Preparing for Pregnancy Self Care and Epigenetic Potential

Allison Creech, MEd, ND

Vis Medicatrix Naturae

Many women seek naturopathic support for hormone balance as a first step toward a future pregnancy. The desire for pregnancy can motivate a woman to engage in new behaviors, such as seeing a naturopath for the first time and activating a new level of self-care. This is a favorite time to work with patients, as they are generally hopeful and excited about the future. That enthusiasm translates to a greater receptivity to change and can make the process of choosing healthy behaviors more straightforward. Regardless of an individual’s specific needs or a practitioner’s preferred treatment methods, our profession has a wealth of resources to offer patients seeking pregnancy and a great track record of positive outcomes. We can have confidence in our ability to help a woman come into greater connection with her body, balance her hormones, and optimize fertility.

Beliefs, Perceptions and Epigenetics

In walking this journey with a patient, I know that there are areas of emphasis that all NDs would attend to; however, I would like to use this forum to address some of the less obvious, but still important, aspects of pre-pregnancy and pregnancy. Each patient’s needs are different, but I recognize and look for the hidden influences that can have great biological impact. I listen to each patient’s narrative and follow their emotional cues as I seek to understand their experience, knowing that the power of transformation lies in perception. I listen for patterns around expectation, around interpretation of experience, around core beliefs, and around the ways the patient understands herself. These factors all influence the way a woman cares for herself and are powerful determinants of health. The science of epigenetics highlights how influential these stimuli are on cellular expression, and shows that perception mediates physiology. Dr. Bruce Lipton, PhD, writes, “Epigenetics is the science of how environmental signals select, modify, and regulate gene activity… Our genes are constantly being remodeled in response to life experiences… Our perceptions of life shape our biology.”1 This epigenetic influence is dynamic and active throughout our lifespan.

The implications of this are especially relevant for a woman with hormone balance and pregnancy in mind. Her state of being changes her neuroendocrine output, impacts her level of health, and influences cellular programming for a growing fetus. Simply stated, a peaceful inner environment will provide different epigenetic signals than a tense or conflicted inner environment. For example, in 1 study, prenatal exposure to a depressed or anxious mood was associated with increased DNA methylation at the glucocorticoid receptor gene and increased HPA-axis reactivity was seen in infants born to mothers diagnosed with depression, and treated with SSRIs, as well as those diagnosed with depression but not treated. Infants born to mothers without a mood disorder did not experience these changes.2 Research in behavioral epigenetics is still in its early days, but the existing literature indicates that maternal mood influences offspring in terms of resilience to stress.

If a woman’s goal is to move into optimal health in preparation for pregnancy, teaching her about the power of epigenetics and working with her to establish a healthier perceptual experience is a valuable service we can provide. It also provides motivation for self-care and for prioritizing one’s own needs over competing demands.

Brain chemistry plays a critical role in perceptual experience. The more we exist in a state of inner harmony, the more balanced our production of dopamine, oxytocin, and other “feel good” chemicals will be. We know that dopamine increases in novel situations, bringing a sense of pleasure while enhancing motivation and learning.3 Pregnancy is most definitely a novel situation, and planning for pregnancy can carry a similar wave of dopamine-enhanced excitement. Oxytocin is recognized for its role in attachment and supports a calm, connected sense of safety and security. It also has anxiolytic and stress-reducing effects.4 These hormones are part of what has been described as the “chemistry of love,” the neurohormonal milieu that helps us engage not only in romantic relationships but also in the relationship one creates with oneself, and especially in the relationship a woman develops with the growing fetus during pregnancy. As we change our emotional state to resonate in love, we shift our hormones, our brain chemistry, and our neural networks. An intentional shift into an authentic place of wellbeing activates neuroplastic changes in the brain, which then makes it easier to maintain and return to that perceptual framework.

