How to Soothe Common Pregnancy Discomforts: Heartburn

In this new series on Giving Birth with Confidence, we’re going to cover some of the most common discomforts that can happen during pregnancy and share tried-and-true ways to help soothe or eliminate them. Pregnancy can be an amazing time in a woman’s life, but it can also be challenging. The reality is that some women’s bodies accept and cope well with pregnancy and some don’t. In any case, having extra tools in your coping toolbox can go along way toward increasing your quality of life during the 4o-ish weeks of pregnancy.

Five Ways to Extinguish the Fire of Heartburn During Pregnancy

By Hillari Dowdle, freelance writer for FitPregnancy

It was heartburn that got me in the end. I could take the swelling, the back pain, the constant trips to the bathroom, the itchy skin, the fatigue, the sweating, the sleeplessness and even the psychological shock of seeing the scale tip 200 pounds. But the constant, searing pain of heartburn made the miracle of pregnancy seem more like a curse—by the middle of my third trimester, my mantra had changed from Please, let him be healthy! to Just get him OUT!

That fiery sensation known as heartburn happens when the lower esophageal sphincter (LES), a muscle responsible for keeping stomach contents in their place, begins to relax or leak. this allows stomach acids to flow upward into the esophagus, explains Suzanne Trupin, M.D., CEO of Women’s Health Practice of Champaign, Ill. Pregnant women are prime candidates for two reasons: First, the hormone relaxin—busy limbering up your joints and connective tissue for an easier birth—slows your digestion, meaning food stays in your stomach longer and triggers more acid production. Second, your growing baby exerts pressure on both the stomach and the LES, increasing the chance that acids will be pushed up into the esophagus.

So what’s an expectant mother to do? Follow these five tips to relieve the pain:

1. Eat less, more often
Overeating exacerbates heartburn, says rachel Brandeis, M.S., a registered dietitian in Atlanta who specializes in prenatal nutrition. “When you’re pregnant, there’s less room for your stomach to expand,” she explains. Maintaining a sensible diet will not only stave off heartburn in the short term, but throughout your pregnancy as well, because gaining more than the recommended weight puts more pressure on your abdomen, which can trigger the condition. Instead of three meals a day, aim for six mini-meals (See “Mini-Size Me” below) of no more than 1 1⁄2 cups of food each, Brandeis recommends. Smaller meals are easier for your body to digest.

2. Eliminate trigger foods
Identify the foods that intensify your heartburn and banish them from your diet. While there are no universally “banned” foods, common heartburn triggers include acidic foods, such as citrus fruits and tomatoes, greasy or fried foods, spicy foods, chocolate, coffee, carbonated beverages, and alcohol (which, as you well know, you should eliminate anyway!).

3. Focus on fluids
“Liquid-y foods are less likely to cause problems than solids, since they move through the stomach more quickly,” Brandeis says. Soups, smoothies, yogurt, milkshakes, protein shakes and puddings are good choices. Look for liquids that offer plenty of protein, such as milk and drinkable yogurt, and aim to make solids a little less so: “chew solid foods slowly and extremely well, until they’re almost liquefied,” Brandeis adds.

4. Sleep smart
To avoid nighttime heartburn, don’t eat anything for at least three hours before bedtime. Elevate the head of your bed by placing books under the legs, and if you’re not already sleeping on your left side, start now; stomach acids will have to travel uphill to reach the esophagus—no easy feat!

5. Time for Tums
It’s fine to find relief in a bottle of tums or rolaids or other calcium- containing antacids. However, “too much calcium can block iron absorption, so don’t take tums at the same time you take your prenatal vitamin,” Brandeis advises. By the time I gave birth, I estimate I’d ingested my own considerable body weight in tums. This overuse created calcium overload, which may have exacerbated my anemia. If you’re taking antacids 10 times a day (or more—as I was), talk to your doctor: she may want to check for ulcers or a hiatal hernia (where part of the stomach protrudes into the chest cavity), or prescribe medication.

Also, avoid antacids that list aluminum (such as aluminum hydroxide or aluminum carbonate) as an ingredient; it can cause constipation and can even be toxic in large doses. Remedies containing aspirin (such as alka-seltzer) should also be avoided during pregnancy; look for salicylate or acetylsalicylic acid in ingredients lists. You don’t want an antacid containing sodium bicarbonate (baking soda) or sodium citrate, either. Both are high in sodium, which causes water retention.

Mini-Size Me

Here’s a sample of what a day’s worth of small, healthful meals looks like:

1 cup of oatmeal with milk and 1 apple

1 cup of yogurt with fruit

1 ⁄2 peanut butter and jelly sandwich and 1 cup of vegetable soup

1 handful of whole-grain crackers and 1 ounce of your favorite hard cheese

2 ounces of chicken, 1 ⁄2 cup of mashed sweet potatoes and 1⁄2 cup of cottage cheese with fruit

Find eight more small snacks that are easy to make, packed with pregnancy nutrients and delicious at fitpregnancy.com/snackideas.

 

Did you experience heartburn during pregnancy? What helped you get rid of it? Share in the comments — women want to know!

 

What Are the Options When Your Baby Is Breech?

By Jeanne Faulkner, R.N., a labor nurse and writer for FitPregnancy. You can read more from Jeanne at fitpregnancy.com/labornurse.

In the U.S. today, about 4 percent of babies are breech at full term, which means they’re in position to exit the uterus feet- or butt-first rather than headfirst. Before 1959, virtually all such babies were safely delivered vaginally; today, most are born by Cesarean section. But as more mothers and babies are experiencing sometimes serious complications associated with surgical deliveries (in 1970, the C-section rate was 5.5 percent; today it’s 34 percent), some experts are re-evaluating their position regarding breech births.

