The loss of a pregnancy, while physically, emotionally and spiritually painful for a woman and her partner, is in many ways a normal part of the reproductive life of a woman. It happens to so many healthy women and frequently there is no apparent explanation for the loss. In contemporary society, where many women may choose to delay pregnancy and may plan only one or two intentional and very desired pregnancies, a miscarriage can be especially devastating. Contemporary women fully expect with the help of medical technology to be able to control all aspects of reproductive health. A woman who has experienced one or more miscarriages may experience a sense that her body has failed her, a great loss of faith in the normalcy of her body, fertility and the potential to carry a pregnancy, fear and anxiety about her next pregnancy.
As midwife, doula, natural health care practitioner or a wise woman in your community, you will most certainly have contact with women dealing with miscarriage. Each woman who contacts you will have different needs as an individuals as well as different needs depending upon where she is at on the spectrum of miscarriage experience: threatened miscarriage, miscarrying, recovering from miscarriage, contemplating or become pregnant again.
Supporting a mom in the immediate aftermath of a miscarriage
Much healing has to happen after a miscarriage and you have a lot to offer a woman who has just miscarried, including your calm and caring presence, your continuity of care and specific remedies to help her heal physically and emotionally. A mother who has recently miscarried may have several health issues that need addressing from a holistic perspective. She will need emotional/spiritual healing, uterine toning and depending on her blood loss she may need treatment for anemia, low energy and blood building.
Healing the Spirit and Mind
Healing emotionally and spiritually begins with grieving. Be prepared to just listen. When you need to ask specific questions to guide you in selecting appropriate treaments do it with sensitivity.
Have a box of tissues nearby. A mother grieving a miscarriage will probably shed tears over her loss. If you have created a safe and comfortable space this will happen even if you have only recently met her.
If the mother becomes emotional, move in closer. As in labor, be open to the woman’s cues. She may appreciate patting and hugging. Other women just like to know that you are there and you understand. You may be moved to tears by the mother’s story. It is ok to shed a few tears with the woman. This is sincere and spontaneous reaction to the pain of another human being. Our ability to be true with our clients is what distinguishes community-based care from most medical practices.
Offer brief heartfelt, empathetic condolences. You can never go wrong with such simple and sincere statements as “I’m so sorry for your loss.” Or “I know how much this pregnancy meant to you.” Unless you know this woman and her religious faith extremely well, avoid comments such as “It just wasn’t meant to be.” Or “He/she is in a better place now.” Some women find such comments hard to bear. On the whole it is best to remain focused on the woman before you and not share lengthy stories from your own life or practice. However, there are times, especially when a mother confesses feelings of which she is ashamed or feels certain that no one in the world has ever had thoughts or feelings as strange as hers, that you may want to share a bit from your experience. Sometimes this sharing can serve to normalize very distressing feelings.
A grieving mother may ask why, why did this happen. You do not, indeed, should not feel that you need to answer this question. Recognize this as a spontaneous expression of grief and confusion; do not mistake this expression of grief for a request for information. This is the time to reiterate your care and sorrow for her. Do not launch into a long discussion of the latest research on pregnancy loss or the various physiological and genetic causes for a miscarriage. The time will come when it will be appropriate to discuss on a more intellectual level why miscarriage happens.
The grieving mother benefits from herbs which support her emotional, spiritual and psychological healing. Sensitive and careful questioning of the mother will reveal detailed information about her distress and allow you to help her with more presicion. The following herbs are some of my favorites for mental and emotional health and can be used not only with the woman who has miscarried but with women at any point in her reproductive lifecycle, pregnancy, in labor or postpartum. If you choose with carefully, small doses (3 drops or so under the tongue, 2 to 3 times daily) are usually quite effective.
Motherwort (Leonarus cardiaca) Specific Indications: worry, insomnia, oppressive feelings in the chest, palpitations, nervous stomach
Agrimony (Agrimonia eupatoria) Specific Indications: worry, tension, hides behind a cherrful façade, the mom who says “I’m ok” with a forced smile, tight breathing, not taking deep relaxed breaths
Prickly Lettuce/Wild Lettuce (Lactuca spp.) Specific Indications: insomnia, worst-case scenario thinking, worry, stiff lower back, stiff neck and trapezius muscles, history of harsh life experiences
Lemon Balm (Melissa officinalis) Specific Indications: insomnia, worry, oppressive feelings in the chest, palpitation, nervous stomach, feelings of heat
Wood Betony (Betonica officinalis) Specific Indications: headaches, worry, women who do not seem “grounded” not in touch with body, or gut-level instincts, lack of confidenceNote: Pedicularis spp. Is also known as Wood Betony, but is not to be confused with Betonica or Stachys
Blue Vervain (Verbena hastata) Specific Indications; intense, hard-working, driven women, women who are hard on themselves and have high expectations, neck and upper back tension, cramps or spasm in the uterus or bowel
You can use the above herbs as simples or make combinations. Motherwort and Lemon Balm (both mints) combine nicely together for use with women experiencing stress and grief in the chest. Another nice combination is Blue Vervain and Agrimony for hard-working women who hide their pain and suffer from tension..
