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Getting Ready: Pregnancy, Nutrition, and Breastfeeding
When you are pregnant, you quickly become aware of the connection between what you eat and how it affects your growing baby, and you don't have to work too hard to seek out information. It seems everyone from your doctor to your sister to your sister's best friend has an opinion on what you should have for breakfast, lunch, and dinner.
"Don't drink coffee."
"Our patients do fine with a small amount of coffee-but be careful with fish."
"Stay away from soft cheese. And watch out for the fat content in hard cheese."
"Cheese is packed with calcium you need-why aren't you eating any cheese?"
"Take your prenatal vitamin and you'll be fine."
Eventually you separate the wheat from the chaff (speaking of which, don't forget to eat a lot of whole grains) and grow more confident about your food choices as you strive for a healthy pregnancy. The best advice tends to lie somewhere between extreme restriction and complete indulgence. Most experts and research agree, for instance, that a cup of coffee a day is usually okay but limit your caffeine intake to no more than 200 milligrams per day;1 soft, unpasteurized cheese is among the foods that may contain dangerous listeriosis- causing bacteria and so should be avoided during pregnancy; certain fish, such as swordfish, can carry high levels of mercury and should be off your pregnancy menu; be aware of the high saturated fat and calorie content of hard cheeses such as cheddar; and yes, prenatal vitamins are really important. (We'll return to these and other dos and don'ts later in this chapter.)
If you are reading this book, we're assuming you're already probably taking good care of yourself and your growing baby, and that you're regularly checking in with your physician for advice and information. We're also assuming that since you're planning to breastfeed, you undoubtedly have questions about how what you're eating now will impact how you nourish your baby after she's born.
As we pointed out in the introduction, there is no magical breastfeeding diet that can be consumed during pregnancy (or afterward) that will guarantee a robust and steady supply of breast milk. However, as you undoubtedly have discovered, maintaining a healthy diet during pregnancy has numerous, excellent benefits for mother and child, whether or not breastfeeding is a goal. And you are more likely to be successful with breastfeeding if you stay healthy and feel strong.
Once you are holding your new nursling in your arms, you'll naturally be less inclined to spend your time planning and preparing meals for yourself and any other members of your household, though your own nutritional needs will still be extremely important! (If you're fast- forwarding to what mealtime will look like after the baby comes, remember that we're here to help. A major goal of this book is to help you balance your dietary needs with those of your nursling, as well as those of other family members.) Therefore, these months and weeks before you give birth and begin breastfeeding are an ideal time to focus more precisely on your diet.
Your Body Is Changing-What About Your Diet?
In the first trimester of a normal pregnancy, a healthy mother-to-be's nutritional and caloric needs won't differ dramatically from what she ate before pregnancy.
If you're eating properly, you'll be able to nourish your growing baby adequately on your prepregnancy diet (with the exception of items to eliminate for safety reasons; see pages 31-32 later in this chapter), though your tastes for certain foods may be altered due to morning sickness or other hormonal changes. It's when you reach the second trimester, however, that the picture begins to change and the increased need for certain macro- and micronutrients, as well as calories, becomes apparent. This phase generally coincides with when you can't button your old jeans!
How much more do you need in terms of nutrients and calories? How much weight should you gain?
Generally, physicians and experts in maternal nutrition recommend that in the second trimester you should up your calories by about 300-350 per day; in your third trimester, you may be advised to increase this by another 100 calories.
As for weight gain, the recommended amount depends on your prepregnancy BMI (body mass index). It simply doesn't make sense to tell a 5'2" woman who is slightly overweight to gain the same amount of weight as a 5'7" woman who is exceedingly thin. Before the widespread use of BMIs, however, pregnant women were frequently given overly general guidelines. Check with your physician to get the number that is right for you, and start with an accurate prepregnancy BMI. (If you are overweight or obese, it's especially important to consult with your physician regarding weight gain.)
