Thoughts from the Midwife:  

What Foods Help Grow a Healthy Baby?

Growing a healthy baby begins with eating a healthy diet. So, where do you start?

The basics are to eat a well-balanced, lower fat diet made up of protein sources, whole grains, fresh fruits and vegetables, dairy products, and plenty of water. Avoid empty calories in junk food, soda pop, desserts/sweets and substances such as alcohol, cigarette or marijuana smoking, or other recreational drugs.

As a general rule if you eat:

• 3-4 servings of protein;
• 4 servings (or more) of fresh fruit and vegetables of varying colors;
• 2-3 serving of whole grains (rice, breads, pasta); and
• 4 servings of dairy per day…

….You will have a well-balanced, nutrient-rich diet!

PROTEIN

Protein is essential for baby’s growth, especially in the second and third trimesters: 70 – 80 grams of protein per day are recommended. Protein sources include: meat, fish, nuts, eggs, soy, and beans/legumes. A quick reference to help add up how many grams of protein you are already eating is this: 1 ounce of meat or fish (or ½ cup cooked beans) = 7 grams of protein. Generally, a normal serving of meat is about 3 ounces and is about the size of a deck of cards.

Other examples:

• Hamburger patty: about 4 oz = 28 grams protein
• Steak: about 6 oz = 42 grams protein
• Chicken breast: about 3.5 oz = 30 grams protein
• Canned Tuna = 40 grams protein
• Egg (one) = 6 grams protein
• Milk (1 cup) = 8 grams protein
• Peanut Butter: about 2 tablespoons = 8 grams protein

Stay safe: Avoid deep sea fish, such as tuna steaks, swordfish, king mackerel, and shark as they can carry high levels of mercury, which are dangerous to growing babies.

DAIRY

Dairy products provide crucial calcium for baby’s bone development and also provide a source of protein. Lower fat dairy products provide the same amount of protein and calcium with less calories. One thousand milligrams of calcium each day is recommended and getting that from a food source means the dairy will be better absorbed by the mother’s body, rather than taking a supplement. Read the label of your dairy product to see how much calcium is present in one serving. Generally if you have four servings per day you are getting enough calcium.

Stay safe: Always eat pasteurized dairy products. Unpasteurized dairy can carry a type of bacteria called listeria, which can be dangerous to babies if a mother becomes infected from listeria.

IRON

Iron is also important to include in your diet. It helps mothers and babies build their blood volume. Iron is an essential element in the making of red blood cells. A mother’s blood volume expands by 50 percent during the pregnancy, and she is also providing iron to the baby to build his/her blood supply. Twenty-seven milligrams daily is what is recommended. Again, eating iron in food means it will be much better absorbed than by taking a supplement. Another easy way to increase the iron in your diet is to cook your food in a cast iron pan. The iron from the pan is absorbed by the food greatly increasing the amount of elemental iron in the food.

Stay safe: Always eat medium to well-cooked meat. Undercooked red meat may carry toxoplasmosis and raw or undercooked seafood may carry Hepatitis A. Avoid deli meats as well as they can carry listeria bacteria just as unpasteurized dairy can.

Sources of “heme iron” are also better absorbed than “non heme iron” sources.

Heme sources of iron:

• Beef
• Lamb
• Pork
• Chicken or turkey
• Seafood

Sources of non-heme iron:

These are absorbed better with a vitamin C source (citrus fruits, strawberries, or broccoli for example)

• Beans
• Fortified Cereals (oatmeal, breakfast cereals)
• Soy beans or tofu
• Dark green leafy vegetables
• Dried fruit
• Molasses

FRUITS AND VEGETABLES

Fruits and vegetables provide a multitude of vitamins and minerals. This is why eating a variety of colorful fruits and vegetables provides the full range of nutrition. They also provide fiber and fluids which are helpful for good digestion.

WHOLE GRAINS

Whole grains such as brown rice, popcorn, whole wheat pastas and breads are preferred over white rice or white breads and pastas. Whole grains are absorbed more slowly by your system, preventing high spikes in blood sugar. White breads and pastas are absorbed quickly and act like a sugar in your system, causing rapid high spikes in blood sugar and leaving your blood sugar to crash later (which makes pregnant women more nauseated or overly fatigued or unsatisfied, wanting to eat more!). Whole grains also have more fiber than white breads.

