In this section, I will respond to questions that are often asked, and I will add your questions as you email them to me. I will answer the questions from my own experience and education, and from what I have learned from Dr. Brewer and others, but I will be relying on you to use your own wisdom and intelligence and responsibility to choose which information fits your needs, your belief system and values, and your situation. Please consult your own midwife for her feedback as part of your process of making your final decisions.

The following questions are answered on this page:

Q: What is the Brewer Pregnancy Diet?

A: It is a diet that was developed in the 1950's and 1960's by an obstetrician, Dr. Tom Brewer, to help women have healthier pregnancies and healthier babies. In the process of his medical education, and researching the work of Hamlin, Strauss, Burke, and Ferguson--doctors who had worked on this issue in the 40 years previously--he discovered that the cause of pre-eclampsia and some other complications was an abnormal blood volume, caused by malnutrition, or food deficiency. The diet consists of 14 food groups. However, it can be summarized as starting with 4 basic components: 2600 calories, 80-120 grams of protein, salt to taste, and unrestricted weight gain.

See here for "Preventing Toxemia of Pregnancy", by Bob Filice, MD

Q: How many pounds can I expect to gain on the Brewer Diet?

A: The average weight gain when using the Brewer nutrition plan is 35-45 pounds. But a weight loss of 5 pounds could be healthy on this plan, or a weight gain of 60 pounds also could be healthy (or more for twins or other multiples). The bottom line is that it's not the number of pounds that should be the issue. The primary concern should be what kinds of food are creating that weight gain. You could gain 35 pounds on refined carbohydrates, and fried foods, and sodas. Or you could gain 35 pounds on lean meats, fruits and vegetables, and whole grains. The second kind of eating style and weight gain would create a healthier pregnancy and baby, even though the number of pounds gained is the same for both.

When Dr. Brewer worked as an obstetrician, he would come out of his office and meet with his patients in the waiting room before their prenatal visits. His first question to them was about what they had been eating that week. Many patients who were accustomed to eating less on the days of their prenatal visits with previous birth attendants, so that they would weigh less, quickly learned that in his practice they had to switch that around and be sure to eat well that day, so that they could give a good answer to his first question, "What have you been eating?"

Q: I want to eat enough protein for my baby, but I don't want to gain too much weight. So would it be okay for me to eat 80-120 grams of protein, but skimp a little on the calories?

A: It is important to use all of the the components of the Brewer Diet together. If you eat the suggested amount of 80-120 grams of protein, but eat as little as 1700 calories, half of the protein that you've eaten will get burned up for the calories that your body needs for all the things that it needs to do. As a result, you will be getting only 40-60 grams of protein for building new baby cells, new blood cells, and new uterine muscle cells.

During a healthy pregnancy, the uterus gains a remarkable amount of new muscle cells during the pregnancy. When the uterus is not pregnant, it weighs only 2 ounces. At the end of a healthy pregnancy, the uterus alone weighs 2 pounds. This means that you need to grow about 1 pound and 14 ounces of new uterine muscle cells with every pregnancy. If you are skimping on calories and burning some of your protein intake for calories, your uterus will probably not have as many muscle cells as it should have, and it could have a more difficult time pushing a baby out than it would have had, if your diet had included more appropriate amounts of both calories and protein.

In addition, a low carb diet could lead to your body breaking down body fat for calories. A by-product of that process is ketones, and ketosis (ketones in the blood) can cause a lack of energy and decreased appetite for you, and brain damage in the unborn baby.

See here for information on the dangers of a low-carb diet in pregnancy

Q: Can I get some of the protein I need by drinking protein drinks, instead of working at getting it all from food?

A: It is better to not use protein drinks during pregnancy (referring to drinks which are made from powdered preparations--sometimes used by athletes for building muscle mass). It is better to get your protein from food. One of the homebirth doctors in the Chicago area has noted that when his clients use protein drinks as one of their sources of protein, the babies tend to become bigger than the babies whose mothers get their protein from food.

As a reference point, most of the homebirth midwives and doctors that I'm familiar with in the Chicago area consider birth weights of 7 lbs to 9 1/2 lbs to be average weights for a well-nourished baby. So a baby would have to be over 9 1/2 or 10 lbs to be considered to be on the higher end of normal.

About 10-15 years ago, one Chicago-area practice of homebirth doctors had a client who gave birth to a 15 lb baby at home, with no problems and no perineal tears.

