The Midwife’s Favorite Herbs

I went to my first herb walk with my baby in a sling. This was maybe twelve weeks or so after giving birth at home. There weren’t the diversity of babywearing options that there are today and it was a good old fashioned ring sling.  I remember scampering over a log that blocked the path near the Minnehaha creek.   We talked about Burdock that day. I was both excited and slightly overwhelmed by the sheer volume of information about herbs that the instructor, Lise Wolff, presented.  Lise would become my  herbalist, teacher, mentor and eventually a colleague.   Pregnancy and natural birth at home with a traditional midwife had awakened my nascent interest in natural healing and physiological, non-interventive birth, interests that would lead me into the work I do today as a midwife and practitioner of traditional western herbalism.

I work with dozens and dozens of local medicinal plants in my practice. People frequently ask me about which herbs I recommend for pregnancy and childbirth.  In my practice, I don’t really find that there is a particular body of remedies that are “herbs for pregnancy and birth.”  Many of the herbs I use in my midwifery practice are the same herbs I use throughout the lifecycle for both men and women.  There are also only a few herbs that I never use in pregnancy due to safety concerns.

There are, however, a few herbs that show up again and again. They are just so useful for the complaints and discomforts of pregnancy and the postpartum or for the newborn.  I will share my favorites with you below.

Motherwort

There is probably no more valuable plant ally for women than Motherwort.  These evocative names, given to the plant by our ancestors can say a lot about what a plant meant to people in our culture a long time ago. Motherwort assuages anxiety throughout the pregnancy and parenting journey, in the early weeks for those fearful of a miscarriage, in late pregnancy for those nervous about the upcoming birth and during the postpartum period when postpartum anxiety and depression can rear their ugly heads. Motherwort can aid in sleep when worry and a restless mind prevent falling asleep. It is particularly useful for those who feel their stress and tension in the chest/sternum area of their body and in the heart.  The scientific species name of this plant is cardiaca, also indicative of it’s usage. Folks who benefit from Motherwort may experience tightness in the chest, pounding heart, heart palpitations and even full panic attacks.  Many people use herbs to treat the spirit and psyche as well as the body and it is believed that Motherwort can help  resolve issues within  a person related to mothering, how you were mothered, being inadequately mothered in your own life or ambivalence about being a mother yourself.  Motherwort is cooling and moistening. It is also an intensely bitter plant and as such is generally not tolerated as a tea. I recommend tincture.  Motherwort is very safe, but it is also powerful and is often effective at doses as low as 3-5 drops at a time, taken under the tongue.  Motherwort comes in handy later in the life cycle; it is an excellent remedy for hot flashes, heart palpitations and anxiety and irritability during the perimenopausal season.

motherwort

Yellow Dock

Some of my clients don’t appreciate the taste of the Yellow Dock tincture that I give them.  It is a little “earthy,” but it is certainly effective. Yellow Dock treats 3 issues that can complicate or cause discomfort to pregnant women:  anemia, acid reflux (heartburn) and constipation. Anemia is a common during pregnancy. Blood volume in the pregnant woman dramatically expands and there is natural hemodilution.  Many women do not consume adequate dietary iron and iron is among one of the more poorly absorbed of the essential nutrients.  Yellow Dock is an excellent remedy for anemia.  Many people find it quite energizing. The plant has some iron in it, but it is not as high in iron as some other herbs such as Nettle and Alfalfa.  Some herbalists, have speculated that as an alterative with an impact on the liver it affects iron absorption, storage  and release into the bloodstream. Whatever the reason, it seems to work quite well, especially in conjunction with herbal iron tonics.

Yellow Dock has a downward energetic effect on the g.i. tract and is a wonderful remedy for acid reflux or heartburn.  It is cooling and sedating to an overactive upper g.i. tract, effectively alleviating this painful discomfort of pregnancy.

Finally, Yellow Dock is also great for constipation, another common complaint of pregnancy. The bowel slowing effects of high levels of progesterone in pregnancy, the weight of the growing uterus and baby and the general squishing of all the organs of the abdomen and pelvis contribute to this uncomfortable situation.  Yellow Dock in larger doses of 1/2 to 1 full dropper full  effectively resolves constipation without cramping or griping associated with herbal laxatives like Senna.  I always emphasize to clients that dependence on Yellow Dock for bowel movements is not a long term solution. It should be used in an acute situation and after bowel movements are regularized the woman should work on maintaining adequate hydration, getting some exercise, more fiber rich foods and the addition of gentle enhancers of bowel function like flax seed or Aloe Vera juice.

