Diet plans

It’s been a while, and I have lots to say. The nausea and vomiting have gotten worse in the last few weeks, which is one of the reasons I have not been sending my daily missives out to the world. The other reason is that I have decided to be way more chill about this whole pregnancy thing. I am going to stick with my midwife, Tiffany, and go ahead with thinking about giving birth at the Cambridge Birth Center at least until later in the pregnancy (like, summer).

The biggest concern for me right now is making sure that I am getting enough nutrients. I found this handy chart:

Meal Planning Guidelines for Pregnant Vegetarians

Food Group	Serving size	No of Servings	Comments
Grains	1 slice of bread;1/2 cup cooked cereal, grain or pasta; 3/4 to 1 cup ready-to-eat cereal	7 or more	Choose whole or enriched
Legumes, nuts, seeds, milks	1/2 cup cooked beans, tofu, tempeh; 3 oz of meat analogue; or 2 Tbsp nuts, seeds, nut or seed butter; 1 cup fortified soy milk; 1 cup cow’s milk, 1 cup yogurt) (1 serving protein = 14 g)	5 or more	Calcium-rich foods such as dried beans, calcium-precipitated tofu, calcium-fortified soymilk, cow’s milk, and yogurt should be chosen often. A regular source of vitamin B-12 should be used.
Vegetables	1/2 cup cooked or 1 cup raw	4 or more	Calcium-rich foods such as kale, collard greens, mustard greens, broccoli, and bok choy, should be chosen often.
Fruits	1/2 cup canned fruit or juice or 1 medium fruit	4 or more	Choose calcium rich figs, and fortified juices often.

I have posted before about how disillusioning it can be to actually read the labels of the meat and dairy “substitutes” in one’s vegan kitchen. I have since realized that in order to eat well, I am going to have to make some major changes in eating habits. It is hard to introduce food items into a daily diet when right now I don’t use them at all. Like, 2 Tblsp of flax oil a day seem pretty important, but because most people eat so much fat, social messages about eating tend to say that you should reduce the amount of oil you just pour on your food. Even though the reasons for that restriction in the general obese American population don’t really apply to me as a skinny vegan, I have still paid attention to that message, resulting in less–not better–health. It seems gross and unhealthy to just add oil or nutritional yeast to whatever I’m eating, but it seems that is to be my new, delicious, healthy habit.

I also need to figure out an easy way to cook more than one vegetable at a meal. Like, if I use a lot of pots and we don’t do all the dishes, then the pots are dirty the next day and I don’t make the vegetables. This was the downfall of the “a smoothie a day” plan – we didn’t clean the blender every night, and then the next morning I wouldn’t have time to clean it and make the smoothie as I ran out the door. I also want to retain the most nutrients in the vegetables – I think steaming is more nutritious than boiling, but I don’t have a lot of experience on how you can steam stuff, especially together. Does anyone have a good resource on this or easy ideas about how to get lots of veggies in their diet?

It’s kind of embarrassing to admit, but changing your diet is difficult. My goal this week is to actually make a chart for each day and then fill in what I eat on it. And carry around a half-cup measure for serving size approximations.

Good news, everyone

I haven’t written this week because looking at my computer screen increases my nausea. However, I do have good news to report: I switched midwives at the birth center, and I really like the new midwife I am working with, named Tiffany. In addition to the Cambridge Birth Center, she also sees patients at a location that is much closer to work/home (the Somerville hospital), so I can reduce the amount of time I am out the office. My next appointment with her is February 13.

I also saw a different midwife, Lorrie, for an urgent appointment on Wednesday about my yeast/bv. Lorrie recommended I take Terazol for the yeast. There was a whole deal where the terconazole cream contains propylene glycol as an inactive ingredient, which I am super sensitive to (it stings like a bitch). Eventually, with the help of two different pharmacists at compounding pharmacies who went way out of their way to help me find a solution, I figured out that Terazol also comes in a suppository form suspended in a vegetable oil base without any of the petroleum-based additives present in many vaginal creams. I got the prescription today, so I am set on that front, too.