Tom Brewer considered any birth weight below 7 lbs 2 oz to be less than optimal.

So what a birth attendant considers to be "big" for a baby is quite relative. Those who would consider a baby over 8 1/2 pounds to be "too big" have probably had their view influenced by their having seen a predominance of pregnant women who aren't as well nourished as they could have been. However, the homebirth practice that noticed that babies seem to grow bigger when the mothers use protein drinks has been practicing with the philosophy that the Brewer Diet is important in pregnancy, and they would most likely be familiar with the 7 to 9 1/2 pound average birth weight for well-nourished babies. So it is my impression that they were referring to babies being bigger than that average when mothers in their practice used protein drinks.

In answer to the question, "Can protein powders or pills substitute for some of the protein exchanges on this diet?" Gail and Tom wrote the following, in The Brewer Medical Diet for Normal and High-Risk Pregnancy (p.104).

No. They are extremely expensive sources of protein. They are often incomplete sources of protein (deficient in one or more of the essential amino acids, or containing them all, but in a most unbalanced form). They are often derived from milk, so why not just use the real food--milk? You do not obtain all the other factors found in real food when you pop a pill or pour out a powder. About the only time we have ever recommended these supplements was when a woman expecting quadruplets called us on our hotline. She knew she had a tremendous nutritional challenge to meet, and by the sixth month of pregnancy she had almost no room to put her food. By concentrating protein and calories into the same amount of milk she had been drinking all along, she was able to keep up with her protein requirement.

For more of the potential hazards of using protein drinks in pregnancy, see here...

A: No. In a normal pregnancy, the hormones of pregnancy protect the mother from the cholesterol concerns that men and non-pregnant women need to be careful about. In addition, the benefits of eating these eggs include vitamin A in the yolk which helps protect women from bladder infections, and albumin which helps protect pregnant women from high blood pressure, pre-eclampsia, and toxemia.

Q: Doesn't eating this much protein place stress on the pregnant body? Couldn't eating this much protein cause kidney problems?

A: "The stress in pregnancy comes from the continuous demands of the growing baby, the growing placenta, and the expansion of your blood supply to keep the placenta in good working order. All these considerations require protein above and beyond what would be adequate for a nonpregnant woman. So adding protein to your diet does not constitute a stress--in fact, it's helping to counteract a stress that pregnancy itself imposes.

Additional protein could cause difficulty only if your liver were impaired and couldn't clear the body of the waste products of protein metabolism, or if you were undergoing severe kidney failure. In each of these circumstances, eating protein in large amounts could be toxic, but eating protein sufficient for a healthy pregnancy would not cause the problems to arise. High blood pressure in pregnancy can be triggered by a lack of protein, not an excess."

The Very Important Pregnancy Program, by Gail Sforza Brewer, p. 87

Q: Some people say that too much protein is harmful. What is the upper limit of safety in pregnancy?

A: Nobody knows, but it certainly isn't the 45 to 60 grams a day some writers propose. In very carefully controlled research at the University of California at Berkeley, for instance, pregnant women were fed diets that contained varying levels of protein--up to 120 grams a day--and it was found that their bodies were still using the protein even at the highest levels of intake.

The theory behind the thinking of those who are leery of protein is that when you eat large amounts of protein, you create a higher level of metabolic by-products that the liver and kidneys must clear from the body. The fear is that the by-products will overpower the body's ability to handle them. This line of reasoning misses an important point: When you have a completely adequate diet, the liver and kidneys get their share of essential nutrients and so step up their clearance rate with no difficulty whatever. In short, you can't overdose on the levels of protein this diet provides--and probably not at levels significantly higher, either.

Dr. Maurice Strauss, a noted internist at Harvard in the 1930s, placed toxemic pregnant women on therapeutic diets up to 260 grams of protein a day and had consistently excellent results in turning their disease around. Of course, we're not advocating this amount of protein for every pregnant woman every day, but it should make the point that protein per se will not poison you or your unborn baby. The real problem, as we will see over and over as we discuss various aspects of pregnancy, is protein deficiency, not protein excess.

The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer with Thomas Brewer, M.D., p 37-38

For more on the misinterpretation of proper levels of protein in pregnancy, by the Cochrane Review, due to misuse of protein drinks in pregnancy, see here...

Q: Since the various Brewer books have different levels of protein that are recommended, how can we know which level to aim for?

