Conceiving Healthy Babies: An Herbal Guide to Support Preconception, Pregnancy and Lactation by Dawn Combs. Gabriola Island, BC, Canada: New Society Publishers; 2014. Paperback, 400 pages. ISBN: 978-0-86571-780-0. $24.95.

This book is described as “a unique herbal guide [that] focuses on plant-based strategies to help couples achieve balance in preconception, pregnancy, lactation and beyond.” It is written for prospective and new parents, though it provides insights for the professional as well. The author aims to assist couples faced with fertility challenges through personal stories and information on diet and medicinal plant use.

Conceiving Healthy Babies consists of three main sections. The first section, “A Journey to Family,” tells the story of the author’s personal journey that starts with her medically diagnosed infertility, which she and her husband overcame with changes in every aspect of their lives. This resulted in the birth of their two children, both of whom she went on to breastfeed. The section includes her valuable story of the challenges she met.

In the second section, “Strategies for Building a Healthy Baby,” the author provides information and advice on a wide range of topics, including foods and herbs for each stage of the perinatal period, techniques such as breast massage and chiropractic intervention, and breastfeeding aids for low milk supply. She writes heartfelt discussions of the role of the mind when challenged by infertility and low milk supply.

The following sections — “General Herb Use,” “Determining the Quality of Herbs,” and “Whole versus Isolated Constituents: The Side Effects of Ethnobotany” — are devoted to medicinal plants. In these pages, the author very briefly discusses botanical constituents of concern, though in an inconsistent and curious manner.

The safety tables presented throughout the book are well-organized and provide a fairly reliable guide to specific issues encountered in the prenatal, pregnancy, and lactation periods. Safety ratings are provided for 248 plants, and information on plant parts used, chemical constituents, and conservation status is easy to find. Galactagogue plants (or anti-galactagogues) are almost all reliably identified as such. However, the traditional Ayurvedic herb shatavari (Asparagus racemosus, Asparagaceae) was overlooked; it is a major galactagogue.

The author uses a simple three-level safety rating — “no contraindications,” “use with caution,” or “generally avoid.” Additional notes are provided for each plant and alternatives are suggested for riskier plants. In most cases, the assigned caution level is accurate and well-considered. Some plants with safety concerns such as genotoxicity and carcinogenicity are not consistently rated, and the author’s views on certain toxic constituents are a concern for this reviewer.

Curiously, all caffeine-containing plants are cautioned based on a 1994 study,¹ which suggested that their use lowers the iron content of breast milk; however, the review concluded that coffee (Coffea spp., Rubiaceae) did not have a negative effect on breastfeeding. The most common side effect experienced by breastfeeding mothers who use caffeine-containing medicinal plants such as coffee or tea (Camellia sinensis, Theaceae) is infant over-stimulation, but this is not mentioned in the text.

On the other hand, the author tends to downplay the safety issues of other plant constituents such as beta-asarone, safrole, and, most astonishingly, pyrrolizidine alkaloids (PAs). The author does not address the PAs in degrees of known hepatotoxicity, nor does she mention that some species of comfrey (Symphytum spp., Boraginaceae) contain PAs of higher toxicity. She states incorrectly that Russian comfrey (Symphytum × uplandicum) leaf does not contain PAs. The safety ratings for medicinal plants with toxic PAs give some cautions, but the author does not recommend avoiding them entirely during the perinatal period. These plants include borage (Borago officinalis, Boraginaceae), comfrey (specified as S. officinale), coltsfoot (Tussilago farfara, Asteraceae), butterbur (Petasites hybridus, Asteraceae), and even liferoot (Packera aurea syn. Senecio aureus, Asteraceae). Although the author explains that women should “generally avoid” liferoot during pregnancy, she writes that mothers can “use with caution” during lactation. If she is really talking about Senecio, this is scary; the plant is widely known to be hepatotoxic due to its PA content.

