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A Workbook to Accompany the 9 Week Class Series
By Betsy Hoffmeister, MPA, IBCLC Illustrated by Adam Crockett
Your Body, Your Baby, Your Birth Copyright 2010. All rights reserved.
This workbook is a work in progress undergoing revision. Your feedback, comments, criticism and praise are greatly appreciated. I have worked hard to cite my sources. The text contains adult language and references to genitalia, human sexuality, and excretory processes and is thus not for the squeamish or faint of heart. Many thanks to Adam Crockett, for the design of my logo and all the fabulous illustrations, all of the families who relied on me as a birth educator, doula, and La Leche League Leader, and whose stories I share, and my Facebook pals for providing me with instant quotable quotes. Thank you Lisa Farino, Kristie Walker and Elizabeth Fletcher for editorial feedback. David James did the copyediting, for which I am eternally grateful.
Dedicated to my own birth partner, Jerry, my two children, Isaac and Rebecca, for gifting me with the joy of birthing them, and to all the babies I have helped journey in this world, one way or another.
Betsy Hoffmeister, IBCLC firstname.lastname@example.org www.betsysbabyservices.com 206 353 9334
Introduction to Northwest Natural Childbirth Background Northwest Natural Childbirth Class Goals Class structure and format Class fundamentals Class 1: Basics – natural childbirth, exercise and nutrition Class Goals What is “Natural Childbirth” Let’s talk about pain for a minute. Powerful parents for a powerful birth: exercise for a healthy pregnancy Foundation of a Healthy Pregnancy: Nutrition Watch what you eat! Homework Class 1 Class 2: Gestating, choosing a health care provider, breathing, communicating & sex Class goals Gestation Breathing – you’ve had a lot of practice Choosing Your Health Care Provider Date night exercise Pregnancy sex: Sex is natural, sex is good, not everybody does it, but everybody should Homework Class 2 Class 3: First stage labor Class Goals Pre-labor Labor, the real deal Homework Class 3 Class 4: Second and third stages of labor, pushing out the baby and placenta What is happening in second stage labor? The “urge to push” Support for the pushing phase It’s a BABY! Placenta birth Homework Class 4
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Class 5: The Birth Un-Plan, and What To Do When Things Get Interesting Class goals The Birth Plan When Labor Gets Interesting Making Informed Choices Sample Birth Plan 1 Sample Birth Plan 2 Sample Birth Plan 3 Homework Class 5 Class 6: Burning questions, and, an overview of emergency childbirth Class goals Partner’s burning questions Unplanned, unattended birth: what to do Homework Class 6 Class 7: Review and rehearsal Class goals Test your knowledge! Labor rehearsal—class activity Homework Class 7 Class 8: No one gave us the parenting manual: the chapter about poop. Class goals The immediate postpartum period The first few days at home And what about mom? Postpartum for the birth partner Maintaining connection with your partner Homework Class 8 Class 9: Breastfeeding: insert part A into part B, repeat Class goals A little background on breastfeeding Breastfeeding basics The all important “ latch” Eating & the “let down” reflex Nursing bras, clothes, and pads Breastfeeding advice Nursing in Public Troubleshooting Engorgement Plugged ducts Mantitis
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Sore, Cracked, Bleeding, miserable nipples Too much milk Not Enough milk Pumped milk smells funny Homework Class 9 Appendix 1: Reverse Pressure Softening and Manual Expression Engorged nipples – Reverse Pressure Softening Appendix 2: Postpartum intimacy A word to the partner It’s not about the sex. Perineal trauma and recovery Appendix 3: Safe sleep sharing Advantages to sharing a sleep space Safe sleep arrangements 24-hour Keeping track of stuff chart Reminder list for moms Reminder list for partners
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Introduction to Northwest Natural Childbirth
Birth is only one part of your parenting journey, but it is the most mysterious part. Pregnancy can also take you by surprise, what with the invisibly growing small human, breasts that are newly the size of grapefruits, areolas the size of pancakes, weird stripes running up your belly, and spontaneous mood swings. But pregnant women are everywhere and are eager to talk to you about the minutiae of their hemorrhoids, support hose, and the quest for the perfect car seat. It’s easy to share the experience. Parenting also seems really obvious. We were all parented, some of us better than others. Children are everywhere, screaming, eating gross stuff off the floor, smiling, and dribbling. Parenting support groups abound. It’s easy to observe parenting and easy to think to yourself “I am never going to do that to my kid!” But birth, birth is another story. Some women will tell you way too much about their birth. Others will look a little spacey and say “I don’t really remember. It hurt a lot.” There are nasty movies and TLC shows of women who didn’t know they were pregnant, fourteen year olds who are pregnant, women pregnant with quintuplets, women who have babies with massive defects. But where are the shows, the discussions, the frank and open conversations about normal, basic, straightforward, simple birth? Birth is really hard to envision. You’ve never done it before. And no one will tell you the straight scoop. Birth is messy. Birth is loud, earthy, smelly, hard, sweaty, sexy, profound, powerful, terrifying, exalting, and transformative. Birth often hurts. Birth can be ecstatic. It is always exhausting. But above all, birth is normal. Thank you for choosing Northwest Natural Childbirth as your gateway to birth and parenting. You had a lot of fantastic options to choose from, and you made a leap of faith. I appreciate it. I hope that this class is going to lift the veil of mystery and show you birth in all its messy glory.
