Alessandra Winfield - Dietitian; Ba ApplSci (Nutritional Science) Ba Hlth Sci Nutrition & Dietetics HONS APD Alessandra is an Accredited Practising Dietitian (APD) who works in her own private practice in Brisbane.  She is a member of the Dietitians Association of Australia.  Alessandra has been working the field of Nutrition and Health Promotion for over 15 years. Alessandra specialises in the areas of infertility, pregnancy, postnatal and children.  She began her specialty after experiencing her long journey with infertility.  Since giving birth to her IVF-babe she experienced first-hand the difficulties and joys of raising a family.  So now Alessandra has some great knowledge, expertise and strategies to pass on to any family who wants to know the best way to achieve health and peace of mind. http://www.ripenutrition.com.au/

1) What foods are best for energy and strength during a long labour?

Some women have assimilated going into labour like “running a marathon”.  So if you prepare for labour like an athlete prepares for a race you can improve your energy levels with the right foods and also improve your recovery time.  In fact, during labour your body automatically prevents your stomach from emptying so that you have as much energy from your last meal as possible.  So if you are able to eat and drink during labour, eat small amounts of food every hour or so.

Firstly, what you can do to prepare for labour is to build a little muscle using some light weights.  This will help your body store some extra energy in the form of glycogen that can be utilised in labour. 

 Secondly, when labour commences eat a combination of high Glycaemic Index (GI) and low GI foods.  By combining these foods you will get both quick-bursts and long-sustained forms of energy.  The energy from the high GI foods will store as glycogen in your muscles ready to be used immediately.  So the more muscle you have the more energy you can store.

Examples of some high GI foods are watermelon, dates, rice crackers, plain sweet biscuits, lollies, white bread, jam, sports drink, cordial  some low GI foods include apples, oranges, pears, dried apricots, stone fruits, yoghurt, vitaweets, nuts (cashews), juice, pasta and grain bread.

Small amounts of fluid are safe to consume during labour for example water, ice, sports drink, fruit juice and milk.  For some people, highly concentrated drinks like fruit juice or sports drinks can cause nausea so just be aware and perhaps have them during recovery after the baby is born.

2) I’m pregnant with my second child and want to try and breastfeed for as long as I can (I didn’t produce much milk with my first and ran out after 3 months).  Can you recommend any foods to try to increase my milk production?

Try to locate a lactation consultant before giving birth so that you can contact her as soon as you need to.  She can also identify any physical or biochemical reason why you may not be producing enough milk.

A hormone called prolactin must be present before milk can be produced.  Each time the breast is emptied of milk, more prolactin can enter the breast and produce more milk, so the key is to empty the breast as often as you can. 

The best way to determine whether or not you are producing enough milk is based on how well the baby is growing.  If your baby is growing in proportion to the infant growth charts then you are probably producing enough milk.

Foods per se do not necessarily increase milk production but they do contribute to the energy (kilojoules) your body needs to make milk.  As demand for milk increases from your baby, so too does milk production. 

Eating small snacks during a breastfeed can be a good time to obtain energy foods.  So have some snacks like dried fruit, nuts, dry breakfast cereal, rice crackers, cheese and fresh fruit ready to eat while you are feeding.  Anecdotal evidence suggests that eating traditional oats (not 2-minute) can increase milk supply – there is no scientific evidence for that, but it certainly can’t hurt.

Make sure you drink plenty of fluid like water, juice and milk so that your body does not dehydrate.  Also, limit your intake of caffeinated drinks and foods like coffee, tea, energy drinks and chocolate so that you don’t lose fluid from these diuretics.  Your body needs extra fluid to make milk.

There is a herb called Fenugreek that is known for its galactogogue (milk stimulator) properties.  This can be taken to initiate an increase in milk supply and once the desired level is reached you can stop taking the herb.  The dosage amount is according to your weight so it is best to see your lactation consultant, naturopath or specialised dietitian for more information.  The herb should not be taken if you have a peanut allergy.

3) I recently had my blood sugar tests done and was told I have gestational diabetes.  Can you recommend a diet that will decrease my blood sugar levels?

