January 8, 1999
Volume 1, Issue 2
Midwifery Today E-News
“Nutrition”
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In This Week's Issue:

1) Quote of the Week
2) Welcome!
3) Commentary
4) The Art of Midwifery
5) News Flashes
6) Vitamin B6: Crucial to Health During Pregnancy
7) Dr. Michel Odent on Prenatal Nutrition
8) Letters

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1) Quote of the Week:

"When a woman comes under your care, assume she's undernourished."

- Dr. Tom Brewer

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2) Welcome to Midwifery Today E-News!

Quick, direct communication is a dream come true for us. There have been many times during the past twelve years of publishing a quarterly magazine that we wished we could inform you about something that was time sensitive. This format gives us a concrete and quick way to reach you in case anything of interest in the realm of midwifery takes place. As always, we continue to be dedicated to bringing you information you can use in every issue. Please forward issues of this newsletter to every midwife, doula, childbirth educator and interested parent you know. Our goal is to weave an extensive network of people interested in the midwifery model of care. With it we can "safety net" more and more mothers and babies all around the globe. Modern technology is providing the means--let's take advantage of it! As well, if you have a web page, please post information about this newsletter on it and help us get the word out. You do not have to be a subscriber to Midwifery Today magazine in order to receive this newsletter, but of course you are always welcome to subscribe. Our quarterly print publication has an impressive history of educating and supporting practitioners and parents of all walks. (If you'd like to subscribe to the _print_ publication, contact inquiries@midwiferytoday.com for information. Send your name, postal address and phone number and mention Code 940.)

Thank you for being part of this important network and for getting the word out. Please email us at mtensubmit@midwiferytoday.com
if you have ideas, articles, techniques or news for the newsletter. Jan Tritten

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3) Commentary

The old saying that what we eat is what makes a baby is true to its word. Eating whole unprocessed foods, eating from the four basic food groups, allowing our bodies to grow appropriately and keeping our fats and sugars to a minimum are all basic ingredients to a healthy pregnancy. Growing a baby proportioned to what our bodies can handle is an increasing concern in our culture. More times than not I see larger babies in smaller women. While genetics plays a partial role, I know what those women are eating has its effects. In the United States women tend to eat more based on easy availability. Variety is extensive here and unfortunately processed foods make up a large part of it. In other areas of the world such as in Asia and South America, women are petite yet they grow babies proportioned to their bodies and have healthy outcomes and easy births. Their foods are simple yet often fit their needs well. Poor food habits are not as prevalent as they are in the United States because these women usually don't have the luxury of choice. Overall, their birth outcomes involve less intervention and are more often accomplished vaginally. Tom Brewer helped us understand that inadequate salt intake could lead to problems such as toxemia in pregnancy. Such a simple solution to a problem the medical world tried to address in every other way than with nutrition! This is just one example that not only proves the need for better nutritional counseling in pregnancy, but proves the need for practitioners to be well educated on the subject. When the value of nutrition counseling is underestimated, it may result in pregnancy problems that would otherwise be preventable. Women need to understand the basics of food preparation and intake and need to be assured that these steps will create the healthiest outcome for them and their babies. Pregnancy provides a golden opportunity for women to focus on nurturing themselves with good food and habits. This empowers them: the better they eat, the better they feel, and what results is health and happiness--two key elements that assure better birth. And good habits learned during pregnancy could lead to lifelong habits and good health! Until we practitioners truly promote the necessity for good nutrition as a key element to healthy pregnancy and birth, many women will simply not know how important it really is. But first we practitioners must give top priority to familarizing ourselves with all aspects of nutrition in the childbearing year. It has too often been overlooked as a main component of care. What women eat creates balance, well being and growth. How they eat not only affects them individually but also affects society as a whole.