Northwest Natural Childbirth Class Goals
1. Empowered, powerful parents starting their journey together as a team. 2. A healthy mother and a healthy baby are always the goals of any birth. 3. Informed decision making by the mother and her partner. 4. Active involvement by mom’s partner as early in pregnancy as possible. 5. Normalizing birth to maximize the likelihood of an unmedicated, vaginal birth. 6. Mother and her partner feel they have made positive birth choices. It may not have been their first choice, if mom opted for anesthesia or a cesarean birth, but the team made the decisions together. Epidural and cesarean are valid, important choices. I want you to feel confident in making those decisions. 7. Healthy, open communication between the mother, her partner, and the birth team. 8. As a team, you will be prepared to give birth with a midwife, a family practice doctor, or an OB/Gyn, at home, at a birth center, in a hospital, or just the two of you in a Denny’s parking lot. 9. Successful initiation of breastfeeding. 10. A strong bond between mother, baby, and partner.
Class structure and format
Each week, we will review the fundamentals of a healthy pregnancy and birth. There will be plenty of reading, in books and online, frequent written and oral assignments, physical exercises to do, relaxation to practice, food to eat, sex to initiate (if appropriate), and some downright squirmy conversations to engage in. This is not a sit-down, shut-up, listen and leave class. You will be called on to cook, dance, vocalize, argue, sway, and grunt. I know you are all busy professionals. But this is the only time you are going to be pregnant with this specific child. You deserve time out of your day to take it seriously and pay attention to this pregnancy and this baby. It will be worth it!
1. Mental, physical, and emotional relaxation. 2. Excellent nutrition. 3. Full information allowing for informed consent. 4. An involved birth partner. 5. A powerful body -- for both partners.
A note about terminology: in this class, birth is always referred to as birth, not “delivery.” The UPS truck delivers packages. Doctors and midwives attend or assist. Mothers give birth. Just this change of terminology shifts the balance of power back to where it belongs. In this text, the growing fetus will always be referred to as “Baby” or “the baby,” and occasionally as “him.” At least in my class the laboring partner is always female, so the “he” distinguishes the baby from the mother. The mother is referred to as mom, mother, laboring woman, she, or her… and the birth partner is referred to as the partner. While many of my couples are married and the majority of partners are male, many are not. I’ve taught birth partners who were the pregnant woman’s startled roommate, or her mother or sister, and even the lesbian parents of the pregnant woman’s absent boyfriend. If you feel all husbandly and coach-ish, feel free to use those terms yourself. It’s all good.
Basics – natural childbirth, exercise and nutrition
• • • • Meet your classmates and teacher. Explore the concepts of “natural childbirth” and “pain in birth.” Demonstrate and practice basic pregnancy exercises. Overview of pregnancy nutrition.
What is “Natural Childbirth”
What is natural childbirth? Doesn’t it hurt too much to do it that way? What are the basic things we should be doing now to prepare for a healthy pregnancy and birth? Natural birth refers to the idea that women are powerfully capable of safely birthing their babies without interference. Some OBs use the terms natural childbirth and vaginal birth interchangeably. In this class, natural birth means a vaginal birth without anesthesia. Why, when safe drugs are so readily available, would anyone voluntarily undergo the strain, discomfort, and pain of birth? Some major reasons why we try to reserve the use of epidural for moms who are truly suffering in labor, rather than to use them universally with every laboring woman: • Birth is incredibly powerful. Moms who birth without drugs can feel like rock stars. It’s an enormous hormonal rush. The work itself sucks, but getting it done feels so, so good. For moms who have a hard time trusting their bodies, an unmedicated vaginal birth may be tremendously healing. Birth can bring couples together. During a medicated labor, everyone’s sort of sitting around waiting for the machines to tell you when to do the next thing. During an unmedicated birth, Mom relies heavily on her partner for support. The partner often feels deeply, intimately connected with both mother and baby after being so involved in labor and birth. Unmedicated birth is good for the baby. Baby is squeezed, stretched, bathed in hormones, introduced to good bacteria, and given the room and support to proceed at its own pace. By the time the baby is born, it is usually prepared to breathe and eat. Baby is more ready to bond with its parents when it is born clear-eyed and clear-headed. Epidural anesthesia may impact babies. A good anesthesiologist will confess to this. Others will lie to your face and tell you that the anesthetic does not affect the baby. Postpartum nurses, lactation consultants, and mothers will tell you that prolonged use of epidural anesthesia may cause Baby to be groggy, have a hard time coordinating his sucking and swallowing, and be difficult to wake up to feed.
