Homeopathy for the modern pregnant woman and her infant

Review

This book review is reprinted with the permission of the National Center for Homeopathy

Reviewed by Susanna Shelton, BA, MDiv, ICHom

Sandra Perko has produced a useful resource for people wanting to successfully employ homeopathy in the perinatal context. Perko has managed to present a comprehensive, yet user-friendly handbook.

I consider the following aspects to be particular strengths of the book:
The sequencing of the chapters Perko begins with an overview of "Homeopathy and its use in Midwifery" in Chapter 1 and "Nutritional Considerations and Safety Precautions" in Chapter 2. This is followed by chapters dealing with pregnancy and birth in a chronological progression-from antenatal to intrapartum and postpartum (with separate consideration of problems encountered with mothers and babies after delivery). In addition, there is a convenient "Alphabetical Table of Contents" of specific conditions which cross references to the appropriate chronological chapters.

Another strong feature of this reference text is the chapter layout and notation system indicating the remedies most often used in a certain condition. For example, in Chapter 7 dealing with intrapartum difficulties, we find a section headed, "Labor Ceases After Beginning - Irregular Labor." Immediately following the heading we find a summary of the condition and possible complications that may arise if it does not resolve. This is followed by a differential of the remedies Belladonna, Cimicifuga, Kali carbonicum, Pulsatilla, Opium, Gelsemium, Secale, Nux vomica, and Cocculus. Each of the remedy names is printed in all caps, bold type and underlined and the standard abbreviation is given. Next follows a diamond rating system indicating the frequency of use in the given condition; the triple diamonds being the most often needed. In the above example we find, for instance, "CIMICIFUGA (Cimic) *** and GELSEMIUM (Gels) **." Under each of these remedy names and diamond indicators we find a concise precis of the indications for the remedy in this specific situation. This format is particularly useful for reference at the bedside especially when time pressures are critical.

Another useful feature of Perko's book is the Quick Keynote References in Chapter 11. This Chapter consists of "one liner" descriptions of the main remedies for all the situations discussed in greater detail in Chapters 3-10. These "one liners" are analogous to definitive line drawings of complex figures which skillfully and briefly encapsulate the essential features of the whole. All of Perko's "one liners" are cross referenced to the more detailed summaries in the main chapters.

Perko refutes the common assumption that pregnancy is a disease that needs to be medically managed. Her philosophy of pregnancy and birth as a natural process that sometimes requires assistance to progress smoothly is clearly indicated throughout the text. Her respect for the birthing process is also clearly informed by the knowledge that even with the best of intentions and most positive philosophy, there are times when referral to secondary professional care is not only desirable but essential. For instance, Perko gives a summary of the signs and symptoms of preeclampsia and its possible complications and the need for specialized referral and assessment.

More excellent features of this book are the glossary bibliography, the Latin name/Common name cross reference appendix and suggestions for putting together birth remedy kits. The glossary gives clear definitions including both homeopathic and conventional medical terms. The bibliography not only indicates the good research behind the text, but also provides a reading list for those who want to pursue further study in the perinatal use of homeopathy. The Latin name/Common name cross reference is another bonus especially for those folks familiar with the herbal remedies who want to know which ones are used homeopathically. The standard abbreviations are also included in the Latin name/Common name appendix. In the midwifery remedy kit lists, Perko suggests a primary secondary and tertiary kit with a range of remedies in different potencies. Her inclusions in the kits reflect a systematic and pragmatic approach to acquiring remedies.

In addition to the strengths mentioned, I found some aspects of the book confusing and need to state my reservations about some of the material.