Cramp Bark

Cramp Bark calms the uterus. This is not a plant like Nettle or Dandelion or Black Walnut. There are not dozens and dozens of disparate indications.  Cramp Bark essentially does one thing and it does it very, very well.  Cramp Bark is an anti-spasmodic with an affinity to the uterus. The uterus is a muscular organ subject to rhythmic spasm. Menstrual cramps, Braxton-hicks contractions, labor contractions and after pains are all cramps and spasms of the uterus.  We welcome labor contractions because they are necessary to complete the birth, but the other cramps…not so welcome.  Cramp Bark is excellent for stopping contractions of pre-term labor, non-progressing but painful prodromal labor and after-pains.  I have had many cases over the years that have convinced me of it’s power to cease  unproductive and unwelcome contractions. We use Cramp Bark on a regular basis for after-pains in our practice. Cramp Bark does not taste unpleasant at all in my opinion. It does tend to be used as a tincture. I usually recommend 1-2 dropperfuls for an average sized woman, doses can be repeated every 4 hours.  Relief usually sets in about 15 minutes after an adequate dose. Cramp Bark has an excellent safety profile. I have a comprehensive profile of this beautiful and useful local native shrub on my sister site, Minnesota Herbalist.

 

 

cramp bark

 

Valerian and Prickly Lettuce

Insomnia can plague pregnant women.  Sometimes sleep can be interrupted by aching hips or the seemingly constant need to pee, but sometimes it’s insomnia from anxiety and worry or a racing mind. Some women report no anxiety and simply have periods of unexplained wakefulness especially in late pregnancy.  Herbal remedies for sleeplessness are a much safer choice than OTC or prescriptions sleeping aids. They are non-habit forming and do not cause a hangover effect.  There are many herbal sleep aids. Two of my favorites are Valerian Root and Prickly Lettuce. Neither of these herbs make a very good tea. I recommend taking them as tinctures.  Valerian is a relaxing and sedating herb. It has the added benefit of relaxing he uterine muscles too and alleviating frequent Braxton-hicks contractions.  It is well documented that a small fraction of users (estimated to be about 5%) experience a reaction to Valerian that is opposite of the intended effect and these users find if more energizing an not at all sedating.  Prickly Lettuce is a relaxing, nervine, anti-spasmodic.   It is among the most reliable of the herbal sedatives for insomnia. It is particularly well indicated when there is muscular tension in the neck, shoulders and trapezius muscles. Those who tend to hold their tension in that area of their bodies and tend to hunch their shoulders benefit from this remedy.  It is also good for calming an overactive mind.  From my teacher, Matthew Wood, I learned that Prickly Lettuce is for those folks whose thoughts always tend build on each other in a sort of snowball effect resulting in a tiny worry becoming the worst possible scenario in the mind of the sufferer. For those cases where a warm bath and  little Chamomile is not enough, I turn to Valerian and Prickly Lettuce.

Dandelion

Dandelion Root is a gentle alterative, enhancing the function of  the body’s systems of metabolism and elimination including the liver, gallbladder and skin.  These systems can be taxed during pregnancy with the added maternal weight gain, increased blood volume, increased caloric intake and elimination of the baby’s waste products via the mother. Dandelion is a near specific for PUPPS rash, a painful, itchy rash that effects about 1 in 150 pregnancies and tends to come on near the end of pregnancy or even postpartum.  Dandelion can be taken as a tea or a tincture. Dandelion is especially useful when combined with flax seed oil(not the seed or seed meal, although these are healthy and a good source of fiber).  Why not try non-toxic Dandelion before turning to steroid creams? I’ve also used Dandelion Root tincture with success for clients who have had other itchy conditions or rashes, gallbladder attacks or gallstones, inflamed sinuses, seasonal allergies and oral thrush and burning mouth syndrome.  It is an excellent, safe, nutritive detoxifying remedy with broad applications.