Epidural anesthesia can increase the risk of jaundice. Baby’s system is not equipped to metabolize narcotics. • Epidural anesthesia affects moms. While most moms are going to be totally fine with an epidural, a certain percentage will experience a long lasting headache or back-ache. Some will have even more unpleasant and dangerous side effects (more on that later). Epidural anesthesia sometimes interferes with the natural progress of labor. It lowers mom’s blood pressure (but when her blood pressure goes down, she’s given IV fluids, which dilute the hormones in her blood, making her contractions less effective – oh no! we need Pitocin®!), increases her temperature (does she have a fever? Tests! Medicine!), restricts her to one position in the bed (no gravity—baby’s not moving!), sometimes slows the labor (Oh no! slow labor! Give her Pitocin®! Oh no! the baby’s heart rate got all wacky! Up the dose of anesthesia! Oh no! the labor slowed down! More Pitocin®! Oh no! bad heart tones!! GET THE BABY OUT!!!). It’s a vicious cycle which is all too common and has increased the cesarean rate in the U.S.
Epidural anesthesia is mostly safe and can be an extremely useful drug. By the time we are done with class, you will know when it is the right time to choose anesthesia, and you should not feel guilty or doubtful about doing so.
Let’s talk about pain for a minute.
Imagine you are in pain. You did thirty pushups two days ago. You have a throbbing headache. You sprained your finger. You have menstrual cramps. What are some things you do to cope with pain? Make a list of things you do. On this list are things moms and dads in my classes say they do to cope with pain. Add your own.
Advil®, Tylenol®, Motrin®, Aleve®, glass of wine… Yell at someone, bitch, complain, whine, moan and groan. Don’t tell anyone, suffer in silence. Deep breathing. Rely on my loved one. Eat something really delicious to distract myself. Go for a walk. Snuggle with my pets. Eat chocolate. Stare at a focal point.
Curl up in a ball and cry. Acupuncture, massage, craniosacral therapy, yoga. Take the hottest possible shower or bath. Meditate or visualize a happy place. Drink tea. Get a huge hug. Pray, give it up to a higher power. Listen to music. Pound on something.
When labor hurts, it hurts for a reason. Your body wants you to change something to help the baby move down. Pain in labor is rarely a sign of something going wrong. It usually is a sign of something – the baby – going in the right direction.
Powerful parents for a powerful birth: exercise for a healthy pregnancy
Giving birth is a hugely athletic event. Some people compare it to running a marathon or climbing a mountain. But running and climbing are entirely voluntary. Giving birth is not a choice, the baby has to come out somehow. For this to work out properly, we need: • • Mom and partner to be in reasonable physical shape. Baby to be lined up properly.
Certain basic exercises will help you get these stars in alignment. Both of you, try to include 30 minutes of active cardiovascular exercise each day (what I like to call “light cardio.”) Swimming feels fabulous. You may feel like a hippo doing ballet out of water, but underwater you may feel like a streamlined, agile and sexy dolphin. Well maybe not sexy, but maternity bathing suits have come a long way since I first got pregnant! Walking is also good basic form of exercise and something you can do together as a team. Pregnancy yoga, belly dance, and step aerobics are also available. During the labor, partners can expect to: be awake way longer than you are used to, walk for hours, hike up and down stairs, assist her in doing lunges, dance with her, hold her upright while she leans on you, have her sitting on your lap, and have her squeeze your hands, arms, or neck. What might you need to do to prepare for this? Increase your stamina, for one thing! If you don’t currently exercise, start. Try to work your way up to 30 minutes of light cardio 4 days per week. By the end of the pregnancy, you should also be doing 2 sets of pushups, working out, or exercising with kettle balls at least four times per week. Anything you can do to strengthen your arms and back will help you out.
Partner: you need to be healthy and fit along with the pregnant mom. Yes, she has to do all the laboring and pushing, but you have to do the walking, squatting, leaning, massaging, stroking, and staying awake along with her. What are you doing to get ready? Make a list here of the physical activity you do over the course of a week. Write down a goal of where you’d like to see yourself in terms of physical fitness by the time the baby is due. __________________________ __________________________ __________________________ __________________________ __________________________ __________________________
Pregnancy exercises: At the end of each chapter, I will indicate how many of each exercise you should be doing daily.
