine with confidence at every stage of pregnancy.
Pregnancy is a magical and mysterious time of life. As it progresses and you move toward parenthood, youíre aware of all the profound ways life is about to changeóit will be filled with joy and responsibility, challenges and love. It can all be exhilarating and overwhelming. The purpose of this book is to help you make the best choices for yourself and your child from before you conceive all the way to the first weeks after birth. Itís my hope that The Whole Pregnancy Handbook will help you experience your pregnancy as a fulfilling and transforming first phase in your life as a parent.
Embracing a Holistic Philosophy
Over the years, itís been my privilege to participate in the physical and emotional journey of pregnancy both as a doctor and a father. In that time, my approach to my entire medical practice has changed. I started out as a classically trained, conventional ob-gyn, but through a series of lessons taught to me by patients, I gradually began to practice integrative medicine, embracing a holistic philosophy that focuses on self-care and the principle that true wellness reflects the coming together of emotional, spiritual, and physical well-being.
My orientation shifted to a holistic approach about five years into my medical practice. Over the course of a couple of months, two colleagues, nurses whom I had worked closely with, came to me after being diagnosed with cancer. Both were told by their oncologists that there was ìnothingî they could do but show up for their chemotherapy treatments. They were told to relax and let the chemotherapy fight their cancer, but they didnít feel comfortable with that. Both wanted to be more proactive in their care. So, after each asked me questions that I couldnít answer about what she could do to help heal her cancer, we began a journey together, discovering how mind-body medicine combined with alternative modalities like acupuncture and herbal medicine could improve not only their responses to treatment, but also the quality of their day-to- day lives.
The lessons I learned with these women about the importance of self-motivation and participation resonated with what Iíd learned practicing prenatal care. As a young obstetrician just out of residency, I quickly realized that my approach was too dogmatic. Iíd often say to a pregnant woman, ìThis is the way it isójust do what I say.î In that situation, the woman might do what I asked, but she didnít believe in my recommendation. This problem hit home after a birth where a woman had experienced complications in labor and required a C-section. Afterward, she developed a wound infection, a not-unusual postoperative event that meant she had to come into the office two or three times a week. As she was leaving one of these visits, she said under her breath, ìThis never would have happened if I hadnít had the C-section.î I was surprised that she felt that way because she was basically okay and her baby was healthy. So I asked her to stay to talk about the Cesarean. I learned that she didnít trust my decision to perform the Cesarean because she hadnít felt sheíd been a part of it. I realized that this lack of trust and her sense that she was an observer instead of a participant in her birth experience couldnít have begun in the labor room. Instead, I believe it reflected the fact that over the course of the nine months of her pregnancy, we hadnít developed a real partnership.
That single, under-the-breath comment was the ìahaî that helped me to see that I needed to change, to become a source of support, information, and comfort to pregnant women, someone they could turn to for guidance, but not someone who would impose proscriptive or dogmatic opinions. I changed my entire approach to prenatal care. I learned how to be open and listen to my patients in a new way, to follow their lead as we work together with the shared goals of a healthful, vital pregnancy, a childbirth anticipated with excitement instead of fear and anxiety, and a newborn brought into the world in a room filled with love, all the while realizing the mystery and sacredness that surrounds the experience.
Iím now a senior faculty member of the Center for Mind-Body Medicine in Washington, D.C., through which Iíve participated in and/or planned mind-body workshops in the Middle East, Macedonia, and in New York, working with firefighters after 9/11. I became the first and only (as of this writing) physician in Connecticut to be board certified in both obstetrics/gynecology and holistic medicine. As an assistant clinical professor at both the Albert Einstein College of Medicine and the College of Physicians and Surgeons of Columbia University, I teach medical students and doctors- in-training about holistic care.
My own journey has been both intellectually fascinating and personally rewardingó and I truly believe that my patients are better served as a result of my embrace of a holistic philosophy of care.
This approach is especially important when a woman is pregnant or trying to conceive. I firmly believe that conception, pregnancy, and childbirth are extraordinary biological events that the body has the wisdom to guide. I see my role as that of a helper who stays in touch with a womanís physical and emotional experiences, someone who tries to uncover and allay any fears that being pregnant may generate. I never expect complications or difficulties, and I never think of pregnancy as a series of medical disasters waiting to happen. But if something starts to go wrong during a pregnancy, I can apply my medical training to the situation.
