This article is written as part of a series on the supposed childbirth ‘bible’ What to Expect When You’re Expecting. The rest of the articles are also quite good. As you can imagine, I don’t recommend this book.
One of the biggest stressors for pregnant women is weight gain. Many women receive little, if any, specific nutritional counseling prior to pregnancy. Few obstetric practices spend much time discussing nutrition in pregnancy, while most focus on weigh-ins at each visit, and discussion of whether you are gaining too much or too little weight.
Compounding this problem are the health agencies that also focus on weight gain in pregnancy. Many of my clients are also clients of WIC. One woman, Bridget, had a frustrating experience with WIC.
Bridget was a big woman, nearly six feet tall, and very overweight. As part of my midwifery practice, I spend a lot of time in early pregnancy focusing on nutrition. All clients are asked to keep a food diary for three days prior to nutritional counseling. Each woman is to write down everything that goes into her mouth. We then use this information to look for things she may be lacking in her typical nutrition, and to discuss pregnancy nutrition needs.
The best thing I can say about Bridget’s food diary is that she was honest. Six cans of Pepsi per day was her average. She ate a large pepperoni pizza by herself. Double Whoppers and fries were her mid-afternoon snack. . .you get the picture. Rather than focusing on what she was doing wrong, we looked at what her baby’s needs were for optimal growth. Fresh fruits, vegetables, whole grains, whole food proteins–we discussed the nutrients her baby would get from each of these food groups. Bridget had had a difficult first pregnancy, and was very motivated to have a better experience this time around. I did not criticize or judge Bridget, but encouraged her to consider ways she could add nutrient-packed foods to her current diet.
I was amazed when Bridget stepped on the scale at her prenatal visit the following month. She had lost seven pounds! I questioned her: “Have you been throwing up? Too sick to eat? Restricting your food portions in order to lose weight?”
Bridget grinned. “Nope. I’m feeling great and eating plenty of all the foods on the list you gave me. I just quit eating pizza and cut out the soda.” She handed me a list of the foods she’d eaten over the last three days, and it was wonderful! Everything on her list was a food packed with nutrition. I complimented her on her efforts.
A few days later, Bridget showed up at my office unannounced. “Look at this!” she said, thrusting a paper at me. It was a form letter from WIC, stating that since she had lost weight, she was “at risk” for many complications of pregnancy, and needed to see her provider as soon as possible. “I don’t understand this!” Bridget complained. “I told them what I am eating, and the woman said that my food choices were all really good, but that I couldn’t lose weight during pregnancy. She said I was getting enough calories, but needed to be gaining weight, not losing. I asked her how I could gain weight when I’m already eating as much as I want, and I’m getting enough calories. She couldn’t answer me or tell me what I need to do to gain weight.”
I reassured Bridget that she did NOT need to worry about gaining weight, but should focus instead on eating a wide variety of nutrient-packed foods. I told Bridget that she was doing fine, the baby was growing, and not to worry about the scale.
Bridget continued to lose weight until the last two months of pregnancy, when she finally hit a plateau and then gained three or four pounds. The day after her baby was born, she weighed thirty pounds less than her initial pregnancy weight.
Recent research indicates that obese women can safely go through pregnancy without gaining weight.¹ Although the Institute of Medicine still recommends a small weight gain for obese women, research does not support the theory that weight gain is necessary. Rather, focus should be placed on what the woman is eating instead of how much she weighs. My experience has been that many overweight women start eating better during pregnancy, because they want to give their baby optimal nutrition. This change in diet leads to weight loss, even though the woman is eating adequate calories and a wide variety of healthy foods. I do not consider this weight loss a cause for alarm.
Conversely, underweight women have been encouraged to gain larger amounts of weight during pregnancy. Some find this difficult and become frustrated when they weigh in on the low side at visit after visit. Again, I do not become alarmed in this situation, but instead discuss what the woman is eating. If she is getting adequate calories and nutrition, and her baby is obviously growing normally (based on fundal height measurements), I don’t stress out about low weight gain.
Then there are the women who have an average weight gain, but rather than gaining a steady one pound per week, as many providers recommend, they have gained nothing at one visit, and four pounds at the next, and so on. Many of my clients have complained that past providers criticized their weight gain patterns at every visit, leaving them feeling frustrated, inadequate, and fearful for their baby’s well-being. Some have felt so traumatized that they refuse to step on the scale. Yet this is the pattern I see most often in women–several pounds gained at one visit, fewer pounds at the next, but a normal amount of weight gain overall.
It is vitally important for women to understand what constitutes good nutrition in pregnancy. There is a wealth of useful information on the internet. Some of my favorites are:
http://www.skinnybitch.net/bun/index.html (warning: you may find their language offensive, but the nutritional information is top-quality)
http://pcrm.org/health/veginfo/vsk/pregnancy.html (vegetarian diet, but excellent nutritional information for every pregnant woman)
http://www.drbrewerpregnancydiet.com/id26.html (The Farm diet, inspired by Ina May Gaskin. They reduced incidence of pre-eclampsia to almost nil, and credit their diet during pregnancy)
You will notice that all of these sites focus on whole foods, which are the key to healthy weight gain and avoiding gestational diabetes. Our society exists on refined foods, and the effect is evident in the poor health of so many people.
These nutritional recommendations are given for the vast majority of women who will have normal pregnancies. Red flags that should alert you to talk to your provider about your weight:
- You are experiencing morning sickness to a degree that you are not able to eat or to hold down much food, and this has been going on for more than twenty-four hours.
- Your baby’s growth, estimated by fundal height measurements, is much greater or much less than expected for your dates, for at least two consecutive measurements performed by the same person. This does not necessarily indicate a problem, but should be evaluated.
Common sense tip for today: Focus on what you eat, not what you weigh. Your body will gain the perfect amount of weight to grow the perfect size baby for you. Weight that is gained through healthful eating is more easily lost after birth.
1. Web MD. Pregnancy: no weight gain for obese women? Retrieved 3/15/10 from: http://www.webmd.com/baby/news/20090602/pregnancy-no-weight-gain-for-obese-women