Herbs in Pregnancy

Herbs

We’ve written in the past about a pregnant woman’s lowered immunity. Good nutrition, sanitation habits, rest, and exercise all help to strengthen the pregnant woman’s immune system—yet she will inevitably be exposed to viruses and other immune challenges. Pharmaceutical remedies may prove too strong or be contraindicated in pregnancy, so we wondered about herbal remedies. What herbs are safe in pregnancy and what herbs should be avoided? We turned to an herbalist with training in the use of herbs during pregnancy and postpartum to find the answers. *

Before receiving clinical training in Herbal Medicine for Women, Julie Pettler worked as a physical therapist. Later, while teaching her young children at home, Julie built a large garden in her yard and began to keep bees. As her love of gardening grew, so did her fascination with the power of herbs—herbs that grow naturally and herbs that can be cultivated—to treat common ailments. “I study history, science, anatomy, and human health [as an herbalist],” Julie says. “Sometimes I walk barefoot through my yard to gather dandelion greens to add some bitter to my diet. Sometimes I order a strong tincture to stimulate a client’s lymphatic system.” In her current herbalist practice, she combines her love of teaching with her love of plants by leading workshops on foraging, herbal medicine making, the holistic use of plants for health and well-being, and the history and science of plant medicine. Studying herbs for women’s health combined another of her passions: advocacy for pregnant women and evidence-based childbirth.

We started the conversation by asking Julie when the pregnant woman can use herbs during pregnancy. “Herbs may be used for general nutritional support during pregnancy, such as with the use of pregnancy “teas,” and confidently used to address common mild discomforts such as nausea, itchy skin (topical use), and heartburn,” she says. “If a more serious issue arises during pregnancy, herbs may be considered in consultation with a knowledgeable practitioner.”

Julie offered a list of categories of herbs traditionally avoided in pregnancy. “Stimulating laxatives, such as Cascara sagrada, [and] aloe and rhubarb should not be used during pregnancy.” She suggests instead non-stimulating bulk laxatives such as flax or psyllium. Tansy, Mugwort, wormwood, and yarrow stimulate menstrual flow and should not be used. Julie points out that the literature on the safety of herbs in pregnancy is often conflicting, so she suggests a conservative approach to the use of herbal remedies.

The following are some of her suggestions for use in pregnancy:

Nausea

Nausea is a common complaint among pregnant women, in particular in the early months. Julie recommends ginger. “It’s the most studied herb for nausea in pregnancy,” she says. “And the studies support the traditional use of ginger.” Ginger can be taken as a tea (simply shaving fresh ginger into a teacup and steeping it in hot water, can create the tea), as ale in the form of ginger ale with real ginger, in capsule form, or as a candy.

Colds and Flus

For immune support, Julie recommends Echinacea initially, at the first sign of a cold or a flu. “It can be combined with elderberry for extra immune support,” she says. “If a cold or flu sets in, Echinacea should be discontinued. Many times though, the use of Echinacea will prevent illness.” Echinacea is best used for a short duration and can be taken in tincture form every few hours for two-three days.

Pregnancy Tea for Uterine Support

Pregnancy teas support and tone the expanding uterus in the second and third trimesters. Julie recommends equal parts Red Raspberry Leaf, Nettle Leaf, Oat Straw, and Alfalfa (measuring one cup combined). Using one quart of boiling water, cover and steep the herbs overnight to make the nourishing tea.

Postpartum

Julie suggests using herbs for after pains and for healing and antiseptic support of the perineal tissue. Antispasmodic herbs include chamomile, catnip, motherwort, and cramp bark, and can provide relief from after pains. Sitz baths, warm compresses, or peri-rinses to support the perineum postpartum can be made using comfrey leaves, calendula flowers, lavender flowers, sage leaf, yarrow blossoms, and rosemary.

A longitudinal study in 2001 on the use of pharmaceutical medications in pregnancy concluded that 91% of conventional medications had not been proven safe in pregnancy; physicians had inadequate information on the safety of medications in pregnancy. The World Health Organization studied the safety of vaccines in pregnancy and reached a similar conclusion—there are not enough studies conducted on pregnant women for obvious ethical reasons.

Most pregnant women have healthy pregnancies despite the lowered immunity. Herbs can provide a safe and low-risk option for women wanting to boost their immune systems when they’ve been exposed to a cold or flu, when they are preparing for birth, and during the early trimesters for nausea or in the postpartum period when their bodies are healing. “I love that the plants are simultaneously simple and complex,” Julie says. “I love the ways herbs can nudge our bodes toward health by nourishing us and supporting all of our body systems. This is an excellent time to slow down and embrace the healing power of plants.”

*Always consult with your healthcare practitioner before using herbs in pregnancy

How to Get Healthy and Stay Healthy During Pregnancy

 

maternity-pictures-1_carmenhibbinsEach woman arrives at a new pregnancy from a different starting point. One woman may have planned for months to get pregnant, taking vitamins, eating healthy, and exercising. Another might be classified as medically obese and is worried about how that will affect her pregnancy—should she lose weight or focus only on eating healthy? While yet another may have, not intending or wanting a pregnancy at the time, been drinking heavily or using illicit drugs. Of course, most women are somewhere in the middle. Ultimately it’s most important that a woman work at getting as healthy as possible, so that she and the baby have the best outcomes.

So how does a woman who is already pregnant get healthy and stay healthy? And what are the risks if she isn’t healthy?

