Kristin Revere and Stephanie Middleburg chat about the importance of nourishing yourself and your baby during pregnancy and the postnatal phase. Stephanie is the author of “The Big Book of Pregnancy Nutrition” and founder of Middleburg Nutrition.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Stephanie Middleburg today. Stephanie is a registered dietician, author, and founder of Middleburg Nutrition. Welcome, Stephanie!
Hi! Thanks for having me!
So happy to have you here! Our primary topic today is all about prenatal nutrition.
Yes, I have – I love this topic. I’ve always loved this. First and foremost, I’m also a mom of two. I have an eight-year-old little boy and an almost two-year-old little girl. I’ve focused on this a ton in my practice. It’s become a specialty, and I have a book coming out April 30th, called The Big Book of Pregnancy Nutrition.
Amazing! And you also have two other books, so you seem like you’re very busy between being an author of multiple books and your own practice as a dietician. Being a mom itself is a busy job. Very impressive!
I mean, the kids have been the inspiration for my books, that’s for sure. So my first book was The Big Book of Organic Baby Food, followed by The Big Book of Organic Toddler Food, and now this pregnancy book is essentially a prequel to the others. And I think being in private practice keeps me so grounded and connected to what people are actually going through and their questions. Literally while I was writing The Big Book of Pregnancy Nutrition, I was taking notes as to what my clients were saying. I think the power of these books is that you can have all the information, but unless it’s communicated in a way that people can be receptive to and understand, those words might not be as effective. I really try to take a realistic approach in my books and my work with my clients, which is a lot of fun.
That makes so much sense, and obviously, the foundation of everything is that prenatal phase and focusing on nourishing yourself. I know there can be a lot of misinformation about following cravings and it’s an excuse to eat whatever you want, but it is so important to focus on proper nutrition, not only for baby, but for yourself.
It’s such an interesting time with my work with my clients because I think women come in this stage with such different mindsets. I work with so many women who are really fearful and anxious about the food that they consume from a food safety perspective and making sure they’re getting all the nutrients, and then there’s other women who are like, this is my time to eat what I want. I’m going to lean into these cravings. But there is still so much confusion out there and so many questions, and it is such an important stage that can really set the tone for both how mom is feeling in her pregnancy and postpartum, as well, which is why I really like to emphasize in this book that it’s food for mama and for baby. It really does start the family thinking about eating quite differently, and I just know from in my pregnancies, even as a practitioner, there were a lot of things that I acted reactively to, being like, why didn’t I know this? Why didn’t anybody tell me this, or why didn’t I research this more? And I see that in my clients, too. A lot of the book was to really provide some information along the way at various stages, whether or not you make changes, but at least to be aware of things to talk to your doctors or your care team about. I think that’s so important. I essentially go through the book as I would with someone that would come into my office. Essentially, the first thing I’m so passionate about is getting bloodwork done for pregnant women. Not everyone has a baseline of where they are at the start of pregnancy, and I feel like that’s such a missed opportunity, especially as it relates to whatever your background is. If you’ve been on the birth control pill for a long time, that can deplete a lot of nutrients like B6 and B12 and vitamin D and C and magnesium and selenium if you’re vegan or vegetarian. You want to know where your vitamin D levels are because you might need more than what’s in your prenatal. Iron, anemia. 50% of women essentially are anemic in their pregnancy, and this usually happens in the second or third trimester, but it’s important to know what your base is to be able to – if this is something, like, should you take an iron supplement in your prenatal; should you take one separately. B12; 38% of women are deficient in it, and they really don’t realize it. Those are really things, when you feel the fatigue – I mean, you’re going to be tired in pregnancy regardless, but it could have to do with some nutritional deficiencies. And one other thing I’m passionate about is blood sugar, hemoglobin A1C. So that essentially measures your blood sugar over a two to three month span, and in pregnancy, most women, unless you’re considered an older mom, your blood sugar doesn’t get tested. You don’t go through the blood glucose screening test until 24 to 28 weeks. Again, if you’re older, you might do it at week 16. That’s far along in your pregnancy to find out that you might have gestational diabetes. We really are looking that studies really show that at the start of pregnancy, if your levels are 5.7 or above, chances are you probably will have gestational diabetes, so why not work on some blood sugar control earlier rather than wait until the middle of your pregnancy? So there’s just some preventative things that I’m just very passionate about women talking to their doctors about just to get more personal information for their bodies to see what’s going on.