Beginning in the 1960s, obstetricians gradually shifted the way they delivered breech babies because they preferred the predictability and the presumed greater safety of a C-section birth. But not every doctor jumped on the C-section wagon immediately; many continued favoring vaginal breech births. That is, until the Hannah Term Breech Trial (TBT) published in 2000 brought them to a screeching halt. The TBT followed 2,083 breech babies in 26 countries, randomly assigned to either vaginal or planned C-section delivery. Early data suggested fewer newborn deaths and injuries occurred in the C-section group. “The impact of this study was stunning,” says Heather Weldon, M.D., an OB-GYN at Southwest Medical Group OB/GYN Associates in Vancouver, Wash. “Within months, breech C-sections went from 50 percent to 80 percent and, by 2006, 90 percent. Then, we found out the study was flawed.”

In fact, critics began poking holes in the TBT immediately after its publication. For example, some poor outcomes attributed to vaginal delivery occurred in birth centers that used substandard techniques or unskilled birth attendants. Some babies had genetic defects or were premature. In short, most weren’t injured because they were delivered vaginally, but because of other factors. Further study indicated that most of the babies recovered fully from their birth injuries regardless of delivery method, and researchers also hadn’t factored in the increased health risks resulting from C-sections.

“The data actually support vaginal breech birth as safe in certain scenarios and not in others,” says Amy M. Romano, C.N.M., M.S.N., associate director of programs at Childbirth Connection, a nonprofit organization dedicated to promoting evidence-based maternity care. “The results should have supported informed decision-making, but instead, hospitals reacted by taking that choice away from women.” Another unfortunate result was that medical schools quit teaching vaginal breech delivery skills to entire generations of new doctors. “Any care provider can get surprised by a breech baby during labor, but many doctors don’t know what to do and that’s dangerous,” says Ina May Gaskin, C.P.M., founder of The Farm Midwifery Center in Tennessee and author of Ina May’s Guide to Childbirth (Random House) and Birth Matters (Seven Stories Press).

Making that baby flip

A baby can be breech off and on throughout pregnancy without causing concern. But after 32 weeks, it might be a good idea to try to reroute him if you want to avoid a C-section. If he’s still breech at 35 weeks, care providers tend to worry, and if 37 weeks comes and goes, it’s time to take action: The closer it gets to your due date, the less likely it is for your baby to flip because there’s just not enough wiggle room.

Three types of breech babies

1} Frank Breech The baby’s bottom faces the cervix and his legs are straight up. This is the most common type and can sometimes be delivered vaginally.

2} Footling Breech The baby’s feet are in the birth canal. This is the second most common type and is generally unsafe to deliver vaginally because of potential cord complications.

3} Complete Breech The baby’s bottom faces the cervix. His legs are bent at the knees, and his feet are near his bottom. The least common type, these babies can sometimes be delivered vaginally.

The following three methods can be tried at 32 weeks or later:

The tilt. Using cushions placed on the floor or an ironing board propped up against the seat of your couch, lie with your hips elevated about 1½ feet above your head. Do this for 10 to 15 minutes three times a day, preferably when your baby is active. There are no reliable statistics, but according to Gaskin, “It works a lot of the time.”

The Webster Technique. “This is a gentle chiropractic adjustment to the pelvis and sacrum that reduces uterine torsion [twisting] and balances the pelvic muscles so that the baby can move into a more optimal position for birth,” says Heather Yost, D.C., a chiropractor at Yost Family Chiropractic in Urbandale, Iowa. “It usually takes four to 10 adjustments, but some babies turn after just one attempt.” The Journal of Manipulative and Physiological Therapeutics reports the technique has a success rate of 82 percent.

Pulsatilla is a homeopathic remedy that stimulates the uterus to settle baby headfirst. It’s best to see a naturopathic physician (N.D.) or a homeopath, though some midwives feel comfortable recommending specific doses and instructions. It’s safe and “sometimes works,” Gaskin says.

The following two techniques should not be tried before 37 weeks because they may stimulate labor:

External cephalic version, performed by either a doctor or midwife, repositions the baby by pushing on the mom’s abdomen and the baby’s head. It’s like a deep abdominal massage. “Sometimes we relax the uterus with medication,” Weldon says. “Then we lift the baby’s body with one hand, get the opposite hand on the baby’s head and encourage a somersault.” An epidural may be given to minimize discomfort during the procedure. According to the American College of Obstetricians and Gynecologists, the average success rate is 58 percent.

Moxibustion, a technique performed by acupuncturists, uses heat from a burning herb, mugwort, to stimulate an acupuncture point on the outside of the smallest toe; this increases fetal activity. Studies show that moxibustion is 30 percent to 36 percent more likely than other methods to make a baby turn head-down, with some small studies indicating that its success rate may be higher than 80 percent.

If you’re close to your due date, your baby is still breech and you want to avoid a C-section, surgery may be your only option unless you can find a doctor or midwife who is qualified and willing to deliver him vaginally or you don’t meet the criteria for a safe vaginal birth. For details about one hospital’s pioneering program, see below.

If you want a vaginal delivery

Oregon Health & Science University (OHSU) in Portland is among a few hospitals nationwide to support vaginal breech delivery. “Without hospital-based options, some patients attempt high-risk deliveries at home,” says Leonardo Pereira, M.D., OHSU’s chief of maternal-fetal medicine. “OHSU has established safety criteria for patients, and we are training clinicians to deliver breeches vaginally in order to make the service available at more hospitals in the future.”

Among other criteria needed to qualify for an attempted vaginal breech delivery, the woman must have her pelvis measured via an MRI, and the baby must be full term and in frank or complete breech presentation. Very small or very large babies may not qualify. To find an appropriately trained doctor or midwife, call your closest academic health center and ask whether vaginal breech delivery is offered or whether they can refer you to providers who do offer it. You can also look for providers at midwife.org or birthpartners.org.

10 Ways to Help Overcome Your Birth Fears

By Alice Lesch Kelly, a health and psychology writer for FitPregancy

Many women who whole-heartedly want to be mothers dread the prospect of having to actually deliver a baby. In fact, while just about every woman feels some anxiety about giving birth, 6 percent to 10 percent of pregnant women suffer intense fear. This can manifest itself in such symptoms as nightmares, heart palpitations, dizziness, shortness of breath, a racing pulse and difficulty concentrating. The good news is that there are ways to reduce your fear of childbirth. Here are 10 of them:

1. Track the source of your anxiety 
Certain experiences can trigger an intense fear of labor. These include a history of abuse or rape; a past miscarriage or stillbirth; a previous difficult delivery; and excessive exposure to traumatic labor stories. Also at risk are women with a history of anxiety, depression and low self-esteem, according to a 2008 study published in the international OBGYN journal BJOG. Understanding why you’re so afraid is a first step toward easing those feelings; keeping a journal can help.