Healing the Body
A simple and effective herbal combination for women who have very recently lost a pregnancy is Lady’s Mantle (Alchemilla vulgaris) and Shepherd’s Purse (Capsella bursa-pastoris). This formula is my standby for almost all post-pregnancy clients including those who have miscarried or terminated a pregnancy as well as those who have experienced normal pregnancy and birth. Lady’s Mantle is a beautiful garden herb from the European tradition with a long history as a mother’s herb. It is gentle, healing, post-pregnancy uterine tonic. The name Lady refers to the Virgin Mary; mantle refers to the shape of the leaves which are rounded to heart shaped and with many pleats and resembles a woman’s cloak. The plant has long been believed to offer spiritual and psychic protection to women who need it—imagine being wrapped and protected in the cloak of the divine mother. The sulphur compounds and other phytochemicals of Shepherd’s Purse, a common weed from the mustard family promotes proper healing of the uterus, good blood clotting and the removal of any stagnant blood or conditions in the uterus. Both herbs are best used as tinctures. If possible try to use handmade tinctures, made by you or a medicine maker in your community. Your clients will prefer the taste of a handmade tincture over that of a commercial tincture made with harsh grain alcohol.
If you were with the woman while miscarrying you will know her approximate blood loss. If the woman called you after miscarrying at home or in a medical care setting, you need to ask her about her blood loss, if she has not already volunteered this information.
There are many excellent herbs available to address anemia and blood loss. Nettle (Urtica diocea), Yellow Dock Root, (Rumex crispus), Alfalfa (Medicago sativa) and the Chinese herb, prepared Rhemania root are all stand-out as iron-rich herbs which also treat the liver. In holistic medicine it is essential not only to provide iron but also to promote the liberation of iron stores from the liver and to aid the liver in the blood building process. Nettles and Alfalfa both make pleasant tasting teas. Yellow Dock will be better tolerated as a tincture. Rhemania Root is purchased prepared at an herb store and is taken by chewing bite-sized pieces. My preferred method of treating blood deficiency and anemia is with medicinal and nutritive syrups with my clients. A strong herbal decoction of any of the above herbs in a base of honey with, iron-rich Black Cherry Concentrate tastes delightful and offers ease of administration compared to teas. Syrups should be taken with meals to maximize absorption of nutrients.
Motherwort, an herb well known as a nervine, is also excellent for deficient blood conditions.
Preparing for the next pregnancy
Getting pregnant again is a great preoccupation for many women who have miscarried. They have many practical questions about timing of the next pregnancy and many fears about miscarrying again. You will want to encourage the woman to avoid intercourse for a few weeks to allow her tissue to heal and all blood loss to cease. Many pregnancy and midwifery books recommend delaying the next pregnancy for anywhere from 6 months to a year, mainly to give a woman a chance to heal psychologically from her loss. I have come to believe that this blanket assertion does not apply to all women. Which of us can say how much time an individual woman needs to heal? There are women who regardless of the advice they are given, will pursue the next pregnancy very quickly after a miscarriage. In my practice, I have seen healthy women go on to get pregnant very shortly after a miscarriage and have extremely healthy pregnancies and babies. For some women, they simply must know that they can get pregnant again and carry the baby. For some women this ability to become and sustain pregnancy after a miscarriage is part of the healing. It restores her shaken faith in her body.
An important part of healing from miscarriage is both to acknowledge her grief but also to but her miscarriage into a larger picture. I often encourage the mom’s I work with the talk with their grandmothers or any living older women they are close to. When speaking with older women and hearing their history of their reproductive lives helps to put miscarriage into perspective. Frequently older women in their 70s and 80s today had no birth control and experienced many pregnancies. My own grandmother experienced two miscarriages and three babies and one child that died in infancy. It is important to acknowledge that the loss of a pregnancy hurts very much but also that is in many ways a feature of the female experience. It is not a sign that she has a defective body and if it is her first miscarriage, it casts no dark cloud over her ability to successfully carry a baby next time.
Supporting a woman with habitual miscarriage
Habitual miscarriage often points to an underlying health issue in the mother. The woman with habitual miscarriage desiring another pregnancy should try to address her health concerns well in advance of the next pregnancy. When the client is ready you can do a thorough gynecological and obstetric interview. Plan on trying to obtain as much detailed information as possible. Examine your own practice and determine if you are able to offer the specific care needed. Cultivate relationships with holistic care practitioners in your area who may be able to offer the type of care your client needs. Anyone working with childbearing women can benefit from a good understanding of charting menstrual cycles using both temperature and cervical mucous checks. Reviewing cycle charts with a woman is a good place to begin the journey of understanding her health and fertility. Charts can alert both of you to the possibility of specific hormone imbalances, especially when short luteal phase is revealed.
Any of the following issues could be in play, disordered hormonal terrain including overall low hormone status, low progesterone, excess androgen, excess estrogen. Treatment with herbs, supplements, diet, homeopathic remedies may all offer help. If you suspect or confirm abnormal uterine positioning consider referral to a skilled bodyworker including Maya Uterine Massage, chiropractic or CST. You may suspect uterine scare tissue from therapeutic d&C, PID or abortion creating a hostile environment, consider herbal therapy for scar tissue, fibroids, endometriosis. Rarely automimmune issues could come into play and the mother’s system needs help moderating the immune response. Think outside the box with habitual miscarriage and look for any areas of a woman’s life and body that need a little extra help.
I am indebted to the women I serve who are my teachers bringing me the experiences I need to move forward as a practitioner and to my Herbal teachers, Lise Wolff and Matthew Wood who shared with me many of the specific indications for the nervine plants that I share with you.