What your labor nurse wants you to know, and other fun facts

Lilly Schott

Phew! When Mary Alice asked me to write this post, I chuckled about what a book I could write on the topic (actually at one point I did start writing said book). And then I thought about what a special opportunity it is to write for a specific audience about the lovely Maternity unit at Martha’s Vineyard Hospital. Also known in my head as “Hôtel La Maternité.” It’s French for fancy.

First off, if you haven’t seen it, it is hands down the coziest and prettiest Maternity unit. It even has all the pillows you could ever want, and I assure you this is a hospital miracle. I’ll brag a little and say that the best part isn’t the building, it’s the nurses, midwives, and doctors. I can tell you that they care about your safety – not surprising – but they deeply care about your birth and parenting experience – amazing! Likely you will have one to one nursing care, which means that literally any time you need something, your nurse is available. This is basically a dream for nurses and families, and can’t be measured in terms of what it will mean for your wellbeing.

So here’s what you really need to know now that I’ve bored you half to tears:

1. Not everybody poops at delivery, so don’t worry about it! We do not care and deal with much worse as nurses! If it happens, we have a special technique called “the wipe and hide.” You’ll be none the wiser. Don’t ask me if you pooped or I have to tell you the truth...

2. Which leads me to number two (pun intended). I will NOT lie to you. We are long past the days when medical professionals thought it wise to keep things from you. If we are worried about you or your baby, you will be the first to know at every step. Ask us ANY question and we will give you the best answer we can. Which leads me to number 3...

3. Sometimes our best/worst answer is “I don’t know.”

a. When will I have this baby?

b. Why did my water break before I started contracting?

c. Why am I in labor at 32 weeks?

d. Why am I shaking?

4. My fourth and (last) piece of info for you today is about a topic which doesn’t get enough street cred! It’s the shakes. Imagine you are very, very cold and your entire body is chattering. Those are the shakes. Women get them in various degrees during labor and postpartum recovery immediately following delivery. They are hormonal in origin, and can be increased by epidurals and surgery. They are TOTALLY benign, but really can be annoying and a tad scary. Your nurse will ask you if you are cold, just to be sure. You’ll say “No, I’m just shaky.” And she will bring you a warm, toasty blanket anyway. You will think, “Does she listen? I said I’m not co - Oh wait, that feels SOOOOO good.”  Really the heat helps calm the shaking muscles a bit, and just feels comforting.

We listen. Promise.

Introducing Food to Your Baby

Dardanella Slavin

Introducing solids to a baby is a major milestone in their life. It is an exciting time for parents but can also be frustrating if your baby is not interested in the foods offered. Babies can show an interest in grabbing at your foods before they are actually interested in eating the food. They may merely be developing their reaching and touching skills and find your food interesting from a tactile perspective. Other cues that a baby may be ready for food are an increased interest in breast or bottle feeding or more frequent waking at night. Remember that breast milk or formula will still be your baby’s main source of caloric intake as they start eating solid foods.

Here are some recommendations for the introduction of solids:

1. Babies have an immature digestive system. With this in mind it is important to feed babies foods that are easy to digest. Foods should be steamed, boiled, mashed, and/or pureed. If you see pieces of food in your baby’s stool it has not been digested. Children under the age of one do not produce very much amylase, the enzyme required to digest grains so do not introduce grains until your baby is at least one year of age.

2. Quality matters. Organic, local, grass-fed foods are superior to conventionally grown and raised food. They contain more nutrients and are free of chemicals.

3. Introduce one food at a time. It is important to watch for reactions to foods as they are introduced. It may be as subtle as a mild rash or as obvious as diarrhea or vomiting. Offer the same food for 2-5 days before adding a new one. If a food is rejected try introducing it again a few weeks later.

4. Make the food taste good. If your baby is breastfed they are used to the flavors from the foods you eat. If they are formula fed it is even more important to develop their taste buds. Introduce a food plain first. If it is rejected try adding spices when you re-introduce.

5. How often should I feed my baby? Start feeding your child once a day in the morning. This allows you to watch for any reactions throughout the day. Work up to 2-3 times per day. If your child is really hungry and a little fussy it may not be the time to introduce a new food or feed any solid food. You may want to feed milk or formula first and then offer the solid food. Some babies will do just fine with solid foods when they are hungry. Follow their lead.

6. Meat stocks. Babies have immature digestive systems. The gelatin in homemade meat stock will help protect your baby’s digestive system by strenghtening the walls of the intestinal tract, protecting against bugs and factilitating digestion. Put an entire chicken or chicken parts in a pot and cover with with water and 2 tablspoons apple cider vinegar. Add celery, onion carrots, a bay leaf and herbs if desired. Let stand 30 mins so the vinegar can pull the minerals out of the bones. Bring to a boil, reduce to a simmer and cook for 1½ to 2 hours. Add stock to the foods you make for your baby or give as a beverage. For a baby experiencing digestive difficulty stock can be bottlefed starting at 4 months. Otherwise, 6 months is recommended.

7. Start with egg yolk. Babies can be offered egg yolk as early as four months, but six months is desirable. Buy eggs that are from pastured chickens. They contain more omega-3 fats which are important for brain development. Boil the egg for 6 minutes and peel away the white. The white should be avoided as it contains proteins that are hard for a baby to digest and can be a potential allergen. Add sea salt to yolk and spoon feed. After six months frozen liver can be added. Simply grate the liver and allow it to thaw before adding to the yolk.

8. Vegetables are next. Start with the orange veggies first, i.e. sweet potato, squash, carrots. If your baby’s skin turns orange their liver is having a hard time converting carotenoids to vitamin A. Take a break from the orange vegetables if that happens. After the orange veggies introduce green veggies, i.e. green beans, zucchini, avocado, asparagus, peas.

9. Advancing the diet. By 7 months of age you can introduce more foods. Pureed meats or fish offer good sources of protein. Remember that meats must be organic and grass fed. Beef and venison are easier to digest than chicken. Wild salmon is a good fish choice. Yellow split peas, green split peas and red lentils puree well after being cooked. They should be soaked overnight in water and whey or lemon juice and cooked with small amounts of carminative spices - cardamom, cumin, fennel, and coriander to help reduce gas-producing qualities of the legumes. By 8-9 months of age introduce pureed green leafy vegetables and good quality organic, plain, whole milk yogurt and homemade kefir from raw milk. As your child approaches one year offer small pieces of food and other vegetables such as beets, peppers, and foods like hummus and tahini. At his point your child should be eating 3 small meals a day.

