Is It Safe to Use Herbs While Pregnant?
If you are pregnant you may be wondering if herbs are safe to use pregnancy and if so, which ones. There is much conflicting advice about the safety of herbs during pregnancy. According to some authorities, pregnant women should stay away from herbal supplements, teas, or other products unless their safety during pregnancy has been established. Yet according to a survey of 578 pregnant women in the United States, 45% had used herbal medicines during pregnancy (Low Dog, 2009). A meta-analysis of studies of pregnant women in the middle east found that 22-82% of pregnant women used herbs (John, 2015). In both studies, most women reported that they did not discuss their use of herbs with their medical doctor for fear of judgement, but that they believed the herbs to be safer than pharmaceutical alternatives.
Research on the Safety of Herbs During Pregnancy
One reason why there is such limited research on herbs during pregnancy is that it is difficult to get a large number of pregnant women to participate in a study to examine the safety of an herb. Herbalist Tieraona Low Dog  explains that,
“Given the small sample sizes in clinical trials studying botanicals in pregnant women, only large differences in measures of pregnancy outcomes would likely be detected. For example, if an herb were thought to increase the rate of spontaneous abortion from 6% to 7%, a sample size of more than 19000 women would be needed. It is highly unlikely that there will be any studies of a botanical (or drug) with this large a sample size.” (Low Dog, 2009).
Thus, pregnant women must rely on a broader body of evidence including traditional and contemporary use, animal studies, pharmacological studies, and clinical trial data as available.
My Plant Medicine Recommendations for Common Pregnancy Symptoms
As I write this I’m currently 8 months pregnant with my third child. I feel like I’m the type of woman who gets every pregnancy-related symptom on the book (almost!), and I am definitely one to choose natural plant remedies first, so I have some first-hand experience to share. Here are my top herbal remedy recommendations for the most common symptoms during pregnancy.
Nausea and Morning Sickness: For many women, like me, the first trimester of pregnancy is dominated by consistent feelings of nausea and the constant threat of vomiting. It’s no fun to feel sick to your stomach all the time, but there are thankfully natural ways to help reduce the suffering. Ginger and peppermint are the most common herbal remedies for pregnancy-related nausea and morning sickness. Both are generally prescribed for stomach pains and aiding digestion, which slows down during pregnancy. There are many ways to take these herbs. Ginger or peppermint  tea , lozenges, a small amount of essential oil applied externally, or an herbal syrup are all common vessels for these natural nausea-fighting herbs. My personal favorite was making an herbal syrup from raw ginger root boiled with a small amount of water and agave (or honey). You can add fresh peppermint leaves too. Strain the syrup into a jar and store in the fridge. Take a spoonful of the syrup as needed throughout the day. While these herbs can help, the biggest factor in whether or not nausea rules from my experience and research is your blood sugar level. Eating frequent snacks throughout the day can be the most effective way to keep nausea away. Even if all food sounds unappealing, finding something you can stomach and keeping it near at all times can save you from getting sick. My go-tos for keeping my blood sugar level in the worst stages of pregnancy-related nausea were bananas, watermelon, strawberries, pineapple juice, saltine crackers, Kix cereal, Cheerios cereal, or granola bars.
Smell Sensitivity: One of the first signs of pregnancy is often a heightened sense of smell and this super-smell-sense can contribute to nausea in pregnancy as well. With all three of my pregnancies I experienced a super sense of smell in the first trimester and smelling certain offending odors would trigger a vomit reflex. I found the best remedy to be lemon essential oil. I would sprinkle a few drops onto a silk scarf and carry it with me as I walked the busy city street to the bus. If I was passing by a restaurant or other place with offensive odors I could simply cover my nose with my lemon scarf and be saved from accidentally losing my stomach contents on the sidewalk. This also works in your own house if your husband still wants to include onions in a meal, but the aroma of alliums makes your stomach weak. Although I have preferred the aroma of lemon, orange or grapefruit essential oils should have the same effect. If you don’t have any essential oil on hand, the rind of the real fruit will work too as long as it’s fresh. Use a sharp knife to peel the colorful rind of a lemon or orange and chop into fine pieces and then wrap them into your scarf or other thin material. You can also soak the rind in a small amount of olive oil to extract the essential oil and use the oil blend as your smell-sensitivity aid.
