Month One

Changing

A Preface to the Weekly Developments

For a brief revisiting of the birds and the bees, the start of your menstruation begins week one of your cycle. In week two, fertilization occurs and in week three, the fertilized egg (blastocyst) implants in your uterus, and the amniotic sac begins to form. So, when you take a pregnancy test (about two weeks after ovulation) this is actually considered week four of pregnancy (see the sidebar “Did You Know: You’re actually two weeks further along in your pregnancy than you may have thought?” for more information).

And of course for all of the upcoming weeks of your pregnancy, it is important to bear in mind that developmental markers are approximations. There’s a broad spectrum of what constitutes normal, and every baby develops at his or her own pace, to some extent. So, take these as guidelines to help you continue to investigate your pregnancy.

WEEK FOUR

• Neural tube is formed.

WEEK FIVE

• Embryo is .13 inches.

• Brain and spinal cord begin to develop.

• Major organs begin to form as well as the digestive, nervous, and circulatory systems.

WEEK SIX

• Baby is about .25 inches.

• The heart and major blood vessels are developing, and the beating heart can usually be detected during an ultrasound.

• The face, hands, and feet start to develop.

WEEK SEVEN

• Baby is .51 inches.

• Over 100 brain cells are produced each minute.

• The heart is becoming more complex.

• The kidneys are forming.

• The arms and legs begin to appear, and joints start to develop.

WEEK EIGHT

• This week, baby is officially called a fetus, which means “little one” in Latin.

• Baby is .63 inches (and growing a millimeter a day) and has a measureable weight now of .04 ounces.

• In case you didn’t know that there was one, the tail is now gone.

• Taste buds are developing.

East-West Fetal Development

The first eight weeks of gestation are correlated with the Chinese Liver. Associations of the Liver system include the element of wood, the color green, the eyes, and bitter flavors. The Liver’s nature is the springing forth of new life (think trees and plants bursting in the springtime).

Did You Know: You’re actually two weeks further along in your pregnancy than you may have thought?

It can be confusing to find out you are “four weeks pregnant” when you’re pretty sure you only conceived about two weeks ago. Four weeks ago, you were probably even having your period.

For a little insight, let’s harken back to the idea of Chinese medicine’s observation of nature as it’s applied to the body. Before there were ultrasounds, women looked to the lunar cycles to understand when they would give birth. After they suspected they were pregnant, women would note the phase of the moon that they saw in the sky and expect to give birth after seeing that same phase ten times. Ten lunar months is about 295 days, whereas Naegele’s Rule (Naegele was an obstetrician in the 1800s who developed the modern standard for calculating due dates) states that an average pregnancy lasts 280 days (forty weeks).

To compensate between the lunar calendar and Naegele’s rule, we count from the first day of your last menstrual period, which adds about fifteen days—the approximate time between menstruation and ovulation—to the total time of pregnancy. So by the time you miss your period and suspect you might be pregnant, you’re already about four weeks along!

Obviously, this is an imperfect system, since menstruation and ovulation dates vary from woman to woman, and implantation doesn’t even occur until seven to ten days after ovulation (and even sooner if you’ve gone through IVF because some of the cellular division has already happened by the time you transfer the embryo), but this should explain why you’re being told you’re four weeks pregnant, and why your due date will probably shift throughout your pregnancy as different measurements and assessments are taken. Interestingly, if left to their own devices, many first-time moms will go about two weeks past their “due date”—which brings us back to the original lunar cycle.

Drawing on the associations and the nature of the Liver, one supportive technique for this stage is to take walks in beautiful places and soak in nature’s calming attributes. Not only is this a good way to get some endorphins going and destress, but being around fecundity is particularly nourishing during this Liver-driven time. Additionally, looking at beautiful greenery at this green stage in your own pregnancy is a great way to reflect on the recent changes to your body and life and to begin to move through them gracefully. The Liver system also goes right into the reproductive tissue. So, activating the Liver through activity promotes blood circulation, which brings nourishment to your baby.

We can also think of this Chinese Liver as being loosely related to our Western nervous system. In fact, in fetal development (from both an Eastern and Western perspective), the nervous system is exactly what’s forming during this time: baby’s brain and spinal cord are already beginning to develop.

Just as you and baby are merged together, in Chinese medicine, emotions and physiology are intimately paired. The first month, while baby’s nervous system is beginning to form, is a great opportunity to work on your own nervous system. Tending to your own potential stress during this new transition supports you as well as baby. You can also think of this time as an opportunity to develop connections to yourself, to your baby, and to your new life.

These first weeks are the beginning of many changes to come. So, building up some supportive tools can help you set the precedent for navigating your pregnancy. It’s a wonderful time to focus on self-nurturing and self-care and to set the rhythm for the journey ahead of you.

Confirming Your Pregnancy

Most women suspect pregnancy around a missed period and confirm with an over-the-counter pregnancy test. The first such test was introduced in 1976, and although the technology to sensitize the test has improved, the results can occasionally still be false-negative or even, very occasionally, false-positive (if this happens you need to look at other hormone-related issues with your practitioner). It is more likely than not that if you’ve taken the test fourteen days or more after ovulation, your test is accurate—no matter how many times you stare at it. If you’d like a more quantitative test (just how pregnant are you, anyway?), you can request a lab test from your physician to look at the amount of human chorionic gonadotropin (hCG), better known as “the pregnancy hormone,” in your blood.

If you have a blood test for initial hCG levels, it’s comforting for the number to be larger rather than smaller (let’s say between 1,000 to 2,000 mIU/mL), but bear in mind that it’s more relevant that this number doubles or at least significantly increases from the initial blood draw to the next one. (A second blood draw is sometimes taken two days after the first one if there’s a question about the initial number or to confirm an appropriate increase.) The variance in the numbers (sometimes initially quite low) and the growth of the number is great, but not solely enough of a predictor for success. So, if it’s looking a little wobbly, hang in there. It’s too soon to know what’s going to happen. The best you can do is delve into supporting your pregnancy.

And if you are scrutinizing symptoms looking for confirmatory signs, know that it usually takes a few weeks for significant pregnancy symptoms to set in. Just stay with what you know right now. You’ve had your first positive pregnancy marker, and you’re pregnant right now. I would also like to emphasize that there’s virtually nothing you can do to disrupt a viable pregnancy. So, do your best to hang out with the unknown and tend to yourself as well as you can.

The Shock of the New

At a time when you may be feeling a bit of shock and craving some familiar comforts, your usual creature comforts may be on the “banned” list—things like coffee, wine, and hot baths are all but forbidden during pregnancy. It’s time to look for some new indulgences that will help you find some ease, nurturing, and nourishment when you need it most. It’s not just about baby; it’s also about tending to you. I highly recommend quiet yet busy activities such as walking, or just being in nature, gentle yoga, meditation or guided imagery, reading, cooking, knitting, or other crafty work—and an occasional cup of hot cocoa—to help you unwind and cope with the stress. These activities can help you feel like you’re doing something good for your pregnancy even if you’re feeling a little lost.

Indeed, emotional shock can often be the very first symptom of pregnancy. Change, after all, is often disconcerting—especially such an incredible change as finding out that you’re pregnant. Even if you’ve been planning this pregnancy, it can be truly traumatic to find out you’re actually pregnant. It’s probably the biggest news you’ll ever get in your life, and it affects your whole life indeed. So, be gentle with yourself as you adjust to this huge change. It is okay to not fully connect with your pregnancy right away. That’s normal. It’s like any other relationship: it takes time to acclimate, build trust, and understand this new dynamic in your life. You have plenty of time to grow into the idea (literally).

For women who have had a hard time conceiving, the nervous system can be patterned around peaks of hope and dips of grief during each previous cycle. It may take some time to reestablish a trust in your body and to adjust and connect with the new paradigm of pregnancy. I like to think of this as “repatterning.” In a therapeutic paradigm, one approach to trauma or a place of stuckness is to consciously and incrementally intervene. Similarly, in this stage of your pregnancy, you are seeking to create new and healthy thought patterns. Now that you’re pregnant, it’s an opportunity to reevaluate what your pregnancy journey means for you and to start to connect, even in the face of risk, with the new life developing in you. It’s time to let go and let nature get to work, and it’s okay to feel nervous. You are not harming your pregnancy by feeling any and all of your feelings.