With common comfrey (S. officinale), the author suggests limiting internal use to four to six weeks per year when breastfeeding. The additional warning to avoid the herb “if known liver problems exist” shows that the author has concern for mothers but overlooks potential risks to infants born with immature livers. The infant liver is not considered mature until two weeks of age, so it is at greater risk from exposure toxic PAs. The appendix promises further information to consider for the “special” case of comfrey, but it lacks detail. The reader is referred to a website that does not discuss the potential safety concerns of comfrey during pregnancy or lactation.

The medical literature contains a well-documented case² of neonatal liver damage and death attributed to prenatal consumption of toxic coltsfoot and butterbur root. A more recent case concerned a pregnant woman’s daily use of “comfrey” (species unnamed) with an unnamed species of Heliotropium (Boraginaceae) that was purchased in Turkey.³ The baby was born with liver failure and subsequently died. However, I don’t think the inclusion of this case lets comfrey off the hook. The risk of liver damage from toxic PAs in humans is currently considered highest for the developing fetus; damage accumulates with every exposure and may not appear for decades. Toxic PAs have been detected in the milk of dairy animals as well as in research animals and honey. It is rational to assume that toxic PAs enter human milk. Therefore, starting a baby’s lifetime load of toxic PAs at birth seems unwise. The reader is simply not given enough information to evaluate the potentially harmful claim that comfrey or any other plant containing known toxic forms of PAs are safe to consume at any dose during pregnancy or lactation.

Allergenic plants are inconsistently identified. Roman chamomile (Chamaemelum nobile, Asteraceae), for example, has been documented to cause allergic skin reactions when used as a nipple remedy,⁴ but this is not mentioned in the notes on this plant.

While providing an interesting insight into the world of Sally Fallon and the Weston Price Institute, the author’s nutrition recommendations may be of limited use for the vast majority of lay readers. Her tone insists that the consumption of grass-fed organic beef and fermented cod liver oil is imperative for success against infertility. Some step-down suggestions for those who cannot follow every dietary suggestion would have been charitable and helpful to many. As a professional lactation consultant, I do appreciate her accurate portrayal of the profession and the role that lactation consultants can play in helping mothers with low milk supply.

More referrals to online or text resources for breastfeeding would have been helpful. Some of the reference texts are older editions of good books, but the inclusion of Dr. Aviva Romm’s medical text, Botanical Medicine for Women's Health (Churchill Livingstone, 2010), is appreciated.

Over-reliance on a single philosophy for nutritional guidance trips up the author at other points as well. For example, she dismisses the use of human milk from nonprofit donor milk banks as the next best option for feeding infants. I was shocked by this negative opinion, which is based on the fact that donor milk is pasteurized. Donor milk saves babies. Outside of medical circles, mothers are finding other sources of human milk — through nonprofit milk banks or milk-sharing with sisters or very good friends. Yet the author promotes only the use of raw cow’s milk in a homemade infant formula (the incomplete recipe is provided in an appendix). The money needed for the ingredients would be better spent on buying human milk through a donor milk bank.

I cannot recommend this book to the general reader as it is too narrowly based on a certain dietary philosophy and provides herbal guidance to prospective parents that, in some areas, may be potentially harmful.

—Sheila Humphrey, BSc (Botany), RN, IBCLC
Author, The Nursing Mother’s Herbal (Fairview Press, 2003)
St. Paul, Minnesota

References

1. Nehlig A, Debry G. Consequences on the newborn of chronic maternal consumption of coffee during gestation and lactation: a review. J Am Coll Nutr. 1994;13(1):6-21.
2. Roulet M, Laurini R, Rivier L, Calame A. Hepatic veno-occlusive disease in newborn infant of a woman drinking herbal tea. J Pediatr. 1988;112(3):433-436.
3. Rasenack R, Müller C, Kleinschmidt M, Rasenack J, Wiedenfeld H. Veno-occlusive disease in a fetus caused by pyrrolizidine alkaloids of food origin. Fetal Diagn Ther. 2003;18(4):223-225.
4. McGeorge BCL, Steele MC. Allergic contact dermatitis of the nipple from Roman chamomile ointment. Contact Dermatitis. 1991;24(2):139-140.