At the same time, over the course of most pregnancies, I can offer the tools of complementary and alternative medical treatments to relieve typical pregnancy aches and pains, help prepare a woman for a positive childbirth, and support her overall physical and emotional health.
The goal of this book is simply to give you the information you need to make your own decisions. To show how an integrative approach to preconception, prenatal, and postpartum care can bring together the very best of conventional medicine with the best of complementary and alternative medicine. I try to answer questions you may have and help you experience the joy, confront the fears, and meet the challenges that pregnancy can bring. I hope that by presenting you with a range of approaches not only to your prenatal care but also to your own unique experience as a pregnant woman, this special time can become one of empowerment and self-discovery.
The Whole Pregnancy Handbook is loosely chronological. The first chapters cover preconception, fertility, and the first trimester. Then comes a chapter that provides an overview of all nine months. It includes a discussion of the physical and emotional milestones of pregnancy; a description of fetal development and prenatal care; and mind- body techniques you can use to connect with your child emotionally, energetically, and physically, and to prepare for childbirth. Later chapters are on common physical symptoms of pregnancy; nutrition; exercise; prenatal tests; complications; and miscarriage, so you can easily find what you need when and if you need it. The final chapters of the book go through preparing for childbirth; the contours of labor and childbirth; and life postpartum.
Throughout, youíll find the voices of women describing their own experiences, as well as interviews with expertsócomplementary practitioners, midwives, doulas, and othersówho have important insights to contribute to understanding pregnancy.
ï Alternative medicine generally refers to diagnostic and treatment methods (also known as ìmodalitiesî) that are independent of those taught and practiced in most American medical schools and hospitals. Because they often encompass entire systems of medical theory that developed separately from what we in the West know as conventional medicine, they are typically considered ìalternativeî only in the U.S. Ayurveda, Tibetan medicine, traditional Chinese medicine, and herbal medicine are all examples of alternative medicine. In theory, alternative medicine is used independently of conventional medicineóand some alternative treatments must be used alone. In practice, alternative treatments are often used alongside conventional care. Medical schools in the U.S. are now beginning to teach some modalities of alternative medicine (primarily herbal medicine and nutritional therapies). However, knowledge of alternative medicine is not required for a medical license in any state.
ï Complementary medicine combines alternative and conventional medical treatment. For example, using regular massage therapy sessions to reduce stress and lower high blood pressure or having acupuncture to supplement fertility treatment.
ï CAM is an abbreviation for ìcomplementary and alternative medicine.î CAM is most often confused with complementary medicine, but CAM is the umbrella term for both complementary and alternative medicine.
ï Conventional or allopathic medicine is the mainstream medicine taught in U.S. medical schools and delivered in U.S. hospitals by licensed professionals, such as a medical doctor, physicianís assistant, or certified nurse-midwife.
ï Integrative medicine shares holistic medicineís philosophy; it emphasizes prevention and self-care, and uses conventional medicines and surgery only when necessary. An integrative medical doctor understands how alternative and complementary treatments can be used alongside or instead of conventional medical care.
ï Functional medicine also shares the principles of disease prevention, self-healing, and noninvasive treatment with holistic medicine. It fine-tunes that approach by focusing on improving the function of the bodyís digestive, immune, and hormonal systems, primarily through nutrition, dietary supplements, and lifestyle changes.
Note: Homeopathy is a well-known form of alternative medicine that uses individualized remedies to treat specific physical complaints and illnesses. Generally speaking, during pregnancy, homeopathic remedies may be used to treat various nonthreatening but uncomfortable side effects, as well as everyday viruses and bugs, as long as your primary medical practitioner knows youíre using them. Homeopathic remedies sold in health food stores have such small amounts of the active ingredients that they shouldnít pose a problem. (Avoid any preparationóhomeopathic or otherwiseó containing blue cohosh, which is used to stimulate uterine contractions.)
Classic homeopathic remedies are tailored to the individual, and require a long, in- depth patient-practitioner interview before they can be prepared. In the United States, homeopathy lacks standard accreditation or licensing in any state. Therefore, its safety and effectiveness depend heavily on the skills of the practitioner. For these reasons I donít use it regularly in my own obstetric practice, and, for the most part, it wonít be included in this book.