Because the authenticity piece is important, we need to recognize that sometimes the best a person can do is move slightly along the scale from disturbed toward peaceful. For example, if we are in a state of rage or extreme anger, the best we might be able to do in that moment is to direct our thoughts and energy into a place of irritation. That is still healthy coping. Or, if we are intensely worried and anxious, maybe the best we can do in that moment is direct our thoughts and energy into a place of neutrality. In this act of consciously responding, we are developing and practicing the skill to choose our inner experience. It is a step toward empowerment, and each small step matters. Epigenetic markers are rewritten throughout our lifetime in response to changes in these templates.

Helping Women Prepare Emotionally

As NDs, we are in a prime position to help patients harness the power of perceptual influences on wellness. The epigenetic regulatory processes describe a viable pathway for Vis to exert its organizing effects, allowing us to further the philosophical origins of our medicine. Ultimately, I hope to help women move into a loving and honoring relationship with themselves, and support them in a commitment to self-care.

Here are some examples of how this might be facilitated: 

  • Exploring the narratives related to a woman’s own life experience
  • Teaching tools that promote self-regulation and healthy adaptation
  • Addressing distortions in self-perception, shifting towards greater benevolence
  • Clarifying expectations and identifying specific fears about fertility, pregnancy, and motherhood
  • Holding space for a woman to express her emotional energies, especially as related to early life, relationship with her parents, and relationship with her partner
  • Holding space for a woman to process any fear or difficult narratives as they relate to sexuality, menses, or physical transgressions she may have experienced
  • Helping to establish a positive and healthy narrative about her reproductive life and an authentic neutral-to-positive expectation; helping her understand that she can thrive, regardless of her reproductive status
  • Providing education about the power of the mind-body connection through specific descriptions of the interactions between expectations, epigenetic activation, and selection at the cellular level, and how changes are transmitted to daughter cells and embryos
  • Providing education regarding embryonic cells’ capacity to adapt to the environment—maternal blood—which is influenced by maternal emotional experience, hormones, and level of arousal
  • Encouraging the use of the pre-pregnancy phase of life as an opportunity to optimize internal rhythms, hormonal sequences, and epigenetic influences
  • Identifying and acknowledging relevant beliefs, assumptions, and expectations at both the conscious and subconscious levels, exploring beliefs such as, “This is easy/ difficult/ painful/ requires work/ I won’t be good at it/ I’m afraid of change/ I don’t deserve it/ nothing good comes easy/ bad things always happen to me

As Dr. Lipton writes, “Human beings have a great capacity for sticking to false beliefs with great passion and tenacity,”1 and part of the work of emotional exploration includes moving through bands of resistance and seeing how they relate back to one’s sense of self and ideas about love and belonging. It is important to be especially attentive to the places where fears are triggered and where a sense of trust and optimism is activated. By holding space through the fears, we hope to connect to a deeper level where trust exist, and shape positive perceptions about our bodies and the world around us. This required helping patients to access a pattern of secure attachment and a fundamental experience of trust, or establish one in the present moment if the patient has not lived this experience. In order to bring about sustained change, this work needs to be integrated experientially: through real-time awareness of a powerful emotional or felt-sense energy experience, the patient is able to establish a new thought pattern.

In summary, although the individual work is different from person to person, my goals in helping a woman prepare for pregnancy are: a safe experience of being connected to her body in a loving way; a perspective of optimistic expectation combined with a sense of competency in meeting whatever may come; stability in managing emotional arousal and self-regulation; and, a narrative that supports adaptation.

Case Examples

I would like to share 3 case examples that I hope will illustrate how these concepts have translated into practice.

Case 1: How hidden expectations heighten distress in spite of conscious knowledge

Amelia came to see me for hormone balancing prior to her first pregnancy. We created a plan that she felt good about, and her first child was conceived during the first month she tried. She had a healthy pregnancy and planned for a home birth but ended up delivering by Cesarean section. We saw each other from time to time during the next 2 years, but began intensive work together again when she became interested in another pregnancy.