Lets look at the central tenets of a healthy pregnancy:

Good nutrition

Eating right helps to build a strong and healthy baby, and it helps the pregnant mom as well. A healthy diet can help to prevent high blood pressure, preeclampsia, gestational diabetes, and premature labor. A healthy diet can help to ensure against the baby growing too big, which could lead to a difficult birth.

Earlier this past year, we outlined a healthy diet for pregnancy. Be sure to eat plenty of protein and whole grains, and focus on color and variety in your fruits and vegetables during pregnancy. Good sources of protein include meats (limit seafood because of the high mercury content in many sources of seafood), dairy, eggs, nuts, beans, and seeds. And the less processed and milled the grains, the better. Drink plenty of water and salt to taste. Eat small, nutritious meals often. And, most of all, limit sweets and high-sugar-content food and drink.

A good prenatal vitamin is important for a healthy pregnancy as well. Prenatal vitamins are specially formulated for a pregnant woman’s needs. In particular, the pregnant woman needs at least 400 mcg of folate (higher if a BMI over 30) and Vitamin D. Folate in the first trimester helps the baby’s developing nervous system and strengthens the mom’s immune system. Vitamin D also helps with the mom’s immune system and helps the baby to develop strong bones and teeth before and after the birth. Vitamin D can be continued postpartum and can help to decrease the risk of postpartum blues.

What if a woman has a high BMI when she finds out she’s pregnant? There is no evidence that dieting to lose weight is good for mom or baby. In that case, she should focus on the healthy pregnancy diet, balancing the pregnancy needs for quality protein, whole grains, and plenty of fruit and vegetables. Many women who struggle with weight before pregnancy discover that eating healthy for the pregnancy helps them to maintain a healthier weight during and after the pregnancy. Most moms-to-be who have a higher BMI at the start of pregnancy can expect to enjoy a healthy pregnancy.

Exercise

Exercise helps the pregnant woman prepare for birth by strengthening and toning her body. It can also help to manage weight, and, combined with a healthy diet, can lower the risk of giving birth to a large baby. The adage is that if a woman already has a regular exercise practice, she can continue the practice. But, if the mom is new to exercise, low-impact exercise with a gradual endurance plan is just as beneficial.

The shift in the woman’s center of gravity and increase in joint laxity can make exercise more challenging. Water sports, such as swimming or low-impact water aerobics, can help support the pregnant woman’s body. Mild exercise in general can help the woman meet the greater oxygen demand that pregnancy creates. However, too aerobic of an activity can decrease her oxygen consumption and lower her overall oxygen volume. Ultimately, exercise can make pregnancy more comfortable and shorten the woman’s labor, and even reduce the need for interventions.

Exercise can also:

  • Reduce back aches
  • Reduce constipation, bloating, and swelling
  • Boost energy levels
  • Help with mood
  • Help with sleep
  • Prevent excess weight gain
  • Promote strength and endurance, which in turn helps the mother in childbirth

If the pregnant woman hasn’t exercised in awhile, but would like to add an exercise routine during pregnancy, she should start slowly, beginning with five minutes and building her endurance by five minute increments until she reaches a thirty minute practice.

What exercise should be avoided during pregnancy? Some forms of exercise are not advisable, such as:

  • Exercise that forces you to lie flat on your back after the 1st trimester
  • Scuba diving, which puts the baby at risk of decompression sickness
  • Water skiing, surfing, and diving, which cause you to hit water with a great deal of force
  • Contact sports such as ice hockey, basketball, volleyball, or soccer
  • High altitude exercise (less oxygen for you and the baby—and risk of altitude sickness, which causes headache and nausea)
  • Any activity that could cause direct trauma to the abdomen, like kickboxing
  • Hot Yoga or Pilates
  • Sports with a high risk of falling, such as downhill skiing, gymnastics, or horseback riding at fast speeds

A regular exercise practice during pregnancy can lead to an exercise practice postpartum, which can help the new mom shed weight and regain muscle tone and strength for her non-pregnant body. Exercise should be avoided for the first month while the woman establishes breastfeeding and recovers from the birth.

Education

In addition to prenatal counseling with a maternity care provider, there are several ways a pregnant woman can educate herself about pregnancy and childbirth:

Childbirth education (CE) classes

CE classes can help the pregnant woman stay focused on pregnancy-specific issues, such as nutrition, lifestyle practices, and preparation for childbirth. Some options for childbirth education classes include: Hypnobirthing, Birthing From Within, Bradley, Lamaze, Birthworks, Centering Pregnancy, Sacred Pregnancy, and others. Local doulas and midwives often have extensive lists of local childbirth education providers, and some midwives offer childbirth classes at birth centers and in their communities.

Books

Books are a powerful way for the pregnant woman to prepare for birth and to learn coping mechanisms for the changing nature of pregnancy. Some favorites include: Spiritual Midwifery, Ina May’s Guide to Childbirth, Diary of a Midwife, Birth Without Violence, Birth with Confidence, and Homebirth Cesarean. There are also literary memoirs about pregnancy and birth, and pregnancy loss that can be powerful and impactful narratives, depending on a mother’s perspective and needs.

Documentaries

Documentaries about pregnancy and childbirth often include interviews with experts, snapshots of individual women’s labors, and commentary on an overall maternity care system. Documentaries, if appropriate, can help children understand an upcoming birth and help pregnant women (and couples) make decisions about what they most want from the birth experience. Some of the better documentaries include The Business of Being Born, Orgasmic Birth, The Face of Birth, Birth Into Being: The Russian Waterbirth Experience, and Pregnant in America. Check out this TED talk by Ina May Gaskin, the international childbirth luminary midwife.

