Folic Acid (Folate)

The importance of folic acid is becoming fairly well known because of an advertising campaign sponsored by the CDC (Center for Disease Control), the March of Dimes, and the National Council on Folic Acid. I think many women are aware of the link between adequate folic acid and reduced risk of neural tube defects, like spina bifda.

Folic acid is critical very early in pregnancy. By the time many women realize they are pregnant, their baby's spinal column and brain are already fully formed (around week four). Many women plan pregnancies, but just about as many are surprised by an unplanned pregnancy. For these reasons, all the books I read recommend that women of childbearing age take a daily multivitamin that contains at least 400 mcg of folic acid, whether they are planning a pregnancy or not.

During pregnancy, most of the books recommend 600-800mcg of folic acid, daily. All the prenatal vitamins I reviewed contained 800mcg of folic acid. While getting some folic acid through diet is certainly do-able, this particular vitamin is another one, like calcium and iron, where supplementing with a vitamin can make a lot of sense.


What does Folic Acid do?
Folic acid is best known for what it prevents: say folic acid and many of us think "prevent spinal bifida", even if we're not sure what spina bifida is. Inadequate folic acid has been linked to neural tube disorders, which are malformations of the central nervous system. Spina bifida is the most common of these neural tube disorders. Many studies have shown that adequate folic acid during the first weeks of pregnancy dramatically reduce these very serious disorders.

In Nutrition for a Healthy Pregnancy, Elizabeth Somer explains just how important folic acid is: "Neural tube defects are the second leading cause of death among infants who die from birth defects in this country (Downs syndrome is the leading cause). One nutrient known to prevent NTDs is folic acid. Numersous studies since they early 1990s have consistently found that folic acid supplementation in women around the time of conception and during pregnancy reuces the risk of NTD, especially spina bifida and anencephaly. Women who supplement with folic acid also deliver babies at low risk for urinary tract, cardiovascular, and limb defects. You also tend to improve your fertility, are less likely to miscarry, and should suffer less from nausea" (6).

It is important to continue to get adequate folic acid because low levels may increase the risk of complications during pregnancy. Some studies show that a deficiency of folic acid during pregnancy can also increase the chance of preterm birth.

Having a Baby, Naturally also mentions folate's importance in DNA synthesis and the formation of red blood cells.


What are good food sources for Folic Acid?
Because folic acid is so important, many foods are now fortified with it, including cereal, pasta and rice.

Good natural food sources of folic acid include: beans and peas, leafy green vegetables, asparagus, sunflower seeds, whole grains, papaya, oranges, blueberries and strawberries.

According to Peggy O'Mara in Having a Baby Naturally, "you can get 400mcg of folate in your daily diet if you eat:

1 glass of orange juice or 1/4C of wheat germ or a small handful of dried soybeans and

1 egg or 2 slices of bread or 1/4 of a cantaloupe and

1 cup of pinto, black or navy beans or two cups of cooked turnip greens, spinach or asparagus or 1 tablespoon brewer's yeast" (25).

Other excellent food sources include:

1 cup of most breakfast cereals = 100mcg
1/2 cup boiled lentils = 180mcg
1/2 cup pinto beans = 147mcg
1/2 cup boiled asparagus = 130mcg
1/2 cup boiled spinach = 130mcg
1/2 cup wheat germ = 100mcg
1/2 cup orange juice, from concentrate = 109mcg
1/2 cup chickpeas, canned = 80mcg
1 cup spinach, fresh = 109mcg
1 cup split peas, cooked = 123mcg

How is Folic Acid absorbed?
Folic acid is not stored in the body, according to The Pregnancy Book, by Dr. Sears, which is why it is so important for women of childbearing age to have a consistently adequate intake of folic acid. Dr. Sears also explains that the kidneys excrete more folic acid during pregnancy, which is one of the reasons why pregnant women need more folic acid than when they're not pregnant.


