PMS Premenstral Syndrome; A Natural Alternative Part 2

Natural Treatment for PMS

Many PMS symptoms do respond well to simple lifestyle changes and safer, more affordable,  traditional time-honored remedies. Experiment with the suggestions below and find those that work best for you. Allow a few cycles with each to properly assess their impact. But, full recovery  begins when you start by honoring your cyclic lunar nature and giving yourself permission to take a monthly hiatus. Trust your body’s inner wisdom and ability to tell you what’s needed. Use this information to reset and heal, embrace your inner wild and the full range of emotions you feel from grief and rage to joy and calm. 

The goals are to reset your body and its natural ability to heal and function optimally by: 

• Reducing root causes like inflammation, toxic exposures, estrogen excess and stresses, gut flora and blood sugar imbalance

• Getting adequate nutrients from food, nature and supplements

• Supporting your stress response, liver and regular bowel movements for detoxing

• Empowering mindset and nurturing your spirit.

SELF-AWARENESS

To increase self awareness, start a journal of your symptoms, noting when they occur in relation to your menstrual cycle, the degree to which each one bothers you or interferes with your ability to function as usual, what triggers them, and what helps. Also pay attention to the food you eat and how it affects you. Try to list at least one possible symptom and some ways in which the PMS experience can be viewed and used to your benefit, an opportunity for deeper meaning and transformation.

Identify vulnerable times and plan accordingly. For example, avoid situations likely to provoke difficulties, put off important decisions and problem solving until later in your cycle when you feel more balanced and clear, schedule extra time for rest, relaxation, enjoyable activities, and support from family and friends.

Openly acknowledge your symptoms to yourself and others most affected to enhance understanding and acceptance. Create your sisterhood tribe of like-minded uplifting women and share your experience with them. We are wired for community. Aside from feeling that you are not alone and isolated, community helps you feel connected, understood and validated, as well as loved and supported. This may also lead to a good laugh and soul nurturing hugs…both are very healing. If you don’t have a community, start by finding a local red tent meetup near you, join the red tent movement or organize your own red tent or moon lodge women’s circle.

DIET AND LIFESTYLE

A healthy diet can make a world of a difference and has short term and long term health benefits that extend far beyond relief of PMS. Maintain excellent nutrition by eating 3 whole, real, organic meals and healthy snacks throughout the day of a variety of nourishing foods. Listen to your body and eat only when you are hungry. 

Include lots of organic fresh fruits, vegetables, nuts and seeds, and fermented foods like kimchi. If you eat grains, make sure they are whole. Eat 20-30 grams protein three times daily such as in nuts, nut butters, seeds, beans, and pastured organic animal protein if not vegan (like wild Alaskan or Norwegian salmon and other fresh cold water fish from non polluted waters, organic pastured eggs, chicken, turkey, beef, lamb, and organic pastured raw goat or sheep dairy). Add a few TBS of ground flax seed to your daily smoothie, applesauce or oatmeal.

Make sure to boost your intake of cruciferous veggies like broccoli, cauliflower and cabbage to balance your hormones. Load up on healthy fats and protein if your symptoms are primarily emotional. Many women feel best physically and emotionally by avoiding genetically modified foods, cane sugar (raw honey, maple syrup, coconut and date sugar are better substitutes), soy, dairy (especially cow) and gluten (choose gluten free grains like oats, kasha, millet, quinoa, and nut flours for baking), and organic living. Eat a paleo, or ancestral diet, basically basically how we used to eat when hunting and gathering, before the mass industrialization of food. Switch to using organic foods, body and household cleaning products without harmful toxic chemicals as much as possible. 

Drink at least 64 ounces per day of filtered, spring or well water between meals (at least 20-30 minutes before or 2 hours after eating). Use cold pressed extra virgin olive oil, coconut oil or organic goat butter or ghee as your primary cooking fat, with sea salt and herbs for seasoning.

Foods to limit or avoid altogether include:

• Processed foods high in sodium, chemicals, refined (white) flours, gluten, soy, cane sugar, partially hydrogenated fat, as these substances all exacerbate PMS symptoms and cause weight gain, as well as other health problems. 

• Commercially raised meat, eggs and milk products from hormone and antibiotic medicated animals confined and not fed their natural clean diet. Depending on your symptoms, you may need to avoid dairy completely. 

• Caffeine found in coffee, black tea, soda, chocolate, and combination over the counter drugs to relieve menstrual cramps such as Midol.

• Alcohol, smoking, and street drugs.

• Toxic cosmetics and body products, household and workplace chemicals, plastic food containers and packaging, pesticides.

• Mind altering medications like sedatives, tranquilizers, sleeping pills, antihistamines and steroids, even common antibiotics and over the counter medications like acetaminophen and ibuprofen unless absolutely and medically necessary. You can aim for a medication free life as much as possible.

Investigate natural alternatives to medications. Acupuncture, Chinese herbs and homeopathy have provided relief to many women with all types of menstrual problems. They are especially helpful if your PMS symptoms are recurrent, chronic and/or so disturbing as to interfere with your sense of health and wellbeing. Try the lifestyle changes and natural supplements and herbal remedies discussed here for a few months, track how you feel and marvel at how much better you feel.

Consult some of the many resources available that discuss how to make healthy but delicious changes in your diet at home and on the road, such as Eating Well for Optimal Health by Dr Andrew Weil and Dr. Kelly Borgan’s Mind of Your Own: The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives. Wonderful wholesome paleo cookbooks include:

•  Well Fed: Paleo Recipes for People Who Love to Eat

• The Wellness Mama Cookbook: 200 Easy-to-Prepare Recipes and Time-Saving Advice for the Busy Cook

• Paleo Comfort Foods: Homestyle Cooking for a Gluten-Free Kitchen

•  Make it Paleo: Over 200 Grain Free Recipes For Any Occasion.

Make sure you are getting enough sleep at night, and rest during the day, and that you get plenty of fresh air and adequate exposure to sunlight during non-peak hours. Weather permitting, spend at least 20 minutes outside with nature in the early morning or late afternoon sun each day.  Allow time for enough sleep at night and rest during the day.

Regular exercise does wonders to prevent and relieve PMS symptoms. Take a brisk walk, dance or an aerobics class, swim, hike, cycle, play tennis, or do whatever moderate activity you enjoy for at least 30 minutes 5 times per week. Authentic yoga has many added benefits, such as enhancing deeper relaxation, inner balance and improving general well-being. I suggest trying a few studios to find the best fit for you, taking regular classes as well as creating your own yoga sanctuary for home practice.

