Overweight mothers often times are told to restrict their calories and to only gain a small amount of weight or even none at all. I have read so many stories of care providers giving over weight moms a really hard time. The Well Rounded Mama talks about this here and shares stories from other women. The scare tactics used against overweight moms range from ‘you will have a large baby and have a stroke while trying to push it out’ to ‘you will develop blood clots’ to ‘you will not be able to sustain a pregnancy.’ It’s really a shame and instead of berating these mothers for being overweight, it would be so nice if mainstream medical care would help them to be healthier and have the healthiest pregnancies possible by focusing on exercise and proper nutrition throughout pregnancy rather than numbers on a scale. Like I have said before, contrary to popular belief, you can not grow a baby with the extra fat on your hips!
In thinking about this topic, I decided to ask Joy Jones what her thoughts were. Joy is an RN and has been working with pregnant women and the Brewer’s Diet for more than thirty years. She has so much knowledge and insight on this that I asked her if I could repost our emails to each other here on my blog. THIS is the information women need. This is what they need to see when they are googling “pregnancy and obesity” and “weight gain recommendation for overweight moms” and ” diet for overweight pregnancy.” So here goes…
Hi Joy, I wanted to ask what your experience is with Brewer's and the overweight mother. I would like to be able to advise an overweight client as I am not sure how she will be treated by the doctors and what kind of dietary guidance and weight restrictions they will give her. She walks daily and hired a personal trainer a few months ago and she said that as long she walks regularly, her borderline high bp stays in the normal range. What are your thoughts? Thanks, Amy
Dear Amy, Dr. Brewer's most basic response to this kind of question was...... 1) The kind of food eaten during pregnancy is more important than the number of poundsgained—both weekly and overall. http://home.mindspring.com/~djsnjones/id11.html 2) Each pregnancy grows a new placenta which needs an expanded blood volume in order tofunction properly.All pregnancies have this need, regardless of the mother's beginningweight. 3) In order to service the placenta adequately, the mother's blood volume needs to increaseby 60% by the end of the second trimester, and then it needs to be maintained at that levelfor the rest of the pregnancy. 4) In order for that blood volume to expand by that much by the 24th week, and stay expanded throughout the third trimester, the mother needs to eat according to a plan that includes acertain level of calories PLUS salt PLUS protein (it's not just about protein, and withoutall three components,this plan is not likely to work as it's designed to do). 5) The mother's body can expand the blood volume only from the food that she eats. ItCANNOT create what she needs for expanding the blood volume, or for creating baby cells, or for creatingnew uterine cells, by breaking down her extra body fat. 6) There are many different reasons for a woman to become overweight. But if part of thereason for a specific individual woman to be overweight includes too many carbohydrates orfats and too little exercise, then she may actually lose weight on the Brewer Diet, simplybecause she is changing her lifestyle to a more healthy way of eating. But weight loss shouldnot be her goal, only a consequence of eating in a better way. 7) If a mother adds extra exercise to her lifestyle, she needs to be careful to add enoughcalories to the Basic Plan of the Brewer Diet to compensate for that extra exercise.Otherwise, she may be at risk of burning up some of her precious protein intake for energy,thus risking having her blood volume drop and triggering the pre-eclampsia process. http://home.mindspring.com/~djsnjones/id95.html 8) A healthy eating style for a healthy pregnancy needs to also include a good level ofhealthy kinds of fats and a good level of healthy kinds of carbohydrates. The Basic Planof the Brewer Diet includes both of those food groups, and you can see how many servingsof each (and examples of good sources) at this page... http://home.mindspring.com/~djsnjones/id96.html If you haven't done it already, I also suggest that you check out the "Obesity" page on mywebsite.... http://home.mindspring.com/~djsnjones/id69.html PART IIDear Amy, I was answering in a hurry earlier because I was thinking that the laptop was going to walkoff again with my husband,but he is using something else today, so I can add a few thingsto my previous response. "I wanted to ask what your experience is with Brewer's and the overweight mother." I don't remember any specific overweight mothers from my experience, although I am sure thatthere were some, since I've been working with pregnant mothers for almost 32 yrs, and probablyabout 500-700 mothers. Whenever I worked with natural-oriented midwives, we tried to focusmore on what the mother was eating between prenatal visits, more than on the number of poundsshe was gaining during those times. The mothers who stand out in my mind are the one who wasapparently eating so poorly that when I showed up to help with the birth, her bones weresticking out of her body, like those on an anorexic woman (I was not included in the teachingor monitoring of her diet during the prenatal care)....or the mother who ate little morethan cocoa puffs, no matter how hard we tried, and ended up with PUPP syndrome and nursingproblems.....or the 2-3 mothers who had 10 lb babies with no problems pushing them out(and the one who had to work harder at it)....or the mothers who got advised to cut back onsalt or calories or to exercise a little extra and ended up with elevated BPs andpre-eclampsia symptoms and hospitalization and premature births as a result.....orthe