Very helpful. And the book is such a great way for you to impact more women. I mean, living in Brooklyn, you can only see so many people in your private practice, so having this guide for people all over the world to better care for themselves and their baby or babies is so important.
Yeah, I really hope so, and that’s really the goal. It was amazing to me how the Big Book of Organic Baby Food really became a Bible to so many women. I am in Brooklyn, but to see how far reaching it was and how helpful it was for so many women definitely helped inspire this book for pregnancy because it is such a confusing time. These are areas where you need a lot of handholding, right, in certain parts, and you need a lot of guidance. Somethings are black and white, but some things, there’s gray area. I think as it relates to even food safety, a lot of women get hung up on it and over-Google. That’s where they get their information from. They might not be getting it from their care team, either. Prenatal stuff is definitely one of those where no one really knows what to do there. You’re told to get a prenatal, and I think unless you have a relative or a friend, there’s no guidance on what specific prenatal you should get or what you should be looking for for yourself. So I have a big chart there, and a section on supplementing your supplements. Again, some women need additional nutrients in addition to just what their prenatal is providing them.
That makes perfect sense. I remember having a friend tell me about the whole food prenatals versus the standard generic ones, and it made such a difference in my nausea and just overall energy.
100%. And sometimes it takes a little bit to find the right combination for you, and that’s okay. You can switch your prenatal in the combination until you find the best fit for you. The first trimester is really hard because 75% of women are going to be nauseous, and there are different forms of prenatals you can take. There are now some powders you can do. There are some liquids. Gummies, which aren’t my favorite; you’re just not going to get enough of what you need as a supplement, but better than nothing, right? Take a gummy in the first trimester until you start feeling better. But really, yeah, unless you know, it’s a really hard area and knowing what to look for. Not everyone will need iron in their prenatal but might need to take it separately because it can lead to some digestive issues. Not all prenatals have choline in it. A lot of prenatals just have, like, 600 to 800 IUs of vitamin D where you might need 4000 IUs of vitamin D. It might not have the right form. You might need more magnesium citrate, for example, if you’re finding you’re constipated. Not to make it complicated, but these are all things to look out for that can be immensely helpful. I’m a big proponent of probiotics, especially later on in pregnancy, because there’s really great research that shows that it can help prevent chronic conditions in kids, like eczema, food allergies, things of that nature, especially if you’re going to have a C-section or for any reason you were put on antibiotics, even during your pregnancy or post, that your baby was put on any sort of antibiotics. I think it’s helpful to take a probiotic in your third trimester and then probably postpartum.
That makes complete sense. So you mentioned earlier, Stephanie, that there were some nutrition tips that you wish you would have known that you shared in the book.
Yes!
I would love to hear more about that.
The supplements was a big one for me. I remember going to the doctor’s office so excited we’re going to have this conversation, and he was like, yeah, take a prenatal. And I was like, do I need vitamin D? He’s like, yeah, could do. Maybe, maybe not, but take it. I remember the conversation was so meh. And that’s one of the reasons why it inspired me to go into detail about these prenatals and again to have the conversation and bring it to your doctor or ask them to test your levels so you can see if you do need more of certain things. Another part was during the blood glucose screening test, my nurses had told me – this is, again, 24 to 28 weeks, your first time to test if you might have gestational diabetes, and you take, like, 50 grams of sugar. I don’t know if you remember this. And then they test your glucose, your reaction to it. If you pass, great. If you fail, then you have to go on to a three-hour glucose screening test, which is way less fun. You want to try to avoid it if you can, but it doesn’t mean that you have gestational diabetes. But anyway, it is not a fasting test, and time and time again with me, I was told it was, and so many of my clients were told it was, which I think sets you up for a disadvantage. If you think about it, if you’re having so much sugar on an empty stomach, you’re going to spike more than if you are consuming this sugar on a breakfast, or after a meal that is really rich in protein and fat, which slows down the absorption of sugar. That was one area that I was like, what? Why? Why did I get this misinformation? Why did I not know this? And now even with the glucose screening test, it depends on how you feel about certain things. First of all, the test is gross.
It is gross.
It tastes like an off-brand Gatorade with a maple syrup texture. It’s not fun. And thank goodness, we’re at a time where there’s so much research and people are paying attention to this prenatal experience. There is a company now that has a dye-free option called the Fresh Test, which I wish I knew about it when I had my pregnancies. It also tastes better. It’s one of those things that you can purchase and talk to your doctor. Just share with them if you have a preference for taking this. And it’s more of a lemon, sour-tasting versus some of those other ones that are orangey or raspberry and just don’t taste very good. Lemon is a better taste than others. But have a strong breakfast before you go; again, rich in protein and fat. So, say, like, eggs and avocado or full fat Greek yogurt with nuts in it, something along those lines. I feel like that gives you a fighting chance so you have more success at that point.