10. Flavoring the meal. Spices enhance food and help develop taste buds. As with other foods, observations should be made when introducing herbs to be sure they are not irritating to your baby. Fresh herbs are preferable but dried may be used as well. Some spices to consider are thyme, tarragon, basil, cinnamon, tumeric, oregano, rosemary, ginger, garlic, onion, fennel, dill, etc. Chicken, beef or lamb stock also increases the flavor of food and introduces beneficial enzymes and minerals.

11. Cooking with oils. Fat is essential for a baby’s development. Use fats such as olive oil, coconut oil, butter, and lard. Avoid oils such as canola, sunflower, safflower, corn or any hydrogenated oils.

12. Water. Once your child is eating solid foods offer water throughout the day.

13. Milk, yes or no? After the age of one raw milk can be introduced. Raw milk contains beneficial probiotics and enzymes and important vitamins and minerals.

14. What not to feed. There are many foods that should not be offered to a baby, especially those that can be mucus producing:

Processed dairy – pasteurized dairy is devoid of enzymes that make dairy digestible and is mucous producing.
Soy – acts as a phytoestrogen and inhibits the thyroid’s ability to uptake minerals.
Citrus – too acidic.
Grains, cereals, flour – Whole grains should only be introduced after one year of age when amylase production has increased. Most grains should be soaked before cooking to reduce phytic acid which inhibits enzymes and chelates minerals. Examples of good grain choices are brown rice, quinoa, millet, and barley. Cereals and flours are over-processed with very little nutritional value, break down readily and act as simple sugars in the body. Processed grains are often mucous producing and cause constipation.
Juice
White sugar and other sugar products and substitutes
Fried foods
Processed foods
Raw fruits and raw vegetables – while fruits are a health food group, they are healthier for your child as a snack every now and then rather than as a meal or as a major component of their diet. Offer fruits that are organic and use the fruits that are in season.

• Supplements. Probiotics are often recommended after birth, especially if the baby was delivered via cesarean section. High vitamin cod liver oil can be introduced at four months. A baby stores up vitamin D it takes from their mother. If the mother is deficient vitamin D supplementation should be given to the mother and considered for the baby.

Dardanella Slavin is a chiropractor and doula who specializes in perinatal care and children. She encourages families to eat nourishing whole foods which leads to a healthy immune system and a healthy brain.

Roe v. Wade: Why It Matters

Susan Desmarais

Roe vs. Wade changed the lives of countless women. It gave women control over their own bodies as they’d never had before. Birth control pills came into being in the 60s giving those with access to and funds for them more control over their reproductive choices.  But the pill was fraught with health issues and was definitely not okay for Catholics.

I remember so well an incident that occurred in the spring of 1974. My primary care doctor, the same doctor who had delivered me, prescribed me the pill for heavy menses.  He told me that if the pharmacist questioned me I should tell him the doctor put me on the pill because it was medically necessary.  Naively, I didn’t think a thing of it.

At my local, small town pharmacy I was gathering some items while the pharmacist filled the prescription. A booming voice came across the store like a shroud: “Susan, what are you doing with this prescription? You are Catholic!”.  I felt instantly cloaked in shame. Then I remembered Dr. Berlad’s words. Meekly, I repeated them and the pills were dispensed.

Many years later, after an ectopic pregnancy and several miscarriages, I became pregnant. It was a surprise, and I was thrilled. My partner was happy, my dad was ecstatic.

At the 16-week mark I began to stain and cramp.  The tentacles of fear gripped my heart, making it hard to breathe.  At a doctor’s visit, blood work and an ultrasound showed that the baby had stopped growing and my pregnancy hormones were not rising. My baby’s heart was still beating as she lay within me, dying. I was told, by a male doctor, that my only option was to have blood work done every two days, an ultrasound every four days, and as soon as Molly (my precious daughter’s name) died, they would take me into the hospital and do a D&C.

I vaguely remember leaving his office, physically moving through my life, my work, for those two weeks that followed. But I don’t remember anything else until the day the doctor called to say my baby girl was dead, and I should come right to the hospital for surgery. In hindsight, I know that my mind must have shut down to protect my heart and my spirit from such piercing pain.

Time marched forward, as did I. I can’t recall much. Back in the 1980s little support was available. No one talked about miscarriage.  My Molly lived and died within me. I carried her tenderly and still do to this day. My daughter would be 30 this year.

Two years later, I would be pregnant again. Cruelly, the same scenario began again, this time at the 18-week mark. Only this time, I had a woman doctor.  She called me to her office and gently told me what was happening. I crumbled into myself, weeping. She touched my shoulder and said, “You have a choice. You could go to Planned Parenthood”. As I raised my tear-filled eyes to her I knew that I would go. I knew in my bones that I couldn’t, wouldn’t go through this horrific realm of hell again.

I do remember going home, laying on my bed, cradling my belly and crying, singing, talking to my son, Patrick. I hoped that as he was fading from life he could feel, sense my boundless love. I went to Planned Parenthood. The worst part was walking through the gauntlet of hate-filled, ignorant, assaultive protestors shoving photos of dead babies into my face. I kept thinking, oh, how much you don’t know. But once inside the women who worked there were compassionate, strong and skilled. My son would turn 28 this year.

I would not have had that choice without Roe v. Wade. It was the last time I would become pregnant. I am forever grateful to have had the choice for a safe, legal abortion. And I know I was able to save my son from a protracted, painful death. I can only hope my daughter felt my love through her pain.

I’ve heard all of the arguments from anti-choice advocates. They have the right to their beliefs.  I will continue, until I no longer can, to ensure that women have access to reproductive choices. Reproductive choice –control over our bodies and our minds –is the cornerstone of all of our freedoms.

And I will continue to offer support for grieving parents who, by horrific chance or heart-wrenching choice, don’t get to see their babies flourish and grow.

Susan Desmarais is a counselor who specializes in working with women and families who experience miscarriage, neonatal death, medical termination of pregnancy, and stillbirth. 

Meet The Parents: Aly Lanzone Wiesner

Meet The Parents is a series of interviews with Island moms and dads in which we learn about the first year of parenthood from a variety of perspectives. If you'd like to be interviewed  please send us an email at info@vineyardbirthcollective.org. 