VITAMINS

A daily pre-natal vitamin is recommended to make sure a woman has adequate amounts of Vitamin A (not more than 10,000 IU), Iodine (220 mg), Zinc (60 mg), Folic Acid (400-800 mcg), and Iron (27mg). Other vitamins and minerals are also included in these prenatals.

There is such a thing as too much of a good thing as well. Appropriate weight gain is also important and only one vitamin daily along with a well-balanced diet is just right.

WEIGHT GAIN

Weight gain recommendation is based on your BMI (Body Mass Index). Calculate your BMI by clicking here. 

• BMI         < 18                           28-40 lbs
• BMI         18-25                       25-35 lbs
• BMI         25-30                       15-25 lbs
• BMI         > 30                           11-20 lbs

A combination of a well-balanced diet and exercise will help you grow a healthy baby!

Marti Churchill, CNM, is a University Medical Center Certified Nurse Midwife offering Midwifery services at Champlain Obstetrics & Gynecology in Essex Junction VT.

For an appointment with Marti please call (802) 879-1802.

From the Midwife: How to Handle Sibling Adjustment

The addition of a new family member – whether it is your first child or your fifth – affects everyone. Understanding that the older siblings need time to adjust is crucial.  The ease of the sibling’s transition has more to do with their personality and ability to transition to any change in their life than it has to do with their gender or the number of years between them. Bringing a new baby into your older child’s life may be one of the most challenging things s/he has had to deal with up until now, but it eventually will also be one of the greatest gifts you can give them.

Take some time helping to prepare them ahead of time can help them set up appropriate expectations and allow for feelings to be shared.

• Tell your child about your pregnancy when you tell your friends. They should hear about it from you directly and not ‘overhear’ it or learn about it from someone else.
• Bring them to some prenatal visits to meet your birth provider, hear the heart beat, and be able to ask questions.
• Describe what life will like in the early days with the baby: they will sleep a lot, cry, breastfeed, need to be held and have their diaper changed.  You will need to spend a lot of time with the baby. The baby won’t be able to play with them and they won’t need to share their toys – in the beginning.
• Try spending some time around a new baby with your child – at daycare or with a friend or family member with a new baby.
• Share pictures, videos and stories about the birth and babyhood of your older child. Tell them about their birth and what they were like as a baby. Express how excited you were when they were born and how everyone wanted to see them and hold them.
• Talk about how much you love them and not matter what you will always love them.  This may seem obvious to you but stating it out loud, a few times in different ways is important for your older child to hear.  Losing your love is what they fear the most.
• Teach them how to hold a baby and practice holding and gentle touching with a baby doll.
• Include them in any preparations they can – giving them choices whenever possible: such as which outfit should you bring the baby home in (A or B), picking out a gift for them to give the baby, choosing the color of the new car seat, etc.
• Read books together about pregnancy, birth, adoption and new baby siblings.
• If you are considering having your older child present at the birth – talk with your midwife about this. Many families have found this to be a very positive experience but it is not necessarily right for every family. Extra preparation should happen around what to expect at the birth, watching videos of birth and the child will need their own support person who can take them out if they become over whelmed. Saving an age appropriate job for them is special such as cutting the cord or putting on the baby’s hat.

Once your new baby is here there are ways to help your older child adjust:

