A Holistic Approach to Prenatal Care

Approximately 135 million of the 331 million people currently living in the U.S have experienced pregnancy and have received, or should have received, some degree of prenatal/maternal care. Despite the fact that no other part of our healthcare system impacts a larger percentage of the population than maternal care, and no other country spends as much on healthcare, the U.S. continuously has the highest infant and maternal mortality rate out of any other high-income country, 32.9 maternal deaths per 100,000 live births (“Maternal Deaths in the U.S. Spiked in 2021”, CDC). This astounding mortality rate has been attributed to various factors including high costs of care, nursing and physician shortages, lack of transparency in treatment, and preventable medical errors. Prenatal care in the U.S. is rarely cited as a leading cause, but current standards of prenatal care in the U.S. tend to focus almost entirely on the medical aspects of treatment, and often neglect the value of holistic well-being and a woman’s lifestyle choices, which can have a dramatic impact on maternal health. This article examines the meaning of holistic prenatal care and explains why it is of vital importance by defining standard medical practices related to prenatal care and what is encompassed in the three most vital tenants of a holistic approach: nutrition, physical activity, and emotional wellbeing.  

Holistic prenatal care centers around the commitment to embracing the nature of women's bodies and maintaining all aspects of wellness throughout the pregnancy journey (“Natural Mama: Holistic Approaches to a Healthy Pregnancy”, Nancy Peplinsky). Holistic prenatal care acknowledges and considers the importance of emotional wellbeing and spirit on the experience of pregnancy, and incorporates therapies such as meditation, vitamin infusions, yoga, and more. An expectant mother’s lifestyle, which includes her physical and mental habits, is given more detailed attention than it would in standard medical practice. It’s important to note that taking a holistic approach is not synonymous with a “natural childbirth”, which includes a “complete avoidance of medication or interventions” (“What is a Holistic Approach to Pregnancy and Childbirth?”, University of Minnesota). A holistic approach to prenatal care begins with the least invasive approach but includes all necessary steps to ensure the safety of a mother and child. Holistic care is often described as trusting the “natural progression of pregnancy and labor” (“What is a Holistic Approach to Pregnancy and Childbirth?”, University of Minnesota). An example of holistic prenatal care is Sage Naturopathic Medicine, a private practice located in Northern California, in which a former midwife “provide(s) adjunct prenatal care for pregnant women who already have an OB/GYN or midwife as their primary provider but desire holistic guidance on optimizing their health during pregnancy” (“Holistic Prenatal Care”, Dr. Molly Jarchow). In the first trimester, care includes nutrition optimization and an individual supplement plan based on a woman’s labs and health issues. In the second trimester, the expectant mother is led through gestational diabetes prevention, childbirth education, breastfeeding classes, and is helped throughout the process of choosing the right doula for her birth. For context, a doula is “a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth” (“What is a Doula?”, DONA International). In the last trimester, a mother is taught how to cultivate healthy vaginal bacteria, how to choose the right pediatrician for their child, and given various holistic medicinal treatments, such as erythromycin eye ointment and the Hepatitis B vaccine. The final phase of care is centered around postpartum healing and easing her transition to motherhood. Another example is the Roots Community Birthing Center located in Minneapolis. This center employs a team of health professionals, “striving to give mothers the resources to help them be at their best — physically, mentally, and emotionally — during their childbearing journey” (“Natural Resources for a Vibrant, Healthy Pregnancy”, Roots Community Birth Center). This care includes a variety of prenatal vitamins, engaging an active lifestyle with recommended activities such as yoga and walking, chiropractic care, acupuncture, hydration, dietary restrictions, and more. 

In contrast, standard or “non-holistic” prenatal care consists of about 8-10 visits over the 9-month pregnancy period. At each visit, the frequency of which increases as the pregnancy progresses, a healthcare provider checks on the woman and her growing baby. Most women receive prenatal care in private physicians’ offices, either from obstetrician-gynecologists or from general practitioners. A healthcare professional will go over standard procedures and examine her past medical history and conditions, any current medications she is taking, and her pregnancy history. In most cases, the only ‘holistic’ elements addressed are a woman’s relationship with drugs and alcohol, her daily stress levels, and how safe she feels in her home. A woman is commonly advised to “eat a healthy diet”, but detailed nutritional instructions are not usually provided. A prenatal vitamin is prescribed, blood pressure and weight are checked, and required vaccinations are given throughout the pregnancy.