Name: Aly Lanzone Wiesner

How old is/are your child/children?
I have one daughter, Ida, and she is two years old.

What were you most anxious about during your pregnancy?
I was anxious quietly, but definitely worried and hoped that everything was normal and healthy. As the carrier of this growing human, I felt a profound sense of responsibility for everything to develop normally, but I was also aware of the fact that if something was atypical, it was likely something out of my control; the tension between this feeling and the cognitive understanding made me uneasy. I had a lot of positive self-talk happening about how everything would most likely be completely fine but my brain would always add "but you never know..." and "be prepared for anything..." I don't think it was an unhealthy worry because it helped me to keep an open mind, but it's the thing about which I was most anxious.

Did you have a birth plan? How closely did your labor resemble this plan?
I had a sketch of a plan but my plan was essentially that I would enter labor and delivery with an open mind. I had never been through this experience before so I wasn't sure what I would need. I knew I would have my husband there as my primary support,  I knew I would have doula support, and I expressed my reluctance about having an IV, "just in case" (IVs make me uncomfortable). It was my wish to have a birth without the need for medication and to avoid a C-section but I wasn't sure if that was possible. I believe that you have to do what you need and that is different for every person and every birth. There is no right way, only your way. I had an incredible birth experience at the MV Hospital. I feel like I floated on that positive experience for months after having our daughter and it still makes me feel so full of happiness when I think about it now. I did not have any medication during the birth, I did not need a C-section, my husband was remarkable, the doulas were outstanding, and the midwives and nurses were exceptional. I barely noticed the IV when it was time to have it in. I feel like I had the perfect team for me and I was so thankful to surrender the role of advocacy from my husband and I to the doulas. Their guidance and consultation was invaluable.

 What Island resources/services did you seek out during pregnancy? After?
During pregnancy, I received chiropractic care, prenatal massage and Thai massages. I went to prenatal yoga a few times but mostly practiced at home. I attended the birth classes at the hospital. After, I continued with the chiropractic care, attended MV Hospital's Postpartum Restorative and Infant Yoga, and several Family Center offerings: Baby's First Year, Infant Massage with Fae Kontje-Gibbs, and a Sleep Workshop with Rebekah Thomson.

What was the hardest part about being a new mom?
There were several tricky situations that I navigated. Letting go of tidying up so much was, and continues to be, a challenge. Before I had Ida, I would never go to bed with dishes in the sink or the floor unswept or laundry unfolded, but I made a decision that connecting with my daughter, asleep or awake, was more important than my need for a certain level of tidiness. I did some tidying when she was sleeping but I also took time to rest when she was sleeping (sometimes because she was sleeping on me). Instead of worrying about not being able to get something done, I embraced it. I was a better mother because of this. Everyone says to rest when the baby rests and I figured "everyone" must have said this for a reason.

 Additionally, it wasn't the "hardest part", but I was surprised that breastfeeding wasn't effortless at first. I had read a lot about it and knew I wanted to, but I didn't expect it to be the dance that it was. Getting the right latch seemed like this technical feat. I had this one nurse who kept hovering over me and critiquing in not the most supportive way. Every time she came to check on me I felt like I was going to be criticized. I know she was trying to help so we would be successful with breastfeeding but I got kind of stressed out about it in the beginning until one of my doulas, who came for a postpartum visit, told me I was doing fine. While I don't remember exactly what she said, she empowered me to trust myself in the process.

What has surprised you most about new motherhood on MV?
What surprised me the most was how great Baby's First Year was. It didn't matter if it was during naptime; I'd go and Ida would sleep in the car on the way there and I'd carry her sleeping in her seat. Marney Toole holds such a great space for new parents. It was so nice to have a destination where you could relax for a while without the worry of "what if she cries" or "where will I change her diaper" and connect with other people who were new parents. I loved the simple format of sharing a high and a low. New parenthood isn't always easy and it was so reassuring to have your "lows" validated or even hear that someone else is going through the same thing. Likewise, it was delightful to hear everyone share what they were loving about being a new parent. I remember wishing it could happen three times a week.

What is one resource for new families that you think is lacking on MV?
I don't think this exists anywhere but there should be a hotline you can call to get someone to come hang out with your baby who may have fallen asleep in the car when you are on your way to run errands so you can get things accomplished.  I've been held car-nap-hostage so many times.  Sometimes you luck out while sitting in the Cronig's parking lot and see someone you know but it can't just be anybody.  The drive from my house to any errand destination is long enough that she still will fall asleep on our way out sometimes. 

What were the products you couldn’t have lived without in your baby's first year?
Lanolin, Ergo baby carrier, coconut oil, lavender oil, Desitin, breast pump (when I went back to work), muslin baby blanket, sound machine, blackout shades, swing, baby monitor.

How did/do you make time for yourself?
I went back to work. Just kidding (sort of). My husband is a great partner and we are fortunate to have family here who love and feel confident caring for our daughter. While I was reluctant at first because I didn't want to be away from her, I would ask for some "me" time from any of them and they were all thrilled to have some Ida-time. They all encouraged self-care. Self-care is essential. To quote Audre Lorde, "I have come to believe that caring for myself is not self-indulgent. Caring for myself is an act of survival." 

If you could go back in time and give your “new mom” self three pieces advice, what would they be?
1. It's okay to let other people care for your baby. I really wanted to handle everything independently and may have had a little bit of a "my way or the highway" mentality. They may all have different ways of doing things but there is more than one way. Flexibility is a great thing to foster.
The next two pieces of advice are things that I did and I'm so happy I did them that I'd tell myself to do it again:
2. Rest when the baby rests. You'll find time to do the other things. Baby carriers are fantastic around the house.
3. Babies are born to attach to a caregiver. Spend time, heart to heart, head to head, connecting often. Let go of the some of the task-related business we get swept up in. When you are in a frenzy (or they are fussing), stop, hold your baby, nourish your baby, comfort your baby, get them to smile. Snuggle. Feel how warm and soft they are. Giggle. Make funny faces. Lock eyes.

Meet The Parents: Nili Morgan

Meet The Parents is a series of interviews with Island moms and dads in which we learn about the first year of parenthood from a variety of perspectives. If you'd like to be interviewed  please send us an email at info@vineyardbirthcollective.org. 

