Pregnancy
Nutrition During Pregnancy
Progesterone and Human Chorionic Gonadotropin are hormones in pregnancy that can suppress the immune system making you more susceptible to illnesses, colds, and viral infections. Make sure to maintain good hygiene and nutrition. WaterđŚ intake should be at least 1â2 your body weight (lbs) in ounces plus an additional 10 ounces for pregnancy.
Pregnancy is not a time to diet. Individuals with a normal/healthy pre-pregnancy weight should gain 25-35 pounds by the end of pregnancy. Underweight individuals should gain 28-40 pounds and overweight individuals should gain 15-25 pounds. The 1st trimester doesnât require additional calories. During the 2nd trimester women require 350+ extra calories and during the 3rd trimester women require 450+ extra calories.
Carbohydrate is your babyâs preferred fuel! Consuming >175g/day helps to avoid ketosis as ketones arenât a good energy source for your baby and can lead to neuro-psychological abnormalities in infants. Carbohydrates should be 45-65% of your total calories.
Healthy carbohydrate options include:
⢠Whole grains (like quinoa, brown rice, and oatsđĽŁ)
⢠Starchy vegetables (like sweet potatoesđ and squash)
⢠Non-starchy vegetables (like beets, broccoliđĽŚ, and carrotsđĽ)
⢠Fruits (like applesđ, berriesđŤ, and mangoes)
⢠Beans (like chickpeas, kidney beansđŤ, and black beans)
Pregnancy𤰠requires additional protein (~25g additional per day) and micronutrients for building tissue.
âŞď¸IRON is necessary for red blood cellđŠ¸development and placenta growth.
- Just 1 small orangeđ worth of vitamin C in a meal can double iron absorption! Iron sources include beans/legumesđŤ, dark leafy greens/broccoliđĽŚ, nuts/seedsđ°, meat, and dried fruits. Cooking in a cast iron pan can also be helpful.
âŞď¸FOLATE is necessary for cell division and DNA synthesis and helps to prevent neural tube defects.
- Sources include leafy greens/broccoli𼌠and beans/legumesđŤ.
- Ask your doctor about taking a folate supplement.
âŞď¸OMEGA 3 fatty acids, particularly DHA, are important for fetal brain development.
- Sources include flaxseeds, chia seeds, walnuts, and salmon.
- Ask your doctor about taking an algae oil DHA+EPA supplement.
âŞď¸VITAMIN A deficiency or toxicity and acne medications may cause birth defects.
- Sources include sweet potatoesđ , mangoesđĽ, carrotsđĽ, and broccoli/greensđĽŚ. Consuming organ meats may cause toxicity.
âŞď¸VITAMIN D is important for bone𦴠and teeth formation as well as immunity.
- Ask your doctor about taking a vitamin D3 supplement as it can be difficult to obtain sufficient vitamin D from food alone.
âŞď¸CALCIUM is necessary for boneđŚ´formation and blood pressure regulation.
- Plant-based sources include dark green leafy vegetables/broccoli đĽŚ, beans/legumes/tofuđŤ, chia seeds, figs, and almonds.
âŞď¸IODINE is crucial to produce thyroid hormones, which are important for fetal brain and nervous system development.
- Sources of iodine include iodized salt, seaweedđ (some are very concentrated), seafood, and eggs.
- Talk with your doctor before starting iodine supplementation, as excessive iodine intake can be harmful for those with thyroid issues and for the developing baby.
It may also be beneficial to avoid excessive caffeineâď¸ intake during pregnancy to prevent blood pressure changes and any potential withdrawal symptoms from your baby after birth.
Gestational diabetes is a type 2 diabetes like condition that affects ~3-7% of pregnant𤰠individuals. In this condition the body is still producing insulin but isnât responding as well since the body is directing nutrients to the fetus. Gestational diabetes is typically tested at 24-28 weeks gestation. Under the supervision of a healthcare provider this condition can be managed well through diet and exercise. If gestational diabetes is hard to control with lifestyle changes insulin or metformin may be prescribed.