While weight gain will vary from woman to woman, less than half of the amount will come from true "baby weight"-that is, the combined weight of the fetus itself, the placenta, and the amniotic fluid. The balance of the weight gain is maternal reproductive tissues such as increased uterus size, blood (its volume increases by 50 percent), breast growth, and additional protein and fat stores. Your heart size alone increases by 12 percent. (We like to think that mothers have the biggest hearts in the world!)
Depending on where you are in your pregnancy, you have undoubtedly noticed that your breasts are changing, beginning with tenderness and soreness that are completely normal. They are also growing rapidly as your body works to make more milk ducts to prepare for breastfeeding. Whether you start out small-breasted or full-figured, the size of your breasts during pregnancy does not impact your ability to nurse your child.
Does your intention to breastfeed mean that you need to supplement or alter those numbers for recommended weight gain and extra calories-in any way? Not at all. Beyond following a healthy and balanced diet during pregnancy, which we will look at in the next section, you don't need to take any special nutritional measures to prepare your body for breastfeeding.
What to Eat Now
You've got your to-do list in hand to get your baby's room or sleeping space ready ahead of time-perhaps it means you'll assemble some furniture, launder some tiny clothing, stockpile diapers, or hang the cow-jumping-over-the-moon picture on the wall. The room, either the nursery or the bedroom where Mom sleeps, will be ready, but what about that other part of your house-the one with the food? Baby's new home can wait a little longer, but let's take a look at what's in your kitchen right now. Whether you're battling morning sickness or you're constantly ravenous (or both), whether you're a reluctant meal planner or absolutely love to cook, now is the time to get your food organized.
Naturally, it makes sense to plan around your changing nutritional requirements. In the first trimester, as we pointed out, if you're eating a healthy diet your body doesn't need much more in the way of calories and nutrition. But starting in the second trimester, and as mentioned earlier, your physician will probably recommend about 350 more calories per day until you give birth. (Remember, this calorie recommendation depends on your BMI-check with your doctor to find out how many calories you need to add.) Generally, that translates to a well-planned snack or two, or perhaps a larger portion of a nutritious food during mealtime-but not an entire extra meal or double portions of an entrÈe or dessert. If you overeat, the extra weight gain will not vanish without significant effort. (Yes, you will use extra calories when you are breastfeeding, but postpregnancy weight loss is still harder than pregnancy weight gain. For more on this topic, see page 203.)
A Blueprint for a Lifetime of Healthy Meals
Here's a simple formula for putting together a healthy meal-not just right now but after your baby arrives, and even after your children are old enough to take you out for Mother's Day brunch and when they have kids of their own. This is also a basic but balanced blueprint for assembling just about any family meal. Growing children will require a serving of dairy at each meal, too; if you are pregnant or nursing include three servings of dairy (skim milk is a good choice) for yourself as well. If you or your family does not consume dairy, talk to your doctor or a nutritionist about alternative calcium sources. The chart in the next section includes some nondairy calcium sources, but there are more.
Strive to include each of the following "big three" in every meal you consume.*
1. Lean protein (eggs, dairy, meat, fish, legumes)-1 serving.
2. Vegetables and fruits (add whole fruit for breakfast)-2 or more servings. (Nutrition experts recommend filling half your plate with veggies and fruit.)
3. Complex carbohydrates (from whole-grain bread products or starchy vegetables such as potatoes, corn, and peas)-1 serving. (For more on complex carbohydrates, see the box on pages 14-15. n
* For average serving sizes of items such as meat and other protein sources, fruits and vegetables, dairy products, and whole grains, see the sample food listings in the chart on pages 10-11 later in this chapter. When serving sizes are given in weight, it's more helpful to picture an everyday object for a visual cue. Some common examples: 3 ounces of fish, chicken, or beef is about the size of a deck of cards; 1 ounce of hard cheese is about four dice; one serving of fruit is the size of a baseball; 1/2 cup of veggies is a rounded handful.
Getting the Dietary Components You Need: What, Why, and How Much
Here are some of the major nutrients you should focus on right now, along with some suggested food sources and calorie counts per average serving. Make sure these items are finding their way into your grocery cart and your kitchen. (See our pantry and freezer/refrigerator lists later in this chapter.) Many of these foods can and should also play an importan...