Lifestyle Adjustments: As you evaluate your nutrition and lifestyle, it would also be helpful to evaluate your level
of activity and add extra nutritious calories if you use extra calories during the week, with jogging, biking, skating, skiing,
or other sports, or other extra calorie-depleting activities, like teaching, dancing, waitressing, nursing, doctoring, or
other activities that keep you on your feet all day. Caring for other children, working both outside and in the home, caring
for other family members, and housework would also use up a lot of calories, especially as the baby gets bigger and you burn
up calories just carrying around the extra weight of the baby, uterus and extra blood volume. You can also evaluate whether
other stresses in your life might be using up extra calories. If you have had extra stresses in your life, then adding extra
nutritious calories and other nutrients to compensate for those calorie-burning stresses would help to keep your blood volume
expanded and your pregnancy and baby healthy.
See here to help you evaluate your daily nutrition patterns
See here for a nutrition/lifestyle self-assessment which I highly recommend
Eating Patterns:The usual eating pattern that we suggest that pregnant women can use to keep up with their nutritional
needs is as follows: breakfast, mid-morning snack, lunch, mid-afternoon snack, supper, bedtime snack, middle-of-the-night
snack. If you are having trouble keeping up with the amount of food that you need, or if you are having trouble keeping your
blood pressure within a normal range, we suggest that you eat something with protein in it (glass of milk, cheese cubes, handful
of nuts, handful of trail mix, etc), every hour that you are awake.
Please be aware that traveling and moving can disrupt your eating routine just enough to trigger a low blood volume problem
which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process
can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself
to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.
Morning Sickness: If you are dealing with nausea, vomiting, or diarrhea, it is vitally important to try to alleviate
those problems as soon as possible, since they also contribute to depleting your blood volume. You can try frequent, small
snacks, herbs, and homeopathy to help you in this effort. If you decide to try using ginger, which can be very effective
for "morning" sickness, use it only in small amounts, and only just before eating some kind of food, since too much ginger
can cause bleeding and possibly miscarriage.
See a resource for homeopathy for morning sickness here
See here for more suggestions of ways to alleviate morning sickness
Adjusting for Salt Loss: It would also be helpful for you to evaluate whether you are ever in situations that result
in your losing extra sweat and salt--situations such as gardening in hot weather, exercising, living in hot homes during the
winter, or living without air-conditioning in the summer, or working in over-heated working conditions. If you do have one
of those situations, it would be helpful for you to add extra salt and nutritious fluids to your daily nutrition. This extra
effort will help to keep your blood volume expanded to where it needs to be to prevent elevated blood pressure, pre-eclampsia,
and other complications.
See here for more information about the importance of salt in pregnancy
Calories plus Salt plus Protein: Eating the recommended amount of protein every day isn't enough to keep your blood
volume expanded to where it needs to be for preventing complications in pregnancy. It is also vitally important to make sure
that your intake of nutritious calories and salt are also at the recommended levels, with special extra allowances added as
needed for your unique situation.
See here for more information on the importance of calories in pregnancy
In September of this year (2008) a study came out from Denmark which seems to emphatically support something which the Brewers
and their supporters have been saying for over 30 years. That is that pregnant women who lose extra salt, or burn extra calories,
through extra exercise NEED to compensate for those losses by adding extra salt and calories to their diets. When they do
not make special allowances for their unique needs in this way, their blood volume will drop, and they will develop rising
BPs, pathological edema, pre-eclampsia, HELLP, IUGR, premature labor, underweight babies, and other complications associated
with low blood volume. This particular study was looking at only pre-eclampsia, and only at recreational exercise, but those
of us who understand the Brewer principles understand that the same principles do apply to all of these other complications,
and to any source of salt/fluid/calorie loss, as well.
"Pregnant exercise 'unsafe'"
"Women who exercise during pregnancy face risk of pre-eclampsia, researchers warn"
"Exercise in pregnancy linked to fatal raised blood pressure condition"
Herbal Diuretics: Unfortunately, some areas of the "alternative medicine" community have followed mainstream medicine
in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy
teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties.
Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant
women to watch which herbs they are taking.
See here for more information about the use of herbal diuretics in pregnancy
Empowering Women: I would also like to add here the assurance that Dr. Brewer was not blaming the mother for her situation,
as some would claim that he was, and neither am I. He is clearly blaming her doctor for not having the routine of examining
her nutritional status and doing a differential diagnosis for her. He is saying that if her doctor is not doing this with
her, then it is most important for her to do it for herself, for the sake of her own health and that of her baby.
The following is reprinted from "Chapter 1" of Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.
"The Complete Pregnancy Diet: Meeting Your Special Needs", by Gail Sforza Brewer (p.1)
Agnes Higgins, past president of the Canadian Dietetic Society and director of the Montreal Diet Dispensary [as of 1983],
has developed a procedure for estimating calorie and protein requirements in excess of the pregnancy levels we've already
established as a baseline. She emphasizes that any of the following factors increases a mother's nutritional needs:
As a corrective allowance, Mrs. Higgins and her staff counsel mothers to add twenty grams of protein and two hundred
calories to their basic daily pregnancy diets for each condition listed above (an individual mother
may be experiencing more than one of these stress conditions).
Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein
and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding
one quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream
pies and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase
the protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or
meat substitute as detailed on the diet list. A sample daily menu plan for a mother expecting twins would look something
Generally speaking, these conditions result in an increased appetite; however, women who are working, moving
their households, or under emotional stress sometimes fail to pay attention to their bodies' signals for more
food. Calling special attention to their extra needs by assigning specific goals for extra protein and calorie consumption
makes it much less likely that their nutritional needs will go unfulfilled.
Undernutrition means any protein deficit between what you're used to getting from your food and the minimum adequate pregnancy
requirement (eighty to a hundred grams per day). The Higgins nutrition intervention method uses a twenty-four hour diet recall,
a technique you can use on your own to see how close your regular diet has been coming to what you actually need. You will
need to write down everything you've eaten for the past twenty-four hours (pick a typical day for you), including all
snacks, all beverages, and all second helpings. Note what the food was, how much you ate, then consult the Protein-Calorie
Counter (see Appendix) to check the amount of protein contained in those portions of those foods. For each gram of protein
you lack, add that to your personal protein goal, plus an additional ten calories to free that protein for its most important
work in pregnancy: keeping you own tissues healthy and building those of your unborn baby. If you come up with a deficit
of ten grams of protein, then, you also need to add a hundred calories to your basic requirements.
See here for entire chapter, "The Complete Pregnancy Diet: Meeting Your Special Needs"
Eating for Two, by Gail Sforza Brewer and Isaac Cronin, available here