Pregnancy: What your doctor may not tell you about your diet

**Edited Sunday to include information from George Elvove, M.D., P.C.
note: In order to bring you accurate information concerning important parenting issues, I've teamed with some local professionals who have agreed to share their knowledge in each of their fields of expertise. I will regularly consult with the professionals when writing about topics like breastfeeding, babywearing, health and natural childbirth, prenatal and pediatric chiropractic care and child rearing. This post includes information from Certified Nurse Midwife Debbie Boucher and George Elvove, M.D., P.C. You can read Debbie Boucher's Snapshot Interview here.

When I was pregnant with Gabe, I asked our former obstetrician, Dr. J., (read: not Debbie or Dr. Elvove!) the type of diet I should follow during my pregnancy. She looked at me slightly confused, thought for a second and suggested following the food pyramid.

You know, Dr. J. said, a normal, healthy diet.

And though I didn't know much about achieving a healthy pregnancy and delivering a healthy baby at that point, her answer didn't settle right with me even though I liked and respected her.

But because she was my doctor and had gone to school for many years to become an OB, I didn't too seriously question her response. Well, I didn't until began reading about glucose testing for pregnant women. The whole concept of glucose testing made no sense to me. Why would you have a pregnant woman fast for eight hours, drink a sugary drink to spike her blood sugar level and then test to see how her body handles this very abnormal-eating situation. (Because who in her right mind fasts for eight hours and then gets up and eats four jelly donuts in the morning while she's pregnant? Maybe some people, but not me!) It was no surprise that I tested a point too high to be considered in the normal range. The results of the test, of course, determined that I was at risk for gestational diabetes. That means, my OB explained, that I would need to undergo the three-hour glucose test.

During that three-hour glucose test, which were quite possibly the worst three hours of my pregnancy, John and I decided to employ a different OB. I wanted an OB who would take my question about pregnancy diet seriously and not employ such strange methods of testing after my body had failed to give the most desirable results in an unnatural-testing situation. Luckily, a friend of mine had delivered with George Elvove, a pediatrician and obstetrician. Dr. Elvove delivered more than 4,000 babies during his career as an OB and was known as a natural-childbirth doctor. And he believes in providing the right nutritional care for pregnancy and lactating women, among other things. He has since retired from OB work but still practices pediatric medicine. I'm fortunate that my Certified Nurse Midwife, Debbie Boucher, did some of her training under Dr. Elvove and adopted the same pregnancy diet he recommended for all of his patients. The diet is based on Tom Brewer's, M.D., Nutrition in Pregnancy diet.

Here is the gist:

*Consume 80 to 100 grams of protein per day
*Limit consumption of carbohydrates to one whole grain per day.
*Eat at least two green vegetables per day
*Eat two to three servings of other vegetables per day
*Eat one to two servings of fruit per day
*Eat two eggs per day
*Eat one Vitamin C source per day
*Eat three to four milk products per day
*Limit fats to two to three servings
*Drink plenty of water
*Eat a yellow or orange-colored fruit or vegetable five times per week

But why follow this type of diet? Debbie Boucher, CNM, and Geoge Elvove, M.D., P.C., gave some important answers. Boucher's answers are written in green. Dr. Elvove's answers are typed in purple.

What is the goal of the diet and why do pregnant women need so much protein?
1. To help with normal growth and development of the baby.
2. To help the woman’s body through the changes of pregnancy including growth of the placenta, production of amniotic fluid, and normal blood volume increase.
3. To help prevent pregnancy complications such as pre-eclampsia, pregnancy-induced hypertension, and gestational diabetes.

"The baby requires protein to create skin, blood, muscle, bone, brain, and organ tissues," Elvove said. "If the mother's diet is inadequate, the baby will take the protein that it requires from the mother's body tissues. Protein deficiency in the maternal diet can lead to preterm labor, preeclampsia/eclampsia, and dysfunctional labor."

Why limit refined carbs? What's the difference between sugar found in bread versus sugar found in fruit?
"Refined carbs and sugar break down to glucose faster than fruit sugars and causes poor glycemic control, which basically causes glucose levels to fluctuate too much," Boucher said. "Poor glycemic control leads to blood sugar abnormalities like diabetes. It also can contribute to blood vessel inflammation which leads to cardiovascular diseases such as arteriosclerosis, hypertension, stroke, coronary artery disease, angina, and peripheral artery disease."

"A high glycemic load results in the over-secretion of insulin," Elvove said. "Excess insulin can result in gestational diabetes and a myriad of health problems in the mother. Barry Sears reviews this subject in detain in his Zone books."

Do you think it's necessary to gluclose test every expecting mother? Do you have any problems with the test?

"I dispensed with glucose testing years ago if a pregnant woman brought me a healthy diet log," Elvove said. "Gestational diabetes is entirely a disease of poor nutrition. A high dose of sugar is not healthy due to the over-secretion of insulin it causes."

While following the pregnancy diet, I felt great! I gained only 22 pounds during my pregnancy with Gabe, and I lost every single one of those pounds within three days of delivering my healthy 6 pound 14 ounce baby. During this pregnancy, I also have felt wonderful. At 20 weeks, I've gained eight pounds and our baby measured right on for our predicted due date. He also has developed well in the womb, and God-willing, he will be healthy and weigh somewhere between six and eight pounds upon delivery.

Yes, I miss my ceral often and sometimes wish I could dive into the world of yummy yummy pasta more often than I should (which is just once or twice a week and is surely made of whole grain); but I do realize that delivering a baby that isn't humongous from ingesting too much sugar is very important to me. I also do not want to contend with losing more than 20- 25 pounds after delivery because maintaining a healthy weight has become very important to me during the past three years.