Dr. Evans: No. In some cases I may recommend a particular therapeutic approach, but for the most part, I donít. For example, for pregnancy-related back pain in the second and third trimesters, acupuncture, massage, and chiropractic are all treatments that can help. If a patient wants to work with an alternative practitioner for typical, pregnancy-related back-pain relief, I will ask about her preferencesódoes she like to be touched, is she afraid of needlesóand explain what each treatment is like. Then, I leave it up to the patient to decide which approach is right for her. Sometimes, since I work with a group of alternative practitioners regularly, Iíll recommend massage therapy over acupuncture simply because I sense the patient will get along especially well with the massage therapist. And if a patient asks for a specific recommendation, I always give one that takes into account the personality of patient and practitioner, and the nature of the treatment.
That said, there are times when I recommend one treatment over others because my clinical experience has shown it to be especially effective. For example, I always recommend acupuncture combined with herbal treatment for women with elevated levels of follicle-stimulating hormone (FSH) or other symptoms of early menopause (known as perimenopause) because in my practice, weíve had consistently good results with that approach. (For more on elevated FSH, see page 38.)
Finding a qualified practitioner isnít always easy, but itís important to learn how caregivers are licensed so you can choose from a well-qualified group of practitioners.
Before the interview, take a few breaths to help focus. Throughout your talk, pay attention to how you are feeling. Does the practitioner inspire confidence? Do you like her voice? Does he understand what youíre there for? Do her explanations make sense to you? If youíre touring the workspace, take a few minutes in the parking lot before you go in to check in with how you feel. When you walk in, notice your sensations. Does the space feel comfortable to you? Do you like the smell? All these signals contribute to your gut feeling about the practitioner, and if something feels off, look for someone else.
Studies of alternative and complementary therapies that are constructed according to the standards of Western science are in an early stage in the U.S. and Europe. The information we have from these clinical trials about CAM therapiesóas opposed to the knowledge about CAM thatís been disseminated by practitioners over time, sometimes centuriesóis scanty. Clinical studies are hard to design because many CAM therapies, and the philosophies behind them, require that treatment be tailored to the individual. To complicate things even more, itís difficult to run an ethical clinical trial of any medicationóconventional or herbalóto assess safety in pregnancy. Finally, even with conventional allopathic medicine, scientific studies arenít always available to give us answers for every clinical situation.
Is it best to avoid even ìsafeî medications and herbs during pregnancy? Yes. Is that always realistic? No. The odds are that at some point during a pregnancy, youíll get a cold or have indigestion or back pain, which a conventional or alternative treatment can help. Will the treatment work? Probably (thereís no 100 percent guarantee for any treatment). Is the treatment or medication safe? If an experienced, well-trained doctor or midwife recommends you take somethingóbe it medicine or herbóif you trust her as a prenatal care provider, you can trust that she wouldnít suggest a treatment if she didnít believe it to be safe for you and your baby. That said, you can choose whether or not to take something, and you can do your own research on drug safety and ask your provider any questions you may have.
Likewise if youíre working with a Chinese or Western herbalist or homeopath whoís experienced working with pregnant women, ask what his philosophy is. Is he cautious in giving herbs to pregnant women? Where does he get his information about herb safety? (For example, Commission E, the German FDA, is a recognized authority on botanical medicine.) How long has he been using this herb with pregnant women and where does he get his herbs? If youíre not familiar with any of his answers, feel free to take notes and do follow-up research. In general, you probably can trust that established, experienced practitioners would err on the side of caution when working with herbs during the preconception, pregnancy, and postpartum periods. But just as with your medical provider, itís important to ask the questions. And you should check with your doctor or midwife before taking anything.
Ultimately, when it comes to safety in all health-related matters, but especially in pregnancy, there are no absolutes, only our best knowledge at any given moment in time.
Another key thing is to find a connection with a practitioner and to cultivate that connection. In the U.S., you get so many different types of practitioners and styles of acupuncture, as well as other modalities of complementary medicine. You as the patient need to feel a practitioner is there for you and listening to you. Really, feeling connected to a practitioner can be more important than the modality itself.
Finally, I believe that a practitioner should empower a patient. As a patient, you should understand that itís your bodyís intelligence receiving the treatment, making sense of it, and then integrating it. The practitioner isnít some big ìHealerî; your body is doing the work. So when you see someone, be open to being critical and engaged. Question them. Why? Why are you giving me those herbs? What can I do for myself? Can I change my diet? Do you suggest I do yoga or qi gong? Do you think I should take naps? The point is that the practitioner should be able to help you engage in your own healing process.
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