Hi all,
I decided to analysis Di's 24hr dietary recall. I have been as accurate as I can. Had to use standard portion sizes, and exclude soya ice-cream, and rice milk, as I could not find them in Crop & Food's The Concise New Zealand Food Composition Tables 7th ED. 2006.
NUTRITIONAL ANALYSIS OF DI's 24HR DIETARY RECALL
3800 calories
142gms protein (15% of Cals) (RDA: 1st trimester 46gm (.75g/kg/per day)
2nd trimester 60gm (1.00g/kg/day)
203gms fat (48% of Cals) (RDA: 20-30% total energy intake)
352gms carbohydrates (37% of Cals) (RDA: 45-65% of total energy intake)
Iron: 51.2mgs (RDA: 27mgs)
Calcium: 1325.9mgs (RDA: 1000mgs)
Zinc: 26.8 mgs (RDA: 11mgs)
Thiamin: 2.67mg (RDA: 1.4mgs)
Niacin: 51.4mg (RDA: 18mgs)
VitB12: 1.02mcg (RDA: 2.6mcg)
Folate: 976mcg (RDA: 600mcg)
References
MOH.2006. Food and Nutrition Guidelines for healthy Pregnant and Breast feeding Women: A background paper. Wellington :MOH
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed 2002. Wadsworth CA
Crop & Food, The Concise New Zealand Food Composition Tables 7th ED. 2006 draft 7:19:00 PM by Julia Delete
Thursday, August 28, 2008
Monday, August 25, 2008
Sunday, August 24, 2008
The B's
Hi there,
I have just being reading a previous post of mine where I say that there is no research that has a finding that tandem breastfeeding is harmful. I need to qualify that by saying providing the lactating mother's diet is adequate in provide all nutrients. I have been doing some reading and although not common, VitB12 deficiencies can occur during pregnancy and lactation.
Plant foods are not a reliable source of vitB12 for vegetarians. The B12 present in spirulina sea vegetables, tempeh, and miso has been show to be inactive B12 analog rather that the real thing. (NZDA Vegetarian Diets 2000 Positon Paper) It recommends supplementation or use of fortified food for vegetarians who avoid or limit animal foods.
Infants of vegan parents may suffer spinal cord damage and develop severe psychomotor retardation due to lack of vitB12 in the mother's diet during pregnancy. Breastfed infants of vegan mothers have been be reported to develop vitb12 deficiency and sever movement disorders. A vegan mother needs a regular source of vitB12-fortified foods or supplement that provide 2.6mcg daily.(Whitney, E.N. & Rolfes, S.R. 2002)
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed., Wadsworth 2002
I have just being reading a previous post of mine where I say that there is no research that has a finding that tandem breastfeeding is harmful. I need to qualify that by saying providing the lactating mother's diet is adequate in provide all nutrients. I have been doing some reading and although not common, VitB12 deficiencies can occur during pregnancy and lactation.
Plant foods are not a reliable source of vitB12 for vegetarians. The B12 present in spirulina sea vegetables, tempeh, and miso has been show to be inactive B12 analog rather that the real thing. (NZDA Vegetarian Diets 2000 Positon Paper) It recommends supplementation or use of fortified food for vegetarians who avoid or limit animal foods.
Infants of vegan parents may suffer spinal cord damage and develop severe psychomotor retardation due to lack of vitB12 in the mother's diet during pregnancy. Breastfed infants of vegan mothers have been be reported to develop vitb12 deficiency and sever movement disorders. A vegan mother needs a regular source of vitB12-fortified foods or supplement that provide 2.6mcg daily.(Whitney, E.N. & Rolfes, S.R. 2002)
Whitney, E.N. & Rolfes, S.R. Understanding Nutrition 9th Ed., Wadsworth 2002
Saturday, August 23, 2008
Rosalind's Visit
Dave here,
Had a good visit from Rosalind. She's good. Even got me and Di doing a 24 hour dietary recall!
I like a very through person like that. Makes me feel confident in her care.
She is a bit worried about Di having anemia, and has prescribed iron supplements. Given us some good ideas about food choices, not that we needed them really, as Di and I like to think that we are informed Vegans. Di keeps talking about not eating eating some kind of nuts, as the baby may develop some kind of reaction to them. She's afraid because she eats so healthy, the baby may develop allergies. Not to sure what that's all about.
Had a good visit from Rosalind. She's good. Even got me and Di doing a 24 hour dietary recall!
I like a very through person like that. Makes me feel confident in her care.
She is a bit worried about Di having anemia, and has prescribed iron supplements. Given us some good ideas about food choices, not that we needed them really, as Di and I like to think that we are informed Vegans. Di keeps talking about not eating eating some kind of nuts, as the baby may develop some kind of reaction to them. She's afraid because she eats so healthy, the baby may develop allergies. Not to sure what that's all about.
our appointment
What a delightful couple.
Di and Dave are so excited about the pregnancy, and I feel very special in sharing in this occasion with them.
We did talk about Di continuing to breastfeed Peter, however, I am not too overly concerned at the moment. We still have a bit of time left, after all, Peter may well wean himself.
My main concern for this appointment is her first antennal blood results.
(haemaglobin 110g/L and Ferritin 9ug/L)
To start with, it appears to me Di has iron deficiency. Our appointment went for at least an hour, as I was explaining to Di and Dave what these terms mean in regard for a healthy pregnancy. I am concerned that she is a vegatarian, however, she has been doing a lot of research herself on the internet, looking at ministry of health sites etc, to gain a better understanding. I think we can become great partners in care together. Communication seems to be going well. I have sourced some literature to help with my treatment plan.
According to Pairman et al (2006), a ferritin level less than 12-15ug/L “indicates empty stores of iron and iron deficiency.” (Harram et al 2001, cited in Pairman et al 2006).
Di’s Haemaglobin is also lowish being 110g/L, however it can be difficult to determine whether this is associated with the relatively normal process in pregnancy of haemodilution, or, anaemia. According to Pairman et al (2006), this result would most likely be anaemia. Pairmain et al (2006) continues by stating that serum ferritin is the blood test of choice in determining iron stores in the body, particularly in the first trimester. As Di is right on the cusp of moving in to the second trimester, I could expect her serum ferritin to drop even more, as according to Pairman et al (2006), haemodilution occurs independent of changes in iron stores. A ferritin level of 15-30ug/L shows that iron stores are too small to cope with the requirements of pregnancy. (Pairman et al 2006).