But as we are thrust into this state of intense flux, it can be very confusing to try to simultaneously indulge in the joy of being pregnant while battling so many uncomfortable symptoms. You might not even feel pregnant. You might feel simply sick. Since nothing in this process is black or white, this, as with the rest of your mothering, will be about continually building a relationship with discomfort and listening to and trusting your intuition. So, give yourself room for “normal nervous.”

Aside from morning sickness, many physical surprises may happen in the beginning stages of pregnancy. Already, your digestion is slowing down to accommodate your pregnancy, and your body’s hormones are making massive adjustments. It’s not unlikely that you will experience insomnia, fatigue, or even lethargy; sore breasts; bloating. There are also more intense symptoms that can arise such as vaginal bleeding, abdominal pain or pelvic pain and odder symptoms such as a metallic taste in your mouth. I can’t tell you how many times women have come into my clinic saying, “No one told me I would feel this (fill in the blank) way!” Seemingly overnight, competent, energetic, productive women are often converted to forgetful, exhausted couch potatoes.

If this sounds familiar, you are not alone! I can assure you that it’s no reflection on your abilities as a mother or a woman, nor does it necessarily speak to your level of self-care. This is just nature taking over. Your body is doing the tremendous work of building a baby, and it’s time for you to slow down. Since most of us have a hard time modifying our lives voluntarily, nature has a nifty way of making us do what we can’t or won’t do for ourselves.

Nutrition

Now that the seed has been planted, so to speak, it’s a great time for the seeds for healthy eating to be tilled as well. We’ve all heard the expression “eating for two,” but although you will probably find yourself eating more than usual, you won’t necessarily be eating double the amount that you’re used to. You should, however, at least double your nutrients and your level of self-care. I think of it like companion planting—a gardening technique that strategizes which plants can be planted in proximity to each other to optimize nutrients and contribute to growth. Like in a companion garden, you and your baby are two people coming together and beginning a symbiotic relationship of shared nutrients to promote the best yield for everyone involved.

As soon as you know you are pregnant, it’s important to start eating in a way that is nutritious and doable for you. Of course, this can be challenging when coupled with morning sickness (more on that later). Recipes with (I hope) palatable morsels are sprinkled throughout this book to support you and your baby throughout the pregnancy. As we move into what to eat, let’s start with what not to eat and build from there.

Foods to Avoid to Prevent Foodborne Illness

For the most part, pregnancy is a great time to follow your instincts about food and eat what you feel like eating. But there are certain foods that pregnant women should avoid. It’s important to minimize exposure to foodborne microorganisms at this time, because your immune system is slightly suppressed during pregnancy—partly to reduce the chances of your immune system rejecting your growing baby.

Aside from personal aversions and what you might already feel inclined to reject, here’s a list of the main cautionary items you should avoid. However, If you do get a food-induced sickness, be comforted by the fact that food poisoning rarely affects the baby’s health.

• High-mercury seafood and shellfish: You can check with your local fish advisories to stay current, but this typically includes albacore, halibut, trout, tuna, salmon, and oysters, as a starting place.

• Raw or undercooked eggs, which are also found in eggnog, batter, hollandaise sauce, and Caesar salad dressing.

• Raw fish and raw meat

• Refrigerated pâtés

• Unpasteurized cheese (brie, feta, Camembert, bleu, ricotta, queso blanco, queso fresco): Pasteurization kills Listeria monocytogenes, which is a likely agent in bacterial infections during pregnancy (see Listeriosis on page 83 for more information).

• Juiced Brussels sprouts: Contain isothiocyanates that can induce chromosomal changes in cells and potentially cause damage to a developing baby.

• Alcohol

• Preferably eliminate, but at least minimize, caffeine, including not only coffee, but also mate and some herbal teas (black tea, green tea, guarana, kola nut, betel, bitter orange, yohimbe, mangosteen).

Herbal Tea

During a time when coffee, black tea, green tea, alcohol, soda, and even too much juice are not optimal, what’s left? Herbal tea can be a comforting treat for women, but—alas—not every herbal tea is safe. Even some of the typical remedies we see on the market for pregnancy have controversial ingredients. The lists below can help delineate what to absolutely avoid versus what to drink moderately, and what you can drink regularly without any concern.

Herbal teas that should be avoided in straight form during pregnancy are:

Aloe

Anise

Black cohosh

Black walnut

Blue cohosh

Fennel

Lime blossoms

Catnip

Comfrey

Dong quai

Ephedra

Ginseng

Hibiscus

Horehound

Kava root

Lemongrass

Licorice root

Mate (often contains as much caffeine as Mistletoe coffee)

Mugwort

Pao d’arco

Pennyroyal

Rosemary

Sage

Sassafras

Saw palmetto

Senna

Vetiver

Wild yam

Wormwood

Yarrow

In addition to the above “avoid” list, there are a few herbs that are a mixed bag, but bear in mind, the dose of herbs in a normal cup of tea is unlikely to have any negative impacts. This is just for you to be equipped with the full picture to choose to be as conservative or lenient as you’d like:

• Chamomile: Some people who have plant or seasonal allergies can also be allergic to chamomile.

• Ginger: Ginger’s function of easing morning sickness, which, by the way, takes about three weeks to kick in, has been substantiated in multiple studies as a safe and effective option, but there’s also some conflicting evidence that early on in pregnancy it may negatively affect fetal sex hormones.

• Nettle: This is a great iron builder and is likely very safe after the first trimester.

• Raspberry leaf: Likely safe after the first trimester, but has shown conflicting results in terms of both preventing, but also potentially stimulating, uterine contractions.

• Rose hips: A great source of vitamin C and can be safely consumed after the first trimester.

DAILY PREGNANCY TEA

It’s tea time, and you may be thinking so, what can I drink? It can be confounding to try to take care of yourself and stay hydrated and simultaneously avoid so many beverages.

Here’s a safe pregnancy tea for daily consumption:

Mix equal parts cinnamon, lemon rinds, and lemon balm steeped in a cup of hot water with some honey.

TAKING ROOT SOUP

I always turn to this soup as a first step in nourishing a new pregnancy. It’s a great way to get in the swing of making bone broth, which can be a wonderful companion during and after birth, and I love the idea of rooting with roots. It’s as easy as one, two, three … four.

Ingredients

1 pound organic, grass-fed beef, cubed

2 turnips, ½" cubes

3 parsnips, quartered

4 carrots, ½" slices

1–2 tablespoons Sesame oil

Sea salt

Bone stock 3 cups (see Boosted-Up Chicken Stock recipe, on page 46)

Directions

Coat the beef cubes in a generous covering of sesame oil and season with sea salt to taste.

Place pot (or Dutch oven) on stovetop and set flame or temperature to medium-high, add beef and sear all sides until brown (approximately five minutes). Add vegetables and stir periodically until starting to soften. Pour bone stock into pot and cover. Either turn stove down to a simmer for forty minutes, or place Dutch oven in the oven and cook at 250 degrees for two to three hours.

Insomnia

You’ve woken up to find that you’re pregnant, and now it may seem like you’ll never sleep again! Most people can’t fathom how they will survive these initial disrupted sleep patterns, let alone the sleep changes that will occur once the baby arrives. The “good” news is that nature has a way of making you practice sleep deprivation long before the baby comes. The even better news is that you will get through it.

I like to call this phenomenon of early-pregnancy insomnia “nature’s preparation.” Pregnancy is a time to begin to acclimate to the impending changes in your life once you have a child. Sleep disruption is most typical in the first trimester and the third trimester—and, of course, postpartum—but evolution has craftily made babies quite cute, and made you innately bonded to them, so that when they inevitably wake you up at night, the lack of sleep fades into the background, and you do what needs to be done to love and nurture your little one.

In the meantime, it can be daunting to feel sleep deprived long before your baby is even here to keep you up at night. Although there is no known explanation as to why nature is full of such ironies, we do know that sleep disturbances occur as a result of physiologic, hormonal, and physical changes associated with pregnancy. For instance, the need to consistently get up and urinate certainly can affect sleep. If you already have an existing sleep disorder, pregnancy may also exacerbate that pattern.

Let’s face it. Anyone is bound to be strung out without enough sleep. However, severe sleep disruption may warrant going to a specialist for appropriate diagnosis and treatment. Having this evaluation prior to birth may help minimize the potential for postpartum depression as well. It’s a good idea to assess the impact your lack of sleep is having on your life and take it from there.