Folic Acid supplements
Nutrition for a Healthy Pregnancy explains that, unlike many other vitamins, folic acid supplements actually work better than food sources. "Supplements are better than food when it comes to raising blood levels of this B vitamin and reducing birth defects . . . Folic acid levels in the blood increased only in the women who supplemented or consumed fortified foods, while dietary intake of folic acid-rich foods produced no change in folate status . . . Your best bet is to include two or more servings of folic acid-rich foods in your daily diet AND take a supplement that includes at least 400mcg of folic acid" (8).

Below are the books I used to write this post:
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

Calcium

During pregnancy, women need various vitamins and minerals to grow the baby - both the process and the baby's actual body. If a woman does not obtain enough of these vitamins and minerals to support her own body as well as the pregnancy, her body will always provide for the baby first, and her own nutrition will suffer.

Women who do not get enough calcium through food or supplement are at risk for osteoporosis (a reduction in bone mass) because of this fundamental principle. A pregnant woman's body will use the calcium stores in her bones to build the baby's skeleton.

Most sources recommend at least 1200mg of calcium each day for pregnant and breastfeeding women.

Do you know how much calcium is in your prenatal vitamin? Here are a few common brands and how much calcium each contains:

Rite Aid Brand Prenatal: 200mg
Rainbow Light Prenatal: 200mg
GNC Prenatal: 500mg
One-a-Day Prenatal: 300mg
Stuart Prenatal: 200mg

Surprised?

Clearly it's important for pregnant women to avoid counting on a prenatal vitamin to meet all of their calcium needs during pregnancy and breastfeeding.

What does calcium do?
As many of us know, calcium builds bones, so it is important prenatally for the baby's bones. Most us also know that calcium is in milk products - it's in breastmilk too! So, nursing mothers need calcium after baby is born too.

Several studies suggest that optimal amounts of calcium decrease the risk of pregnancy-induced high blood pressure (PIH) and pre-eclampsia.

In the Sears' Family Nutrition Book, Dr. Sears writes that "calcium is one of the most vital minerals for optimal functioning of your entire body" 955).


What are good food sources for calcium?
Good sources for calcium include dairy products like milk, yogurt, and cheese; fortified products like soy milk, orange juice, and cereal; fish; soy products; and greens. Here are some specific numbers:

Milk, low-fat: 1 cup = 300mg

Cottage Cheese: 1 cup = 155mg

Yogurt, low-fat, plain: 1 cup = 400mg

Parmesan cheese: 1 ounce = 336mg

Cheddar cheese: 1 ounce = 200mg

Sardines: 3 ounce = 371mg

Orange juice, calcium-fortified: 1 cup = 300mg

Tofu: 3 ounces = 190mg

Salmon: 3 ounces = 180mg

Broccoli, chopped (raw): 1/2 cup = 47mg

Almonds: 1 ounce = 80mg

Cereal, calcium-fortified: 1/2 cup = 100-200mg

Spinach, cooked: 1/2 cup = 136mg

Orange: 1 medium = 50mg

Soybean nuts: 1/4 cup = 116

Honestly, calcium was never a problem for me, because I love dairy. If I had one serving of cheese during the day (approximately 150mg), plus two glasses of milk for dinner (which equals 4 cups of milk, for a total of 1200mg), that was my calcium. People who don't tolerate dairy well, though, or who simply don't like it, need to be more mindful about including non-dairy calcium-rich foods in their daily diets.

O'Mara offers these suggestions for obtaining 1,000mg of calcium through food sources:

1 cup of milk or fortified soy or rice milk and

1 cup of yogurt or fortified soy or rice yogurt or 1 cup of cooked collard or turnip greens and

3 ounces of sardines or 1 stalk of broccoli and 1 cup of cooked turnip greens (26).

How is calcium absorbed?
In Nutrition for a Healthy Pregnancy, Elizabeth Somer explains that "the total cost of pregnancy for a woman who has had two babies and has breast-fed them both for three months is approximately 100,000 mg, the equivalent of more than 333 extra glasses of nonfat milk!" (77).