1. Kegel: The Kegel, or pubococcygeus muscle, is a hammock of muscles connecting the pubic bone to the coccyx. Also known as your pelvic floor, it holds up all of your internal organs, especially your uterus. The vagina, urethra, and rectum pass through the pelvic floor. The baby needs to glide through this muscle group as it descends. A well toned muscle also promotes good sex and urinary and fecal continence (not wetting or pooping your pants). The Kegel muscle helps the baby’s head get into the proper position for birth. We’ll be doing a lot of these. If you’ve never done one before, drink a very large beverage and wait a while. Then, sit on the toilet if you’re a woman or stand in the yard if you’re a guy. Start peeing. Stop mid stream. If you’re a guy, try writing the word P-E-E in capital letters. Every time you stop the flow of urine, you are tightening your pelvic floor muscles. Don’t do that regularly, because at least in theory, stopping the flow of pee in mid stream could cause urine to back up the urethra with infection as a consequence. Now that you have isolated that muscle, you can play around with different ways of tightening it. Partners: do these along with her. If you are her lover, you can help her with her Kegel exercises by helping her test her internal muscle tone. Keep it fun, please. Guys, remember you also have a Kegel muscle. Old men are also prone to incontinence. Some men swear that doing Kegel exercises really improves their sex lives. You should do your Kegels too. Repetitions: We will be doing a lot of these! Work them into your daily routine. 2. Pelvic rocking: This simple and useful exercise can help with lots of pregnancy related problems. It can help move the heaviest part of the baby – its head and back – towards your front, so that baby is facing your butt. This is ideal. It also helps stretch your lower back, can help relieve pressure on your intestines to aid your digestion, and lifts the baby off your bladder and urethra. It is similar to the “catcow” yoga stretch, but without the cat part. Rest on your hands and knees and flatten your back. Let your head be in a neutral position. Do not look up or forward. Slowly drop your belly towards the floor and slowly return to a flat position. Repeat. Partners: get down next to her and do this along side of her. If she’s having trouble, put your hand lightly on the small of her back to show her the area she’s supposed to be working. Remind her to do this first thing in the morning and last thing before bed, and during the day as well. Repetitions: Start with 15 twice a day, plus a few throughout the day especially if you have indigestion or stiffness.
Tailor sitting: In the old days, tailors sat on a bench cross legged to do their work. Tailor sitting
encourages the uterus to move forward. It may help increase circulation and should help stretch your thighs. Sit cross legged on the floor, and lean forwards or backwards. Switch it up, stretching your legs regularly. If you can’t comfortably sit cross legged, at least have your knees bent and the soles of your feet touching. Partners: You can help her by joining her on the floor. Have a picnic dinner, watch a movie, play Scrabble on the floor. Repetitions: Do this exercise throughout the day whenever it’s appropriate for you to be sitting. 3. Butterfly or legs-apart exercise: During labor, you will be using leg muscles you are not accustomed to working on a regular basis. The Butterfly exercise helps strengthen both your inner and outer thighs. It will help you during the first stage of labor, when many moms experience sore, achy thighs, and right after birth, when many moms have very shaky legs. Sit face to face. Mom might need to lean against something sturdy. Lean back with your knees up and the soles of your feet together. Partner, face her. Place your palms on the outsides of her knees. Mom, press his hands towards the floor. Partner, just resist. Partners: You have to be present and awake for this one. Just apply resistance, it’s not a contest, don’t try to win. She should be engaging her thigh muscles without using her abdominal muscles if at all possible. Repetitions: Start with three per day, work your way up to ten or fifteen. 4. Squatting: Some form of squatting is the most powerful position for the second stage of labor, the pushing stage. Your unmedicated body will naturally prompt you to get into a modified squatting position. Squatting helps you bring the full pressure of your upper body, lungs and diaphragm down on your uterus, opens the outlet of the pelvis by up to 30%1,and shortens the vagina. (Temporarily.) This exercise will give you thighs of steel for the pushing phase. Most moms don’t birth in a full squat, with
1 Different resources cite different increases in opening, but, the consensus is, squatting opens the outlet of the pelvis by 1-2 cm. The paper “The effect of maternal posture on pelvic outlet MR measurements” by Sven Claude Andre Michel et al, Department of Radiology, University Hospital, Switzerland, 2001, shows significant difference in pelvic outlet diameter between nonpregnant women lying down or in a full squat. They conclude “Our results show that a difference in maternal posture can result in a significant increase of pelvic distances and thus give scientific evidence that changing position during labor can facilitate delivery.” For a more instinctive look at this, the movie “Orgasmic Birth” shows a wide range of women in undisturbed birth all choosing upright squatting or semi-squatting positions for birth. http://cds.ismrm.org/ismrm-2001/PDF7/2080.pdf