mothers who were able to hold back their creeping BPs with hourly doses of protein andcalories and sodium....and the mother who weaned her baby at 4 weeks so that she could goon a cruise with her extended family (leaving the baby at home)....and the ESL mother whoinsisted on bottle-feeding her baby for the first 3 days because colostrom is obviously notbreast milk or adequate for feeding a baby. I also remember a few pregnant women who had losta lot of weight before the pregnancy, who had to stand with their backs to the number displayon the scales, at every prenatal visit, so that they could eat well and not be anxious aboutthe number of pounds that they were gaining. For those women we also had to put many noteson the outside and inside of their charts to caution all the people caring for them to NOTtell them what their weight gain was. I don't consider age or being slightly overweight or having recently lost a lot of weightas being risk factors on their own. I think that the groups of women with those factorsin their lives may have higher rates of pre-eclampsia (and the other complications associatedwith low blood volume),simply because when those women go to mainstream care-givers they arelabeled "high risk" and put on inadequate diets, which then creates the very complicationswhich they are trying to prevent. In addition, on the subject of age, depending on lifestyle, you might have a 40 yr old womanwho is healthier than a 25 yr old--aside from the issue of increased difficulty in conceiving. "I want to advise her as I am not sure how she will be treated by the doctors and what kindof dietary guidance they will give her." I can almost guarantee you that most doctors will treat her as "high risk" and try to controlher pregnancy and birth to pieces. I think that the only way that she will have a chanceat a normal pregnancy and birth is to go to a very good midwife. Homebirth would be herbest bet. But if she is not comfortable with that option, she should not evenattempt it, because if she does not believe in her gut that homebirth is her safest option,she will most likely just get transported to a hospital mid-labor, for lack of progress.Her cervix simply will not open if she is not laboring and giving birth in a place that feelssafe to her, and with care-givers who feel safe to her. Her next best option would be abirth with a midwife in a free-standing birth center. Her next best option would be a hospital birth with a midwife--preferably a non-mainstream type of midwife (many midwivesare just as medically-minded as OBs are, or almost as much). For that last category, she should look for midwives who do not share an office with theirback-up doctors, but work in a practice which is independent from that of their back-updoctors. She can also interview midwives and see which ones insist on all the testspossible, and which ones make at least some of the various prenatal tests optional(the latter being the more natural-birth oriented ones, in my opinion).She can also checkvarious homebirth websites for suggested lists of questions to ask midwives to see if theyare the kind of midwife that is more natural-birth oriented. She can also use the questionsthat I have listed on my first "Registry" page.... http://home.mindspring.com/~djsnjones/id97.html I also suggest that she go to her local public library and check out "The Pregnancy After 30Workbook", by Gail Brewer (or she can get it through inter-library loan, through her localpublic library, if they don't have it). The following is Dr. Brewer's chapter in that book.... http://home.mindspring.com/~djsnjones/id72.html At the very least, I suggest that she hire a very, very good, very experienced, very wellcertified doula (and preferably one who has extensive experience in both home and birth centerand hospital births), from the FIRST DAY that she knows that she is pregnant. This doulacan help her work her way through finding out what are the best options for prenatal carein her area, help her to choose a more natural-birth oriented care-giver who also fits herunique comfort level and needs, and help her through every step of the way as hercare-giver offers (or insists on) various tests, procedures, or life-style changes, helpingher to see how much broader her choice of options is than her care-giver might be giving her.A doula might charge a little more for this all-pregnancy kind of care than she would forthird-trimester/labor kind of care, but I suspect that she will be able to find a doula willing to do this, especially if she explains why she needs this kind of help, and that shemight be willing to pay a little more for this kind of care. She might also be interested in the article about how a woman with pre-existing hypertensionwas able to go off of her anti-hypertension drugs when she got pregnant, just by adding moresalt to her diet.... http://home.mindspring.com/~djsnjones/id70.html She might also be interested in the recent study which cautions women against doing too muchexercise when they are pregnant because it can increase their risk of developing pre-eclampsia –which I think underlines the Brewer caution to be very sure to add enough calories and salt tothe diet when a pregnant woman has extra exercise in their lives (exercise of daily livingas well as recreational exercise). You can scroll down to the bottom of the page to wherethe paragraph in red lettering is. I don't remember precisely, but I think that this studysuggests that more than 15-20 min of moderate recreational exercise a day is too much for apregnant woman. http://home.mindspring.com/~djsnjones/id95.html Again, I hope that this helps. Best wishes, JoyRead Full Post | Make a Comment ( 1 so far )
This website is very informative and explains how the Brewer Pregnancy Diet works in great detail. The author if the site is Joy Jones. She is an RN and childbirth educator with extensive knowledge of the Brewer diet and nutrition in pregnancy.
