Dandelion Revolution

After a bout of tossing and turning, I got out of bed and wandered to my book shelf. Matthew Wood’s Healing Wise – New World Plants edition called to me, so I picked it up and randomly opened it to the entry on blue cohosh, Caulophyllum thalictroides. As I read, I realized that I needed to learn much more about this Eastern US woodland herb in the Berberidaceae than I thought.

I have been a birth doula since 2006, and although I haven’t been a bustling, full-time doula, and I don’t use herbs during labor per se (which is kind of out of a doulas’ scope of practice anyways), I still consider herbs for pregnancy one of my favorite topics. From talking to midwives, herbalists and moms with personal experience, I had never heard a positive story about the popular black and blue cohosh combination used during the last few weeks of pregnancy to prepare the uterus for labor, or to induce labor after the due date. Comments include three accounts of allergic reactions, most accounts of nothing happening after taking it, and one women who thought that it induced labor too early and contributed to a long labor.

When people asked me about preparing for labor in the last few weeks of pregnancy, I would talk about positions, yoga, exercise, sexual activity, rest and relaxation, visualizations and affirmations, nutrition and hydration (including herbal teas, of course), but I never thought to mention an herbal partus perpatorus. This is mostly because of what I heard from herbalists and/or midwives like Aviva Jill Romm.

Romm, who is a midwife, mentions that blue cohosh is an herb contraindicated for use in pregnancy, and she says that

“Blue cohosh has been implicated in at least one and possibly several incidences of cardiac problems in newborns, including myocardial infarction  (heart attack) when taken by pregnant mothers in the last three weeks of pregnancy, even when used in the generally recommended doses. Blue cohosh has not been associated in the medical literature with problems when used short-term during labor, but the potential for such problems cannot be entirely discounted. Again, the use of blue cohosh as a general late pregnancy tonic is not advisable, it should never be taken prior to three weeks before the due date, and its use is best left to qualified health professionals.”

Romm does mention the use of black and blue cohosh might be indicated to help promote uterine contractions when the due date has come and gone, and that together, the cohosh pair may be a better alternative to pitocin induction. She also says that blue cohosh can both relax and tone the uterus and that “the right balance of relaxation and tone is necessary for effective flavored. The use of many such herbs was taught to us by Native American women, who have long use herbs in late pregnancy for the purpose of easy birth.” Conflicting information, no?

On one hand, a few (or even just one) isolated incidences of cardiac problems make using this herb ‘not advisable’, on the other hand, a long-standing Native American use makes it sound not only perfectly safe, but something desirable.

The medical journal that Romm discusses is a 1998 issue of Journal of Pediatrics. She states that blue cohosh contains alkaloids and cardiac glycosides, which are well-known in the herbal and medical community to having effect on cardiac muscles. Romm also states that blue cohosh, black cohosh, partridgeberry, and spikenard were used as a partus preparators, or herbs that were taken towards the end of the pregnancy to prepare the body in uterus for labor. Romm states that partus preparators would be used “with the hope of ‘ensuring a speedy delivery’”. I do appreciate that Romm brings to light the question of why herbs would be used or needed to do what the body and your can do on its own.

After re-reading Romm’s stance on blue cohosh and feeling confused, I searched in my other herbals for more clarity, going first to one of my favorite herbalists, Rosemary  Gladstar. She discusses the controversy around blue cohosh, and reminds us that the study was done of one isolated constituent of the plant (caulosaponin) being injected to lab animals in finding a narrowing of the arteries. From this, scientists said that blue cohosh may be responsible for heart damage.

Gladstar also gives a good account of the uses of blue cohosh, discussing it’s wonderful use in speeding up slow or drawn out, long labors where it is combined with black cohosh and pennyroyal. It should be thought of as a specific medicine, not as a tonic or food herb, and should not be used until the end of pregnancy. She quotes Dr. Shook, a physiomedicalist, who said,

“This exceedingly valuable herb is well called ‘woman’s best friend’ for the reason that it is much for a reliable and far less dangerous at expediting delivery in those cases were labor is slow and very painful. This is a very old Indian remedy. They believe it to be the best parturient in nature, and it was the habit of their women to drink the tea several weeks before labor”.

Uterine tonics can be used to treat pain since they regulate the muscular activity of the uterus, making them to be more regular, rhythmic and orderly. Australian NP and herbalist Ruth Tricky also puts in her two cents regarding the blue cohosh controversy and neonatal heart failure. In one case, the mother of took three times the prescribed amount of blue cohosh, in another, the dose was not named. It is hard to detect a toxic dose when the dose by these individuals is not the recommended dose.

Tricky mentions blue cohosh along with dang quai, false unicorn root and raspberry leaf in a class of uterine tonics which “initiate regular uterine contractions and regulate uterine tone” (319). The references that Tricky reviewed indicated that some constituents of blue cohosh seemed to increase the contraction force and rates while another alcoholic extract of the whole herb increased uterine tone that decreased the rate and amplitude contractions (no wonder, since and herb is more than the whole of its parts, or in this case, the whole of just a handful of parts). Uterine tonics like these can treat hemorrhage because they are able to improve weak muscle activity of the uterus, but also relax excessive spasm. Specifically, Tricky (239) says that blue cohosh is use:

“…when spasm seems to be localized in the cervix, resulting in acute crampy pain was very little flow. Women with this pain pattern usually experience relief once the flow becomes established”.

Let’s not forget that blue cohosh is a muscle relaxant. If it’s good for the uterus, it can be good for other muscles with all of their tendoness attachments. Matthew Wood gives many other uses and indications for the herb including amenorrhea of young women, chronic uterine disorders, particularly of those with broken-down constitutions, insomnia and nervousness, rheumatic conditions for spasmodic muscular pain, sexual debility, joint pain and more. It is quite useful, though, for bringing on suppressed menstruation, relieving cramps and menstrual pain, especially when considering its anti-spasmodic nature. Woods says blue cohosh as a “menstrual remedy, it can remove congestion of the uterus from muscular and vascular constriction and tension often accompanied by malposition of the uterus”.

Blue cohosh is a great example of not boxing in an herb and based on its most popular use. Perhaps blue cohosh should be used as a tonic herb rather than an herb only to induce strong contractions at the end of pregnancy. Also we cannot judge the safety of an herb on a few isolated, yet incomplete, reports or studies. Single isolated constituents are interesting to study, and they can contribute to a the chemical and biological activity of the constituent, but their findings cannot be seamlessly extrapolated over the use of the whole herb.

If we use the herb when indicated, if we understand it’s personality, actions and historical usage, if we use the smallest dose necessary, and consider using it as a tonic rather than a strong single-purpose uses, if we take the few studies with a grain of salt and combine with other herbs to produce a synergistic individually made formula, than this and other much maligned herbs could be used safely and indeed very effectively.

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Tricky, Ruth. Women, Hormones, and the Menstrual Cycle.

Gladstar, Rosemary. Herbal Healing for Women.

Wood, Matthew. Healing Wise – New World Plants.

Romm, Jill Aviva.The Natural Pregnancy Book: Herbs, Nutrition, and Other Holistic Choices.