• Plan a birthday party for the day you get home. Have a frozen ice cream cake in the freezer or have a family member or friend get one for that day, have balloons, and a “0” candle. Sing Happy Birthday to the baby and have the older sibling give the baby a gift AND have the baby give them one.  It brings home the meaning of what a BIRTH day really is while creating a celebration for the whole family.
• “Love bomb” the older sibling. Have people special to the older child be around more in the first week or two to fill in for the attention that you would normally give him or her.
• Set aside time each day (away from the baby) for each parent to give uninterrupted one-on-one time with the older child. Even 10 minutes of focused attention has an amazing effect of showing them how you still love them and they are important. Let them chose the activity and you follow their lead.
• Listen – really listen  – to how your child feels about the new baby and the changes in your family. If they express negative emotions, acknowledge them.  Help your child put words to their feelings. Never deny or discount their feelings.
• Create ways for them to express negative feelings – draw an angry picture, act out feelings towards a doll or roar like a lion – but hurting is not allowed!
• “Baby” your older child if that is what they crave. This may help stave off regression in other areas that are less acceptable to you. You may think your older child will become more independent when the baby comes home but often it is not the case.  Expect less independence and you may get more.
• Remind visitors to pay attention to the older child (and not just the baby)
• Have a few extra treats/gifts in the closet in case friends bring gifts for the baby and the older child feels left out.
• Find jobs and creative ways the older child can help you: baths, dressing, pushing the stroller, putting silverware away from the dishwasher, helping vacuum, running to get the book to read while you breastfeed, etc. Follow your child’s lead on this and be careful not to overdo it. Any chance you can give the older child choice and power in their life, the more they feel in control – and less likely to act out for attention and power.
• Talk about the ways being older is beneficial – they can chose what to eat, can go to the park and play, having friends, etc.
• Read books together about families in transition – any time you can talk about and acknowledge their mixed up feelings & that they are all normal and ‘ok’ the better they can negotiate the roller coaster of change.

Marti Churchill, CNM, is a certified nurse midwife at Champlain OB/GYN  and Fletcher Allen Health

Frequently Asked Questions About Midwifery

Champlain OB/GYN is excited to add Certified Nurse Midwifery care to our practice. All changes bring questions, so we’ve asked the Fletcher Allen midwives to answer a few commonly asked questions.

 

I’m confused, I thought midwives delivered babies at home.  Do they deliver babies at Fletcher Allen?

 

Many people think “home birth” when they hear the word “midwife,” and are surprised to learn that midwives deliver babies in the hospital. In fact, Certified Nurse Midwives (CNMs) have practiced at Fletcher Allen for over forty years, and have delivered thousands of babies in Fletcher Allen’s Claire M. Lintilhac Birthing Center! The Fletcher Allen midwife team is available 24/7 and provides prenatal, postpartum and well-woman care in the office, and labor, birth and initial postpartum care in the hospital.

 

Most midwife-attended births in the United States take place with Certified Nurse Midwives in hospitals, just like at Fletcher Allen.  CNMs are healthcare professionals who specialize in assisting normal, uncomplicated births. They are Advanced Practice Registered Nurses with graduate education in midwifery. They have graduated from an accredited nurse-midwifery education program, which includes a university degree as well as hands-on clinical training by practicing CNMs. They also have passed the national certification exam of the American Midwifery Certification Board (AMCB).  In Vermont most home birth midwives are either Certified Professional Midwives or Naturopathic Doctors, who go through different education and certification processes. 

 

Why would a woman choose a midwife?

 

Many women choose to give birth with the help of midwives because of a desire for individualized care and a unique birthing experience. The word “Midwife” literally means “With Woman.”  The midwifery model of care is evidence-based, promotes listening to women and respecting their desires, and minimizes the use of medical interventions unless necessary or requested by a woman. Midwives believe a woman and her family deserve the knowledge they need to make good health choices for themselves. A midwife does not simply tell a woman what to do, since what is right for one person may not be right for the next. Instead, a midwife offers information and helps each woman decide what is best for her and her baby, building a healthcare relationship grounded in trust and respect.

 

Midwifery care also produces improved health outcomes. National research indicates that women who choose a Certified Nurse Midwife have lower rates of induction of labor, cesarean birth, and perineal trauma, and higher rates of breastfeeding.  CNMs can prescribe medications and order diagnostic procedures when appropriate and medically indicated. 

 

Midwives use the same schedule of prenatal appointments and routine testing in pregnancy, but they tend to spend more time with women during prenatal visits, and more time by a woman’s side in labor – supporting her and watching for any health concerns.  They provide exceptional, individualized care to women across the lifespan, through pregnancy, birth, postpartum and beyond.

 

What if I have a complication that requires an obstetrician?