At my urgent appointment with Lorrie, I also got to hear the heartbeat of my fetus. Yay! It sounds really fast, kind of like a beat machine. A great moment, but I wish Kelly could have been there.

I have one more upcoming appointment (the morning of January 28th), for the “ultrascreen” prenatal testing. This is a combination ultrasound and blood test that screens for the probability of chromosomal abnormalities and neural tube defects. Because I was not taking an adequate source of folic acid during the first few weeks of my pregnancy before I realized I was pregnant, Kelly and I decided that we would go ahead and get the screening. What I think is that the testing will confirm we have little to worry about, but it would be nice to know early if, for instance, our fetus had anencephaly. Kelly and I have talked about “what would we do if…” and for me, it would be much, much harder to terminate the pregnancy past the point of quickening even if it turned out that it like had no brain or something. I’m already pretty deeply attached to the pregnancy.

I thought that the point of “quickening,” or when the mother can first feel movement from the fetus, was significant in Judaism, but the internet seems unable to enlighten me on this point. Can anyone else find info on this or knows what I am talking about?

I appreciate all the comments I’ve been getting lately, everything from support to eating tips to the medical perspective (thanks, Stace). As Laura suggested, I have been eating a lot of calorie-dense foods like olives and avocados, which unfortunately is expensive in the winter. Thank goodness for the global agricultural economy, right? (No, wait…)  Anyway, your comments mean a lot to me.  Thanks for reading.

The weather is beautiful today, but there is a severe cold warning in effect for the weekend. Bummer.  I think tonight Kelly and I are going to go to Grasshopper Restaurant again, and then to services at Temple Sinai.

Finding a provider

I had no idea that finding a prenatal provider would be so difficult. There is Dr. Shafi in Burlington, who I really like, but Burlington seems too far away to travel for regular appointments and the nurse I was working with there didn’t seem like she did a good job of listening to me. There is CNM Christley in Cambridge, but I think my rough pelvic exam from her actually led to a yeast infection, and it doesn’t seem encouraging that her office is using outdated medical procedures (no lubricant during pap smears, see earlier post and info here). Then there is the Davis Square office of Harvard Vanguard Medical Associates. I would like to switch my care to them because they are the closest office and so Kelly may be able to attend more of my appointments. Unfortunately, they do not have any midwives and as of now I don’t know anyone there.

(Later)  I am on a waiting list for sooner appointments at HVMA in Davis, but I have appointments on February 15 and 22 with a NP and MD, respectively.

And I have an appointment at 3:00 today with a midwife at the Cambridge Birth Center to screen me for yeast/bv.  I might also switch my care to the Somerville Women’s Health Center at the Somerville Hospital, where I could work with a CNM.  It is closer to home and work than Cambridge is, and ALL I NEED IS TO FIND ONE DECENT PROVIDER!

I know I am making this more complicated than it needs to be, but I am really tired of this.

“Morning sickness”

Television is just wrong.  Morning sickness is not just dry-heaving before breakfast.  First of all, nausea happens all day long.  And second of all, barfing isn’t satisfying like normal barfing – you don’t feel better afterwards.  I just barfed again in the bathroom, and my stomach is telling me it’s going to happen again pretty soon.

Isn’t this supposed to be getting better as I approach the second trimester, not worse?

Nutrition and acupressure

First, thank God for my girlfriend A. She came over last night and gave me some anti-nausea acupressure wrist bands, and they are really really helping. A lot. I am still nauseous, but only a little bit as opposed to omfg I wanna die. Also, it was just nice of her to come over, since she had to walk.

I am calling all my peeps by a single letter on my blog because I want to preserve their and my anonymity, but on the other hand who cares? I can’t decide on this issue. Input, loyal readers?