In Chapter 1, Perko makes the following bold assertions, "... in actual fact, homeopathic 'drugs' or remedies are indeed safe for the mother and the developing infant alike. Mothers (and fathers) who are treated with homeopathic remedies prior to and throughout the pregnancy, labor and delivery are healthier and are far less likely to develop problems. Any problems which do develop would likely be of a milder nature than they would have been without homeopathic care.. Homeopathy is the safest and most effective method of treatment of the pregnant woman's emotional and physical well-being." While my own experience and that of the many homeopaths and midwives I work with confirms these assertions, I question the wisdom of making such claims without including qualifying statements about where these conclusions originate. I'd have liked to see qualifiers such as, "we have over 200 years of clinical anecdotes which suggest these favorable outcomes" or "we have no known contraindications for the use of homeopathy in the perinatal context."

Later, Perko states, "If used correctly, there is not the slightest threat or harm to her baby." This statement makes me wonder what would happen if homeopathy were used "incorrectly" and what exactly constitutes "correct" and "incorrect" use. I wonder how homeopathic novices using this text will be able to differentiate between correct and incorrect use of homeopathy.

I'm also concerned about the lack of distinction between which are acute and which are chronic situations and the knowledge base necessary to appropriately manage the chronic problems. For example, a perineal laceration is a clear cut (no pun intended) acute situation whereas postpartum depression is not. The indicated remedies for a perineal laceration are few and almost anyone can determine the appropriate remedies to use with a modicum of knowledge and experience. Postpartum depression on the other hand is a complex syndrome involving a much bigger totality of symptoms and many more remedies are indicated. Appropriate and sensitive management of a case of postpartum depression requires a substantial knowledge base and experience which is not adequately addressed in the eight pages of text in Perko's book, covering 18 remedies. I have the same reservations about the appropriateness of including therapeutic listings and cursory descriptors for remedies to use in: "pregnancy and the sexually abused woman" and "dominant emotional states during pregnancy."

I also question the wisdom of including birth defects in this text. This is another example of where the benefits of considered chronic treatment may be missed by the novice who might refer to this section and assume that Phosphorus is the remedy for Club Foot! Likewise I question the prudence of listing Baryta carb Baryta mur Carcinosin and Calcarea carbonica under the heading "Down's Syndrome" with no indications for the use of these remedies. I agree that birth defects and the symptomatology which results will often respond positively to homeopathic treatment. My concern is that the unsophisticated reader may be tempted to routinely prescribe the listed remedies and nosodes without having the materia medica knowledge and long-term case management skills necessary to maximize the benefits of treatment. I'd have preferred to see a general statement about the potential role of homeopathy in the acute and chronic aspects of birth defects when carefully prescribed by a competent practitioner.

In Chapter 1, Perko states, "...certain remedies, such as Cimicifuga, Caulophyllum and Thuja should not be used in the early stages of pregnancy as they may cause miscarriage." I, too, have heard this precaution but have yet to see it substantiated. I wonder if this is a myth based on a single anecdote in our literature which has been repeated over and over again without question. So far, I've not seen these remedies indicated in early pregnancy, I wonder what others have experienced and would like to report. Perko also gives pre- cautions about repeating nosodes after the initial dose even when indicated in the pregnancy. I'd like to know the reference for this and any case studies where adverse effects occurred. Perhaps these are the "incorrect" uses of homeopathy referred to in Chapter 1. If so, such important contraindications for the use of certain remedies demand clear reference to sources.

I would have preferred to see references for statements like, "Think of Sepia in cases of low-lying placenta... this is due to a hormonal imbalance caused by the pill." I wonder if this has been documented in the homeopathic or medical literature. I was also confounded by the indication Perko gives for Hyoscyamus in the Neonatal Hernia section; she says, "The umbilicus is open and urine oozes through." I can't see how this is anatomically possible.

In Chapter 2, Perko discusses the nutritional aspects of antenatal care. I concur with her nutritional suggestions for dealing with and assessing fatigue in early pregnancy I found it curious that no suggestion of remedies was made vis-a-vis mild fatigue. In my practice, I have found Arnica and Ferrum phos effective for mild fatigue during the first trimester. Arnica in particular if the woman says she feels "beat up" or "as if I've run a marathon" and confirmed especially when she says, "Don't touch me; I'm OK really!" I use Ferrum phos when there are no clear indications for other remedies, and its use is confirmed if the woman looks pale but has rosy cheeks and describes feeling as if she's coming down with something. Often she'll say, "it's like I'm going to get a sore throat but it doesn't happen."