A diet high in saturated fat (butter/ghee, whole milk, cheese, meats/sausage/bacon, coconut oil) and simple/processed carbohydrates (sugar, flour, refined grains) can increase the risk of developing diabetes by promoting insulin resistance.
Helpful tips include:
âŞď¸Consuming regular meals & snacks with low glycemic foods: High fiber foods (like fruitsđ, veggiesđĽ, and whole grains) have a lower glycemic index since they take longer to digest.
âŞď¸Exercising â activities like walking, riding a stationary bikeđ´, swimming, and strength trainingđŞ can help regulate blood glucose levels.
âŞď¸Replacing saturated fats with unsaturated fatty acids.
- Omega 3 fatty acids are a great substitute since they have anti-inflammatory properties (sources include flaxseeds, chia seeds, walnuts, and salmon).
- Other healthy fats from whole foods include avocadosđĽ, nutsđ°, and seeds.
- Olive oil can be a healthier option due to its higher proportion of monounsaturated fat compared to saturated fat and omega-6 fatty acids- itâs still important to be mindful of the omega-6 to omega-3 ratio.
- I recommend avoiding cooking oils and water sauteing, steaming, or pressure cooking/using an instant pot instead.
âThis is not medical advice. Contact a healthcare provider for your individualized nutrition needs.Â
Food Safety During Pregnancy
People are more susceptible to food borne illnesses during pregnancyđ¤°because the immune system is generally lowered. The developing fetus can be infected by foodborne bacteria crossing the placenta. If sick early on in pregnancy the baby may not fully recover.
âď¸Clean and wash𧟠your hands, kitchen surfaces, and utensils regularly.
âď¸Wash your produce and play close attention to separating raw meat and eggs from produce to avoid potential cross-contamination.
âď¸Cook and store foods at the appropriate temperatures. It is best to immediately wash surfaces and utensils that come into contact with raw animal products with soap and hot water.
âď¸In the refrigerator, meat should be placed on the bottom self in a plastic bag to prevent any leaking.
âď¸It is useful to have two cutting boards: one for produce and one for meat and seafood.
âď¸Beef, pork, and seafood should be cooked at 145 degrees Fahrenheit. Poultry and leftovers should be cooked at 165 degrees Fahrenheit. The use of a meat thermometer can be helpful.
âď¸Never let foods stay in the danger zone (40 to 140 degrees Fahrenheit), the temperature range where the most rapid growth of bacteria occurs.
âď¸Refrigerator temperatures should be no higher than 40 degrees Fahrenheit.
The following can contain microorganisms harmful to pregnancy:
âŞď¸Unpasteurized dairy products: such as raw milk and cheeses made from raw milk
âŞď¸Soft cheeses: feta, brie, and blue cheese
âŞď¸Cold cuts
âŞď¸Raw or undercooked meat, seafood, and eggs
âŞď¸Unwashed fruit and vegetables
âŞď¸Raw sprouts: alfalfa, clover, and radish sprouts
âŞď¸Cross contaminated foods
âŞď¸Cat feces â buy a self-cleaning litter box or ask someone else to clean the litter box
âŞď¸Soil â wear protective gloves when gardening
Toxoplasma is a problematic parasite which can be found in undercooked and raw meat, unwashed produce, contaminated utensils and surfaces, dirt, and cat feces. This can cause serious health problems for a baby including blindness and mental retardation.
Listeria, a bacterium, is also a potential health risk found in ready-to-go foods such as meat and dairy, as well as soil. It can grow while in the refrigerator and, if consumed, can potentially cause miscarriage.
Avoid sushi đą, as it is not cooked and might contain parasites and bacteria that could be hazardous to baby as well as deli meat due to risk passing listeria to baby and ensure that meat is fully cooked.
Fish high on the food chain like halibut, tuna, and swordfish can be risky during pregnancy due to their high levels of methylmercury which can cause nervous system damage to the baby (fully cooked salmon can be a replacement). Oysters and clams may also contain high levels of mercury and arsenic.Â
Pregnancy Tip: Perform core workouts on your fists
Dealing with wrist pain during pregnancyđ¤°or lactationđ¤ą? It could be due to ligament laxity. đŤ Try performing core work on your fists or forearms instead of your hands to keep your wrists in a more neutral position and help alleviate discomfort.