Another prime example that I was not aware about was when I was induced, which I have feelings about now, of course. This was in my first pregnancy. I didn’t know that doctors don’t allow you to eat once you start the process, and I would have been more prepared. You’re essentially going through labor – your body is being put through a major physical test. You’re running a marathon. To subside on Jello…
It does not work.
It does not work, and I think it’s something you can have a conversation with your doctor. I mean, they’re concerned about aspiration, but it’s really – I think just to have the conversation. I do believe most people can have more foods. I mean, this is where I’m a fan of bringing some bone broth, whether you made it or get it from a trustworthy source, that you can sip. It’s going to give you so much more energy. You can even bring in honey sticks. Something like energy bites. I mean, things that are going to get digested very quickly. But you need energy to take you through your labor and to help you recover postpartum. I have a labor aid recipe, which is essentially your own DIY electrolyte mix that you can bring that has sugar and salt and really hydrating. That was in a time of, like, what do you mean I can’t eat? I was starving, and I was so depleted. And I know so many women go through that, as well. I definitely list out a lot of things to eat if you were home, or if you’re going to a hospital, things that you could bring. So those were three examples, I think, where I was not as prepared as I wish I was from a food perspective.
Fortunately, there are fewer restrictions on eating in the hospital now, at least in my area in Michigan. As a doula, my clients are able to snack on a lot of the items you mentioned.
Which is amazing!
Yes, big change.
It’s a big change, absolutely. And I think one of the other areas that I wanted the book to go into is that fourth trimester recovery. I don’t think women are prepared for how tired and how starving they’re going to be once the baby arrives, especially if they do plan on nursing. Every client of mine is so surprised how hungry they are.
Absolutely. Especially, like you said, with breastfeeding. I felt like I could eat all the time, and yet I also felt like I was caring for my baby and toddler at the same time.
100%. Suddenly, your nutrition isn’t about you anymore, right? But yet your needs are the highest they’ve ever been. You just went through a marathon. You carried a baby for ten months, and you’re nursing, which essentially is like you’re running at least six miles a day. This is such an important time to think about fortifying yourself, and women are just so depleted and exhausted. I really have – not necessarily a meal plan, but the guidance in terms of, like, your snacks really have to be mini meals and things that you can do to make sure that you’re fortifying yourself. You just need more of everything, essentially, at this stage. You need even more protein. You need even more of the healthy fats. You need even more of the hydration for you and the carbohydrates. That was a stage that I just was like – it’s a feeling that you’ve never felt before, and you want to keep up your milk supply, too, which is really important. I have 40 recipes in the back of the book. My other two books were more of cookbooks. This is more of a nutrition book with 40 recipes. But I definitely have some recipes. They’re divided into sections. One section is some lactogenic recipes that can help boost milk supply. I have sections of breakfast. I have healthified comfort foods. I have things you can freeze in advance during that nesting period. I really have – I want people to rely on their freezers a lot to have a lot food in advance that you can just defrost. I think it’s really, really important. I have a whole sweets section. I have a vegetable section, which are really hard for a lot of pregnant women to consume, especially in that first trimester, and they want sour tastes. A slaw is great; or so many of my clients could, in the beginning, get down a cucumber salad with rice wine vinegar and olive oil and sesame seeds, something along those lines. Any chance to get some nutrition in when you’re not feeling good. But also through that postpartum, nutrition deficiency is like – you know, some people develop thyroid issues and they don’t realize that maybe that might be contributing some feelings of depression and anxiety. Those are nutrients to pay attention to, as well. Your needs for iodine in pregnancy increase 50%, which is huge. And again, iron; your needs increase one and a half times. Your blood volume doubles in pregnancy. I don’t think a lot of pregnant women prior to pregnancy necessarily thought about their iron intake unless they were anemic, but especially iron, iodine, protein in the postpartum stage is really important. And as you said, you probably see so much depletion in these women.
Definitely. So one thing that is a constant struggle – you mentioned freezing food, and it’s great that you have all of these recipes, but oftentimes with well-meaning family and friends and meal trains, the food that is prepared is not often the healthiest for a postpartum mother.