But to palliate your initial sleep changes during this formative period of pregnancy, you may want to try a guided audio relaxation to help lull you back to sleep in the wee hours. By the way, this is a great time to record any active dreams you may be having. Many women enjoy looking back on their vivid pregnancy dreams as their own private storyline of their pregnancy. These dreams can often be a portal into examining some of your subconscious fears, anxieties, and hopes about your pregnancy, mothering, and intimate relationships.

Depression and Anxiety

Depression and anxiety, which I consider spectrums of each other, are complex issues, and the gradient of severity can be great. My general advice is that whatever tips the scales in one direction or another for you is worth seeking support around, but if depression and anxiety are arising for the first time during your pregnancy, do take into account that it is normal to have large feelings surrounding this big event.

Attempt to not compound the existing feelings by adding worry into the mix. Instead, try to give yourself permission to feel the full extent of what you’re feeling and move slowly, with an emphasis on observing rather than changing your state. Combine this emotional stillness with physical movement such as walking, and if this initial approach doesn’t settle you a bit, seek out whatever levels of support feel right—more time with your partner, regular meet-ups with friends or family, massage, acupuncture, talk therapy, or even psychiatry to explore the potential of help from medications.

Fluid Changes: Bloating, Swollen Breasts, and Increased Urination

Fluid changes abound right now, so it’s a deceptive time in that you might feel like the retention—or “fatness”—already calls for maternity clothes. What’s actually happening is that progesterone from the placenta is in full swing, and this same hormone that’s favorable for implantation also mimics symptoms of premenstrual syndrome (PMS) such as bloating and breast tenderness.

Progesterone also relaxes smooth muscle tissue in your body, including in your gastrointestinal tract. This relaxation isn’t so relaxing for you since it slows down digestion and metabolism, which is another contributor to bloating and flatulence. Not to worry—after the first month of distention and discomfort, your bloating will probably start to recede, and you’ll enter a pregnancy weight that actually represents the baby’s growth. As for the other discomforts, sluggish digestion does continue to increase throughout pregnancy and can elevate from gas to constipation and heartburn, but staying on the move can help everything move along.

Did You Know That There Are Nonpharmaceutical Ways to Combat Insomnia?

The only thing you can control (usually) is your breathing. So, focusing on your breath can be a great way to connect with safety when you’re feeling out of control. Meditation and Mindfulness have been shown to help with both falling asleep and waking up.

A basic technique is to focus on the rise and fall of your breath: inhaling and expanding your lower belly, then exhaling and gently pulling your lower belly toward your spine. Every time your mind wanders (which may be every millisecond), simply return to focusing on the rise and fall of the inhale and the exhale. Try a cycle of ten minutes of this breathing once a day.

Eliminate all caffeine, alcohol, and nicotine from the start (this will help with sleeping better and is, of course, important for baby’s health in general).

It’s worth noting that although light-exposure therapy is a popular technique, there have been short-term side effects recorded, such as headaches and, ironically, insomnia. You can also just try locking in your bedtime and waking-up time in order to maintain a stable sleep-wake rhythm.

Acupuncture is quite conducive for helping with pregnancy-related sleep disruption by relaxing the nervous system and promoting gentle endorphin production. We also say in Chinese medicine that the mind is stored in the heart. So, by using Chinese medical theory applied to acupuncture points, acupuncture can address the mixed, heart-based emotions that can be coming up during this time in order to quiet the mind. Try the acupressure point (Pericardium 6), which is described in the morning sickness section of this book, on yourself too.

A journal can be a welcome forum for those active pregnancy dreams, or to help an overactive mind relieve looping thoughts.

A snack before bed can also prevent you from hunger in the middle of the night.

Sweet dreams!

Breast Changes

Breast changes are often among the first indications of pregnancy, and enlargement usually starts to accompany tenderness about eight weeks in, although, in subsequent pregnancies, breasts sometimes don’t get as tender or as enlarged because they have been desensitized to the hormone changes from the previous pregnancy.

Normal accompaniments to these changes may include itchiness, stretch marks, and a darkening of your nipples and areolas, along with the bumps on your areolas (Montgomery’s tubercles) becoming more noticeable as they start expressing colostrum (a fluid that comes before milk) toward the end of pregnancy.

Va-va-voom! Don’t touch me! may be one of the conflicting sentiments as your breasts start to enlarge. In one study, changes in breast size were associated with the baby’s gender. Mothers of females developed more pronounced breast changes than mothers of males. This study went on to suggest that from an evolutionary perspective, early breast enlargement in women might function, as it does in other animals, as a sexual stimulus to maintain attractiveness during pregnancy. Considering the many preferences and aspects of attraction, who knows about this, but if the size increase is piquing your partner’s interest, it is, alas, usually a taunt, since your breasts are so sore that they’re likely off limits.

NOTE: When you’re changing up bra sizes, which I recommend doing right away, be sure to stay away from underwire, which can be restrictive to the important flow of blood to your breasts.

Frequent Urination

On another fluid note, the urge to pee can be an early indicator of pregnancy. Contributing factors include hormone changes and increased blood flow to your kidneys, which govern your bladder function. Down the road, this symptom is also exacerbated by the actual pressure of baby growing and compressing your bladder. So, start memorizing all of the bathrooms on your daily routes, but don’t let it discourage you from staying extremely hydrated. You can wear a panty liner if you need to account for some extra or unexpected leakage.

Flatulence: How to Not Fuel the Fire?

Most flatulence is produced from bacteria in the large intestine breaking down food. To assist this process, you can boost up on healthy gut bacteria (see the probiotics recipes throughout this book) and also experiment with eliminating foods that may be culprits for you, such as:

• Fats and dairy products (for a calcium-rich milk alternative, you can try the almond milk recipe, page 32)

• Beans

• Cruciferous veggies such as cabbage, cauliflower, Brussels sprouts, and broccoli

• Asparagus

• Highly processed foods—especially if they have high-fructose corn syrup

• Wheat

• Corn

• Potatoes

• Fried foods

Other tips for lessening intestinal woes are to eat small meals throughout the day, chew really well, drink beverages separately from food, and avoid carbonated drinks—you don’t need more things bubbling. A brisk postprandial walk can stimulate your digestion too.

NOTE: Smoking increases stomach acidity. So, if you weren’t already motivated to quit smoking, maybe this will put a different kind of fire under you.

Vaginal Bleeding and Cramping

It is always unnerving to see bleeding during your pregnancy. There are obvious connotations. However, bleeding can be normal at different stages, or even throughout a healthy pregnancy. Vaginal bleeding occurs in 15 to 25 percent of early pregnancies, and 50 percent of women who have vaginal bleeding in the first trimester of pregnancy still have a viable pregnancy. Having said that, it’s always advisable to get evaluated by your physician to rule out anything else that may be going on—and for your peace of mind.

Always act on the conservative side with bleeding: put your feet up and eat nutritious, iron-rich foods (see the section on anemia, page 137) to help keep up your stamina during this time of not only carrying a baby, but also losing blood.

With first-trimester bleeding, the most common things your physician will be working to rule out are miscarriage, ectopic pregnancy, cervical infections (which can inflame and agitate your vaginal tissue), and gestational trophoblastic disease (a very rare pregnancy-related tumor).

I’ve seen women go through entire pregnancies with what resembles a level of bleeding that you might associate with your period, and still have wonderfully healthy babies.

The first step to identifying the cause of the bleeding is to talk to your healthcare provider, but here are some tips for beginning to interpret the data for what’s typically within a safe, albeit disconcerting zone:

• Spotting and light bleeding episodes are not typically a risk for miscarriage, especially if the bleeding lasts for only one to two days.

• Heavy bleeding in the first trimester, especially when there’s also pain, is associated with higher risk of miscarriage.

• Seeing the yolk sac within the gestational sac during an ultrasound is a definitive sign of a healthy beginning to pregnancy, regardless of bleeding.

Cramping that feels like menstrual twinges often accompanies spotting and can be indicative of implantation, which occurs approximately seven to ten days after ovulation. As the baby continues to settle in to his or her new home in your endometrial lining, this periodic cramping might continue. This is different than sharp, stabbing, continual, and localized pain, which warrants getting checked out.

A Note on Miscarriage

Miscarriage is, of course, one of a pregnant woman’s earliest and most profound concerns. In the unlikely event you suffer a miscarriage, I can confidently say that there’s nothing you did to cause your pregnancy loss. It is very hard to disrupt a viable pregnancy.