The Brewer Diet, as I discussed in a previous post, focuses on protein, salt and calories. Joy goes into depth on the benefits of the diet and how nutrition can affect:
As I have said before, diet cannot necessarily cure every pregnancy issue but it can affect many aspects of pregnancy and it is something that we can and should control. Please be sure to read about the Brewer diet if you are pregnant and pass this on to anyone you know that is pregnant.Read Full Post | Make a Comment ( 2 so far )
Preeclampsia is a disorder that only occurs during pregnancy and just after in the postpartum period. It can affect both the mother and the unborn baby and is estimated to affect between 5-8% of pregnancies. It can be very dangerous and it along with some related disorders are responsible for about 76,000 maternal deaths and 500,000 infant deaths per year. It is not something to mess around with.
The symptoms of preeclampsia are high blood pressure, presence of protein in the urine, sudden weight gain, headaches, swelling and blurred vision. It is typically rapidly progressing which is why when a woman’s blood pressure is higher than what her normal has been during the pregnancy, the care providers tend to start watching closely.
Preeclampsia is most common in the first pregnancy. The risk factors for preeclampsia are:
Previous history of preeclampsia, particularly if onset is before the third trimester
History of chronic high blood pressure, diabetes or kidney disorder
Family history of the disorder (i.e., a mother, sister, grandmother or aunt who had the disorder)
Women with greater than 30% Body Mass Index (BMI).
Over 40 or under 18 years of age
Polycystic ovarian syndrome
Lupus or other autoimmune disorders such as rheumatoid arthritis, sarcoidosis or MS.
The chances of having preeclampsia in a second pregnancy are kind of vague. According to preeclampsia.org:
” If I had preeclampsia in my first or an earlier pregnancy…
There has not been significant research looking at the rate of reoccurrence in subsequent pregnancies, however the consensus among experts is that preeclampsia in a previous pregnancy is the single largest risk factor for developing preeclampsia. It is entirely wrong to say that if you had it in your first–you will not get it again. The risk of having it again is approximately 20%, however experts cite a range from 5-80% depending on when you had it in a prior pregnancy and how severely you had it.
The risk increases if since your previous pregnancy you have developed chronic hypertension, diabetes, or if you are having IVF, twins or other multiples, as well as the risk factors mentioned above.”
Often times women are given magnesium sulfate to prevent preeclampsia from becoming full on eclampsia (seizures and possible stroke). With severe preeclampsia, women are given the magnesium sulfate while still pregnant. Because preeclampsia is the largest known cause of prematurity in the U.S., treatment with magnesium sulfate often buys enough time to administer steroids to strengthen the babies lungs.
The side affects of magnesium are:
# General muscle weakness
The risks of magnesium sulfate are:
# Cardiac arrest
# Pulmonary edema (lungs fill with fluid; can be fatal)
# Chest pain
# Cardiac conduction defects
# Low blood pressure
# Low calcium
# Increased urinary calcium
# Visual disturbances
# Decreased bone density
# Respiratory depression (difficulty breathing)
# Muscular hyperexcitability
The risks to the baby are:
# Motor depression
# Decreased muscle tone and drowsiness
# Respiratory depression
# Meconium ileus
# Long bone demineralization
# Congenital rickets
# Radiographic bone changes
# Neuromuscular blockade with gentamicin
# Marked hypotension with nifedipine
In short, it’s nasty, mean stuff (even meaner than pitocin for all you ladies who got a kick out me calling pit nasty and mean)
If you had preeclampsia in your first pregnancy (especially if you had magnesium!) you are probably wondering if there are ways to prevent it in subsequent pregnancies. There is contradictory information on this. Some doctors say you can’t prevent it, some say you can. There aren’t too many ways to say that you can’t prevent it so I guess I don’t have to go into detail with that. I will explore possible ways to prevent it. The way I see it is if the potential prevention methods won’t hurt, why not try?