2. Don’t wait until labor day
Start identifying and dealing with your fears at the beginning of your pregnancy, not the end. Chances are good that your worries are deep-seated, and it can take time to get to their root and address them. Anxiety tends to increase as a pregnancy progresses, becoming most intense as a woman’s due date approaches, so try to get a jump on the source and solutions early on.

3. Consider therapy 
A study conducted in Finland found that women with an intense fear of labor who underwent cognitive (talk) therapy had shorter labors and fewer unnecessary C-sections than those who didn’t. “If a woman feels that her fear is taking over other aspects of her life, such as her intimate relationships, I usually suggest that she see a therapist,” says Margaret Plumbo, C.N.M., a midwife at Health East Clinic in Woodbury, Minn.

4. Learn relaxation skills 
Practicing self-hypnosis, meditating and doing breathing exercises while you’re expecting can help calm you during pregnancy and labor. Listening to guided-relaxation tapes that describe your perfect “peaceful place” is another effective option.

5. Share your fears 
Don’t hesitate to tell your doctor or midwife that you’re afraid; just talking about it may help, and she may have ideas about how to reduce your anxiety. Sometimes just learning the facts—how often delivery complications actually occur, for example—can put your mind at ease. If your caregiver doesn’t seem to listen or lacks compassion, consider finding a new one.

6. Put your fears in writing 
Create a one-page birth plan that includes your desires about such options as pain medication, laboring positions and fetal monitoring as well as an honest explanation of your fears. Share it with your caregiver during a prenatal visit and have a copy ready to give to the nurses when you’re admitted to the hospital. Knowing that your caregivers are aware of your concerns will help reassure you.

7. Have a midwife or doula 
Midwives and doulas spend more time with women during prenatal visits and labor than OBs do, and their presence and insights can help you cope with your fears. “Your doula or midwife understands you and will stay with you during labor,” says Marshall, Va.-based former doula Bonnie B. Matheson, founder of Childbirth Solutions LLC.

8. Shut out negative stories 
Don’t watch scary TV shows about childbirth, read horror stories or listen to friends recount the gory details of their labors. Some experts believe that fear of delivery has become more widespread since the advent of sensationalized depictions of childbirth.

9. Learn about pain relief 
Most women fear the pain of childbirth to some degree, but knowing that safe and effective means of relief are available can help lessen your anxiety. Take a childbirth course, talk with your caregiver beforehand about medication and other pain-relief methods and include your intentions in your birth plan.

10. Explore your options 
Some women fear the typical hospital childbirth experience. Choosing alternatives, such as having your baby in a homelike birthing center that permits women to deliver in different positions and have more control over their experience and environment, can often allay such fears.

Power Positions for Labor

Giving Birth with Confidence is pleased to once again provide articles from FitPregnancy through our resource-sharing partnership. 

Women all over the world give birth squatting, leaning or even standing. We lie down. What do they know that we don’t?

By Nancy Gottesman, a health writer for FitPregnancy

If your car stalled at the bottom of a hill, you certainly wouldn’t try to push it uphill. So why does it make sense to fight gravity by lying down during labor? This is just one reason why the standard hospital labor position—semi- or fully reclining—is not ideal. For one thing, when you’re lying on your back, your uterus compresses major blood vessels, potentially depriving the baby of oxygen and making you feel dizzy or queasy. “Most women feel better when they are not lying on their back during labor,” says certified nurse-midwife Katy Dawley, Ph.D., C.N.M., director of the Institute of Midwifery at Philadelphia University in Pennsylvania. In addition, when you’re reclining, the baby’s head puts pressure on pelvic nerves in your sacrum, increasing pain during contractions. Remaining upright and leaning forward reduces this pressure while allowing the baby’s head to constantly bear down on your cervix. As a result, dilation tends to occur more quickly.

“Lying on your side, standing, sitting, walking, rocking—anything that keeps you active can help decrease pain and speed up labor,” says Dawley. Just be aware that a prenatal visit is the time to discuss with your doctor or midwife the different positions you think you’d like to try. “In the throes of labor, you’re not going to be able to advocate for yourself,” she explains.

Seven soothing labor positions

Here’s another reason to be open to the possibilities: Fetal heart monitoring during labor can help determine which positions you can sustain without impairing circulation to the baby, so it’s best to have a repertoire available. Some options:

1. Get on all fours. This position eases back pain and helps the baby rotate into the optimal position for delivery—facedown. (When the baby is faceup, the result is the dreaded “back labor.”)

2. Lean forward. This can help make uterine contractions more effective in bringing the baby down. Drape your chest over a table, bed, countertop, pillow or exercise ball (see “Get on the [Birthing] Ball,”).

3. Lie on your left side. This may increase blood flow to your baby and can help reduce back pain. Support your belly and legs with pillows.

4. Lunge. Place one foot on a sturdy chair or footstool and lean into that foot during contractions.

5. Rock. Sit on an exercise ball, the edge of the bed or a chair and gently rock back and forth.

6. Sit and lean. Sitting in a chair, prop up one foot and lean forward into it during contractions.

7. Sway. Put your arms around your partner’s neck and sway back and forth; pretend you’re slow dancing.

Ready, set, push! While the position may be less convenient for hospital personnel, squatting is especially effective when you’re ready to push. In fact, squatting is sometimes called the “midwife’s forceps” because of its ability to work with, not against, gravity, enlarge the pelvic opening and speed the pushing phase of labor.

One study found that first-time mothers who squatted while pushing had labors that were 23 minutes shorter on average than women who labored semi-reclining. They also required significantly less oxytocin (Pitocin) to stimulate contractions. What’s more, they had less back pressure, fewer forceps or vacuum deliveries, and fewer and less-severe perineal tears and episiotomies.