I was surprised to find Caulophyllum, Cimicifuga or Rhus tox absent in the section 'Arthritic or Rheumatic Pains During Pregnancy" Their indications for arthritic and rheumatic pains in pregnancy are well described by Richard Moskowitz in Homeopathic Medicines for Pregnancy & Childbirth on pages 186-190. Likewise Calc fluor was not mentioned in reference to varicosities nor in relation to the prevention (or minimization) of stretch marks. I and my colleagues have seen Calc fluor's affinity with, "the elastic fibers: esp. of veins" as described in Phatak's Materia Medica and consistently confirmed. I was also surprised to see Pulsatilla as the only remedy listed in the section on "Cystitis during Pregnancy"; I've found many other remedies useful here, namely, Staphisagria, Nux vomica, Causticum and Apis. I'd have liked to see reference to the fact that painful and or delayed progress in labor is often due to OP (occipital posterior) presentations. I have found Gels and Kali carb to be invaluable in these situations where the OP is causing not only inefficient effacement and dilation of the cervix but also severe back pain. When the appropriate remedy is given the results are nothing short of miraculous-babies often turn with the next contraction and the pain disappears while the labor progresses. Another old favorite of mine is Bellis perennis-especially in the treatment of subinvolution of the uterus after delivery In my birthing notes, Bellis gets the triple diamond for subinvolution.

I would have liked a section devoted to the use of homeopathy in initiating labor. Many times I have seen Caulophyllum, Cimicifuga and other remedies successfully used to initiate and sustain labor. Typically, this occurs in women who are overdue and there are medical indicators for induction. Judicious use of the well chosen remedies has often made redundant the Prostaglandin pessaries and Syntocinon IVs used as chemical means of inducing labor.

I strongly question the wisdom of advocating and listing various prophylactic recipes for easy birthing/efficient laboring. I am particularly wary of the appropriateness of the combination recipe of Am/ Puls/ Gels/ Caul/ Cimic to be taken daily for the last four weeks of pregnancy Not only does this run contrary to the classical homeopathic principle of the single remedy but also to the principle of individualization of every case of disease; the principle of prescribing based on the totality of symptoms; and the principle of the minimum dose necessary to stimulate and sustain a positive curative response. In New Zealand we are seeing cases of uterine inertia on the one hand and precipitous labors on the other hand as the seeming results of "prophylactic" uses of Caulophyllum et al in otherwise healthy women. The conclusion based on these observations is that "if it ain't broke; don't fix it; 'cause you might just get an inadvertent proving of Caulophyllum."

There is an aspect of "prophylaxis" mentioned by Perko that I definitely concur with-the apparent prevention of postpartum bleeding in women given Arnica in the previous stages of delivery This has been strongly confirmed by the many midwives I work with. In fact, some claim that the normal blood loss associated with birth appears less when Arnica is used in the first and second stages of labor. One midwife colleague of mine wonders whether this is one reason why her "Arnica ladies" seem to have a significantly quicker recovery response after delivery.

Despite my stated reservations, comments and suggestions above, I recommend this book to all serious students of perinatal homeopathy. It is a good solid reference book. Homeopaths with little (or rusty) knowledge of perinatal processes, physiology and pathology would do well to complement their use of Perko's book with one of the leading midwifery texts such as Margaret Miles' Textbook of Midwifery or Varney's Midwifery. Midwives and other medically trained providers of birth support would do well to complement their use of Perko's book with books on homeopathic theory such as Koehler's Handbook of Homeopathy or Vithoulkas' Science of Homeopathy in addition to Moskowitzs Homeopathic Medicines for Pregnancy and Childbirth or Castro's Homeopathy for Mother and Baby.