Somer offers this explanation for how the body handles its need for calcium during pregnancy and breastfeeding:

"During gestation, it helps compensate for higher calcium needs by increasing the average amount absorbed into your bones from food - from about 20 to 25 percent prior to pregnancy to as much as 50 percent during pregnancy. While nursing, your body compensates for the loss in breast milk by reducing calcium losses in the urine . . . Regardless of absorption, you need to make sure you get enough of this mineral prior to, during, and after pregnancy" (78).

In Having a Baby, Naturally, Peggy O'Mara explains that calcium is aborbed better when taken with vitamin C and vitamin D (26).

O'Mara adds that "new research on calcium is beginning to make some experts believe that getting the body to retain calcium stores is much more crucial in the prevention of osteoporosis than how much of it you consume. Consuming too much alcohol and caffeine and eating a high-protein diet seem to deplete the body of its calcium stores more quickly. Exercising helps the body to hold on to its calcium supply" (26). These habits - avoiding alcohol, limiting caffeine, and exercising regularly - have many health benefits for pregnant women and their babies beyond calcium retention, but that's certainly one more good reason to make them a priority.

Finally, calcium is aborbed best when smaller amounts of calcium-rich foods are eaten through the day and with meals.


Calcium supplements
For women who do not get enough calcium through their diet, a calcium supplement can make up the difference. Here is a list of recommendations to keep in mind if you decide to take a calcium supplement:

Avoid "natural source" calcium pills like bone meal or oyster shell because they might contain lead, a very toxic metal.

Take the calcium supplement at a different time - not at the same time as a prenatal or iron supplement, because calcium interferes with iron absorption, and iron interferes with calcium absorption.

Take calcium with vitamin C and vitamin D (400IU) to increase absorption.

Know how much of the calcium in your supplement is elemental - that's the amount that's actually usable by your body.

Taking calcium before bed may help you sleep.

Below are the books I used to write this post:
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

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

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

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

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

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

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

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

Good Breakfasts for Pregnant Women

This post is the first of a new Wednesday series about nutrition during pregnancy. I figured it'd make sense to start with breakfast!

When I was pregnant the first time, I had to be out the door by 6:40am so I could be at work (I was a high school teacher) between 7 and 7:15. I've never been a morning person. I've never enjoyed eating as soon as I get up - I'd much rather have breakfast after I've been up for an hour or so. Well, I found that when I was pregnant, sleep was very, very precious. In order to sleep a few minutes longer, I was sacrificing breakfast time. Turns out, that made me feel nauseous: morning sickness!! And, it turns out, the threat of morning sickness was very motivating to me - breakfast became the most important meal of the day because having it (or not) affected how I felt the rest of the day.

With baby #2, I knew I was pregnant way before the positive pee stick - one of the first major signs was breakfast. Without it, I chased a toddler and a puppy (whose bright idea was that combination??) all day feeling queasy & exhausted. With it, at least I was just exhausted. I would've been exhausted anyway!

I decided to check back on the weeks of food journaling I did with baby #1 (not so much with baby #2), to see just what I did have for breakfast. Here are some of the meals:

Mozzeralla cheese stick + fruit/veg muffin (x5 school mornings)
Yogurt, apple salad, 1 slice carrot bread, juice
2-egg souffle + 2 pieces of bacon; OJ and milk
Banana bread + milk
Cream of wheat with dried apricots and pecans
2 slices of whole wheat bread toasted with cheese; 1 apple; dill pickles and milk (what??? I was pregnant!)
OJ; yogurt with granola and blueberries
Cottage cheese with pineapple; OJ
Cottage cheese eggs; whole wheat toast; milk; OJ

These breakfasts were from my second trimester - first trimester breakfasts were different, mostly a can of ginger ale and those skinny pretzal sticks. By mid-morning I was usually feeling better and so could sneak in a snack before lunch. I did find that if I made a smoothie in the blender and slowly sipped it (again with the pretzals!) on my way to school, that also worked.