SUPPLEMENTS FOR PMS

For general health and physical and emotional well-being, make sure to take the supplements here that include a whole food multivitamin, omega threes, probiotics, Vitamin D, plus:

• Calcium, 250-500mg 2-3 times daily

• Magnesium glycinate, citrate or taurate, one of the most important supplements for women, 500-800mg 1-2 times daily (aim for approximately equal amounts of calcium and magnesium, or even double the magnesium, but you can reduce the magnesium if you get diarrhea, or divide the doses throughout the day with the capsules or in tasty powder form) and bathe in it before bed for 15-20 minutes, adding 1 cup Epsom salts to your bath for a restful sleep

• Vitamin B complex, 20-50 mg 1-2 times daily with methylated folate  

• Vitamin B12 sublingual (under the tongue), in the form of methyl, hydroxo or adenosyl cobalamin,) 1000-5000 mcg daily to 2-3 times weekly depending on symptom severity and blood levels

• Vitamin E, 400 IU 1-2 times per day (higher doses with premenstrual water retention and cramps)

• Curumin (Turmeric), 500 mg 1-3 times daily to reduce inflammation linked to depression, anxiety and other mental health challenges

• Evening Primrose oil, Borage or Black Currant oil, 500-1300 mg 1-2 times daily

• Maca powder or capsules to balance your hormones, stress response and relieve PMS

• DIM (Diindolylmethane), 25 mg of 25% diindolylmethane, from Brassicacae vegetables and/or Sulforaphane, 400-800 mg daily, or add Broccoli Sprout powder to your cooking to balance the estrogen dominance

Make sure you are getting enough essential fatty acids by taking 1000-2000 mg of the fish oil with 300 mg DHA/EPA twice daily, and adding the additional Evening Primrose, Borage or Black Currant oil all with GLA (gamma linoleic acid). Metagenics, Vital Choice, New Chapter, Innate Response and Nordic Naturals make high quality, trusted fish oil supplements, tested free of toxins and pollutants. But, as with all supplements, give a 6-8 week trial of continuous use to see results.

If You Have Troubling Emotional Symptoms

Implement the lifestyle changes and natural remedies for stress and emotions that apply not only in pregnancy but beyond, and certainly are critical for relief of troubling emotional PMS symptoms. Learning how to calm yourself and activate your relaxation response is key, using a regular practice of meditative breathwork. Biofeedback, energy medicine, hypnotherapy and self-hypnosis can also do wonders, but deeper transformative healing, release of stuck emotional and past trauma energy comes with conscious connected breathwork.

Spend more time outside in the sun as mentioned above, non peak hours, ideally without or low dose all natural sunscreen. If you do not spend at least 2 hours daily in the sun (a cloudy or winter day is sufficient), buy a full spectrum bright light therapy for the indoors, and expose yourself to 2500-10,000 lux two hours per day.

BALANCING EMOTIONS

Seek balance in your emotional life, instead of going for highs and the lows that follow. Surrender to and embrace the cycles of life and its ups and downs and ups again, and know that day always follows night, and light always comes after darkness. Nothing is permanent, including waves of emotion. Learn how to ride them, move them through your body with dance or breathwork, without getting too attached to any one feeling or the story around it.

Live one hour at a time, or better yet, one moment, one breath at a time. Become intensely conscious of the present, and acutely sensitive to your feelings and inner experiences, using all of your senses. Observe, watch and allow whatever comes up without judgement or thought.

Life is stressful and always has been, and eliminating all outside stress, especially that which we can not control, is not an option. We can only work on changing our outlook about stressors we cannot change. This involves deep profound and rewarding transformation, cultivating spirituality, and an attitude of surrender, acceptance, realizing that very little in life outside of our own way of thinking and behaving is in our control, and believing that everything happens for our ultimate benefit and growth as a human being, even if we do not understand why. 

RELAXATION TECHNIQUES

You can learn to activate your own relaxation response to stressors and quiet your nervous system with breath awareness and relaxation techniques, mastery over your thoughts, and also by modifying what you can in your day to make it less stressful and more in alignment with your core values. This includes, for example:

• Cutting down on the added nonessential burdens in your life, especially if you feel overwhelmed

• Avoiding overscheduling yourself

• Changing work hours to avoid rush hour traffic

• Allowing more time to get places

MINDFULNESS AND MINDSET

A wonderful life-changing approach to internal stress, feelings of depression and anxiety is learning about present moment awareness and mindfulness, and incorporating them into your daily life.

Know that you are in charge of the thoughts you dwell on, feelings and how you react to stressful or painful situations, and that you have the ability to change your attitude and reaction to life experiences to more health enhancing responses. For example, you can surrender to and totally accept unpleasant life events over which you have no power. You can also view them as potential gifts, powerful stimulus to change, a wake-up call, an opportunity for personal growth, redirection and spiritual practice. 

You can always try to focus as much attention as possible on the now, literally without letting your thoughts wander and dwell into the past or imagined future. Mastery over your thoughts, attitudes and reactions can have a dramatic impact on your brain chemistry, balancing the hormones responsible for affecting moods and emotions, and preventing and even treating clinical depression and anxiety.

Reduce feelings of tension and increase feelings of calm centeredness and balanced grounding by taking a “healing interval” to meditate for 10-20 minutes 2-3 times per day. Sit comfortably and quietly. Keep your eyes closed and internally focused between your eyebrows or softly gazing at a low, still object or place (like where the floor meets the wall). Turn off the mental noise and think and do absolutely nothing. Simply be aware of your breathing in all its details, the present moment and everything that you notice within it. If you get lost in thought, simply bring your attention back to watch your breath.

Tap into your spiritual self and practice slow deep abdominal breathing, yoga (especially Yin, gentle and restorative), QiGong, Tai Chi, progressive muscle relaxation techniques (yoga nidra), visualization and guided imagery, or cutting edge stress reduction audio programs and courses. For example, imagine you are in a place where you feel whole, inner joy and peace, and spiritually connected. Or think of a healing or rejuvenating spiritual energy or light flowing through and around you. This is an essential, yet easy to learn, tool with endless benefits and rewards to your physical and emotional health. Locate your nearest Zen Center (Zen is NOT a religion and does not conflict with any religion) or read any book by Thich Nhat Hanh, Pema Chodron, or Shunryu Suzuki to learn the basics of meditation and Zen practice.

Listen closely to your body’s messages. You may need to either slow down or become more busy with things that bring you deeper satisfaction and enrichment. You may need more time for yourself, or you may need to focus more on giving or helping others. It is extremely beneficial to find a small way to help someone in need each day, by giving your time, energy and presence to ease the burden and increase the happiness of even one person. Focus on connections with family and friends, healing relationships, making peace and giving love.

Try to make a conscious effort to increase feelings of forgiveness, appreciation, love, joy, optimism and healing, while letting go of anger, resentment, envy, fear, sadness and negativity. Most importantly, increase your awareness of anxiety provoking, tension causing, or depressive thought patterns that are not serving you. Try to shift your attention to something more positive and ultimately change your mental state. You can actually transform them at their deeper subconscious roots with Clarity breathwork. 

Mastery over your thoughts, attitudes and reactions can have a dramatic impact on your brain chemistry, balancing the hormones responsible for affecting moods and emotions, and  preventing and even treating clinical depression and anxiety. 

BREATHWORK

Start with breath awareness - being more conscious about your breath, and simply focusing all of your attention on your breathing. Get curious about all the details of your sensations as you inhale and exhale, without trying to change anything. Notice what you are currently seeing, hearing, smelling, feeling, tasting. Just watch without judgment. This brings you to the present and is deliciously relaxing. 