I didn’t blog yesterday about my visit with the nutritionist, so I will do it today. First of all, I brought with me the book Becoming Vegan by Davis and Melina, and the nutritionist said that it was a great book and she used it to help me figure out what I should be eating. When I described my typical diet, she said that I am a healthy vegetarian – I guess she sees a lot of people who just eat junk food. She emphasized the following for my diet:

1. I need to be getting 3-4 servings of protein a day, with a single serving being 14 g of protein. She suggested that I eat at least one serving at each meal. For instance, for breakfast I could have a smoothie with protein powder, or some soy yogurt and toast with peanut butter. For lunch I could have some veggie meat, and for dinner I could have beans or legumes.

   Since becoming vegan, I always read the ingredient labels on my food, but I don’t usually read the nutrition facts. This suggestion has focused me on reading the protein content and serving size of my food, and I have found some surprising things. First of all, most dairy substitutes in my kitchen (soy cheese, tofu cream cheese, silken tofu, and soy ice cream) do not have comparable levels of protein as what they are substituting for. You have to eat a lot more tofu than cheddar cheese to get the same amount of protein. Even more disappointing is that the soy cheese (Follow Your Heart brand), tofu cream cheese (Tofutti brand), and soy ice cream (So Delicious brand) have effectively no protein content at all – they are not protein-rich foods. In other words, while these substitutes may fill a hole in my diet in terms of flavor, they do not actually serve as substitutes in terms of nutritional content. Bummer! Soy meat substitutes can have similar drawbacks: for instance, one vegan Flame-Grilled Gardenburger patty has 11 g of protein, but one ground beef patty of comparable size has almost twice as much protein. This doesn’t mean that I can’t get enough protein from a vegan diet, but it does mean that I can’t assume that taste substitutes are also nutritional substitutes. I need to be a lot more careful so I can make sure I get at least 14 g of protein 3 times a day.

2. I need to get enough calcium every day, and it needs to be paired with Vitamin D in order to be absorbed. The nutritionist suggested I eat foods fortified with Vitamins A, D, and calcium, and that I take a calcium supplement that contains Vitamin D. I have been taking Tums, but apparently that is not a good source of calcium because it contains no Vitamin D. She suggested that I eat calcium-rich dark green vegetables, and gave me a list.
3. I should be eating a higher-than-normal calorie diet, which because of the nausea means I need to eat a number of small meals throughout the day. I have always been a little confused by serving sizes – if I am supposed to eat 3 or more servings of fruit a day, how much fruit is that? The nutritionist gave me a list of serving sizes that I can stick on the fridge, and I am hoping to start a food diary so I can see what I am getting and what I am not (Becoming Vegan has a really good example of this). She also gave me a couple of tips about how to figure serving sizes. If I generally use the same bowls at home, I can measure out a serving of fruit or beans or whatever using measuring cups, and then put it in the bowl. After a couple of times, I should be able to know how full the bowl has to be to contain one or two servings of food. Like any system, once I get used to thinking about portions of food in terms of servings, I should be able to calculate how many servings of different food groups I have eaten at a particular meal.
4. The nutritionist also suggested I add more oils such as canola oil, corn oil, and peanut oil to my diet, and said that olive oil alone does not supply what I need in order to maintain digestive health. She suggested I eat avocados, nuts, and other oil-rich foods.
5. We talked about iron and she said that with my prenatal vitamin I should be getting enough iron for the first two trimesters, and might want to consider a supplement in the third trimester.

Anyway, the wrist bands don’t work completely, but a can of ginger ale and a couple of handfuls of oyster crackers later, and somehow I managed not to hurl.

Be there!

Okay, so last night K and I went to the information session at the Cambridge Birth Center.  All in all, it seemed like a nice place to give birth.  Though the one birthing room we saw was small, apparently the other two are much bigger.  I did have a couple of problems with the center: one, they don’t seem to keep detailed statistics.  This is something I expected from reading the books by Ina May Gaskin – that a birthing center would be able to give more information than “It is our policy to break the waters of a laboring woman if they haven’t broken already by around 8 cm dilation.  This happens in a minority of cases.”  Oh, a minority of cases?  That’s informative.

