Monday, May 30, 2011

Food and Pregnancy

As I have navigated the waters of prenatal care in the Netherlands, I have made my mental comparisons with with food suggestions/restrictions found in the U.S.  Of course, my knowledge about the U.S. comes solely from my friends with kids and the sometimes scarily paranoid women from's message boards.  So, I try to make my comparisons with a grain of salt.  During my first visit with my midwife (pregnant women don't see an OBGYN here unless there is a medical issue) and again during a less than entertaining "Enlightenment Evening" program I was required to attend in my first trimester, I learned what it was that the Dutch medical community, not to mention the Dutch government, thought it best for pregnant women to eat.  I translated some of the highlights from the government website (kind of like the USDA) for the blog:

General guidelines according to the website:

·       Eat according to the “Disk of Five.” *It's like the food pyramid, and I love how important bread is.  I was told at my meeting that pregnant women should aim for six pieces of bread a day.
·       Drink 2 to 3 glasses of milk and 1-2 pieces of cheese per day.  Instead of milk you can have buttermilk, a yogurt drink, chocolate milk, yogurt or vla (kind of like pudding).
·       Get enough iron, for example from whole grain bread and red meat.  Eat foods rich in vitamin C during meals to help with iron absorption.
·       A vegetarian diet is fine.  Make sure you get enough B-vitamins and iron.
·       Artificial sweeteners, such as aspartame, are not harmful during pregnancy.  *Women on freak out about this all the time.
·       Too much vitamin A can be harmful to a fetus.  Therefore, don’t eat more than 3000 mcg of vitamin A per day.  This pertains to animal products and supplements.  Because there is so much vitamin A in liver, it’s best not to eat it during pregnancy.  *My Dutch pregnancy book notes that the vitamin A found in things like butter or margarine doesn’t pose a risk.

Here are the things best avoided:
·       Sandwich toppings: don’t eat more than one sandwich with liver products, like paté, per day
·       Coffie: the maximum number of cups of coffee per day should be 4 because of the caffeine.  Tea and cola also contain caffeine, but from these products you shouldn’t drink more than eight glasses (assuming you don’t also drink coffee).  *I should note that a glass of soda here is about 8 oz., which is way less than what you would get in a restaurant in the States.
·       Fish: Fish is very healthy.  But don’t eat:
o   Vacuum-sealed fish found in the refrigerated section like smoked salmon, eel, mussels (these can be eaten if cooked first)
o   Raw fish or shellfish, like oysters *Although the website states this, I was told by the midwife that raw fish is perfectly fine if I know that it’s fresh.
o   Swordfish, Bluefin tuna, shark, or king mackerel.
o   Eel from Dutch rivers *What does that say about Dutch rivers?
o   Fatty fish no more than twice a week, because of the dioxins *During my "Elightenment Evening" we were told that fatty fish, like herring, is good to eat.
·       Meat: no raw meats (like steak tartar, carpaccio) and liver
·       Licorice: Don’t eat too much licorice or drink too much licorice tea.  *Gross.  I promise not to eat too much licorice.

There were other things on the list that I expected to see, which I didn't include here (just the usual suspects, like "get enough folic acid," and "don't drink alcohol or consume drugs").  All in all, however, the list feels less restrictive to me than what I've observed in the U.S., but as I said before, I'm looking at the American dietary suggestions from afar.  I do think that the most striking differences between here and the U.S. were the suggestions for bread and dairy products (so many!) coupled with the much more lax attitude about caffeine consumption.  In fact, it feels to me like it's a more lax attitude about consuming potentially harmful things (like *gasp* sushi) than what I've gathered about attitudes in the U.S.  I don't really know how restricted pregnant women feel in America, but I do know that I was once chastised by a pregnant friend during a chat session for suggesting she get a cup of coffee when she said she really wanted one.  Seriously, I got a mini-lecture about caffeine and low birth weight.  There are plenty of suggestions for diet here, but most of them verge more on moderation instead of complete exclusion.  Again, that could be my interpretation of it, as that corresponds more with my philosophy about healthy eating during pregnancy.  If I were in the U.S., I'd probably eat the same way I do here, regardless of my health provider’s suggestions.

