Nutrition in Pregnancy and Childbirth

Food for Thought

Lorna Davies, Ruth Deery, Lorna Davies, Ruth Deery

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780415536059
• eBook ISBN: 9781136280375
• Edition: 1
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

Making good nutritional choices can mean women optimise the outcomes of their birthing experience and offer their babies the best possible start in life. To support this, all health professionals who work with women during pregnancy, birth and the postnatal period need to have an appropriate knowledge of nutrition, healthy eating and other food related issues.

This evidence-based text provides an informative and accessible introduction to nutrition in pregnancy and childbirth. As well as allowing readers to recognise when nutritional deficiency may be creating challenges, it explores the psychosocial and cultural context of food and considers their relevance for women's eating behaviour. Finally, important emerging issues, such as eating during labour, food supplements and maternal obesity, are discussed.

An important reference for health professionals working in midwifery or public health contexts especially, this book is also the ideal companion for a course on nutrition in pregnancy and childbirth.

Part I

Healthy Eating and Nutrition in Childbirth

1

So What’s for Dinner?

Ruth Deery

Food is an important commodity in all our lives because, nutritionally, we have to eat to survive. Pregnancy and birth are also known to be extremely energy-demanding processes, with the ingestion of food a crucial part of this process (Davies et al., 2013). However, food has much more than a biological function, as there are cultural and emotional connotations associated with disease, death, emotion and pleasure. Culturally, food is also about a person’s interaction with their environment and community: having ‘multi-sensorial properties of taste, touch, sight, sound, and smell … it has the ability to communicate … and constitutes a form of language’ (Counihan and Van Esterik, 2013: 10). Therefore the individual, social and cultural significances of food are as important as its nutritional factor. From a midwifery and pregnant woman’s perspective, food and nutrition are two important cornerstones in determining the outcome of pregnancy and birth. As midwives, we need to understand the different connotations of food in human life, particularly so within the context of pregnancy and birth.

The chapters in this book address food and nutrition in pregnancy, during birth and in the postnatal period from some of the different perspectives highlighted above. The book takes an interdisciplinary and cross-cultural perspective to nutrition and food but is not a complete meal. It is not meant to be a deeply theoretical book. Rather, it is an appetizer, meant to introduce midwives and other health professionals to the variety of intellectual dishes now available and developing around food and nutrition in health. It is highly appropriate for midwives and other health professionals who connect with women during pregnancy, birth and the postnatal period to have a sound cross-cultural knowledge of nutrition, healthy eating and other food-related issues, given the multicultural and interdisciplinary nature of our work as midwives. This will enable us to recognize when nutritional deficiency or attitudinal and behavioural issues (for example, the adage ‘eating for two’) towards food may be creating challenges for midwives and women. Such challenges might be differing attitudes to food, the meaning and reason for preferences of certain foods, ambivalence to foods, and attitudes, behaviours and beliefs about the relationship between diet and health (see Chapter 13). These challenges are not specific to pregnant women. As midwives, we too need to be challenged to address our own values and beliefs so that we can provide compassionate, person-centred care for pregnant women and their families.

Increasingly we are seeing food-related issues playing a significant role in clinical practice situations. For example, we are now concerned with excess food consumption and there is an alarming concern over increasing obesity rates (Unnithan-Kumar and Tremayne, 2011). In midwifery, obesity in pregnancy has had a considerable impact for women with a high BMI both in terms of choices around childbirth and their qualitative experience of our maternity services (see Chapters 12 and 13; Deery, 2011). ‘Obesogenic organisms’ have been described as living in environments where routine and everyday circumstances encourage them to eat less and exercise more (Hanlon et al., 2012: 90). Whilst environmentally this might be ideal, using ‘eating less and exercising more’ as a mantra for losing excess weight is not helpful because it does not take account of the different ways in which individuals ‘use’ food, culturally and emotionally. For example, excess body fat is valued in some cultures because it is a sign of health and wealth (Belasco, 2008; Brown, 1993), attainable only by those of higher socio-economic standing. Other individuals use food as a means of dealing with the stresses of everyday life (Orbach, 1986). However, these viewpoints have shifted over time, with fatness/obesity now seen in Western society as being deviant, ugly and as a disease (Lupton, 2012). Fatless bodies have now become something for Western women to emulate, although boundaries have become blurred as to what actually constitutes acceptable thinness. Thus we have seen an increase in eating disorders such as anorexia nervosa and bulimia (Bordo, 2013; see also Chapter 6). Susie Orbach’s words describing the pressures some women feel when striving for thinness are as relevant today as they were in 1986:

Diet, deprive, deny is the message women receive, or – even more sinister – they must pretend that cottage cheese and melon is as pleasurable as a grilled cheese sandwich for lunch. For a woman, then, food is an object of an entirely different character. It is a potential enemy and a threat. A cardinal rule of femininity, from young women in their teens through women in their fifties, is that they should be desirable. Desirability is linked with an ever-diminishing body size, which is attainable by most women only through severe restrictions on their food intake. And because the ‘right size’ for women has been decreasing yearly since 1965, so women have been encouraged to decrease their food intake yearly.