Here are some smoothie ideas to play around with:

Fresh or frozen fruits: banana, berries, peach slices, melon
Low-fat vanilla or plain yogurt or soy milk
Orange juice
Ice, if you want
Non-fat powdered milk (to increase protein)

Combinations I like:

yogurt + banana + small scoop of peanut butter
yogurt + frozen strawberries + banana + 1T powdered milk
soy milk + banana + frozen strawberries
yogurt + banana + OJ
yogurt + mix of frozen berries

I know some people swear that putting a few handfuls of spinach or a big kale leaf doesn't change the taste of a breakfast smoothie while adding great nutrients... I haven't personally tried this, but if you have (or if you do), I'd love to hear what you thought.

If you noticed a theme of a low-fat dairy source (skim milk, low-fat cheese stick, or low-fat yogurt) plus fruit/veggie bread or muffin for the second trimester breakfasts, that's because that's what I usually would grab on my way out the door. For my second pregnancy - when I was home, there was a lot of yogurt + fruit + homemade granola.

I'll be posting more recipes each week - here are a few to get you started:

Morning Glory Muffins - from Cooking Light

1 1/4 C Flour
1/2 C Packed Brown Sugar
1 Tsp Baking Soda
1 Tsp Cinnamon
1/4 Tsp Salt
1 C Carrot -- Shredded
1 Small Cooking Apple (Rome) – Shredded
1/3 C Raisins
1/4 C Pecans – Chopped
1/8 C Flaked Coconut
4 Oz Crushed Pineapple In Juice – Drained
1/3 C Vegetable Oil
1/3 C Apple Butter
1 Tsp Vanilla
1 Egg
1 Egg White

Preheat oven to 350 degrees.

Lightly spoon flour into dry measuring cups. Combine flour and next four ingredients (flour, brown sugar, soda, cinnamon, salt) in a large bowl.

Shred or chop apples and carrots and pecans (in food processor is easiest). Add to flour ingredients with raisins, coconut, and pineapple.

In separate bowl, combine oil, apple butter, vanilla and eggs. Stir well with a whisk. Add oil mixture to flour mixture; stirring just until moist.

Spoon the batter into a 12 muffin cup pan coated with cooking spray.

Bake at 350 degrees for 25 minutes. Remove muffins from pans immediately to cool on a wire rack.

Pregnancy modification: all whole-wheat flour or half and half whole wheat & white; and/or a few tablespoons of wheat germ mixed in with the flour to add protein. Cooking Light lists the muffins as having 2.6 grams of protein each with just white flour.

These muffins keep very well in the refrigerator. My kids also really like them.


Sweet Potato Bread - from Cooking Light

1/3 cup flaxseed
2 cups all-purpose flour
1 teaspoon baking powder
1/2 teaspoon baking soda
1/4 teaspoon salt
1/4 cup (2 ounces) 1/3-less-fat cream cheese, softened
3 tablespoons butter, softened
1/2 cup packed brown sugar
1/4 cup honey
1 large egg
1 large egg white
1 cup mashed cooked sweet potato
Cooking spray
Preparation

Preheat oven to 350°.

Place flaxseed in a clean coffee grinder or blender; process until coarsely ground. Lightly spoon flour into dry measuring cups; level with a knife. Combine flaxseed, flour, baking powder, baking soda, and salt in a large bowl; make a well in center of mixture. Beat cream cheese and the next 5 ingredients (cream cheese through egg white); stir in sweet potato. Add to the flour mixture, stirring just until moist.

Spoon batter into an 8 x 4-inch loaf pan coated with cooking spray. Bake at 350° for 50 minutes or until a wooden pick inserted in center comes out clean. Cool 10 minutes in pan on a wire rack; remove from pan. Cool completely on wire rack.

Note: To freeze bread for up to 1 month, place in an airtight container, or wrap in heavy-duty plastic wrap or foil. Thaw at room temperature.

Pregnancy modification: Again, I used half & half whole wheat & white flours. I also used sweet potatoes from a can - mashed what I needed and put the rest in the freezer for the next time I made this. With just white flour, Cooking Light lists the protein grams per slice as 3.6.