We began our appointment quite casually. Di and Dave knew what we were to discuss, and appeared relaxed and comfortable. I actually had a few hours to spare, so I could relax too.
We talked about how important the mineral “iron” is to the body, particularly during pregnancy. I explained that iron is an important mineral that is available to the body from food, in two forms. Haem, being a structure of haemaglobin, and, non-haem iron.
Haem iron is present in meat, poultry and fish. Non –haem is also present in meat, fish and poultry, but is also the only form found in plant foods.
Since she is a vegetarian, I would like to recommend her including foods in each meal of non-haem and haem foods. Ideally, I would like to suggest including fish twice a week together with a selection of non-haem foods. She also does not consume dairy products, however according to the NZ dietetic Association, soy is a good form of calcium as well as cooked legumes, nuts and seeds, almond butter spread for her morning toast, green leafy veggies, dried figs and even calcium fortified orange juice. I have given her lists of recipe ideas for each main meal of the week, and encouraged her to include foods rich in vitamin C to assist in iron absorption in the gut.
Fortunately, Di does not drink too much tea and coffee. I have advised her to consume a cuppa at least 3 hours apart from her meals as the tannins in tea particularly, reduces iron absorption up to 40%.
ABOUT ANAEMIA
During our appointment, I also explained that significant anaemia can pose a real threat to the overall well being of the mother and baby. The physiological changes that commonly occur in pregnancy may either expose an underlying anaemia, or it may continue to develop during the pregnancy. (coggins 2001, cited in Pairman et al 2006). “Haemoglobin levels are used as a primary measure of anaemia, as approximately 70% of iron in the body is haemoglobin”. (Jordan 2002, pg 268, cited in Pairman et al 2006, pg 353).
Another thing is, when diagnosing anaemia, it’s important to differentiate between other types of anaemia, such as folate, b12, sickle cell, thalassaemia and autoimmune anaemia. Pairman et al (2006) recommends correct diagnosis to avoid unnecessary treatment regimes that may actually cause more harm than good. Iron overload can occur in women with haemochromatosis, or inneffectice erythropoiesis, such as sickle cell disease and thalassaemias.
However, from her latest antennal screen, I feel we need to treat iron deficiency anaemia. She does take 800mcgs of folate per day, and has done for the past 3 months. There are no indications of family history with any above mentioned conditions.
My recommendations include diet variation as described, and also an iron supplementation of approximately 105mg of iron daily throughout pregnancy. Mainly as her ferritin is only 9ug/L. Best to be taken before food, to help reduce side effects of tummy upsets. I would recommend Ferrogradumet, which contains 105mg of elemental iron. I have also written out blood slips for a repeat screen in another 4 weeks.
By the end of our appointment, I could tell Di and Dave were a little overwhelmed with our topic, however I think I have inspired them to be creative in their meal preparations, making them interesting, healthy and cost effective for their lifestyle. Hopefully Peter will enjoy it too.
I am a fairly new midwife, so I tend to source my books and current literature to support my practice. I think we’re on track so far. Di and Dave both know to call me at any time if any more questions arise.
I shall catch up with them both within 4 weeks.
These references were great.
Pairman S, Pincombe J, Thorogood C, Tracy S, (2006), Midwifery preparation for practice, Elsevier, Australia
Vegetarian Diets – American Dietetic Association, Journal of the NZ Dietetic Association, Vol 54, No 2.
Di and Dave are so excited about the pregnancy, and I feel very special in sharing in this occasion with them.
We did talk about Di continuing to breastfeed Peter, however, I am not too overly concerned at the moment. We still have a bit of time left, after all, Peter may well wean himself.
My main concern for this appointment is her first antennal blood results.
(haemaglobin 110g/L and Ferritin 9ug/L)
To start with, it appears to me Di has iron deficiency. Our appointment went for at least an hour, as I was explaining to Di and Dave what these terms mean in regard for a healthy pregnancy. I am concerned that she is a vegatarian, however, she has been doing a lot of research herself on the internet, looking at ministry of health sites etc, to gain a better understanding. I think we can become great partners in care together. Communication seems to be going well. I have sourced some literature to help with my treatment plan.
According to Pairman et al (2006), a ferritin level less than 12-15ug/L “indicates empty stores of iron and iron deficiency.” (Harram et al 2001, cited in Pairman et al 2006).
Di’s Haemaglobin is also lowish being 110g/L, however it can be difficult to determine whether this is associated with the relatively normal process in pregnancy of haemodilution, or, anaemia. According to Pairman et al (2006), this result would most likely be anaemia. Pairmain et al (2006) continues by stating that serum ferritin is the blood test of choice in determining iron stores in the body, particularly in the first trimester. As Di is right on the cusp of moving in to the second trimester, I could expect her serum ferritin to drop even more, as according to Pairman et al (2006), haemodilution occurs independent of changes in iron stores. A ferritin level of 15-30ug/L shows that iron stores are too small to cope with the requirements of pregnancy. (Pairman et al 2006).
We began our appointment quite casually. Di and Dave knew what we were to discuss, and appeared relaxed and comfortable. I actually had a few hours to spare, so I could relax too.
We talked about how important the mineral “iron” is to the body, particularly during pregnancy. I explained that iron is an important mineral that is available to the body from food, in two forms. Haem, being a structure of haemaglobin, and, non-haem iron.
Haem iron is present in meat, poultry and fish. Non –haem is also present in meat, fish and poultry, but is also the only form found in plant foods.
Since she is a vegetarian, I would like to recommend her including foods in each meal of non-haem and haem foods. Ideally, I would like to suggest including fish twice a week together with a selection of non-haem foods. She also does not consume dairy products, however according to the NZ dietetic Association, soy is a good form of calcium as well as cooked legumes, nuts and seeds, almond butter spread for her morning toast, green leafy veggies, dried figs and even calcium fortified orange juice. I have given her lists of recipe ideas for each main meal of the week, and encouraged her to include foods rich in vitamin C to assist in iron absorption in the gut.
Fortunately, Di does not drink too much tea and coffee. I have advised her to consume a cuppa at least 3 hours apart from her meals as the tannins in tea particularly, reduces iron absorption up to 40%.