Then, sit up straight but comfortably, with your eyes closed, internally keeping your gaze between your eyes, or open and focused on a nonmoving distant object or place. You can do this reclining, as long as you are not likely to fall asleep - the point is to be conscious throughout.  While breathing be mindful, and just observe and release any muscle tension working your way slowly from head to toe. Practice Ujjai breathing. This is done by breathing at the pace and depth that feels right for you, but by inhaling through your mouth or nose, directing the breath into the back of your throat which makes a sound like ocean waves. I think of it like a calm, slow, and smooth circular version of gasping on inhale and fogging a mirror on exhale. This is meditation, combined with the benefits of breathwork.

Before going to bed at night, as well as before rising in the morning, periodically throughout the day, and whenever you feel stressed, triggered, down or upset, practice the following 3-part breathing exercise: 

• Exhale slowly through your mouth with an audible sigh while consciously releasing any and all muscle tension.

• Imaging a pump expanding your abdomen and lower back as you breathe down deep into your belly.

• Allow ribs to expand with air, then inhale air into your upper chest towards your collar bone and shoulders. 

• Inhale in this way for a count of 4.

• Hold for a count of 4 while staying relaxed.

• Exhale slowly through your mouth for a count of 4, releasing in the same order as the inhale, collapsing/returning to baseline, your abdomen, ribs, then upper chest.

• Repeat this cycle a total of 8 times or at least a few minutes. This is the ideal form of breathing, as opposed to rapid shallow breathing. With each exhale, let go and relax more. 

Once you get the hang of it, play with various types of breathing. Try  several minutes of inhaling and exhaling, each to a count of 3, 4, 5 or 6 without the hold, keeping it smooth and even. Then double the length of exhalation. For example, so if you inhale to a count of 3, then exhale to a count of 6. 

See how it feels to triangle breathe for a few minutes:. Inhale for a count of 3 or 4, exhale to the same count of 3 or 4, then pause for the same count of 3 or 4, while consciously and deeply relaxing your diaphragm muscle of respiration, as well as all other muscles. Repeat for several cycles.

Then see how it feels to box breathe. To do this, inhale to a count of 3, hold for a count of 6, exhale for a count of 6, hold for a count of 3. Repeat for several minutes. Many love this type of breathing so much they do it as often as they can, such as while waiting, in transit, before rising in the morning and going to sleep at night. 

Another great breathwork technique that disengages your conscious attention from thought and relaxes the nervous system, and can be done any time (like when traveling, waiting in line, resting, bathing, or on the toilet) is forced exhalation. After a normal breath, try squeezing as much air out as possible using your intercostal muscles, then allow breath to come in naturally and deeply, but automatically. Repeat the cycle for several minutes.

These breathwork and relaxation techniques are simple to do, health enhancing, totally safe, and without side effects. If you need more personal guidance, schedule a session with me. 

CREATE A FORTRESS OF POSITIVITY AND INSPIRATION

Minimize time online, especially addictive stressful apps, social media and computer games. Try to stay away from things (like certain books, movies and news), situations and people (like those who are angry, stressed out, negative, pessimistic, critical, fearful or demanding) that agitate your mind, raise your internal tension, bring you down and worsen your emotional state. If someone who you are close with continually criticizes, belittles, demands or negates your feelings, try to give positive straightforward suggestions about approaches that would be more helpful to you, or consider having this person come with you to some professional counseling sessions. 

Surround yourself as much as possible with calm, centered, and positive people, things, sounds and places that inspire, uplift, relax and restore you to inner peace and serenity. Treat yourself to a massage every week, bring more art and music into your life, try to allow time each day to do something you enjoy, and something that makes you laugh. Collect 4-8 hugs per day. The emWave personal stress reliever from the Institute of HeartMath is a wonderful hypnotherapy and biofeedback tool to lessen your body’s reactions to stress.

WHAT’S YOUR BODY TELLING YOU?

Listen closely to your body’s messages as your body is insanely wise. You may need to either slow down or become more busy with important things, or things that bring you deeper satisfaction and enrichment. You may need more time for yourself, or you may need to focus more on giving or helping others. It is actually extremely beneficial to find a small way to help someone in need each day, such as by giving your time, energy and presence to ease the burden and increase the happiness of even one person. Focus on connections with family and friends, healing relationships, making peace and giving love.

It is important to be open and honest about your feelings to yourself and to share important ones with your partner, a close friend or family member, or a professional therapist if needed. Suppressed emotions are ultimately more damaging and they can cause all sorts of physical, psychological and relationship problems if not properly dealt with. It is also essential to periodically release pent up emotions with a good cry, followed by a good hug. Do not hesitate to tell this to your friends and family so they can be more sensitive to your needs. Join a holistic PMS support group and discuss familiar experiences, share feelings, and discuss problem- solving techniques.

For persistent symptoms, make sure to have your provider check a comprehensive thyroid panel with thyroid antibodies, your vitamin D and B 12 levels, fasting glucose and hemoglobin A1C and address issues accordingly. Do what you can to address the root of your symptoms and minimize underlying possible causes. Some women benefit from natural bio-identical progesterone two or even three weeks before the period starts. Discuss with your holistic provider about prescribing it using a compounding pharmacy. Read renowned integrative psychiatrist Dr. Kelly Brogan’s Own Your Self: The Surprising Path beyond Depression, Anxiety, and Fatigue to Reclaiming Your Authenticity, Vitality, and Freedom and take her life changing online course Vital Mind Reset.

HERBAL SUPPORT 

There are a variety of herbal formulas that combine some of the herbs listed below, or you can try them individually. Many of the favorites are in my online holistic apothecary under the PMS, menstrual cramping and adrenal support category. It may take several months to notice a beneficial response, so give it time as you are working on your lifestyle. 

Common herbs recommended include Chaste Tree (Vitex), 2-4 dropperfuls 1-2 times daily of the tincture or 1-2 capsules dried herb, up to 500-1000 mg daily, or Don Quai, 1 dropperful tincture or 2 capsules up to 500-1100 mg daily twice daily. 

Physician, midwife and herbalist Dr. Aviva Romm advises additional herbs like: 

• Black Cohosh, 2-4 dropperfuls of the tincture, or 40-80 mg capsules 1-2 times per day

• Peony (which is many of the herbal PMS combinations)

• Adaptogens to support your stress response, regulate blood sugar, increase calm energy, and general well-being like Asian ginseng and American ginseng, Eleuthero, Schisandra, and Ashwagandha, 2-4 dropperfuls of each tincture or 1-2 capsules twice daily

• Dandelion root, Milk Thistle, Artichoke and Curcumin (Turmeric) to support liver clearance of excess hormones, and detoxification. HerbPharm Liver Health, Now Liver Refresh and Gaia Liver Cleanse are excellent combinations.

You can use any of these herbs to calm and support premenstrual emotional stress type symptoms, to relieve insomnia, headaches, and avoid constipation.

For Bilateral Cyclic Swollen or Tender Breasts, Bloating and Water Retention

In addition to everything mentioned above, implement any of these strategies as relevant to you, to reduce bloating and swelling.

Ditch the underwire tight fitting bras (most of the time).

Regularly massage your breasts and chest gently with Almond or Arnica oil to encourage lymph drainage. You may want to ask a massage therapist for guidance. 