The differences associated with holistic care have been proven to have significant benefits on the health of an expectant mother and her developing child. During pregnancy, a woman is not only “eating for two” but growing a developing human inside her body. Therefore, getting the proper nourishment throughout these 9 months is of vital importance: “The right foods nourish the growing baby, the placenta and the mother’s increasing blood volume, maintaining the mother’s body during the complex mission” (“Natural Mama: Holistic Approaches to a Healthy Pregnancy”, Julie Peterson). The American College of Gynecologists and Obstetricians states that a pregnant woman’s daily diet must consist of 1,000 milligrams of calcium, 27 milligrams of iron, 220 micrograms of iodine, and 450 milligrams of choline, 770 micrograms of Vitamin A, 85 milligrams of Vitamin C, 600 international units of Vitamin D, 1.9 milligrams of Vitamin B6, 2.6 micrograms of Vitamin B12, and 600 micrograms of folic acid. These are not just recommended but necessary to avoid birth complications, increase a mother’s energy, and for successful fetal development. Because these requirements are not realistically achievable purely through food, a daily multivitamin has become an essential part of an expectant mother’s diet. A generic prenatal vitamin is almost always recommended in standard medical practice, however, there is debate around whether these vitamins are sufficient. In “Natural Mama: Holistic Approaches to a Healthy Pregnancy”, a soon to be mother named Wallace describes the difference between her first and second pregnancy by switching vitamin brands: “The first time, I took generic prenatal vitamins. With the second pregnancy, I found whole-food supplements. I never got that exhausted, and my second baby was a healthy weight” .Wallace’s latter approach, of taking whole-food, natural supplements, would be considered a holistic approach to prenatal care.

In 2021, Maryam Kebbe, Emily Flanagan, Joshua Sparks, and Leanne Redman conducted a cross-sectional national study titled “Eating Behaviors and Dietary Patterns of Women during Pregnancy”that was soon published in the National Library of Medicine. Women in the study were all over 18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. The study found that the majority of women took a daily vitamin throughout their pregnancy and reported eating more calories per day. However, “despite these pregnancy-related dietary changes, the majority of women denied trying a specific dietary pattern during pregnancy”. This denial was attributed to “complexities in navigating the dietary landscape that is often overwhelming, ambiguous, and conflicting”. This is unsurprising, given the extensive list of dietary requirements cited in the  paragraph above. The denial was also attributed to multifaceted factors such as “sociodemographic diversity, anthropometrics, individual characteristics, and interpersonal relations”. The study concluded that expecting mothers are not averse to changes in their diet, but lack proper understanding of how certain dietary changes may be beneficial to their health and the health of their infants. The majority of women do not have the time, money, or awareness to seek out holistic prenatal care, and must rely solely on their primary provider, which far too often means a recommendation for a generic vitamin and a conversation regarding healthy eating: “Most doctors merely provide antenatal vitamins to pregnant women for the sake of maternal health” (“Prenatal meditation influences infant behaviors”, Ka Po Chan). A Google search for “prenatal dietary recommendations” illustrates how overwhelming it can be to search for information on the internet, particularly since it can be difficult, if not impossible, to reconcile conflicting information and discern what sources can be trusted. It is also important to note that every woman’s body is different. This is why many holistic prenatal care practitioners conduct labs to determine the specific vitamins and minerals an expectant mother needs, unlike the generic, one-size-fits-all prenatal vitamins a woman generally receives from a standard medical practitioner.  