Support

Rhea Dempsey writes about the “circles of influence” that surround the pregnant woman—from friends and family to the wider culture. These circles ultimately impact the woman’s pregnancy and birth experiences.

The people with whom the pregnant woman surrounds herself make a big difference in how healthy, physically and emotionally, the woman will be during pregnancy. The following are important questions to ask:

  • Is the pregnant woman’s home a safe place?
  • Does she have emotional support?
  • Is she more concerned with the anxieties and fears of her mother, her sister, her husband, her friend, than her own?
  • Is the pregnant woman able to decide how and where she wants to birth based solely on her needs and wants?
  • Is her maternity care provider supportive of her wishes?
  • Can she ask questions without fear of belittlement or of her fears being minimized?
  • Does she have access to healthy food and clean water?

A healthy pregnancy hinges on physical elements such as a safe place to live, the opportunity to exercise, access to healthy food and clean water, and good prenatal care, but it also hinges on emotional health, and support is central to a pregnant woman’s emotional health. Support often means more listening than talking, and support means something different for every woman. And, ultimately, after pregnancy, the birth is most about the woman and her baby, not the people who surround her. Sometimes the best support is the most minimal support, support that allows the woman to decide how she wants to birth and who she wants to support her during the birth.

Getting healthy during pregnancy will mean something different for each woman. For instance, a woman who struggles with alcohol and drugs may need to first focus on addiction recovery. After she is clean and sober, she can move on to good prenatal care and nutrition, as well as creating a circle of support that is healthy and best for her and the baby. For a woman who doesn’t have good nutritional habits, getting healthy may mean focusing solely on nutrition and exercise. And for a woman who lives in an unsafe home, getting to safety may be the first step toward a healthy pregnancy.

Focusing on the main tenets of a healthy pregnancy will help a woman get healthy and stay healthy throughout pregnancy, with great benefits to both mother and baby.

Natural Ways to Boost the Pregnant Immune System

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Pregnant women are more at risk for acquiring infection or viruses given the altered immune state that accompanies pregnancy. Most care providers and health agencies agree that the flu is a risk in late pregnancy and recommend certain types of flu vaccines. But there are also natural ways to aid the pregnant immune system.

Habits


Regular Exercise

Gentle exercise cleanses the lymph system and flushes bacteria out of the lungs. When the body heats up with exercise, it helps the body to fight infection. Breathwalking, yoga, swimming, and Tai Chi are gentle forms of exercise that are beneficial for pregnant women.

Sleep

The importance of sleep cannot be stressed enough. The body resets with sleep and a healthy immune system relies upon its restorative aspects. It can be hard to get comfortable in the third trimester when the baby gains the most weight just before birth. Sleeping on your side with a pillow between the legs is one of the most comfortable positions for sleep for the pregnant woman. Heartburn can also be a problem late in pregnancy. Be sure to eat small meals in the evening or drink tea with cinnamon or ginger or peppermint. If you find your sleep is interrupted at night, try to fit in a nap during the day.

Diet

A strong diet during pregnancy helps not only with immunity, but also with the size of the baby, which in the end can ensure an easier delivery. Check out our post on the optimal pregnancy diet and tips for eating healthy.

Hydration

Most midwives will tell you that hydration is key to a healthy pregnancy. Taking in enough fluids helps to flush your lymph system and keep your kidneys and bladder healthy, and water helps to form the placenta and the amniotic sac. Dehydration during pregnancy can lead to serious pregnancy complications, including neural tube defects, low amniotic fluid, inadequate breast milk production, and even premature labor. These risks, in turn, can lead to birth defects due to lack of water and nutritional support for the baby. Aim for at least eight 8-ounce glasses of water a day.

Hand washing

Be sure to wash your hands regularly. Anti-bacterial soaps are not recommended, but washing with regular soap is a good habit to develop while pregnant and when handling your newborn, postpartum. The most effective hand washing method involves lathering the backs of your hands, between your fingers and under your nails. Be sure to wash your hands after attending a group gathering or playing with young children.

Immune Boosters


Vitamin C

A master immune booster, Vitamin C helps immune cells mature; has an antihistamine effect; controls excesses of stress hormones, which suppress immunity; is antiviral and antibacterial; and raises interferon levels, an antibody that coats cell surfaces. In addition to Vitamin C supplements, the following foods contain the vitamin: papaya, bell peppers, strawberries, oranges, grapefruit, broccoli, pineapple, kale, kiwi, or Brussels sprouts.

Tumeric

Tumeric is the food that keeps on giving. Research has shown that it’s a better inflammatory than many OTC anti-inflammatory medications and equal to low dose steroids. High in antioxidants, anti-cancer by nature, good for digestion, and excellent at controlling inflammation, turmeric offers many immune benefits. You can add turmeric to smoothies, drink turmeric tea, or add turmeric to your favorite dishes.

Garlic

Garlic is a powerful natural antibiotic. One clove is powerful enough to combat infection, with its five milligrams of calcium, 12 milligrams of potassium, and more than 100 sulfuric compounds. It’s most powerful raw. If you feel a cold coming on or feel flu-like, try a raw garlic “shot:” one minced garlic clove in a small amount of water, chased by more water. Or, if you’re really ambitious, consider a shot of raw garlic, ginger, carrots, and lemon for a quick immune boost. Raw pesto is a wonderful way to get your raw garlic – toss on pasta or slather on a piece of toast or use in place of tomato sauce on pizza.