Pelvic Congestion/Varicose Veins
Pelvic congestion and varicosities (distended veins) can occur when pelvic veins become lax/enlarge to the point that there is no longer just one way movement of blood flow. Blood pooling can put pressure on parts of your pelvis or nervesâĄď¸ leading to discomfort. The appearance can fluctuate (can look like little freckles and can go away).
Symptoms can include:
âŞď¸Pressure in the abdomen/pelvis
âŞď¸Pain in the legs
âŞď¸Asymmetrical/swelling of the labias
âŞď¸Pain with intercourse (increased blood flow can pool)
âŞď¸Pain with periods
âŞď¸Urinary urgency/frequency
âŞď¸Veins in the pelvis easily visible
âŞď¸Spider veins in the legs
Symptoms are typically worse at the end of the day, with prolonged standing, and when pressure is applied to the abdomen or when bearing down (Valsalva/straining on the toilet). Typically, there is improvement with lying down.
Increased levels of estrogen during pregnancy𤰠can contribute to the pelvic veins being lax. Women who have multiple pregnancies may be more at risk due to the increased blood volume in the pelvis. Pregnancy cradle underwear (ex: V2 supporter, The Femme Jock) applies compression and can be helpful to wear during pregnancy for varicosities, edema, and feelings of pelvic pressure. Find discount codes in the link in my bio.
Some other ideas to help relieve symptoms include:
âŞď¸Bridge positioning while lying down (can elevate hips under a pillow)
âŞď¸Massage labia up towards groin
âŞď¸Compression garments/biker shorts â wearing a V2 supporter can help
âŞď¸Apply a cold compress (ex: frozen peas)
âŞď¸Lymphatic drainage & lymph foam pads in underwear
âŞď¸Walk regularly & do ankle pumps
âŞď¸Avoid prolonged sitting/standing & crossing legs
â¨These tips donât substitute pelvic floor PT. Feel free to reach out if you are experiencing symptomsâ¨
Foot Changes During Pregnancy Can Impact the Pelvic Floor Muscles
Estrogen, progesterone, and relaxin are dominant hormones in pregnancy𤰠that can loosen ligaments. This instability can put strain on surrounding muscles.
Ligament laxity along with the added weight of a babyđś can affect footđŚśshape and size. Foot arches can flatten out making the foot wider and longer.
This can lead to postural changes such as:
âŞď¸Stress to the inside of ankles
âŞď¸Bunions on the big toes
âŞď¸Stress to the inner knees
âŞď¸Hip internal rotation
âŞď¸Pelvis misalignment
âŞď¸Leg length difference
When hips are stuck in internal rotation this can contribute to pelvic floor muscle tightness, inner thigh muscle tightness, and hip external rotator weakness.
Strengthening of the glutes and the muscles that support your foot arch along with manual therapy and education on postural alignment may help prevent and alleviate symptoms related to foot ligament laxity and muscle imbalances.
Foot and ankle pain during pregnancy may be improved with:
âŞď¸ Performing foot and ankle strengthening exercises
âŞď¸Wearing supportive shoes
âŞď¸Seeing a pelvic floor physical therapist
â¨Donât hesitate to reach out if youâre experiencing symptomsâ¨. It is important to rule out other potential causes of foot and ankle pain during pregnancy, such as plantar fasciitis or tendinitis, which may require specific treatments or interventions.
Core and Pelvic Floor Support Garments/Bloomers
These are great to use during pregnancy and postpartum to provide a gentle compression and âliftâ to the pelvic floor.
They can:
âŞď¸Improve symptoms of pelvic pressure/pelvic organ prolapse, vulvar varicosities (varicose veins), round ligament pain, pubic symphysis pain, and C-section discomfort
âŞď¸Provide C section scar compression/support
âŞď¸Support diastasis recti (splitting of the 6-pack abdominals)
You still need a strong core - donât rely on garments or bands to do all the work for you!