Iron Intake: Pregnancy demands an increased supply of iron, and this is one nutrient that some women already may struggle with. Prenatal vitamins usually contain a healthy dose of iron, but also can come with the cost of contributing to constipation which opens to the door to a new host of uncomfortable complaints (trust me on this one, or you can see for yourself!). Although mainstream medical practitioners and nutritionists are relentless about pushing iron supplements on pregnant women, I’m not so sure that they are necessary. I knew from my bloodworm that my iron levels were healthy before pregnancy, and my first trimester blood tests confirmed I had healthy iron levels. My midwife agrees that pushing iron supplements on pregnant women often goes overboard and she has been fully on board with me not taking iron supplements and instead focusing on continuing my nutrient-dense diet. If you are planning to use prenatal vitamins, try to look for ones that use whole food sources as ingredients, and ones that have less than 100% of the RDI for iron in a single pill. When I was taking supplements, I found the ones where you have to take a few a day to get the 100% RDI for iron are the least constipation-inducing. You can also get your iron from natural plant food sources  which is what I have been doing.
Constipation: Constipation is an uncomfortable symptom of pregnancy for many women due largely to the increase in the hormone progesterone which slows down the digestive system. It is important for pregnant women to avoid laxatives that cause rapid digestion or increase peristalsis (intestinal movement) as these same medicines can also stimulate uterine contractions leading to miscarriage. Avoid senna, herbal laxative teas, and other laxative stimulants. Making sure you are getting adequate dietary fiber, exercise, and proper hydration are the safest and most effective ways to prevent and cure constipation (avoiding artificial sources of iron, as discussed above, can also play a big part in combatting constipation). Fresh fruit is an excellent source of dietary fiber and hydration and eating a good amount of fruit daily should help keep your bowel movements smooth and regular. Even if you are tired or don’t feel up to exercising, getting out for a walk can be a great way to help work out digestive issues as well.
Emotions: Pregnancy brings with it many hormonal changes and that can often lead to mood swings, heightened emotions, and sensitivity. I definitely experienced a spell of super-sensitivity and was easy-to-tears in my first trimester. Pregnancy can also accompany feelings of overwhelm or anxiousness about giving birth or the life changes that will follow bringing a new child into the world. Herbs are a friend for calming and leveling emotions and my two favorites in this department are lavender and chamomile. Both lavender and chamomile are calming herbs that can help alleviate anxiety and restore calm. Again, there are many vessels for the aromatherapy. If you have an essential oil diffuser, simply add a few drops of essential oil and breathe deep. Or, combine several drops of essential oil with water in a small spritzer bottle and carry in your purse. Spray the calming mist on your face throughout the day as needed. A drop of essential oil on your wrist also works, or make a sachet of the fresh herb to carry with you and smell as needed. Inhale deeply. These essential oils, and others, can also be helpful during labor. (Prenatal yoga is also a great way to help balance the emotions and body in preparation for giving birth.)
The Best Herbs To Use During Pregnancy
Now that I’ve shared my personal favorites, I’ll discuss in more detail the most common herbs prescribed during pregnancy that are widely available and considered safe. Perhaps the most common herbs used during pregnancy are red raspberry leaf and nettles. These herbs are generally regarded as safe by the herbal community and are the main ingredients of teas readily available at grocers. Ginger and mint are two other common herbs used to treat nausea in early pregnancy which are generally regarded as safe and effective.
Red Raspberry Leaf
Red Raspberry Leaf, Rubus, brewed as a tea or infusion, is among the most safe and widely-used herbs during pregnancy. Red Raspberry is used as a tonic for toning the uterus and many pregnant women will drink it daily or make large batches and drink several cups throughout the day during pregnancy. According to herbalist Susan Weed, author of Wise Woman Herbal: The Childbearing Year,
“Most of the benefits ascribed to the regular use of Raspberry leaf tea throughout pregnancy can be traced to the strengthening power of fragrine or to the nourishing power of the vitamins and minerals found in this plant.” (Weed, 1986).