Apply a Castor oil pack on your breasts for 1 hour 3 times weekly  to prevent and treat menstrual breast tenderness, but not during heavy bleeding. Soak a large piece of cotton or flannel cloth with cold pressed Castor oil, fold it so it is about 4 inches or layers thick, apply to your breasts and cover with a non toxic eco-friendly plastic bag. Apply heat over it using a hot pack, hot water bottle or heating pad, then cover with another towel. Lay down on a waterproof absorbent pad and rest with it in place for 60 minutes. You can reuse the saturated cloth several times and wash as needed.

Keep well hydrated with plenty of water, as it helps to clear the excess fluid you are retaining. If you do not usually use caffeine, and are interested in a natural diuretic, drink black or green tea regularly premenstrually. Cornsilk tea and Parsley tea are also effective and without caffeine - drink 1 cup 2-4 times per day. And eat more parsley, watermelon, cucumbers, celery, beets, garlic, lemon, cranberries and other natural food diuretics 

Another safe herbal diuretic is Dandelion. Take 1-2 freeze dried 500 mg capsules 500 mg per day. If you need a stronger diuretic, try Hawthorne Berries, 500 mg per day of standardized extract during the time you have premenstrual bloating from fluid retention.

Some find that Vitamin C with bioflavonoids is also helpful. Take 200 mg per day up to 500-1000 mg three times a day premenstrually as needed and tolerated, and increase iodine in food by eating more sea veggies. Take Iodinde as directed if you are deficient. Take a homeopathic combination remedy Mastodynon for relief of breast soreness.

For Cramps and Low Backache 

Experiencing pain is humbling, and it can be a chance for personal growth. It can be an opportunity to practice techniques that will help with life and the inevitable pain that all experience at various points, as part of being human in this world. Techniques like breathing, mindfulness, befriending and relaxing into intense sensations. Pain provides a chance to learn patience, acceptance of normal bodily changes associated with pregnancy, and how to prioritize, delegate, let go of activities of overwork or those that create increased stress, and allow others to help.

Do any of the breathwork techniques discussed in the breathwork section, and throughout all the exercises, practice embracing, relaxing into and even magnifying intense sensations without the mental story about them. Can you make friends with discomfort and pain, instead of trying to escape, numb or fight them? Is there something that they can teach you? Get curious about all of their details, including the borders or edges, and parts of you that feels good, or does not have unpleasant sensations. 

Yes, there are remedies to help alleviate pain. But you will be amazed how effective this practice is, and how much it will help you to better cope with your cramps, as well as with the pain that is an inevitable part of being human. It is the suffering from the pain that is optional, so you can choose not to suffer.

In addition to the above mentioned diet and lifestyle changes:

• Eat more plant based and naturally fermented veggies (kimchi) like sauerkraut

• Stick to real whole organic foods

• Use and eco-friendly natural household and body products

• Eat more fatty fish, like wild Alaskan or Norwegian salmon

• Eliminate processed refined foods, partially hydrogenated fats, caffeine, cane sugar, gluten and dairy

• Limit red meat to low-fat cuts

. Many women report much relief after a few weeks of making these dietary adjustments.

Remedies to start before the cramping:

Apply a Castor oil pack on your lower abdomen for 1 hour 2-4 times weekly  to prevent and treat menstrual cramps, but not during heavy bleeding. Follow same instructions as mentioned above.

Add several drops of one or combination of the essential oils Lavender, Rose, Ginger, Cinnamon, Clove, Marjoram and or Clary Sage into a bottle of Almond or Arnica oil and massage them into your low abdomen each day, starting 1-3 weeks before your period. 

Start or expand on key supplements in addition to those mentioned above like omega threes and calcium/magnesium. Take probiotics as directed, up your vitamin D to 2000-4000 IU depending on blood levels, add 100 mg of each of Vitamin B1 and Vitamin B6. Also consider Vitamin E (in the alpha tocopherol form), 400 IU per day, and Vitamin C, 1000-5000 mg per day a few days before and during the cramping. During the days of heavy cramping, depending on your dietary intake and the severity of your symptoms, you can take 100 mg of Magnesium Glycinate every 2-3 hours up to 1000 mg. Too much magnesium may cause diarrhea in sensitive individuals, but loose stool is a welcome sign if you have been constipated. 

To reduce inflammation and relieve pain, take Curcumin (Turmeric), 1-2 400-500 mg capsules, and Ginger, 1-2 capsules or 500-1000 mg each 1-3 times per day. Also try, Ceylon Cinnamon 2-3 capsules (has been researched effective using up to 3000 mg day) starting the week before your expected period. These are as effective as many over the counter medications, so you can also take it when you feel cramping during the first few days of flow.

Remedies for cramps:

Try modalities for general aches and pains as relevant to you now.

Use organic disposable pads, reusable cloth pads or a Diva menstrual cup when you have cramps...it lessens cramps!

Taking an Epsom Salt bath with a few drops of any of the essential oils Lavender, Rose, Ginger, Cinnamon, Clove, Marjoram and/or Clary Sage, and also put them in your room diffuser.

Rub Menastil on the skin over the lower abdomen. Afterwards, apply locally a hot or cold pack, heating pad, hot water bottle, herbal infused hot or cold pack, or try moist heat using a hot damp towel or packs from a hydrocollator (what the professional chiropractors, massage and physical therapists use). Thermacare makes portable disposable heating pads you can wear. 

Use a TENS unit.

Drink Red Raspberry leaf and/or Chamomile tea as much as you like. You can make your own infusion by adding a handful of Red Raspberry leaf or a pinch of Chamomile to 1 qt boiling water in a glass canning jar, covering and steeping Red Raspberry for 4-8 hours or Chamomile for 15-20 minutes. Strain, then add fresh lime or lemon juice, mint leaves or a dash of honey to taste (optional). Another great herbal combination is Earth Mama Period Tea. You can also take Red Raspberry leaf capsules as directed. 

Take two dropperfuls each of Cramp Bark, Black Haw and Motherwort, with ¼-½ dropperful of Chamomile tincture in a little water or juice every few hours.

Another herb that is helpful for painful cramps is Don Quai, 2-4 dropperfuls of tincture 2-3 times per day or 2 dried root 500 mg capsules 2-4 times daily. It can be taken up to every 4 hours in some cases, but only in consultation with an experienced herbalist, doctor of traditional Chinese medicine or integrative holistic practitioner, as there are some safety concerns and herb/drug interactions. 

Black Cohosh can be taken in lower, or higher doses depending on your unique situation, but an average dose in capsules to take is 250 mg 2-4 times daily, or 1 1/2 dropperfuls of tincture a few times per day. 

Try the Chinese herb Xiao Yao Wan with Bupleurum as directed.

Dr. Aviva Romm also reports success with:Valerian (1 capsule) 225 mg first few days, - best taken at night, as it can make you sleepy, and Fenugreek 900 mg 3 times daily. She is a wonderful, trusted, and well respected resource for natural remedies and herbal medicine as a physician, midwife and herbalist, and has much to offer regarding effective alternative modalities and herbs for pain relief.

Get a menstrual or mayan abdominal massage. Initially, you may want to consult a massage therapist, although eventually your partner may be able to learn some of the basics. 

Other effective alternative practitioners you can consult include specialists in homeopathy, yoga therapy, Shiatsu, reflexology, energy work, hypnotherapy and guided imagery, acupressure and acupuncture, and traditional Chinese medicine.