dandelion

Yarrow

Yarrow is one of my favorite remedy for postpartum hemorrhage.  When bleeding is excessive but not so excessive that it automatically requires a pharmaceutical, I usually reach for Yarrow and Shepherd’s Purse and put a squirt of each directly in a woman’s mouth. Yarrow is one of Western herbalism’s great hemostatics and has long been used for bleeding from all types of wounds, menstrual flooding, bleeding from the bowel, nosebleeds, in addition to postpartum hemorrhage.  As a great blood mover it is also a good remedy for bruising and varicosities. I favor it topically for these applications.  Yarrow is a good addition to a sitz bath during the postpartum to help heal perineal skid marks of tears and ease bruised and swollen tissues. As an infused oil it can be applied topically to hemorrhoids to tone the distended vein and improve circulatory return.

yarrow close up

The Colic/Galactogogue  Carminitives: Fennel, Anise, Dill Seed, etc.

These aromatic, volatile-oil rich seeds pack a lot of power in a tiny package.  I also find it to be an elegant and efficient design or accident, depending on your perspective, that the same seed remedies that are helpful for infant colic also increase breast milk production. These tasty little seeds can be used by both mother and baby. For babies with uncomfortable gas, make a weak tea of the seed or seeds of your choice.  Start with a scant teaspoon of seeds. Crush them lightly with a mortar and pestle.  Cover them with boiling water and put a saucer on top of the tea cup or a lid on the glass jar to keep the volatile oils from escaping into the air, borne on steam.  Let the tea cool and give 1 teaspoon to a tablespoon of lukewarm tea at a time.  This is essentially homemade gripe water, without the preservatives and for a fraction of the cost. You can store the tea in the fridge for up to 3 days using as needed. Fennel, Anise, Dill and a few other seeds in this family also have a reputation for helping to increase the supply of breastmilk.  Anise and Fennel are ingredient’s in geneabirth’s Mother’s Milk Tea blend that our clients pick up from us.  You can drink these teas solo or in combination with other galactogogues for a nurturing self-care practice and as an aid to build your supply during the postpartum period. They have the added benefit of tasting great!

Fenugreek

Western herbal medicine has a rich tradition of galactogogues used to enhance nursing and milk supply.  Fenugreek is among the most powerful and effective of these remedies. Women find that it enhances the let down, making it quicker and stronger, in addition to increasing the supply. Fenugreek can be taken as a tincture, tea or in capsules.  Effective doses of this very safe herba are quite high and a common rule of thumb is to take it until your sweat smells like maple syrup. Fenugreek is also a good hypoglycemic agent and can be helpful for women with mild gestational diabetes in conjunction with appropriate dietary changes. In some parts of Asia and Northern Africa, Fenugreek is and has been used to promote a smooth birth.  It’s not clear to me from my research if it used somewhat in the way we use Raspberry Leaf or if it is more strongly oxytocic. For that reason I only recommend it during pregnancy in larger doses for blood sugar control from the 36th week onwards. Prior to that, I recommend Cinnamon.

Goldenseal

The broad-spectrum anti-microbial can’t be beat. I use Goldenseal sparingly due to concerns about overharvesting and the sustainability of the plant communities. This is one of the only herbs I use or recommend that I don’t grow myself or wildcraft.  I buy and encourage my clients to buy cultivated, organic Goldenseal rather than wildcrafted.  Goldenseal powder applied to the baby’s umbilicus stump dries it very, very quickly and prevents infection. Many families who have done nothing to the cord with previous babies, remark on how quickly the cord dries with the application of Goldenseal and how clean and non-goopy it is by comparison.  Goldenseal is also fantastic for thrush/yeast diaper rash. These awful rashes are characterized by inflamed looking lesions and plagues in the diaper area and often there are satellite lesions as the rash spreads. I recommend mixing Goldenseal powder into a high quality Calendula and zinc oxide diaper rash cream like Weleda or Burt’s Bees or some other brand and applying liberally to the baby’s bottom.  I also find Goldenseal useful for maternal vaginal infections including yeast, thrichomoniasis, BV and GBS.  Gelatin capsules filled with Goldenseal can be inserted vaginally.  It is important that the capsul is gelatin, which melts at body temperature, not vegetable cellulose which does not melt when inserted.  Sometimes I make suppositories for my clients which incorporate Goldenseal along with infused herbal oils, essential oils, coconut oil and cocoa butter to treat more intractable infections.

There are so many fine herbs that can be used for pregnancy discomforts. It’s hard to keep the list focused on just a few.   Here’s to a happy, healthy, natural pregnancy!