Healthy Fats

It’s important to obtain adequate essential fatty acids (EFAs) from the diet during pregnancy and lactation. DHA supplements, an Omega-3 fatty acid, based on cultured microalgae are available in many natural food stores. EFAs boost the pregnant woman’s immune system, support endocrine function and normal function in tissues, and lessen inflammation.

Linoleic and alpha-linolenic, key components of EFAs, cannot be synthesized in the body and must be obtained from food. Omega-6 fats are derived from linoleic acid and are found in leafy vegetables, seeds, nuts, grains, and vegetable oils (corn, safflower, soybean, cottonseed, sesame, sunflower). Most diets provide adequate amounts of this fatty acid, and therefore planning is rarely required to ensure proper amounts of omega-6 fatty acids. A less common omega-6 fatty acid, gamma-linolenic acid (GLA), has been shown to have anti-inflammatory effects along with other disease-fighting powers. GLA can be found in rare oils such as black currant, borage, and hemp oils.

Research suggests that fatty acids are needed for fetal growth and fetal brain development. The EFAs are important for infants as they ensure proper growth and development and normal functioning of body tissues. Increased omega-3 fatty acid intake in the immediate post-natal period is associated with improved cognitive outcomes. It’s important that the mother’s diet contain a good supply of omega-3s because infants receive essential fatty acids through breast milk.

Zinc

The body requires zinc for production, repair, and functioning of DNA – the basic building blocks of cells. Beans, nuts, breads, seeds, dairy, and some cereals provide zinc. Too much zinc is not beneficial, so if you consider taking zinc supplements, be sure to talk to your midwife or doctor first.

Vitamin D

Vitamin D supplementation during pregnancy and breastfeeding is generally recommended. Vitamin D plays a key role in the process of priming T cells to be ready to attack invaders and to fight infection. Sunshine, oily fish, and eggs are good sources of Vitamin D. If eating fish, it’s recommended to limit the servings to 12 ounces a week because of the exposure to methylmercury in most fish.

Almonds

Almond skin contains naturally occurring chemicals that help white blood cells detect viruses and even help to keep them from spreading. Almonds contain healthy fats, fiber, iron, protein, and magnesium. Almond butter is high in protein and good fats. It’s a good substitute for peanut butter and can be served on apples, crackers, or bread.

Chicken Soup

The old adage is true: eating chicken soup boosts the immune system. The broth and vegetables combine to provide anti-inflammatory benefits. Chicken soup decreases the duration and intensity of colds and flu by inhibiting the migration of white blood cells across the mucous membrane, which, in turn, can reduce congestion and ease cold symptoms.

Yogurt or Kefir

A healthy gut is an important building block of a healthy immune system. Yogurt and even better, Kefir, are full of probiotic benefits. Buy plain yogurt or kefir and add fruit-juice sweetened jam or fresh fruit and honey to avoid the high sugar content of commercial flavored brands.

Hot Lemon Water with Honey

Fresh lemon juice is an immune powerhouse, filled with Vitamin C, vitamin B6, vitamin E, folate, niacin thiamin, riboflavin, pantothenic acid, copper, calcium, iron, magnesium, potassium, zinc, phosphorus and protein. Squeeze the juice of one fresh lemon into a teacup, fill the rest of the cup with hot tea water, and sweeten with raw honey. This drink is especially soothing when you have a sore throat, cold, or sinus issues.

hot-lemon-water

Proper hydration, healthy diet, moderate exercise, and sleep are the building blocks of a healthy pregnancy. The basic prenatal multi-vitamin offers a lot of immune enhancing properties (don’t take a generic multi-vitamin as they often contain Vitamin A, which is contraindicated for pregnancy.) Experiment with some of these immune boosting tips, but most of all enjoy your pregnancy and let your midwife or physician know if you have any questions about immunity in pregnancy.

The Immunological Paradox of Pregnancy

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photo credit: Carmen Hibbins

For most women, navigating pregnancy is difficult. There are decisions to be made: maternity care, labor preferences, place of birth, newborn care, breastfeeding, etc. Not to mention vaccines. Currently the CDC recommends the influenza vaccine for all pregnant women. When making the decision to accept or decline the flu vaccine, it’s important to first understand a pregnant woman’s immune system, as well as the ingredients in different kinds of flu vaccines.

The immune system is a complicated system of cells, tissues, and lymphoid organs—a giant communication network. When cells receive alarms about antigens in the body (viruses, bacteria, parasites, fungi), they produce chemicals that seek to destroy the antigens ability to invade the body. Recently research has shown the importance of a healthy gut for a strong immune system – and for brain health. Really, we are only just beginning to understand the complexity of human immunity.

What we do know is that a woman’s immune system changes significantly from the moment of conception. The innate immune system, the immediate response part, is activated, which results in an increase in white blood cells (monocytes and granulocytes) and the pregnant woman’s production of natural killer (NK) cells decreases. Research has shown that a critical balance of immune cells as well the factors they produce are vital to a healthy pregnancy. Interfering with a pregnant woman’s immune responses is thought to have a negative effect, in particular in the early stages of the pregnancy. The decreased immunity and increase in white blood cells ensures implantation and the development of the placenta. Without it, the fetus can be rejected. Thus, the vast majority of vaccines aren’t indicated for pregnant women and they are generally avoided if possible.

The immunological paradox of pregnancy is complicated, delicate, and beautiful in the way only nature can be.