ABOUT ANAEMIA
During our appointment, I also explained that significant anaemia can pose a real threat to the overall well being of the mother and baby. The physiological changes that commonly occur in pregnancy may either expose an underlying anaemia, or it may continue to develop during the pregnancy. (coggins 2001, cited in Pairman et al 2006). “Haemoglobin levels are used as a primary measure of anaemia, as approximately 70% of iron in the body is haemoglobin”. (Jordan 2002, pg 268, cited in Pairman et al 2006, pg 353).
Another thing is, when diagnosing anaemia, it’s important to differentiate between other types of anaemia, such as folate, b12, sickle cell, thalassaemia and autoimmune anaemia. Pairman et al (2006) recommends correct diagnosis to avoid unnecessary treatment regimes that may actually cause more harm than good. Iron overload can occur in women with haemochromatosis, or inneffectice erythropoiesis, such as sickle cell disease and thalassaemias.
However, from her latest antennal screen, I feel we need to treat iron deficiency anaemia. She does take 800mcgs of folate per day, and has done for the past 3 months. There are no indications of family history with any above mentioned conditions.
My recommendations include diet variation as described, and also an iron supplementation of approximately 105mg of iron daily throughout pregnancy. Mainly as her ferritin is only 9ug/L. Best to be taken before food, to help reduce side effects of tummy upsets. I would recommend Ferrogradumet, which contains 105mg of elemental iron. I have also written out blood slips for a repeat screen in another 4 weeks.
By the end of our appointment, I could tell Di and Dave were a little overwhelmed with our topic, however I think I have inspired them to be creative in their meal preparations, making them interesting, healthy and cost effective for their lifestyle. Hopefully Peter will enjoy it too.
I am a fairly new midwife, so I tend to source my books and current literature to support my practice. I think we’re on track so far. Di and Dave both know to call me at any time if any more questions arise.
I shall catch up with them both within 4 weeks.
These references were great.
Pairman S, Pincombe J, Thorogood C, Tracy S, (2006), Midwifery preparation for practice, Elsevier, Australia
Vegetarian Diets – American Dietetic Association, Journal of the NZ Dietetic Association, Vol 54, No 2.
Friday, August 22, 2008
Eat well to feel well
Julia being Julia
I can understand why Dave is concerned. Especially if Di experienced the maternal fatigue of early pregnancy due to hormonal influences. Not easy with a busy toddler to care for as well.
My advice to Dave is just to let nature take its course. There is no current research that says that tandem breastfeeding is harmful to mother, child and newborn. The need for physical nourishment is minimal for a child older than one year, when the newborn arrives. It is more for the security and psychologic benefits. (Lawrence 1999) Abrupt weaning with the arrival of a new baby who replaces Peter's place at the breast would not be good timing!
Di, because she is a vegan, and still breastfeeding Peter will have increased nutritional needs. A vegetarian or vegan diet can meet the increased demand for energy and protein during pregnancy, but there may be problems in trying to achieve the recommended intake of some vitamins and minerals, especially for vegans, due to dietary restrictions.
MOH Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women , 2006, pg117, gives some good practical advice for the vegetarian and vegan pregnant and breastfeeding women. It includes eating a variety of foods across the four major food groups. Iron status should be closely monitored, with medications used if required. Adequate sources of calcium from alternative food sources should be consumed if diet does not contain milk products. Vitamin B12 supplements are more likely to be required. Include more omega-3 LCPUFA rich foods such as green leafy vegetables, nuts and seeds. The MOH advises that if there is a family history of allergic disease peanuts and peanut products should be avoided in pregnancy and breastfeeding.
Lawrence, R.A. Breastfeeding A guide for the Medical Profession 5th Ed 1999 Mosby
I can understand why Dave is concerned. Especially if Di experienced the maternal fatigue of early pregnancy due to hormonal influences. Not easy with a busy toddler to care for as well.
My advice to Dave is just to let nature take its course. There is no current research that says that tandem breastfeeding is harmful to mother, child and newborn. The need for physical nourishment is minimal for a child older than one year, when the newborn arrives. It is more for the security and psychologic benefits. (Lawrence 1999) Abrupt weaning with the arrival of a new baby who replaces Peter's place at the breast would not be good timing!
Di, because she is a vegan, and still breastfeeding Peter will have increased nutritional needs. A vegetarian or vegan diet can meet the increased demand for energy and protein during pregnancy, but there may be problems in trying to achieve the recommended intake of some vitamins and minerals, especially for vegans, due to dietary restrictions.
MOH Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women , 2006, pg117, gives some good practical advice for the vegetarian and vegan pregnant and breastfeeding women. It includes eating a variety of foods across the four major food groups. Iron status should be closely monitored, with medications used if required. Adequate sources of calcium from alternative food sources should be consumed if diet does not contain milk products. Vitamin B12 supplements are more likely to be required. Include more omega-3 LCPUFA rich foods such as green leafy vegetables, nuts and seeds. The MOH advises that if there is a family history of allergic disease peanuts and peanut products should be avoided in pregnancy and breastfeeding.
Lawrence, R.A. Breastfeeding A guide for the Medical Profession 5th Ed 1999 Mosby
Wow! I spoke to Di briefly on the phone to arrange an appointment. The amount of research she has done is mind boggling! I'm feeling a bit out of depth here, but she's on the right track. I must also ask if her farm is on tank water. I would like to recommend her boiling the water at least, prior to drinking.
I have been so very busy lately, I haven't slept in about 29 hours, as I 've had a couple of prem. births, not too drastic, 36 to 37 weekers, and of course, more booking appointments. It's a really busy time for me...Anyway, tomorrow I look forward to seeing Di and Dave, and talk about a plan for them.
Nighty night.
I have been so very busy lately, I haven't slept in about 29 hours, as I 've had a couple of prem. births, not too drastic, 36 to 37 weekers, and of course, more booking appointments. It's a really busy time for me...Anyway, tomorrow I look forward to seeing Di and Dave, and talk about a plan for them.
Nighty night.
Introducing Rosalind
Hi All,
My name is Rosalind, I have been a Midwife now for 2 years and enjoying every minute of it.....well, most of the time :-)..
I live on a rural property no too far away from Nelson, and tend to look after women who also reside in this area. My caseload is fairly full at present, coming up to spring time I suppose.