Don’t want to squat in the middle of your hospital room? Use the squatting bar on your hospital bed for support. The correct form: knees wide, feet flat on the floor. Warning: Don’t try squatting unsupported unless you’re sure you can hold the position and keep your balance. In fact, you should get in shape by practicing squats during your pregnancy: You don’t want to find out at the crucial moment that your leg and thigh muscles aren’t up to the task. (But don’t worry if you’re approaching labor and you haven’t practiced squats — you’ll be surprised at what your body is capable of.)

Other options for delivery include sitting on a birthing stool, kneeling or crouching on your hands and knees. No problem if you’re having a midwife deliver your baby at home or in a birthing center. Otherwise, make sure in advance that your doctor and hospital policies give you the green light.

Get on the (birthing) ball

Using an exercise ball could help you get through labor. The ideal size for most women is about 65 centimeters in diameter. When you sit on it, your knees should be bent 90 degrees. Here are various ways to use one:

Place the ball on a bed or sturdy chair, stand facing it and lean forward so that your upper body rests on the ball. This will enable you to stand up longer without overtaxing your muscles.

Kneel in front of the ball and drape your body over it. This will encourage a baby who’s faceup to rotate into the proper position for delivery (facedown) and relieve the pain of back labor.

Sit upright on the ball. This relieves pain and pressure on your back and perineum (the area between the vagina and rectum).

Tips from a labor nurse

If you’re spending even part of your labor in bed, here are suggestions from Fit Pregnancy’s “Ask the Labor Nurse” blogger Jeanne Faulkner, R.N.:

Angle the head of the bed 45 degrees and put a pillow or rolled-up towel under one hip; this will help “tip” the uterus off of your large blood vessels, improving circulation to the baby and your brain.

If the baby is faceup and this is causing back labor, lie as far on one side as possible, then rest your top leg on the mattress in front of your belly. This encourages the baby to rotate into the ideal (facedown) position for birth.

Changing positions every 10 contractions while you’re pushing can help “corkscrew” the baby out. Start lying on one side, go onto your back, turn to the other side, then get on your hands and knees.

Power Positions: Finding the Best Position for Birth

By Nancy Gottesman

 

If your car stalled at the bottom of a hill, you certainly wouldn’t try to push it uphill. So why does it make sense to fight gravity by lying down during labor? This is just one reason why the standard hospital labor position—semi- or fully reclining—is not ideal. For one thing, when you’re lying on your back, your uterus compresses major blood vessels, potentially depriving the baby of oxygen and making you feel dizzy or queasy. “Most women feel better when they are not lying on their back during labor,” says certified nurse-midwife Katy Dawley, Ph.D., C.N.M., director of the Institute of Midwifery at Philadelphia University in Pennsylvania. In addition, when you’re reclining, the baby’s head puts pressure on pelvic nerves in your sacrum, increasing pain during contractions. Remaining upright and leaning forward reduces this pressure while allowing the baby’s head to constantly bear down on your cervix. As a result, dilation tends to occur more quickly.

“Lying on your side, standing, sitting, walking, rocking—anything that keeps you active can help decrease pain and speed up labor,” says Dawley. Just be aware that a prenatal visit is the time to discuss with your doctor or midwife the different positions you think you’d like to try. “In the throes of labor, you’re not going to be able to advocate for yourself,” she explains.

Seven soothing labor positions

Here’s another reason to be open to the possibilities: Fetal heart monitoring during labor can help determine which positions you can sustain without impairing circulation to the baby, so it’s best to have a repertoire available. Some options:

1. Get on all fours - This position eases back pain and helps the baby rotate into the optimal position for delivery—facedown. (When the baby is face up, the result is the dreaded “back labor.”)

2. Lean forward - This can help make uterine contractions more effective in bringing the baby down. Drape your chest over a table, bed, counter top, pillow or exercise ball (see “Get on the (Birthing) Ball,” below).

3. Lie on your left side - This may increase blood flow to your baby and can help reduce back pain. Support your belly and legs with pillows.

4. Lunge - Place one foot on a sturdy chair or footstool and lean into that foot during contractions.

5. Rock - Sit on an exercise ball, the edge of the bed or a chair and gently rock back and forth.

6. Sit and lean - Sitting in a chair, prop up one foot and lean forward into it during contractions.

7. Sway - Put your arms around your partner’s neck and sway back and forth; pretend you’re slow dancing.

 

Ready, set, push!

While the position may be less convenient for hospital personnel, squatting is especially effective when you’re ready to push. In fact, squatting is sometimes called the “midwife’s forceps” because of its ability to work with, not against, gravity, enlarge the pelvic opening and speed the pushing phase of labor.

One study found that first-time mothers who squatted while pushing had labors that were 23 minutes shorter on average than women who labored semi-reclining. They also required significantly less oxytocin (Pitocin) to stimulate contractions. What’s more, they had less back pressure, fewer forceps or vacuum deliveries, and fewer and less-severe perineal tears and episiotomies.

Don’t want to squat in the middle of your hospital room? Use the squatting bar on your hospital bed for support. The correct form: knees wide, feet flat on the floor. Warning: Don’t try squatting unsupported unless you’re sure you can hold the position and keep your balance. In fact, you should get in shape by practicing squats during your pregnancy: You don’t want to find out at the crucial moment that your leg and thigh muscles aren’t up to the task.

Other options for delivery include sitting on a birthing stool, kneeling or crouching on your hands and knees. No problem if you’re having a midwife deliver your baby at home or in a birthing center. Otherwise, make sure in advance that your doctor and hospital policies give you the green light.

Get on the (birthing) ball

Using an exercise ball could help you get through labor. The ideal size for most women is about 65 centimeters in diameter. When you sit on it, your knees should be bent 90 degrees. Here are various ways to use one:

Place the ball on a bed or sturdy chair, stand facing it and lean forward so that your upper body rests on the ball. This will enable you to stand up longer without overtaxing your muscles.