So what exactly are the risks and benefits of the flu vaccine? The benefit is easy to define: influenza poses a substantial risk for the pregnant woman, in particular during the later months of pregnancy. The woman’s altered immune state can leave her susceptible to certain infections and viruses, and when she contracts the flu it can be hard for her fight it. The CDC states:

Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, as well as to hospitalizations and even death. Pregnant women with flu also have a greater chance for serious problems for their developing baby, including premature labor and delivery.

The risks of influenza are real, despite the large number of women who have healthy, safe pregnancies without contracting the flu. So what about risks associated with the vaccine? Most of the research on vaccines is conducted on non-pregnant subjects, so researchers are careful to qualify results. The consensus tends to be: less vaccines overall for pregnant women, but the flu vaccine is indicated given the risks associated with the flu.

Current research focuses on the type of flu vaccines. Most flu vaccines are considered “non-adjuvanted.” An adjuvant is an additive used to increase the immune response to a vaccine. Adjuvant vaccines are important during pandemic times, as adjuvants allow more vaccines to be produced using less antigens and are therefore more cost effective. But adjuvants are pro-inflammatory and can aggravate other immune issues. Given the altered immune system of a pregnant woman, most researchers suggest that only non-adjuvanted flu vaccines be administered.

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The WHO organization issued the Safety of Immunization during Pregnancy report in 2014. The research is far from conclusive, but the WHO takes a careful look at results from studies around the world. In terms of the flu vaccine, they conclude:

Pregnant women and infants suffer disproportionately from severe outcomes of influenza. The effectiveness of influenza vaccine in pregnant women has been demonstrated, with transfer of maternally derived antibodies to the infant providing additional protection. The excellent and robust safety profile of multiple inactivated influenza vaccine preparations over many decades, and the potential complications of influenza disease during pregnancy, support WHO recommendations that pregnant women should be vaccinated. Ongoing clinical studies of the effectiveness, safety, and benefits of influenza vaccination in pregnant women in diverse settings will provide additional data that will aid countries in assessing influenza vaccine use for their own population.

If you’re pregnant, weigh the risks and benefits, and take into account any specific immunity issues. Is your immune system weakened for any reason? What is the risk of exposure? Do you tend to contract the flu? What is your family history in terms of vaccine reactions? Are you high risk for any other reason? Talk over the risks and benefits with your care provider. Ultimately, the decision is yours. Your pregnancy is your pregnancy, and a mother’s intuition is often the best guide.

If you choose to have the flu vaccine administered during your pregnancy, be sure that the vaccine is non-adjuvanted/inactivated. In the next blog post on Birth Outside the Box, we’ll discuss ways to naturally boost your immunity during pregnancy – ways to help you counteract the altered immune state that nature has carefully designed to ensure a successful pregnancy. Garlic? Diet? Sleep? Exercise? We’ll cover it all!

Good Cheer and The Pregnancy Diet

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It’s that time of year. The time when we bake cookies and fudge and tasty pies. The time when the workplace break room is littered with holiday candy and plenty of chocolate. It’s a time when it feels almost obligatory to feed the sweet tooth. But what if you’re pregnant? Does pregnancy give you an eat-all-you-want pass with the holiday sweets? The short answer is no. But then again, as with most anything, it’s all about balance.

We as midwives make nutrition an important part of the care we offer pregnant clients. It’s the hallmark of good prenatal care. To help pregnant women navigate this holiday season, we asked a seasoned midwife/educator/author to share her tried and true pregnancy diet, a diet based on a modified American Diabetes Association (ADA) diet, with specific portion sizes and an accompanying chart. The best part? Desserts are not off-limit, although one piece of pie could blow a lot of the small, allowed portions.

Juliana Van Olphen-Fehr, CNM, PdD, retired director of the Shenandoah University nurse-midwifery program and author of Diary of a Midwife, spent an entire prenatal visit on nutrition when she had a combination home/hospital practice. Clients often joked that subsequent prenatal visits were diet confessionals; some tried to hide ice cream cones from her view when running into her outside of appointments. The nutrition prenatal session left its indelible mark on the pregnant women she served and the Fehr pregnancy diet was a hallmark of her successful practice.

Recently, we asked her if her opinion on the optimal pregnancy diet had changed all these years later: “No. Not one bit…. You are what you eat, so when you’re pregnant, so is the baby [what you eat]. What your job is, when you’re pregnant, is to nourish that body and really make sure that the body inside you will grow up to be an incredible and productive human being.”

Dr. Fehr frames the pregnancy diet in both biological and historical perspectives. Our brain requires glucose. “It doesn’t use protein and vitamins. Glucose is it. And now the pregnant woman has two brains and one is really changing fast. It’s growing and it’s interested in getting all the nutrition it needs.” Yet, historically, humans’ access to sugar was seasonal and typically fruit, or at the very least, lactose, another sugar, from a cow’s milk.

“Humans were designed to survive despite the lack of access to sugar. That’s what we were meant to do, because [historically] we didn’t have it. The problem is that evolution takes thousands of years to develop. We now have so much access to sugar; we are inundated with it. We need it. We crave it.”

But at some point the pancreas won’t keep up with a contemporary intake of sugar. And that creates problems for both the baby and the mother.