Name: Nili Beth Morgan

How old is/are your child/children?
Aaron will be two April 24 and I am due with our second child at the end of the summer.  

What were you most anxious about during your pregnancy?
Health - I had some health issues in my third trimester that required a medication that had a "DO NOT TAKE IF YOU ARE PREGNANT" label prominently displayed. Thankfully, everything was fine, both for me and for the baby, but the idea that something I needed to be healthy, and my baby needed, could possibly also do harm was scary.

Did you have a birth plan? How closely did your labor resemble this plan?
I was told not to plan, and I am glad that I listened. Aaron arrived three weeks early and my labor lasted 32 hours. So, while I was surprised and rushed at first, I had plenty of time to "plan" as the labor went on!

What Island resources/services did you seek out during pregnancy? After?
During pregnancy I attended prenatal Yoga a few times - less for the yoga and more to see and meet other expectant mothers. After Aaron's birth, Baby's First Year, with Marney Toole and the Family Center (a program of Martha’s Vineyard Community Services) was invaluable. Marney's amazing ability to create a safe, caring space created a circle of Mothers and caregivers that I still rely on for advice and play dates.

What was the hardest part about being a new mom?
Scheduling. Scheduling time for myself, scheduling time to be with my husband, scheduling my work and other activities. Aaron was small and required feeding every hour and half at first, I felt like I was always nursing! When we started supplementing with formula to get his weight up, and my husband or someone else could feed him, it still seemed impossible that I could take 15 minutes here or even an hour there, and do something other than be a mom. Take a shower or something crazy.

It is still really hard to find any kind of balance in that area, but it all comes together.

What has surprised you most about new motherhood on MV?
Motherhood seems to be constantly surprising. Motherhood on the Island has been amazing because I have a great support system: My family is wonderfully helpful and loving. When comparing my experience with those of my off-Island friends it seems that the major difference is that I didn't have to search to find a community for Aaron

What is one resource for new families that you think is lacking on MV?
I may be lucky, but between Baby's First Year and my follow up visit with our wonderful hospital midwifes, I felt cared for.

What were the products you couldn’t have lived without in your baby's first year?
A good, easy-to-use baby carrier. I loved my Ergo. Click-Connect stroller - the ease of moving from vehicle to stroller without waking or re-strapping an infant made errands much easier. Extra receiving blankets, towels or burp rags - anything to clean up quickly and not have to do laundry every twenty minutes.

How did/do you make time for yourself?
Who knows! Play dates, grandparents, aunts and uncles.

If you could go back in time and give your “new mom” self three pieces advice, what would they be?
1. Go out to dinner when they're really small, it's much easier with a sleeping infant than an interested, mobile toddler.

2. Don't buy that toy. You have plenty and people will keep on giving you more.

3. Sleep train before they can call out for "Momma!!!!" Screams are easier to deal with than direct pleas!

Thank you so much, Nili! 

What Does A Doula Do?

Elissa Lash, DONA International Certified Doula

You’ve come across the word doula in birthing books, or at a childbirth class – maybe a friend worked with a doula, or you even heard the recent piece on National Public Radio about doulas helping to decrease the rate of pre-term labor.  Yet, you still aren’t completely clear on what a doula does for a birthing mother, and what doesn’t a doula do, and how much do they cost and should you have one?

Vineyard Birth Collective recently held a potluck brunch titled “Meet the Doulas” where we strived to answer those questions and more.  I’ll try to encapsulate the information in this blog post for those who missed the event.

I’m a certified doula, trained by DONA International.  I had a doula at the birth of both of my children, now ten and six, so obviously I’m a fan of labor support.  However, I also know that the birth of your baby is a deeply personal and sacred event and there is no one-size-fits-all recommendation for what will make your labor and delivery the best possible experience for you.  Choosing a doula, or whether to have a doula, is an important decision with no right or wrong answer.

“Doula” is an ancient Greek word that roughly translates to: a woman who serves women.   In today’s world, the word doula has come to mean a person who is trained and certified in childbirth support and who attends births at home, at birth centers and at hospitals, by offering physical, emotional, and informational support before, during, and after birth.  Not to be confused with midwives or labor and delivery nurses, certified doulas are not trained or licensed to offer medical care, prescribe medication or actually deliver babies.

Physical support often includes positioning/movement suggestions and assistance for the birthing mother, massage, counter pressure, hydrotherapy, breathing practices and other physical (non medical) pain relief techniques, as well as coaching for the husband or partner to be also able to assist in comfort measures.  Emotional and informational support includes helping the clients ask the appropriate questions, suggestions for alternative perspectives, and coaching clients on how to advocate for their birth preferences.

A certified doula will have completed training in these techniques and will have had actual childbirth experience and practice. The doula certification process requires coursework on the physiology of childbirth, attendance at three births with sign off from the attending physician or midwife, as well as an essay, interview and payment of professional dues.  Many doulas complete this process through DONA International or other accredited organizations that offer oversight, protocols, and education for childbirth educators and labor assistants throughout North America.

Typically, a doula’s services will include a prenatal intake to determine a couple’s birth preferences, and allow time to discuss strategies to deal with labor and birth as well as postpartum.  Once a doula is professionally booked with a client, she may have the client sign a contract and/or request a deposit or “on call” fee.  Most doulas agree to be on call and available for a birth for two weeks prior to and post a woman’s estimated due date.  On Martha’s Vineyard, that means no off-island trips without prior agreement with the client.  Some doulas work with a back-up person or partner to help cover on-call dates or times that may be difficult.  The doula should discuss partner/or back-up coverage at the first meeting. 

Doula services include support for the entire duration of the birth, no matter how long.  Fees are set well ahead of time, and doulas do not charge “by the hour”.  Many doulas also include a postpartum visit to discuss the birth, and talk about strategies for self-care and healing after the birth, as well as help a new mother connect with resources she may need for herself or the baby.

Most Island doulas offer a sliding fee scale that can range from $400 - $1200 – don’t be embarrassed to ask about fees upfront.  The money part can be an important factor for many families, and most doulas are able to work with a client to make sure that services are affordable and available.  In fact, some doulas in training will agree to support a birth on a sliding scale, for little or no charge.

If you have questions or want to find out more about a local doula, please contact me, or any of the doulas listed on the site.  We’d be happy to have an informational interview or email with you!