One lady who I have come to look after, and who doesn't live too far away from me either, is Diana. She is a 26 year old Gravida 2, Para 1, currently at 14 weeks gestation. I met with herself and her partner Dave at the booking appointment last week..They seem like neat people. Totally in to living off the land, and enjoying a natural lifestyle, something I like too.
Part of my initial assessment began with establishing a relationship with them, and working out their wishes for their pregnancy. They appear to be a very "close" couple and care for each others well being. That's why I call it "their" pregnancy. Afterall, it is their baby, and Diana appears to involve Dave in her decision making.
I have recieved Diana's booking blood results back. There has been a backlog, lots of babies arriving in this chilly weather.
HHmmm....haemoglobin 110g/L and Ferritin 9ug/L..... I am aware that this family are vegans, and pretty much live off their own produce, which is great, however she does not consume dairy products. They also have a son called Peter.
My concerns...
-Is Diana still breastfeeding Peter? Dave mentioned "all that breastfeeding". Also, how old is Peter?
-How involved is Diana in handling of animals on the farm? Such as newborn lambs?
-Does she have allergies?, paticularly to bee stings, as they have a few hives on site.
-Diana's overall responsibility on the farm, now that she is pregnant.
-Vegan diet. Her blood results are a concern for me!
-Her physical appearance. Diana appears tired, pale and lethargic. She's quite a petite lady, with peeling nails, and white spots all over the nail beds. I won't phone her to discuss these results, I'd like to see her and Dave, and discuss options face to face. I 'd also like to give her some easy to read info. about diet and recipe suggestions, and most of all, explain these blood results to both of them. 4 ears are better than 2! I'll phone them later today, as I am in clinic till around 5pm.
My name is Rosalind, I have been a Midwife now for 2 years and enjoying every minute of it.....well, most of the time :-)..
I live on a rural property no too far away from Nelson, and tend to look after women who also reside in this area. My caseload is fairly full at present, coming up to spring time I suppose.
One lady who I have come to look after, and who doesn't live too far away from me either, is Diana. She is a 26 year old Gravida 2, Para 1, currently at 14 weeks gestation. I met with herself and her partner Dave at the booking appointment last week..They seem like neat people. Totally in to living off the land, and enjoying a natural lifestyle, something I like too.
Part of my initial assessment began with establishing a relationship with them, and working out their wishes for their pregnancy. They appear to be a very "close" couple and care for each others well being. That's why I call it "their" pregnancy. Afterall, it is their baby, and Diana appears to involve Dave in her decision making.
I have recieved Diana's booking blood results back. There has been a backlog, lots of babies arriving in this chilly weather.
HHmmm....haemoglobin 110g/L and Ferritin 9ug/L..... I am aware that this family are vegans, and pretty much live off their own produce, which is great, however she does not consume dairy products. They also have a son called Peter.
My concerns...
-Is Diana still breastfeeding Peter? Dave mentioned "all that breastfeeding". Also, how old is Peter?
-How involved is Diana in handling of animals on the farm? Such as newborn lambs?
-Does she have allergies?, paticularly to bee stings, as they have a few hives on site.
-Diana's overall responsibility on the farm, now that she is pregnant.
-Vegan diet. Her blood results are a concern for me!
-Her physical appearance. Diana appears tired, pale and lethargic. She's quite a petite lady, with peeling nails, and white spots all over the nail beds. I won't phone her to discuss these results, I'd like to see her and Dave, and discuss options face to face. I 'd also like to give her some easy to read info. about diet and recipe suggestions, and most of all, explain these blood results to both of them. 4 ears are better than 2! I'll phone them later today, as I am in clinic till around 5pm.
Thursday, August 21, 2008
worries
Dave here a again.
I think Di must have got lost. I hope she finds her way home soon. I miss her, and besides she promise me her legend tofu and broccoli pizza for dinner!
Gives me a chance to have another word though. I am worried that all the goodness from her food is going to Peter, instead of the new growing baby. She is still breastfeeding you see. She had done a fabulous job, but think its time to wean. I am worried that her and baby may get sick. She might get time to rest.
Cheers, Dave
I think Di must have got lost. I hope she finds her way home soon. I miss her, and besides she promise me her legend tofu and broccoli pizza for dinner!
Gives me a chance to have another word though. I am worried that all the goodness from her food is going to Peter, instead of the new growing baby. She is still breastfeeding you see. She had done a fabulous job, but think its time to wean. I am worried that her and baby may get sick. She might get time to rest.
Cheers, Dave
Tuesday, August 19, 2008
First word
Hi, Dave here. Being a man I have to have the first word!
I am wrapped that Di is having another baby. Peter is such a great kid. Smart like his dad too. Of course Di would say its all that breastfeeding, but I don't know about that. We live just outside of Nelson. Bit chilly with all that snow about at the moment. Di knitted me a handspun woolie jumper from our own sheep. Man, is it warm. Only get to wear it about once or twice a year. Di's busy clicking those needles for our new one.
We have our own certified organic farm. We produce our own wool, have several beehives, have a herd of free range chickens, and have a large organically grown vegetable and flower garden. Di and I sell honey, spun wool, free-range eggs and vegetables down at the local farmer's market on Sunday.
We are Vegans, have been for awhile. We almost manage to live off the land.
Our midwife's name is Rosalind. Seems nice. Hope she will listen to our concerns, and help us with our choices. Next visit I'll give her some hive honey, to sweeten her.
Cheers for now, Dave
Role Play #2
Aim: To discuss the issues of dietary restrictions during pregnancy
Diana is a 26 year old (gravida 2, para 1) who is 22 weeks gestation. She and her partner Dave live on a rural section outside Nelson. They have an organic farm where they produce a selection of produce for themselves and as a way of generating some income. Diana is restrictive in what she consumes - she and Dave both follow a vegetarian diet and do not consume dairy products. Diana has recently been advised by a family member that it is important to eliminate common food allergens from your diet when pregnant to reduce the chance of your baby developing food allergies. her midwife Rosalind is a relatively 'new' midwife having been in practice only 2 years.