If you still need an over the counter medication and you are not planning a pregnancy, take one aspirin with food each day during the week BEFORE your cramping begins, to reduce the production of substances called prostaglandins responsible for cramping during the actual period. If the cramping is still uncomfortable when your period comes, acetaminophen (Tylenol), aspirin or ibuprofen (Motrin) can be taken as directed for relief if needed on a rare occasion, but it really is less toxic to avoid these medications which are not as benign as we have been led to believe, and use the natural alternatives instead.

For additional resources, read Women's Bodies, Women's Wisdom (Revised Edition): Creating Physical and Emotional Health and Healing, by beloved integrative holistic OB/GYN Dr. Christiane Northrup and Wellness Mama - ‘an online resource for women and moms who want to live a healthier life...fact-checked by our editorial and research team and reviewed by medical advisors for accuracy.’

For any natural remedy you use, give a two to three month trial to see how it affects you. Do your own research. Just because it is natural does not mean it is safe in any amount or combination for you to take. When in doubt about herb and supplement dosing unique to you, interactions, side effects and concerns, or you simply need more personalized guidance, consult your holistic or integrative medical provider, seasoned naturopath, herbalist, or If you need personal guidance, don’t hesitate to arrange with me an online coaching call or an in person holistic gynecology appointment. 

Contact your practitioner if these suggestions do not help, especially if your PMS symptoms are severe enough to cause you significant personal or interpersonal difficulties, if your symptoms do not go away after the first few days of your period and/or last throughout most or all of your cycles, if your symptoms persist or worsen despite trying these suggestions, if you are at risk for harming yourself or others, abusing drugs or alcohol. 

Tearing at birth

Worried about tearing at birth? If so, you are not alone. Although no guarantees (for example baby can come out with their hand by their head - compound presentation, that can result in lacerations), there are things you can do to help prevent tearing during pregnancy and at birth, even if you tore or had episiotomy previous birth. I have helped many mamas not tear or not tear enough to need stitching repair, despite the most serious of tears last time.

First off, say NO to routine episiotomy, in which the provider cuts your perineum and vagina at birth. It is is not only one of the most harmful, painful and unnecessary routine obstetric procedures, but also can lead to more serious tearing extending to the anus (third degree) and even the rectum (fourth degree). Make sure you maintain excellent nutrition, take in low glycemic foods and drink (especially if previous tear was related to baby’s large size - white four, fruit juices and sugar foods tend to grow bigger babies), avoid toxins like smoking, encourage baby anterior as you get close to term to prevent posterior positioning - I go into all this in more depth in my Natural Birth Secrets book 2nd edition. Research is conflicting about benefit of simple perineal massage to prevent tearing. What is more clear according to the research are devices specifically made to stretch vaginal and perinal muscles. In the last three to four weeks of pregnancy, you can prepare the muscles of your birth canal with one of the researched effective, pelvic floor medical training devices like Epi-no, or Aniball (easier to get in the US) as athletes and dancers stretch before working out or performing to prevent injury. They are like a balloon of sorts, that you insert into your vagina and gradually inflate 15-20 minutes daily, over a period of time to the size of baby’s head. They not only significantly reduce the risk of tearing or episiotomy, they also help you feel more prepared physically and mentally (and get a sense of what it feels like to have your birth canal stretch to the size of baby’s head so you relax into it), they ease childbirth, prevent stress urinary incontinence and been demonstrated to have other important benefits from reduced length of second stage of labor to improved Apgar scores - less fetal distress during the pushing phase. Incorporate the practice into your love making and have fun with it. Many mamas in my practice and midwives around the world swear by them, and urge first timers as well as mamas who have had more severe tearing or episiotomy previously to use them because of their successful results.

At the time of birth, to try to prevent tearing, you can honor the resting phase of labor, between end of transition and before feeling the urge to push. Wait for that powerful instinctual urge to bear down, when the baby descends low enough in your birth canal to elicit your natural fetal ejection reflex, and then use soft blowing breaths, to gently allow the emergence of your baby without forced coached pushing or pushing before you feel the urge, especially just because you are told your’e fully dilated. Gentle grunts to work with your body’s natural urges are not the problem. Avoid birthing positions like lithotomy (lying on your back with legs in stirrups, a flat surface or held wide open) or deep squatting. Use more upward, forward leaning, hand and knees or side lying, standing or dangling high squat positions, and if you are concerned, ask for perineal support by your attendants or have a water birth. I discuss this more comprehensively in my Online Guide to Childbirth.

You make plans for the best outcome, then surrender to the journey. Lean into the wondrous intensity of it all.

Routine Labor Interventions Needing to be Abolished

Routine interventions in healthy labor and birth that need to be abolished when all is well include not allowing food and drink, IV, laboring and pushing in bed on back, artificially breaking your bag of water, continuous electronic fetal monitoring - including the admission and periodic strip, using the outdated Friedman curve to asses progress, forced coached pushing during the resting phase before the fetal ejection reflex - during the resting phase once diagnosed as fully dilated, episiotomy, immediate and premature cord clamping.

Many labor in hospitals that don’t allow food and drink, and need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking food and drinking plenty orally. If you’re pregnancy and labor are healthy and proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists (ACOG), the American Society of Anesthesiologists (ASA) & of course the World Health Organization (WHO) all recommend encouraging oral fluids instead of IV fluids.

Why is this not happening? Routine intravenous fluids can over hydrate and decrease newborn weight & blood sugar & cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection; IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. It’s harmful practice to restrict needed nourishment and hydration during labor and birth. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV. There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, and needing treatment beyond natural remedies and medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

Artificially breaking your water is another routine intervention that has no place in normal birth. The bag of amniotic fluid is intact for a reason. Let it break on its own. Most often that is late labor or during pushing. Occasionally it breaks before labor or rarely doesn't break at all, leading to an en caul birth with baby born in the amniotic sac.

If you’re told there is little to no risk - it's just nothing - you are not getting informed consent or evidence based care. Breaking it artificially without medical reason has drawbacks like causing more intense painful contractions and use of pain medication to cope, increased risk of infection and fetal distress from cord compression without the protective barrier around baby. It can also lead to malposition of baby which can lengthen labor. All this leads to a cascade of other interventions from IV Pitocon, continuous external or internal fetal monitoring using an electrode screwed into baby’s scalp, and c - section. If your cervix is not soft, thinned out or dilated much, the risks of all the above significantly increase. If baby is presenting other than head first, or not yet engaged in your pelvis, breaking the water can cause the cord to prolapse needing emergency cesarean to save your baby’s life. It's proposed benefit of speeding up labor is possible, but no guarantee. Is that worth the risks? Sometimes a provider tells you they want to do it to check for meconium - not uncommon, which baby at some time of stress in pregnancy or labor had its first bowel movement that mixes with amniotic fluid. If there are no signs of fetal distress and heart rate is reassuring, why create more stress? Knowing there is meconium stresses the team, then you, as they now treat you as having a complication that requires more intensive surveillance. There is no need for this when all is well. When there’s a problem, such as prolonged or stuck labor and you’re exhausted or not coping well, after trying all other more natural remedies, breaking the bag can help. But make sure you are well informed by preparing in advance with my Guide to Pregnancy Birth & Postpartum.