(Orbach, 1986: 65)

Food as a ‘potential enemy and a threat’ can describe the way in which some people ‘use’ food (sparingly and to excess) to deal with the stresses of life. The manner in which people use food in this way is a neglected area of research and one that is rarely taken into account when midwives are giving nutritional advice. An edited text by Unnithan-Kumar and Tremayne (2011) addresses some of these less well-understood motivations relating to body weight in different social, economic and cultural contexts.

The dominant bio-medical discourses around pregnant women and their behaviours are understood primarily as risks to their contained fetus (Davies et al., 2013). As such, issues of nutrition and feeding in pregnancy, including food scarcity and obesity as well as specific food taboos, present us with an ‘ingenuity gap’ (Homer-Dixon, 2000; Hanlon et al., 2012) – a gulf between the above challenges and our capacity as midwives to provide and devise effective solutions with women. Midwifery has the potential to offer an interconnected approach, encouraging healthy eating in the interests of the mother–fetus dyad (Davies et al., 2013; see Chapter 13).

As midwives, we are in a privileged position to be connecting with women when they are at a vulnerable time in their lives – a time that gives us the opportunity to work in partnership with them. As Leap (2000: 4) has stated,

At every stage of our interactions with childbearing women, as midwives, we should be adopting behaviours that will ensure that women can take up the power that will enable them to lead fulfilling lives as individuals and as mothers. The process of empowerment may have far reaching consequences in terms of women’s feelings of self worth and confidence.

As midwives, we know pregnant women who come from communities with low levels of social capital may be particularly at risk from a fragmented midwifery approach. As Putnam (1995: 67) has stated, ‘“social capital” refers to features of social organization such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit’. However, maternity services have been criticized, especially in the UK, as providing services that are unconnected, too complex and fragmented (Kirkham, 2010) and not inclusive, facilitative, or user friendly (Feldman, 2013). Disconnected services are not conducive to the provision of effective and equitable maternity services for women and in the UK we now read about women who make choices to opt out of our services (Edwards and Kirkham, 2012). We also know that lower socio-economic status seems to be a risk factor for increased levels of obesity, particularly among women and members of ethnic minorities (Wilkinson and Pickett, 2010). Environment may also be related to the accessibility of healthy food, although proximity to appropriate shops does not necessarily make healthy food accessible to everyone. Financial resources, mobility and expertise in cooking are also factors to take into account (Wilkinson and Pickett, 2010).

As Kirkham (2010) highlights, we live in a highly technologized society where problems are defined and solved by experts with specialist knowledge. As midwives, we tend to create a dependency culture, wanting to ‘make things better’ and ‘work problems out’ in a solution-focused way for women. Despite efforts in public health to move from this type of approach to making more changes to our physical and social environment, a healthier approach to individual lifestyle (especially around nutrition) does not seem to have taken place (Hanlon et al., 2012). In midwifery particularly we seem to have adopted an approach that can reproach women for eating poorly and thus placing their babies/children at risk as a result. This blame becomes most obvious in the dilemma of obesity, and I use this as an example here.

The issue of obesity, weight gain and pregnancy within a conventional weight-based paradigm has attracted enormous attention in recent years (Aphramor, 2005; see Chapter 13). Pregnant women using maternity services often receive clear messages that if they are obese they have a greater risk of developing a range of complications in pregnancy and childbirth (Deery and Wray, 2009). Obesity has become increasingly medicalized, with its relationship to poor neonatal outcome often misstated as cause rather than a correlation (Davies et al., 2013). In this respect the ‘black box, junk in; junk out’ scenario comes into play – inconclusive, incorrect evidence is deposited into the box, and reappears at the other side of the black box as legitimate conclusions (Fleck, 1979). As a result the media and health professionals often leap to conclusions that any possible health risks (e.g. hypertension, diabetes, heart disease and cancers) are caused by obesity. When behavioural variables are strongly favoured, other legitimate forms of evidence simply do not enter into the public domain for discussion and debate; the regurgitated ‘junk’ is merely asserted without reference to evidence that demonstrates otherwise, or questions the credibility of the findings (Aphramor, 2005). Increasingly, health professionals are taught to view obese women as ‘a statistic waiting to happen’ (Vireday, 2002), when in fact not all obese women will present as problematic. The degree of risk will vary, with clear differences between a well-nourished and an under-nourished pregnant woman, and weight/fat alone does not capture that distinction (Davies et al., 2013).

When midwives focus on women’s problems and needs a deficits model comes into play. When we do this we define communities and women in terms of what they cannot do, do wrong, or do not possess (McLean, 2011). Indeed, as described above, we encourage women to depend on midwives as well as on hospital and welfare services. Therein is the potential to disempower women who are the intended beneficiaries of our maternity services. As discussed earlier, women who are not seen by some midwives and obstetricians to be making adaptive changes towards health are labelled and stigmatized (Deery, 2011; see also Chapters 12 and 13). Such an approach also prevents midwives from asking questions about the promotion of health, well-being and nutrition from the perspective of the woman using maternity services.

Policy development has also focused too much on the failure of individuals and local communities to avoid disease, rather than on t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Illustrations
• Notes on contributors
• Acknowledgements
• Foreword by Barbara Katz Rothman
• Part I: Healthy eating and nutrition in childbirth
• Part II: Context and cultural issues
• Part III: Debates and controversies
• Part IV: Practical application and the way forward
• Index