Wednesday, October 29, 2008

A Few Links for the Week & A Survey

Updated Birth Plan Template at Navelgazing Midwife has some excellent suggestions about birth plans.

11 Common Skin Changes during Pregnancy, from the Dr. Sears' e-newsletter. Includes information on "pregnancy glow", pregnancy mask, acne, linea nigra, dark areas becoming darker, red palms and soles, spider veins, skin tags, heat rash, itching and PUPP.

From the blog Real Women, Real Options, Real Birth:
"Traditionally women have learned about birth through stories passed on from their mothers or other female relatives. Sounds great but there are women for whom their mothers are uncomfortable telling their birth story or their mother is a Twilight Sleep mom or had some other birth experience that rendered her unable to recall many details of her birth experience. Today, we have more and more women exploring all of their birth care options and birth stories range from birthing a baby under the moonlight because “I wasn’t sure I wanted to be at the hospital and fight the docs who didn’t agree with natural childbirth” to “the doc and I high-fived each other because this was his first time catching a baby with mom on her hands and knees” to “my midwife guided my hands into the water to catch my daughter.”"
So, who’s your birth link? Take the poll and see the results!

After the Birth, What a Family Needs, a blog post by Gloria Lemay, has some great ideas of how to get useful support during the "babymoon", those first weeks postpartum.

A heartwarming success story about a mom breastfeeding triplets on the Motherwear blog.

I'll be back on schedule next week, with a look at calcium!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine
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Wednesday, October 22, 2008

Prenatal Nutrition: Iron

The sources that I read consistently suggest a goal of about 30mg per day of iron for pregnant women. This is a lot of iron for most women, and it can be a challenge to get that much iron through food. Iron is one of the nutritional needs that many pregnant women do not meet through diet, which is why prenatal supplements can be so helpful.

What does iron do?

The Family Nutrition Book, an excellent resource by Dr. William Sears and his wife Martha Sears, an R.N., explains why iron is critical to health:
"Iron is necessary to make hemoglobin, the substance that carries oxygen through your blood to all the cells in your body. Hemoglobin is what makes red blood cells red. With insufficient iron, and therefore not enough hemoglobin, red blood cells become small and pale and don't carry enough oxygen. You may have heard the expression, 'tired blood.' This refers to blood that is low in iron and that can't carry enough oxygen to vital organs and muscles. 'Tired blood' results in a tired body.

Iron is needed not only for blood but also for brains. Neurotransmitters, the neurochemicals that carry messages from one nerve to another, require sufficient iron to function properly. A person with an iron deficiency may have a tired mind as well as a tired body" (Sears 58).

During pregnancy, a woman's blood volume increases by 40%, so additional iron is essential to maintain good health and energy levels. It is also important for the creation of the baby’s red blood cells. In Having a Baby, Naturally, Peggy O'Mara states that the health benefits of "getting enough iron during pregnancy may also reduce the risk of premature delivery and low birth weight" (26).

Elizabeth Somer's book Nutrition for a Healthy Pregnancy explains the additional need for iron during pregnancy in even more detail, "The iron costs of pregnancy are high. More than 246mg of iron is stockpiled in the baby's tissue prior to delivery, and another 134mg is taken up by the placenta, and about 290mg is used to expand the volume of the mother's blood. That equates to about 2.4mg a day during pregnancy just to cover the iron costs of pregnancy. In addition, 1.0mg or more is needed to maintain the mother's normal body processes. Since you absorb only about 10 percent of dietary intake (although iron absorption increases as much as 50 percent during pregnancy in some women), you must consume about 30 to 60mg or more of iron daily to ensure optimal iron status" (84).

What are the symptoms of iron deficiency?

According to The Family Nutrition Book, the following are possible signs of iron-deficiency anemia:
paleness (especially in the face, palms and nail beds)
weakness
fatigue
shortness of breath
irritability
difficulty concentrating
increased susceptibility to infections
intolerance of cold temperatures
constipation
brittle, thin, spoon-shaped nails (63).

What food sources are good sources of iron?

Beef (4oz): 3.5mg
Ground beef (4oz): 2.5mg
Chicken (4oz): 1.6mg (dark meat) to 1.0mg (white meat)
Turkey (4oz): 2.5 (dark meat) to 1.6 (white meat)
Potato with skin: 2.5mg
Beans (1/2C): 2.0mg
Lentils (4oz): 3.0mg
Barley (4oz): 2.0mg
Sweet Potatoes (4oz): 1.7mg
Pumpkin seeds (1oz): 4.0mg
Cream of Wheat (4oz): 5.0mg
1/2C cooked spinach: 3mg
1C dry roasted mixed nuts: 5.0mg
1 egg: .7mg
Quinoa (grain): 9.0mg
Dried Fruit (1/4C): 2.0mg
Iron-fortified breakfast cereal: check your favorite brands

Peggy O'Mara writes that "You need 27mg of iron in your daily diet. You can get enough of it by consuming:
1/2C of cream of wheat (fortified) or 2 servings of beef, turkey, or clams or 1 cup of lentils and

1 cup of lima or kidney beans or black-eyed peas or 1/2C of prune juice, and

1 wedge of watermelon or 12 dried apricot halves or 1T of blackstrap molasses or 2 eggs, and

1 cup of cooked spinach or 2 cups of cooked kale or 4 oysters and

2 slices of whole wheat bread or 1/2C of tofu or 1 chicken leg" (26).

That equals out to some interesting food combinations, in my opinion, but it gives an idea of some iron-rich food sources and combinations. This is one way I can imagine including these selections in a day:
Breakfast: Cream of wheat cereal and 6 apricot halves
Snack: Wedge of watermelon
Lunch: Sandwich on two slices of whole wheat bread
Snack: Prune juice (?? but then I don't like beans)
Dinner: Omelet of quiche with eggs and spinach

There, that sounds more appetizing.

How can I maximize iron absorption?

"Eating food rich in vitamin C along with plant sources of iron helps to unbind phytates and the oxalic acid and increase iron absorption. Vitamin C can double the amount of iron absorbed from a food. Meat, poultry, and fish also enhance the absorption of iron from plant sources . . . Meat can double the amount of iron absorbed from veggies. The best partners for getting the maximum amount of iron out of food are meat and foods high in vitamin C eaten together at the same meal" (Sears 59).

Here are some suggestions of food combinations to maximize iron absorption listed in the Sears book: spaghetti with meat and tomato sauce; meat and potatoes; chicken fajitas with broccoli, sweet peppers and tomatoes; fresh fruit, iron-fortified cereal.

Nutrition for a Healthy Pregnancy offers this helpful information, "Iron intake involves a balance between iron promoters and iron inhibitors, and entails more than just eating iron-rich foods. Here are a few ways to maximize your promoters to guarantee you get the most from your diet:
1. Always consume a vitamin C-rich food with every meal, such as orange juice, a tossed salad, broccoli, more most fruits. Vitamin C improves the absorption of iron and counteracts some of the inhibitors in foods, such as phytates in whole grains and tannins in tea and coffee.

2. Consuming small amount of red meat, such as extra-lean beef, with large amounts of iron-rich plants, such as split pea and ham soup, increases the absorption of the plant iron.