Every day a pregnant woman needs grains and carbohydrates to offer the brain the sugar it needs. But the trick is to keep track of serving sizes and amounts. A pregnant woman and her growing baby needs:

  • 9 servings of carbohydrates
  • 9 servings of protein
  • 3 servings of milk
  • 3 servings of vegetables
  • 6 servings of fruit
  • 5 servings of fat

And the serving sizes are small: 1 ounce of meet or cheese, 1 egg, or 2 tablespoons of nut butter meet the protein serving requirement. And nut butters also count for 2 of the fat exchanges. Vegetable serving sizes are ½ cup cooked or 1 cup raw. One half of a bagel, 1/3 cup cooked lentils, 1 small potato, or 2 cups cooked pasta meet the carbohydrate serving size requirement.

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So where does that leave a pregnant woman during the holidays? A little bit of good math, planning, and awareness go a long way. Enjoy that pie, but be mindful of the carb, dairy, fruit, and fat exchanges. Enjoy that piece of fudge, but pull back on your dairy and fat servings for the remainder of the day. And be sure to fill the rest of your day with all of the nutrients that are most important for you and your growing baby. You’re eating for two. Two brains, two pancreases, one of each that are still growing and developing. A good diet is an investment in your own health and in the long-term health of your baby. Cheers!

Breast Health: Basic Anatomy and Cancer Prevention

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It’s Breast Cancer Prevention Month. Midwives care for the whole woman, from pre-conception to well-care post-childbearing. Invasive breast cancer affects 1 in 8 women. It’s sobering to think that, in 2016, there are more than 2.8 million women with a history of breast cancer in the U.S (women currently receiving treatment and women who have finished treatment.) Throughout a woman’s life, normal breast changes occur. So how does a woman stay informed on what is normal and when to be concerned about changes in her breasts?

Most of the women we see in our practice choose to breastfeed and are successful. A breastfeeding mom experiences changes in breast shape, the feel of the exterior of the breast (engorgement before and then a smaller breast once the baby has nursed) and sometimes-painful knots – or plugged ducts. New moms who choose not to breastfeed or have barriers to breastfeeding may also experience changes in their breasts postpartum. Most of these changes are normal, and breast cancer while pregnant or lactating is extremely rare. Older women also experience changes, such as softer, fattier breast tissue, or mammograms that show calcifications.

It can be hard to tell what’s what and with national concern about, and awareness of, breast cancer, it’s helpful to review the basic anatomy of a woman’s breast. The National Breast Cancer Foundation has a wonderful video on female breast anatomy. Imagine if all women learned about this basic female anatomy in school, well before their risk factors increased? Female breasts are complex systems of lymph vessels and nodes, blood vessels, milk ducts, lobes and lobules, nerve endings, ligaments, connective tissue, and fat tissue. Check out the video to better understand how all of the elements work as one complex system.

Certain factors in a woman’s life increase risk, such as genetics; a mother, sister, or grandmother who has had breast cancer; alcohol consumption; a first child after the age of thirty; not nursing or nursing for less than a year; early menstrual onset; non-bio-identical Hormone Replacement Therapy (HRT); previous radiation exposure; poor diet, which increases risk of all cancers; obesity; and ethnicity—white women have a slightly higher chance of developing breast cancer, but African American women who are diagnosed young are at risk for a more aggressive, more advanced stage form of breast cancer.

Midwives encourage mothers to breastfeed, eat healthy, and limit alcohol consumption. But life isn’t just a series of neat checklists and all that we can do is our best with any given situation. If you know you have one or more of the risk factors, do your best to affect the other factors. Angelina Jolie very publicly chronicled her painful decisions about her risk of breast cancer, and then later her painful decisions regarding ovarian cancer risk. The mutation of her BRCA1 gene meant she had an eighty-seven percent higher risk of developing breast cancer and fifty percent chance of developing ovarian cancer, cancers that claimed the lives of her mother, grandmother, and aunt.

The basic tenets of breast cancer prevention that we recommend to the mothers we serve include:

  • Regular breast exams. You know your breasts best. Pay attention to even subtle changes and don’t be afraid to ask your healthcare provider questions.
  • A healthy lifestyle. Limit alcohol consumption, eat a diet heavy with fresh vegetables and fruits and limit fatty foods, exercise regularly—especially walking or yoga as they give cardiovascular benefits without stressing the immune system—and, if you are planning to have children and have no physical obstacles to successful lactation, plan to breastfeed for at least eighteen months.
  • Clean air, clean water. Research suggests that toxins in our environment contribute to higher cancer rates. Rid your home of toxic cleaners and perfumes and use a good water filter to ensure a clean home and safe drinking water.
  • If breast cancer or ovarian cancer run in your family, ask your doctor to run the BRCA1 test to check for mutations.

Many of us know women who have been affected by breast or ovarian cancer. Support the women in your community who have to undertake this painful journey. Womanhood is a sisterhood. We’re all in this together.

 

 

Busy Mom Lifesaver #3: Strategic Cooking

Strategic cooking? What’s that? When you’re short on time, it helps to think about the big picture and come up with a strategy. You want to avoid eating out, you want food that tastes good, and you want to have food that involves minimal preparation, right? I love to cook, and when I have time, I am happy to spend hours in the kitchen making an elaborate meal. But, most days, I just want to get some food on the table and get it there quickly. I learned a long time ago that with a little forethought, I could cut a lot of time off of my cooking, save quite a bit of money, and make sure my family ate food they liked. Without this planning, we’re like most people – it’s 4:30pm, and we turn to each other and ask, “what’s for dinner?” Nobody has any ideas and next thing you know, we’re getting Thai food.

image-7One solution that has worked well for my family has been freezer cooking. Frozen assets, freezer cooking, once-a-month cooking, planned overs — whatever you call it, thinking about cooking this way has been a Godsend for me. It took me many years of being a grownup to figure this one out for myself and try it. Once I did, I was hooked.