I wish you a healthy, happy, empowered birth.

Elissa Lash has worked as a prenatal yoga instructor, doula and childbirth educator for over ten years in New York, Boston and on Martha's Vineyard. She teaches a free prenatal yoga class every Monday night at the YMCA (membership not required) and can be reached at eelash@hotmail.com. 

Eating for Two: Nutrition during Pregnancy

Prudence Athearn Levy, MS, RDN, LDN 

Pregnancy is such an exciting time in our lives. I loved and cherished both of my pregnancies, both at the time, and thinking back now, to that new, full of possibility brief moment in time, both scary and exciting, and for me resulting in two, so different, but each incredible, brilliant, loving and lovable boys. Each pregnancy was so different for me, in what it meant, how I felt, and what I was capable of accomplishing, but equally magical in their own ways.  For many of us, myself included, it is the time when we are most diligent with our health goals, knowing intuitively that our life choices directly affect the little one growing inside us. 

Sometimes though, it can also be overwhelming, worrying whether what we are doing is the best thing for baby, or reading and hearing conflicting information - especially about what we should and shouldn’t eat while pregnant. Rest assured, if you are taking care of your body, staying hydrated, eating enough to gain some weight but not too much unnecessary weight, exercising if you are able, and not smoking or engaging in other harmful activities, your baby should grow just as he or she should. That said, paying closer attention to your nutrition during pregnancy can help you have an easier, happier pregnancy, better birth experience, healthier baby, and make it easier to return to pre-pregnancy weight.

Pregnancy and breastfeeding are the only times in our lives that what we eat (or don’t eat) actually does affect someone else directly - baby! The phrase “eating for two” is correct in this sense, but your calorie needs don’t actually increase that much. In fact, during your first trimester you don’t need to consume any more calories than you used to (as long as you were meeting your nutrition needs and not underweight before pregnancy). After that, you’ll need to consume about 300 extra calories per day during your second and third trimesters- about what you would get by eating an extra snack of a banana with 2 tablespoons of almond butter. Gaining too much weight can make pregnancy, delivery and returning to pre-pregnancy weight more difficult, is linked with obesity later in life, and increases your risk for pre-eclampsia, pregnancy induced hypertension (PIH), and gestational diabetes. That said, it is equally important to remember that pregnancy is not a time for weight loss or restrictive eating. Gaining too little weight increases your risk for a premature birth, and/or having a low birth weight infant (with greater risk for developmental difficulties and other health problems).  It’s important to follow your obstetrician’s recommendation for weight gain that is right for you specifically. And remember, a healthy pregnancy does include some fat storage- you’ll need this during both labor and when breastfeeding your baby. Most of your weight gain goes to increases in blood volume (your blood volume increases by up to 60%!), increases in your uterus and breast size, placenta weight, overall fluid volume and amniotic fluid, and of course the size of your growing baby!

When I’m working with a pregnant mom to help her optimize her nutrition, we go through her specific needs for nutrients, and how she can plan her meals to get those through food. Here, I’d like to give you a general sense of which nutrients are most important to pay attention to getting through food during pregnancy, and give you some ideas to help you make the most of your pregnancy nutritionally!

Most women know it is important to eat a varied diet rich in fruits, vegetables, whole grains, calcium-rich dairy or dairy alternatives, lean meats or vegetarian sources of protein (i.e. legumes, organic soy), nuts and seeds, and healthy fats. But now you have specific and/or increased needs for calories and protein, along with the micronutrients iron, vitamin C, folate (folic acid), vitamins B6 and B12, zinc, calcium, vitamins D and A, iodine, choline, and DHA (an omega-3 fat). Water/fluid needs increase as well, generally by 2-4 cups/day, and I usually recommend aiming for between 64 to 96 ounces each day.  By getting these necessary nutrients through food and pure water (in addition to your prenatal vitamin, if recommended by your nutritionist and/or doctor), you’ll be maximizing the nutrition your baby receives.

One of the most important nutrients, omega-3s (especially DHA) serve key functions during pregnancy. They make up almost half the structure of the human brain, and are essential when the fetal brain is forming. Omega-3 intake during pregnancy is also associated with improvements in your mood and memory, which is a double incentive for finding safe sources of omega 3s to consume. Fatty fishes are the best source of DHA, but some can be too high in mercury or PCBs to safely consume regularly. Be sure to avoid shark, swordfish, king mackerel and tilefish, and limit your bluefish intake to only the lighter flesh and no more than 6 oz/week. Wild salmon is a great choice, and we can safely have two servings per week (up to 12 ounces). I do recommend choosing wild salmon whenever possible, but another option is exclusively organically farmed fish. Faroe Islands salmon is another sustainable farmed choice.  You can also get your DHA through canned light tuna (I recommend buying canned light tuna only from companies that both use smaller fish and test for mercury and PCBs such as Wild Planet). Many other varieties of fish are also considered safe during pregnancy, and help you meet your increased protein needs as well, such as flounder, sole, haddock, cod, tilapia, and halibut. If you don’t eat high omega-3 fish, I recommend a pure and third-party tested supplement of 300 to 500 mg DHA per day throughout pregnancy and breastfeeding, as it is very difficult to get enough usable DHA through vegetarian sources such as flaxseed.

Eating for two also means you need to pay extra attention to protein. Your developing fetus needs extra protein, one place in particular: structural development of the placenta. Approximately 950 g of protein are synthesized for your fetus and placenta. Usually an extra 10-20 grams/day will meet your needs, and I typically recommend a total of 80-100 g/day to optimize fetal development. Great sources of protein are plentiful: poultry, fish, shellfish, eggs, beans, lentils, beef, pork, tofu, tempeh, edamame, nuts, seeds, and organic or growth hormone-free dairy foods are all high in protein. For reference, a 4 ounce serving (the size of deck of cards) of meat or fish yields 28 grams of protein, two eggs are 12 grams, 1 cup of Greek yogurt is about 23 grams, and ½ cup of beans or 2 tablespoons of nut butter give you 8 grams of protein.