butt down by her heels, but will modify the squat on hands and knees, lying on her side, sitting on a birth stool, or leaning over her partner. From a standing position, slowly squat down until your thighs are parallel to the floor. Slowly stand up. Over the course of the next weeks, you will gradually work your way up to holding a squat for several seconds. If you need support, please have your partner face you. You will both be more stable standing on a carpeted surface (if you’re on a slippery floor, please take your socks off first.) If this hurts, modify the squat until it is comfortable. Partners: If she’s going to pick something up off the floor, remind her to squat. Don’t drop stuff on purpose or she will have an excuse to pick it up and throw it at your head. Repetitions: include throughout your day, plus one set of squats daily as well. (Remember, you’ll get an assignment in your homework every week). 5. Relaxation: Although relaxation is not technically an exercise, it is something all of us need to practice. I want you to find a position that allows you to relax all of your muscles at the same time. During labor, your goal is to be able to relax your entire body in response to your partner’s voice and touch, giving your uterus the freedom to do its job of contracting without the rest of your muscles fighting it. We will demonstrate one comfortable position today, but, you should experiment at home to find the position that is most comfortable for you. This side lying position has the advantage of supporting all of the muscles in your body and your uterus, too, without any work on your part. In this position, you put very little weight on your uterus, because you are supported with pillows. Your partner has full access to massage everything and monitor your relaxation. It helps with the baby’s rotation. And, it may make contractions more effective – translate, more intense. Partner: help her get into this position for relaxation practice, and if she needs your help adjusting pillows before she goes to sleep, try not to resent the fact that there is no longer room in the bed for you.
Foundation of a Healthy Pregnancy: Nutrition
“Don’t eat that – you’re pregnant!” Quick, name three things you’re not allowed to eat that you really miss. The list grows ever longer. When I was pregnant with my first child in 2000, I wasn’t supposed to smoke, drink alcohol, or eat too much tuna. By the time my second one came along, I wasn’t supposed to eat tuna more than what, once a month? No sushi, ditto lunchmeat, unpasteurized cheese, lox, pate, unwashed vegetables … it felt like every meal was a minefield. Then I started reading about whole foods diets and colorful eating and suddenly it all made sense. I’m giving you a fantastic article by Cynthia Lair, our own Bastyr University and PCC food guru. Her words are so comforting and sensible and non-restrictive. If you have a minute of down time and need some great menu ideas, visit her hilarious website, www. cookusinteruptus.com for tips on whole foods eating. Yes -- you are growing a new person, and that new person deserves a healthy diet. But, the baby will grow no matter what you eat. You can grow a healthy baby on a diet of Froot Loops™ and Twix™, but would really want to? Your diet impacts not only fetal development, but also the growth of your placenta, blood, and amniotic sacs. The average pregnancy weight gain is between 25 and 35 pounds. For most of us, that’s going to be no problem whatsoever. If you are significantly overweight, it’s probably Quick quiz: How many extra a good idea to moderate what you eat to gain less than 25. If you’re calories does a woman significantly underweight, you may need to gain considerably more. expend during a day of That’s why it’s an average. Talk to your health care provider about breastfeeding? what she feels is a safe weight gain for you if you are under- or over__________________________ weight. Extra bonus points: Name an
exercise that would burn an equivalent amount of calories. __________________________ __________________________
Eating Healthfully in Pregnancy
If you follow a few simple rules, you can eat beautifully, deliciously, and healthfully, which will naturally lead to healthy fetal __________________________ development, strong placenta and amniotic sacs, and normal weight __________________________ gain. If you wish, you can follow a regimented pregnancy diet. I can __________________________ provide you with a worksheet on that. However, I prefer to trust that you are grownups, you’ve been eating for a long time, and with a few tweaks, you can probably be eating better during this pregnancy than you ever have in your life. It’s a nice time to adjust your partner’s diet too. Many male partners gain up to 15 pounds of sympathy weight during pregnancy. Immediately after birth, mom will lose a ton of weight just from birthing the baby, then losing the placenta, extra blood, extra fluids, and amniotic fluid. Afterwards, mom is expending enormous calories on a daily basis simply lactating. However, if you, birth partner, are eating like a pregnant person, please don’t. Instead, eat healthfully. Remember, you need to run that marathon right along next to her. (And the more you weigh, the harder it is to do pushups).2
2 Some moms are so queasy in their pregnancies that the term “morning sickness” seems like a cruel joke. The term “hyperemesis” refers to the condition of “constant puking.” Moms experiencing constant nausea will need to work closely with their health care provider to make sure that they have adequate nutrition. Counter-intuitively, keeping your stomach full most of the time, eating small protein-rich snacks all day long, may actually help reduce the nausea. If this is you – I’m so sorry. There are medications available for nausea and hyperemesis. They may even help.