3. Cook in cast-iron skillets. The iron leaches out of the pot into the food, raising the iron content of the meal.

4. Select iron-fortified foods.

5. Drink tea and coffee between meals. Tannins in these beverages (even if they are decaf) reduce iron absorption by up to 80 percent if consumed with food.

6. Take iron supplements on an empty stomach to improve absorption [as long as this doesn't cause nausea!]" (85).

Additional suggestions I can think of:
Potato with skin, chopped broccoli, and a little chopped ham (or bacon)
Beef-barley stew
Mashed sweet potatoes with a little orange juice and honey
Cream of Wheat cereal with chopped almonds and chopped dried fruit
Breakfast cereal and a glass of orange juice
Breakfast cereal, nuts, and dried fruit trail mix
Quinoa hot cereal for breakfast with chopped dried fruits
Qunioa pilaf
Chili with ground beef and tomatoes

It's important to remember that iron from animal ("heme" iron) sources is absorbed much higher amounts than iron from plant sources ("non-heme" iron). Heme iron is absorbed at a rate of 15-35% whereas non-heme iron is absorbed at a rate of only 2-20%. Dr. Sears reminds us that "the percentage of iron listed on the package label is certainly not the amount of iron that gets into your bloodstream. This is especially true of iron-fortified cereals, in which only 4 to 10 percent of the iron listed actually gets absorbed. The amount of iron absorbed from any food depends on the type of iron in the food, the body's need for iron, and the company of other foods eaten at the same meal" (65).

Peggy O'Mara writes recommends concentrating on "dark green leafy vegetables such as spinach and kale. Also eat plenty of whole grains, seaweed, soy products and fortified cereals" if you follow a vegetarian diet (26).

Finally, "The following foods hinder iron absorption: tea and coffee; high fiber foods such as bran; soy proteins; antacid medicines; milk or dairy products consumed with a meal" (Sears 60).

What about iron supplements?

Because adequate iron intake is critical for mother and baby during pregnancy, and because it is higher than what many women are able to consume through food alone, some women find that they need to take an iron supplement. I have heard good things (anecdotally) about Floradix, which is available at many health food stores and on Amazon, where you can check out their reviews, too. Here's what The Motherwear blog had to say about Floradix, Help for the Weary.

O'Mara does caution: "Most prenatal vitamins will provide the amount of iron necessary for expecting women. It is very important, however, to check with your health care provider before taking any additional supplements because too much of it can be toxic. Also keep in mind that some women will experience more constipation with increased iron supplementation" (26).

If anyone has any experience with overcoming anemia or any iron-rich recipes, please leave a comment!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Friday, October 17, 2008

All Women Should Be Offered Midwife-led Care

This is a truly groundbreaking study: Midwife-led versus other models of care for childbearing women!

Background
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care.

Objectives
To compare midwife-led models of care with other models of care for childbearing women and their infants.

Main results
We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).

Authors' conclusions
All women should be offered midwife-led models of care and women should be encouraged to ask for this option.

Plain language summary
Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.

Finding a Midwife in Maine

There are many midwives currently working with families here in central Maine, both CNMs (Certified Nurse Midwives) who attend births in hospitals, and CPMs (Certified Professional Midwives0 who attend births at home. There is also one independent, free-standing birth center in Maine, staffed by midwives: The Birth House, in Bridgton.

Waterville Women's Care
Rights at Maine General, Waterville Campus
Waterville
877-7477

Central Maine Medical Center OB/GYN
Rights at CMMC
Lewiston
795-5770

Women's Health Associates
Rights at St. Mary's Hospital
Lewiston
777-4300

The Women's Center
Rights at Miles Memorial Hospital
Damariscotta
563-4700

Mid Coast Medical Group
Rights at Mid Coast Hospital
[This group appears to include several offices at different locations with different phone numbers.]
Brunswick
729-4996

Cathy Heffernan, CNM
Winthrop Family Practice
Rights at Maine General, Augusta Campus
Winthrop
377-2111

Heather Stamler, CPM
Vassalboro
873-5225

Midcoast Midwifery
Christine Yentes, CPM
Monroe
525-7740

Morning Star Midwifery
Donna Broderick, CPM
322-6464
Ellie Daniels, CPM
338-0708
Belfast

Mother Bloom Midwifery
Anna Fernandez, Traditional Homebirth Midwife
Blue Hill
326-4373

The Pregnancy Support Center
Jan Willson
Lewiston
777-3776

Northern Sun Family Health Care
Sarah Ackerly, ND, CPM Topsham
798-3993

Birch Moon Midwifery
Holly Arrends, CPM
Bath
522-6043

Casco Bay Midwifery
Schyla St. Laurent, CPM
Falmouth
797-7463

Open Circle Midwifery Services
Robin Doolittle, CPM
Deirdre Sulka/Meister, CPM
Greater Portland
838-2157

Sacopee Valley Birth Services
Brenda Surabian, CPM and
Lindsay Johnston, CPM
Parsonsfield
329-2111

To search for more midwives in Maine, go to the Midwives of Maine website or the Find a Midwife section of the American College of Nurse-Midwives website.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Thursday, October 16, 2008

How to Choose a Prenatal Vitamin

Many women take prenatal vitamins during their pregnancy. Some expectant moms take store brand vitamins, others get a prescription from their care provider for a specific brand. Since taking a prenatal vitamin is such a common aspect of pregnancy, I thought I'd spend the next few "Nutrition Wednesday" posts on it. This post will be an overview - and then each week I'll highlight a few common vitamins/minerals contained in the vitamin: what each does for mom and baby; common dosages; what foods contain this nutrient etc.

Interestingly, as I checked in several pregnancy and prenatal nutrition books, I found that there was not a consensus on prenatal vitamins: several books went so far as to explain that if mother's diet is excellent, prenatal vitamins are unnecessary. Most of the my sources, however, did suggest using prenatal vitamins almost as insurance:

The Harvard Medical Guide to Healthy Eating During Pregnancy has a helpful chapter called "Dietary Supplements - What's Good and What's Not". In this chapter, the author explains that
"Most physicians recommend taking a prenatal vitamin to ensure that pregnant women are not deficient in nutrients. This is an important point, because the goal of taking a vitamin is not to 'boost' the levels of any one nutrient to excess but to bring abnormally low levels of nutrients to a normal level. A reputable supplement with the right amount of vitamins and minerals can serve as a safety net in case the foods you eat fail to supply a critical nutrient that your baby needs, or if nausea and vomiting are preventing you from eating a balanced diet" (92).
and

Peggy O'Mara writes in Having a Baby, Naturally :
"Taking a prenatal vitamin can help ensure adequate vitamin levels, although it should not be used as a substitute for a good diet. Experiment with the best time of day to take your supplement, because taking it on an empty stomach may contribute to nausea. Taking it with a meal is usually best" (11).

Okay, so that's why many doctors and midwives recommend taking prenatal vitamins... now, which one to take? Here are some guidelines:

First, take a prenatal supplement, meant specifically for pregnant or breastfeeding (lactating) women. Prenatal vitamins have been modified to correspond with pregnant women's needs, and will work better than a traditional multivitamin.