The first time I did once-a-month cooking was about 10 years ago. It was a rather long and arduous process, but the result was a freezer full of great meals for my family, a bundle of financial savings, and a huge load of stress taken off of my plate. I think I was about 7 months pregnant with my youngest son when I did once-a-month cooking the first time. My motivation was to put away meals to help keep my sanity during postpartum (good plan). Over the years, I’ve gotten pretty good at doing the freezer meals, and now it goes pretty quickly, so I wanted to share with you some ideas to make the process easier and some resources for freezer meal recipes.

Day 1: Plan and Prepare

I usually break up freezer meal cooking into two days. One day of planning and preparation and one day of actual cooking. You’re going to need to set aside some time to gather your recipes and figure out what to make. Sometimes, you can just make your own favorite meals in bulk and divide them up and freeze them. Other times, you’ll want to follow some sort of freezer meal cooking plan. Whatever you’re planning to do, take some time up front to do some planning.

My absolute favorite freezer cooking site is 365 Days of Crockpot. I love how she has it so beautifully organized. The shopping lists are wonderful. The recipes are made in assembly line fashion so it goes very quickly. She lays it all out to the point where you put your bags in the loaf pans, and then her instructions say “2 T Tomato Paste in bags 3, 6, 7,10, 13, 18.” This page has a video that explains her method. You’ve got to see it! I absolutely love it. Her meals are quite good, too. If you want to try out her method, I’d recommend starting with these:

8slowcookerfreezermeals

In addition to doing one of her plans, I also like to make up some of our go-to meals like meatloaf, taco meat, and meatball mix. Now that I use the Instant Pot for my spaghetti and meatballs, I don’t precook the meatballs. Instead, I have the meatball ingredients mixed together so that I can just defrost it, form it into balls, and put it into the marinara sauce in the Instant Pot. It cooks for 5 minutes at high pressure and 10 minutes pressure release.

Go shopping

Once you’ve gathered your recipes, it’s time to make your grocery list. This is not a time where you’re going to want to be making trips to the store in the middle of your cooking, so make your list and check it twice…three times. Go get your shopping done.

Make sure you have plenty of zip top bags, aluminum foil, labels, and permanent markers. I took a tip from one of the freezer cooking sites online and use loaf pans to hold the baggies of ingredients when I’m doing my freezer cooking. This holds the upright and open, ready to receive the next ingredient. I got mine at the dollar store and I save them just for freezer meals.

Clean and De-Clutter

Clean out your freezer. Toss all of the old freezer-burned veggies and meat. Make some space for all of your new meals!

Clean your kitchen top to bottom. You are going to need every inch of counter space for this job. You probably will need to expand your project onto the kitchen table too. Clear off the counter tops of any unnecessary items. Empty the dishwasher and sink. Put everything away. Sharpen your knives and get ready to cook!

The Big Day!

Get some help

I personally recommend having a helper (or a few) when you do once-a-month cooking, especially if this is your first time doing it. There’s a lot of work involved, and having someone help you with it will make all the difference. It’s a great time to teach kids organizational skills and cooking skills.

Divide and Conquer

Some people like the more focused parts of freezer cooking, like chopping veggies. If that’s their gift, have that person chop veggies. I have a few people in my family who are a little overwhelmed with the 30 loaf pans with open baggies on the countertop. They’re much happier to just chop the veggies. Great, chop veggies! My youngest likes to do labels. Cool, make labels! I, on the other hand, like managing the whole operation and keeping track of what goes into each bag. That’s my gift, so that’s what I do. There’s plenty of work to go around, and if you have kids old enough to babysit younger kids, or if you have kids old enough to help you with cooking, all the better. Now that I have older kids, I’m blessed to have two teens who have cooking skills that rival my own. Plus, my husband is every bit as good at this as I am.

Label, Label, Label

Once in a freezer bag or wrapped in aluminum foil and stored in your freezer, all of the meals look pretty similar. You absolutely have to label. I highly recommend double-bagging your meals and labeling the inner baggie. Then, put the cooking instructions on an index card and place it between the inner and outer baggie. When you defrost your freezer meal, remove the instruction card first so it doesn’t get wet from condensation, otherwise your instructions will likely become difficult to read. Another option would be to label and number the bags, and then keep a list of your meals separately with the cooking instructions. Either way, you need a plan for how you will keep track of what you have and how to cook it.

How you freeze it matters

If you lay a baggie of something liquid on a rack in your freezer, it will conform to the rack as it freezes and you’ll never get it out of there later. Trust me; it has happened to me. Freeze flat items on aluminum baking sheets and then stack them, preferably in a box so that they don’t fall out and land on your foot when you open your freezer door. Again, that’s happened to me. If you are using the loaf pan method, freeze things in the baggies inside the loaf pans, and then pop them out like ice cubes in an ice cube tray. You can store them like bricks in your freezer.

Think ahead about how you’ll be cooking the item you’re freezing. If something is going into a slow cooker and you’re not going to defrost it first, freeze it in a container shaped like your slow cooker. That way, it can defrost in the slow cooker. If you’re freezing a meatloaf, wrap it in aluminum foil in such a way that you can place the frozen meatloaf back into the loaf pan while it’s still wrapped. You’ll be able to defrost it like that, bake it, and then throw the aluminum foil into the recycling bin, eliminating the need to wash the meatloaf pan.