- Jill Cohen, midwife

Numerous books that contain good information on nutritional care are available to both practitioners and pregnant women. Here are some of them:

  • The Brewer Medical Diet for Normal and High Risk Pregnancies by Gail Brewer, Simon & Schuster 1983
  • Eating Healthy for a Healthy Baby by Fred Plotkin & Dana Cernea MD, Crown Publishing, Inc. 1994
  • Food--Your Miracle Medicine by Jean Carper, HarperCollins 1993
  • The Healing Power of Foods by Michael Murray, Prima Publishing 1993
  • Holistic Midwifery by Anne Frye, Labrys Press 1995
  • Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition by Tom Brewer, Keats Publishing 1982
  • The Natural Pregnancy Book by Aviva Jill Romm, Crossing Press 1997
  • Nutrition for a Healthy Pregnancy by Elizabeth Somer, Henry Holt Books 1995.
  • Nutrition in Pregnancy and Lactation by Bonnie Worthington et. al., CV Mosby Co. 1977
  • Prescription for Nutritional Healing by James & Phyllis Balch, Avery Publishing 1990
  • The Pregnancy After 30 Workbook by Gail Sforza Brewer, Rodale Press 1978
  • Whole Foods for the Whole Family by Roberta Johnson, 1981

If you have suggestions for other good references, please e-mail us the information or write a review!

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3) The Art of Midwifery

Aconite is a homeopathic remedy used for ailments due to fright, especially when the symptoms come on suddenly. One mother reported that her newborn had not peed or passed meconium in the first 24 hours of life. His birth had been a difficult one--stuck shoulders which had not been easy to dislodge and the midwife drenched in sweat by the time delivery was complete. But he had opened his eyes and begun to breathe almost immediately, resuscitation was not required, and no remedies were given. Urine retention in the newborn is an aconite symptom, perhaps one that could have been avoided in this case if the remedy had been given right after birth for the sudden fright of the shoulder dystocia. One 200 C dose brings relief. Subsequently, after traumatic birth, I have administered aconite prophylactically and have not seen another case of urine retention.

- Patty Brennan

When beginners are overwhelmed with the amazing science of herbalism, I tell them to just meet one herb first. By studying one herb to completion, you will come to know all herbs. When you have proven trustworthy with your first herb and its body of empowering knowledge, another herb will be introduced. It is similar to the way midwives establish a practice--one birth at a time.

- Jeannine Parvati Baker

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4) News Flashes

Rethinking Iron Supplementation

A study of medications used by 5,851 pregnant women suggests that iron supplements may be prescribed unnecessarily in many cases. The authors point out that iron deficiency anemia is difficult to accurately diagnose during pregnancy due to the pregnancy-associated hemo-dilution associated with plasma volume expansion. While iron is often prescribed based on serum hemoglobin levels, serum ferritin levels are a more accurate reflection of iron stores. The researchers suggest serum ferritin measurements at 16 to 20 weeks, and some recommend a repeat during the last trimester. Several recent studies have suggested that iron supplementation may not be entirely without risk.

- Annales Chirurgiae et Gynaecologiae 83:80-83, 1994

Epidurals: Not Without Consequences

Over a four year period, researchers evaluated 1,657 nulliparous women with term pregnancies and singleton infants. Of these, 1,047 women (63 percent) received epidural analgesia, which was given upon request. This group's average labor was six hours longer than that of the women not given epidurals. Intrapartum fever above 100.4 degrees F occurred in significantly more women who had epidurals (14.5 percent vs. 1 percent), and more newborns in this group were evaluated for sepsis (34 percent vs. 9.8 percent). Of all neonatal sepsis workups, 86 percent occurred in the epidural group. Even babies without fever were three times more likely to have had a sepsis workup if their mother had an epidural. These relationships held up in multiple regression analyses.

- Journal Watch: Women's Health, March 1997

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6) Vitamin B6: Crucial to Health During Pregnancy

A deficiency of vitamin B6 during pregnancy interferes with protein use in a number of ways. It decreases hydrochloric acid production, which in turn decreases protein absorption (hydrochloric acid aids in protein's digestion). Inadequate B6 intake leads to the burning of protein as fuel. This uses up protein that should be used for normal body building--or baby building--functions. Too little B6 also causes amino acids that have been absorbed to be utilized improperly. B6 has very crucial functions as a co-enzyme or essential helper for at least fifty different enzyme reactions involving the conversion of amino acids into needed substances.

