Physical Preparation for Birth & Postpartum | Nutrition
The physical preparation seems to be the second topic on most people’s lists, after intellectual preparation, when it comes to getting ready for birth and postpartum.
What boggles my mind is that many providers don’t really go into this topic at all with their patients/clients. Most HOME BIRTH midwives do, I would say, but what I’ve heard from women who have seen allopathic providers during their pregnancies (doctors or hospital nurse midwives) is that there is not a lot of focus on the physical prep for a healthy pregnancy, birth, and postpartum besides maybe giving the women a list of foods NOT to eat.
This, to me, is not a very holistic or balanced way to prepare. And often leaves women with health issues during pregnancy or postpartum that could have been avoided, as well as just a general sense of feeling very restricted in what they should do for their baby’s health.
I like to split this topic up into different categories or types of physical preparation:
Nutrition
Activity
Sleep and Relaxation
Increasing oxytocin
Pelvic floor health
Let’s start with a big one: nutrition! I’ll touch on the other topics in future blog posts.
Nutrition
There are so many different types of diets for pregnancy that will help prepare your body and your baby for birth and for optimal health during postpartum.
A big one promoted by midwives is The Brewer Diet.
The history of The Brewer Diet is actually pretty cool. Dr Brewer was a doctor who worked in a high risk clinic starting in the 50s. He saw patients who had a lot of health issues in pregnancy, like diabetes, preeclampsia, eclampsia/toxemia, premature labor, placental abruption, anemias, low birth weight, high blood pressure, etc..
He started trying to find a way to help these women avoid these issues in the first place (instead of treating the issues after they already showed up), and he found that when women ate a specific diet or had elements of a particular diet during pregnancy, they had less health issues.
He started his own high risk pregnancy clinic, and educated everyone who came to see him as a patient in this particular diet, and he found that he reduced the amount of severe health issues during pregnancy by crazy percentages.
He really put forth the importance of blood volume expansion during pregnancy in order to avoid common and dangerous health issues of pregnancy. Blood volume expansion is a natural part of pregnancy and is necessary in order to sustain the baby, the placenta, and help all the other organs of the mother’s body as they work harder during pregnancy.
In a typical healthy pregnancy, blood volume (the quantity of physical blood circulating in the body) increases by as much as 60%! So instead of a 130 lb woman having 3.5 quarts while not pregnant, she will end her pregnancy with 5.6 quarts of blood if she has adequately expanded her blood volume. Two extra quarts!
I’m sure you can imagine that a body that wasn’t able to increase the mother’s blood supply adequately would leave her body in a state of stress and panic, trying to function under sub-optimal conditions PLUS sustaining the life of a baby.
The body equates a restricted blood volume during pregnancy with hemorrhage (bleeding out). So in this sense, the body will do what it feels necessary to save the life of the woman who is hemorrhaging (actually in reality she is trying to sustain a pregnancy with a restricted blood volume). This is when health issues show up.
The internal organs must be preserved, often at the expense of the limbs. The blood vessels will constrict, causing high blood pressure, there will be swelling in the limbs, rapid weight gain from the body retaining lots of fluids in order to try to increase the blood volume, headaches, etc..
This is diagnosed as preeclampsia usually, and will show up on lab work as the kidneys and liver not performing optimally. If she is encouraged to restrict her calories or eliminate salt from her diet at this point, it will just make things worse because blood volume will be even MORE constricted, and actual eclampsia/toxemia (seizures, coma, and/or death) could ensue.
So, how do we ensure a mother’s body has the building blocks to make extra blood during pregnancy?
She needs to eat enough calories and enough protein and enough healthy salt.
The only way for the liver to make the extra albumin (a substance similar to egg white that helps expand the blood volume and create the correct pressure balance within the veins to encourage this blood volume expansion process to continue) is from PROTEIN.
This needs to be in combination with adequate calories though. When a woman is not eating enough calories but IS eating enough protein, her body will burn the protein as calories (just to keep the body functioning) instead of allowing the liver to use the protein to build the blood.
Dr. Brewer recommends that during pregnancy, a woman eats
2600 calories
80-120 grams of protein
and healthy salt (Celtic sea salt or Himalayan salt) to taste.
While that surely seems like a LOT of calories and protein to literally everyone who hears about this diet from their midwife during pregnancy, the proof is in the pudding!
When we see women eating this diet in a healthful way, we don’t see any health issues during pregnancy, energy levels and sleep are super optimal throughout pregnancy, there is less blood loss during/after birth (plus the body is able to handle blood loss better because there is extra blood to lose), and a more peaceful postpartum without symptoms of depletion.