Diana is a 26 year old (gravida 2, para 1) who is 22 weeks gestation. She and her partner Dave live on a rural section outside Nelson. They have an organic farm where they produce a selection of produce for themselves and as a way of generating some income. Diana is restrictive in what she consumes - she and Dave both follow a vegetarian diet and do not consume dairy products. Diana has recently been advised by a family member that it is important to eliminate common food allergens from your diet when pregnant to reduce the chance of your baby developing food allergies. her midwife Rosalind is a relatively 'new' midwife having been in practice only 2 years.
Feedback and Congratulations
Hi Everyone,
Awesome postings for your first attempt at a Role Play online. I particularly like the banter back and forth in the comments and you have started to show evidence of supporting the comments with references and thinking about the scenario.
Valerie please let me know if you are finding this difficult as you need to interact more.
I will email your next characters and post role play #2 up now.
Cheers Megan
Awesome postings for your first attempt at a Role Play online. I particularly like the banter back and forth in the comments and you have started to show evidence of supporting the comments with references and thinking about the scenario.
Valerie please let me know if you are finding this difficult as you need to interact more.
I will email your next characters and post role play #2 up now.
Cheers Megan
Sunday, August 17, 2008
Leafy greens and supplementation
Hello All,
I have just returned from a weekend off. Celebrating a birthday! I phoned Shannon, after receiving a tx from her. I am pleased that she is finally feeling better and it is nice to hear that she is getting some rest time.
She ask me about taking folic acid. She is taking 800mcgs but has read that 400mcgs is the recommend dose. I explained that supplementation of 400mcgs daily is enough to prevent neural tube birth defects, but the NZ health dept recommends taking the 8oomcg tablet as it is the only strength available as an over the counter medication from pharmacies.
She ask me my advise on supplements in general. I follow MOH guidelines, and do not actually recommend any except folic acid. If she is able to eat a wide variety of fresh fruit and vegetables about six serves per day, at least four veg, and two fruits, and at eat at least six servings of bread and cereals, she will meet all her nutritional requirements. The need for supplementation will depend on her individual diet and nutritional status. Lucky she doesn't smoke or drink or use drugs, or expecting twins, all of which may benefit from supplementation.
Iron medication should only be considered if iron deficiency -anaemia is diagnosed.
I have just returned from a weekend off. Celebrating a birthday! I phoned Shannon, after receiving a tx from her. I am pleased that she is finally feeling better and it is nice to hear that she is getting some rest time.
She ask me about taking folic acid. She is taking 800mcgs but has read that 400mcgs is the recommend dose. I explained that supplementation of 400mcgs daily is enough to prevent neural tube birth defects, but the NZ health dept recommends taking the 8oomcg tablet as it is the only strength available as an over the counter medication from pharmacies.
She ask me my advise on supplements in general. I follow MOH guidelines, and do not actually recommend any except folic acid. If she is able to eat a wide variety of fresh fruit and vegetables about six serves per day, at least four veg, and two fruits, and at eat at least six servings of bread and cereals, she will meet all her nutritional requirements. The need for supplementation will depend on her individual diet and nutritional status. Lucky she doesn't smoke or drink or use drugs, or expecting twins, all of which may benefit from supplementation.
Iron medication should only be considered if iron deficiency -anaemia is diagnosed.
Saturday, August 16, 2008
More nutrition
I guess I have become all enthused with these guidelines here. Yes I am bored to tears, Bruce has not come home, and Ben is sound asleep. A real angel! I do want to watch the olympic finals soon, so I'll make this quick. :-) I have gone through the NZ food safety guidelines Emma gave me, and to my dismay, I have to limit my caffeine intake. I do lurve my coffee....oh well, as long as I have 2 cups per day, perhaps.
Another thing - interesting! That these guideleines suggest taking an 800mcg supplement! Not 400mcgs, as the "NICE" guidelines state. Hhhmm...I'll go with the 800mcgs. I should check with Emma on that one :-)
Another thing is mercury in fish! I guess I have to steer clear from those big fish, particularly from geothermal waters, like shark, swordfish and marlin. I can't eat too many oysters and "queen scallops" due to cadmium concentrations...Yeah right.....I really have that sort of lifestyle :-) Well I have my 3 page list of what to eat and what not to eat courtesy of the NZ food safety guidelines.
Well, I guess I've got to get rid of the cat :-(. The guidelines say cats carry toxoplasmosis in their poo. I suppose if I get Bruce to empty the cat litter and do the gardening, we could keep "Banjo".....Bruce will be happy......I'm sure....
Gotta go, Mahe drysdale's racing!!!
Another thing - interesting! That these guideleines suggest taking an 800mcg supplement! Not 400mcgs, as the "NICE" guidelines state. Hhhmm...I'll go with the 800mcgs. I should check with Emma on that one :-)
Another thing is mercury in fish! I guess I have to steer clear from those big fish, particularly from geothermal waters, like shark, swordfish and marlin. I can't eat too many oysters and "queen scallops" due to cadmium concentrations...Yeah right.....I really have that sort of lifestyle :-) Well I have my 3 page list of what to eat and what not to eat courtesy of the NZ food safety guidelines.
Well, I guess I've got to get rid of the cat :-(. The guidelines say cats carry toxoplasmosis in their poo. I suppose if I get Bruce to empty the cat litter and do the gardening, we could keep "Banjo".....Bruce will be happy......I'm sure....
Gotta go, Mahe drysdale's racing!!!
Friday, August 15, 2008
Nutrition stuff
Hey, Shannon here, still finding my way around this site and learning all about "blogging"..
Gee... I remember when a friend of mine had her first baby a while back, she would tell me she could eat pretty much what she liked, and most of all, what she felt liked. She once had a craving for raw bacon....yes.....raw bacon......and she ate it! I don't really believe her....she is quite a lot older than me.
Biazarre as it sounds, I don't remember too much, how, or what I did in regard to food preparation and tastes when I was pregnant with Ben.
Since my last appointment with Emma, she's given me a whole lot of stuff to read, about the Do's and Don'ts to do with eating in pregnancy. I'm too tired, and my lack of concentration is at its peak! Do they call that pregnancy brain, or what?!? It's also too frightening for me to read, I'll worry if I eat something that's undercooked, or has been sitting around too long! Then, I'll be made to feel I have killed my baby.......not on!