While you have increased needs for the majority of the vitamins and minerals listed above, and each are each essential for proper growth and development of your baby, you will get most of these when you eat a varied diet including lots of fruits and vegetables, nuts and legumes. If salads and steamed vegetables make you gag (like they did for me during my first pregnancy- shocking as they are usually my favorite foods!), try incorporating them into smoothies, soups or egg dishes to make them more palatable. Or, you may do better with raw vs. cooked vegetables, or vice versa. Don’t stress if you just can’t eat a lot of vegetables- you can use fruits and nuts and seeds to get many of the same nutrients, in addition to a good prenatal vitamin for extra folate. Similarly, if beans and lentils turn you off, try blending them and sneaking them into your quesadillas or pasta sauce. And if you can’t tolerate dairy during pregnancy, make sure you are getting enough calcium through leafy greens, beans and lentils, and/or fortified plant-based milks. Getting enough calcium may help you stave off leg cramps, and preserves your own stores of calcium while baby takes what he or she needs for the formation of bones and teeth.

Iron is another key mineral worth mentioning on its own. Your needs increase from 18 mg/day to 27 mg/day! Most women choose to ensure they are meeting this increase by taking a prentatal vitamin with iron, but you can also reach this by consuming a targeted amount of green, leafy vegetables, lean meat and poultry, legumes, organic soy, and whole grains. Another key nutrient that most women know that we need more of is folic acid, but even if your prenatal vitamin has the recommended dose (800 mcg), I recommend getting at least 200 mcg from folate-rich food sources such as citrus fruits and juices, and the aforementioned dark-green leafy vegetables, nuts, and legumes and whole grains. And finally, the last nutrient I’ll mention here specifically (because our needs increase by almost 50% for fetal cell growth and brain development) is zinc. You’ll meet your increased zinc needs by including meat, fish, dairy and/or eggs in your diet daily. If you are vegetarian, you might want to consider a prenatal with added zinc, as vegetarian sources (ie whole grains, wheat germ, black eyed peas and miso) have less absorbable zinc.

There is so much you can do to ensure a healthy pregnancy, and optimizing your nutrition is just one of the things you can do to feel your best. So eat well, relax, sleep, stretch, move often, and enjoy this amazing and powerful time in your life!

Prudence Athearn Levy earned her Masters’ degree in Human Nutrition from Colorado State University in 2003, and completed her internship and credentialing in 2004. She provides nutrition therapy and counseling in all areas of nutrition, specializing in diabetes, weight, eating disorders, maternity, postpartum, childhood nutrition, cardiovascular health, GI health, and food allergies.

Meet the Practitioners: Cathleen Vincent, Lic.Ac.

Meet The Practitioners is an ongoing series in which we invite local caregivers to answer a few questions about themselves and their areas of expertise.
For practitioners interested in being featured, please contact us at info@vineyardbirthcollective.com. 

Cathleen Vincent is board certified and licensed to practice acupuncture by the Massachusetts Board of Medicine. She lives and works on Martha’s Vineyard and offers individually tailored treatments for people seeking wellness and health. She works currently out of the Yoga Barn in West Tisbury and also offers house calls.

Here, Cathleen talks about the many benefits acupuncture can offer both women and men in the various stages of the pregnancy and postpartum periods.

How long have you been an acupuncturist? 
I've been in practice for 10 years.

What is your training? 
My education is an undergraduate degree in Mathematics major from Bates College in Maine and a graduate degree in Chinese and Japanese Acupuncture from the New England School of Acupuncture in Boston, MA.

What is acupuncture?
Acupuncture is a 3000-year-old tradition originating in China.  It uses needles, herbs or probes to stimulate areas in the body called acupuncture points to promote healing, wellness and balance for physical, mental and emotional strength, relief and health.  

Science is still trying to fully understand why acupuncture helps to heal the body.  One theory is that acupuncture suppresses the body's adrenal stress response, allowing the body to engage its own healing mechanisms more efficiently.  Chinese medical theory believes that a person is a unified energetic and physical body, and that health is achieved by allowing the body's natural energy to flow freely and unencumbered.

You often see people for issues related to fertility and pregnancy. Is this a big part of your practice?
I see people for many health and wellness issues, but I do have specific training in acupuncture during pregnancy and birth, and acupuncture to support fertility health.  

I love the journey of fertility, pregnancy, birth and post partum.  It is a very special time in life where any natural and non-invasive care to support a woman or man is so valuable.  The lovely thing about acupuncture is that is can work well with many other forms of health care without interfering with other treatment protocols.

How can acupuncture help with during pregnancy? 
Acupuncture offers such wonderful support throughout pregnancy.  The one thing acupuncture almost always does is help to regulate and relax a person-- mood stabilization, stress relief, and mental support are important things to have during a pregnancy.  

Acupuncture can also help with nausea, morning sickness, heartburn, constipation, diarrhea or irritable digestion. I have also seen patients get relief from aching muscles, leg cramps, hemorrhoids, Carpal Tunnel Syndrome, discomfort from varicose veins, back pain and correcting a breech presentation during their pregnancies.  

How can acupuncture help with fertility? Post-partum concerns? 
Acupuncture can help to regulate some hormonal fluctuations and/or imbalances that are commonly experienced with fertility and the post-partum phase.  While not the only causes, hormonal imbalances in sex hormones (estrogen, progesterone, testosterone) or body function hormones like thyroid or adrenal hormones can cause fertility challenges.  Any major disruption in these hormonal systems can cause problems conceiving or regulating a pregnancy or maintaining mood in the post partum phase.

Could you explain a bit about your holistic approach and what other disciplines you use to supplement your treatments? 
Acupuncture is a holistic therapy. All body systems are taken into account, even if you are coming in for a specific complaint.  

Besides acupuncture, I also offer cupping therapy, moxibustion, energy work, zero balancing, and a fully present composure.  

Does acupuncture hurt?  
Nah.  Not really.  You can certainly feel the needles sometimes, and there can be a sensation awareness.  But in general, once the needles are in you no longer feel them, and they should not feel painful.

Can acupuncture help move things along during labor?
Acupuncture helps to promote a healthy labor, but it cannot make a woman begin labor before she is ready.  I have seen acupuncture help many women ease into labor and continue with a healthy birth.  Acupuncture can help strengthen and ease a woman's labor and birth process, but Mother Nature always has the last say! 

Meet The Practitioners: Mary Alice Robinson

Meet The Practitioners is an ongoing series in which we invite local caregivers to answer a few questions about themselves and their areas of expertise. 
For practitioners interested in being featured, please contact us at info@vineyardbirthcollective.com. 