 

As a practice based in an academic medical center, the Fletcher Allen Nurse Midwives collaborate seamlessly with Obstetricians, Maternal Fetal Medicine specialists, and Pediatricians when needed. If a woman has a complication during pregnancy, the midwives will consult with collaborative obstetricians at Champlain OB/GYN and Fletcher Allen. During labor or prenatal assessments in the birthing center, they may consult with Fletcher Allen Obstetricians, who are available in the hospital 24/7.  If need arises for a cesarean, vacuum or forceps-assisted birth, a midwife stays with the woman and her family in a supportive role, and a Fletcher Allen Obstetrician delivers the baby.

 

Do I have to have an un-medicated birth if I use a midwife? I think I might want an epidural.

 

Midwives offer a variety of pain relief options in labor, including massage, relaxation, use of a tub, and epidural anesthesia if desired. Using a midwife does not mean a woman must have un-medicated childbirth. Approximately 45% of Fletcher Allen midwifery patients desire or need some form of anesthesia during their births, and epidurals are readily available.

 

I’m hoping for a natural childbirth. Will a midwife stay with me in labor to help me get through it?

 

One of the hallmarks of midwifery is labor support. The Fletcher Allen midwives set up their call days in 24-hour shifts to help provide continuity of care during long labors, and have the next day off so they are able to stay up to provide support. Midwives are directly involved providing care during labor, encouraging movement and position changes to promote labor progress, and using hands-on support, hydrotherapy, and gentle words to guide pain coping. The Fletcher Allen midwives stay attuned to their staffing and their total number of patients so they can provide direct support as much as possible, when desired.

 

If you have additional concerns please talk with us at your prenatal visits!  The birth of your baby is also the birth of you as parents and the growth of your family.  Sometimes navigating this transition can feel overwhelming. The Doctors and Midwives want you to feel safe, supported and informed about your care.

Exercise the Heart in Pregnancy

April 30, 2014 by:

Marti Churchill, CNM, a Fletcher Allen Healthcare certified nurse midwife offering prenatal care at Champlain OB/GYN.

Pregnancy brings out our strongest desire to stay healthy — for ourselves and for the baby growing inside.  Yet, many women have questions about what exercise is safe and how much and for how long?
Exercise is good for the pregnant body. Even if you haven’t been an avid exerciser before the pregnancy it is safe to begin to move your body and begin an exercise regime after you become pregnant. You just need to start slowly and gradually increase the length and frequency and intensity of your exercise over several weeks.  If you are already an athlete or actively exercise on a regular basis – then continuing to exercise at that same level is almost always a good thing.  Talk to your midwife about any limitations that may apply to your specific situation.
Things to consider while you exercise:

• Stay hydrated – drink water before and after you exercise.
• Stay cool – exercise indoors or in the morning or evening and not in the heat of the day.
• Elevate your heart rate – but be able to maintain a conversation with someone during the exercise.
• Move your body for at least 30-60 min 5-6 times per week.
• Avoid any exercise where you might fall after the first trimester– waterskiing, mountain biking, downhill skiing, contact sports, etc.
• Listen to your body – if something doesn’t feel right or is causing discomfort or pain, stop.
• It is OK to do core exercises or strength training with weights in pregnancy. You just may need to modify the amounts of weight used and not do core work on your back.

Did you know?

• Exercise actually gives you energy.
• Exercise helps you sleep better.
• Exercise reduces stress by creating a physical outlet for it.
• Exercise helps you maintain healthy glucose levels.
• Exercise promotes strong muscles which facilitates a healthy labor and recovery after the birth.
• Exercise helps you to gain the right amount of weight for a healthy pregnancy.

Some good exercise for the pregnant woman:

• Yoga (not Bikram)
• Walking
• Swimming, Water Aerobics
• Aerobics, Pilates, Spinning, Zumba
• Running
• Nordic skiing or snow shoeing
• Biking on paved bike trails or on a stationary bike

Before you start exercising or continue to exercise please contact your midwife or obstetrician to discuss your own situation.


Marti Churchill, CNM, is a Fletcher Allen Health Care certified nurse midwife offering prenatal care at Champlain OB/GYN .