The Harvard Medical School Guide to Healthy Eating During Pregnancy offers these additional considerations:
"It is safest to choose a supplement from a large, reputable manufacturer at a retail pharmacy, because these companies will be under higher scrutiny to provide a safe product than small companies that sell products over the Internet or in smaller stores. Choose a formula specifically designed for pregnant women, and check to see that it provides the level of vitamins and minerals that you need. You can ask your doctor to recommend an over-the-counter vitamin or to prescribe one through your pharmacy. Some people may also choose not to take a multivitamin, instead preferring individual supplements of the nutrients they need most. In this case, it's important to make sure you are getting the right dose, because individual-nutrient supplements are often sold as doses above the recommended daily dose" (93).

According to this same book, here is a list of Dietary Reference Intakes During Pregnancy, for women 19 years old or older:

Calcium: 1000mg
Phosphorous: 700mg
Magnesium: 350mg
Vitamin A: 770mcg (2,560IU)
Vitamin D: 5mcg (200IU)
Flouride: 3mg
Thiamin: 1.4mg
Riboflavin: 1.4mg
Niacin: 18mg
Vitamin B6: 1.9mg
Folate: 600mcg
Vitamin B12: 2.6mcg
Panthothenic acid: 6mg
Biotin: 30 mcg
Choline: 450mg
Vitamin C: 85mg
Vitamin E: 15IU
Iron: 27mg
Zinc: 11mg
Copper: 1000mcg
Selenium: 60mcg
Iodine: 220mcg

Elizabeth Somer writes in Nutrition for a Healthy Pregnancy that
"the secret to supplementation is to do it sensibly. Choose a multiple vitamin and mineral that supplies at least 400mcg of folic acid and approximately 100-200 percent of the Daily Value for all other nutrients. If you don't consume daily at least two calcium-rich foods, such as nonfat milk and fortified soy milk, and lots of magnesium-rich whole grains, wheat germ, and legumes, then consider supplementing your multiple with extra calcium (500mg) and magnesium (250mg) since no one-pill multiple contains enough of these two minerals. In addition, you will need additional iron if blood or tissue iron levels are low" (10).

Here is Mothering's response to "I'm looking for a really good prenatal vitamin and wondered what your suggestions would be."
I have used DaVinci Laboratory's Ultimate Prenatal Vitamins for 20 years with excellent results. It is in a base of herbs so consult with your midwife or doctor about your own health needs in this area. Some vitamin shops carry this product although it was formerly for professional use only. Ask your doctor to order it for you if you cannot find it locally visit their website at www.davincilabs.com Wishing you a beautiful pregnancy and birth experience.

So there are a few caveats about prenatal vitamins:

1. Don't assume all prenatal supplements (or supplements in general) are safe.

The author of the Harvard Medical School Guide to Healthy Eating During Pregnancy cautions that "dietary supplements are regulated differently from either food or medications. The responsibility for ensuring a supplement's safety lies with the manufacturer, not an overseeing agency such as the FDA . . . supplements that contain the same ingredient have been found to vary widely in quality and content. This doesn't mean that all supplements are dangerous; most reputable companies know that ensuring a safe, consistent product is in their best interest. But you can't assume that everything sold on your pharmacy's shelves [or online!!] has been tested for quality and safety" (92).

For example, you might want to check out a vitamin on this list before you buy it: Survey Data on Lead in Women's and Children's Vitamins. I was shocked to notice a significant overlap between health food store vitamins and the vitamins on the list for the highest lead content.

2. Prenatal vitamins sometimes cause nausea in pregnant women, especially in the first trimester. If your prenatal vitamins make you nauseous or add to your morning sickness, consider switching brands or - what I've found anecdotally to help the most women - take them at night after dinner rather than in the morning on an empty or nearly empty stomach. The Midwifery Today e-newsletter had an article about this common problem just recently: Nausea and Prenatal Vitamins

3. While taking prenatal vitamins can be "insurance" against a nutritional deficit, it's critically important to eat a balanced, healthy diet during pregnancy. Our bodies absorb nutrients much better from food than from vitamins, and many times the combinations involved in foods or traditional recipes combine together to work better in our bodies. Also, there are lots of important phytochemicals in fruits, vegetables and whole grains that are not available (yet?) in prenatal supplements.

Several of the books mention iron, calcium, and folic acid as three nutrients in prenatal vitamins that are particularly important, because many pre-pregnant and pregnant women do not get adequate amounts of these nutrients through the foods they eat. We'll start with those next week. In the meantime, these are the books I used to compile this information, and would recommend reading as additional resources:

The Pregnancy Book, by William Sears, MD and Martha Sears, RN
The Harvard Medical School Guide to Healthy Eating During Pregnancy, by W. Allan Walker, MD
Nutrition for a Healthy Pregnancy, by Elizabeth Somer, MA, RD
Having a Baby Naturally, by Peggy O'Mara

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, October 15, 2008

Prenatal Vitamins

Many pregnant women take prenatal vitamins, as recommended by most care providers. If you take prenatal vitamins, do you know what vitamins and minerals they contain, and at what levels?

This is a "quiz" I do with families during our first class:

How much of your daily requirements are supplied by your prenatal vitamin?

Write down your estimate by each of the following ingredients:

1. Vitamin A ______%

2. Vitamin C ______%

3. Folic Acid ______%

4. Iron ______%

5. Protein ______%

6. Calcium ______%

7. Omega-3 Fatty Acid ______%


Some people believe that by taking a vitamin (or vitamins), they're covering their nutritional "bases" without eating a variety of foods, especially fruits and vegetables. Does taking a prenatal vitamin make up for a poor diet?

I'll post a follow-up discussion and resources on prenatal vitamins tomorrow!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Sunday, October 12, 2008

NY Times Health Update Links

I receive the weekly Health Update e-newsletter from the New York Times. There have been several interesting articles lately:

Fan in Room Seems to Cut Infants' Cut Infants Risk of Crib Death (SIDS)
"Dr. Li said the use of fans should not replace other sleeping strategies for lowering SIDS, like removing soft bedding and putting babies on their back. He noted that the gains shown in the study were an average for the whole group, including for babies whose care did not meet the guidelines. Still, even if a baby had a safe sleeping environment, the risk of SIDS was lowered by about 16 percent for those who had a fan in the room, although the trend was not statistically significant.

“If parents wanted to do more to reduce the baby’s SIDS risk,” he said, “they can add a fan.”"


More links to safe sleeping information and SIDS prevention:

An interesting article on SIDS and bed-sharing and breastfeeding.

Dr. James McKenna offers a complete guide to bed-sharing on the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame website, including sections on guidelines, advantages, long-term effects

Safe Sleeping with Your Baby provides recent information on sleep-sharing from attachment parenting gurus, the Drs. Sears.

Safe Sleeping tips from Drs. Sears for all babies, those co-sleeping or sleeping in a crib.


Advances in Testing for Down Syndrome Rely on Mother's Blood
"For three decades, scientists have been trying to develop a noninvasive prenatal test for Down syndrome that would replace amniocentesis, which can cause miscarriages.

Now, scientists using powerful genetic techniques are closing in on that goal with tests that require only a blood sample from the pregnant woman."


Acetaminophen in Babies Tied to Asthma Risk
"The use of acetaminophen in the first year of life is associated with an increased risk for asthma, eczema and allergic runny nose later in childhood, a New Zealand study reports. Acetaminophen is sold in the United States under the brand name Tylenol and as an ingredient in many other pain relievers."