Unfortunately, miscarriage occurs as a normal part reproductive life for many women—and it doesn’t mean anything about your ability to successfully carry your next child. As a matter of fact, it’s not until three pregnancy losses occur that most doctors recommend evaluation, and even then, 70 percent of pregnancies after recurrent losses have a chance of success. This is certainly not meant to make you worry about miscarriage, nor to diminish the severity or grief that you may experience in the event of a miscarriage, but sometimes, having the facts under your belt can provide an avenue of hope.

In the case of possible genetic abnormalities, which is the most prevalent thought around the cause of otherwise unknown reasons in a pregnancy loss—especially as one ages, nature usually makes the tough decision for you, but if you feel inclined to investigate the cause of your miscarriage, you can consult with a gynecologist or reproductive endocrinologist for a tissue biopsy and investigate what may have happened, plus add some strategies that may prepare you to try again with more success.

I also encourage you to seek out resources such as therapists or books on pregnancy loss, and some physical support such as acupuncture or massage, during this difficult time to help you gain insight and heal.

Cancer in Pregnancy

The most common cancers in pregnancy are estrogen-sensitive cancers such as breast (there’s even a specific diagnosis called pregnancy-associated breast cancer) and cervical. There are now a multitude of ways to safely diagnose and begin to address these cancers during pregnancy. Although it is a daunting diagnosis and can impose on breastfeeding (if receiving chemotherapy or radiation after delivery the drugs pass through the milk, and the process itself may diminish your milk supply), cancer itself rarely harms the baby.

Treatment decision should be made collaboratively with a multidisciplinary team including your gynecologist, oncologist, and a pediatrician.

Molar Pregnancy and Choriocarcinomas

A hydatidiform mole (also called a molar pregnancy) occurs when sperm cells fertilize an egg that doesn’t contain a nucleus (the mother’s DNA). So, all the genetic material is from the sperm cell, which of course precludes the possibility of a baby being able to form. Surgery is the solution. However, the abnormal tissue of the mole can continue to grow after surgery, which is the primary contributing factor to choriocarcinoma.

Choriocarcinoma is a rare, malignant cancer of the uterus that most often occurs after a hydatidiform mole but can also arise from a miscarriage, tubal pregnancy, or even a normal previous pregnancy. This cancer is classified as a gestational trophoblastic disease (GTD).

Trophoblasts are cells on the outer layer of a blastocyst, which provide nutrients to the embryo and develop into the placenta, but in this condition, the cells grow into the lining of the uterus. This is a more complex condition that will require your specialists to get on board to navigate a treatment path.

Bell’s Palsy

Bell’s palsy is characterized by one-sided weakness or paralysis of the face and often discomfort on one side of your head. It comes on suddenly and usually gets worse over a period of a few days. Thirty percent of the time, Bell’s palsy can be a predictor for preeclampsia.

Although you might feel temporarily disfigured, this is a beautiful example of how Chinese medicine can give insight into origins and relationships of a symptom for a Western diagnosis that doesn’t have a known reason or good treatment strategy. The Chinese medicine explanation (you’ll definitely have to step out of your Western mind for a moment for this) is that when the Liver, which is very active during pregnancy (it governs important aspects of reproduction, hormones and processing stress), gets a bit enraged (usually from an encounter with stress) it generates heat, and just like heat rises, the Liver “flares” up and drives these internal symptoms to the head and face. This is called “Liver wind.”

The very real result of this euphemistic “Liver wind,” is Bell’s palsy. This is also the same mechanism that causes high blood pressure. So, from a Chinese medicine model, it makes perfect sense that Bell’s palsy and high blood pressure (an aspect of preeclampsia) go together. The good news is that acupuncture can target the Liver system to get things back in check. So, see an acupuncturist for this one—the sooner the better, as results for this are more reliable if you can expedite your treatment.

As a side note, if you have an incidence of Bell’s palsy, you might need to rule out Lyme disease, as Bell’s can be a symptom of that tricky-to-diagnose condition.

Epilepsy

Epilepsy and other seizure-related disorders can be unpredictable and dangerous during pregnancy if not managed with appropriate medications. This is very challenging, since adverse outcomes during pregnancy, such as congenital malformations, are associated with antiepileptic drugs. Additionally, estrogen, which is at an all-time high during pregnancy, has been shown to lower your seizure threshold (making you more susceptible). Perhaps to balance this, progesterone, which is also dominant in pregnancy, has an antiseizure effect, but our bodies don’t necessarily provide us with all of the management or balance that we need.

Our body can, however, hint at our potential well-being. Studies have shown that epileptic women who are free from seizures for one full year before pregnancy are less likely to suffer from seizures during pregnancy. If you suffer from epilepsy, the best strategy for pregnancy is to assess your current medication levels with your physician and receive close monitoring throughout your pregnancy.

In Chinese medicine, epilepsy is attributed to a more extreme gradient of the “Liver wind” that we discussed in the Bell’s palsy section above, and just as with Bell’s palsy, acupuncture can be a safe and viable method for managing and treating seizure disorders.

NOTE: A standard supplement recommendation for pregnant women with epilepsy is to take 5 milligrams of folic acid daily.

Metallic Taste

The technical name for the metallic taste you might experience before you even know you’re pregnant is called dysgeusia, which you might notice sounds an awful lot like “disgusting.” Dysgeusia isn’t limited to the flavor of pennies corroding in your mouth; you might also notice a sour or bitter flavor.

Dysgeusia comes from the same origins as nausea and vomiting—which is to say, we don’t really know why it happens from a Western point of view. Although, we can surmise that the notable changes in the secretion of hormones that occurs during this stage may be partially responsible. Chinese medicine relates sour and bitter flavor profiles to the action of the Liver, which as you now know, is an active system during this time, and women who experience severe nausea and vomiting (also a Liver-driven theme) tend to be the ones who also experience dysgeusia.

It’s also common to develop an enhanced sense of smell during pregnancy, which is intimately connected to your sense of taste. Like nausea and vomiting, dysgeusia typically recedes or disappears altogether in the second trimester.

In the meantime, to troubleshoot:

• Assess your current medications (some medications can cause a metallic taste).

• Make sure you’re taking your prenatal vitamin to get enough B12 and zinc, as those deficiencies can be a potential source of the metallic taste.

• Check out your oral health with your dentist (and be sure they’re well-versed in preganacy-safe dentistry modifications).

• Drink the Morning Mocktail recipe—it might help override the unpleasant taste as well as strengthen your digestion.

• Concoct and swish with the recipes for Mild Mouthwash or Green Tea Mouthwash on pages 27–28.

MORNING MOCKTAIL

In addition to being very hydrating, this drink is rich in magnesium, fiber, and enzymes and is a good source of beneficial fats and oils. It’s also an efficient way to get a full spectrum of green veggies into your diet if you’re not inclined to be eating a pile of them every day. As you may recall, green is also the color that’s associated with the Liver system. So, boosting up on these greens means a boost to this whole system.

Put a handful of each or some (depending on availability and inclination) of the following veggies in a blender, with equal parts coconut water and coconut milk to mask the “greenness” a bit and increase electrolytes and subsequent hydration.

Celery

Beet greens

Dandelion greens

Parsley

Cilantro

Swiss chard

Kale

Pineapple chunks

A small piece of chopped ginger root (optional based on discussion of herbal teas in the beginning of this section)

1 tablespoon coconut oil

Strain through fine mesh if your blender doesn’t liquefy the ingredients.

MILD MOUTHWASH

Mix ¼ teaspoon baking soda in 8 ounces of water and swish and spit to neutralize the pH levels in your mouth.

GREEN TEA MOUTHWASH

1 teaspoon powdered green tea (also known as Matcha)

Dissolve and mix the powder in warm water and swish and spit to enhance antibacterial and anti-inflammatory activity in your mouth.

See resource section for where to get powdered green tea.

Rhesus Factor (Rh Factor)

None of us likes the idea of outright rejecting our offspring, but sometimes our body doesn’t cooperate with our feelings. Rhesus Factor (Rh) can be one of those times. Rh is a protein on the surface of red blood cells. If you have this protein, you are Rh positive, and if you don’t, you’re Rh negative.

