Nutrition in Pregnancy

One of the fundamental differences between the care of a midwife and an obstetrician is the emphasis on good nutrition. How a woman eats in her pregnancy can effect her physical and emotional well-being as well as the growth of her baby, a healthy placenta, and healthy perineal tissues. With a healthy balanced diet and exercise, many of the complications that can cause a woman to be considered "high risk" can be avoided.

Nutrition is at the heart of midwifery care. Midwives discuss with their clients from the first meeting to 8 weeks post partum about their diet and what changes, if any, can be made. When I ask a woman to bring a 7-day diet history, it is more for her to see and evaluate than for me . Looking at this together, recommendations can be made but many times the woman already sees the improvements that are needed just by writing down what she's been eating.

Balancing Your Diet

It doesn't cost more money to eat healthy and you don't have to shop at Whole Foods to get nutritious well-balanced meals and snacks. Actually, the opposite is true as processed foods do cost more. A diet that consists of good sources of protein, whole grains, calcium, fresh vegetables, and fruits is the basis of a balanced diet. When you look at the food pyramid, it suggests 5 servings of vegetables. Wow!! However, the serving size is 1/2 cup and so if you eat a 2 and 1/2 cup hearty salad with lots of fresh veggies, you've already met your quota for the day. If you have a diet that is balanced then you don't have to worry about getting the amounts of folic acid needed for healthy neuro-tube development between the weeks gestation 4 and 5.

Weight Gain

The most important thing to remember in your pregnancy is that as long as you are eating healthy it doesn't really matter what the scale says. A woman who is of average weight pre-pregnancy, will gain an average of a pound per weeks pregnancy. Since there is an estimated 40 weeks pregnancy this would equal an average of 40 pounds. Instead of looking at what the woman gains between each prenatal visit, I like to look at the overall weight gain. This can vary from woman to woman and from pregnancy to pregnancy as they each are different. It is not uncommon for a woman who is over-weight before she conceives to gain very little in her pregnancy, if any at all, and still have a healthy 8 or 9lb. baby. What a woman gains the first 37 weeks goes to her for breast feeding stores. What is gained the last few weeks of pregnancy will go mostly to the baby.

Protein

One of my favorite books is "Natural Childbirth the Bradley Way". However, the amount of protein that is suggested in the book is way too much!!! If you consume at least 3 portions of protein a day, this should be more than adequate. Many women today are vegetarians and there are plenty of ways to get good sources of protein to meet the needs of your growing baby. See sneaky ways to get protein. For many women, at or around 6 weeks gestation, morning sickness will begin. Not all women experience this and again it will vary from woman to woman and pregnancy to pregnancy. It is due to the increased amounts of progesterone and estrogen circulating in your body. One of the ways to hopefully decrease this symptom is to get small frequent portions of protein and/or a complex carbohydrate. As often as every one hour while awake to a minimum of every two hours. If you wake up to urinate in the middle of the night, it is a good idea to have a small snack ready by your bed. Going 7-8 hours without eating can greatly increase the amount of nausea you experience in the morning. This is probably why it is more common first thing in the morning. It will also help to avoid those hypoglycemic times that are so common in pregnancy.

Calcium

The amount of calcium a woman needs during pregnancy is 1200 mg. a day. A good average of what each serving of dairy contains is 300 mg. So this means 4 servings of dairy a day. There are a few green leafy vegetables that are just as high as dairy (see Choices for Calcium) such as mustard greens, collard greens, and kale. Symptoms of low calcium are leg cramps, increase irritability, and insomnia.
If you are a vegan or lactose intolerant, then taking a calcium supplement will give you and your growing baby what you need. I like the liquid calcium citrate/magnesium combo as it is easier for your body to absorb than a pill. Pills are fine too. If you are not sure you are absorbing the pill due to the fact that you are having signs of low calcium, then take your pill and put it in a small amount of white vinegar. Stir it occasionally over the next 30 minutes . See if it is completely dissolved at the end of the 30 minutes . There are very few prenatal vitamins that have more than 200 mg., so getting the calcium in your diet or taking a supplement is important. Keep in mind that if you are a big milk drinker that the phosphorus in the milk can inhibit calcium absorption. This doesn't mean you can't have your milk but be aware of what your body is telling you. Also, if you drink milk, be sure it is the Fat Free as what you need is the calcium and not the fat. Even 1-2 % has almost as much fat as whole milk. At about 36 weeks pregnancy, the baby's bones start to ossify. So if you have been free of low calcium symptoms and then they start at about this time, you probably need to up your calcium intake.

Iron

Almost all woman will have a decrease in their iron stores between 24-28 weeks pregnancy. This is due to the fact that your body is making a whole liter of extra blood for you to help with the growing baby. The fact that you make the liquid part first (plasma)means that each red blood cell is diluted. It is also a good sign that your blood volume in expanding and it is just a normal physiological process that happens in normal pregnancies. How do you know if you need more than high iron rich foods and need a supplement? At the beginning of your pregnancy, I will check the woman's complete blood count (also known as CBC) as it is part of the initial lab work. This looks at the red cells and white cells. The main part of the red cell that we need to see is the hemoglobin and hematocrit. The hemoglobin is the part of the red cell that carries the oxygen and is why if a person is anemic they can be tired and short of breath. The hematocrit is the percentage of red blood cells and goes along with the results of the hemoglobin. The hematocrit is about 3 times as much as the hemoglobin on average. I will look at these values with the woman and explain what the normal levels are : Normal Hemoglobin 11.7 or Higher and Hematocrit 35-37% or higher. It takes 2-3 weeks to make a red blood cell, so if the woman is already low on her iron stores at the beginning of her pregnancy, it is probably a good idea to take a supplement before the peak of making the extra liter of blood is reached. Then, at 24-28 weeks pregnancy, I will check the woman's CBC again along with the screening for gestational diabetes. Then, I will check one more time about mid-third trimester.
(see Iron Rich Foods).

Empty Calories

During your pregnancy, your liver and kidneys are working extra hard to filter your baby's blood. If a woman has a diet that is full of empty calories, this puts an extra load on your liver and kidneys and can lead to toxemia, blood pressure problems, prematurity, and other risk factors in pregnancy. In the first trimester, it is sometimes hard to eat healthy between weeks 6-12 and you are trying to get in what ever you can. Don't worry so much about it till after your 12th week. (The special "window" of time when things can go wrong in development of the neuro-tube is between the 5-6th week of gestation before the nausea starts).

Last Weeks of Pregnancy

At the end of your pregnancy starting around 36-37 weeks pregnancy, the baby's bones start to ossify so you may need to add a supplement as mentioned above. One of the most important things to remember from this time till the baby is born, is to stay on your healthy diet. Even the most rigid health-nut can fall off track and start eating less healthy these last few weeks. Don't forget that most of what you gain from here till the baby is born , goes to the baby. It is much easier to push out that 8 or 9 lb. baby than that 10 or 11 lb. If you don't feel like cooking, avoid those take-out food places and just keep healthy foods that are easy to prepare around. This will help you avoid the temptation!!

Pregnancy is a wonderful time to learn more about your body and nutrition!!!!

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