PREGNANCY AND LACTATION
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 2-1/3 to 2-1/2 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.