If you’re Rh negative and your baby is Rh positive, your body might produce antibodies that attack baby’s red blood cells. This only becomes relevant during pregnancy (and is kind of like an allergic reaction to bee stings, which gets much worse with the second sting—in other words, it is often only an issue in subsequent pregnancies). And since your baby has its own blood system during the pregnancy, it is really only relevant during delivery, amniocentesis, or chorionic villus sampling—when your blood can comingle with baby’s.

If you’re Rh negative, you’ll be monitored through blood tests at different stages during your pregnancy, and you may be required to get an injection of Rh immune globulin to help prevent your body from producing Rh antibodies. If you’re already producing these antibodies, the injection won’t counteract it. You and baby will be monitored for the possibility of baby needing a blood transfusion either during pregnancy (through the umbilical cord) or right after birth.

It’s helpful to get dad measured for Rh factor too, because if you’re negative and he’s negative, baby will always be negative, but if you’re negative and dad is positive, you have the unknown variable of baby possibly being either Rh positive or Rh negative.

The Basic Prenatal Checkup Schedule

Your checkups can range from making you feel comforted to overly monitored. Since much of pregnancy is just like parenthood, navigating on your own the best you can in-between visits may console you. Having said that, there are plenty of studies that indicate regular checkups produce healthier babies. We can deduce that this helps everyone catch any issues as soon as possible. However, visit increments vary depending on your needs, desires, and the advice of your practitioner. And note that there is usually an increased frequency of visits if you are carrying multiples. Here are some general guidelines for what to expect:

Four to twenty-eight weeks

One visit per month

Twenty-eight to thirty-six weeks

Two visits per month

Thirty-six weeks to delivery

One visit per week

Living with Your Liver

Some liver conditions such as HELLP syndrome are unique to pregnancy, but others such as hepatitis may be pre-existing issues. Either way, optimizing your liver’s function during pregnancy is an important aspect of managing your care.

HELLP Syndrome

HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelet-count syndrome. Thankfully, the occurrence of this pathology is small (happening in only about 0.8 percent of pregnancies), but this risk increases to 10 percent if you have severe preeclampsia, which is really the only thing to monitor, since there are rarely any hints at the acute development of HELLP. If this syndrome develops, it is a severe and potentially life-threatening issue that needs immediate emergency medical intervention.

Exercise

The analysis of available research on exercise and pregnancy basically says to do what you did before—unless you did nothing before you got pregnant, or are prone to running marathons regularly. Essentially, you should continue to exercise moderately and mindfully. You are your own best barometer for what’s right for your body during this time. Exercise has many health benefits, such as endorphins and cardiovascular strengthening that can contribute to your pregnancy and your own health and well-being during pregnancy.

A general guideline to keeping your heart rate within good boundaries is to still be able to talk while you’re exercising. I also recommend avoiding extremely heavy lifting or severe abdominal crunching. Although, the truth is, it’s very hard to dislodge a viable pregnancy. Babies are resilient, and so are you.

Some pregnancy-conducive exercises to explore, if you haven’t already, are prenatal-specific yoga and Pilates. Both emphasize relaxation and strengthening. Swimming is wonderful for building lung capacity and counteracting shortness of breath, and walking and hiking are great for circulation and bone density. Just be aware of how the hormone relaxin can leave your ligaments a little looser and predispose you to sprains and strains with rigorous, weight-bearing exercise. So, make sure to stretch, and no matter what you do, always pay close attention and be responsive to your body’s needs and sensations.

Hepatitis

The word hepatitis translates from its Greek and Latin roots to literally mean “inflammation of the liver,” and the ABCs of this inflammatory process of the largest internal organ (the skin being the largest organ overall) actually include hepatitis A, B, C, D, E, G, and X. However, the most prevalent ones that we’re concerned with are A, B, and C.

The Truth about Caffeine

We’re all entitled to a vice, and coffee is a worldwide choice. It’s actually the number one source of antioxidants for most people. During pregnancy, however, it’s time to let it go. Caffeine is not evil, but in pregnancy its role is controversial, and there is enough evidence that points to it being unfavorable—especially in early pregnancy. When we talk about caffeine, we’re not just talking about coffee but also caffeinated teas, soda, and some over-the-counter medications.

Western medical literature does say that drinking one to three cups of coffee per day is okay, but caffeine stays in a pregnant woman’s system for about triple the amount of time that it circulates in a nonpregnant woman, and to boot, it crosses the placental barrier, where the baby lacks the adult enzyme needed to effectively metabolize the caffeine. Since caffeine has been linked with low birth weight, preterm delivery, and even miscarriage, I say try another method of indulgence for these ten months (and a bit more, if you’re breastfeeding). After all, research indicates that adrenaline doesn’t even come from the coffee itself, but from the anticipation of the cup of coffee. So, maybe you can rewire your excitement into a cup of hot cocoa.

Chocolate, contrary to popular belief, does not contain the same stimulant as coffee. Chocolate contains an alkaloid called theobromine, which is in the same class of compounds as caffeine, but is not caffeine. However, since they’re related, chocolate should also be consumed in moderation for some of the same reasons. If you need a little indulgence, the benefits of a cup of cocoa do outweigh the potential negative side effects of coffee. Chocolate, with a 70 percent cacao content, has been shown to contribute to reducing blood pressure and stabilizing blood sugar during pregnancy and may lower the risk of preeclampsia.

A Note on Decaffeinated Coffee

Although it initially seems like a better option, if it’s not water processed, that means harsher chemicals are used to filter out the caffeine—also not good for you or baby. Even decaf has a little bit of caffeine in it, and with the extended stay of caffeine in your body during pregnancy, it’s just not the best choice.

COFFEE ALTERNATIVE: COCOA WITH HOMEMADE ALMOND MILK

Cocoa Ingredients

½ part carob powder (found at most health-food stores, and of course online)

½ part cocoa powder (70 percent cacao content)

Almond Milk Ingredients

1 cup raw, unsalted almonds, skin-on

4 cups filtered water, plus more water for soaking almonds

1 ½ teaspoons honey, or one whole pitted date

Dash of salt

You will also need

Blender

Fine mesh strainer or muslin cloth

1-quart glass jar or storage container

Directions

Blend all of the almond milk ingredients together on high until liquefied, and strain into your jar or storage container. Pour 1 cup of almond milk into a small saucepan and keep the rest in the fridge for next time. Bring almond milk to a simmer and slowly add carob and cocoa powder to taste. I recommend starting with 1 tablespoon of each. Continue to stir or whisk until thoroughly blended and warm.

Hepatitis A (HAV)

HAV is contracted from contaminated food, water, or feces. Pretty much everyone who develops HAV makes a spontaneous, full recovery without the need for intervention and without running the risk of developing a chronic liver condition. If your baby is exposed, the infection is usually mild and the good news is that the baby will have immunity to it for life, but you can minimize your chances of getting HAV by managing your sanitation—washing your hands and your food. The main treatment is rest and a nutritious diet.

Hepatitis B (HBV)

HBV is transmitted through infected body fluids such as blood (which is the primary way that your baby is potentially affected during birth), sexual fluids, or from being pricked by an unsterilized needle. It is inconclusive whether or not C-section mitigates the risk of transmission to your baby, and although HBV is also transmitted through breast milk, when you’re not on antiviral therapy; if your baby is vaccinated, breastfeeding is not contraindicated.

Treatment strategies such as the antiviral medication Tenofovir (Viread) depend on your viral load and how advanced your condition is. As ever, managing anything during pregnancy includes balancing an analysis of the risks and benefits to you and baby.

To be up-to-date on taking antivirals for HBV during pregnancy, you can check out the antiretroviral pregnancy registry (APR): http://www.apregistry.com/forms/interim_report.pdf.

Preventing HBV includes practicing safe sex and not sharing any personal items that can impart traces of blood such as razors or manicure implements. For managing HBV during pregnancy, rest and nutrition geared around repairing the liver are essential. The basic nutritional principles are to eat low-fat, easy-to-digest foods such as broths and soups with lots of bitter greens such as dandelion, chicory, and endives (these help stimulate the liver to process bile and eliminate toxins more effectively), and spices that are known to contain liver-protecting compounds, including turmeric, garlic, and black pepper.

Additionally, start each morning with a glass of warm water with half of a freshly squeezed lemon in it (helps the liver to gently flush out accumulations.) Continue to hydrate throughout the day with electrolyte drinks (see the Electrolyte Refresher recipe on page 37 to make your own), and incorporate some of the supplements below.