Mary Alice Robinson is a Registered Nurse at the Martha’s Vineyard Hospital and volunteers with the Martha's Vineyard Breastfeeding Network, a community resource that provides 24-hour support and consultations for breastfeeding women on the Island. Here she answers a few questions about her involvement and common challenges faced by new breastfeeding families.

What is your position at the hospital?  
I am a Registered Nurse in the Operating Room. I began working at the Martha’s Vineyard Hospital in the nutrition department in 2008 and I was hired as an RN 5 years ago. I also help teach a portion of the childbirth education series on breastfeeding.

How did you get involved with the breastfeeding network?
I was invited to become involved with the breastfeeding network by Joyce Capobianco, the nurse manager of the maternity department. She was looking for a staff member from the operating room that could be available to support mothers with breastfeeding directly following cesarean births. I was really excited to become involved.

What services does the network provide?
The network provides free breastfeeding education and consulting for Island families. We have a pager that allows for 24-hour live support from a certified breastfeeding counselor. We offer in home visits, phone calls, and texting support, even in the wee hours of the night. We also encourage families to come into the maternity department for assessments and information at any time.

Last June we started a support group with the YMCA called the Breastfeeding Café. It’s a weekly event, currently held on Wednesdays, and it's a nice time for moms to get together and ask questions and share their experiences.

How can people contact you?
The pager number is 508-396-7498. There will be a message on that line with the contact information for the counselor on-call.

What are the most common breastfeeding questions you hear from new or expecting moms?
The most common question in the beginning is, "How do I know if my baby is getting enough milk?" I know I wondered the same thing as a new mother. There are ways we can assess this from the baby’s perspective, like expected weight gain, signs of satisfaction after feedings, or counting wet diapers. But I also try to encourage mothers to trust their abilities to feed their babies. Focus on one feeding at a time, one day at a time, and trust in your body's amazing ability to nourish your baby.

Why are you passionate about breastfeeding education?
I'm passionate about education and empowerment, which is why I love being a nurse. I don't consider myself a proponent for breastfeeding. I’m more of a support person for new families trying to figure out what works for them. If a mother wants to breastfeed I want to help her in any way that I can to follow through with that goal. I am inspired by our Island community and how we come together to share knowledge and offer support. I feel really lucky to be even a small part of that.

Any advice you want to share for newly breastfeeding mamas or pregnant women thinking about breastfeeding?
If you are on the fence, give it a shot. You have nothing to lose! If you are struggling in the early days, stick with it. I promise it gets easier. Like many aspects of parenting, breastfeeding is rewarding and it can also be stressful at times, so don't be afraid to ask for help. Breastfeeding is the optimum nutrition for your baby and the health benefits for mom are numerous. Take care of both of you!

Newborn Sleep Tips: Establishing Healthy Habits

Rebekah Thomson, Certified Sleep Coach

Congratulations on the birth of your little ones! Most of my sleep advice is directed toward children six months and up. By that age, babies are decreasingly reliant on nighttime feedings (though some may still need a few) and more prepared for behavior modification. That said there are some basic, developmentally appropriate ways in which we can begin to lay a solid sleep foundation with babies under six months. And in the case of parents returning to work, coping with postpartum depression or blues, or simply burnt out from sleep deprivation, some early interventions may be necessary.

First, a word about sleep advice from well-intentioned family and friends…

Like parenting in general, how we approach sleep is very personal. Parents must decide for themselves what they feel comfortable with, what meshes with their values and philosophy, and what works for their child’s unique temperament and needs. Lots of friends and family like to opine about sleep, but it is essential that parents listen to their gut and understand that while an approach worked for one family, it does not necessarily mean it’s a good (or healthy) fit for theirs.

There are significant individual differences between all children (and adults!), particularly in babies under six months. This is why one size does NOT fit all and what worked for a friend and her baby, may not work for you. This is especially true for feeding. For example, some infants with large stomach capacity may be able to consume large amounts of breast milk or formula, enabling the baby to go 3.5 hours without another feeding. Another baby with a smaller capacity may truly need to eat every 2 hours. Both are healthy and normal for this variable age group, but clearly the babies have very different feeding needs. Alternatively, one baby’s mother might have an abundant milk supply, while the other’s mother’s supply might be perfectly adequate, though not sufficient to stretch out feedings. Attempting to do so would actually put their otherwise healthy baby at great risk. Then there are babies with reflux, who have a totally different set of feeding needs. For this reason, any recommendation from a book, friend, or family member for scheduled feedings – or stretching out feedings – should be taken with a BIG grain of salt.

Establish a healthy feeding pattern as soon as baby is born.

With young babies, almost everything revolves around feeding, including sleep. Making sure their feeding needs are being met is essential to their health and growth, as well as any sleep success. Most infants need approximately 6-7 full feedings between 6am–10pm, plus more at night depending on their growth and individual needs. “Full” is the operative word here. If breastfeeding, this usually means emptying both sides. The goal is to avoid snacking throughout the day, though shorter cluster feedings in the late afternoon as well as extra comfort feeds are perfectly fine.

If there is any concern or doubt about whether the baby is getting sufficient calories during each feeding – or if breast or bottle-feeding become challenging – consult your pediatrician and/or one of our island’s great lactation consultants promptly. If their answer doesn’t sit right with you, seek a second opinion.

Note: Babies usually have growth spurts around 3 and 6 weeks, and 3 and 6 months. It is essential that they receive additional calories at these times and if breastfeeding, that they go to the breast more to up their mother’s milk production so that she can meet their need.

Create a flexible feeding and sleeping routine

A flexible routine does not mean a minute-by-minute schedule, but rather a sensible framework so that full feedings and sleeping are prioritized. Almost every sleep book on the market agrees that in general, an “eat – active time – sleep” cycle (in that order) is beneficial. In other words, feed your baby “up.” When she wakes, give her a full feeding (and burping). Then encourage her to stay awake for a short period. This is the time to engage with your baby, give her some tummy time, take her outside, etc. How long this active time should last is dictated by her age (wakeful windows get increasingly longer) and your baby’s cues. When she starts to show her sleepy cues – yawning, rubbing her eyes, zoning out, mild fussiness, etc. – you’ll know it’s time for her to rest. This cycle can be continued throughout the day, at least until the afternoon when her central nervous system is more taxed.