 

7 Things You Can Do with Your Placenta…Instead of tossing it.

plplacenta

Our appprentice, Hayley, is also a placenta specialist. She encapsulates, makes tinctures and cord keepsakes for many of our families and her private clients.  She has written this great article about all the things you can do with your placenta. When Sarah and I were having babies, most homebirth families buried the placenta and planted a tree or some other plant on the site. This is a lovely and meaningful choice. In the last few years we’ve seen an explosion of interest in placenta medicine.  So many choice! What do you want to do with this amazing organ that nourished your baby months?

by Hayley Duke; Placenta Specialist, Doula, Apprentice Midwife

Most people see the placenta as that thing that comes out after the baby is born, the afterbirth. In the hospital they take it away, but what do they do with it? Usually, the placenta is sent to pathology for analysis per policies. After they analyze it, it is thrown into a bucket with formaldehyde and tossed into the biohazard waste. After your baby is born, the placenta likely won’t be on the forefront of your mind but try not to forget about this beautiful organ that transferred oxygenated blood and nutrition to your baby throughout the course of your pregnancy. Here is a list of 7 things you can do with your placenta instead of tossing.

1. Encapsulate It.

The most popular form of encapsulating is based on Traditional Chinese Medicine (TCM). The first recording of using placenta in the form of medicine was by a pharmacist in China in 1578. It was started to be used in 1980 in America by a midwife who studied TCM. Encapsulation works by dehydrating the placenta and then grinding it up into a powder. The powder is then placed into vegetarian capsules. Your placenta is filled with wonderful things like: iron, vitamins B6 (aids in the making of antibodies), vitamin E (heals damaged skin cells), corticotropin-releasing hormone (reduces stress levels), oxytocin (known as the feel good hormone-essential for successful breastfeeding), and more!

2. Turn it Into a Tincture.

Turning your placenta into a tincture is just another great way to ingest the nutritional benefits. A tincture only takes a small piece of placenta so if you’d like to, you are still able to encapsulate it as well- in fact, a lot of Placenta Specialists will even offer you a discount for doing both. To make a tincture, the small piece of placenta steeps in 100 proof alcohol inside a dark colored glass bottle for at least 6 weeks. After 6 weeks you are able to take the tincture on as ‘as needed’ basis. The average recommended dosage is 7-10 drops held under the tongue for 60 seconds or more drops if going to be diluted in juice. This dose can be taken a few times per day but as always, listen to your body. The tincture has been useful for many women from PMS to menopause and can even be used for the teething infant. A tincture is a great choice if encapsulation isn’t an option for you, it is simple to do at home and the shelf life is indefinite.

3. Placenta Art.

Placenta art can be something as simple as a placenta print to something very complex like placenta jewelry. A placenta print takes very little time and supplies, here’s what you do: Get a large piece of paper or canvas, paint or food coloring if you want to encapsulate afterwards, and some cotton swabs. Lay your placenta out on a clean surface, vein side up (this is the fetal side) and pat dry with a paper towel. If you want to be really creative, you can turn the umbilical  cord into a fun shape or letter. Then take your paintbrush or cotton swabs and paint the entire placenta and umbilical cord. You can do a mix of colors or just one – whatever suits you. After everything is painted, take your paper or canvas and place it right on top of the placenta. The color from the placenta will transfer onto the paper. You can do this as many times as you’d like, just make sure to wipe the placenta down with a paper towel between prints. This is a fun project the whole family can get involved with. Have fun! Placenta jewelry is very time consuming and takes a lot of practice, with a quick Etsy search you can find instructions to do it yourself or someone to do it for you.

4. Smoothie.

Yum! Placenta smoothies are a delicious way to enjoy the benefits of your placenta immediately after birth. There are many benefits for consuming raw placenta, including: it promotes faster healing, aids in easing into the hormonal transition, helps to prevent baby blues, decreases postpartum blood loss, replaces iron, vitamin B6, protein, and minerals. This is a quick and easy way to consume your placenta and like the tincture, it only takes a small chunk so you’re still able to use your placenta for something else that interests you. You can use any smoothie recipe but this one is my favorite:

Tropical Raw Placenta Smoothie Recipe

  • 3 inch chunk of placenta
  • ½ Cup frozen or fresh mango
  • ½ Cup frozen or fresh strawberries
  • ¼-¾ Orange juice (depending on consistency preference)
  • 1-2 Tbsp Flax seed (optional)
  • 2-3 Ice cubes

Blend ingredients together until you reach the desired consistency. Serve immediately. Contact a placenta specialist for proper placenta storage instructions to ensure a healthy placenta.