Kneel in front of the ball and drape your body over it. This will encourage a baby who’s faceup to rotate into the proper position for delivery (facedown) and relieve the pain of back labor.

Sit upright on the ball. This relieves pain and pressure on your back and perineum (the area between the vagina and rectum).

Tips from a labor nurse

If you’re spending even part of your labor in bed, here are suggestions from Fit Pregnancy’s “Ask the Labor Nurse” blogger Jeanne Faulkner, R.N.:

Angle the head of the bed 45 degrees and put a pillow or rolled-up towel under one hip; this will help “tip” the uterus off of your large blood vessels, improving circulation to the baby and your brain.

If the baby is faceup and this is causing back labor, lie as far on one side as possible, then rest your top leg on the mattress in front of your belly. This encourages the baby to rotate into the ideal (facedown) position for birth.

Changing positions every 10 contractions while you’re pushing can help “corkscrew” the baby out. Start lying on one side, go onto your back, turn to the other side, then get on your hands and knees.

Healthy Pregnancy Tips for Vegetarians and Vegans

 

Rest easy, all you pregnant vegans and vegetarians out there: Medical experts, including the American College of Obstetricians and Gynecologists and the American Dietetic Association (ADA), have given you the green light to continue your current way of eating— as long as it’s well-planned. “You can have a healthy pregnancy on such a diet,” says Dawn Jackson Blatner, R.D., an ADA spokeswoman who sees pregnant vegetarians in her private practice. “You just have to do it right.”

A vegetarian (meat-free) or vegan (no animal products, not even milk or eggs) diet can help prevent obesity and chronic illnesses, including heart disease, cancer and diabetes. It’s also more Earth-friendly than the typical American carnivore’s diet. That said, “Pregnancy is not the right time to become a vegetarian if you aren’t one already,” says Lara Field, M.S., R.D., a dietitian at the University of Chicago Medical Center who counsels pregnant women.

Here’s the reason: The risks of nutritional deficiencies are more pronounced with a vegetarian diet, and pregnancy is a time when you need more of certain vitamins and minerals. If you’ve been eating animal products, quitting now would just limit your options, Field says.

In addition to taking a high-quality prenatal vitamin, here’s how you can make up for any nutritional weak links if you do decide to stay meat-free during your pregnancy.

Protein This nutrient is vital for cell growth and development—yours as well as your developing baby’s—and you need about 70 grams every day right now. Beans can provide much of what you need. “Beans are the magic bullet for vegetarians and vegans,” says Blatner, who is also the author of The Flexitarian Diet (McGraw Hill). “Along with lots of protein, beans provide iron and zinc.” Zinc is also necessary for cell growth and normal fetal development.

To get the protein you need, simply replace animal products with any type of beans, including soybean products like tempeh and tofu; just keep in mind that experts advise limiting your soy intake to one or two servings daily during pregnancy. In recipes, substitute one-half cup of beans for every 3 ounces of meat.

And here’s a bonus if you’re concerned about putting on too much weight during your pregnancy: Beans are a low-calorie protein source: 1 cup of soybeans has 298 calories and 29 grams of protein; 1 cup of lentils has 226 calories and 18 grams of protein; 1 cup of pintos has 245 calories and 15 grams of protein; and 1 cup of firm tofu has 176 calories and 20 grams of protein.

Don’t forget about nuts, too: These are also rich sources of protein (and healthy fats), as are low-fat dairy foods—milk, yogurt and cheese.

A word of advice: Don’t rely too heavily on cheese or faux burgers to replace meat in your diet. Why? Veggie “meats” are usually laden with sodium, and cheese is very high in saturated fat. “Vegetarian and vegan diets are perceived to have a ‘health halo’ around them,” says Blatner. “But if you’re not eating the right foods, these diets can be unhealthy, too.”

Iron This mineral, which helps red blood cells deliver oxygen to the fetus, also protects you from anemia, a common problem during pregnancy even among meat eaters. According to Blatner, pregnant vegetarians and vegans need as much as 50 milligrams of iron daily. Besides beans, other vegetarian iron sources include iron-fortified cereals, prune juice, black-strap molasses, spinach and raisins.

To help your body absorb the iron contained in foods, eat vitamin-C- rich foods (such as red peppers, citrus fruits and strawberries) and sprouted grains along with them. “Sprouting decreases the compounds that make it more difficult for your body to absorb iron,” Blatner explains.

Vitamin B12 This vitamin, which is required for proper red blood cell formation and neurological function, is most abundant in animal products, which makes getting enough of it a little tricky for vegetarians. Though there are a few nonmeat sources of B 12 (fortified breakfast cereals, for example), the ADA recommends that both vegans and lacto-ovo vegetarians (those who eat eggs and dairy products) take B 12 supplements to help them get the 2.6 micrograms daily needed during pregnancy.

Calcium & vitamin D Dairy products are chock-full of these baby bone-building nutrients, but vegans will have to turn elsewhere to get the 1,000 milligrams of calcium and 400 IU of vitamin D they need daily. “Vegans can eat dairy alternatives—like milk and yogurt made with soy and hemp—as well as orange juice,” Field suggests, “but read labels to make sure they’re fortified with calcium and vitamin D.” Fortified tofu, seaweed, figs, collard greens and mustard greens are good vegan sources of calcium.

Omega-3 fatty acids Cold-water oily fish, such as salmon, are the main sources of these healthy fats, which enhance fetal brain and nervous system development. Good plant sources include algae, canola and flaxseed oils, walnuts and leafy green vegetables. Supplements are also safe during pregnancy. The recommended dietary allowance (RDA) for pregnant women is 1.4 grams daily, but up to 3 grams of fish oil daily is probably safe. Vegan omega-3 sup- plements are also available.

3 SMART VEGETARIAN SNACKS

■ VANILLA HEMP MILK 1 cup contains at least 25 percent of your daily requirements for calcium and vitamins D and B 12.

■ PLAIN YOGURT 8 ounces of low-fat unsweetened yogurt contain 12 grams of protein and 45 percent of your calcium needs.

