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 thebump.com'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 thebump.com 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.