Fragrine is an alkaloid that helps tone the muscles of the pelvic region, including the uterus. Red Raspberry also contains vitamins A, B, C, calcium, iron, phosphorus, and potassium. According to Weed some of the benefits of using this herb include preventing miscarriage, easing morning sickness, reducing pain during and after birth, helping to bring down the placenta after delivery, and helping the body produce plentiful breast milk.
While not used as widespreadly as Red Raspberry leaf during pregnancy, Nettles, Urtica dioica, is recommended by herbalists as a safe an effective tonic to combine with or alternate with Red Raspberry Leaf. Nettles has a reputation as a nutritive herb because of its long list of vitamins and minerals known to be important in human growth and health. Nettles are a rich source of calcium, potassium, phosphorous, iron, sulphur, and vitamins A, C, D, and K. According to Weed the benefits of Nettles for pregnant women include easing leg cramps, diminishing pain during and after birth, preventing hemorrhage after birth, reducing hemorrhoids, and increasing production and richness of breast milk (Weed, 1986).
Ginger, Zingiber officinale, is perhaps the most commonly used herb for treating nausea during pregnancy, particularly in the first trimester. A meta-analysis of the research surrounding the effectiveness and safety of ginger during pregnancy was published in 2018. To evaluate the effectiveness of ginger for treating nausea, only double-blind, randomized, controlled trials were included. To evaluate safety of ginger during pregnancy controlled, uncontrolled, and pre-clinical studies were included. 15 studies and 3 prospective clinical studies found that consuming 1 g of fresh ginger root per day produced significant decrease in nausea and vomiting and no risk for the mother or her future baby (Stanisiere, 2018). Fresh ginger root can be brewed into tea  or into a syrup. Herbalist Susan Weed recommends up to 25 capsules of powdered ginger daily may provide complete control of severe nausea and vomiting throughout pregnancy (Weed, 1986).
Chamomile, besides being soothing for the nerves, is also a good digestive aid and alternative to ginger for treating pregnancy-related nausea. Chamomile tea is recommended to aid digestion and to combat nausea. For chamomile’s relaxing aromatherapy benefits, I infuse the fresh flowers and leaves into a jar of olive (or almond) oil and enjoy applying to my skin or bath as needed.
Herbs to Avoid While Pregnant
Not all herbs are safe for use during pregnancy. Herbs, like all plants, contain numerous chemical constituents which have a variety of physiological affects of the human body. Herbs may contain substances that cause miscarriage, uterine contractions, premature birth, or injury to the fetus. Lists of herbs to avoid during pregnancy vary greatly depending on source. In Wise Woman Herbal: The Childbearing Year, herbalist Susan Weed provides a list of herbs to avoid during pregnancy including antihistamines such as Osha Root. Most laxatives and diuretics should be avoided including flax seed, senna, aloes, castor oil, turkey rhubarb, buckthorn, cascara sagrada, buchu, horsetail, and juniper berries (taken internally). Herbs containing steroid-like factors, including agave, ginseng, licorice, hops, and sage, should also be avoided. According to the American Pregnancy Association, the following herbs are considered unsafe or likely unsafe during pregnancy:
- Saw Palmetto – when used orally, has hormonal activity
- Goldenseal – when used orally, may cross the placenta
- Dong Quai – when used orally, due to uterine stimulant and relaxant effects
- Ephedra – when used orally
- Yohimbe – when used orally
- Pay D’ Arco – when used orally in large doses; contraindicated
- Passion Flower – when used orally
- Black Cohosh – when used orally in pregnant women who are not at term
- Blue Cohosh – when used orally; uterine stimulant and can induce labor 
- Roman Chamomile – when used orally in medicinal amounts
- Pennyroyal – when used orally or topically
Other herbs, which are common in the kitchen, may still be used in normal amounts for cooking, but should be avoided in medicinal amounts. These include:
- Celery seed
- Liquorice root
Ginseng: Among Herbs That Are “Possibly Unsafe”
Many herbs have a label of caution for pregnant women due to conflicting opinions or absence of concrete science. Use of Ginseng, Panax ginseng, one of the most commonly used herbs in the United States and around the world, during pregnancy is one that remains subject of debate. Recommendations regarding using Ginseng during pregnancy are conflicting. The American Pregnancy Association lists it among herbs that are “possibly unsafe.” According to herbalist Susan Weed, Ginseng should be avoided during pregnancy due to its steroid-like factors, but can be useful in lending immediate energy to assist during a difficult labor.