■ LENTIL SOUP 1 cup contains 9 grams of protein and 4 milligrams of iron.

>> By: Nancy Gottesman is a health and nutrition writer in Santa Monica, Calif.

How to Choose a Midwife

By Jeanne Faulkner, RN, a labor nurse in Portland, Oregon

More women are choosing midwives, but lingering myths and confusion mean that many moms-to-be still have questions. We’ve got answers.

Midwives are being “rediscovered” by growing numbers of pregnant women today. According to the National Center for Health Statistics, in 2006 (the most recent figures available), they attended a record-busting 317,168 births—7.4 percent of all U.S. births; 96.7 percent of them took place in hospitals, 2 percent in birth centers and 1.3 percent in homes. To help you decide whether to go the midwife route, here are answers to some of the most common questions.

What advantages do midwives offer?

The Midwives Model of Care views pregnancy and birth as normal events; as a result, midwives suggest and perform fewer interventions than are typical with most obstetric care. “Midwives focus more on nutrition and education,” says Judi Tinkelenberg, C.N.M., R.N., clinical director of Sage Femme Midwifery Service and Birth Center in San Francisco. “We do fewer routine, often unnecessary tests—for example, we don’t automatically do ultrasounds if they’re not needed. We make decisions with patients based on informed consent.” Midwives also spend more time with patients than most OBs do, which means they often offer more personalized care.

What exactly does “midwife” mean?

All midwives provide prenatal and postpartum care, attend labors and deliver babies. Some provide additional services, such as routine gynecologic exams and contraception care. But do your homework; anyone can call herself a midwife. Here are the distinctions:

>>Certified midwives (C.M.) meet American College of Nurse-Midwives (www.midwife.org) requirements, but they do not need to be nurses.

>>Certified nurse-midwives (C.N.M.) are nurse- practitioners who are certified by the American College of Nurse-Midwives.

>>Certified professional midwives (C.P.M.) meet North American Registry of Midwives (www.narm.org) certification standards.

>>Direct entry midwives (D.E.M.) are educated through self-study, apprenticeship, midwifery school or college- or university-based programs that don’t include nursing. They include certified midwives and certified professional midwives.

>>Lay midwives are sometimes called traditional, unlicensed or “granny” midwives. These women are educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren’t certified or licensed.

>>Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.

For more information on the different types of midwives, go to www.mana.org.

What’s the best kind of midwife?

That depends on whether you want a hospital or out-of-hospital birth, a low-intervention or medicated one. The most important thing is to make sure anyone you’re considering is qualified and experienced. “Direct entry midwives and certified nurse-midwives have different educational pathways, but they’re all well-trained and competent,” says Geradine Simkins, D.E.M., C.N.M., M.S.N., president of the Midwives Alliance of North America. Most C.N.M.s deliver in hospitals, while C.P.M.s have specific training and expertise in out-of-hospital births.

The Institute of Medicine and the National Commission to Prevent Infant Mortality praise the contributions of certified nurse-midwives in reducing the incidence of low-birth-weight infants and call for their increased utilization, and the new federal Health Care Reform Act strengthens the legitimacy of certified direct entry midwives.

Is it safe to go with a midwife?

Yes, as long as you have no pregnancy complications or risk factors for birth complications. For 60 to 80 percent of low-risk pregnancies, it may be even safer to go with a C.M. or a C.N.M. than with an obstetrician. That’s because midwives use less fetal monitoring and over-diagnose fetal distress less often, which means fewer interventions, such as C-sections and forceps- or vacuum-assisted deliveries. Studies show that C.N.M.-attended births are associated with 31 percent fewer low-birth-weight babies and 33 percent less neonatal mortality.

If you have certain health risks, including obesity, diabetes or hypertension or are carrying multiples, you might still qualify for midwife care, but only if it’s coordinated with an OB. If you want to give birth at home, make sure your midwife has protocols for a quick transfer to a hospital in case of an emergency.

How do costs and care compare with those of obstetricians?

Midwifery care can cost less overall, but C.N.M.s are sometimes paid similar rates as OBs. Insurance companies currently pay for most C.N.M. services, and under the new federal health care legislation, certified D.E.M.s will also be covered.

As for whether the midwife you see for prenatal visits will deliver your baby, it’s the same as if you were seeing an OB. “Many private practice midwives make a special effort to be at their own patients’ births, even when they share call with partners,” says Karen Parker Linn, a C.N.M. in Portland, Ore. In shared practices, several midwives work together. Patients see different ones during pregnancy and deliver with whomever is on call, though midwives sometimes come in for patients with whom they’ve formed a special bond, Linn adds.

Do doctors respect midwives?

Most hospital-based midwives are well-respected by OBs. Out-of-hospital midwives? Not as much. Most out-of-hospital births are safe, but when trouble arises and patients are transferred to hospitals, doctors sometimes feel like the clean-up crew for high-risk deliveries.

“Midwives are fantastic options for low-risk women,” says Kathleen Harney, M.D., chief of obstetrics for Cambridge Health Alliance and the C.N.M-managed Cambridge Birth Center in Massachusetts. “Their philosophy and training are more focused on birth as a healthy, natural process. Doctors are trained to think something adverse may happen,” she explains. “The truth is somewhere in between. Working in concert with midwives reminds OBs not to be overly interventionalist.” .

5 questions to ask a midwife

1. What is your training, experience and certification, and do you have references?

2. Where do you deliver—at home, in a birth center and/or in the hospital?

3. What percentage of your prenatal patients do you actually deliver yourself?

4. For an out-of-hospital birth, what’s your emergency backup plan?

5. Do you take medical insurance?

The Perfect Partner

When Christina Carey, 40, imagined her baby’s birth, she pictured her husband by her side, lovingly supporting her throughout labor and delivery. But when showtime arrived, she was surprised to see an entirely different side of him.

Although Carey, who lives in Hoboken, N.J., had planned on having a vaginal birth, complications necessitated a Cesarean section. “I was fine with the unplanned surgery, but my husband was a wreck,” she recalls. “He got lost on his way to the operating room and arrived late for the surgery. Once he got there, he was so nervous he couldn’t talk. I was hoping that my husband would distract me, but the exact opposite happened,” Carey adds. “I didn’t plan on having to calm him down.”