Continuous electronic fetal monitoring (EFM) is still routine despite the overwhelming amount of evidence against its use. Non reassuring fetal heart tones is the second most common reason for first time cesarean in the States, after “Failure to progress”’, many unnecessary as babies are born vigorous without any signs of it. Per the research there is no benefit for the admission and periodic 20 min continuous electronic fetal monitoring strip either, in healthy low risk pregnancies. It isn’t just ineffective, it’s uncomfortable, harmful, leads to increased continuous fetal monitoring, other risky interventions and cesarean without making any difference in baby outcomes. There is no evidence to show that this kind of fetal monitoring is safe or effective, and has contributed to huge increase in cesarean rate without improving Apgar scores, cord blood gases, admission to neonatal intensive care unit, low oxygen brain damage and cerebral palsy, stillbirth and newborn death. Even Obstetric professional organizations like ACOG acknowledges this and endorses intermittent fetal heart rate monitoring with a hand held doppler in low risk pregnancies and those laboring without complications. Furthermore, they encourage training of staff to its use to facilitate freedom of movement and increased comfort. NICE in the UK as well as SOGC in Canada agree there is no evidence to justify routine use of continuous EFM & that intermittent hands on listening to fetal heart rate is the preferred method of monitoring. NICE goes as far as opining that providers NOT even offer continuous EFM to laboring women low risk for complications. The ACNM says intermittent listening of baby’s heart rate with a hand held device should be the preferred method of fetal monitoring in those low risk for complications. Research is not clear & guidelines differ even regarding who does benefit from continuous fetal monitoring, when it comes to certain higher risk complications. This is not what is happening in reality of US hospitals due to a variety of factors from big business of EFM, understaffing, lack of training and equipment to outdated policies, providers not keeping current or practicing evidence based care.

I don’t like to disturb a laboring mama when all is well, just periodically need to check on baby. Some mamas prefer the fetoscope but it can best be assessed with mama on her back, & most in labor don’t want to get out of tub and be on their back. I love using it in pregnancy, but in labor, find most prefer the doppler so mamas can stay in the tub, shower or any position they want to, & everyone can hear that most often reassuring heartbeat. Distressed babies usually tell us whether we use hands on doppler or intermittent monitoring - which also allows for freedom of movement and the enormous benefits of upward mobile positioning plus more contact with and support from your provider. Research also documents the benefits of continuous labor support (which can involve plenty of privacy if that’s what you need!). Being a midwife fly on the wall is often the best intervention in normal labor, who can be there if needed, otherwise keep the fly on the wall role- with a huge heart.

Assessing progress by outdated rigid parameters needs to go. According to evidence based birth, the definition of a “normal” length of labor that has been used since the 1950s based on the biased, flawed Friedman curve is obsolete. The new, evidence-based definitions of normal labor should be used, and the vague term “Failure to Progress” should be abandoned. Yet still used in many hospitals.
If the laboring mama and baby are both healthy, and as long as the length of labor does not qualify as an arrested labor, laboring mamas should be treated as if they are progressing normally, even if what seems to be slow and prolonged for the mama. Pregnant mamas - especially first time vaginal birthers should be given more time in the early phase of labor, making sure they keep well nourished and hydrated, mobile and active but also rested, and also well supported with a doula or doula like care. I have many more suggestions in my online course Guide to Pregnancy, Childbirth & Postpartum, as this can be a challenge to mamas and their partners.

If you are wanting or needing an internal exam, six centimeters—not four centimeters—should be considered the start of the active phase for most people and caregivers should keep in mind that normal early labor (before six cm) sometimes includes a period in which there may be no change in dilation for hours. People may decide, together with their caregivers, to delay birth center/hospital admission until active labor. Similar with homebirth, but there is a more intimate relationship there between midwife and mama, with periodic contact in early labor being the norm.

Still, people are still being told to labor in bed, and give birth on their back. I can’t believe this is still happening despite not just common sense but loads of research about the harmfulness and risks to this practice.

Laboring and pushing your baby out on your back goes against gravity and trying to do so is more work and stress on your body and baby. Laboring and pushing with the force of gravity is less painful and all the more easier. Lying on your back also causes your heavy uterus to exert some compression on major blood vessels that go to the baby which can cause fetal distress, let alone to your upper body and head - why people don’t feel well on their back late pregnancy. It’s a position that was created by doctors not birthing mamas, who would be more comfortable in any other position when given the choice. As it’s a position best for the provider not the mama and baby. And that’s the best birthing positions - what feels best at the time to work your baby down and out. I go over these best positions to labor and help your baby come through your birth canal and into the world with demos in my Online Guide to Pregnancy, Birth and Postpartum - sold separately or bundled.

Mamas need to be moving asymmetrically as they need to move working with their body and baby as well as using the force of gravity to help them guide baby down and out. The pelvis is three bones connected by ligaments and it can stretch to accommodate baby. It’s at is smallest capacity on your back. Pushing on your back is much harder as you have to work against gravity. Occasionally some mamas need to rest and can lay on their side, and some do want to birth on their back and it works for them. But the routine practice of insisting all mamas labor and birth on their back is harmful.

Good bye to forced coached pushing when fully dilated. If and when you are told you are fully dilated, rest, eat and drink if you need, get up and dance…but wait for the fetal ejection reflex (FER). When you wait for the FER, and naturally feel the urge to push, instinctively push, working with your body. It is a bit similar to pooping - think of what it feels like and what happens when you try to push it out for a prolonged period of time when you don’t feel the urge. Then think of how easy it is when you just go after feeling the urge. Some may need or want a little gentle guidance to get started but avoid forced coached pushing. It’s not evidence based because it’s harmful, associated with such problems as more swelling, tearing, fatigue, fetal distress etc. Honor the FER!

It happens. The sensations of pushing and FER, fetal ejection reflex can be so intense that mamas initially may want to fight it, which makes it all the more harder. What we resist persists. When we dive in and lean into the sensations we birth.
Being in the water helps. Movement in asymmetrical positions & roaring like a lion helps, as does channeling your inner monkey, letting your primal take over. Relaxation & coping techniques to practice in pregnancy so you can just tap right in to them in labor are a huge help, as is bringing fun, joy, the primal & sensual, & enhancing pleasure using all your senses into the birth experience . But a complete change in mindset and perspective is key, as is my preparation. You can learn to use different language for the sensations of labor, instead of pain which implies illness and something that needs to be remedied, and to see them for what they are. You can learn to use other words for contractions, which imply tension and negativity, and the word contraction is not empowering, and does not fully explain what is happening. Yes, the top of the uterus contracts so the birth canal can open and expand, as well as push out your baby. So expansions are also happening in labor – that is really the goal of what you are doing – expanding so your baby can emerge from your womb to the outside world, and you can both be birthed as a new mother and baby.

Suffering is a choice. And you can chose to embrace your intense sensations for what they are, as healthy signs, what is needed to birth, what your baby needs to transition earth side - not that anything is wrong. I go cover this in much greater depth in my online Guide to Pregnancy, Labor & Childbirth.

