Are you safe with traditional herbs while pregnant?

When a colleague went to hospital to give birth, lying next to her was another woman who continuously took traditional herbs. Despite the doctors and nurses advice to her to stop drinking them, she told the professionals that she trusted and could not do without them.“Well, they did leave her but kept checking on her progress. During examination, the baby’s head was visible but in the last minutes, the baby’s position changed. I heard doctors saying, ‘Emergency; it’s a cord prolapsed’ and within a short time the woman was rushed into theatre for a caesarean.”

A cord prolapsed is a rare obstetrical emergency that occurs when the umbilical cord descends alongside or beyond the foetus. It happens when the umbilical cord precedes the foetus’ exit from the uterus. It is often concurrent with the rupture of the amniotic sac. When this happens, the foetus moves downward into the pelvis and puts pressure on the cord. As a result, oxygen and blood supplies to the foetus are diminished or cut-off and the baby must be delivered quickly Did the herbal medicine help the woman, or was it the cause of her problems? Or was it neither? Nobody knows for sure. Many women here still rely on and believe that traditional herbs do help them at the time of delivery – even when they are under the care of professional doctors.

The impact is not well understood. Traditional remedies in some cases appear to have benefits, although their advocates often make unproven claims. And just as modern drugs can have unintended side effects, it appears that traditional treatments do not always have the desired effects. If you are pregnant, the lesson is, to be careful.

Research about the herbs
According to the World Health Organisation, traditional medicine refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illnesses. Dr Herbert Kadama, an obstetrician/gynaecologist at Mulago Referral Hospital, found widespread use of traditional medicines during his research on pregnant women at Mulago in 2002.

“They are used by all classes of woman in all tribes and religions,” he says. “It’s a culturally or traditionally embedded behaviour because however much one might be educated, this does not alter their behaviour. They will still use the herbs.”The doctor says that the traditional medicine most commonly used by pregnant women is mumbwa, which is made from a mixture of leaves and clay. People who provide it make a wide range of claims about what it does.

Nnalongo Gladys Nakirijja, a Traditional Birth Attendant (TBA) at Kawempe, says it not only eases common pregnancy-related problems like morning sickness, backache and swelling of feet, but also helps babies avoid being born with skin rashes, prevents malaria and offsets curses in cases where a pregnant woman sleeps with another man who is not the father of the baby. Other local herbs used by pregnant women are mululuza, ebombo, ejyobyo, lizard and human faeces. A variety of claims are made about these herbs, too, according to Dr Kadama. “The people who give women these herbs claim they soften the pelvic bones thus enabling them to give birth easily,” explains the doctor.

He adds that some women take herbs so that they can change the sex of the baby – a claim that scientists strongly dispute. Some women who have had caesarian section deliveries use the herbs because they believe their scars will not hurt or rupture when they give birth. This claim, too, seems dubious. According to Dr Kadama, herbalists tell the women that such herbs shift the scar from the stomach to the back at the time of delivery. Some people believe the herbs change the positioning of the baby and prevent cases of eclampsia (convulsion during pregnancy).

But how can a woman evaluate such claims?
In the absence of research, there is little evidence to rely on other than word of mouth, and non-scientific observations like this one from Ms Nakirigya: “In most cases, a woman who has been taking emumbwa will easily give birth which is not the case with the other woman who has not been taking it,” she says. Dr Kadama acknowledges that local herbs sometimes works, when it comes to speeding up delivery. But, he says, “They are not well researched, and therefore pregnant women are not advised to take them.”

He says that in the first trimester (first three months of pregnancy), women should not use any kind of medication or drugs “because during this time, the baby is just forming so anything taken wrongly can affect the baby.”Ms Nakirigya, 75, has been a TBA for over 50 years, says that herbs like mumbwa can be taken by women from the time they learn of the pregnancy until they give birth.
But Dr Kadama, says that herbs such as mumbwa, ejjobyo and mululuza can induce labour, and are taken without the recommended dosage. And since they are taken throughout pregnancy, they can lead to a miscarriage, premature births and even to delivery of babies with abnormalities like short or no limbs and disfigured heads.

Mr Patrick Bateganya the General Secretary for the Uganda Nurses and Midwives Association (UNWA), says that at times the uterus of a woman using herbal medicines might contract too early, in the process suffocating the baby and leading to a still birth. Herbal medicines can also lead to maternal death, according to Mr Bateganya. “When women take these herbs, they go through the blood stream and thus directly act on the muscles of the uterus. So this causes the uterus to contract abnormally and the number of times it contracts are also very many as compared to the normal. So at some point, the uterus becomes very weak and thus ruptures as a way of giving passage for the baby to come out. And when it does rupture, this leads to excessive bleeding which if not controlled, can lead to maternal death,” he explains.

He warns that in cases where some herbs are inserted into the woman’s private parts, they do cause infections to the mother and baby. And such infections might either lead to a miscarriage or the delivery of a baby with infections like skin problems.

So what can be done
Given the uncertainties and lack of research about these traditional herbs, Dr Kadama says it’s wise to avoid herbal remedies.

Do not risk the unknown, because these herbs are not researched,” he says, adding, “They can have immediate or long term effects. Pregnancy is a delicate state which deals with two people’s lives.”

He recommends that during pregnancy, instead of using herbs, all mothers should go for antenatal care because this way, they will be taught how to take care of themselves.

Dr Kadama advises that in cases where pregnant women are not sure of the positioning of the baby, they should go for an ultra sound scan so that they can rule out all doubts instead of taking herbs without even knowing if you are taking them for the right reason.

The gyaenacologists urges more research on the herbs. “I would encourage government to increase research in these medicines so that we can benefit from them.”