Ack!!!!!!!!! Not that I medicated my kids all the time, but they were both intense teethers - swollen bloody gums, lots of crying, at night especially... I guess a lot of that was after 12 months, but my daughter started teething at 4 months, so I know she got some.


And from last week: You're Sick. Now What? Knowledge is Power. Not all of this applies, certainly, because pregnancy and birth are not illnesses. An interesting perspective. Here's an excerpt:
"“I don’t think people have a choice — it’s mandatory,” said Dr. Marisa Weiss, a breast oncologist in Pennsylvania who founded the Web site breastcancer.org. “The time you have with your doctor is getting progressively shorter, yet there’s so much more to talk about. You have to prepare for this important meeting.”"


If you want to sign up for the free newsletter, go to the NYTimes Member Center and sign up, indicating which newsletters you want.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Saturday, October 11, 2008

Stretch Marks, Round Ligament Pain, and Nausea, Oh My!

Several links to some excellent information on a trio that concerns many pregnant women...

Round Ligament Pain, in the Lamaze Week 19 e-newsletter:
"Baby’s first movements may not be the only sensation in your belly these days. If you notice a sharp pain or pulling sensation on one side of your lower belly when you twist, bend or reach, you may be experiencing round ligament pain. The round ligaments, just a couple of centimeters long when you begin pregnancy, stretch like rubber bands to many times their pre-pregnant size as your uterus grows.

Round ligament pain is usually brief – coming on suddenly and subsiding over a few minutes. If you experience round ligament pain often, think of it as your body telling you to move a little slower. Get in the habit of supporting your belly with your hands when you get up from sitting or when you bend, twist, cough, or sneeze. You might even consider using a maternity belt to support your belly—you can find one at most maternity retailers. Try a warm compress on your lower belly if the pain doesn’t go away right away. And take heart in knowing that round ligament pain is usually short-lived. By next month, your body will be used to the stretching, and these sudden shocks of pain should be a thing of the past.

Of course, if you have any concern that your pain is something more serious, or if you are experiencing other symptoms, such as a fever or vaginal discharge, consult your care provider."
I've noticed that many women seem to talk about round ligament pain the most during weeks 20-24; I've theorized that many babies go through a growth spurt around that time, so moms sometimes feel the ligaments stretching in a painful way.

I liked this blog entry about common pains during pregnancy, from Healthy Mother Wellness & Care.

Finally, the Midwifery Today e-newsletter has two interesting articles - one connecting prenatal vitamins and vomiting/nausea also known as morning sickness and one with a recipe for make-your-own belly butter and other herbal remedies for stretch marks.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Friday, October 10, 2008

USA Today Article on High-tech Interventions

High-tech Interventions Deliver Huge Childbirth Bill

I am so pleased to see this article in a mainstream newspaper! I do wonder about the title though... I would love to have seen something about how the costs don't produce healthier mothers and babies - that piece, to me, is the real story.

Here are two excerpts:
"Childbirth is the leading reason for hospitalization in the USA and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, a report says today.

U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, the authors write. More than $2.5 billion a year is spent on unnecessary C-sections, which now represent nearly a third of all deliveries.
[The language in this sentence is unclear to me: it makes it sound like ALL of the Cesareans are unnecessary; clearly there are times when a Cesarean birth is appropriate use of technology. Maybe the "which now represent" refers to C-sections in general, not unnecessary ones in particular? Anyway...]

Reducing expensive techniques such as C-sections and increasing low-cost approaches such as childbirth assistants called doulas would improve mothers' and babies' health while cutting costs, the authors say.

. . .

"The University of Wisconsin's Douglas Laube, a former president of the American College of Obstetricians and Gynecologists, blames "very significant external forces" for the overuse of expensive technologies in maternity care.

"I don't like to admit it, but there are economic incentives" for doctors and hospitals to use the procedures, says Laube, who reviewed the new report before its release.

For example, some doctors might get bonuses for performing more labor inductions, which adds costs and increases the risk of C-sections, which, in turn, increase hospital profits because they require longer stays.

In addition, some doctors order unnecessary tests and procedures to protect against malpractice suits, Laube says."
It's important to remember that these higher prices DO NOT equal better care. The United States is not the standard-bearer for safety for mothers and babies. Using 2008 statistics, the United States (6.3/1000) currently ranks BEHIND the following countries for infant mortality rates: South Korea (5.94/1000), Cuba, Isle of Man, Italy, Taiwan, San Marino, Greece, Monaco, Ireland, Canada, Jersey, New Zealand, United Kingdom, Gibraltar, Portugal, Netherlands, Luxembourg, Guernsey, Liechtenstein, Australia, Belgium, Austria, Denmark, Slovenia, Macau, Isreal, Spain, Switzerland, Andorra, Germany, Czech Republic, Malta, Norway, Anguilla, Finland, France, Iceland, Hong Kong, Japan, Sweden, and Singapore (2.3/1000).

If you are interested in reading the report, it is available in pdf format, and a print copy can be obtained for free by emailing your contact information.

Milbank Report: Evidence-based Maternity Care
"What are top implications for policy makers, childbearing women and maternity professionals?"

Policymakers can play an important role in improving quality, health outcomes and resource use by addressing barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.

Childbearing women need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices — for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task — and can have very big pay-offs.

Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.

I am so excited to read this report and be able to include this information in my classes!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Great Blog Posts

I've been reading some great blogs lately, and wanted to list the posts I've enjoyed/learned from the most. In no particular order:

The Profit of Pain Relief and All About Due Dates: Do Due Dates Mean Your Baby is Due? on Bellies and Babies

We Birth the Way We Live on Birth Change

Conscious Cesarean Birth on Making Birth Safe in the U.S.

This blog post includes a link to the full text of an amazing article, "The Natural Cesarean: A Woman-Centred Technique"
Abstract: Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.

An FYI post on Breastfeeding and Codeine on the Motherwear blog

Where Have All the Flowers Gone on Real Women, Real Options, Real Birth discusses this article - "Doctor Won’t Make The Cut: Feeling Pressure from Hospital for More C-sections, She Leaves".

And from the same blog, Behind the Numbers: Surgical Birth in the USA.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, October 8, 2008

Meals to Freeze

Many women are approached with offers to help "after the baby comes". I suggest considering asking these generous friends to bring a meal that you can eat and freeze the leftovers (or make two meals: one for now and one for later!). Or, when things are going smoothly during pregnancy, make a few extra meals "for your freezer".

Postpartum life is busy with lots of new adjustments, and although everyone knows good nutrition is important, it can be easy to sacrifice to sleeping, or baby care. Breastfeeding mothers, in particular, need to be sure they are eating well.

Here are a few recipes that I've enjoyed postpartum - they do run the gamut from easy/quick to more involved as well as from lower-fat to yum: cheese! They all freeze well, just be sure to store them carefully in freezer bags, foil (line casserole dish with two criss-crossing layers of foil; fill; lift out of casserole and seal foil), tupperware, etc. Many of the recipes can be portioned out and stored in one-person sizes, so they can be reheated easily without waste.

Keep in mind, too, that other things you already make might also freeze well: soups, muffins, breads, pesto, oven-baked "fried" chicken, pizza dough, pie crust etc. Frozen berries and vegetables are also great to stock up on to round out a meal.