Routine episiotomy in a normal birth is of the most harmful unnecessary procedures. It’s so not evidenced based care. And if you do tear despite prevention efforts (it can still happen), little tears heal fine on their own; if we have to do a repair we do try to put everything exactly or almost exactly how we found it. The perineal and vaginal area of a mom who has given birth vaginally before never looks exactly like it did prebirth. But we do our best! Sometimes there is some scar tissue that forms and definite changes from muscle stretching. These are our beauty marks and badges of honor.

Immediate and premature cord clamping is another harmful routine intervention that needs to be stopped. Just think about it. We did not cut cords right away for most of history. No mammal cuts the cord after birth. They just allow the normal natural physiological process to proceed instinctively…or they would have not survived as species.

The number one best recipient for cord blood is baby. 1/3 of baby’s own blood backs up into the placenta during birth. Baby needs to get it back - it is loaded with blood volume oxygen, nutrients, stem cells, antibodies and ingredients essential for transitioning from womb to world and long term health. If you want to donate or bank the cord blood, if baby is doing well at least wait 10 - 15 minutes so your baby gets most of it and there is still enough to bank.

Don’t let them convince you to have it cut ever after a minute because they are in a rush or tell you some misinformation that it’s not good. Clamping right away was probably invented for the doctor but now we know it’s harmful. Delayed optimal clamping can even be done after cesarean until placenta is birthed if there is no other problem.

I have way more info on this in my Natural Birth Secrets book 2nd edition but make sure this is clearly communicated to your providers and written in your birth plan. Ideal is to wait until it stops pulsing completely, flat and white, and you can even feel and see that yourself. When all is well I don’t cut it until after the placenta unless they want a lotus birth.

The best intervention in normal labor and birth is no intervention. Beloved obstetrician Dr. Michel Odent goes further and says best intervention in healthy childbirth is to knit. Knitting keeps our hands occupied instead of trying to meddle and fix something that isn’t broken. Part of Hippocrates oath doctors have to take after training is “First Do No Harm.”

But knitting goes deeper. It is the calm presence of an experienced attendant who has seen it all, communicating to you with their body language to relax, all is well. Their calm is contagious and will make you feel more calm. Their heart, ears, eyes and mouth are open to listen, watch, support, encourage and help you as needed; and of course they can put the knitting down as appropriate, but the point is brilliant.

The ideal is birth attendants are there, so there with the laboring mama, especially towards later labor when sensations can get intense, but know that mama needs to feel private, safe and undisturbed to labor best, to not feel watched; so we try to leave her alone, on her own, until she needs us. Even then, we try to be in background so mama doesn’t feel watched, after doing needed assessments without causing much disruption, as a lifeguard just in case and there of course if more support is needed.

Prepare yourself to be empowered, have an advocate and birth YOUR way!

Premature Rupture of Membranes at Term

How do you know your main bag of water breaks? You feel a pop & fluid bursts out of your vagina like a river, making a large ~ 2 1/2 - 3 cup puddle on the floor, or it totally saturates your clothes or where you were sitting/lying. You keep leaking fluid throughout the day that’s not pee, saturating your maxi pad like the first morning baby diaper, or your poured at least a few cups in it. It looks clear, blood tinged with white specs of vernix, or it’s brown/green color of baby’s first poop meconium (let your provider know). It does not look or smell like pee or semen (no history of recent sex). Your provider sees it flowing out of your vagina, pooling in your vagina on sterile speculum exam or on microscope, or simply + Amnisure test.

And it’s not the few tablespoons of fluid between the two membranes that can release before labor making ~ pancake size stain on your underwear, seat, sheets. It is important to know that as main membranous bag is intact. When in doubt discuss with your provider. They can confirm or rule it out. The test strip that turns blue with amniotic fluid is not diagnostic by itself as it can also turn blue with other things, like blood and even the fluid in between the membranes. It is important to be certain of the diagnosis of PROM. You do not want to be falsely diagnosed as “ruptured membranes” with all the possible unnecessary potentially treatment that entails.

PROM - premature rupture of membranes means when the main amnion bag of amniotic fluid breaks at term, before labor. It happens 8-10% of the time. It’s important to know for sure it’s not just a crack in the inner chorion membranous bag, leaving the main bag intact, so you’re not on the “clock” unnecessarily. Babies are double wrapped with a few tablespoons of fluid in between the two membranes - enough to make a pancake sized stain on your underwear or whatever you’re sitting on if outer bag tears, but then no further leakage. If in doubt, I advise wearing a maxi pad & walking around a few hrs. If it becomes saturated like an overnight diaper that’s the main inner bag with lots more fluid just > 1/2 liter; if it remains dry PROM is unlikely.
But is this “clock” evidence based? No. Recommending to induce to avoid risk of infection & stillbirth is based on outdated low quality studies from 1959s-1960s. According to newer quality research, as long as mom & baby are doing well & meet certain criteria, induction is just as much an evidenced based option as waiting for mama to go into labor on her own up to 48-72 hours later, without increased risk newborn health problems or death. 77-95% will go into labor anyway by 24 hours.

Many leading professional organizations like ACNM, RCOG, NICE, AOM, & RANZCOG recommend offering both options as acceptable as long as certain criteria are met - like single term uncomplicated pregnancy, clear fluid, no fever, no GBS, & normal fetal heart rate. ACOG says induce immediately but that if mom declines, waiting for labor to start on its own (expectant management) is acceptable. Waiting for labor to start on its own has very good outcomes for moms & babies. Induction of labor has strong consequences like the cascade of interventions, cesarean & birth trauma, & many opine it can not be justified as standard of care for a normal physiological occurrence in healthy term pregnancy.
It’s important to know your rights to autonomy, & be educated to make an informed decision if this happens. Do avoid or minimize internal exams or anything internal as it increases risk of infection.

If you are interested in more gentle ways of bringing on labor naturally refer to my Natural Birth Secrets book second edition.
Be informed, empowered & educated with my online course Guide to Pregnancy, Birth & Postpartum - sold separately or in a bundle.

Induction of Labor: Invalid Reasons

According to the research, not many of the common reasons for induction are evidence based. People are feared into induction too often unnecessarily. For a surprising number of conditions, there has been no proof of the benefit or effectiveness of labor induction but actually have been shown to cause more harm - like suspected big baby, being labeled as high risk by your age alone, isolated ow amniotic fluid, and intrauterine growth restriction before term.

The benefits of imminent birth must outweigh risks of induction of labor and all that entails. That is when mama’s or baby’s life is in jeopardy and imminent birth is life saving as compared to possible dangers of continued pregnancy.

Thanksgiving, Christmas or any holiday are certainly not complications of pregnancy. Rates of induction continues to skyrocket, remarkably so in the days leading up to the holidays, with US rates in general, way above the rates from even 20 - 30 years ago, but our outcomes are continuing to get worse! A large amount of research demonstrates the risks far outweigh the benefits of induction especially when mom and baby are healthy. Elective induction without a well-supported medical reason clearly increases risks - for babies especially before 39 weeks. Induction before 41 weeks significantly increases chance of having a cesarean birth, major abdominal surgery with all its associated risks - especially for first time vaginal birthers and having a cervix that is unripe - not ready. Induction also greatly increases the chance of needing pain relief like epidurals which have their own risks for both mom and baby.