Amelia was initially confident about herself with regards to pregnancy #2, but became increasingly worried when she did not conceive immediately. As a result of her anxiety, she began asking for more naturopathic treatments and researching herbs and other fertility supports online. Although I tried to assure her that more is not always better, we ended up creating a comprehensive hormone optimizing fertility preparation program to ameliorate the guilt she felt about not doing things 100%. She reported, “In order to not feel guilty, I need to know that I am doing everything possible to ensure a healthy pregnancy.” When she did not conceive in the first few months, she began to have intense anxiety around infertility and actively question what she was doing wrong and what more she could do. In spite of her conscious understanding that conception can take time even when you are doing everything right, and that there was no known reason for her to anticipate a problem, Amelia had a powerful subconscious expectation for immediate conception. This expectation, coupled with a fundamental bias towards her own inadequacy, was causing her great distress.

It took 5 months for Amelia to conceive, and in that time we witnessed the stream of fears that were activated around not being able to get pregnant quickly, what she was not doing right, and her general default perception of something being wrong. As we held space for her to notice and consider her fears, she began to see how they were not based in truth but instead were linked to a narrative that was not serving her. We worked to release her from the emotional bonds generated by fear at the level of subconscious perception, and to shift her to a place of connection and trust with her body. I also helped her to understand the value and significance of even a few moments of calm, centered presence. We discussed how the brain, our neurochemistry, and our hormone systems are dynamic and I shared some research with her demonstrating that even 2 minutes of active relaxation daily, practiced for 21 days, can rewire the brain. Although she still experienced moments of intense anxiety and doubt, she committed to her own self-care by choosing to direct herself into a place of calm multiple times a day and by connecting with and being present to her body with a focus on trust and love. I also prompted her to notice things her body does well and to affirm that her body has a deep inner wisdom.

As Amelia’s pregnancy has progressed, she has been able to significantly decrease her level of stress while increasing her level of self-care. She makes time to speak lovingly to her body and her unborn baby each day. She chooses to disconnect from thoughts that do not serve her and is learning to meet her fear with a sense of trust and love. I encourage her in these choices each time we meet and remind her how these choices help optimize function both in her body as well as in her growing baby’s body.

Nevertheless, as the end of her pregnancy approaches, Amelia has become hyper-focused on whether she can successfully have a vaginal delivery. We have been able to identify a perception that she has failed as a woman because she did not vaginally deliver baby #1, and that this failure will be confirmed if she is not able to vaginally deliver baby #2. She talks with great pain about how she was “incapable of delivering” her first baby. We have worked through this by actively challenging cognitive assumptions around what constitutes delivery, by exploring different scenarios that honor the wisdom of her body and validate the medical necessity of her C-section after a difficult and prolonged labor, and by spending time holding space for the grief and shame she has felt. Through this work, she has integrated what she knows to be true cognitively with what she feels to be true internally, bringing her into a state of greater harmony and giving her a narrative that emphasizes resiliency and wisdom rather than failure and inadequacy.

Interestingly, part of Amelia’s existing narrative is that the women in her family all have difficult first births and easier subsequent births. Rather than assuring her, this stokes her fear that, if she does not deliver her second child vaginally, she will fail at something her mother and sisters have been able to do. This adds to her sense of intensity, pressure, guilt, and shame.

In the final weeks of her pregnancy, we are discussing the ways that her general sense of inadequacy has surfaced around the specific topic of vaginal delivery. Amelia has been able to get some objective distance and increase her ability to be self-reflective in this process. The last time we met she told me that she recognizes that, if it were not this topic, it would be something else, and that the real problem to be addressed is her perception of herself in her physical body and as a woman. She acknowledged a basic sense of inadequacy that has been with her as long as she can remember and a fear that no matter what she does, it will never be good enough. We sat together in that space as she began to dissolve the emotional bonds she held to that narrative. I complimented her on the courage she showed in being both kind and honest with herself as she looked through her story to a deeper level of experience.