MAPLE-PECAN GRANOLA

2 cups regular oats
1/2 cup pecan pieces
1/2 cup maple syrup
1/4 cup packed brown sugar
2 tablespoons canola oil
1/8 teaspoon salt

Cooking spray

Preheat oven to 300°.

Combine oats and next 5 ingredients (through salt); spread on a large jelly-roll pan coated with cooking spray. Bake at 300° for 30 minutes, stirring every 10 minutes. Cool completely.

Serve with plain or vanilla yogurt and fruit (banana, berries, etc).

Freeze in freezer bag.



EASY CHICKEN CASSEROLE

This doubles easily and freezes well.

6-8 chicken breasts or thighs, boneless
4-6 Slices Swiss Cheese
1 Can Cream Of Mushroom Soup
1/2 C White Wine
2 C Seasoned Stuffing Mix
4 Tbsp Melted Butter
Salt
Pepper

Wash chicken pieces with cold water and pat dry. Cut off any extra fat. Place in a greased casserole dish large enough to hold them in ONE layer. Sprinkle with salt and pepper. Top with cheese slices.

Mix wine and soup until smooth and pour over everything.

Mix stuffing with melted butter and sprinkle evenly on top.

Bake at 300 F for 1 1/2 hours.

Serves 4-6

Freeze cooked casserole in portion sizes to reheat in the microwave, or freeze unbaked casserole, thaw in refrigerator and bake.


CAPONATA WITH PENNE AND SHREDDED ITALIAN CHEESE

This is more work and a lot of ingredients, but really, really good.

2 tablespoons (2 turns around the pan) extra-virgin olive oil
4 cloves garlic, chopped
1/2 to 3/4 teaspoon crushed red pepper flakes
1 red bell pepper, seeded and diced
1 cubanelle Italian long green pepper, seeded and diced
1 large sweet onion, peeled and chopped
2 ribs celery, chopped
1/2 cup large green olives, pitted and chopped
1/2 cup Kalamata black olives, pitted and chopped
1 (3-ounce) jar capers, drained
1/2 cup (a couple of handfuls) golden raisins
1 medium firm eggplant, diced
Salt
1 (32-ounce) can diced tomatoes
1 (14-ounce) can crushed tomatoes
1 handful flat-leaf parsley, chopped
Penne pasta (12-16oz)
Mozzarella Cheese or Italian blend cheese, shredded (8oz)

Place the cutting board near the stovetop. Preheat a big, deep pot over medium heat. Add oil, garlic, and crushed pepper. As you chop vegetables (peppers, onion, and celery), add them to the pot. Once vegetables are in there, increase heat a bit.

Stir in olives, capers, and raisins. Salt the diced eggplant and stir into the pot. Add tomatoes, diced and crushed, to the pot and stir caponata well to combine. Cover pot and cook caponata 15 to 20 minutes, until vegetables are tender. Stir in parsley and remove pan from heat.

Combine half (freeze other half) and pour over cooked penne pasta. Sprinkle with parsley, red pepper flakes, and shredded cheese. Bake until cheese melts.

I freeze the caponata mix already cooked and then thaw/microwave; make pasta and bake.


BULK SPAGHETTI SAUCE

2lbs Italian sausage
2t garlic, minced
2C onions, chopped
5 jars commercial spaghetti sauce (12C)
½ C green pepper, chopped
4 16 oz cans Italian-style stewed tomatoes, cut up, undrained
½ C celery, chopped

Brown sausage, onion, green pepper, celery and garlic in large pot. Add sauce & stewed tomatoes. Simmer on low to medium for at least one hour. Stir occasionally. Allow to cool. Set aside sauce needed for other recipes and freeze the rest in bags/containers for sauce over pasta.


BEAN BURRITOS

These freeze very well (as burritos, or the mix) and it's easy to make a much larger batch of filling. I’ve used one chile from a can of chipotle/adobo instead of the jalapeno and that works fine too.

3/4 cup rice (I use brown)
2 tablespoons olive oil
2 medium onions, chopped
4 garlic cloves, chopped
1 jalapeño chile, chopped (ribs and seeds removed, for less heat) or 1 canned chipotle chile
1/2 teaspoon ground cumin
coarse salt and ground pepper
3 tablespoons tomato paste
3 cans (15 ounces each) pinto beans, drained and rinsed
1 box frozen corn kernels (10 ounces)
6 scallions, thinly sliced
8 burrito-size (10-inch) flour tortillas
2 cups shredded Monterey Jack cheese (8 ounces)
Salsa and sour cream (optional)

Cook rice according to package instructions; set aside.

Meanwhile, heat oil in a large saucepan over medium. Add onions, garlic, jalapeño, and cumin; season with salt and pepper. Cook, stirring occasionally, until golden, 10to 12 minutes. Add tomato paste, and cook, stirring, 1 minute.

Add beans and 1 1/2 cups water; bring to a boil, reduce heat to medium, and simmer, stirring occasionally, until thickened, 10 to 12 minutes. Add corn; cook to heat through, 2 to 3 minutes. Remove from heat; stir in scallions. [I just mix rice into bean mixture at this point.]

Heat tortillas according to package instructions; fill with rice, bean mixture, and cheese.

Assemble: Mound 1/4 cup rice, 3/4 cup bean mixture, and 1/4 cup cheese on one side of tortilla. Fold, and hold in sides. Starting from filled end, holding sides in as you work, tightly roll into a bundle. Place on a baking sheet, seam side down, and prepare remaining burritos.

Serve immediately, with salsa and sour cream, if using, or wrap individually in plastic and freeze up to 3 months.

Reheating From Frozen

Microwave and oven: Remove frozen burritos from plastic wrap. Place on a microwave-safe plate; microwave on high for 3 minutes. Transfer to baking sheet; bake at 450° until crispy, about 10 minutes. This is our favorite quick method. (I do it this way, but crisp up in my toaster oven.)

Oven only: Remove frozen burritos from plastic wrap; rewrap individually in aluminum foil. Place on a baking sheet; bake at 450°, 40 minutes; remove foil, and bake to crisp, 5 to 10 minutes. (To reheat defrosted burritos, remove any wrapping, and bake for 10 minutes.)

Microwave only: Remove frozen burritos from plastic wrap. Place on a microwave-safe plate, covered with a microwave-safe bowl, and defrost at high power for 3 to 4 minutes; uncover, and microwave on high, 3 to 4 minutes longer.


BROCCOLI SOUFFLE

6 beaten eggs
12 oz grated cheddar cheese
6 T flour
half a stick of butter
1 - 24 oz carton of cottage cheese
1 large bag of frozen broccoli (I prefer about same amount of fresh, washed/chopped/steamed - about one large head)
Garlic powder

Melt butter in a 9 x 13 dish as oven is preheating to 350. Combine all the rest of the ingredients and pour into the dish. Make for 1 hour or until a knife inserted in the center comes out clean. Cool 10 minutes and then eat.

Can be frozen either in a large blocks for dinner or small squares of foil for lunches.


TURKEY LOAF

This doubles, triples etc. very easily.


Mix 1 pound of Ground turkey
2 eggs
enough Pepperige Farm stuffing to hold the loaf shape
1 jar turkey gravy per loaf

Shape into loaves, wrap well and freeze.