You may not be wearing garment or bands right if you experience increased:
- Pelvic pressure/heaviness
- Pain
- Urinary leaking
â¨Consult your healthcare practitioner before wearing compression garments and donât hesitate to reach out if you have any questions or concernsâ¨
Pregnancy Belly BandÂ
If you lift your belly𤰠and it helps wear a belly band!
Belly bands can provide abdominal, back, and hip support. This can help improve:
- Back pain
- Pelvic pain
- Hip pain
- Diastasis â6 pack ab separationâ
I like the Babybellyband by CABEA (10% off with code Restored10). They also have additional straps you can add on to their original band.
â¨Compression groin bandsâ help relieve pelvic pressure/heaviness, varicosities and labial swelling, and prolapse
â¨Shoulder strapsâ extra support during exercise and prolonged standing
You can always double belt with an SI belt for extra support (see my reel on the Serola SI belt). You can also wear belly bands postpartum for diastasis or C section support. You still need a strong core - donât rely on bands to do all the work for you.Â
Wear the band:
low at the pubic bone
looser at the top so not compressing pelvic organsÂ
You may not be wearing the band right if you experience increased:
Pelvic pressure/heaviness
Pain
Urinary leaking
Urinary Frequency & Constipation are Common during Pregnancy
Increased progesterone during pregnancyđ¤°slows GI motility which can contribute to constipation and hemorrhoids.
You'll likely notice increased thirst as well. Your kidneys are working extra hard due to increased fluid (40-60% more!). This along with hormonal changes and pressure on your bladder from your uterus and baby can lead to increased urinary frequency.
Try to consume a lot of liquids and fiber to reduce constipation risk. FruitsđŤ, vegetablesđĽ, and whole grains are great sources of fiber!
ConstipationđŠ can cause increased pressure on your bladder leading to increased urinary frequency.
Pelvic floor muscle tension can also contribute to constipation as well as urinary frequency and urgency. It is important to learn how to fully relax your pelvic floor muscles prior to birth to help prevent trauma.
I like to see people during the 2nd trimester for a pelvic floor and core check. Around 34 weeks itâs great to have a âlabor prepâ session to help you find the positions where your pelvic floor is most relaxed and learn perineal massage.Â
Muscle Cramps & Restless Leg Syndrome are Common During Pregnancy
Muscle cramps and restless leg syndrome often make their debut during pregnancyđ¤°. Weight gain, joint laxity (where muscles work harder to move the body and maintain stability), decreased blood supply to the lower body, and even imbalances in electrolytes, vitamins, and minerals can join the party, making cramps a common pregnancy woeđŠ. The good news? They usually bid farewell after childbirth.
Pro tip: Keep a massage gun and a strap by your bed for nighttime massages and stretches.
As for restless legs, itâs not just a muscle game; changes in dopamine levels can also be at play. This urge to move the legs is often more intense at night and can improve with activity and walking.
Birth Preparation
Pain relief during labor:
TENS (Transcutaneous Electrical Nerve Stimulation) is a non-pharmacological option that is deemed safe and noninvasive during labor! Send me a DM for my TENS handout đ (TENS may interfere with fetal monitoring and cannot be used in water). One method is to turn up the intensity with every contraction and then turn the intensity back down once the contraction subsides.
Water from warm bathsđ and showersđż can have a relaxation effect and can encourage pelvic floor muscle relaxationđ
Walking epidurals allow for gravity and movement to help your baby come down
Diaphragmatic breathing and massageđââď¸from a partner can help improve pain as well as reduce anxiety and enhance progress
Applying pressure to the perineum with a warm moist washclothÂ
Aromatherapy can be helpful, but you may become nauseous of the aroma so try not to put the oil directly on your skin and instead put it on something you can take out of the room if needed
Other options for pain relief include ice/cold packs, hypnosis, music therapyđś, acupuncture/acupressure, and craniosacral therapy
â¨This is not medical advice. Contact a healthcare provider to decide what pain management is best for youâ¨
Relaxation Techniques during Labor
⢠Dim the lightsđĄ and play soft musicđśÂ
⢠Slow dance with your partner to improve your comfort from rhythm and music. This can also improve back pain from the pressure of a partnerâs hands.