For example, induction of labor is absolutely appropriate in worsening gestational hypertension or preeclampsia, if mama or baby has a serious illness in which prompt treatment is needed after birth. But even in pregnancies that go beyond 41-42 weeks, there are pros and cons, potential risks and benefits to watchful waiting versus labor induction, which must take into account mama’s preferences, knowing that she has medical legal right to autonomy and declining induction of labor.

IUGR is not an evidenced based reason to induce labor. There are a variety of known causes of true IUGR (intrauterine growth restriction), like high blood pressure, heart/lung/kidney disease, diabetes, malnutrition, serious anemia, cigarette smoking, drug and alcohol abuse, certain infections, and fetal abnormalities. But do know that in well dated pregnancies, the majority (80-85%!) of babies identified as having IUGR are simply constitutionally small but healthy. They are just weighing below the tenth percentile. All of my four babies were off the growth charts diagnosed small for gestational age (SGA) but I and my husband are not tall and I simply make six pounders who consistently grew but stayed way below average in growth by height and weight even as kids.

Oligohydramnios - low amniotic fluid, by itself (not associated with other problems such as preeclampsia or birth defects) is also not a reason for induction as it is not associated with increased risk of poor outcomes, nor backed by the research. Actually, the main risk of low amniotic fluid at term in a healthy pregnancy is induction and cesarean as a result of the induction, and potentially the risk of lower birth weight of a baby born too early. There is no evidence that inducing labor for isolated oligohydramnios has any beneficial impact on mother or infant outcomes, but rather the risks of induction far outweigh the alleged benefits. A large body of research indicates that ultrasound measurement of low amniotic fluid is a poor predictor of actual amniotic fluid volume, so potentially inaccurate assessments dictate risky recommendations. Amniotic fluid in an otherwise healthy pregnancy lessens in the few weeks before birth, and post term related to decreased swallowing and urine output by baby. But it is often related to dehydration, seen more in summer months. If a mama drinks 2 - 2.5 liters of water daily she is likely to increase the amount of amniotic fluid volume, and she can up her amount if a low amount was detected on ultrasound.

Induction at 39 weeks of pregnancy is based on the Arrive study, which has flaws and goes against common sense as well as all the science & research up until now. The American College of Nurse Midwives does not support it and continues to advocate for spontaneous labor & healthy normal physiologic birth as well as a women’s right to self determination. For a thorough analysis of the the Arrive study on which these recommendations are based here are a few resources:

- evidencebasedbirth.com/arrive
- midwife.org/ACNM-responds-to-release-of-arrive-trial-study-results

- sarahbuckley.com/should-every-mother-be-induced-the-arrive-trial

- Lamaze.org/connecting-the-dots/parsing-the-arrive-trial-should-first-time-parents-be-routinely-induced-at-39-weeks.

Inducing labor or cesarean for suspected big baby in pregnancy isn't evidence based care and is potentially harmful. Estimated fetal weights based on ultrasound or abdominal assessment are notoriously inaccurate. They do not account for the ability of the pelvis to stretch, the power of mobility and gravity, baby's head’s ability to mould to navigate through the birth canal.

Especially because of the inaccuracy of estimated fetal weights, it is not evidence based care to induce labor or send you to the operating room for this alone. It is a fear based practice and has way more risks than benefits and again, not backed by the research. Time to stand firm. Don’t let them scare you. Fear increases your stress and negatively impacts your labor. You have the right to decline and even switch providers to those more calm, supportive of your choices and who practice evidence based care.

Even if baby is a good size, baby’s not yet fused skull bones can mould to fit through the pelvis which can stretch and increase capacity in asymmetrical upright and mobile positions, which also work with gravity. Plenty of mamas birth ‘big’ babies when given the opportunity and support. You have your provider there also as a lifeguard in case of need, like to relieve the uncommon but potentially serious complication of stuck shoulders called shoulder dystocia which can also happen in smaller babies. It’s certainly easier to push out smaller babies, and you can do your part by staying off sugar foods, refined carbohydrates, and juice. But no, don’t succumb to this routine practice of induction or scheduled cesarean for suspected big baby (macrosomia).

TRIGGER WARNING: With permission I share a tragic story of someone I knew who was having her first baby. She was told she needed to be induced before due date because they said baby’s weight was almost 10 pounds and she had a small frame. It was a top notch, highly esteemed medical center and hospital. Induction at 39 weeks no surprise didn't work, so birth was by cesarean. Baby weighed 7 1/2 pounds. Mom bled profusely during surgery. That is a risk of cesarean especially followed by medications for induction. She bled so much they removed her uterus. She ended up in a coma in the ICU and despite blood transfusions and intensive care she died. There is a patch for her in Ina May’s large Safe Motherhood patchwork quilt project, one patch devoted for every maternal death in the US.

For a more inspiring birth story of redemption, on a happier note, another mama came to my practice wanting a VBAC. Her first cesarean was done for suspected big baby over 9 pounds, but baby weighed only 7 pounds. She said her doctor told her no trial of labor as her pelvis was too small for her big baby and it would be too dangerous. She had a lot of trauma from her birth experience which propelled her to educate herself, prepare big time do things in a whole different way next baby. She took my online signature course Guide to Pregnancy, Birth & Postpartum & used my Natural Birth Secrets book 2nd edition as her “bible” she called it. She read lots of other books, took my prenatal yoga classes….and switched to midwifery care with me against her obstetrician’s warnings she and her baby might die. We worked closely together. She was so proud of her ability to have a beautiful VBAC at home (HBAC), and that a 9 pound baby slipped right through her birth canal without a tear. She actually wrote her obstetrician telling him that her pelvis grew.

Sometimes I have to get real with you to drive a point. Despite all the money and technology of modern US medical and hospital care, the United States ranks the worse among developed countries in terms of birth outcome statistics - our maternal mortality and morbidity rates are on the rise like no other country, and rates of neonatal morbidity and mortality and birth trauma are also horrendous. The countries who have best outcome stats are countries that have more midwifery care that services the low risk healthy population who benefits most by not disturbing physiologic birth when all is well, leaving the obstetricians to provide care to those who have higher risk conditions, complications and need lifesaving medical and surgical care. When high risk care is applied to healthy low risk people, we see more problems, we contribute to the horrid outcome stats of our country.

So let baby come when they are supposed to come and don't let anyone pressure you into an unnecessary induction. Even back in 2013, a listening to mothers survey showed that 4 out of 10 mothers (41%) said their care provider tried to induce their labor. You have the right to say no and switch providers to those who support the natural process of letting labor start on its own when all is well. Rates of routine unnecessary inductions are on the rise - from 9% of births in 1989 to 31.37% of births in 2020, which increases risks - including failed induction as the body is not ready, & unnecessary cesarean with all that entails.

Remember we are not in control or as wise as the greater intelligence that designed the process. Giving birth is such a lesson in surrendering to that greater power that transcends us all.

What can you do? Empower yourself with resources like my book & online course Guide to Pregnancy, Birth and Postpartum - bundled together or sold separately! Say No!! Prepare like a boss. Go to supportive providers. They are out there. We must be the change we want to see.