As her perceptual bias cleared, the possibility of experiencing herself differently opened. She could visualize it but not quite feel it and asked if there was a remedy I could prescribe to support the process (she is an advocate for homeopathy). I did prescribe a remedy, and I asked her to connect with the image she had of herself multiple times each day, noticing when she began to feel it in an experiential way. I also asked her to make time each day to lie down and send love to her baby and her body, in whatever way feels good to her. I will continue to support her in establishing an experience of security, trust, and allowance for herself through the rest of her pregnancy. I will also actively encourage her to stay in a narrative that supports a peaceful, calm, or neutral state.

Case 2: Love, trust, courage, and resilience

Courtney is the kind of woman that meets challenges head-on and likes to take action. She is self-reflective, strongly cognitive, and is interested in the emotional realms. She has a dedicated drive for accomplishment and has positive expectations for success. We had been working together for many years before she expressed interest in balancing hormones in preparation for pregnancy. She has an avid interest in healthy eating and nutrition, so we collaborated to identify some new, food-based approaches. She described feeling empowered with her new nutritional focus and excited to be making changes for a more vital life. At 35 years old, she dismissed the idea of advanced maternal age as irrelevant and instead affirmed a sense of herself as vibrant and happy.

Courtney was surprised when she conceived without much effort. We made space in our next appointment to discuss her honest and conflicted feelings about the experience. When she first realized she was pregnant, her first reaction was fear and a feeling of not wanting it yet. Over the next few weeks, she gradually began to experience happiness and joy about being pregnant, but still had conflicted feelings. By sitting with those feelings, she became aware of a deeper layer of experience that felt like a state of panic, and was able to translate the sense of urgency she felt as an expression of her desire to complete some important projects she had been working on professionally. She realized how important these goals were to her, as well as how they affected her self-esteem.

She was also able to reflect on a perceptual perspective that she used to judge herself based on whether or not she was being a hard worker. She was able to articulate how a narrative equating hard work with success had motivated her in certain ways, but also how it was damaging to her sense of self, since she rarely felt secure in her sense of achievement, and worried because she was working hard but wasn’t achieving the measure of success she wanted. She was also afraid of what pregnancy and motherhood would mean for her professional goals. She was open to the idea of creating a new story, that she could stay motivated while letting the experience of achievement, completion, and success sink in. This let her connect to her joy in working toward her goals and her sense of purpose in the project she was working on. When she connected with this new story, she felt empowered to take action on her own behalf and reported a significant decrease in overall stress. She also felt more positive about herself and confident in her ability to stay true to the things that had meaning for her.

Courtney had a number of different daily practices that she used to remind herself to come back to a place of trust, confidence, and love. She noted their value to her, especially after she had a miscarriage at 5 weeks. Courtney chose to use this experience as an opportunity to validate her desire for pregnancy and affirm a deep sense of trust in her body’s wisdom and accepted the miscarriage as an act of love from her body. She renewed her commitment to self-care, and her intent to be vibrant. Courtney decided she wanted a few months to give her body a chance to heal and reset, so she and her husband chose to wait before they began trying again. In that time, she continued her focus on healthy living and we added a layer of endocrine support.

When I saw Courtney next, she described how she had continued to address fears as they came up and had identified some residual negative perceptions about being a mother, particularly a working mother, that she felt were limiting her. Soon after, she emailed me to say she was pregnant again and delighted. As her pregnancy progressed, Courtney embraced the joy she found in being pregnant and, to her surprise, even with seeing her body change, since she had previously worried that body image issues would be a big deal for her. Courtney stayed connected to her love for herself, her body, and her baby; she continued a high level of care for herself, acknowledged fears as they came, and felt radiant through her pregnancy. She is encouraged by the knowledge that all the effort she makes on her own behalf has exponential return for her unborn baby in terms of its genetic expression and physiologic set-points. She smiles as she tells me how some people eat for 2 but she has decided to love for 2. “I’m feeding us love!”