Susanna Shelton trained at The College of Homoeopathy in London and the National Center for Homeopathy, U.S. She has worked closely with birthing women and midwives since 1984 and specializes in the use of homeopathy in pregnancy and birth. Susanna has been living in New Zealand since 1991. She teaches homeopathy at several leading polytechnics and homeopathic colleges including the Bay of Plenty College of Homoeopathy in Tauranga where she is the Principal.

Homeopathy Today
February 1998

This book review is reprinted with the permission of the International Foundation for Homeopathy

Reviewed by Betty Idarius, L.M, CHom.

Pegnancy and childbirth are ideal times for the use of homeopathic medicine. The mother-to-be's vital force is strong, allowing for fast and clear responses to the correctly prescribed remedy. Treating the mother has the wonderful added benefit of also increasing the overall health of the unborn child. In an emergency situation, the correctly chosen homeopathic remedy can quickly transform a potentially life-threatening situation into one of health and well-being. Homeopathy, with its compliance to the laws of nature, eliminates the possibility of adverse side effects commonly accompanying conventional medicine. Homeopathic medicine is unquestionably the safest and most effective method of treatment at this time. Few books, however, are currently available that combine both topics.

Now, thanks to Sandra Perko, we have the most complete book by far on the subject of homeopathy for pregnancy, childbirth, and newborn care, titled Homeopathy for the Modern Pregnant Woman and Her Infant. One hundred seventy-eight remedies are covered, including many lesser known remedies. The table of contents alone runs for 30 pages. Included are the more common subjects and remedy differentials for morning sickness, nutrition, miscarriage, malposition, labor difficulties, hemorrhage, as well as more obscure topics, such as preeclampsia, disturbing fetal movements, hydrocephalus, retarded closing of fontanelles, undescended testicles, and 16 separate birth defects, just to name a few.

Though the topics and remedies covered in this book are extensive, Sandra has been able to organize the information so that it is easily accessible to the user. Sandra states, "My main goal, above all else, was to provide a reference work which would be not only easy to use, but also arranged in such a way that the information could be quickly accessed." This she has succeeded in doing, and doing well.

First, Sandra includes an abbreviated and alphabetized Table of Contents which can be quickly scanned to find the major chapter heading under which that subject appears. This is followed by the expanded Table of Contents, which lists chapter titles, subtitles, as well as all remedies covered under each. Chapter 11 is a Quick Keynote Reference aid using major keynotes to help in remedy selection. From the expanded Table of Contents you can easily and quickly find the section of the Quick Keynote Reference you are looking for. Lastly, the book includes a very complete index.

Homeopathy for the Modern Pregnant Woman and Her Infant is not written for beginners to homeopathy, but is geared to the more advanced practitioner. It is assumed that the reader has a working knowledge of the theory, principles, and practice of classical homeopathy. The book is meant to serve as a highly useful therapeutic practice guidebook in particular for physicians and midwives. All homeopathic practitioners, however, who work with pregnant women will find it indispensable.

Each chapter begins with Sandra's sage advice on the clinical management of that particular topic gleamed from her many years of experience working with expectant mothers and midwives. Next are remedy differentials which are clear, vividly portrayed, and well organized. Also included are invaluably useful insights from many of the "old masters," as well as such "modern masters" as Paul Herscu and Ananda Zaren.

With her background as a clinical nutritionist, Sandra includes an informative chapter on "The Importance of Nutrition in Prenatal Care and Some Precautions." Though not written as a primer on how to offer nutritional counseling to pregnant women, it offers an excellent overview of the importance of proper nutrition during pregnancy, as well as substances and environmental hazards that are considered teratogenic (causing malformations) to the fetus. Other gems of nutritional advice are found throughout the book.