They also have a clear list of reasons for transfer to a hospital, so it’s not just willy-nilly.  And it is possible to refuse procedures or be clear about what you will and will not allow beforehand, which reduces my fear of being pressured into unnecessary medical intervention.  The birth center does not have a time limit on labor, which is fantastic.  And they welcome expressions of sexuality during birth (for instance, breast and clitoral stimulation and kissing your partner, all of which are supposed to make the birth faster and easier).

But they were very clear that the midwife you see for labor and delivery will probably NOT be the midwife who you see for prenatal care.  The way the presenter explained it was pretty funny – she said that the birth center values a model they call primary midwife care, where you see the same midwife for all your prenatal visits and develop a relationship with them.  And the presenter went on to say that the person attending your birth is whoever happens to be on call, which is unlikely to be your midwife since the midwives work only 1-2 shifts a week.  BUT she would absolutely trust any of her colleagues, it’s a great group.  I was like, huh?  I mean, even if you see an OB-GYN in the most medico-technocratic setting, you can expect that your primary prenatal care provider will at least make an attempt to be at your labor and birth.  We see Mt. Auburn next week, so I wonder if their policy will be any different.

Yesterday was my worst day for nausea.  I have found that the magic food that makes my nausea disappear is a vegan version of a McDonald’s hamburger: I lightly toast a bun and K cooks me up a flame-grilled garden burger, and then I add a bit of ketchup and mustard (sloppily, just like Mickey D’s) and 3 dill pickle chips.  It’s amazing.  I’ve had three already this week.

Appointments

Tonight K and I are going to the information session at Cambridge Birth Center. Tomorrow I have an appointment with the chief nutritionist at Harvard Vanguard Medical Associates in Somerville, my primary care practice.

Finally tossed my cookies

…or rather, breakfast cereal.

Blech. I just barfed in the bathroom at work. I shouldn’t have had such a big breakfast. Now my mouth tastes like barf and I don’t have any gum. That was the first time I barfed, which is good…on the other hand, I was kind of hoping that my nausea would lessen, not worsen.

I had an appointment with a midwife at Cambridge Birth Center on Friday. It was my first real intake appointment, and I was disappointed by it. First of all, they run a lot of tests at the first intake: they took 6 tubes of blood, I peed in a sterile cup, and I had to get a Pap smear and multiple vaginal STD swabs, as well as a complete physical exam (heart, lungs, reflexes, breast, and manual vaginal exam). The Pap smear was incredibly painful. I think it was one of the most painful Pap smears I have ever had. The midwife did not use lubricant, and when I asked her about it she told me that you can’t use lubricant when doing a Pap smear. LIES! Recent studies show that lubricant does not adversely affect pap smear results. I have a chronic vulvar pain issue, possibly exacerbated by increased sensitivity because of increased blood volume during pregnancy. I could not believe how much it hurt to have the speculum forced inside. You would think that if they knew you were going to have to have an unlubricated thing inside you, they could warn you so you could do some kegels or something to get yourself a bit more aroused and relaxed and wet. Or they could let you do it yourself – can you imagine someone else putting an extra-large tampon inside of you? How much more painful would that be than doing it yourself. I thought a midwife would have gentle hands, but this one definitely didn’t.

(A friendly coworker across the hall gave me some gum. Score!)

The second reason I was disappointed is that I thought that the first appointment would include time for the midwife and I to talk about our goals for the pregnancy, to get to know each other, and to talk about the model of care used at the birth center. How can I meet other moms-to-be? Are there opportunities to hear birth stories from women who gave birth at the birth center? I asked a number of questions, but the midwife said that usually it is the second appointment at which the patient asks questions. Well, sorry I am doing things out of order!

