CHAPTER VIII PREGNANCY AND LACTATION

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There are many traditions in regard to the food requirements of the prospective mother. Many of these have been proved fallacies. As a matter of fact it is the woman more than the developing child who is likely to suffer if the diet is insufficient or badly balanced.

Factors Affecting Diet during Pregnancy.—In formulating a dietary for the pregnant woman, then, not only must the needs of the child be considered but those of the mother also, since the developing embryo draws from the body of the woman materials necessary for its growth, and if these needs are not covered by an increase in the diet, her body and that of the child also will show evidences of lack of nourishment.

Phosphorus and Calcium Requirements.—If, for example, the mother’s diet is lacking in those materials which produce growth, or is deficient in those mineral salts, such as those of phosphorus and calcium, which are requisite and necessary for the growth of bones in the infant, the mother’s bones and teeth will show this loss and in all probability the baby will sooner or later also show a like deficiency. However, it must be remembered that the pregnant woman is under a strain, both physical and mental. She must not be encouraged to eat beyond her needs or the digestion will be disturbed.

Nutritional Disturbances in Early Months.—The nutritional disturbance manifested by nausea and vomiting in the morning is due, not to the stomach or any disturbance therein, but to the fact that a mild form of poisoning occurs, resulting from the substances produced through the formation of the placenta reaching the general circulation on account of the incomplete establishment of the connection between the embryo and the mother. As soon as this connection is complete and fetal circulation is established this “morning sickness” disappears.

Food Requirements of Prospective Mother.—The food requirements of the prospective mother are not materially affected during the first four months of gestation, and even after this, when the infant is developing rapidly, and up to the date of its birth, the mother’s requirements are only increased about 20%. The amount of food necessary to cover the body needs, for maintenance and energy of a woman living a sedentary or moderately active life, plus 20% for building materials for the growing child, will be adequate for the pregnant woman. Thus, if her needs are ordinarily from 2,000 to 2,400 calories per day, after the fourth month they will probably be increased to 2,400 or 2,800 calories a day and will rarely ever be more than 3,000 calories a day.

Dietetic Treatment of Normal Pregnancy.—The peculiar conditions surrounding the woman at this particular time must be taken into consideration in arranging her diet. The building foods which are necessary for the developing child must be given in the simplest form, milk and eggs being used liberally and meat sparingly to obviate any unnecessary tax being placed upon the kidneys. The use of fruit and green vegetables to supplement the milk and eggs is urged. It has been found advisable at such times to give small meals frequently rather than the regular meal three times a day. The feeling of “fullness” which often occurs during the last two or three months of gestation makes it more comfortable for the pregnant woman to eat less at a time and oftener. If, for example, she be given a glass of rich milk or a nutrient beverage, either of enforced malted milk, albumenized orange juice, buttermilk, zoolak, or koumiss, at about eleven o’clock in the morning and again about four o’clock in the afternoon, she will have taken sufficient nourishment to meet the new requirements without taxing her digestion or imposing extra work upon the kidneys.

Abnormal Symptoms.—The chief point to keep in mind is any abnormal symptom which may develop. The chief of these is albumen in the urine. The urine must be examined frequently and measures taken immediately to overcome albuminuria should it occur. It is wise, as has already been stated, to restrict the meat in the diet, and in cases where albumen is found in the urine even when the meats are restricted, it may be necessary to place the patient upon a milk diet for a time until the urine clears up.

Supplementary Feeding.—Cereals, especially the whole cereals, must be used liberally. Gruels made with milk are often found valuable additions to the dietary. The prospective mother must be urged to take a regular amount of gentle exercise, not to become over-tired, or excited, to eat sparingly at night, and to drink plenty of water. She must avoid becoming constipated by eating plenty of green vegetables and fruit.

Sample Diet Sheets.—The following dietary is suggested: Breakfast should consist of thoroughly cooked cereals, wheatena, cream of wheat, malt breakfast food, cracked wheat, rolled or cracked oats, served with cream or sugar or both, whole wheat bread, muffins, or biscuits, with butter, raw or stewed fruit, coffee, tea or cocoa with milk. Luncheon may consist of milk or vegetable soups, eggs in any form, boiled potatoes, sweet potatoes, string beans, greens, or any green vegetables, simple desserts such as custards, rice or tapioca puddings, bread pudding, etc., milk, tea, cocoa, buttermilk, zoolak or koumiss as beverages. For dinner, if albuminuria is not present, a small piece of meat may be taken, together with green vegetables, rice, potatoes, simple salads, and a simple dessert, milk or coffee with milk as a beverage.

Selection of Food.—The following foods may be used to formulate the diet sheet: Wheat, oat, or corn cereals, rice, tapioca, made into simple puddings or served as breakfast foods; fruits, oranges, prunes, apples, raisins, dates, figs, or grapefruit, stewed or raw. The fruit juices may be used instead of the whole fruit if the latter disagrees. Vegetables: peas (green or dried), beans (string beans or dried beans), spinach, greens (turnip, mustard, or beet), cabbage, onions, celery, lettuce, served as vegetables or in soups, potatoes. Meat: lightly broiled beefsteak or stewed or boiled meat or chicken served not more than once a day or three times a week. Eggs, prepared in different ways. Cheese dishes. Breakfast bacon or ham in moderate quantities, butter, olive oil (or other salad oils) in moderation, whole wheat, graham or bran bread, Boston brown bread and crackers, milk, cocoa, chocolate, buttermilk, malted milk, koumiss, or zoolak; coffee and tea in moderation.

The diet, as has already been stated, may be supplemented by nutrient beverages or milk gruels.

DIET IN LACTATION

The diet of the nursing mother, as has been explained in a previous chapter, must not only cover her own requirements but must likewise be adequate to furnish the extra requirements imposed by the nursing infant.