A diet for Gestational Diabetes is very similar to a Type 2 Diabetes diet except you are also accounting for a growing baby as well.  The most important point is to keep your blood glucose levels within the recommended range of 4-8mmol/L.

Generally, a diet that consists of adequate carbohydrates mostly with a low Glycaemic Index (GI), low in saturated fat, minimal sugar and lean protein will help manage your blood glucose levels.  Your dietitian can help you monitor your levels by observing what you eat and drink using a food record.  No two people are the same and that goes for how a person will be able to manage their diabetes, it is best to be monitored by a health professional like a diabetes educator, endocrinologist or dietitian.

Some low GI foods include soy & linseed bread, pasta, oats, milk, yoghurt, apples, pears, bananas, prunes, fruit loaf, baked beans and sweet potato.

Exercise is a key component of managing Gestational Diabetes because it helps utilise any excess glucose and improves the way insulin works.  Try to go for a 30-minute walk everyday.

 
4) I’m just over four months pregnant and haven’t been able to stop eating chocolate (and sweet things in general).  My mum says it’s my body telling me I need these things and not to worry about it, but my doctor tells me  I’m gaining weight too quickly (6 kg in the last 4 weeks) and that I have to cut back.  Sometimes I feel I have no control and can’t stop eating the chocolate.  Can you recommend any foods that might curb my sweet cravings?

During pregnancy our bodies can have an increased sensitivity of the senses, like taste and smell.  In your case it looks like the desire for sweetness has increased.  Before you were pregnant you may have already had this desire but not to this extent.  Your doctor is right about being concerned about gaining weight too quickly as this can contribute to complications like eclampsia or gestational diabetes.

As with any craving it is better to identify the reason behind it before treating it.  For example having a condition called glucose intolerance means that glucose (a form of sugar) is not getting into your cells properly and so you body craves sweet or carbohydrate foods.  A glucose tolerance test (GTT) will identify this condition.  You will need a GTT in pregnancy to test for gestational diabetes.

A craving for chocolate may indicate a lack of serotonin (a hormone that regulates mood, sleep and appetite).  Your body naturally craves foods that can increase serotonin – which chocolate can do.  However, it would be better for you and your baby to find other ways to increase serotonin without increasing fat, sugar or calories.  Foods like lean turkey & chicken, salmon, tuna and low Glycaemic Index carbohydrates like grainy breads, yoghurt, milk, apples, oranges, pears, dried apricots, stone fruits and bananas can help increase serotonin.

The best way to curb your sweet craving is to reduce the intake of them.  I know that is easier said then done but reducing a little bit each day is the way to desensitise your body of craving sweet foods.  Also, remove any artificial sweeteners from your diet like:  sugar-free gum, diet cola, low-joule soft drinks, diet jams, diet jelly, ‘light’ hot chocolate/coffee mixes, diet cordial, diet yoghurt and “diet” anything.  All these do is increase your body’s threshold of sweetness, as artificial sweeteners are much sweeter than ordinary sugar.

Areas an Accredited Practising Dietitian can help you may include:

Ø       Pre-conception health and nutrition

Ø       Infertility

Ø       Polycystic Ovarian Syndrome (PCOS)

Ø       A Healthy Pregnancy & Labour

Ø       Gestational Diabetes

Ø       Multiples

Ø       Weight management

Ø       Morning sickness

Ø       Breastfeeding nutrition

Ø       Post-pregnancy weight loss

Ø       Infant feeding problems eg reflux or failure to thrive

Ø       Allergies & Food intolerances

Ø       Starting solids

Ø       Fussy eaters

Ø       Brain Food for Children (improving learning and behaviour)

Ø       Postnatal depression nutrition

Ø       Weight management for children

Ø       Healthy Eating on a Budget

Ø       Diabetes

Hannah Dahlen - Midwife; RN, RM, BN (Hons 1st), MCommN, PhD, FACM. Hannah is the Associate Professor of midwifery at the University of Western Sydney and has been a midwife for 20 years She is also the Secretary of the Australian College of Midwives NSW Branch and the National Media Spokesperson for the Australian College of Midwives. www.midwives.org.au

1)  I am due with my first baby on the 19th January 2009, during my birth classes the mid wife recommended that the best place to settle a baby crying baby is the partner’s chest. What are your thoughts?  Therese Hargreaves 

The best place to settle a baby is usually with mum but sometimes it works well to hand the baby to dad. Sometimes the baby can sense your anxiety and you fuel each other and sometimes it is simply the fact that they can smell you and know that smell means food! Just the different motion and odours of dad and can be enough to send the baby to sleep. My advice would be to try several things and find what works for you.