Finally, I am disappointed by the statistics offered by the two birth centers I am considering. For instance, Cambridge Health Alliance has a primary (first-time pregnancy) cesarean section rate of 16% and Mt. Auburn has a primary c-section rate of 14%. Neither of these seem particularly good. The Coalition for Improving Maternity Services’ Mother-Friendly Childbirth Initiative says that a mother-friendly hospital, birth center, or home birth service has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals. This means that Mt. Auburn is within the threshold, barely. I was also disappointed to learn that at Cambridge Birth Center, fully 20% of women who begin their labor at the birth center are transferred to the hospital. This becomes more disturbing when you realize that few women are even allowed the opportunity to use the birth center: you must have a completely “normal” birth with no complications and desire to give birth without pain medication or medical intervention. Once women are transferred to the hospital, they no longer have contact with the midwife they have been laboring with. Instead, there is a single hospital midwife who was described to me by the midwife I saw as “extremely busy” and who apparently tends to all of the women giving birth in the hospital at one time. To be considered mother-friendly, a hospital, birth center, or home birth service would have clearly defined policies and procedures for communicating with the original caregiver when transfer from one birth site to another is necessary.

Oh man, am I going to barf again? (Stomach of iron, stomach of iron)

I am in the process of getting a referral to a nutritionist, and hopefully I can make an appointment today for sometime in the next week. I have to figure out ways to get more protein – maybe I should get some of that soy protein powder so I can put it in the fruit smoothies I make. I was so happy this weekend because it looked like I was getting my appetite back. Now I don’t even want to see any food.

On the K front, everything is going well. We had a really good talk yesterday about our fears and expectations, and while we’re both still like, “aaaaaaaaaah!” about our financial future, we’re also looking forward to increasing the love and joy in our lives with a child. Also, we had sex for the first time while pregnant (well, while KNOWING I was pregnant), and it was pretty good. There was no bleeding afterwards, which I guess can happen (but isn’t a problem), I wasn’t freaked out about the cervix-bumping, and there was no pain even after that horrible exam the day before.

That lemon bar

So, how vegan is vegan?

Food

I believe, along with PETA, that if you eliminate the obvious animal products in your diet (animal flesh, milk, and eggs), you are eliminating 99% of the animal suffering from your diet. Although I do read ingredient labels for animal-derived ingredients such as glycerin, I try not to stress about that last 1%. My rule of thumb for food has always been that if I am really craving something, I can have it. This rule works for me because what inevitably happens is that I try to eat that hamburger, piece of pie, et cetera, and it completely grosses me out.

Prime example: yesterday I went to Diesel, a local cafe that carries some vegan baked goods and makes vegan sandwiches and salads. I got a fantastic sandwich with tofu, hummus, sprouts, tomato, and cucumber on a thick 7-grain bread (it was great!), and then was tempted by the baked goods. Unfortunately, all they happened to have that was vegan was the muffins, which did not sound good. They had a wonderful looking lemon bar, and I decided to “cheat” and go for it – I haven’t been eating a lot of fat or protein lately due to nausea, and figured that a bit of egg couldn’t hurt me. I had a bit of my lemon bar while waiting for my sandwich, and it was horrible! I forgot that the crust would have milk or butter in it, and to my vegan taste buds it tasted spoiled. The eggy smell of the lemon custard was a complete turn-off. I had a second bite to make sure (wishful thinking), and surrendered the rest of the lemon bar to the office piranhas when I got back to work. What a bummer! It’s that kind of thing that keeps me an honest vegan.

Fortunately, K and I went to Grasshopper for our anniversary dinner and had the No Name, a protein-packed wheat gluten dish.

Medicine

I am taking a prenatal vitamin, which I suspect is not even vegetarian, much less vegan. On the other hand, taking the pill daily is part of what gives me the confidence to eat a balanced vegan diet during pregnancy.

I was prescribed a flu shot by the doctor when I became pregnant. They are recommended to all pregnant women, since pregnancy changes the immune system and makes dangerous complications from the flu, such as pneumonia, more likely. When I was given the shot, I was asked if I had any egg allergies because the vaccine is incubated in eggs. Knowing this, I still took the shot.