One of the things that stands out in my limited brain capacity is the "NICE" guidelines, 2003. I don't think the're "NICE" at all, they scare the living s**t through me.. There's pages and pages of stuff, but I'll tell you a bit about the diet stuff. Nutritional Supplements for example, it says to take a dose of 400mcgs daily, I thought you could take up to 800mcgs, that's what I remember my last midwife saying, and you can buy it in tablet form at the chemist.
"Pregnant women and those intening to become pregnant, should be informed that dietary supplementation with folic acid, before conception and up to 12 weeks gestation, reduces the risk of having a baby with neural tube defects -(anencephaly and spina bifida)...P.8 Gee man, I'll take that, I want a healthy baby eh? I think that's something to do with the nervous system in the developing aby. I had to ask Emma what these scary sounding words are?!?
I thought all pregnant women were advised at some point to take an iron supplement. I remember having heaps of blood tests last time, and my iron was borderline, or something..And mum keeps telling me to eat LIVER and KIDNEYS yucko! Mum says liver and kidneys have heaps of iron, but I keep telling her that thse guidelines say no to that as that stuff has too much Vitamin A! Mum says Bullocks to that! ( ha ha)
I am fortunate at my age to still have a grandmother alive, some would beg to disagree with me, but anyway, you have not met her, so I'll be polite! :-) She still lives on the original dairy farm mum and her great herd of fellow siblings grew up on, and still milks a few cows - (my uncles pretty much run the farm for her now)....but anyway, she's full of pride with her with her fresh milk, and makes her own butter...still, but is not speaki ng to me at the moment 'cause I won't accept her endless supply of unpastuerised milk! Yes, I did love it once, but not now. According to these guidelines, unpasteurised milk can contain the bacteria "listeria" which can cause miscarriage. Also, soft cheeses, and pate. That's ok, don't like that anyway.. Bruce is not a great fan either.
Salmonella is another biggie here where I usually love my eggs real runny, but now it seems I need to have them cooked through.
I feel like I am a student again, which was in the real dark ages mind you, I don't enjoy reading, and I find all this stuff tedious. Bruce is way too busy to help, he thinks it's all my responsibility. Whatever, he's still a cranky so and so. I guess I'll food Emma with all my questions, afterall she's the expert eh? I believe everything she tells me, and I'll just do as she says......
The other thing of interest to me was what the guidelines say about alcohol and smoking.
According to these "NICE" guidelines, 2003, "Excess alcohol has an adverse effect on the fetus" P.10. Yeah, how many times are we told that? But, you can apparently that means you can limit alcohol consumption to 1 standard unit per day. What's 1 unit? well, it equates to a single measure of spirits, a small glass of wine, and half a pint of beer, which I'd guess would probably be about 300 mls or so. I have chosen not to drink at all. A small price to pay to eliminate one risk, I suppose.
Lastly, another was om smoking. I do know of women who have continued to smoke right through their pregnancy, and also been exposed to secondary smoke. The guidelines, of course, advise against this habit, as it can cause low birth weight in new borns, and possibly pre-term labour.
The guidelines go on and on, and I thank Emma for providing me with all this info. She gave me loads of stuff, web addresses etc etc, but these guidelines just stuck out in my mind. Anyway thanks for reading, I'm lonely today, Bruce is out working, and Bens at playgroup.
Gee... I remember when a friend of mine had her first baby a while back, she would tell me she could eat pretty much what she liked, and most of all, what she felt liked. She once had a craving for raw bacon....yes.....raw bacon......and she ate it! I don't really believe her....she is quite a lot older than me.
Biazarre as it sounds, I don't remember too much, how, or what I did in regard to food preparation and tastes when I was pregnant with Ben.
Since my last appointment with Emma, she's given me a whole lot of stuff to read, about the Do's and Don'ts to do with eating in pregnancy. I'm too tired, and my lack of concentration is at its peak! Do they call that pregnancy brain, or what?!? It's also too frightening for me to read, I'll worry if I eat something that's undercooked, or has been sitting around too long! Then, I'll be made to feel I have killed my baby.......not on!
One of the things that stands out in my limited brain capacity is the "NICE" guidelines, 2003. I don't think the're "NICE" at all, they scare the living s**t through me.. There's pages and pages of stuff, but I'll tell you a bit about the diet stuff. Nutritional Supplements for example, it says to take a dose of 400mcgs daily, I thought you could take up to 800mcgs, that's what I remember my last midwife saying, and you can buy it in tablet form at the chemist.
"Pregnant women and those intening to become pregnant, should be informed that dietary supplementation with folic acid, before conception and up to 12 weeks gestation, reduces the risk of having a baby with neural tube defects -(anencephaly and spina bifida)...P.8 Gee man, I'll take that, I want a healthy baby eh? I think that's something to do with the nervous system in the developing aby. I had to ask Emma what these scary sounding words are?!?
I thought all pregnant women were advised at some point to take an iron supplement. I remember having heaps of blood tests last time, and my iron was borderline, or something..And mum keeps telling me to eat LIVER and KIDNEYS yucko! Mum says liver and kidneys have heaps of iron, but I keep telling her that thse guidelines say no to that as that stuff has too much Vitamin A! Mum says Bullocks to that! ( ha ha)
I am fortunate at my age to still have a grandmother alive, some would beg to disagree with me, but anyway, you have not met her, so I'll be polite! :-) She still lives on the original dairy farm mum and her great herd of fellow siblings grew up on, and still milks a few cows - (my uncles pretty much run the farm for her now)....but anyway, she's full of pride with her with her fresh milk, and makes her own butter...still, but is not speaki ng to me at the moment 'cause I won't accept her endless supply of unpastuerised milk! Yes, I did love it once, but not now. According to these guidelines, unpasteurised milk can contain the bacteria "listeria" which can cause miscarriage. Also, soft cheeses, and pate. That's ok, don't like that anyway.. Bruce is not a great fan either.
Salmonella is another biggie here where I usually love my eggs real runny, but now it seems I need to have them cooked through.
I feel like I am a student again, which was in the real dark ages mind you, I don't enjoy reading, and I find all this stuff tedious. Bruce is way too busy to help, he thinks it's all my responsibility. Whatever, he's still a cranky so and so. I guess I'll food Emma with all my questions, afterall she's the expert eh? I believe everything she tells me, and I'll just do as she says......
The other thing of interest to me was what the guidelines say about alcohol and smoking.