In essence, B6 deficiencies decrease the absorption of protein, cause much of the amino acids that are absorbed to be burned as fuel instead of being used as protein building blocks, and interferes with the body's normal utilization of amino acids. Since toxemia has been linked with protein intake, it is not surprising that an inadequate intake of B6 is also associated with toxemia, since a B6 deficiency in effect leads to the under-utilization of the available protein. That B6 plays a role in some cases of toxemia is not simply a deductive possibility. One study that measured the amount of biologically active B6 (pyridoxal phosphate) in placentas found that the placentas of toxemic women had far less B6 than placentas of healthy women. Another study compared the rate of toxemia in women who took ten milligrams of supplemental B6 daily to women who did not take a B6 supplement. The incidence of toxemia was significantly lower in the supplemented group. B6 deficiencies also can lead to some of the symptoms of toxemia: edema, headaches, abnormal brainwave patterns and convulsions.

Foods high in B6: Rice bran, beef liver, sesame seeds, chick peas, wheat bran, baked potato with skin, banana, rye flour (dark), mackerel, tuna, brewer's yeast, plantain, refried beans, salmon, coconut, dry sunflower seeds, All-Bran cereal, wheat germ, avocado, filberts/hazelnuts, chicken liver, beef round steak (lean), prune juice, chicken, corn flour, dark turkey meat, acorn squash, raisins, spinach, amaranth If your client chooses to get some of her B6 through a vitamin supplement, a B complex vitamin would probably be more beneficial than taking B6 alone. For example, riboflavin must be present for the dietary form of B6 to be converted into its biologically active form. Supplemental warning: Large doses of B6 postpartum reduce prolactin levels, suppressing lactation. Megadoses of B6 can cause nervous system damage, bloating, depression, fatigue, irritability, headaches, numbness and difficulty walking. If a woman has been taking a large dose of B6, she should taper down to a normal level slowly. Dropping suddenly to a normal level can cause deficiency symptoms. People with ulcers should consult a physician before taking B6 because of its effect on the production of hydrochloric acid.

- Althea Seaver, "Feeling Fine: Avoiding Some Common Discomforts of Pregnancy," Midwifery Today Issue No. 21

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7) Dr. Michel Odent on Prenatal Nutrition

During the phase of rapid brain growth, i.e., the second half of pregnancy, priority is given to a basic question: which nutrient is essential for brain development? The answer is simple: the developing brain, which is mostly made of fat, has a thirst for one particular molecule, commonly called DHA. All midwives should know about this molecule, which is a long chain polyunsaturated fatty acid of the omega 3 family. During the last trimester of fetal life, more than fifty percent of the fatty acids which incorporate the brain are represented by DHA. I anticipate a complementary question and underline that DHA is preformed and abundant in the sea food chain (and human milk). Of course the developing brain also needs polyunsaturates from the other family (omega 6), and in particular a long chain molecule commonly called AA. These fatty acids are abundant in the land food chain, and AA is preformed and abundant in any animal food. Omega 3 and omega 6 are not interconvertible in the human body. Until recently most research about nutrition during pregnancy has been based on protein and calorie intakes. Today our understanding of brain development as a priority offers reasons to evaluate the effects of prenatal nutritional counseling programs focusing on the balance between different families of lipids. There are other reasons for a shift in emphasis. One is that the production of the different prostaglandins involved in the regulation of uteroplacental blood flow and the birth process are influenced by the dietary intakes of lipids. Another reason is that transfatty acids cross the human placenta with potential adverse effects on fetal growth. Let us recall that transfatty acids are man-made molecules whose shape is almost unknown in nature. Where preeclampsia and eclampsia are concerned, we are able to establish links with several controlled trials of the effects of fish oil supplementation during pregnancy (although eating fish should not be confused with taking capsules). Our research also reflects statistics associated with the comparatively low rate of preeclampsia in countries where the diet is rich in sea fish.