Can bake from frozen - put in 350 degree oven for 1.5 hours. Can also be cooked in the crockpot - start in the morning on low.

Put turkey gravy over it as it bakes. If you like sweet potatoes or baked potatoes, throw in oven to cook while turkey loaf does.


LAVINA'S SPINACH LASAGNA

You can use half sharp cheddar cheese and half Monterey jack cheese. Easy to make half for dinner and freeze other half. To save time, you can use no-bake lasagna noodles and/or shredded cheese.

2 Lb Low-Fat Cottage Cheese
1 Tbsp Parsley
1/4 C Butter -- Melted
2 Eggs
1 C Parmesan Cheese -- Grated
1 Lb Monterey Jack Cheese -- Grated
9 Lasagna Noodles
3 Pkg Spinach – Chopped – thawed and drained
Salt
Pepper
Garlic Powder

Mix cottage cheese, parsley, butter, eggs, and seasonings.

Grease a 9x13" baking pan and layer as following: 3 noodles, 1/2 cottage cheese mix, 1/2 jack cheese, 1/2 spinach, and 1/2 Parmesan cheese.

Repeat, ending with noodles.

Dot with a little more butter and sprinkle with a bit of Parmesan cheese.

Bake at 350 F oven for 35-40 minutes.

Garnish with basil and/or parsley and serve.

Freeze in portion-sizes, or in unbaked in an 8x8" pan. Reheat in microwave (portion-sizes) or thaw and bake in the pan.

Do you have a favorite meal that freezes well? To share it, just leave the recipe in the comments section.

PS. This is my fiftieth blog post - the first one published 4/30/08. My web traffic has more than doubled - almost tripled (!!) since then.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Tuesday, October 7, 2008

Keeping a Journal during Pregnancy

There are a few things I really wish now that I had done during my two pregnancies and births. The first one is that I wish we'd taken more pictures of me/baby during pregnancy, labor, and right after the birth. I do have a few for each child, but looking back I really wish I had more.

The other thing is that I wish I'd kept a journal. Not necessarily a formal one; I do have one partially filled out in a sweet book my sisters gave me when I told them my husband & I would be trying to conceive. I treasure that book, but now I also wish I had more of a day to day or week to week informal record.

In fact I started off well during my first pregnancy, but that only lasted a few weeks; here's a few of the entries:
October 13: Your first Maine hike – “The Roost” near Gilead, Maine. We had perfect weather: beautiful blue skies and peak fall color. I had a difficult time hauling us up the mountain.

October 16: I had my first real dream about the baby: we were at the doctors having an ultrasound done & the baby was very clearly a boy!

October 17: Our first trip to the doctor’s to get blood drawn. It was strange to stare down at the paper and see, under diagnosis, “pregnancy”!

There are tons of online journal websites, some baby-oriented and others not. And there are lots of blank books, and baby "fill in the blank" journals at bookstores.

Here are a few additional resources:

The beautiful Birthing From Within Keepsake Journal.

In the September e-newsletter, Birthing From Within's founder, Pam England, discusses the three kinds of knowing as "primordial knowing", "modern knowing", and "knowing thyself" - this is a terrific article, and also a good starting place for considering why/how journaling can be a helpful part of birth preparation.

The Week Fifteen Lamaze e-newsletter also discusses journaling, "Focusing on your thoughts and daydreaming about motherhood can be a great way to slow down and relax. Even if you don’t think of yourself as a writer, journaling can help make your feelings, thoughts and concerns clearer to you. Furthermore, spending time thinking about your growing baby starts the important bonding process even before your baby is born." This article also includes some journal writing prompts.

I've never gotten into the whole scissors/layout/stickers thing, but this scrapbooking website has some good suggestions for a pregnancy scrapbook or journal.

More good ideas here.

Here is a link to Wondertime magazine's journal prompts for young children.

And this is an intersting blog post "Journaling Can Provoke an Oxytocin Response".

Finally, if you want to read other people's journals, you can look online at pregnancy blogs, or go book shopping. A few of my favorite books are Having Faith, by Sandra Steingraber, The Blue Jay's Dance, by Louise Erdrich, and Operating Instructions, by Anne Lamott.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Friday, October 3, 2008

Links & Other Goodies

From Midwifery Today's September e-newsletter:

"What makes pain intolerable to women is fear. What takes the fear away is knowledge, relaxation and focus. Yes, when these things are incorporated, there will still be pain but it will not be intolerable. Remember, you are hearing this from a certified wimp."

— Gloria Lemay


From the Sears' September e-newsletter: 10 Balanced Breakfasts - good for prenatal/postpartum moms and their table-food eating children!


Free Co-sleeping Webinar on Mothering, featuring James McKenna, Lysa Parker, Barbara Nicholson and Paul Fleiss. Excellent information on the physiological reasons to co-sleep, explanations of co-sleeping benefits for baby and mom, and a lot more.


Some blog entries I've enjoyed lately:

Amazing New Research from AJOG, on Making Birth Safe in the US.

Well, bloglines isn't working for me right now... I guess there will be a long list next Friday!!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Thursday, October 2, 2008

"Only When I Need To"

When an expectant mother asks her care provider for information about how often (s)he does inductions, cesareans, episiotomies, etc., one common response is:
"Only when I need to..." or
"Only when it's necessary..."

Are those good responses? The problem is that these answers are subjective; they're dependent on a particular doctor or midwife and his/her training, experience, and personal perspective - even someone's personality can come into play.

If all doctors and midwives provided individual care based on evidence, this type of answer would be more acceptable. However, other factors besides the individual and the evidence come into play in decision-making. I read in Pushed that "A 2006 analysis of ACOG obstetric recommendations found that only 23% were based on ‘good and consistent scientific evidence’ and that nearly half were based primarily on consensus and expert opinion, the weakest level of evidence" (Block 266).

To take it out of the medical field - because I believe subjectivity is part of being human, not just a factor in medical decisions:

I used to be a high school teacher, before my children were born. Whenever a parent would ask me "When do you call parents?", I would explain the particular situations that would elicit a phone call home. I could have said, "only when I need to", but I wouldn't have, because it does not truly answer the question. I do not think most parents would have accepted such an answer - nor should they.

Some teachers really hate calling parents, or don't want to spend the time to do it, so they may call only when a student is in danger of failing the class & it's mandated by school policy. Others may call when a student is in danger of failing, or is having behavior issues, to try to get parents to help turn the situation around. Others may call when a student is in danger of failing, for behavior issues, as well as for a sudden change in work quality, behavior, attendance etc. Finally, some teachers truly value home/school communication and make it a priority - those teachers may call for the previous reasons plus to congratulate students for a particular achievement. I'd bet all of those teachers would say they're calling when they "need to" - it's just that their opinion of "need to" is obviously very different.

Since "only when I need to" isn't a real answer, I believe a follow-up question is in order, even if it is hard to ask. Moms and dads deserve to understand the routines the care provider uses, so they can make an informed decision about whether or not that doctor or midwife is a good fit for them.

Some follow-up questions might include:
What percentage of births do you do ____________ for?
What specific situations do you use ____________________?
What other procedures/medications do you sometimes use instead & when/why?
I'm really hoping to avoid _________________, what can I do ahead of time or during the birth?