A search on google will reveal warnings against using Ginseng during pregnancy from WebMd.com, Healthline.com, Science Daily, AcuppunctureToday.com, and BabyCenter.com. Most of these warnings appear to be linked to a Chinese study which found a component in Ginseng caused malformations in rat embryos (Joswick, 2004). Whether whole ginseng is dangerous for a human pregnancy has not been demonstrated, so many media outlets urge caution. However, five years later, a meta-analysis that searched 7 electronic databases for existing research on the topic found strong scientific evidence that Ginseng is not associated with adverse effects when used during pregnancy. They noted that while there is evidence of teratogenicity with exposures to ginsenosides (a component of ginseng), these studies used animal embryos and an exposure to these compounds that is much higher than levels achievable through normal human consumption. Still, the researchers err on the side of caution concluding that,
“Panaxz ginseng should be consumed with caution during pregnancy, especially during the first trimester and lactation” (Seely, 2008).
Caution About Herbal Supplements During Pregnancy
Most medical sources, nutrition texts, and health experts recommend an abundance of caution be used when selecting herbs during pregnancy to ensure their safety for the mother and developing baby. According to the American Pregnancy Association,
“Unlike prescription drugs , natural herbs and vitamin supplements do not go through the same scrutiny and evaluation process by the FDA. As a result, the quality and strength of an herbal supplement can vary between two batches of the same product and between products from different manufacturers.” (American Pregnancy Association, 2020)
In her book, Cycles of Life, regarding herbs appropriate for the various stages of a woman’s life, Registered Herbalist Ellen Kamhi, RN, RH, PhD, (the “Natural Nurse”), writes,
“Since many chemical constituents in herbs are capable of passing through the placenta, it is better to play it safe. Don’t use any herb (or pharmaceutical drug for that matter) without checking reliable sourced to determine its safety for use during pregnancy.” (Kamhi, 2001)
Growing a baby is a big and important undertaking and natural plant medicines can be your ally and friend. Traditional herbal remedies, like the ones recommended in this article, are widely-used and considered safe and effective. There are, of course, many other herbal remedies and medicines recommended by different practitioners and it’s up to you to verify with a trusted source if they are safe and effective. Pregnant women can use herbs safely during pregnancy as long as they are well-informed and choose appropriate doses of plants that are safe for a growing baby.
References: 1. Alsaad, A.M., Fox, C. & Koren, G. Toxicology and teratology of the active ingredients of professional therapy MuscleCare products during pregnancy and lactation: a systematic review. BMC Complement Altern Med 15, 40 (2015). https://doi.org/10.1186/s12906-015-0585-8  2. American Pregnancy Association. (2020, August 27). “Herbs and Pregnancy.” Retrieved November 18, 2020, from https://americanpregnancy.org/is-it-safe/herbs-and-pregnancy-1003/  3. John, Lisha J, and Nisha Shantakumari. “Herbal Medicines Use During Pregnancy: A Review from the Middle East.” Oman medical journal vol. 30,4, 2015, pp. 229-36. doi:10.5001/omj.2015.48 4. Joswick, Diane. “Research Warns Against Ginseng During Pregnancy.” Acupuncture Today , Vol. 05, Issue 04, April, 2004. 5. Kamhi, Ellen, Cycles of Life: Herbs and Energy Techniques for the Stages of a Woman’s Life, M. Evans and Company, Inc, New York, 2001. 6. Low Dog, Tieraona. “The use of botanicals during pregnancy and lactation.” Alternative therapies in health and medicine vol. 15,1, 2009, pp. 54-8. 7. Seely, Dugald et al. “Safety and efficacy of panax ginseng during pregnancy and lactation.” The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique vol. 15,1 (2008): e87-94. 8. Stanisiere, Julien et al. “How Safe Is Ginger Rhizome for Decreasing Nausea and Vomiting in Women during Early Pregnancy?.” Foods (Basel, Switzerland) vol. 7,4 50. 1 Apr. 2018, doi:10.3390/foods7040050 9. Weed, Susan, Wise Woman Herbal: For the Childbearing Year, Ash Tree Publishing, New York, 1986.