Eat real food.
I have a few simple rules for eating during pregnancy. Eat more protein, eat colorfully, eat intuitively, and eat real, whole food.
Why more protein?
Protein is the basic building block of your placenta, amniotic membranes, and extra blood, not to mention of every cell of the baby’s body. The U.S. Centers for Disease Control simply recommend 3-4 servings daily of protein-rich foods for the pregnant woman. Ask your care provider what they recommend for protein intake. Animal sources of protein high in iron will help reduce your risk of anemia.
What is eating colorfully?
This is a great way to teach nutrition to children – eat a rainbow of food every day. The cheerful kid’s band “Swingset Mamas” even has a song called “Colors of the Rainbow.”
Picking red strawberries from a field, I eat a yellow banana with every meal Oranges full of vitamin C, Keeps a runny nose far away from me. Pass the green peas if you please, And make a mushy avocado into guacamole. I like blueberry pancakes at breakfast time, And sucking purple plums in the hot sunshine.3 The more intensely colored a food is, the more dense it is in minerals, vitamins, and other nutrients. Deep colors usually indicate that a food is rich in antioxidants which may help protect your body against disease. Richly colored foods tend to be more flavorful as well. Research shows that organically-grown foods are more nutritious and higher in antioxidants than conventionally grown foods.4 Wild Alaska salmon and grass-fed meats5 have more long-chain fatty acids, the kinds of fats that are good for your brain. Try to eat a variety of colors every day. Instead of thinking, “did I eat my three servings of fiber a day,” think, “Did I eat something green, red, blue, orange, or yellow today?” And no, Skittles® don’t count.
3 © 2006, Swingset Mamas. 4 “New Evidence Confirms the Nutritional Superiority of Plant-Based Organic Foods,” State of Science Review, March 2008, Charles Benbrook, Xin Zhao, Jaime Yanez, Neal Davies, Preston Andrews. The Organic Center. http://www.organic-center. org/science.nutri.php?action=view&report_id=126 While this study is published by The Organic Center and thus bias is suspect, it is a meta-analysis of nearly 100 studies which should make it reliable. Alternate reports funded by conventional agriculture research institutes are also available. 5 http://news.ucanr.org/newsstorymain.cfm?story=531 “Grass-fed beef has more beta-carotene, vitamin E and omega-3 fatty acids than beef produced using conventional cattle-feeding strategies, according to a research review conducted by University of California Cooperative Extension and California State University, Chico.”
Part of my goal for you is to help you tune in to your body, listen to yourself and your baby, and trust yourself that you are smart and know what you need. But, societal messages tend to override what our body tells us. Is your body craving Skittles™? Try freeze dried berries. Desperate for Doritos™? Substitute jicama with chili salt, or popcorn with Brewer’s yeast and sea salt. Are you yearning for a Big Mac™? Try a serving of steak – with quinoa on the side. Subvert those urges for food with a trademark next to its name. Convert those ideas in your head to their healthful, natural alternatives. Unfortunately, the natural alternatives usually take a little more work to prepare. If you must have fast-moving foods, try a pho restaurant or a mom-and-pop burrito shop instead of a fast food chain; pick up snacks at Whole Foods or PCC instead of 7-11. Don’t be nutty and deprive yourself all the time. If you need a treat, try the darkest possible chocolate, preferably one full of dried fruit. Dark chocolate is rich in antioxidants.
When is food not food?
Follow Michael Pollan’s advice and stay out of the center aisles of the grocery store. That’s where the processed crap is. Try to avoid foods with unpronounceable ingredients. If your great-grandmother wouldn’t recognize it as food, it’s probably not food.6
What are whole foods?
A “whole food” is a food in as close to its natural state as possible. Most of the food sold in the U.S. is processed and no longer recognizable as food. That’s because there is a lot of money to be made turning raw ingredients – soy, corn, dairy, wheat – into complex processed foods. Interestingly, these are some of the foods most likely to cause allergies and inflammatory reactions in people, particularly in infants. (The first ingredient in most infant formulas is soy or milk. The second ingredient is often corn syrup.) For example, corn is food. Summer in Maryland meant putting water on to boil, running out to the garden, picking corn, shucking it on the way back to the kitchen, boiling it, and eating it as soon as it cooled down enough not to scorch your tongue. Most of the people indigenous to this continent depended on corn as a staple food until Europeans came along and introduced wheat and soy. But, corn is incredibly versatile and easy to turn into not-food.