Besides, the response to the follow-up question can be very telling as well. Does the doctor or midwife become defensive or aggressive ("When did you go to medical school?")? Does he/she use scare tactics ("Well, you wouldn't want to tear from here... to here, would you?")? Is the answer still vague ("I don't really know how many ______________ I do... when the baby/mother needs it... sometimes" etc.)? It's a good thing to know sooner than later if your care provider responds to thoughtful questions in such an unprofessional way.

Or, does the care provider sit down and answer the question: "well, I don't usually do episiotomies, let's see - I've done three or four in the past year, when we needed to use the vacuum extractor to help mom push the baby out" or "for most first-time mothers, I do episiotomies. A clean cut heals better than a tear". Another example, "I'm comfortable with moms birthing in any position - I've caught babies with mom on hands/knees, using a birth stool, leaning on the back of the bed, in the water tub; many moms do seem to end up using the bed...; I offer suggestions sometimes, and would be happy to help you find an efficient position for pushing, if that's what you're looking for. Tell me more about what you're hoping for..." or "I want moms to be on the bed so I can monitor the baby. Some moms are propped up, some are lying down, or on their side."

Not all of those answers are based on evidence (baby can be monitored very nicely in a variety of positions, it just depends on care providers experience; episiotomies do not heal better), but at least the mother knows where the doctor or midwife stands on the issue and can make a real decision, ahead of time.

The best overall resource I've read about choosing a caregiver is in Henci Goer's The Thinking Woman's Guide to a Better Birth - she has a whole chapter to discuss options and questions to ask etc.

Two of my most popular posts also address choosing a care provider: Choosing a Care Provider & Birth Place and Pregnancy and Birth: What Are My Choices?.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Wednesday, October 1, 2008

Local Eating Part Two: More Recipes

What a delicious time of year this is: many get the urge to bake, or to cook warm, hearty meals as the weather gets cooler. And there is still lots of choices for local eating. At my local farmstand (that carries only locally-grown food), there are late-season tomatoes, peppers, green beans and corn, plus potatos, lots of winter squash, cauliflower, broccoli, carrots, lettuce and spinach, and maple syrup and honey. The local apple orchards are offering picking on at least five kinds of apples. Yum!

Last week, I offered recipes for foods with kale, pears, and apples. This week, I will focus on root vegetables, winter squash and spinach.

SPINACH

Spinach, either raw or cooked, can be very tasty and is very nutritious. It is a good source of Niacin and Zinc, and a very good source of Dietary Fiber, Protein, Vitamin A, Vitamin C, Vitamin E (Alpha Tocopherol), Vitamin K, Thiamin, Riboflavin, Vitamin B6, Folate, Calcium, Iron, Magnesium, Phosphorus, Potassium, Copper and Manganese.

One of our favorite spinach side-dishes takes about 15 minutes, and there really is no recipe. It's just a simple fresh spinach saute: wash spinach very well, and spin mostly dry; heat a little olive oil in a saute pan, and add a few cloves of chopped garlic. Saute the garlic on low-medium heat for a minute or two until it is just starting to turn golden (not brown!). Add the spinach, stir to combine, and cover until the spinach starts to wilt & cook down. If you're cooking a lot of spinach, you may need to add the spinach in intervals so it all fits into the pan (when the first bit cooks down, add the second bit, etc.). When the spinach is wilted/sauteed how you like it, season with salt and pepper & serve. Variations include adding a little bit of red pepper flakes with the garlic; squeezing lemon, or a little of your favorite vinegar just before serving. Some people even add oil-packed sun-dried tomatoes, olives, capers, golden raisins, or pine nuts.

A delicious spinach meal comes from the Everyday Food magazine:

Easy Egg Florentine with Baby Spinach and Goat Cheese

4 slices (1 inch thick) sourdough bread
3 tablespoons olive oil
Coarse salt and ground pepper
2 scallions, thinly sliced
1 pound baby spinach
1/3 cup crumbled fresh (pasteurized) goat cheese (3 ounces)
4 large eggs

Heat broiler, with rack set 4 inches from heat. Place bread on a baking sheet, and brush both sides with 2 tablespoons oil. Season with salt and pepper. Broil until golden, 1 to 3 minutes per side; set aside.

In a large nonstick skillet, heat 1 teaspoon oil over medium. Add scallions and as much spinach as will fit; season with salt and pepper. Cook until wilted, tossing and adding more spinach as room becomes available, 2 to 3 minutes. Drain off excess liquid; mix in goat cheese. Transfer to a bowl; cover to keep warm. Set aside.

Wipe out skillet; heat remaining 2 teaspoons oil over medium. Gently crack eggs into skillet; season with salt and pepper. Cook until whites are almost set, about 1 minute. Cover, and remove from heat; let stand until whites are set but yolks are still soft, about 3 minutes.

Top each piece of toast with spinach mixture and 1 egg; serve immediately.


ROOT VEGETABLES

Root vegetables include potatoes, parsnips, carrots, turnips, etc. A large potato, with skin is a good source of Vitamin C, Vitamin B6, Potassium and Manganese, plus has 7g of protein. Carrots are, of course, a very good source of Vitamin A, as well as Dietary Fiber, Vitamin K and Manganese. You can check out other root vegetables on this nutrition data website.

Here's a simple recipe that uses a delicious variety of root vegetables:

Roasted Root Vegetables

3 1/2 cups coarsely chopped carrot (about 1 1/2 pounds)
3 cups coarsely chopped parsnip (about 1 pound)
1 3/4 cups coarsely chopped peeled turnips (about 1/2 pound)
2 tablespoons olive oil
1 teaspoon brown sugar
1/2 teaspoon sea salt
2 medium red onions, each cut into 8 wedges
2 tablespoons chopped fresh parsley
1 tablespoon balsamic vinegar
1/4 teaspoon freshly ground black pepper
Preparation

Preheat oven to 450°.

Combine first 7 ingredients in a shallow roasting pan; toss well. Bake at 450° for 1 hour, stirring after 30 minutes. Add parsley, vinegar, and pepper, tossing to coat.

Nutritional Information
Calories:175 (26% from fat) Fat:5.1g (sat 0.7g,mono 3.4g,poly 0.6g) Protein:2.9g
Carbohydrate:31.9g Fiber:6.7g Cholesterol:0.0mg Iron:1.3mg Sodium:267mg Calcium:80mg


And here's a potato chowder that also uses fresh corn:

Corn and Fingerling Potato Chowder with Applewood-Smoked Bacon

2 slices applewood-smoked bacon (I used regular)
1 3/4 cups diced onion
3 1/2 cups fresh corn kernels (about 7 ears)
1 teaspoon chopped fresh thyme
2 garlic cloves, minced
2 cups fat-free, less-sodium chicken broth
1/2 cup 2% reduced-fat milk
1/2 cup half-and-half
8 ounces (1/4-inch-thick) rounds fingerling potato slices (I used red potatoes)
1/4 teaspoon salt
1/4 teaspoon freshly ground black pepper
Thyme sprigs (optional)
Preparation

Cook bacon in a large Dutch oven over medium heat until crisp. Remove bacon from pan; crumble. Add onion to drippings in pan; cook 8 minutes or until tender, stirring occasionally. Add corn, chopped thyme, and garlic to pan; cook 30 seconds, stirring constantly. Stir in broth, milk, half-and-half, and potatoes; bring to a simmer. Cover and cook 10 minutes or until potatoes are tender, stirring occasionally.