My one area of concern is the offering of four combination remedy regimes "some homeopathic physicians and midwives use" for the anticipatory management of delayed labor beginning four weeks prior to the expected due date. The routine induction of labor, so common in today's obstetrical management, is usually completely unnecessary. This complex topic should, in my opinion, have been dealt with at greater length. Suggesting-treating a potential situation which is not currently manifest goes against the practice of classical homeopathy, and could in itself cause complications in women who are sensitive. If delayed onset of labor truly does occur, there is still plenty of time to use homeopathy at 41 weeks gestation, to effectively encourage labor to begin.

Lastly, we find an extensive Appendix with a very insightful section titled "General Procedures in Fundamental and Constitutional Prenatal Care" for the "Experienced Homeopathic Midwife and Practitioner." Here Sandra elucidates on many of the fine points of treating the pregnant woman. She answers such questions as: If you have given a woman her constitutional remedy several months ago and now she becomes pregnant, should you repeat the remedy? What criteria must you take into account in order to best proceed with her care? What about the woman who comes for homeopathic care for the first time during pregnancy? How should you handle the layers in her case? What are the special considerations for giving nosodes to a pregnant woman? How does the state of health of the unborn baby affect the pregnant woman? Is it appropriate to address her acute problem first or to try and find the fundamental or constitutional remedy? What about treating the woman whose symptom picture is completely different now that she is pregnant?

The appendix continues with suggestions for remedies to purchase in building your midwifery remedy kit, a complete list of homeopathic organizations and associations, homeopathic pharmacies, schools and seminars, midwifery associations, literature sources, recommended reading for prenatal and neonatal nutrition, a table of remedies used in the book, with abbreviations and common names, as well as a glossary of terms.

Is this just another homeopathic book that will decorate your bookcase? Definitely not! Homeopathy for the Modern Pregnant Woman and Her Infant will undoubtedly become a frequently used and well-loved book for any homeopath working with pregnant women and newborn babies. My congratulations and gratitude go to Sandra Perko for her invaluable contribution to the fields of both homeopathy and midwifery.

Betty Idarius is a homeopath and midwife practicing in Ukiah, California.

RESONANCE - September/October 1997

This book review is reprinted with the permission of Jan Tritten, editor of Midwifery Today.

Sandra Perko has written a superb practical text for the physician and the midwife. Comprehensive and thoroughly referenced, this extensive yet easily accessed book is a must for practitioners whose clients are interested in gentler, alternative ways of healing.

After two beginning chapters of introductory material and information and cautions on general self-care, chapter 3 addresses morning sickness specifically. Here we begin to appreciate the precision with which the practitioner of homeopathy works. Thirty-one remedies are recommended for as many kinds of morning sickness.

Chapter 5 is a detailed look at miscarriage. Clearly listed etiology and characteristics are followed by an extensive section on causes and remedies with explanations. Chapter 6 addresses serious problems in pregnancy such as edema, toxemia, breech and gestational diabetes; it also takes a sensitive look at the history of sexual abuse as well as emotional states of pregnancy.

Everything from false labor and distressing labor to nervous fathers and grandparents is addressed in the long chapter on labor. Since most births are not "picture perfect," this chapter helps the homeopathic midwife be ready to deal with problems quickly and effectively as they arise. Following are highly descriptive chapters on postpartum difficulties such as retained placenta, hemorrhage, infections, subinvolution of the uterus and depression, on problems in the newborn, and on breast and nursing problems.

Perko sums it all up with an extensive section on keynote references which helps speed up the process of choosing the correct remedy by putting the practitioner "in the ball park." Remedies are arranged in the order in which they appear chapter by chapter. Appendices, a glossary and a reference list complete the work.

Because it is geared toward the advanced practitioner, a good basis of homeopathy is required in order to make full use of the book. The author warns in her introduction that it should not be used to learn basic theory, principles and guidelines of classical homeopathy. However, a recommended reading list included as an appendix helps the beginner find books that explain the foundation of homeopathy.

Midwifery Today
Autumn 1997