Hepatitis C (HCV)

HCV is usually spread through direct contact with HCV-infected blood. The approaches to prevention and management are similar to HBV, but there’s not a safe medication treatment available during pregnancy.

Some pregnancy-safe support to boost immunity during pregnancy can include:

• Vitamin C: 1,000 mg one to three times a day (antioxidant)

• Co Enzyme Q10: 200 mg at night (antioxidant)

• Acetyl-L-carnitine: 500 mg a day (antiviral and antioxidant)

• Probiotics containing Lactobacillus acidophilus (if you are taking immune-suppressive drugs, only take under supervision)

• N-acetyl cysteine (NAC): 200-500 mg three times a day (liver and antioxidant support)

• Cordyceps: 3 grams two times a day (a Chinese medicinal mushroom to support the liver and improve the immune system)

• Reishi mushroom: 150-300 mg two times a day (another type of mushroom used in traditional Chinese medicine to decrease the hepatitis virus)

Supplements and medications to avoid because they are particularly harsh on the liver include:

• Vitamin A

• Tylenol

Acute Fatty Liver

The causes of this pregnancy-specific condition aren’t always known, but if the liver already has scar tissue or cirrhosis from chronic hepatitis, the extra demands on this organ during pregnancy may predispose you to this condition. It’s also postulated that acute fatty liver can arise from a deficiency of an enzyme produced by the liver that normally allows pregnant women to metabolize fatty acids.

Symptoms are most common during the third trimester: nausea, vomiting, pain in your upper abdomen, jaundice, and increased thirst and urination. This condition can become incredibly severe fairly quickly and can adversely affect both you and your baby. Your baby could be born with a deficiency in this enzyme, but the more severe threat is a high mortality rate for such pregnancies. The only treatment is a delivery at the earliest time that’s relatively safe, typically followed by plasma-exchange therapy. Barring severe damage, there’s a good prognosis for recovery for everyone after birth.

Anatomy of a Prenatal Vitamin

Pregnancy is an amazing time of change in your body and in your life. It’s important to take prenatal supplements, but note the word “supplement”—prenatals are not intended to replace the nutrition you get from food, but to round it out. They should be used with a backdrop of striving for good nutrition through whole foods. The foods you eat before and during your pregnancy will prepare your body to support healthy growth and development and contribute to a nourished pregnancy and birth.

During this time, you need extra food and nutrients. Here’s a review, based on the Dietary Reference Intake (DRI) from the Institute of Medicine (IOM) of what a pregnant woman should consume and how much. You can use this information to inform you about attaining optimum health for you and your baby’s growing needs and as a guide for assessing a prenatal vitamin and incorporating the appropriate foods alongside your vitamins.

If you’re worried that you’re not getting enough of something, it can be easy to duplicate nutrients by taking them through multiple supplements. But keep in mind that there can be too much of a good thing. So, be sure to refer to the guidelines on the upper limit (UL) of certain nutrients that you don’t want to take too much of.

As a foundation for your prenatal vitamin support, a couple of high quality brands that I recommend, which are typically easier to get down than some of the others, are an over the counter option such as Rainbow Light (see resource section) and Thorne, which you can get prescribed through your healthcare provider.

NOTE: I recommend avoiding prenatal vitamins with fish oil in them. Fish oil can easily go rancid and corrupt the health-giving effects of the other nutrients—rendering them more harmful than helpful. If you’re taking fish oil, be sure to source a brand that is refrigerated and screened well for heavy metals, toxins, and other contaminants.

The Fundamental Building Blocks for Your Daily Nutrition

Calories: 2,300-3,200 (if you’re carrying multiples, add 300 calories more for each additional baby)

Fiber: 28 grams

Protein: 71 grams (increase about 10 grams per trimester)

Carbohydrates: 175 grams

Water: 3 liters

VITAMIN A 770 MCG (UL 3,000 MCG)

Also known as Retinol, vitamin A is important for the development of the heart, lungs, kidneys, eyes, and bones, as well as the circulatory, respiratory, and central nervous system. It also helps with resistance to infection and aids fat metabolism and helps maintain normal vision. Vitamin A is particularly essential for women who are about to give birth, because it helps with postpartum tissue repair.

Having said all of that, too much vitamin A can cause birth defects. 770 mcg or the equivalent, 2,565 international units (IU) of vitamin A is the daily recommended dose for pregnant women. For perspective, three ounces of cooked beef liver contains 27,185 IU and three ounces of cooked chicken liver contains 12,325 IU. The food sources of vitamin A below will help you define what to include in your diet so as not to be too intimidated by this important nutrient.

Food Sources: Vitamin A from animal sources such as beef, liver, and cod liver oil is fat soluble and can build up and become toxic, whereas plant or carotenoid sources do not accumulate in the body in the same way. So, foods such as butternut squash, cantaloupe, carrots, dried apricots, kale, papayas, paprika, peaches, pumpkins, spinach, sweet potatoes, and turnips are preferable sources of vitamin A during pregnancy.

VITAMIN C (AS ASCORBIC ACID) 150 MG (UL 2,000 MG)

Vitamin C contributes to tissue repair, specifically the production of collagen—a structural component of cartilage, tendons, bones, and skin. It is also an antioxidant that protects you from cellular damage, aids your body in fighting infections, and helps you absorb iron.

VITAMIN C-RICH ELECTROLYTE REFRESHER

This electrolyte beverage can help you boost up on vitamin C and keep you hydrated by transporting fluids and nutrients to your cells. Here’s how to make your own delicious, low-sugar electrolyte drink:

Ingredients

Water

Coconut Water

Sea Salt

Citrus Juice (mix and match orange, grapefruit, lemon, lime to your liking). Fresh squeezed has the highest degree of nutrients and is always the most delicious, but it’s fine to use store bought in a pinch.

Coconut Sugar or Honey (optional)

Directions

Mix equal parts water and coconut water (which has natural electrolytes in it). Add a pinch of sea salt (even though this increases fluid retention, it also helps with fluid transportation). Squeeze in citrus juice from oranges, grapefruits, lemons, or limes. Add an optional small amount of organic coconut sugar or honey.

You can keep a jug of this refresher in the fridge to sip on.

Food Sources: Citrus fruits, broccoli, cabbage, green peppers, melons, oranges, potatoes, strawberries, and tomatoes.

CALCIUM (AS CALCIUM CITRATE-MALATE) 1,000 MG (UL 2,500 MG)

As a culture, our current calcium intake is about a quarter of what we used to consume before the start of agriculture about 10,000 years ago. So, most of us run a little calcium deficient, and the need for calcium is even 50 percent greater during pregnancy.

Calcium helps form the baby’s teeth and bones, aids in heart and muscle function, and is important for blood clotting and proper nerve function. If you don’t have enough calcium, your body will pull it from your bones, and since the minerals in the body are in a delicate, dynamic balance, if a deficiency in calcium exists, other minerals may also be out of balance. The following recommendations to increase calcium absorption should also improve the effective utilization of all minerals in the body.

Food Sources: Contrary to popular belief, calcium from milk sources is usually not well absorbed or tolerated. Some high-quality yogurts and kefirs contain probiotics and pose an exception to this rule. In general, more easily assimilated calcium-rich pregnancy foods include:

• Arugula

• Beans (adzuki, black, lima, mung, soybeans)

• Blackstrap molasses

• Chicken

• Collard greens

• Dark chocolate (high-quality and at least 70 percent cacao content)

• Dried fruit (figs, prunes)

• Dried seaweeds (arame, hijiki, kelp, kombu, wakame)

• High-chlorophyll foods (blue-green algae, chlorella, spirulina, wheat or barley grass)

• Kale

• Nuts and seeds (almonds, cashews, hazelnuts, sesame seeds)

• Parsley

• Pumpkin

• Quinoa

• Sardines

• Tofu

• Turnip greens

• Watercress

• Whole grains (barley, buckwheat, corn, millet, rice, rye, wheat berries)

NOTE: Some sea vegetables provide ten times as much calcium as cow’s milk, and three cups of arugula (basically a full salad portion) provide 400 mg of calcium.

Just as it’s important to get enough calcium from the foods you eat, it’s also important to avoid foods and substances that inhibit the absorption of calcium.