⢠Warm bathsđ and showersđż can have a relaxation effect and can encourage pelvic floor muscle relaxationđ
⢠Apply essential oil on a washcloth (or something you can remove from the room if it gets overwhelming)Â
⢠Apply a warm washcloth to the perineumÂ
⢠Keep the jaw relaxedÂ
⢠Have your partner give you a massageđââď¸. Some ideas include:
â Deep pressure to avoid tickling
â Avoid moving quickly from body part to body part to avoid irritation
â Apply pressure over sacrum or SI joint for support
â Squeeze hips to compress or gap the sacroiliac (SI) joint
â Contract relax techniques for progressive muscle relaxation
â Not initiating touch after contraction has started
â Once a contraction has started either release or donât move and hold deep pressure
⢠Every hour of labor try to:
â Get up and use the bathroom as gravity can help baby enter the pelvis
â Change position â can encourage rotation of baby and any position held for an extended period of time can become uncomfortable
â Practice diaphragmatic breathingđ§ââď¸
â Hydrate with waterđ§
Labor positions to reduce perineal trauma/tearing during labor:
It is great to maintain upright positions as gravity can assist your baby and promote progression of slowed labor â examples include walking, slow dancing, standing, standing leaning forwards on a supportive surface, sitting (birth balls can be great!), kneeling, leaning over a ball, and lap squatting between partnerâs knees. Squatting can be a good position if you are able to fully relax (if not, you may be more likely to tear).
Side lying may be beneficial if you have a large baby or this is your first childbirth. This position can also provide rest between pushing.
Quadruped on your hands and knees with hips internally rotated is another possible birth position that is especially helpful for back labor/occiput posterior position (back of babyâs head facing low back/sacrum) as it can:
Help alleviate pressure of baby
Assist in the rotation of baby Â
Take pressure off hemorrhoids
Positioning through labor progression:
Early labor: Hip external rotation to open the pelvic inlet/help baby descend (knees out/toes in - ex: deep squat, childâs pose)
As contractions get closer together: Asymmetrical movements to open middle pelvis if trouble with baby descending (1 foot on stool & lean forward/back, side stepping up stairs, curb walking)
Pushing phase (2nd stage): hip internal rotation to open the pelvic outlet (knees in/feet out - ex: hand and knees, side lying with feet around a peanut ball)
Caution: Hip labral tears can occur due to forceful hip flexion and internal rotation during pregnancy or delivery. An example is bringing your knees to your chest with your legs blocked from moving into external rotation.
Around 34-35 weeks I like to do a âLabor Prepâ session to help you find the positions where your pelvic floor is most relaxed and teach perineal massage.
If you have SI joint pain avoid deep squats, asymmetrical positions such as having one knee to your chest with the other extended, and positions where your pelvis is fixed to the bed (lying on your back). On hands and knees, kneeling, or tall kneeling can be good alternatives.Â
If you have pubic symphysis pain avoid deep squats, asymmetrical positions such as having one knee to your chest with the other extended, and sidelying with legs wide/rotated outwards. On hands and knees, kneeling, or tall kneeling can be good alternatives.Â
With tailbone pain avoid laboring in sitting, semi-reclining or lying on your back. If you must be lying on your back roll a pillow under your sacrum to lift the tailbone off the bed to allow freedom of movement. Good alternatives include hand and knees, kneeling, tall kneeling, and sidelying.
With spondylolisthesis or spinal stenosis avoid back extension. Take caution with laboring on hands and knees, kneeling, tall kneeling, or in standing. Good alternatives include a deep squat, supported squat, sitting, sidelying, or on your back with towel under hips to promote back flexion.Â
With discogenic back pain avoid positions with back flexion such as deep squats, sitting, and lying with knees to chest. Good alternatives include hands and knees, tall kneeling, kneeling, sidelying, and lying on back with a rolled towel or pillow under your back to promote extension.
With hip pain avoid excessive hip positions. Beneficial positions include hands and knees, kneeling, tall kneeling, and sidelying with pillow support.Â
With knee pain itâs best to keep the knee mid-range in positions that donât compress the joint. Avoid kneeling, tall kneeling, and hyperflexion/hyperextension of the knee.