It has been suggested that increasing dietary fiber can prevent preeclampsia. The study suggests that out of 383 women, the ones who consumed more than 24 grams of fiber a day (the top 25% for consumption) has a 51% reduction in the risk for preeclampsia. So go eat some fiber ladies!!! Your body will thank you in more ways than one;)
“It’s not genetics. It’s not random. The cause is NOT unknown. Toxemia CAN be stopped. PreeclampsiaA-toxic-condition-developing-in-late-pre… CAN be stopped. Best of all, YOU can stop it!
HOW? All the scientific research being done on toxemia and preeclampsia these days is focusing on treatment, and none of it is promising. But the research has already been done, many times and many ways in the past 50+ years, and we know that you can PREVENT this from happening to you in the first place, no matter what your personal history may be. The simple answer? GOOD NUTRITION.
Common sense tells you to eat right when you’re pregnant, and traditional wisdom says you’re “eating for two“. So why are doctors telling you to cut out salt, avoid gaining too much weight, and giving you little or no information about what IS a good diet for pregnancy? Why is the medical community so disinterested in this information? As one doctor put it, “No one is going to make any money off good nutrition.”
The simple prevention methods are to be sure to drink lots of water, avoid alcohol and caffeine.
Exercise has also been suggested as a prevention method. Basically, exercise improves circulation which in turns improves blood pressure.
Speaking of exercise, stretching exercises may be more effective at reducing the risk of preeclampsia than walking is for pregnant women who have already experienced the condition and who do not follow a workout routine, according to researchers at the University of North Carolina at Chapel Hill School of Nursing. So get some prenatal yoga videos and go for it!
* Before becoming pregnant, ask your doctor to perform a thorough evaluation of your blood pressure and kidney function.
* If you or a close relative had vein or lung blood clots before, ask your doctor about testing you for clotting abnormalities (thrombophilias ). These genetic defects increase your risk for preeclampsia and placental blood clots.
* If you are obese, consider weight loss.. Weight reduction may decrease your risk of developing preeclampsia again.
* If you have insulin-dependent diabetes mellitus, good control of your blood sugars before becoming pregnant and early in pregnancy reduces your risk for having preeclampsia again.
The prevention of preeclampsia has been the focus of multiple clinical trials. The following medications and supplements have been extensively studied for their potential to prevent preeclampsia:
* calcium (for example, Os-Cal);
* fish oil supplements (for example, Promega);
* supplements with vitamins C and E; and
* baby aspirin (for example, Ecotrin Adult Low Strength).
However, large studies have not shown calcium supplementation, baby aspirin, or fish oil supplementation to be beneficial in preventing preeclampsia. Early studies with vitamins C and E show a possible beneficial effect, but larger studies should be conducted before these agents can be broadly recommended. .
So, what do I think (for what it’s worth, right?)? I think that if it’s not going to cause any harm then try it! If it were me I would:
Get tested for thrombolphilias (I am biased, I have a blood clotting disorder but still if you can treat that and maybe prevent PE, go for it!)
Follow the Brewer diet as best I could
Exercise: walking and prenatal yoga daily
Lose any extra weight before getting pregnant again
Eat lots of fiber (but if you are doing Brewer’s you probably already are)
Drink lots of water (I read one 1/2 ounce per lb of body weight)
Make sure to get lots of calcium and vitamin C
Good luck all you mamas who had it round one. I wish you all the best for round two;)Read Full Post | Make a Comment ( 25 so far )
I thought long and hard about what my first post should be about and I think keeping up with the current news seemed appropriate. In the spirit of all things birth, here are the newest recommendations on weight gain in pregnancy.
Here is a link to an article discussing the new recommendations.
But I kind of have a problem with this. Instead of asking moms “how much weight have you gained?” maybe we should be asking “what are you eating?” instead. So often moms are told to eat healthy and balanced. We are supposed to do that anyway but especially when we are pregnant. But what does healthy and balanced mean anyway? What does a pregnant women really need? How much nutrition counseling are we getting at our prenatal appointments? Are we even talking about nutrition at prenatals or are we just stepping on the scale month after month and getting a little slap on the hand when we go above the ‘limit’? And by the way, contrary to popular belief, you cannot build a baby from the extra stores of fat on your hips.