Case 3: Blurring the line between nature and nurture

Naomi has been my patient for more than 9 years. She had her first child 7 years ago, after several years of difficulty with conception, miscarriages, and failed in vitro fertilization procedures. She was passionate in her desire for a family and expected that she would have at least 3 children. However, after years of trying through multiple routes, she had decided to move on and gave away all the baby gear that she had saved. But as she turned first 38 and then 39, it became clear to her that she desperately wanted a second child. She had always imagined a little girl and had a name picked out for her since the first pregnancy. She thought about this baby girl constantly and decided to do whatever it took to conceive. Ultimately, that meant using a donor egg.

Although elated to be pregnant, Naomi had a persistent thought: “Is this really my baby?” She felt guilty for having this thought and tried instead to be grateful that she was pregnant, but she couldn’t disengage from the worrisome feeling that the child she was carrying wasn’t, and would never be, hers. Her level of stress and tension rose daily as she struggled through her inner conflict.

When we met, I introduced the idea of epigenetics to her, and we talked about the role of DNA in directing cellular expression. She came to understand the importance of the uterine environment and the impact of maternal blood chemistry on the developing child. Although the DNA in the egg is not hers, she is the one growing the baby; therefore, her information will be used to determine the way that the DNA is used to build cells, systems, and eventually a human being. She did some research on her own and gained a new understanding of how cells are organized to seek adaptation within an environment, but even more importantly she gained freedom from a distressing belief system. She has a new narrative now and finds peace in knowing that she is having a biological influence on her daughter. All of the distress she was feeling about her daughter not being “hers” has dissolved, and she is no longer bothered by intrusive thoughts. She released the guilt she was feeling and is focused on loving herself and her unborn child. She is committed to developing a strong, connected relationship that will serve them both and is actively affirming beliefs that support that connection.

Claiming Our Power

It may not always seem obvious to work in this realm, but I have come to appreciate the immeasurable power perception has in our lives and bodies. The subconscious templates we use to interpret our experiences impact our choices around self-care, alter neuroendocrine patterns, and directly influence fetal adaptation. I believe that love for self is paramount, and will inevitably invoke the Vis to activate a more vibrant state of wellness. As we increase life-force energy and remove obstacles to its flow, we embody a greater expression of love for self. This is our power—power in our bodies, power in our life experience, and power in what we are passing on to our offspring. As we claim our power, we also need to understand that it is not a failure if, despite our best efforts, our desired outcome does not immediately manifest. While it is true that we can be a great agent in directing our life-force energy, it is also true that we cannot insist that the energy do any particular thing. Sometimes physical patterns are immediately responsive, sometimes they are stubborn, and sometimes there are extenuating factors that are beyond our immediate influence. What we can do is let go, trust the process, and know that love is never wasted. We can recognize that pulling ourselves into a higher state of vitality is worth the effort and attention, that WE are worth the effort and attention, regardless of how that manifests physically. When we embody greater vitality, we remember a connection to our own unique expression and find the joy of our being. We are each a unique expression of life-force energy, we have creative agency in our lives, and our ability to be sovereign within truly determines our lived experience.

In the words of the poet Rabindranath Tagore, “Reach high, for stars lie hidden in you. Dream deep, for every dream precedes the goal.”

References:

  1. Lipton B. Biology of Belief. Carlsbad, California: Hay House; 2015.
  2. Masterpasqua F. Psychology and epigenetics. Rev Gen Psychol. 2009;13(3):194-201
  3. Fischetti, M. Your brain in love. Scientific American. https://www.scientificamerican.com/article/your-brain-in-love-graphsci/. Published February 2011. Accessed December 2016.
  4. Esch T, Stefano G. The neurobiology of love. Neuro Endocrinol Lett. 2005;26(3):175-192.

Allison Creech, MEd, ND, is a naturopathic doctor who splits her time between seeing patients in private practice, teaching courses in Health Psychology and Naturopathic Counseling at CCNM, and parenting her young child. She has a passion for mind-body medicine and the healing power of the Vis. She has a special interest in working with women around pregnancy, and believes that, with naturopathic medicine, many things are possible. She graduated from CCNM in 2004 after pursuing graduate studies in clinical psychology. She can be reached online at www.alightalive.com or by email at dr.allison.nd@gmail.com

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