“It’s very important to have someone there to help you through labor,” says Michael Abrahams, M.D., an OB-GYN at Maimonides Medical Center in Brooklyn, N.Y. But as Carey learned, being a birth partner doesn’t come naturally to every father-to-be. Fortunately, childbirth experts say that with some planning and preparation, most men can grow into the role. Here’s how you can help.

Make sure he’s educated
“The more partners are aware of the decisions that may have to be made, the more helpful and supportive they can be,” Abrahams says. Childbirth classes, books and videos give helpful information about the stages of labor, pain-relief options and possible complications of medical interventions. Education has its limits, however, and acknowledging that is another important step for your partner. “Despite birth courses, nothing really prepares him for that moment,” Abrahams says.

Discuss your intentions
Talk with each other about any expectations you both might have regarding laboring preferences, pain relief and medical interventions. Don’t do this while you’re driving to the hospital, but during the weeks and months before your due date. “One of the key expectations that should be shared is feelings about the use of pain medications during labor,” says Penny Simkin, a Seattle doula and author of The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions (Harvard Common Press). “If you want natural childbirth and he thinks that’s stupid, you have a problem. You’ve got to get on the same page.

“You both also need to understand that the birth plan must be flexible enough to incorporate necessary changes if unplanned interventions become needed or if labor is so fast that there’s no time to get an epidural you may have planned,” Simkin says.

Help him expect the unexpected
There are many ways a partner can support you—massaging your back, placing cold compresses on your forehead, even channel surfing for a distracting TV show. “But it’s important for him to know that your reactions to these measures may change during labor,” Simkin says. “For example, a massage may feel heavenly for a while, then become really unpleasant. He needs to know that’s normal, and he shouldn’t take your reaction personally.”

Likewise, your partner should know that what entertains you in everyday life may infuriate you in the delivery room. Jokes are a prime example. “A lot of men use humor to alleviate the stress, and it’s not always appreciated,” Abrahams says.

Understand where he’s coming from
“It’s in the nature of men to need something tangible and task-oriented to do during a crisis,” says Jeanne Faulkner, R.N., a labor-and-delivery nurse in Portland, Ore. “But labor tends to involve a lot of sitting and just ‘being,’ and that’s hard for a lot of guys.”

You may expect your partner to be your rock during delivery, but don’t be surprised if he starts to crumble a bit. “It’s an emotional time for the father as well, and it can be hard to watch a loved one in pain,” says Erin E. Tracy, M.D., an OB-GYN at Massachusetts General Hospital in Boston.

Consider his comfort level
Some partners are happy to be in the delivery room but have no interest in having a front-row seat. If yours is more of a head-of-the-bed guy, it will be better for both of you if you don’t order him to hang out with the doctor at the foot of the bed. “He doesn’t have to see every last detail,” Abrahams says. He doesn’t have to cut the umbilical cord, either.

Respect his traditions
In some cultures, the idea of a man witnessing childbirth is horrifying. Try not to take it personally. “Some men show up in the delivery room because they want to be an ‘American’ dad, but it’s incredibly uncomfortable for them,” Faulkner says. “They try, but then realize they just can’t be there.”

Resist the urge to force him
If the thought of being in the delivery room makes your partner break out in hives, demanding his presence may backfire. “If the man is there grudgingly or neglecting the mother, it contributes to her stress levels, and stress interferes with labor,” Simkin says. “The day you give birth is a day you’re never going to forget. You want it to be a good memory.”

Are you better off without him?
If you think your guy won’t make a good birth partner, you have two options.

First, you can have him with you in the delivery room, but don’t expect more from him than what he is comfortable doing. If you go this route, consider working with a midwife or doula who can give you what he can’t, advises doula Penny Simkin.

Or, you can station him in the waiting room, and invite someone else, such as your mother, to be your birth partner. Warning: This won’t work if your relationship with your mother is strained. “The delivery room is not the place to be working out family dynamics,” says labor nurse Jeanne Faulkner, R.N. If you ask someone else to be your birth partner, do so early in your pregnancy, so she has time to attend childbirth classes and take other steps to prepare.

Top 10 Pregnancy Nutrition Blunders

By Amy Paturel

It may be tempting to trash your healthy eating habits during pregnancy. After all, you’re going to get big no matter what you eat, right? Not so fast. Experts say that making nutrition mistakes during pregnancy not only robs your baby of crucial nutrients, it also sabotages your own short- and long-term health. Make pregnancy an opportunity to improve your health, says registered physician assistant Amy Hendel, author of 2008’s Fat Families, Thin Families. Take care of yourself before pregnancy, or improve your eating habits as soon as you know you are pregnant.” Start by avoiding these top 10 prenatal nutrition mistakes.

1) Not eating enough whole foods in their natural state. Hendel recommends eating fewer packaged, processed foods and more whole foods that are natural sources of essential nutrients, such as 100 percent orange juice: It provides folate, vitamin C and potassium.

2) Eating unsafe foods. Raw fish (that means sushi) is better left alone during pregnancy, as it may contain pathogens that could harm your growing baby. So are mercury-laden swordfish, mackerel, tilefish and albacore tuna. Also avoid unpasteurized soft cheeses as well as deli meats, unless you heat them until steaming before eating.

3) Skipping breakfast. “Bodily processes continue during sleep, so by the time you wake up, your nutrient stores are low and need to be replenished,” Hendel says. She recommends eating a breakfast containing lean protein, whole-grain carbohydrates, healthy fats, dairy and fruit. A good example: A whole-grain English muffin with 2 teaspoons of nut butter, a banana and a glass of nonfat milk.

4) Eating for two. During pregnancy, the need for some nutrients doubles, but calorie needs increase very little. “Actually eating for two means extra weight gain, which can lead to gestational diabetes, a large baby and a difficult delivery, not to mention having to get rid of all that extra weight,” says Bridget Swinney, M.S., R.D., author of 2006’s Eating Expectantly. “Most women need a max of only 300 extra calories a day during the second and third trimesters; some need less and very few need more,” she says. That translates to less food than you may think, so make it count: an ounce of almonds, ¼ cup dried apricots and a piece of string cheese.