Transfer 2 cups potato mixture to a blender. Remove center piece of blender lid (to allow steam to escape); secure blender lid on blender. Place a clean towel over opening in blender lid (to avoid splatters). Blend until smooth; return pureed mixture to pan. [Or, if you have one, use an immersion blender!!] Stir in salt and black pepper; sprinkle with crumbled bacon. Garnish with thyme sprigs, if desired.

Nutritional Information
Calories:186 (27% from fat) Fat:5.5g (sat 2.7g,mono 1.2g,poly 0.4g) Protein:7.6g
Carbohydrate:27.8g Fiber:3.4g Cholesterol:18mg Iron:1.1mg Sodium:398mg Calcium:84mg


WINTER SQUASH & PUMPKIN

There are so many interesting pumpkin recipes that go beyond pie - one of my new favorite uses for canned pumpkin is in pasta sauces, but I also have two favorite pumpkin muffin recipes, and a recipe for pumpkin butter that is especially wonderful at this time of year. These recipes call for canned pumpkin, but skinned, roasted, pureed fresh pumpkin can easily be substituted. If you roast your own, be sure to save & roast the seeds, too! Pumpkin is a very good source of Dietary Fiber, Vitamin A, Vitamin C, Vitamin K, Iron and Manganese.

Winter squash can also be cooked lots of ways - my family's favorite is the winter squash puree below, but we also enjoy it roasted. Winter squash is very nutritious - to see the analysis of a particular winter squash, check out NutritionData.

Pumpkin Butter

This is good swirled in plain yogurt and granola; over cream cheese served with whole-grain crackers; in oatmeal; and on toast.

1 (29 ounce) can pumpkin puree, approx. 3 1/2 cups
3/4 cup apple juice
2 teaspoons ground ginger
1/2 teaspoon ground cloves
1 1/3 cups brown sugar
1 tablespoon ground cinnamon
1/2 teaspoon ground nutmeg
Juice of half a lemon (I don't actually use this)

1. Combine pumpkin, apple juice, spices, and sugar in a large saucepan; stir well. Bring mixture to a boil. Reduce heat, and simmer for 30 minutes or until thickened. Stir frequently. Adjust spices to taste. Stir in lemon juice, or more to taste.
2. Once cool, pumpkin butter can be kept in an airtight container in the fridge.

To preserve: Spoon hot pumpkin mixture into hot jars, filling to within 1/4 inch from top. Remove air bubbles; wipe jar rims. Cover at once with metal lids, and screw on bands. Process in a boiling water bath for 10 minutes.

(I haven't canned it, but I have frozen it.)


Pumpkin Muffins

These very simple muffins are so good. They can easily be made into mini-muffins, too; mini chocolate chips are a delicious addition.

1½ cups all-purpose flour
1 teaspoon baking powder
1 cup canned solid-pack pumpkin (from a 15-oz can)
1/3 cup vegetable oil*
2 large eggs
1 teaspoon pumpkin-pie spice
1¼ cups plus 1 tablespoon sugar**
½ teaspoon baking soda
½ teaspoon salt
1 teaspoon cinnamon

Put oven in middle position and preheat oven to 350 degrees F. Put liners in muffin cups.

Whisk together pumpkin, oil, eggs, pumpkin-pie spice, 1¼ cups sugar, baking soda, and salt in a large bowl until smooth, then whisk in flour mixture until just combined.

Stir together cinnamon and remaining 1 tablespoon sugar in another bowl.

Divide batter among muffin cups (each should be about three-fourths full), then sprinkle tops with cinnamon-sugar mixture. Bake until puffed and golden brown and wooden pick or skewer inserted into the center of a muffin comes out clean, 25 to 30 minutes.

Cool in pan on a rack 5 minutes, then transfer muffins from pan to rack and cool to warm or room temperature.


Ginger-Pumpkin Muffins

These muffins are a little more complicated to make, but so good.

5 1/2 tablespoons minced crystallized ginger
1/2 cup dried currants or raisins
2 tablespoons brandy

2 cups sifted unbleached all purpose flour
1 tablespoon ground ginger
2 teaspoons pumpkin pie spice
1 1/2 teaspoons baking soda
1/4 teaspoon salt
3/4 cup plus 2 tablespoons cooked pumpkin puree or canned solid pack pumpkin
1/2 cup plus 2 tablespoons low-fat buttermilk
1 teaspoon vanilla extract
2 large egg whites
1 large egg
3/4 cup plus 3 tablespoons (packed) golden brown sugar
1/2 cup unsulfured (light) molasses
1/4 cup vegetable oil

Preheat oven to 375°F. Line sixteen 1/3-cup muffin cups with paper liners. Mix 2 1/2 tablespoons crystallized ginger, currants and brandy in small bowl.
Sift flour, ground ginger, pumpkin pie spice, baking soda and salt into medium bowl.

Whisk pumpkin puree, buttermilk and vanilla in another bowl. Using electric mixer, beat egg whites and egg in large bowl until foamy. Add 3/4 cup plus 2 tablespoons brown sugar; beat until light, about 2 minutes. Beat in molasses and oil. Beat in dry ingredients alternately with pumpkin mixture in 3 additions each. Stir in currant mixture.

Divide batter among prepared muffin cups.

Mix 3 tablespoons crystallized ginger and 1 tablespoon brown sugar in small bowl. Sprinkle evenly over muffins. (I just sprinkle with the sugar, as my kids don't like the lumps of ginger on top...)

Bake muffins until tester inserted into center comes out clean, about 25 minutes.


Butternut Squash Puree with Orange, Ginger and Honey

This can be made with acorn squash as well.

Nonstick vegetable oil spray
5 pounds butternut squash, each cut in half lengthwise, seeded (about 2 very large)
1/4 cup (1/2 stick) butter
2 tablespoons frozen orange juice concentrate, thawed
2 tablespoons honey
2 tablespoons minced peeled fresh ginger (I just use some powdered ginger)
1 teaspoon grated orange peel (I leave the peels out)
1 teaspoon grated lemon peel
3/4 teaspoon ground cinnamon
1/2 teaspoon (scant) ground allspice (I sprinkle some nutmeg instead)

Preheat oven to 375°F. Spray large baking sheet with nonstick spray. Place squash, cut side down, on prepared sheet. Bake until squash are very tender when pierced with fork, about 50 minutes. Cool slightly. Scoop out pulp from squash and place in processor. Using on/off turns, puree pulp until smooth. Transfer squash puree to bowl.

Combine butter, orange juice concentrate, honey, ginger, and orange peel in heavy small saucepan. Boil until mixture is reduced to 1/3 cup, about 3 minutes. Stir mixture into squash puree. Mix in lemon peel, cinnamon, and allspice. Season generously with salt and pepper. (I do this differently; I just add the oj concentrate, honey and spices to the squash in the food processor and puree, then serve.)

(Can be made 1 day ahead. Cover and refrigerate. Rewarm over medium-low heat, stirring often, or cover with plastic wrap and microwave on high until heated through, about 5 minutes.)

Transfer to bowl and serve.

Happy eating!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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