Food Requirements of Nursing Infant.—When the baby is a month old he should be growing rapidly, and his food requirements at this period and until he is about three months old will be approximately fifty calories per pound of body weight in the twenty-four hours. As he grows older his requirements grow gradually less in proportion to his weight. This is because the rate of growth is less, so that for the next three months the requirements are from 43 to 40 calories per pound of body weight per day, and 35 calories per pound during the last three months, or by the end of the first year of life.

It has been estimated, as before stated, that the average infant will take 2? to 2½ ounces of mother’s milk per day[63] to each pound of body weight and that every ounce of mother’s milk will yield on an average 20 calories. Hence a month-old baby weighing ten pounds will be taking about 23 ounces a day, yielding 460 calories. Scientists have estimated that for every calorie produced by the milk two extra calories must be provided by food, so that for the baby requiring 460 calories per day, to cover his requirements the mother will be obliged to consume extra food to yield 920 calories, or the regular amount to meet her normal requirements plus the extra food to make sufficient food for the baby.

Diet of Nursing Mother.—The diet of the nursing mother need not be different from that to which she is accustomed. She should be warned against overwork or over-fatigue, nervous excitement and worry, since these factors affect the digestion of the nursing baby. She must be careful not to eat indigestible foods or foods which disagree with her, as such things will undoubtedly affect the digestion of the infant. When an article of food does cause digestional disturbances in the baby, it should be carefully omitted from the mother’s diet.

Factors Retarding and Stimulating Milk Secretion.—Constipation in the mother reacts quickly and unfavorably upon the secretion of milk. The same has proved to be the case when she becomes excited, nervous, worried, or over-tired.

The average diet for the normal woman is safe for the nursing mother. If her supply of milk is deficient, it may be at times increased or stimulated by the drinking of a glass of milk between meals or by taking a cup of hot cereal milk gruel. It was formerly believed that beer, ale, or stout acted directly upon the mammary glands, stimulating the secretion of milk, but there is little proof of this and the drinking of alcoholic beverages need not be encouraged on this account, since often more nourishing beverages fulfill the purpose more efficiently and without bad results.

SUMMARY

Gastric Disturbances.—The nausea and vomiting so often a part of early pregnancy is not believed to be the result of a disordered stomach but primarily a mild form of poisoning resulting from the incomplete establishment of the fetal circulation.

Adjusting the Diet.—The adjustment of the diet to cover the needs of the prospective mother and those of the developing child is essential. The amount of food taken by the mother is not materially changed during the first three months of gestation. An average normal diet is all that is necessary. After this time a twenty per cent. increase in the woman’s diet will furnish adequate means both for her maintenance and for the growth and development of the child.

Type of Food.—The kind of food which is necessary for the pregnant woman to take during this period is very similar to that taken ordinarily. It is necessary to furnish food materials rich in calcium and phosphorus, with an adequate supply of proteins in their simplest form in order to meet the requirement of the growing organism. Milk and eggs furnish the most efficient foods in this respect and the prospective mother should see that they form the chief items of her daily dietary. Milk furnishes calcium in its most available form for the developing skeleton of the growing infant, hence it is necessary to provide the mother with food to replace the mineral which is withdrawn from her body.

Meat in the Diet.—Meat should be eaten sparingly by the prospective mother, as it imposes needless work upon the already taxed kidneys and, if eaten in excess, will give rise to dangerous complications. Milk and eggs will provide ample protein for all purposes.

Albumen in the Urine.—Albuminuria is one of the most frequent complications in pregnant women. It should be combated and controlled as soon as possible. The allowance of meat should be cut down or entirely eliminated from the diet until the urine clears up. When albuminuria is persistent in spite of efforts to overcome it, the patient must be placed upon a strict milk diet as used in acute nephritis, to prevent dangerous complications arising.

LACTATION

Diet of Mother.—Her dietary need not differ materially from that to which she is accustomed. She must avoid indigestible foods or any article which has been proved to disagree with either the infant or herself.

Factors Regarding Secretion of Milk.—Constipation, worry, nervous excitement, and over-fatigue all have an unfavorable effect upon the secretion of milk and must therefore be avoided by the nursing mother.

The Bowels.—Constipation of the mother reacts quickly and unfavorably upon the health and comfort of the baby, hence it should be avoided by eating coarse breads, green vegetables, and fruits, when they do not disagree with the baby, by drinking plenty of water and taking a certain amount of outdoor exercise to keep her own health in good condition.

Stimulating the Milk Production.—When the milk supply is deficient it will be advisable for the mother to drink a glass of milk or a bowl of cereal milk gruel between meals. Alcoholic beverages are not necessary to insure an adequate secretion of milk. The milk or milk gruels answer the purpose more efficiently and without bad results.

Energy Requirements of Infant.—The average baby requires fifty calories per day per pound of body weight to cover his energy growth and development needs for the first three months of life, after which the rate of growth is less and his requirements decrease from forty-three to forty, then to thirty-five calories per day per pound by the end of his first year.

Amount of Milk Needed for Infant.—Approximately two and one-third ounces to each pound of body weight per day covers the needs of the average baby.

Fuel Value of Mother’s Milk.—Each ounce of milk yields twenty calories.

The Making of Milk.—It has been estimated that for every calorie yielded by milk, two extra calories must be provided by food.

PROBLEMS

(a) Formulate a dietary for a pregnant woman, allowing for a twenty per cent. increase over her normal requirements.

(b) Show how the diet may be made to cover the need for additional iron, calcium and phosphorus.

(c) Formulate a diet for a nursing mother with an infant two months old and weighing twelve pounds.

FOOTNOTE:

[63] “Feeding the Family,” p. 93, by Mary Swartz Rose.


                                                                                                                                                                                                                                                                                                           

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