Some people like to have one placenta smoothie right away after the birth and then encapsulate the rest, while others like to have several smoothie. If you would like to save your placenta to make more smoothies, have someone cut the placenta into small 3 inch or so pieces. Place those pieces spaced out on a baking sheet so they’re not touching. Throw the baking sheet into the freezer for a few hours until completely frozen. Once frozen, store pieces in a double bagged freezer zip loc. It is very important to use proper handling- clean utensils, supplies, work space, and wash hands thoroughly.

If this sounds like to much work after you’ve just had a baby, no worries! Placenta specialists are happy to come to your home, hospital, or birth center to prepare a smoothie for you!  

5. Lotus Birth.

The act of lotus birthing is leaving baby, umbilical and placenta attached for days while the umbilical and placenta dry out, naturally and gently detaching from baby. Lotus birth is the biological way to sever the bond. This is encouraged by rubbing salts and herbs into the raw placenta to preserve the tissue. It is a common misconception that you cannot choose both lotus birth and placenta encapsulation. As long as the placenta is taken care of properly and diligently during the lotus birth, the salting preserves the tissue, similar to salting fish or meat, and the placenta can be rinsed, steamed, dehydrated and put into capsules. Another benefit of lotus birth is it truly encourages the mother to take a babymoon. The babymoon is the period after birth in which the mother is lying with her newborn, bonding, nursing and cuddling skin to skin.

6. Bury It.

Burying your placenta in the garden or under your favorite tree is a wonderful way to honor the life sustaining organ. Not only will you always know where it is, the placenta also makes a great fertilizer. Remember to bury it at least 1 foot deep so you won’t have to worry about it being dug up by any curious animals.

7. Donate It.

There are plenty of people and organizations that would love to have your placenta. Call around to your local midwives, doulas and placenta specialists. Sometimes these birth workers are studying the placenta or training their students to know what is normal and what isn’t, therefore they need to see a lot of placentas. Your placenta can also be donated to be used for medical purposes to help other people (yes, placentas are just that awesome!) www.placentadonation.com is a good place to start if you’re interested in learning more about that.

 

Hayley is a doula, placenta encapsulator and apprentice midwife serving the Twin Cities and surrounding areas.. She believes in families and loves discussing anything related to pregnancy, birth, and babies. If you have any  questions or just want to chat, she is available by phone or email.

hayley duke geneabirth apprenticehttp://www.naturesintentbirthservices.com

239-357-6616

hayleyduke@naturesintentbirthservices.com

Safe and Natural Remedies for Heartburn in Pregnancy

natural heartburn remedies

Heartburn is a common complaint of pregnancy.  Heartburn may be more common in pregnancy due to the large amounts of circulating progesterone in the body of the pregnant woman. Progesterone has the effect of relaxing tissues including the lower esophageal sphincter meaning that it is a lot easier to experience reflux of acidic stomach contents.  The pressure of the growing uterus may also play a role in the upward movement of stomach contents–there’s just not enough room for some women!  For some women heartburn is just an occasional nuisance brought on by a meal that is too spicy or acidic, while for other women heartburn is an ordeal brought on by just about anything a woman eats making her quite miserable.

If you recognize that a certain food or type of foods causes heartburn, the easiest remedy to eliminate these foods while you are pregnant. Common offenders are spicy foods, tomatoes and fatty foods. Sometimes, however, the heartburn is completely unpredictable and is seemingly caused by a very bland food.  We’ve even had pregnant women tell us that water triggers heartburn. This can be really frustrating.

Another strategy successfully employed by many pregnant women is to avoid lying down or reclining in the time immediately following eating.  If the growing baby  and looseness in the g.i. tract is causing stomach acid to back up into the esophagus this makes sense. Plan your meals for a little bit earlier in the evening to avoid being in a reclining or supine position right after eating.

Some moms tell us that drinking milk or eating a little yogurt or ice cream can ease their heartburn.  If dairy is a part of your diet, this can be an easy fix.  Milk and yogurt can definitely be a healthy part of your diet and even  a little bit of ice cream once in awhile is fine.