I do wonder if the seemingly more permissive attitude about diet during pregnancy has to do with the fact that healthy, pregnant women are monitored here less in general.  During the first half of my pregnancy, I have seen my midwife twice, never had an internal exam, been weighed once, and have already had the last of my two routine ultrasounds.  Other than that, I've pretty much been left to just go live my life.  Obviously, I can call my midwife at any time if I have concerns or a problem, but I was told that there really is no need to see me if everything feels fine.  As the weeks go by I'll see my midwife more, but she won't weigh me (I haven't come across a single weight gain recommendation beyond the standard, "don't eat as if you are eating for two"), and I won't have another ultrasound unless there appears to be a problem.  I happen to like this hand-off approach but could see plenty of women not enjoying it, and there have been a handful of times I have wished that it was routine to see my midwife more often, if only just to listen to the heartbeat.  (Sidenote: I was told by the midwife at my last appointment that I could always call and make an appointment to do just that if it would ease my mind, but I've never felt that I truly needed to do it.  Trust me, I would call if I wanted to or felt I needed to.)

One of my friends jokingly asks me if I get in my six pieces of bread a day, and I'm afraid to let the Dutch authorities know that that usually doesn't happen.  I guess as long as I stay away from the raw meat and keep it under four cups of coffee, they won't send anyone in for me, but that would be true no matter where I lived.  In the end, they are only suggestions.


  1. Interesting to hear your perspective!

    The food stuff does sound less restrictive, although I wonder if part of the reason the Dutch can be more liberal would be the fact that sushi is not necessarily flown from far, far away (as it is where I am in MN) and that food practices in general are better & more regulated. But then again,there is nothing more American than being paranoid while pregnant. Ha.

    I would like to say that your midwife experience is in line with midwives here. My first appointment wasn't until 10-12 weeks (and every four weeks after that until you are much further along) and they only do one ultrasound the entire time (barring problems/concerns). The only reason they would do an internal before 36 weeks would be if you are due for an annual exam. And even at 36 weeks and beyond I could opt out of an internal. There is such a huge difference between typical obstetric care and midwifery - it's just that midwives are the norm everywhere else but here. Luckily, I live in a place with a unusually high number of midwives so it is easy for me to make that type of care seem totally normal.

  2. Nice to hear what your experiences have been in America. I can tell you people in L.A. are just as paranoid about raw fish, and some of that can be pretty darn fresh. I don't go out for sushi much here, but I do enjoy herring every now and then. It's also all the other stuff I hear American women talk about, like lunchmeats or salad dressing, that don't ever come up as an issue here. I'm sure there are also very cautious eaters here, too, but I'm somewhat cut off from a lot of chit chat with other women. Such is the price of working at home by myself. I guess I'll find out more if I talk to the women in my prenatal yoga class starting next month.

    You're right to point out that the midwifery model of care is probably quite similar. I suppose I should have pointed out in my post that I was comparing my friends' experiences, which have been with OBs, with my own here. Thanks for commenting! I love you blog!

  3. Pregnancy as an expat--such an interesting experience! The Japanese say absolutely *nothing* about consuming sushi, but overeating? I was weighed *every* time-- the weight gain restrictions are REALLY restrictive (8-10 kg. Total. Srsly.). By the time Cici came along, I just lied about my starting weight so it wouldn't look to the doctor like I was "overgaining" (is that a word?). Japanese women are also warned against eating too much salt (and so are told to avoid instant cup noodle, umeboshi, too much soy sauce, and so on). On the other hand, I liked getting an ultrasound every month:-)) There's a *lot* more I could go on and on about, but this will be way too long!

    Just take *good* care of you, sweetie! Can NOT wait to see baby pics!!

  4. I was hoping you'd chime in about your experiences in Japan. Are you kidding, only 8-10 kg.! I haven't heard a peep from anyone about how much I "need" to gain, but I read so often that I shouldn't be eating for two that it had me a little anxious about my gigantic amounts of food intake for a while. I've calmed down about it, but I still have my moments.
    Nothing here about too much salt, which is a good thing for me. I seemed to live off of bags of chips and oven fries for about a month in the first trimester. Nothing hit the spot like a large intake of carbs, fat, and salt.

  5. Lordy-- the smell of McDonald's made me nearly barf during the first trimester (Koshi)... during morning sickness I could handle pancakes and orange juice. Pizza crust. Crackers. Straight carbs with no oiliness or fat. Could not look at hamburgers--not even photos of hamburgers on menus. Couldn't stand the smell of ramen, either. Took years to get over that! And the smell of rice cooking-- gag! Shun thought I was insane-- until I informed him that every other *japanese* mother I'd talked to said Exactly The Same Thing, Thank You Very Much. I iz not Freaky Foreigner! I figured out by the suddenly weird smell of rice that I was pregnant the third time (Cici)! "Why does the rice cooking in the rice cooker smell so... uh oh." (Went and got Clear Blue at drugstore next day... discovered nose was not lying to me).