5) Overly restricting calories. “Dieting may deprive both you and your baby of important nutrients,” says
Hendel. If you gain a healthy 25 to 35 pounds during pregnancy, your body should naturally lose that weight after delivery. If you are under- or overweight at the start of pregnancy, you may need to gain more or less. Consult your doctor and see fitpregnancy.com/weightgain for guidelines.

6) Getting too much caffeine. Caffeine can cross the placenta and is difficult for the fetus to metabolize, says Melinda Johnson, R.D., a Phoenix-based spokeswoman for the American Dietetic Association. At least one study, from Kaiser Permanente, linked heavy caffeine consumption with miscarriage; however, another by the National Institutes of Health found no association between intakes of up to 350 mg a day and miscarriage. “Moderate amounts of caffeine (less than 250–300 mg a day, or about two 8-ounce cups) shouldn’t be a problem,” says Swinney. Caffeine also lurks in sodas and tea.

7) Eating only three squares a day. “Smart snacking can alleviate many pregnancy problems, such as nausea, heartburn and cravings,” says Swinney. Plus, eating healthy snacks between meals can make it easier to get the nutrient-dense foods you need. She recommends fruit, vegetables, yogurt, whole-grain crackers, low-fat cheese, nuts and sunflower seeds. A more constant flow of calories in proper portions also helps keep blood sugar levels in check, particularly important for women with gestational diabetes.

8) Relying too much on prenatal vitamins. Even if you take your prenatals religiously, you still need to eat right. “We can’t extract all the good things from fish or produce and put them into a pill,” says Megan Tubman, M.S., R.D., owner of Fresh Start Nutrition Studio in New York. A prenatal vitamin definitely helps, but many nutrients, especially phytochemicals (such as lycopene in tomatoes and anthocyanins in blueberries) are only found in food.

9) Satisfying cravings with the wrong foods. Instead of loading up on empty calories (such as sugary sodas, processed snacks and sweets), choose the most nutrient-rich sources to satisfy your cravings, says Melinda Johnson. Hankering for ice cream? Have a bowl of frozen yogurt. Want a slice of greasy, cheesy pizza? Try a few whole-grain crackers with low-fat cheddar cheese. When only the real thing will do, indulge your cravings occasionally—with proper portion sizes. Check out FitPregnancy’s Recipe Finder for healthy choices.

10)
Going into weight-gain denial. “Monitoring your weight will help you know if you’re eating the right amount,” Tubman says. “If you gain too much, you can modify your food intake or activity level to get back on track.”  What’s your BMI?

Taking Care of Yourself after Baby Is Born

By Hillari Dowdle

Pregnancy was the healthiest time in my life. With baby on board, I finally found the motivation I needed to eat right, get enough rest and exercise. But the minute I delivered my son, my focus shifted entirely to him. I wanted the best for him, 24/7, and put myself entirely at his service. What new mom wouldn’t?

Somewhere around the six-month mark, however, I realized I might have gone a little overboard on making it all about him. He was thriving, yes, but I wasn’t sleeping. I wasn’t bathing. I wasn’t getting out of the house. I was flabby and exhausted, and—worst of all—bursting into tears four times a day. I was, in short, a mess.

With 20/20 hindsight, I can see that I’d have been a better mother in those early months if I’d taken a little time out to attend to my own needs. Experts agree. Here’s their advice for staying happy and healthy.

Put Yourself on a Feeding Schedule
The most important thing you can do to maintain your energy is to eat well, says Eileen Behan, R.D., author of Eat Well, Lose Weight While Breastfeeding (Ballantine Books). “You need to remember to feed yourself; if you don’t, you’ll run out of energy and make poor food choices that you regret later,” she says. To get what you need, aim to make 90 percent of your food choices nutritious ones. “Put yourself on a feeding schedule that’s not too different from the one you’ll want to move your child to—three meals a day, plus a couple of snacks,” Behan says.

Share the Sleep Burden
New moms should take care to schedule sleep for themselves at night. “A few uninterrupted hours of sleep at night will help keep the brain chemistry steady and the biorhythms on track,” says Shoshana Bennett, Ph.D., author of Postpartum Depression for Dummies (For Dummies). Sleep with the baby close to you, or in a bedside bassinet, so you can nurse in bed. Or, pump in advance and let your partner handle late-night bottle feedings so you can sleep in shifts.

Beat the Baby Blues
Postpartum depression will strike 1 in 7 new mothers, says Bennett. And, it can happen later than you think, sometimes up to one year after delivery. Ask a friend or your partner to help you watch for the signs. “If you’re angry all the time, if you don’t have an appetite, if you feel hopeless or anxious, or if you’re taking it personally that the baby’s not eating well, these are signs that you may be depressed,” she says. “Normal baby blues should be gone within two weeks of the birth.” Antidepressants can be a safe option, but they’re not the only answer. “Many moms are afraid to come forward because they don’t want to take medication,” Bennett says. “Sometimes support, education and good nutrition are all that’s needed.”

Sneak in Exercise
It takes stamina to care for a baby—and the demands only grow once your child is on the move. “You can get energy and relieve emotional and physical stress with exercise,” says LaReine Chabut, author of Lose That Baby Fat!(M. Evans & Co.). “But it’s unrealistic to plan workouts every day of the week; you’ll set yourself up for failure that way. Instead, do it on the fly—fit in 10 minutes twice a day if you can.” The best way? Join other moms on stroller walks with your baby (see “Rock and Stroll” as well as a post-baby abdominal workout below).

Join a New Moms Group—or Not!
It sounds a little selfish, but in the early days of motherhood you should do whatever makes you feel best. Join a new moms group, take a bubble bath, make a date with daddy—these are all good ideas, but only if they make you feel better and not like one more addition to your to-do list. Because when it comes to really feeling good, it’s all about you.