Thankfully, there are a number of simple, affordable, safe remedies that a woman can use to ease heartburn symptoms during pregnancy, without resorting to acid blocking OTC or prescription medications.  You may have to try more than one to find the remedy that works for you. These same remedies can be used by anyone experiencing heartburn or GERD throughout the lifecycle.

Raw Almonds–Raw almonds are a folk remedy for heartburn. Using  raw almonds for heartburn has the added benefit of providing mother and baby with excellent nutrition. Almonds are rich in protein, fiber and high quality fat, as well as high amounts of magnesium, calcium, iron, trace minerals and lots of B vitamins.  Almonds are a super food! Raw almonds contain cyanogenic glycosides, a type of plant chemical found in many plants and plant parts in the rose family, of which almonds are a member.  Many herbalists use these plants  for symptoms characterized by heat, inflammation and burning sensations, sounds like heartburn, right?  Herbalists use these plants to sedate over-active processes in the body, reduce spasm and inflammation. We speculate that the cyanogenic glycosides increase parasympathetic nervous system activity and improve digestion.  Cyanogenic glycosides in normal, moderate amount, like eating a handful of almonds every day, are well tolerated and processed by the body.

Papaya Enzymes and Apple Cider Vinegar— While it may seem counterintuitive, heartburn and acid reflux may not mean you have too much stomach acid. Sometimes low stomach acid can actually contribute to heartburn.  Having robust digestion and helping things digest faster and better help some women reduce heartburn symptoms papaya enzyme tablets  and apple cider vinegar are two affordable, widely available and safe remedies for heartburn.  You can purchase papaya enzyme tablets at the local co-op.  They are chewable and slightly fruity flavored. You can take them as needed for symptom relief.  While they don’t work for everyone, many of our clients tell us they find relief with the papaya tablets.  Apple cider vinegar is a traditional, folk remedy that is used to improve sluggish, weak digestion.  I suggest buying the naturally fermented apple cider vinegar available at the co-op.  A cloudy “mother” should be present in the bottom of the bottle.   Mix the apple cider vinegar with some water.  You can make it more palatable wit a little fresh squeezed lemon juice and some honey if you need to.  Try it!  If it doesn’t work for you, move onto one of the other types of remedies on this list.

Slippery Elm Lozenges–Slippery Elm is a soothing, mucilaginous herb that can ease the sensations of heartburn.  It ‘s a safe and gentle remedy derived from the inner bark of a widespread species of elm.  Pregnant women can consume it without worry.  It can also be given to babies and children.  It has a slightly maple like flavor.  Slippery Elm is available as a bulk herb which can be made into a tea or purchased as powder or in  premade lozenges.  I think the most convenient way to take Slippery Elm is as a lozenge.  You can find these at the co-op often near the checkout. They are marketed as a lozenge for sore throats and coughs, but they work great for heartburn.  You can suck or chew them– the texture is a lot like a Tums or Rolaids–whenever you have heartburn symptoms.

Yellow Dock–(Rumex crispus) is a great herbal ally in pregnancy.  This is one of my favorite remedies for heartburn and acid reflux in the pregnant and non-pregnant alike.  This classic western herbal remedy has a pronounced effect on the g.i. tract.  Herbalists feel like it has a downward energy in the body reducing reflux as well as balancing bowel function.  I recommend larger doses for constipation but also sometimes find that smaller doses can help people with rapid, crampy bowel movements. It’s not uncommon for herbs to act in this balancing fashion, being used for conditions on both ends of a spectrum.  Yellow Dock is also a great blood builder and is a good choice for women with iron-deficiency anemia.  Yellow Dock is not the sort of herb most people would enjoy as a tea. The flavor is pretty earthy, in fact, you might say like dirt plus something else you can’t quite put your finger on.  Personally I find it interesting and not at all unpleasant as a tincture and that is the form I recommend for my clients.  It’s easy to consume a suitable dose in just a few seconds with a tincture. Try 5-10 drops at first.  If that isn’t quite enough to get the desired result, move up to 1/2 -1 dropperful.

With these remedies available most women can find relief from heartburn during pregnancy.  Talk to your midwife or healthcare provider about natural or over the counter remedies you use during pregnancy.