According to these "NICE" guidelines, 2003, "Excess alcohol has an adverse effect on the fetus" P.10. Yeah, how many times are we told that? But, you can apparently that means you can limit alcohol consumption to 1 standard unit per day. What's 1 unit? well, it equates to a single measure of spirits, a small glass of wine, and half a pint of beer, which I'd guess would probably be about 300 mls or so. I have chosen not to drink at all. A small price to pay to eliminate one risk, I suppose.
Lastly, another was om smoking. I do know of women who have continued to smoke right through their pregnancy, and also been exposed to secondary smoke. The guidelines, of course, advise against this habit, as it can cause low birth weight in new borns, and possibly pre-term labour.
The guidelines go on and on, and I thank Emma for providing me with all this info. She gave me loads of stuff, web addresses etc etc, but these guidelines just stuck out in my mind. Anyway thanks for reading, I'm lonely today, Bruce is out working, and Bens at playgroup.
Wednesday, August 13, 2008
Hiya, Emma here
Just phoned Shannon to find out whether she had a nice evening out, and whether or not the nausea has settle. I hope she didn't have pate at Shed 5. I forgot to mention to Shannon that it is recommended for pregnant women to avoid liver and liver products because of the high concentrations of Vitamin A. Excessive intakes of Vitamin A in the form of retinol may be toxic to the developing fetus.(Williamson 2006).
Hate to be a killjoy, but I hope Shannon also knows to restrict her caffeine intake as well. Studies have shown an increased risk of both low birth weight, and spontaneous abortion.(Williamson 2006).
I am going to give her a copy of The NZ and Safety Food Authority for pregnancy so she can find what other foods to avoid. I have been called into Delivery suite. Perhaps She and Bruce can can ask more questions for me when I get home, if not too late.
Just phoned Shannon to find out whether she had a nice evening out, and whether or not the nausea has settle. I hope she didn't have pate at Shed 5. I forgot to mention to Shannon that it is recommended for pregnant women to avoid liver and liver products because of the high concentrations of Vitamin A. Excessive intakes of Vitamin A in the form of retinol may be toxic to the developing fetus.(Williamson 2006).
Hate to be a killjoy, but I hope Shannon also knows to restrict her caffeine intake as well. Studies have shown an increased risk of both low birth weight, and spontaneous abortion.(Williamson 2006).
I am going to give her a copy of The NZ and Safety Food Authority for pregnancy so she can find what other foods to avoid. I have been called into Delivery suite. Perhaps She and Bruce can can ask more questions for me when I get home, if not too late.
Tuesday, August 12, 2008
This might be of interest
The general guideline out there now seems to be we don't know how much is too much so avoid alcohol during pregnancy.
I'm unsure of the definition of an alcoholic and can't seem to find it anywhere either.
This press release looks at baseline data from 2006 - has anything changed.
Sunday, August 10, 2008
To drink, or not to drink
Emma here,
Shannon has just phoned me. Bruce is taking her out for a meal at Shed 5, lucky thing. Hope the night is clear so she can really relax and enjoy the harbour lights of Wellington.
She ask if it is OK to have a glass or two of wine, with her dinner.
Heavily drinking throughout pregnancy, i.e. more than 80g of alcohol per day(equivalent to 10 units), is linked with an increased risk of fetal alcohol syndrome.(James and Ralph, 2000). There is currently a lack of consensus opinion on what is a safe level of alcohol consumption during pregnancy (Williamson 2006). The Royal College of Obstetricians and Gynaecologist (RCOG) concluded that consumption of more than 3 drinks per week during the first trimester of pregnancy leads to increased risk of spontaneous abortion, and intakes over 15 units per week may have a negative effect on birthweight. The RCOG advises women to be cautious about their alcohol consumption during pregnancy and to consume no more than one standard drink per day(RCOG 1999). Australia and Canada recommend complete abstinence from alcohol. (Mukherjee et al. 2005).
I informed Shannon of the above, in a way she could understand, so that she and Bruce could make an informed decision on whether to drink or not. I am glad that they are going out for the night. I hope she doesn't suffer from nausea, at the wrong moment.
Shannon has just phoned me. Bruce is taking her out for a meal at Shed 5, lucky thing. Hope the night is clear so she can really relax and enjoy the harbour lights of Wellington.
She ask if it is OK to have a glass or two of wine, with her dinner.
Heavily drinking throughout pregnancy, i.e. more than 80g of alcohol per day(equivalent to 10 units), is linked with an increased risk of fetal alcohol syndrome.(James and Ralph, 2000). There is currently a lack of consensus opinion on what is a safe level of alcohol consumption during pregnancy (Williamson 2006). The Royal College of Obstetricians and Gynaecologist (RCOG) concluded that consumption of more than 3 drinks per week during the first trimester of pregnancy leads to increased risk of spontaneous abortion, and intakes over 15 units per week may have a negative effect on birthweight. The RCOG advises women to be cautious about their alcohol consumption during pregnancy and to consume no more than one standard drink per day(RCOG 1999). Australia and Canada recommend complete abstinence from alcohol. (Mukherjee et al. 2005).
I informed Shannon of the above, in a way she could understand, so that she and Bruce could make an informed decision on whether to drink or not. I am glad that they are going out for the night. I hope she doesn't suffer from nausea, at the wrong moment.
Congrats on Progress
Well done everyone with the direction you are taking in the role play - start thinking about advice you give and what science supports the advice. Remember that best practice is about supporting your practice with research. Feel free to talk out of character and look at where you are going with the role play - make sure you relate back to the aim of this role play.
Saturday, August 9, 2008
Meeting Shannon, Bruce and Ben
Phew! I have just had a very busy 24hrs. I had 2 of my ladies birth, meet up with Shannon and her family for the first time, and on top of that my dog Zac has a sore front paw.
It was nice to meet up with Shannon and her family. I look forward to getting to know them more as her pregnancy progresses. Boy, that Ben is a busy lad.