Also, don’t skip out on the salt part of this equation. Healthy pregnant women need (and often crave) lots of salt. As long as she is following her taste buds plus eating healthy versions of salt, it is not possible for a healthy pregnant woman to eat too much healthy salt during pregnancy.
Salt also helps with the pressure inside the circulatory system, pulling fluids from the tissues into the blood stream, helping to create more blood volume (and to avoid swelling.. no cankles, please!!). We don’t really see swollen ankles or legs in women who follow a healthy Brewer Diet for this reason.
Here is a link to the Brewer Diet recommendations. All of the categories that he splits food into (dairy, eggs, protein, etc.) are important to help provide the building blocks for adequate blood supply.
There is also a handy checklist you can print out and put on your fridge to make sure you’re getting all the categories in each day or over the course of a week.
Here is a list of the categories and food recommendations for each category.
Pay attention to the quantity, too. When it says "8 servings of protein each day” on the checklist, each serving of animal protein is only 1 oz on the list of suggestions. That is totally approachable!
Another great guide for pregnancy nutrition is from Lily Nichols’s book “Real Food For Pregnancy.”
Lily worked in public policy and in a clinic as a dietician and saw firsthand how nutrition was affecting women during pregnancy and their birth outcomes. She had a particular interest in gestational diabetes (so if you do, too, she has written a book about that specifically that you should check out as well).
She started looking at all the research and public policy info on nutrition during pregnancy and found that it was severely lacking and usually way off the mark. She examined traditional cultures too, and what they did in terms of pregnancy nutrition.
After all that research and digging, she came up with recommendations that helped patients/clients at her clinic improve pregnancy outcomes and avoid common pregnancy health issues.
Her big push is toward nutrient density of the food we eat, or getting the most bang for your buck out of everything you put in your body when you’re pregnant.
Real foods, high in nutrient density, lots of healthy fats, and plenty of protein. Makes a lot of sense, right? :)
Her book is awesome, and I recommend it for every pregnant woman. It has lots of great recipes, tips for any health issues that may crop up during pregnancy, as well as info on how to be as healthy as possible by practicing better body mechanics and eliminating toxins from your daily life.
One last recommendation I like to encourage women to look into is the Weston A Price Foundation guidelines and research.
Weston A Price was a dentist who didn’t like seeing more and more dental issues (like overcrowding/need for braces, etc..) and cavities as time progressed. He set out on a world research tour to try to find out why some cultures didn’t have dental issues and some did.
What he found was that traditional cultures that ate diets rich in nutrients and fats had much better teeth and facial structure, and less health problems overall.
This foundation now has guidelines for pregnant women to consider when deciding how to eat during pregnancy in order to avoid issues like poor latch, tongue tie, and to form strong healthy teeth and bones and body structure in the babies they are carrying.
What about vegetarian or veganism during pregnancy?
This is an interesting topic, one that I would love to learn more about. In general, I’ve found in my personal experience with women I serve and with women that my midwifery sisters serve, that there are less issues and less work for women who eat a healthy diet that includes animal products during pregnancy.
That being said, I do know that there are vegans and vegetarians who put in the work to eat super healthful protein-rich and nutrient dense diets and have amazing outcomes and no health issues.
But you really do have to put in the work!
The Brewer Diet website that I linked in the first section has a page for vegetarians with guidelines for diet during pregnancy based on Dr. Brewer’s recommendations.
Ultimately, I think a woman should do what is most comfortable for her, after she has researched and felt into it intuitively as well. Knowing the benefits and risks of each diet and how that could affect the pregnancy, your health, and the baby is important.
Everything that we do as midwives should center the woman in her own decision-making process and value where she is on her path. The worst thing possible is seeing a woman stressed out about food while she’s pregnant. It should be natural and intuitive and it should encourage the woman to feel as healthy and balanced as possible throughout the pregnancy and after! If that means not eating animal products, so be it. :)
That being said, if health issues DO start cropping up that can easily be rectified with changes to diet, I think those are important conversations to have. Because SO much can be avoided by a healthful diet!
Alright, hopefully all of that makes sense. :)
If you’re interested in learning in greater detail about nutrition for pregnancy, conception, fertility issues, or optimal postpartum, book a session with me!
I love this topic and have loads more I could talk about it as it pertains to all the different aspects of our childbearing years. I’d love to hear from you, where you’re at, and how I can help support you in your unique journey <3