Foods and substances that inhibit calcium absorption:

• Alcohol

• Cigarettes

• Coffee

• Diuretics

• Excessive protein

• Excessive salt

• Refined sugar

• Soft drinks

• Bell peppers, eggplant, potatoes, and tomatoes (these vegetables contain the calcium inhibitor solanine)

• Too little or too much exercise (moderate exercise prevents calcium loss, but excessive physical activity has been shown to cause calcium loss)

VITAMIN D (AS VITAMIN D3) 5,000 IU IN EARLY PREGNANCY AND 6,000 IU IN LATER STAGES (UL 10,000 IU)

Without the pre-hormone vitamin D, we do not have the substrate for calcitriol (the hormonally active form of vitamin D), which is pivotal for brain development—especially during pregnancy. Vitamin D also helps your body maintain proper levels of calcium and phosphorous to build your baby’s bones and teeth.

A vitamin D deficiency during pregnancy can cause slowed growth and skeletal deformities and may also have an impact on increased risk for rickets in babies, low birth weight, delayed development, and long-term lowered immune function. A deficiency of vitamin D has also been linked to a greater risk of pregnancy complications, including preeclampsia.

CALCIUM-RICH SEA VEGETABLE QUINOA BOWL

Makes 4 servings

Ingredients

1 cup dried quinoa

3 cups water or vegetable or chicken stock (see Boosted-Up Chicken Stock recipe)

1 cup kale, finely chopped

¼ cup basil, coarsely chopped

2 tablespoons nutritional yeast

1 tablespoon dulse flakes (a sea vegetable that can be found in many health or specialty food stores)

½ a lemon, juiced

½ an avocado

1 tablespoon flax seeds

1 tablespoon pumpkin seeds

2 tablespoons cold-pressed olive oil

A pinch of sea salt

Directions

Rinse quinoa and drain. Bring quinoa and water or stock to a boil. When the water boils, reduce to a simmer. Simmer with lid not completely on, allowing some air to escape.

Cook for about twenty minutes, or until the liquid has evaporated and the quinoa is cooked.

Stir in the kale, basil, nutritional yeast, dulse flakes, and lemon juice. Top with avocado, flax, and pumpkin seeds. Drizzle olive oil over the top and season with sea salt.

CALCIUM-RICH SAVORY MEDITERRANEAN YOGURT

This dish is a nice change of pace that incorporates both sweet and savory flavors. Chickpeas (garbanzo beans) are an incredible source of folate as well.

Ingredients

¼ cup finely chopped yellow onion

2 tablespoons butter or ghee (clarified butter)

1 large garlic clove, minced

½ teaspoon ground cumin

A pinch of ground turmeric

One 15-ounce, BPA-free can of chickpeas, drained (or cooked from dried chickpeas)

1 cup water or chicken or vegetable broth

Lemon wedge

Salt and freshly ground black pepper, to taste

¼ cup slivered almonds and/or walnuts

1 ½ cups whole-fat yogurt with live cultures

1 cup chopped or grated cucumber

1 tablespoon chopped mint

Directions

In a medium skillet, heat the butter or ghee until it melts but does not brown.

Add onion and garlic and cook over medium heat until onion is translucent, five to seven minutes.

Stir in cumin and turmeric, stirring, for one minute. Add the chickpeas and broth and bring to a boil. Cover and simmer over low heat for fifteen minutes. Remove lid and bring back to a boil. Cook, uncovered, until the liquid is reduced, about three minutes. Stir in a squeeze of lemon and season with salt and pepper. In a small, dry skillet, toast the almonds or walnuts, stirring, until golden—about four minutes. Scoop yogurt into a bowl and top with chickpea mixture, nuts, cucumber, and mint.

Food and Lifestyle Sources: Vitamin D isn’t actually a vitamin at all. It’s a prehormone that is catalyzed into useable vitamin D by a heat reaction, which may account for part of the reason that sun exposure is necessary for vitamin D conversion. Vitamin D can be obtained through dietary intake, but unless you have a diet rich in reindeer meat, lichen, or seagull eggs, it is unlikely that you are getting adequate dietary sources. So, make sure you get some sun, and since prenatal vitamins usually only contain a trace level of vitamin D, supplement with a liquid form of vitamin D as well.

FOLIC ACID AND FOLATE (AS 5-METHYLTETRAHYDROFOLATE) 600 MCG (UL 1,000 MCG)

These two terms for vitamin B9 are often used interchangeably, but folate occurs naturally in food and folic acid is the synthetic compound. The body tends to metabolize the food source better, and since this is such an essential ingredient for pregnancy for helping to prevent neural tube defects (NTDs)—serious birth defects of the spinal cord (such as spina bifida) and the brain—it’s ideal to be getting your dose in even before you conceive, but certainly throughout pregnancy. Some research suggests that getting enough folate may also help lower your baby’s risk of other defects such as cleft lip, cleft palate, and certain types of heart abnormalities.

Your body also requires folate to make normal red blood cells and prevent anemia, and it’s essential for the production, repair, and function of basic cellular building blocks. So, getting enough folate is particularly important for you and the rapid cell growth of your placenta and developing baby.

Food and Supplement Sources: To boost your supplementation, good food sources of folate are: asparagus, broccoli, chicken liver (just be mindful of the amount of this one based on the vitamin A discussion), dark leafy greens, dried peas and beans, green beans, green peas, melons, oranges, spinach, and turnip greens.

NOTE: If using a supplement, look for methylated folate (called 5-MTHF). Unlike folic acid, it doesn’t need to be converted by the liver. So it delivers the usable folate directly to your system and doesn’t mask B12 deficiency.

IRON (AS IRON PICOLINATE) 27 MG (UL 45 MG)

Iron is recommended to help prevent or treat anemia and helps the placenta develop and keeps you and your baby strong.

IRON WOMAN ENERGY SNACKS

Put all of the following in a mixing bowl, stir, and shape into bite-sized morsels to keep in the fridge and snack on one to two times a day:

½ cup tahini (sesame seed butter)

½ cup almond butter

2 tablespoons molasses

1 tablespoon wheat germ (take out if you eat gluten free)

1 tablespoon ground flax seeds

1 teaspoon spirulina or other green, chlorophyll-based powder

Food Sources: There are two types of iron that you get from food: heme and nonheme. Heme iron is found in animal foods such as egg yolks, poultry, liver, red meat, salmon, and sardines canned in oil; nonheme iron comes from plant sources such as artichokes, baked potatoes, beets, broccoli, chickpeas, dried apricots, dried prunes, figs, lentils, lima beans, molasses, oatmeal, pumpkin seeds, sesame seeds, and wheat germ.

NOTE: Plant-based irons are best absorbed if eaten with foods rich in vitamin C such as dark leafy greens (kale, mustard greens, Swiss chard etc.), papaya, parsley, and thyme. Iron absorption from any source is interfered with when consumed with tea or coffee.

THIAMIN (AS THIAMIN HCL) 4 MG

Also known as vitamin B1, thiamin enables you and your baby to convert carbohydrates into energy. It’s essential for your baby’s brain development and aids the normal functioning of your nervous system, muscles, and heart.

Food Sources: Thiamin is found in brown rice, flax seeds, legumes, oatmeal, potatoes (skin on), sunflower seeds, and watermelon.

RIBOFLAVIN (AS RIBOFLAVIN 5-PHOSPHATE SODIUM) 3.6 MG

Also known as vitamin B2, riboflavin helps your body produce energy. It promotes growth, vision, and healthy skin, and it’s important for your baby’s bone, muscle, and nerve development. Riboflavin is a water-soluble vitamin, which means your body doesn’t store it, so you’ll need to consume enough each day.

Food Sources: Riboflavin is found in soybeans, beet greens, yogurt, spinach, eggs, and almonds.

VITAMIN B6 (AS PYRIDOXAL 5-PHOSPHATE) 10 MG (UL 100 MG)

Also known as pyridoxine, B6 helps your body metabolize protein, fats, and carbohydrates. It also helps form new red blood cells, antibodies, and neurotransmitters and is vital to your baby’s developing brain and nervous system.

IRON-RICH KALE CHIPS

Chop a bunch of destemmed kale into about 3-inch pieces and lightly coat with olive oil and mustard. Spread on a lined baking sheet and cook in a preheated oven at 350 for approximately twenty minutes. NOTE: Kale should be allowed to dry thoroughly after rinsing, or it won’t get crispy.