Shanon's pregnancy is progressing along as normal. She has terrible nausea, which she experiences mainly in the morning and evening. She as has no vomiting. I hope that this will settle as she enters the 2nd trimester at 12 weeks. Being hungry, and dehydrated can cause the nausea to increase, so I recommend that Shannon tries to eat small frequent meals and snacks throughout the day, and try to drink plenty of fluids. It may be at this stage of her pregnancy she eats what she feels like when she wants to. Ginger may be a help. When she first wakes in the morning it would be good to get out of bed slowly, if time and Ben allows. Dry toast and crackers are quite good, along with chewing gum and eating hard lollies. Hopefully she can avoid foods with bad smells. I have heard that when she does feel nauseated she should avoid drinking citrus juice, water, water, milk, coffee and tea which doesn't leave her with a lot of options for fluids. Lemonade is suppose to be good. I have my fingers crossed that the nausea will settle. I have heard that acupuncture may help, and know of a midwife in Wellington who performs acupuncture that I can refer her to, if needed.
Shannon is also experiencing constipation. I have suggested that she eats high fiber foods as her nausea permits like wholegrain cereals, breads, dried fruit, and fresh fruit and vegetables. Drinking as much fluids as she is able, about 2 litres is recommended. Getting out and about, walking, perhaps going for a swim at the local pool will help with the constipation, as well as providing actives for Ben and her to do together.
I have given her a copy of MOH "Healthly food guidelines for pregnancy''
Moving to Wellington has been hard for the family. Shannon misses her mum and friends, and Bruce is away through the week with his job. I suggested that Shannon drops into The Family Center, run by Plunket, as they run playgroups for Ben to enjoy. This will give Shannon a chance to meet other mums and have a break from caring for Ben.
I hope some of these things work for Shannon and her family. I will ring her next week to see if her nausea has settled, and constipation has improved.
It was nice to meet up with Shannon and her family. I look forward to getting to know them more as her pregnancy progresses. Boy, that Ben is a busy lad.
Shanon's pregnancy is progressing along as normal. She has terrible nausea, which she experiences mainly in the morning and evening. She as has no vomiting. I hope that this will settle as she enters the 2nd trimester at 12 weeks. Being hungry, and dehydrated can cause the nausea to increase, so I recommend that Shannon tries to eat small frequent meals and snacks throughout the day, and try to drink plenty of fluids. It may be at this stage of her pregnancy she eats what she feels like when she wants to. Ginger may be a help. When she first wakes in the morning it would be good to get out of bed slowly, if time and Ben allows. Dry toast and crackers are quite good, along with chewing gum and eating hard lollies. Hopefully she can avoid foods with bad smells. I have heard that when she does feel nauseated she should avoid drinking citrus juice, water, water, milk, coffee and tea which doesn't leave her with a lot of options for fluids. Lemonade is suppose to be good. I have my fingers crossed that the nausea will settle. I have heard that acupuncture may help, and know of a midwife in Wellington who performs acupuncture that I can refer her to, if needed.
Shannon is also experiencing constipation. I have suggested that she eats high fiber foods as her nausea permits like wholegrain cereals, breads, dried fruit, and fresh fruit and vegetables. Drinking as much fluids as she is able, about 2 litres is recommended. Getting out and about, walking, perhaps going for a swim at the local pool will help with the constipation, as well as providing actives for Ben and her to do together.
I have given her a copy of MOH "Healthly food guidelines for pregnancy''
Moving to Wellington has been hard for the family. Shannon misses her mum and friends, and Bruce is away through the week with his job. I suggested that Shannon drops into The Family Center, run by Plunket, as they run playgroups for Ben to enjoy. This will give Shannon a chance to meet other mums and have a break from caring for Ben.
I hope some of these things work for Shannon and her family. I will ring her next week to see if her nausea has settled, and constipation has improved.
Thursday, August 7, 2008
I am Shannon. My family and I have recently moved to Wellington from Gore due to my Patrner Bruces' employment. I am currently 11 weeks pregnant and am suffering incredible morning sickness often in the morning and late afternoon. I find I am struggling to keep up with our 2 year old son Benjamin as he is a typically healthy, busy boy. I am also becoming quite constipated.
When I am feeling a little better, I enjoy going for walks along the beach and picnic lunches with Benjamin and Bruce, (when he's around).
I am looking forward to meeting my midwife to talk about my pregnancy symptoms.
When I am feeling a little better, I enjoy going for walks along the beach and picnic lunches with Benjamin and Bruce, (when he's around).
I am looking forward to meeting my midwife to talk about my pregnancy symptoms.
WELLCOME
Hi guys! I have made it!
Let me introduce myself. My name is Emma, and I have been working as a midwife for fifteen years. I live in Wellington and have worked as a core midwife for Wellington hospital for 10 years. The last 5 years have seen me working as a independent midwife, in a group practice with 3 other midwives. I have a wide variety of interests, including trying to live a healthy lifestyle, if that can be described as an interest! My dog, Zac, keeps me honest by providing me with lots of exercise. I am a keen gardener, and have a garden full of vegetables. I try very hard to maintain a healthy weight, which is not always easy!
I believe eating 'right' now helps protect me for the future.
Tomorrow I have an appointment to see Shannon, who has just discovered that she is eleven weeks pregnant. Shannon has moved from Gore recently, as Bruce, her partner, has transferred to Wellington with his job. Shannon and Bruce have one other child, Benjamin who is two years old.
Shannon phoned me today. She says that she is well, although suffering from extreme nausea in the early morning and again in the late afternoon. She is starting to become constipated.
I am looking forward to meeting with Shannon and her family. I hope that I am able to provide her some relief for her discomforts.
Let me introduce myself. My name is Emma, and I have been working as a midwife for fifteen years. I live in Wellington and have worked as a core midwife for Wellington hospital for 10 years. The last 5 years have seen me working as a independent midwife, in a group practice with 3 other midwives. I have a wide variety of interests, including trying to live a healthy lifestyle, if that can be described as an interest! My dog, Zac, keeps me honest by providing me with lots of exercise. I am a keen gardener, and have a garden full of vegetables. I try very hard to maintain a healthy weight, which is not always easy!
I believe eating 'right' now helps protect me for the future.
Tomorrow I have an appointment to see Shannon, who has just discovered that she is eleven weeks pregnant. Shannon has moved from Gore recently, as Bruce, her partner, has transferred to Wellington with his job. Shannon and Bruce have one other child, Benjamin who is two years old.
Shannon phoned me today. She says that she is well, although suffering from extreme nausea in the early morning and again in the late afternoon. She is starting to become constipated.
I am looking forward to meeting with Shannon and her family. I hope that I am able to provide her some relief for her discomforts.
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