My theoretical vision of human preeclampsia also takes into consideration studies of fatty acid profiles of red blood cells, which mirrors the dietary fat intake over a two to three week period. According to a study conducted in Seattle, women with the lowest levels of omega 3 are 7.6 times more likely to be preeclamptic than those with the highest levels. I propose a hierarchy between the numerous biological imbalances associated with preeclampsia. The central imbalance, in my view, is the enormous discrepancy between the blood levels of DHA (the molecule essential for brain development) and the other polyunsaturates. In preeclampsia, the level of DHA remains stable. It does not drop dramatically like the level of other polyunsaturates. The price is an imbalance inside the family of omega 3 fatty acids and finally in the whole system of prostaglandins (I would need pages to enter into all the details). Such data suggest that brain development is a priority among humans: whatever the circumstances, the levels of one of the most important molecules for brain development remain stable. In order to simplify very complex phenomena, I propose to distinguish two critical phases in the genesis of preeclampsia. The first phase is in relation to the response of the maternal immune system at the time of placental implantation (this is confirmed by the fact that a previous miscarriage, a previous blood transfusion, or a long sexual cohabitation before conception reduces the risks of preclampsia). The second phase--the one that is influenced by nutrition--occurs later in pregnancy, when the fetal brain development is the most rapid and the demand in specific nutrients, and in particular long chain fatty acids, is maximum. Then the onset of a vicious cycle is possible, that is to say the disease preeclampsia. Preeclampsia appears as the price some human beings must pay for having a large brain while the nutritional supplies are not appropriate.

Not only can we propose a hierarchy between well documented biological imbalances, but we can also establish links between different ways to reduce the risks of preeclampsia/eclampsia; the most direct way is to consume oily sea fish. This is in agreement with geographical variations in the rates of preeclampsias. For those who do not have access to the sea food chain (or who do not eat fish for individual or cultural reasons), great importance must be given to catalysts of the metabolism of unsaturated fatty acids: only the precursor of the long chain omega 3 polyunsaturates (alpha linolenic acid) is provided by the plants of the land food chain. Magnesium is one of these catalysts, and where preeclampsia is concerned, the preventive and curative effects of magnesium are well known. Calcium is another one, and many studies have evaluated its preventive effects. Tom Brewer recalled that the Frenchman Pinard had already demonstrated, a century ago, that a milk diet could reduce the risk of eclampsia. Zinc is also a well-known catalyst of fatty acid desaturation and preeclampsia is associated with low zinc concentration. There are many ways to provide these catalysts through the land food chain. It is worth mentioning that sea fish represents an abundant source for all of them. It also makes sense, in order to prevent preeclampsia, to reduce as much as possible the level of blocking agents of the metabolic pathway of unsaturated fatty acids. Among them are the transfatty acids. It is significant that, according to Williams' Seattle study, the risk of preeclampsia is correlated with the levels of transfatty acids in maternal red blood cells. Alcohol and pure sugar are also blocking agents of the reactions of desaturation and should be theoretically avoided; hormones such as cortisol are also known blocking agents: situations of "helplessness" (high level of cortisol) can increase the risks of preeclampsia. It is also theoretically important to avoid fast destruction of long chain fatty acids available. That is why, during pregnancy, there is an increased need in antioxidant substances such as vitamin E, carotenoids, vitamin C and selenium. It is significant that in regions where the soil is deprived of selenium, the rates of preeclampsia are exceptionally high. Let us underline that sea fish is also rich in selenium.

- Michel Odent, MD; excerpted from "Land Food... Sea Food... Brain Food," Midwifery Today Issue No. 40

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8) Letters

You are to be applauded for your efforts and I would like to extend my support for the project. My partner and I are midwives working at a progressive private hospital on the Sunshine Coast. We are venturing into homebirth, myself having worked previously as a team midwife in the United Kingdom. We have extensive experience in the essential social aspects of both and have missed the community aspects of care. Anything which promotes the social and family oriented aspects of birth and the true freedom of informed choice and client centered care is to have my total supprt. Please keep my partner and myself on your list. Nigel Duncan and Cathy Bock Queensland, Australia I loved reading your email newsletter. Well done! Thanks, and I'll tell others.

- Pam England

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