What is it?
Food? Snack Food? Not Food?
Service Size 1 cup 164g (164 g) Amount per Serving Calories 177 Calories From Fat 18 % Daily Value* Total Fat 2g 3% Saturated Fat 0g 2% Trans Fat Cholesterol 0mg 0% Sodium 0mg 0% Total Carbohydrate 41g 14% Dietary Fiber 5g 18% Sugars 5g Protein 5g Vitamin A Calcium 9% • Vitamin C 0% • Iron 17% 4%
Service Size 1 tortilla 24g (24 g) Amount per Serving Calories 52 Total Fat 1g Saturated Fat 0g Trans Fat Cholesterol 0mg Sodium 11mg Total Carbohydrate 11g Dietary Fiber 2g Sugars 0g Protein 1g Vitamin A Calcium Calories From Fat 6 % Daily Value* 1% 1% 0% 0% 4% 6%
Guess what these “foods” are. Which are most nutritious? Which would make a good snack? Which should you avoid?
0% • Vitamin C 2% • Iron
*Percentage Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.
*Percentage Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.
Ingredients: Ground corn treated with lime, water, cellulose gum, propionic acid (to preserve freshness), benzoic acid (to preserve freshness), phosphoric acid (preservative), dextrose, guar gum, amylase.
Service Size 1 kides order 282g (282 g) Amount per Serving Calories 123 Total Fat 0g Saturated Fat 0g Trans Fat 0g Cholesterol 0mg Sodium 0mg Total Carbohydrate 31g Dietary Fiber 0g Sugars 31g Protein 0g Vitamin A Calcium Calories From Fat 0 % Daily Value* 0% 0% 0% 0% 10% 0%
Service Size 1 tbsp 19g (19 g) Amount per Serving Calories 53 Total Fat 2g Saturated Fat 0g Trans Fat 0g Cholesterol 0mg Sodium 0mg Total Carbohydrate 14g Dietary Fiber 0g Sugars 5g Protein 0g Vitamin A Calcium Calories From Fat 0 % Daily Value* 0% 0% 0% 0% 5% 0%
Service Size 1 ounce 28g (1 ounce (28g)) Amount per Serving Calories 145 Calories From Fat 70 % Daily Value* Total Fat 8g 12% Saturated Fat 1g 5% Trans Fat 0g Cholesterol 0mg 0% Sodium 172mg 7% Total Carbohydrate 18g 6% Dietary Fiber 1g 6% Sugars 0g Protein 2g Vitamin A Calcium 0% • Vitamin C 5% • Iron 0% 2%
0% • Vitamin C 0% • Iron
0% • Vitamin C 0% • Iron
*Percentage Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs.
Ingredients: Carbonated Water, high fructose corn syrup, caramel color, phosphoric acid, natural flavors, caffeine.
Ingredients: Light corn syrup, high fructose corn syrup, vanilla.
Ingredients: Whole White Corn, Vegetable oil, and Salt.
Watch what you eat!
If you eat a superb diet, good for you. Skip this next section. However, if you have questions about your diet, observe your food intake for four days. It doesn’t have to be four days in a row, just four sample days out of the next week. Both partners can try it. Feel free to use the excel spreadsheet I slaved over, or write it on the back of receipts or put it in your iPhone. I don’t care, because the interesting part comes at the end. Evaluate yourself. Here’s how you score. Use the Department of Health and Human Services/National Institutes of Health “serving size chart.” Every time you eat a serving of the following types of foods, give yourself points. Foods may count multiple times.7 In addition to these basic foods, cook with healthy fats and oils. Cynthia Lair prefers butter, ghee, unrefined coconut oil, cold-pressed extra virgin olive oil, unrefined sesame oil, and for high heat cooking, expeller pressed grapeseed, safflower, sunflower, or peanut oil. (Note to self: stop buying canola oil). Good fats aid in growing stretchy skin and enable the absorption of fat-soluble vitamins A, D, E and K.8 Food Type
Green, red, orange, yellow, or purple foods Whole grains: Popcorn, quinoa, whole wheat or corn tortillas, whole grain bread, whole grain cereal. Read those labels, though. I am looking for foods that are high in fiber and NOT full of added chemical-derived vitamins! Oatmeal, not whole grain Froot Loops®! Beans, tofu, nuts, eggs beef, chicken, fish, turkey, cheese, yogurt, cottage cheese, or another type of protein Calcium foods: almonds, milk, cheese, yogurt, broccoli, bok choy, etc. Water: for each glass of water or cup of non-caffeinated tea you drink per day (be careful with juices, which convert to sugar very rapidly) Dark chocolate Snack foods: fried, fatty, or sugary non-food Soda: for each soda, sports drink, or sugary drink White rice, white bread, white pasta 1 Minus 5 Minus 10 Minus 3 4 (yes, you get to count these foods twice) 3 10
Number of Points To Award Yourself
7 If you are having trouble with nausea or vomiting, consult your health care provider and disregard this exercise. 8 Go to www.cookusinterruptus.com and search for cookus cupboard, fats, oils & vinegars for a funny video and overview.