  6. Fascinating! Thanks for that. God, Holland really does love dairy as much as Denmark. Like- what is the POINT of all of that dairy??? You are talking to someone however who eats two cartons of cottage cheese a day. Thought I hate milk.

    Intersting, too, that they tell everyone to calm down about the apsartame. I take back the stomach pumping measure I had proposed on my blog. :)

    One difference I see between Holland and Denmark is that they encourage iron - but in Denmark there is none of that- you WILL take an iron pill daily and you will LOVE how constipated you become. That is the motto. This way they get away with not testing anyone for anemia. And I guess it makes sense because basically every pregnant woman becomes anemic anyway. Although it's hard to know if it's really anemia or just a lower hematocrit of pregnancy.

    Just have to say I agree with the Japanese weight gain guidelines posted above by Yoko. I am at 6.4 kg weight gain now at 32 weeks and see absolutely no benefit in gaining MORE than 10 kgs. There are tons of risks with gaining too much, plus it is uncomfortable.

  7. SLG- Oh, yes, there is a lot of love here in the NL for the dairy. I love cottage cheese, and I've been eating so much of it lately. Is it popular in Denmark? It's not here, so it only comes in expensive, tiny cartons. I miss the big tubs of it that I could buy at Costco.

    Interesting that Denmark pushes the iron supplements. I've been told I'm welcome to take a prenatal vitamin if I want, but that it isn't necessary if I eat a balanced diet.

    I know that I've said it before, and I think I've mentioned on your blog that I never weigh myself. Weight guidelines make me very nervous, although any sort of preoccupation with weight makes me uncomfortable. I wonder if concentrating on a pregnant woman's weight takes away from more important discussions about healthy eating practices and appropriate levels of exercise.
    I know that there are risks and complications associated with "overgaining" (love the word, Yokohamamama). What about women who stay active and eat well but still gain more than the recommended amount? Some women are going to gain more weight than others during pregnancy, because that's simply how their bodies are built, and pushing weight guidelines on them could lead to feelings of frustration and guilt. At least, that would be my reaction. Oy, I think I might be internalizing this too much. :)

  8. Personally, I think there's some plot to keep women obsessed over some basic matters so that they don't start asking difficult questions about pregnancy. The dietary guidelines are pretty obvious, I think.

    The licorice thing is interesting. In the U.S., almost no "licorice" has actual licorice in it, but is merely anise-flavored. Real licorice root, which is sweet and doesn't taste like anise, has glyocrrhizin, which can mess with potassium levels and blood pressure. I have a feeling that european licorice probably has some real licorice in it (and now I have a craving for the salty fish-shaped licorice common there and hard to find here).

    Mmmmm. If you can get real licorice, maybe you can get real root beer too (though it's extremely unlikely, given that every european I've met thinks it tastes like medicinal mouthwash), which is banned here for being supposedly carcinogenic.

  9. Steve,
    I'm kind of curious to know what you think the difficult questions of pregnancy are. I disagree, however, that dietary guidelines are obvious to everyone, pregnant or not.
    Oh, no, the Dutch take their licorice very seriously, and the teas and candies here are made with real licorice. If you truly love the salty kind, I'd be happy to send some to you. I think it's disgusting, but a few million Dutch people would disagree with me.
    Sadly, no root beer here. The flavor is absolutely not appreciated in Europe. There is also no love for ginger ale, which makes me truly sad.

  10. The salty licorice-- ah, the memories. I actually kind of got the hang of that, living in Germany. It tastes good to put a piece in your mouth and suck on it while drinking hot tea. Srsly.

    No root beer love in Japan, either--gave Yokohamapapa a sip one time in the US. He thought it was just totally weird. Kids don't like it either. *sigh* Ginger ale, though, is big, as is ginger in general--which is a very happy thing. Did you know that sweet ginger syrup in hot Chai tea is A Very Good Thing? I got addicted to that this past winter:-)

    @Sea Legs Girl-- I thought that maybe the Japanese weight gain guides were probably suitable for the average tiny Japanese woman. It wouldn't make sense for a woman who only weighs 47kg to begin with to gain 15 or 20kg. I gained around 13 or so kilos-- which was more than they liked, but I gained almost the *exact* same amount all three times, so I think it was just my body. It all pretty much came off, so I didn't worry about it.

  11. I have a source for salty licorice here - I just blanch at the price. And you should see what real pumpernickel costs!!! (and as long as I'm commenting again, my last comment had a very strange typo)

    I tried to read the disk of five link and am embarassed at how bad (near nonexistent) my Dutch is. Not having spoken it for 20 years has made me just a little rusty!