This is really good with low-fat cream cheese spread on it.

And last, my favorite yummy, yummy granola:

Maple Pecan Granola - from Cooking Light

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
Preparation

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 1 hour, stirring every 15 minutes. Cool completely.

Note: Store in an airtight container for up to one week.

My note: it can also be frozen. I love it with fresh berries and/or banana and plain low-fat yogurt. Also good with pumpkin butter swirled in during the winter when fresh berries are harder to find (or afford!).

Cooking Light lists the protein grams as 2.2/serving.

If you're looking for more ideas about the specifics and benefits of healthy eating during pregnancy, click on the nutrition label below, or here. Enjoy!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

New Links & Resources

Before I get to the safety issues surrounding different birth choices, I want to highlight several of the interesting resources and links I've come across lately.

Some goodies from the Midwifery Today online newsletter "E-News 10:17", include a quote

"We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents."

— Elizabeth Davis
Excerpted from "Autonomy at Work: Woman-Centered Birth and Midwifery," Midwifery Today, Issue 42

and a link to an excellent, excellent article, "VBAC & Choice: Many Questions and a Few Answers", by Nancy Wainer. I bet the whole article is amazing.

The Mothering email newsletter also offered a great article, "Easing Tension and Fear in Natural Childbirth by Understanding Sphinct*r Law*: A Conversation with Ina May Gaskin" as well as information about how to attend a free "webinar" (I've done two through Lamaze so far, and they've been great) on cosleeping, presented by James McKenna and Dr. Paul Fleiss. To learn more and how to sign up, visit http://www.mothering.com/interactive/webinars/cosleeping.html. I'll "be there".

In the Lamaze online newsletter for "Week 11" (no, I'm not pregnant - just checking out their resources!), there was an ask-the-expert question about pregnancy classes. The question was: "I’m in my first trimester with my first baby. I plan to take childbirth classes closer to my due date. But I feel like there is so much to learn about pregnancy—not just the birth. My doctor answers some of my questions during my prenatal appointments, but there isn’t enough time for all of them. Is there a class I can take about pregnancy?" I wonder if there is enough interest to do a pregnancy class here in Central Maine? I would love to do a class for moms/partners who are TTC or are newly pregnant - to answer questions about pregnancy, prenatal testing, exercise and nutrition, and also to talk about choices for care providers and hospitals. At the point when most of my clients' take classes, they have to be supremely unhappy with or uneasy about their care provider to change (though some still do!). I'd love to offer women/partners the information they need to think through their choices before their third trimester! Any thoughts on pregnancy classes? Oh - and if you're reading this and wondering, I would happily do a private pregnancy class - just send me an email!

Also, my local LLL leader sent out an email with information about new resources from the US Department of Health and Human Services, Health Resources and Services Administration regarding breastfeeding and employee/employer policies. They're free, too.

"The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: For Business Managers"

Abstract: This manager’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It focuses on a company’s potential return on investment in the areas of employee retention, health insurance, absenteeism, productivity, and employee loyalty. The booklet includes profiles of companies with existing supportive lactation programs and references.

"The Business Case for Breastfeeding. Steps to Creating a Breastfeeding Friendly Worksite: Employees' Guide to Breastfeeding and Working"

Abstract: This employee’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It includes information on where to find breastfeeding help and support, how to begin breastfeeding at home, and how to adjust to breastfeeding at work. The booklet includes support websites, figures, and guidelines for addressing supervisors.

The Business Case for Breastfeeding. Steps for Creating a Breastfeeding Friendly Worksite: Easy Steps to Supporting Breastfeeding Employees

Abstract: This human resource’s booklet is part of a series of materials designed to create breastfeeding friendly worksites. It details an integrated approach to implementing a cost-effective lactation support program. The booklet gives steps to support breastfeeding employees, explains how to merge work requirements with employee needs, offers program options, and outlines the program’s return on investment for the company. It includes profiles of employers with existing supportive lactation programs.