Before getting out of bed
10 protein+4calcium=14 5 whole grain+10 eggs+10 red vegetable=25 3 liquid 10 nuts+10 fruits=20 3 liquid 4 calcium+10 protein+5 whole grain+10 red vegetable=29 10 fruit (red/green/white, does that count triple? 10 orange fruit 10 orange vegetable. Surely worth extra. -5 whoops, but so yummy 3 liquid 10 fruit+10 nuts=20 -5 snacks, needed something crunchy… 10 orange fruit 3 liquid 10 awesome protein 10 awesome green vegetable 10 green veg again! I rock! 10 awesome non-animal protein! -10 It was really good. 10 fruit 1 dark chocolate+1 fruit. Sort of.=2
Corn tortilla, eggs, salsa
Handful of almonds & raisins
Grilled cheese on whole wheat bread with tomato slices Apple
Satsuma Baked sweet potato Two pieces leftover fudge (small pieces) Water
Apple with almond butter Bowl of corn tortilla chips Ten dried apricots Water Grilled Salmon Sauteed kale Salad Quinoa Lemonade Fruit salad (contained blueberries!) Dark Chocolate covered pomegranate – c’mon, it’s practically health food! Popcorn (air popped, with olive oil & sea salt) Water
5 whole grain 3 liquid 200 (Yay, I rock).
Comments: rocked the orange fruits and veggies today. Decent whole grains. Coulda done better with the green foods. Salad for lunch tomorrow? Send fudge to work with Jerry, concentrate on chocolate covered pomegranate. It’s GOOD FOR ME!
Homework Class 1
Get a copy of Ina May’s Guide to Childbirth by Ina May Gaskin, The Birth Partner by Penny Simpkin9 and The Womanly Art of Breastfeeding, 8th Revised Edition. If you are not confident in your choice of health care provider, pretty please borrow and read Your Best Birth by Ricki Lake. The Baby Book by Dr. Sears is bar-none the best infant-to-two baby care book on the market. All of these are available at the library and used. Please watch Ricki Lake’s The Business of Being Born. It is a great background to our class.
Reading: In Ina May’s Guide to Childbirth, read as you wish from Part I. In Part II, read the Introduction,
and Chapters 1, 2, and 3 and p. 187-190. In The Birth Partner, read Part I.
Workbook: Review workbook class 1, fill in blanks. Review workbook class 2. Go on a date together
and do the “Date Night Exercise” on p. 28. This is meant to be thought provoking for you both!
Food: Bring a vegetarian food to share that contains eggs. Please don’t all bring hard boiled eggs. Rather,
eggs can be in muffin batter, egg fried rice, salads, etc. Email the rest of the group to coordinate so there’s minimal duplication. Keep track of your intake for four days this week (days need not be consecutive).
Relaxation: Spend ten minutes per day in relaxation together. Physical exercise:
20 Minutes Cardio 2 Sets 20 pelvice tilts 3 butterflies 5 Squates 5 sets 10 kegels Relax together 10 minutes/day Partner: pushups. Set your baseline! Monitor Diet
9 Notes on the books: Ina May’s Guide to Childbirth is written by the preeminent midwife of our time, Ina May Gaskin. Ina May is absolutely a hippy. Do NOT let this turn you off if you are not a hippy. Her birth statistics are better than any other health care provider in the entire country! I insist on this book because it normalizes birth and because her discussion of how the body works in pregnancy and labor is the best I have ever read. Recognize that she works in Tennessee, where the medical establishment is not birth friendly. We are operating in a much friendlier hospital environment, in general. Most of the book will make you feel happy about birth. Used copies are available for about $10. I don’t know why, maybe it’s because people love it and don’t want to pass it on. The Birth Partner is comprehensive and factual (some find it dry). Penny Simpkin is our local birth guru, doula, and educator. It’s an excellent guide for how labor works, but more importantly, what the partner should be doing throughout pregnancy and labor. The book does emphasize what a doula can do for you. If you are not interested in hiring a doula, ignore those bits. Dozens of copies are available used through amazon.com for as little as a penny per copy with $4.00 shipping.
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