Yes. Well, this is where – it’s true. I mean, hopefully, you can be an advocate for yourself and ask your well-meaning friends and family if you have certain requests of what you would like to eat. I think it is also maybe in advance going – if you don’t think you might be cooking, it might be going through restaurant menus that you know you’ve loved before and highlighting certain things that a partner or someone can order that you know is healthy that you like. I know in New York and various cities, there’s some postpartum or just meal delivery services. Instead of gifts, a lot of friends accumulate funds for things like this and do a week of meal delivery for a mother or for the family, something along those lines. I think a little bit of that is thinking in advance what would be the most helpful. And your friends want to help. Your family wants to help. If it’s money for a meal delivery service, do it.
Or even for friends and family members who love to cook, send them some of the recipes in your book.
Exactly. Exactly. I mean, that’s one thing that’s amazing about the Big Book of Organic Baby Food and Toddler Food. All these women or families who are telling me that they might not be cooking it, but they’re giving it to their caretakers, the recipes, so they’re giving it to the grandparents and are like, here, make anything from this book. So it just makes their lives so much easier.
Definitely. Yes, as postpartum doulas, we do light meal preparation, so we make snacks and food for toddlers. It is always helpful to have a guide or recipe that would be helpful for the entire family.
Exactly. I always try to strike a balance with all my books. These are going to be foods that the whole family can enjoy that’s nutritious and yummy, but easy. Easy, too. I want my recipes to be under 30 minutes. Some are going to take more time, like if you’re making – I do have a lasagna. Obviously, that’s going to take more cooking time. But it can last in the freezer for a long, long time. I don’t want someone to spend tons of time in the kitchen if they don’t want to. That’s why I want the recipes to be accessible and easy for everyone.
Love it. Any final tips for our listeners, Stephanie?
I would just – I mean, again, one of my things is just that you have to be your own advocate during this. Listen to your body. It is such a fun and exciting time. Be an advocate. Ask questions to your doctor. Ask your friends questions. I think probably you see this, too, for nursing. If you plan to nurse – I just think for women to go into it knowing that nursing is hard. I see this time and time again, and I know it for myself. I think the nursing situation can make or break your first few weeks for you of your postnatal experience. I think a lot of women have their hearts set on nursing and if they can’t do it, it becomes emotionally and physically really tough. I think just having a perspective that it’s hard. Not to say don’t do it, but everybody responds to it differently. I just want people to set their expectations and maybe have a plan B in mind if it doesn’t work out and that it’s really okay. And also to try to set up some support for it. If you know of a lactation specialist or if your doula is a lactation specialist, really reach out for that. But again, I just feel like I was so lucky and thankful that my friends were super open and honest about their experience about that being tough. I went in knowing that it might not work, and that’s okay. I think just in this space, again, there’s so many resources to help you nurse and there’s so many great formulas, too, on the market now that I feel like we just didn’t have access to even a few years ago. There’s always options. I just think that’s one thing that’s really important. And I would also say don’t worry if in that first trimester, you feel like all you can eat is bread and butter and cheese. It’s okay. Get through it. Your baby will be fine. They will take from your stores. But do try to slowly incorporate, even if it’s a few bites, some protein for you. The less that you eat, it’s sort of like this vicious cycle. And if you’re nauseous, the less that you eat, you can become more nauseous, and you can get reflux. So you really do sort of need to get that. You need to eat to support your body and probably eat every two to three hours. But I will say, just to take that pressure off, don’t worry about it. A lot of women don’t feel well. Do the best that you can. That’s why second, thirst trimester and postpartum, we want to focus on the mom, too, to make sure that she can be healthy to support herself, to have your body heal as it should. And then also to be able to go into a second or third or fourth pregnancy with their tanks full, right, instead of depleted.
That’s what it’s all about.
Yep, that’s what it’s all about.
Well, thank you for those tips. Very helpful advice. So, Stephanie, fill us in on how to get your books, to start, and then how our listeners can connect with you.
Great. My books – you really can get them anywhere. Amazon, for a lot of people, is just the easiest. Amazon.com. But you can get them at Barnes & Noble and Target, online and in the stores. The pregnancy book won’t be out until April 30th, but the other two at any point. And you can find me @smiddleburg-rd. That’s my Instagram. And then middleburgnutition.com is my website. And even though I’m based in Brooklyn, New York, I actually do a lot virtually. I do a combination there. I love working with women or families one on one, in any capacity.
Thank you so much for sharing all of your wisdom, Stephanie. It was lovely, and I’ll have to have you back on to expand our conversation in the future.
I would love that. Thank you so much!
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