Happy pregnancy and dining for two!

Breastfeeding help: Night weaning the serial nurser

note: In order to bring you accurate information concerning hot parenting issues, I've teamed with some local professionals who have agreed to share their knowledge in each of their fields of expertise. I will regularly consult with the professionals when writing about topics like breastfeeding, babywearing, health and natural childbirth, prenatal and pediatric chiropractic care and child rearing. This post includes information from International Board Certified Lactation Consultant and Registered Lactation Consultant Jeanne Cygnus. You can read Jeanne's Snapshot profile here.

It's no surprise that Gabe loves milk more than almost anything else in his little world. As the former Fat Kid Club President, I also can assure you my child has inherited the love for anything food or drink related. So, while considering both of those facts, I'm sure you can understand why I was [nervous, scared, frightened] absolutely freakin' terrified to begin the night-weaning process at 16.5 months in late Dec. But I couldn't hack it anymore. I began to feel like a walking zombie during the day after waking up every two hours to give my all night-nurser his favorite cuisine.

Plus, I was beginning to feel like my toddler, who eats enormous amounts of solid food and drinks quarts of cow milk and breastmilk during the day, no longer needed milk during the night. Actually, I began feeling like he was just waking up because mom's diner was open 24 hours, so why not indulge in all of those late night snacks.

So I spoke with John, who quickly got on board, and we began devising a plan to night wean our serial nurser. First, thought, we consulted Dr. Sears' The Baby Book for some tips on night weaning, and I also spoke with Jeanne Cygnus, our lactation consultant.

After hearing my diagnosis of the situation, Jeanne reassured me that Gabe was at the age where he could go all night without needing to nurse.

"As far as age goes many babies start sleeping through around 3 mos (with interruptions around 4 mos!)," Jeanne said. "Some aren't ready until 6-8 months; most babies should be able to by the time they are 10-12 months, but there are always exceptions."

And those exceptions make it hard to give an exact age where parents can definitively say their child is ready to night wean.

"The problem with giving any concrete answer here is that there are many different reasons babies nurse at night," Jeanne said. "Some babies nurse at night because they are so active during the day that they do not stop long enough to take good feeds and need to make up calories during the night to maintain their growth. Some babies also do this if they don't feed well from bottles while at day care --they'll eat enough to get by [during the day], and then make up for it by eating during the night. Trying to force these babies to forgo eating at night can cause them unnecessary hunger and poor weight gain."

Jeanne said other babies have very vivid dreams, wake themselves up, become frightened and need the comfort of nursing to settle back down into a sleep-mode.

"These babies may not nurse for very long, but they rely on the comfort of the connection with mom in order to feel safe and secure again. These babies can be 'trained' that they have to cry it out alone, but it may not be the best message to send for their long-term emotional health."

And finally some babies seem to just get into a rhythm of sleep/wake cycles and become "used" to nursing as part of this cycle.

"These are the babies that really don't 'need' to nurse, but are in a habit," Jeanne said. "These are the night-nursings that are generally fairly easy to eliminate and doing so can actually be beneficial to both mom AND baby as baby starts sleeping for longer stretches."

Overall, no one can tell a mom when to start night-weaning better than mom herself!

"Most moms often have an idea of which of these is going on, based on their baby's temperament and patterns," Jeanne said.

I could tell Gabe, at 16 months, was waking because his body simply had become accustomed to waking several times per night and then nursing back to sleep, so we proceeded with night-weaning plans.

Dr. Sears recommends asking dad for help during the night so that baby will accept forms of comfort other than the breast. He also recommends in his book talking to your little milk monster and then sticking with the plan. There will be rough nights, Dr. Sears, says, and I agree. But those first few nights were not as hard as I thought they were going to prove.


The first night we began night weaning, we laid down in Gabe's big-boy bed (a full size mattress on a box spring on the floor), and explained that Gabe was going to "night night" (our word for sleep), mama was going to go night night, dada was going to night night and milk was going to go night night. He looked at me, smiled and asked for milk. I nursed him before bed, and then again told him that everyone, including milk, was going night night until it was light outside. I doubt much of that sank in because like clockwork he woke up two hours later expecting a boob. John then went into Gabe's room, laid down with him and snuggled him back to sleep. Gabe cried. He wailed for mama. John calmly explained that everyone, including milk, went night night.

But it worked. Gabe went back to sleep. And after a few nights of crying for milk, he finally accepted the new form of comfort from John. After about a week, Gabe began sleeping in his bed until about 4 or 5 in the morning every night. Gabe also comes to bed with us after waking and snuggles with us until about 7 or 7:30. When he wakes at 5, I do nurse him, and he falls right back asleep.

I had a few concerns about my day-time milk supply dropping, so Jeanne gave me a few tips. She said because my supply had dropped so much and Gabe was nursing so frequently through the day, I might want to consider waking up about 5 hours after his last night nursing to pump. Little did we know when she offered that advice that my supply actually dropped because I was pregnant, so pumping would not have helped.
"The only time I recommend pumping after 5 hours is if you experience a dramatic decrease in supply during the day and are trying to increase over-all milk supply OR in the early months of breastfeeding when babies really aren't meant to be sleeping through the night and your breasts need that nighttime stimulation," Jeanne said. "In most cases, with most moms and babies, sleeping through the night at [Gabe's] age is normal, and mom should not be concerned as long as she's comfortable, as the body does adjust."

Generally, though, most moms who are ready to night wean need not wake to pump.

"As [baby grows] older and is taking solids, going longer at night should be fine as long as you are not waking up uncomfortable or engorged, which could put you at risk for mastitis," Jeanne said.

Need Jeanne's help? www.cygnuslacation.com.