During pregnancy, poor diets lacking in key nutrients such as iodine, iron, folate, calcium and zinc, can cause “anemia, pre-eclampsia, hemorrhage and death” in mothers (“Maternal Nutrition”, UNICEF). Preeclampsia remains the top preventable cause of maternal deaths in the United States. Hemorrhages, or excessive bleeding, is the cause of 14% of maternal deaths. Poor diets can also lead to “stillbirth, low birthweight, wasting and developmental delays for children'' (“Maternal Nutrition”, UNICEF). UNICEF estimates that low birthweight affects more than 20 million newborns every year. These fetal conditions can also threaten the health of a mother. Stillbirth, for example, causes months of cramping, bleeding, and passage of blood clots. A holistic approach to prenatal nutrition, such as that taken by Sage Naturopathic Medicine, includes “nutrition optimization” and an “individual supplement plan based on a woman’s labs”. These holistic elements are vital and should be a part of every mother’s prenatal care. 

Along with diet, a woman’s physical activity is a central component of holistic prenatal care. A clinical review, “Exercise in Pregnancy”, set out to determine the effects of exercise on pregnant women and their developing children. Sally K. Hinman, Kristy B. Smith, David M. Quillen, and M. Seth Smith had expecting mothers perform at least 30 minutes of moderate-intensity, low impact exercise on most days of the week. They concluded that the “benefits of exercise in pregnancy include reduction in Cesarean section rates, appropriate maternal and fetal weight gain, and managing gestational diabetes”. These reductions can have significant consequences, as the maternal mortality rate due to elective Cesarean Section is two to three times higher than that of natural delivery. In addition to easing the process of birth, exercise has tremendous benefits for the ease of a woman’s pregnancy, including weight control, improved mood, maintenance of fitness level, and the alleviation of common pregnancy symptoms like “constipation, back pain, bloating, swelling and fatigue” (“Prenatal Yoga: The Perfect Pregnancy Exercise”, Maura Hohman). Despite these various benefits, a study by J Zhang and D A Savitz titled “Exercise During Pregnancy Among US Women” found that only “forty-two percent of all women reported exercising during pregnancy, half of whom exercised longer than 6 months”. Clearly, standard medical care is not sufficiently emphasizing and informing women about the importance of daily exercise during pregnancy. In contrast, exercise is a central component of a holistic approach to prenatal care. The holistic care practice Roots Community Center, for example, ensures that every mother is continually engaging in an active lifestyle with a variety of activities including yoga and walking. 

J Zhang and D A Savitz’s study also found that walking was the leading form of exercise among pregnant women. While walking is certainly a beneficial form of prenatal exercise, yoga continues to remain a frontrunner in the world of holistic prenatal care. Maura Hauman, in an article titled “Prenatal Yoga: The Perfect Pregnancy Exercise” explains that prenatal yoga differs from regular yoga in that it is more gentle on the body, taking into account the physical toll that labor takes on a woman. Prenatal yoga also “emphasizes breathing, stretches and strengthening moves that help your body prepare for labor” (Hauman). Yoga is the ideal exercise because it combines mindfulness and meditation with physical activity. Pregnancy not only significantly changes the way your body looks on the outside, but on the inside as well. The dramatic shifts in hormone levels, as well as the added stress of big life change, can be eased through practicing yoga: “Another study showed that integrated yoga - that is, exercise-based yoga combined with meditation, deep relaxation and breathing exercises - significantly decreased levels of depression in moms-to-be” (Hauman). A clinical trial study conducted by Leili Yekefallah, Peyman Namdar, Leila Dehghankar, Fereshteh Golestaneh, Soghra Taheri & Frahnaz Mohammadkhaniha titled “The Effect of Yoga on the Delivery and Neonatal Outcomes in Nulliparous Pregnant Women in Iran” led 70 randomly chosen expecting mothers through hatha yoga routines for the duration of their pregnancy. The results were dramatic: “Yoga reduced the induction of labor, the episiotomy rupture, duration of labor, also had a significant effect on normal birth weight and delivery at the appropriate gestational age”. The study definitively determined that yoga is an “ideal way to spend the pregnancy period”, allowing pregnant women to “make connections with their mind, body, soul, and fetus”. 