Or how about my recent intravaginal ultrasound? The lube the technician used may have contained glycerin derived from a vegetable or an animal source, which was not disclosed. I didn’t even ask.

The whole medical industry is based on animal testing and vivisection, and I am sure that pregnancy medicine is no different. Even the statistics and recommendations I read, and the various screenings and tests that are available to me, I have to assume have been at least partially developed as a result of animal exploitation. And at the same time, I don’t want to reject all contact with Western medicine.

Destruction of the Environment

I drive a gas-powered car. I eat prepacked convenience foods and rarely shop in the bulk aisle, and my waste goes directly to the landfill. Much of the produce I buy at the grocery store is not organic and has been shipped across continents by plane, train, and automobile. Our whole society–human society–is based around the assumption that humans can and should use the rest of the natural world and its inhabitant for human uses, and that non-human animals and the environment have no intrinsic value. To really escape living with the consequences of this assumption, you would have to drop out of much of human society.

A Life of Compromise

As a result, most city-dwelling, non-crunchy vegans live lives of compromise. We’ll buy a car, but not one with leather seats. Or, we’ll have the salad, please, even if it comes in a styrofoam container. Or we won’t eat honey but we’ll kill spiders that wander into our houses.

Knowing that being vegan is a compromise, I am occasionally willing to bend the rules dictated by my conscience.

It’s a thorny ethical problem to consider, though, the line between my health and the health of the unnamed animal, especially when it comes to modern medicine.

Fear

Pregnancy comes with a lot of fear, and much of it does not originate with the expectant parents.  That kind of fear, I can understand: How will we afford a child?  How will being parents affect our relationship?  Am I eating well enough for the pregnancy?  Will a car accident/high-altitude plane travel/overheating/being too cold damage the embryo?  Will I have a miscarriage?  These fears seem reasonable to me.

But there is a lot of fear that is just attached to the tiny statistical chance that something, something will go wrong and instead of a healthy, “normal” child, we will end up with some kind of monster.  I mean, seriously, a monster.  For instance in the book Baby Catcher by Peggy Vincent, which is chock full of inspiring birth stories from a midwife, the last tale is of a pregnancy that goes horribly wrong–the baby is stillborn, and through intense medical intervention a doctor manages to create a pulse and breathing.  There has been so much oxygen deprivation, however, that the child must be institutionalized for life, and all it ever does is scream.  Isn’t being locked in an institution, with no ability to interact or enjoy life, screaming, forever, everyone’s worst nightmare?

A lot of the prenatal screenings and tests are predicated on a worst-case scenario.  I am between 9 and 11 weeks, the appropriate time for Chorionic villus sampling.  This is invasive test (they stick a needle in you) is basically a biopsy, the analysis of which “may indicate” any of more than 200 disorders.  It is used to detect, for instance, genetic and chromosomal abnormalities.  I am low-risk for gen/chrom abnormalities – K’s family has no history of abnormalities, and although I have an Ashkenazi Jewish background, it’s only on my dad’s side and K doesn’t share that background.  As far as I know, no one in my family tree has ever had Tay-Sachs, making it unlikely that I carry the disease.

3% of all people are born with birth defects, or “abnormalities of structure, function, or body metabolism that are present at birth.”  That seems like a small number until you realize that it is 1 in 33.  Only about 30 or 40% of birth defects have a clear cause.  And there’s not a lot you can do about it if you learn during pregnancy that your fetus has one.  Sometime a condition can be treated in utero, sometimes knowing about a condition allows for the chance to take greater precautions during birth, and sometimes knowledge of the condition results in the couple having a therapeutic abortion.  A lot of times, though, it seems like it wouldn’t do you much good to know.

My general sense is that it’s best to do the less invasive testing, like ultrasound and blood testing, and then unless something indicating trouble comes up, put my faith in the universe.