PUMPKIN SEED PESTO

This is a delicious and iron-rich spread you can eat on crackers or bread, use as a vegetable dip, mash with a sweet yam, or add to pasta. In a food processor or blender, pulse the following ingredients:

6 tablespoons extra-virgin olive oil (you can use more or less depending on your texture preference)

A handful of fresh herbs such as basil, cilantro, and parsley

1 tablespoon tahini butter

1 tablespoon pumpkin seeds

2 tablespoons of walnuts and/or pine nuts

A dash of salt

1 clove of fresh garlic (omit if you’re having digestive trouble)

NOTE: Research shows that extra vitamin B6 may relieve nausea and vomiting for some women during pregnancy. See section on morning sickness for more info on using B6 for nausea and vomiting.

Food Sources: Vitamin B6 is found most prevalently in bananas, beef, salmon, and sunflower seeds.

ADDITIONAL NUTRIENTS

In addition to the above crucial elements, a good prenatal vitamin will also contain:

Niacin (as niacinamide) 30 mg (UL 35 mg)

Vitamin E (as d-alpha tocopheryl) 15 mg (UL 1,000 mg)

Vitamin K (as vitamin K1) 100 mcg

Vitamin B12 (100 mcg as adenosylcobalamin and 100 mcg as methylcobalamin) 200 mcg

Biotin 50 mcg

Pantothenic Acid (as calcium panothenate) 16 mg

Iodine (as potassium iodide) 150 mcg (1,100 mcg)

Magnesium (as magnesium citrate-malate) 100 mg (UL 350 mg)

Zinc (as zinc picolinate) 25 mg (UL 40 mg)

Selenium (as selenium picolinate) 50 mcg (UL 400 mcg)

Copper (as copper picolinate) 2500 mcg (10,000 mcg)

Manganese (as manganese picolinate) 5 mg (UL 11 mg)

Chromium (as chromium picolinate) 100 mcg

Molybdenum (as molybdenum picolinate) 50 mcg (UL 2,000 mcg)

Boron (as boron picolinate) 1 mg (UL 20 mg)

A Note on Fats and Sugar

Don’t be scared of fat. The right types of fat are necessary for proper growth and development of your baby. Good sources of essential fats are avocados; fish (after the first trimester) such as mackerel, salmon, and sardines; flax seeds; nuts such as almonds, hazelnuts, and walnuts; and oils such as coconut oil, olive oil, and sesame oil.

As for sugar, optimizing nutrients isn’t just about consuming the right things, but also being attentive to things that leach the precious little sustenance you are likely able to get down right now. Sugar does just that, and should be minimized in order to maximize your other nutrients.

If you’re craving sugar, a good way to begin to diminish the craving is to boost up on protein. Instead of a pastry, a great go-to food is a yam or sweet potato, which can satiate your craving for sweets without assaulting your blood sugar. Here are two recipes to keep on hand—a protein-rich soup base and a sweet potato puree.

BOOSTED-UP CHICKEN STOCK

Folklore strikes again. A chicken is able to lay an egg pretty much every day, and in Chinese medicine, we encourage you too to replenish daily with this easy to digest, protein-rich broth to help you hatch your healthy baby. As queasiness sets in, it’s a great way to consume a gentle-to-digest, mineral-rich food source—and doubles as a base for other recipes that call for stock.

Ingredients

1 pound organic chicken or beef bones from your local health-food store or butcher (you can also just put a whole, uncooked chicken in the pot and use the meat for a plethora of dishes)

* As a variation, use 1.5-2 pounds of beef knuckle bones

3 carrots, scrubbed and chopped

3 celery stalks, chopped

2 inches of fresh ginger root, chopped

1 onion, peeled and halved

1 lemon, washed and halved

Whole head of fresh garlic, peeled and smashed


Generous tablespoon of sea salt

Water to fill stockpot

1 bunch parsley, chopped

2 tablespoons apple cider vinegar

1 tablespoon coconut oil

Directions

In a large pot, add the coconut oil and brown the bones on all sides over medium-high heat. Add everything else but the parsley, and fill stockpot almost full with water. Bring to a boil, and then reduce to a simmer for eight hours up to overnight (it will only get richer), periodically skimming the fat off the top. Add parsley, then turn off the heat. Strain the solids out through a colander and discard or reincorporate carrots and celery and chicken pieces (if you’ve used a whole chicken) into the soup.

The broth can be sipped as-is, or used as a base for other soups and recipes in this book and beyond. If you’re not going to use the stock within a few days, freeze it.

SWEET POTATO PURÉE

Use the stock in the last recipe as a base to puree ¼ cup of homemade stock with 1 cup steamed sweet potatoes, 1 tablespoon of butter or ghee, and a pinch of cumin. Top with cilantro and a squeeze of lime.

Checklist for Month One

• Take your prenatal vitamin.

• Eat like you’re taking a prenatal vitamin.

• Familiarize yourself with pregnancy nutrition, including the safe and not-so-safe pregnancy foods.

• No more changing the cat litter.

• Review your health insurance.

• Find an obstetrician and/or midwife, and schedule and prepare for your first prenatal appointment.

• Confirm whether any prescriptions you’re currently taking are not safe during pregnancy.

• No more martinis or smoking (See section on How to Quit Smoking in month three).

• Start some preemptive antinausea techniques such the Morning Mocktail recipe and home acupressure point (found in month two).

• You may want to start a pregnancy or dream journal.

• Consider joining a pregnancy forum or group, online or in-person.

• Start some financial planning for your family.

What Is the Placenta, Anyway?

The placenta is a link between you and baby. In some cultures, the placenta is referred to as “little mother.” This organ, which embeds in your uterus and connects to the baby by the umbilical cord, works to support your baby throughout pregnancy. The placenta is responsible for the exchange of oxygen and nutrients between you and baby’s blood and develops from some of the same cells that are in your uterine walls, as well as cells from the developing baby. So it really is a mixture of you and baby. This little helper also produces hormones that help your baby grow and develop, and just like your baby, the placenta grows throughout pregnancy.

The first hormone produced by the placenta is human chorionic gonadotropin (hCG), which is what’s being measured in a positive pregnancy test. hCG also ensures that the corpus luteum of the implanting embryo continues to secrete progesterone and estrogen to signal to the body not to have a period (progesterone is produced by the placenta for this reason as well). Other wonders of hCG are that it suppresses your autoimmune response so that your body doesn’t reject the placenta or baby. The placenta also produces human placental lactogen (hPL) and estrogen, which both contribute to the development of your mammary glands in early preparation for lactation.

The placenta provides some immune protection for baby against most bacteria, but not viruses. That’s why contracting a virus such as chicken pox can be very dangerous during pregnancy. The passive immunity you pass on to baby lingers for a few months after birth, which is why the health of your immune system is an imperative piece of baby’s immune system.

Other things that can adversely affect baby via the placenta are obesity and gestational diabetes, which can increase or decrease levels of nutrients transported to the baby and result in overgrowth or restricted growth of baby. Alcohol, nicotine, and other drugs can cross the placental barrier and cause damage to the baby. If they’re in your life, it’s time to give them up.

During birth, the placenta separates from the wall of the uterus and is birthed after your baby. This usually occurs about fifteen to thirty minutes after baby’s birth. Letting baby suckle right away (most babies can find their way on their own to the nipple if given ample opportunity on the chest after birth) can help stimulate contractions that help pass the placenta. Many women opt to keep the baby on their chest during this time, with the umbilical cord still attached to the placenta, to allow all of the nutrients to pass through. What’s passing through is also known as cord blood, which is sometimes harvested and banked. Unless personal choices or family history warrant saving your cord blood, there is no medical reason to cut the cord immediately after birth, and not cutting it may help the baby’s immune system adapt to life outside the uterus.

Some stuff that can go awry with the placenta:

• Placenta accrete: when the placenta implants too deeply into the uterine wall

• Placenta praevia: when the placenta is too close to or blocking the cervix

• Placental abruption: when the placenta separates from the lining of the uterus before it’s supposed to

• Placentitis: includes various infections that can pass to baby

A note on the umbilical cord: Normally this conduit between the baby and the placenta contains two arteries and one vein for supplying oxygen and sustenance to the baby, but occasionally there can be a single umbilical artery. If this happens, you will most likely want to seek out a fetal echocardiogram to monitor the baby’s heart, since the oxygen flow is reduced and this presentation can sometimes increase the risk of congenital heart disease (CHD) in baby.