Expecting mothers must not only be advised to incorporate exercise into their lives, but given the proper information about how to exercise. It’s important to note that in 2021, only 19.6 percent of American women participated in sports, exercise, and/or recreational activities daily, meaning that over 80% of women in the US have little to no experience with physical activity (“Americans Engaged in Sports and Exercise per Day”, Christina Gough). Any dramatic lifestyle change is complicated by pregnancy. A woman who has no experience with regular exercise who is advised by a doctor to begin exercising will have a very difficult time suddenly adhering to a consistent exercise routine for the next 9 months of her life. Standard medical care fails to support women in this critical way. In contrast, holistic prenatal care offers both emotional support and abundant information to mothers, making this lifestyle change a bit smoother, and a lot more probable. 

The third and final tenant of holistic prenatal care is an expectant mother’s mindset and emotional wellbeing. The meditation and breathing exercises incorporated into yoga classes have been proven to increase the mental wellbeing of expecting mothers. This theory has been tested time and time again, and mindfulness training continues to aid in maternal and fetal health. A study conducted in 2017 assigned expecting mothers to either mindfulness training or traditional childbirth classes. The results were dramatic, proving that taking part in a mindfulness course during pregnancy “reduce(s) the fear of labor, decrease(s) the use of pain relief, and lower(s) the risk of postnatal depression” (“Study shows benefits of mindfulness in pregnancy”, Tommy’s). “Prenatal meditation influences infant behaviors” by Ka Po Chan describes a quantitative study carried out at the Obstetric Unit of Queen Elizabeth Hospital in Hong Kong in 2014. The blood cortisol level of babies was higher in the group of women consistently meditating, which translates to a child’s ability to fight off illness, respond to injury, and works as a stabilizer of blood pressure and blood sugar levels. The infants of the intervention group also had better temperaments than those of the control group. This study focused more on fetal health than maternal health, but it is relevant, as the two are inextricably intertwined. A healthy baby is linked to a healthy mom, and vice versa. 

Engaging in simple daily meditation can significantly reduce a mother’s stress, the toll that stress takes on her baby, and the risk of a premature birth (“What to know about Meditation During Pregnancy”, Jessica Moore). Mindfulness is so powerful that its effect can span beyond the time of birth: “A study from the Netherlands showed that mothers who scored high in mindfulness had babies who were better able to settle down, adjust to new environments, and control their attention and behavior” (Moore). Pregnancy takes a toll not only on a woman’s body, but on her mind as well. Mindfulness can help women manage the stress of pregnancy and approaching motherhood, as well the complex feelings and physical changes inherent to pregnancy. The emotional stability of a mother not only eases her experience of pregnancy but is linked to significant benefits in both her and her child’s long-term health and wellbeing. As discussed above, the only ‘holistic’ elements in regard to mental health that are consistently addressed in standard medical practice include a woman’s relationship with drugs and alcohol and her daily stress levels. Merely communicating the importance of low stress levels, rather than conveying tangible ways to decrease one’s stress levels, will inevitably only raise a woman’s amount of stress by making her stressed about her stress levels. The holistic approach to prenatal care makes a mother’s emotional wellbeing a top priority. Some of the benefits from holistic prenatal care are not the actual benefits derived from the various treatments and lifestyle changes, but the emotional stability that the constant support and attention of a holistic caregiver brings. For example, a common aspect of holistic prenatal care is choosing the right doula for a woman’s birth. Doulas are professionals trained specifically to emotionally guide and support a woman through pregnancy and birth, giving women continual reassurance, encouragement and praise throughout their journey. The holistic approach to prenatal care, which places the same emphasis on caring for a woman's soul and mind as it does her physical body, is of great benefit to her and her developing child.    

The current standard for prenatal care in the US is not where it needs to be. The National Partnership for Women & Families summarizes this pervasive issue: “Too often, maternity care in the United States fails women and families – in not being accessible, safe, equitable, woman-centered, evidence-based or affordable” (“Maternity Care in the United States: We Can - and Must - Do Better”, National Partnership for Women & Families). No other aspect of our entire healthcare system has a greater effect on the health of our population, as maternity care affects every single person in this country. Our nation continually grapples with why 80 million citizens are living with obesity, 30 million with diabetes, and 26 million with heart disease. While the answers to these questions may be vast and complicated, the acknowledgement that human health begins with a mother’s prenatal care is quite simple. Standard prenatal care must incorporate the holistic approach that has been shown to have the greatest impact on the health of women and their babies.