I ordered ten of each, completely for free (including S&H) just now, very easily.

And lastly, The True Face of Birth blog has had some great posts in the past few days, including one about doulas ("Doulas Make a Difference"), which sites a RCT (randomized controlled trial) study about doulas; one about "The Dance of Breech" with great drawings and links; and a reminder that "The Birth Survey is Here!" - yay! There doesn't seem to be any information for Maine mothers yet, but hopefully there will be soon.

Enjoy the links!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

*Sorry about the asterisk - that word was attracting some unwanted attention from search bots.

Pregnancy Awareness Month Week Four: Nurture

As is pointed out in the Pregnancy Awareness newsletter this week, to nurture means "to nourish".

It is incredibly important to nourish ourselves as mothers (as people!) - our bodies, our minds, our souls. A mother who takes time to nurture/nourish herself will, over time, be able to nurture/nourish her children more completely.

More on this later... right now I'm back to the couch with my little guy who has the stomach flu & desperately needs Mama-nurturing.

Christina @ Birthing Your Baby
Independent Childbirth Classes in Central Maine

Pregnancy Awareness Newsletter Link

Pregnancy Awareness Newsletter for May 4th: Eduation Week

I found this comment in the newsletter particularly insightful: "During my pregnancy with my daughter India (who is now 3) I read what seemed like hundred of books. Books on pregnancy, books on birthing, books on parenting and then some. I had no firsthand experience of being a mom and I wanted to go into motherhood equipped with as much information as possible. I feel it is important to educate oneself to feel empowered but I also feel it is important to weed out what does not feel right to you. Use your intuition to guide you and you will find your way."

There are lots of ways to learn about pregnancy and childbirth: talking to friends/family, reading books and magazines, going online, watching television shows etc. All of these methods are much less powerful than actually experiencing a bunch of births, in real life.
One of the best ways to learn about anything is by seeing it done. In the "olden days", birth was a part of life that happened where everything else did - at home, with our families. So from a young age, to adulthood, and then as grandmothers, women used to be a part of many births - not just their own but their mothers, sisters, aunts, daughters, friends, etc... Over time, more and more births moved into hospitals, and birth has become more and more separate from everyday life, simply because it is not something that we "do" regularly. Most women do not attend a birth (except on their own birth-day!) until they themselves are birthing a baby.

I think that the separation of birth from everyday life has made women more scared and anxious about it. The info-tainment baby tv shows don't help either. If most of what I knew about birth came from cable tv and a few acquaintences or friends who shared scary birth stories with me, I'm sure I would be thinking about birth from a very scary, anxiety-filled perspective. The tv shows compress something that might take 10-20 hours and shape it into a narrative that makes sense and is exciting enough to bring people through the commercial breaks. So much of realtime birth is boring, really - it's waiting for things to pick up, it's moving through real life until the flow of contractions strengthens and moves us into Laborland, it's resting in the tub or on the birthball, resting in-between pushing contractions etc. All this resting and waiting and moving on with life isn't terribly interesting, which is why a long labor can be condensed into such a short narrative which really doesn't tell the truth about the whole experience. And that's one of the big problems with these shows - that they seem like non-fiction - hey! this is something that really happened! - but really, they've been so distorted that they've become fiction, and are no longer a credible source of information.

The Listening to Mothers II survey summary states that "First-time mothers identifited books as their most important source of information about pregnancy and childbirth, and those who had given birth before relied most on their own prior experiences. Far more mothers were exposed to childbirth through TV shows than through childbirth education classes. As they neared the end of pregnancy, most women felt confident and a majority also felt fearful about their upcoming birth." Ack! is about as articulate as I can be about the more TV shows than childbirth classes sentence.

Later this week I'll post some of my favorite pregnancy and childbirth books, and discuss how childbirth classes can be helpful. I'll leave you with this fun link I found today: Virtual Labor Game

Christina @ Birthing Your Baby
Independent Childbirth Classes in Central Maine