Planned Overs

Another solution for our family has been Planned Overs. It’s a different way to think about leftovers. I try to think ahead when I’m cooking. It’s enough effort to cook once, why cook twice, right? I learned a long time ago to cook more than we need at one meal and think about how we could use the leftovers while I’m making the first meal.

Today’s Rotisserie Chicken is Tomorrow’s Chicken Enchiladas and the Next Day’s Chicken Soup

Get a couple of rotisserie chickens and a bag of salad for dinner one day. Chop up the leftover chicken meat to use for the next couple of days.

For the chicken enchiladas, put half of the leftover chicken meat and a can of black beans in a skillet with about a cup of salsa and heat it up. Add a little sour cream and cheese, roll it into tortillas, cover with more salsa and cheese, and bake at 350°F until hot and bubbly. I usually serve it with salsa, avocado, sour cream, and shredded lettuce.

For the soup, I use this as a good opportunity to use up veggies on hand that are perhaps on their last leg. It’s basically a “clean out the fridge night.” Put the chicken bones into the Instant Pot with whatever veggies you like. Season with salt & pepper and some thyme. Add the remaining chopped leftover chicken, put that in there too. Cook in the Instant Pot on the soup setting or cook in the slow cooker on low all day. Remove the bones and serve.

Today’s Pot Roast is Tomorrow’s Beef Vegetable Soup

Chop up your pot roast leftovers (meat, potatoes, carrots, whatever). Put it in your crockpot (or Instant Pot) with some stewed tomatoes and a bag of frozen mixed vegetables. Add beef stock to cover. Season with salt & pepper and fresh rosemary. Cook in the slow cooker all day, or cook in the Instant Pot on the soup setting.

Today’s Tacos are Tomorrow’s Tamale Pie

Make up some taco meat. I generally use ground beef, but you could use chicken or pork or turkey. My recipe is pretty simple – ground beef, onion, seasonings, Ro-Tel tomatoes, cilantro, black beans. I like to make a lot of taco meat and freeze some, but I also will reserve some to make up a tamale pie. This is a simple and quick way to use up taco leftovers. Layer corn tortillas, taco meat, cheese, and salsa in a casserole dish. Top with salsa and a little cheese. Bake at 350°F until hot and bubbly. Serve with avocado slices and some sour cream or plain Greek yogurt.

Today’s Veggies are Tomorrow’s Frittata

Time to use up the veggies! This is great for a make ahead breakfast or Sunday brunch. For more detailed instructions, here’s a post I did about making frittata, but you can really just wing it. Gather whatever veggies you like – onion, zucchini, mushrooms, spinach, broccoli, tomatoes. I generally just use up the leftovers in my fridge. Rough chop them veggies. Using an oven-safe pan, saute your veggies, and then add 6-12 beaten eggs (depending on how big you want the frittata to be). Cook it like you would scrambled eggs until it is partially set, add some cheese, if you like, and then broil until the top is set. Basically, you’re cooking the bottom and then the top. Remove it from the oven, wait a minute, then flip it out onto a cutting board. Cut into wedges and serve. Or, let it cool and wrap it up for a quick breakfast for the next few days.

Today’s Pork Roast is tomorrow’s Pork Fried Rice

This is a great way to use up leftover meat and rice. It also works well with leftover quinoa. I like this with pork, but you could do this with leftover chicken or beef, too. Chop the leftover meat into bite sized pieces. Chop up an onion. In a large skillet, heat some oil and saute until translucent. Add the meat and cook until heated through. At this point, you could add some leftover peas, corn, broccoli, or other vegetables you like. Push the food to the edges of the pan. Beat 3 eggs and cook the eggs in the center of the pan. Once cooked, mix with the other ingredients. Add some soy sauce and sesame oil. Add cooked rice. Add more soy sauce and sesame oil as needed and serve.

Today’s Spaghetti and Meatballs is Tomorrow’s Lasagna with Meat Sauce

This couldn’t be much easier. You could even do this as you’re putting away your leftover sauce and meatballs, which would probably be faster and would eliminate having to wash the spaghetti sauce pan twice.

Heat up the meatballs and sauce in a large saucepan. Using a potato masher, mash the meatballs and break up the large chunks of meatball in the sauce. Add an extra can of tomato puree. Mix ricotta cheese, parmesan cheese, chopped spinach, an egg, and salt and pepper in a bowl. Layer sauce, then uncooked lasagna noodles, ricotta mixture, shredded mozzarella, sauce, noodles, etc. The final layer should be noodles, sauce, and then mozzarella. Cover and bake 1 hour at 375°F. Uncover and bake until the cheese browns and is bubbly. You want to be generous with the sauce since you’re using uncooked noodles. The noodles will absorb a lot of the sauce.

Today’s Meatloaf and Mashed Potatoes is Tomorrow’s Shepherd’s Pie

When you’re putting away your leftover meatloaf, chop it up into small pieces. The next day, put the meatloaf pieces in a baking dish, add some mixed vegetables and a can of Amy’s Cream of Mushroom Soup. Top with leftover mashed potatoes. I like cheese, so I add a sprinkle of sharp cheddar on top. Bake at 375°F until the potatoes start to brown and everything is hot and bubbly.

Now, time for me to start planning my next freezer meal adventure! Let me know how it goes for you. I’d love to know which sites you’ve found helpful and which recipes have worked for your family!