In the U.S. we have so much access to so much processed food and fast food. We have so much junk food available to us 24/7 and well, anyone who has been pregnant knows that cravings are hard to resist. The thing is though, that when we are pregnant we need so much more than what tater tots (guilty here!) and candy bars can provide. We need more than sugary cereal for breakfast and a soda at lunch to settle our queasy stomachs. I think that it would much more productive if during prenatal visits ample time were spent on nutrition counseling rather than focusing on the scale. It’s already been proven that diet can control gestational diabetes and pre-eclampsia and PIH. How about preventing it? Yep, that too.
Dr. Tom Brewer is one of the leading experts on pregnancy and nutrition. The Brewer’s Diet focuses on protein, the building block of pregnancy and salt which is necessary and should not be restricted. Dr. Brewer spent 50 years dedicating his life to helping women be healthier in pregnancy, feel better in pregnancy and to have healthier babies. His research demonstrates that good nutrition can help prevent still birth, premature birth, pre-eclampsia, anemia, placental abruption, infection and miscarriage His research showed that by eating properly that many of the common problems of pregnancy can be avoided and he did this without ever worrying about weight gain. He stressed that the amount of weight you gain is not an indicator of the nutritive value of your diet.
Protein is vital to a baby’s growth. During pregnancy, protein and amino acids are needed for the placenta. Your baby’s physical growth depends greatly on protein. New tissues and organs grow by laying down and combining millions of proteins. The Brewer Diet suggests that 80-100 grams of protein a day are necessary for an expecting mom.
Concerning salt intake he says
“Salt restriction during pregnancy limits the normal expansion of the blood volume, with disastrous consequences. Depending on the degree of sodium restriction and the subsequent blood volume limitation the placenta may:
* grow slowly, or not at all,
* develop areas of dead tissue (infarcts) that cannot function,
* be unable to accomplish the transfer of nutrients to the baby,
* even begin to separate from the wall of the uterus, causing hemorrhage and cutting off the baby’s oxygen supply.”
Here is a printable copy of the diet.
Below is what the printable copy has on it:
If You Are Pregnant
Have you ever tried to watch your nutrition with the diets in popular pregnancy books? It’s downright frustrating! Dr. Brewer’s diet is simple, yet powerful. No double-counting certain foods in different categories, or complicated calculations of grams and calories. Just print this sheet and check it off daily. PLEASE print it as many times as you need to! Make copies!! Pass it on to your friends! Spread the word!!! (Sorry, this form is not interactive, the boxes are just for looks.)
Every day of the week, you and your baby should have:
Milk Servings (8 grams each) = 32 grams
Eggs (6 grams each) = 12 grams
With just 2 eggs and 4 glasses of milk you’ve already laid
a “protein foundation” for today’s excellent nutrition!
You’re halfway there! Subtotal = 44 grams
Meat/Protein (avg. 25 grams each) = 50 grams
Green Leafy Veggies (under 1 gram each) = 2 grams
Other Veggies (under 1 gram each) = 1 gram
Whole Grain Bread (2 grams each) = 6 grams
Citrus Fruit or Juice (~1 gram each) = 1 gram
Other Fruit (under 1 gram each) = 1 gram
Butter (1 gram each) = 3 grams
Protein Grand Total (if all boxes checked) = 109 grams
And don’t forget the following foods weekly:
Whole grain cereal (oatmeal, wheatena, etc.)
Yellow or orange fruits and veggies
Liver (if you like it)
A whole potato, any style.
If you were overweight before pregnancy, or have been diagnosed with diabetes (or simply don’t like potatoes ;-)), skip the potato and choose instead from the following list: large green pepper, grapefruit, lemon, lime, papaya, tomato (one piece of fruit, or one large glass of juice).
Congratulations! You’ve given your baby the best possible start in life by eating right TODAY! Simply do this every day during pregnancy, one day at a time, and you’re doing everything you can to ensure that you and your baby won’t suffer from toxemiaAs-defined-by-the-1997-Merriam-Webster-M…, low birth weight, IUGR, and a host of other nutrition-related ills. Way to go!!
So, while yes, we probably shouldn’t be gaining 75lbs in pregnancy, I think rather than setting weight restrictions on women it would be much more helpful and productive if dietary suggestions were being published instead. Everyone should do their own research and homework. I mean, who I am I to throw a diet that I believe in on my blog and expect everyone to follow it? We have to take responsibility for ourselves and our bodies and our babies so go read about it!Read Full Post | Make a Comment ( 24 so far )