2) What are some ideas for my birth plan that might help in a twin birth without epidural?

Because of the increased risk of the babies becoming distressed during the labour most women are encouraged to have their babies heart rates continuously electronically monitored but you can ask for this to be done intermittently so you can move around. We also now have mobile monitoring units that enable mobility as well. There is also a tendency to encourage women to have an epidural block in case there is a need to get the babies out quickly. It is, however, the mother’s choice and women do choose to have twins without epidural anaesthesia and you generally have a greater chance of a normal birth if you avoid it. Moving around as much as possible using water for the labour will help you cope with the labour better without pain relief. Don’t get induced unless absolutely necessary as this increased the chance of needing an epidural and of the babies becoming distressed.

3) I’ve read many books on ovulation and  articles on "when to have sex to increase the chances of falling pregnant" and all say to have intercourse 3-1 days before ovulation (to ensure the sperm are in the fallopian tubes ready for the release of the egg), so intercourse before or on the day of the temperature drop (ovulation) is best...right!!!
But then I was informed by my doctor to wait till the first temperature rise to have intercourse.  (My mother was also given the same advice  29 yrs ago to conceive me ... and here I am.)  Wouldn’t the temp rise indicate ovulation has already taken place which would indicate that it is too late to conceive this cycle?  So my question is ... WHICH ADVICE IS CORRECT?
Just to be sure, my husband and I have been having intercourse every 2nd night. Jodi Osborne

Try to concentrate sexual intercourse to your most fertile week, which is 4 days before and 4 days after you expect to ovulate. You can work out when you ovulate by counting back 14 days before your period is due. You should also become familiar with the physiological signs of ovulation such as an increase in the amount and stretchiness of the vaginal mucous. Increased libido during ovulation is nature’s way of getting you and your partner together.

Optimal frequency of sexual intercourse is an area of great debate. Maximising sexual intercourse (every couple of days mid cycle) around the time of ovulation is of course ideal but restricting yourself at other times of the cycle to ‘save the sperm’ up is not necessary and indeed can reduce the motility.

Sperm form best at a temperature just below the body’s temperature, which is one reason why the testicles are outside the abdomen. Tight underwear can increase this temperature and reduce the sperm count. Getting your partner out of the Y fronts into the boxers and out of the tight jeans and into the lose pants might help improve his sperm count. Because it takes the sperm two to three months to form you will have to keep this up at least this long! Other factors that can influence sperm production are to do with certain occupations, such as professional drivers who are sitting down all the time causing an increased heat that restricts the manufacture of sperm

4) I found out I'm 4 months pregnant with twins.  I’m wondering what to expect or if there is anything I really need to know.  I don’t have any other children and have no idea what to do.  Any advice and information would be greatly appreciated. Melissa

Congratulations! You are about to embark on a wonderful journey. Caring for two babies can be so overwhelming that women can forget to care adequately for themselves. Women having twins need to get very good at saying ‘yes’ to help as they will need support. During your stay in hospital the midwives can help you learn how to care for your babies. Women often feel inadequate and overwhelmed but confidence will grow as you accomplish tasks and learn to organize yourself.

You can breastfeed both babies at once. There is now a tendency to get the mother to feed one baby on a certain breast for the day and then swap to feeding the other baby on that breast for a day. At around 2-3 months of age babies tend to identify with one breast and stick to it. Of course this is entirely individual and you need to find what works for you.

A good diet is essential for a mother breastfeeding two babies and recovering from the birth. Postnatal exercises are also important. These exercises will help to strengthen your stomach muscles and pelvic floor and also improve the function of your bladder and bowels

Women often feel left out after they have had twins because so much attention is focused on the babies. It is important to nurture the mother of twins so she has the energy to nurture her babies. The early days following the birth can also be difficult as the parents learn to identify with their babies as individuals. As I always say to women, twins are double the trouble but twice the fun!