The beauty of this routine is that it makes parenting easier. Infants don’t differentiate their cries right away, so it can be hard figuring out why she’s not happy. However, if you know she has had a full feeding, she’s been appropriately stimulated, and now she’s fussy, she’s probably ready to sleep. On the other hand, if she’s had a partial feeding because she fell asleep during the feeding, it’s hard to read her cues. Is she hungry again? Did she not rest enough? Is something else wrong?

The “eat – active time – sleep” cycle brings other advantages too. It helps to disassociate falling asleep and eating (though it’s fine for infants to fall asleep at the breast/bottle sometimes). And for babies dealing with reflux, having upright time after feedings is crucial.

Look for natural day/night cycle to emerge, usually 6am-6pm or 7am-7pm.

Most babies fall into a 6am-6pm or 7am-7pm (or thereabouts) schedule. During the day, we want to focus on full feedings every few hours, outside time, lots of floor time to practice new skills, and napping at appropriate intervals. When you notice your little ones starting to get tired around 6pm or 7pm, she’s probably ready to call it a day.

Many parents mistake this fussiness as a need for one more nap. But after a 12-hr day, her central nervous system is taxed, and it is time to get her into a less stimulating, more sleep friendly environment. Bring her to the bedroom, give her one last feeding, change her diaper, dim the lights, turn on some white noise (especially if the rest of the house is still up and at ‘em), sing her a song, swaddle her up (if she’s into that), and put her to bed.

Manage day and night feedings so that caregivers can get some rest too.

Even though she’s ready to hit the sack around 6 or 7pm, a later evening feeding works well for babies and parents. Rouse her for full, boring feeding 2-3 hours later (around 9-10pm), then put her straight back to bed. Then YOU go to bed too!

Babies can naturally take one long stretch per 24-hour period. At first the long stretch may just be 4 hours, but it will lengthen over the upcoming months to 5-6-7 hours and will eventually become her night sleep. We want to encourage the long stretch to be at night after that last 9-10pm-ish feeding. If she takes it during the day in the form of an epic nap, she will legitimately be up all night making up for calories didn’t receive during the day. (Yes, that means wake a sleeping baby from a nap so that she doesn’t sleep through a daytime feeding.) And if she does her long stretch from 6-10pm, then you haven’t benefited from it. So encourage her little body to take its long stretch after that last evening feed.

Note: If mom really needs some more sleep, see if another caregiver can do the next feeding (probably around 1-3am) so that mom can get a solid stretch herself. If breastfeeding, this can be a bottle of expressed breast milk. As the saying goes, “If mama isn’t happy, ain’t nobody happy.” Knowing how intense as the first few months can be, we need to do what we can to support ourselves. An uninterrupted 6+ hour stretch of sleep can do wonders for a mom coping with baby blues, postpartum depression, or simply trying to regroup after a challenging postpartum time.

I could go on (and on, and on), but will stop there for now – more infant sleep suggestions to come. In the meantime, wishing everyone a very happy holiday season with your little ones.

Rebekah Thomson is a Gentle Sleep Coach, trained and certified by Kim West (AKA The Sleep Lady), author of Good Night Sleep Tight. She works individually with families struggling with sleep challenges and offers workshops regularly. Rebekah and her husband live in West Tisbury with their three children, who offer her ongoing professional development opportunities. She can be reached at www.countingsheepmv.com.

What I Didn't Get to Tell You Then

 Susan Desmarais, Counselor

Our culture has many national days or months of observance.  We set aside time for people to come together or individually pause, remember and reflect on beginnings and endings. Some endings are more openly spoken of than others. Some are held close to one’s heart and while they dim with time the poignancy never completely recedes. Between 10 and 20% of pregnancies will end in miscarriage. One in 160 will result in stillbirth. Making the death of a baby in utero far more common than many realize. Yet the sorrow is silent, borne in parents hearts, usually without supportive ritual to offer solace, a bit of comfort.

Understandably and sadly many don’t know what to say to a newly grieving parent. Understandable because our culture at large doesn't give grief or grieving people tender space in which to be with loss, pain and emptiness.  We feel awkward saying something, not wanting to make someone cry or make them think of their loss. But please know this…giving someone the chance to cry is healing, speaking about their loss validates it and tells them someone else recognizes their pain….that they are not alone.

When a baby dies in utero or during labor words are never adequate..except to say…. I don’t know what to say, words fail me.  October is National Pregnancy Loss Month, hopefully during this month parents will know they are not alone in their loss. What follows here is an essay written by me after my final miscarriage.

What I Didn’t Get to Tell You Then….

I didn't tell you how much I loved you from the moment I guessed you were forming, changing, growing inside of me. You were a miracle to me - as you floated in my precious vessel within - I wondered …

What color will your hair be? Red like mine? Would you have the same twinkle your Grampa had in his eyes?  How many freckles would you have? No, not will you have them, freckles were a foregone conclusion. Were you going to be a girl? A boy? That didn't matter much to me.

I didn't tell my hopes for you. I hoped you would be carried on strong, sturdy legs so you could run like the wind when you wanted to. I hoped your intuition would be your north star, your very own compass.  I hoped you would grow an open, resilient heart filled with compassion, light and spirit. I hoped your mind would be pliable, creative and strongly connected to your heart spirit. I hoped your breath would be easy, your eyes gentle and your smile plentiful.

I didn't get to tell you my dreams. I dreamt of feeding and rocking you as a baby. I dreamt of your first steps, the first time you smelled a flower, the petals tickling the tip of your little Irish nose as a new scent entered your senses. I dreamt of the first time a puppy kissed your sweet face and you giggled with sheer joy. I dreamt of your first day of school, the first fish that Grampa would help you catch. Oh, how he would have loved you. You would have lit his world, his heart.

I dreamt you would grow up to be a hippie, a doctor or the president, whichever path you chose would be your path, maybe you would be all three!

What I did tell you as my body started to cramp, too soon, pain from my uterus piercing my heart was…..Please Stay…………..I will love you always…..

Susan Desmarais is a counselor who specializes in working with women and families who experience miscarriage, neonatal death, medical termination of pregnancy, and stillbirth. After Susan retired from working as a bereavement counselor, she chose to offer this specialty as it is dear to her heart. She can be reached at obsusan@icloud.com.