A: The basic place to start is with the 4 glasses of milk (or an equivalent) and 2 eggs every day. Each glass of milk should be only 1 cup, which gives you 8 grams of protein. Each egg gives you 6 grams of protein. So from this starting place you already have 42 grams of protein.

If you add 1 serving of salmon (1 oz), you add about 6 grams of protein. And if you add 1/2 cup (1 oz) of walnuts, you add another 7 grams of protein. So in this case, just adding 2 servings of protein to the basic milk and eggs, gives you only 55 grams of protein, where the Brewer minimum is 80 grams.

Adding 6 servings instead--1 oz salmon (6 grams), 1/2 c. walnuts (7 grams), 1 c. bean soup (8 grams), 1 oz chicken (7 grams), 1/2 c. almonds (13 grams), and 1 c. yogurt (8 grams)--gives you 91 grams of protein, which is much closer to the Brewer minimum.

Just for reference, if you eat a portion of chicken or fish which is the size of the palm of your hand, or the size of a deck of cards, that portion is about 3-5 oz of protein. A 3-5 oz portion of salmon will give you about 18-30 grams of protein, and a 3-5 oz portion of chicken will give you about 21-35 grams of protein.

A 3-5 oz portion of animal protein (such as chicken, fish, or beef) will count for 3 servings of protein in the Brewer Diet--see the Brewer Diet chart in Right from the Start (pp.11 & 19).

Whether the 80 gram Brewer minimum, or something higher, works for your pregnancy or not is another question. I once had a student who was apparently getting 90 grams of protein a day, and she still was having some kind of problem which looked as though she wasn't getting enough (edema or elevated blood pressure--I can't remember). In such a case, I would suggest that the mother aim at a higher protein level in the 80-120 gram range, or even something higher, increasing it as quickly or as gradually as she needs to, until she finds the level at which her body responds and the symptoms go away (see answer to previous question). She should also increase her calorie intake, to preserve all the protein that she's eating, and prevent it from getting burned up for calories. It could be that some people need more protein and calories to get their blood volume to increase to the point that whatever unhealthy process they are experiencing will turn around and become a healthy process.

Q: Can I refuse the Glucose Tolerance Test?

A: Yes, you can--just as you can decline any test or procedure or medication that is suggested to you. It is standard procedure for the nurse or midwife or doctor to simply enter into your chart that you have declined this test, or whatever they have suggested for you. If your care-giver is reluctant to allow you to decline this test, you can offer to substitute another, more acceptable test. You can also offer to sign a waiver in which you state that you understand what you are doing and that you release them from any liability. The legal terminology is something like: "I hold (name) harmless for any consquences which may result from my decision." If the care-giver feels strongly enough about their opinion on whether you should take this test, or whatever they are suggesting, they can choose to no longer be your care-giver, or you can choose to find a more flexible care-giver. But it's usually not a good idea to stay with a care-giver who is not willing to work with you to come to solutions that you are comfortable with, because then you may find yourself in labor with a care-giver who is not providing the accepting, peaceful, trustworthy atmosphere that you need in order to labor well.

The Glucose Tolerance Test (GTT) is considered to be the "standard of care", but as we have seen in the past 50 years of obstetric precedents, the "standard of care" is not always the best of care. The obstetric "standards of care" of our modern mainstream medical system are sometimes based on faulty assumptions, faulty traditions, faulty belief systems, or faulty research. Some examples of those "standards of care" which we reject as not being the best of care are practices such as confining the laboring woman to bed, continual fetal monitoring during labor, not allowing a laboring woman to eat whatever she wants to eat; the over-use of pain medications, episiotomies, IVs, C-sections, and other interventions; the early clamping/cutting of the umbilical cord, non-religious circumcision, and many other practices which are detailed on the "Other" page of this website.

The Glucose Tolerance Test has a history of a high level of false-positive or false-negative results, and it is a very unreliable indicator of whether the pregnant body is handling blood sugars in a healthy way. So even though it is the "standard of care", many of us in the alternative-birthing field do not consider the GTT to be the best of care.

One reason for this unreliability is that the results of this test are easily skewed if your body happens to secrete adrenalin around the time that your blood is drawn. Some types of events that can cause your body to secrete adrenalin include the fear of needles, concerns about the ramifications of the test results, fighting traffic on the way to the test (and fears about being late), and having a fight with your husband or children in the parking lot. And any time that your body secretes adrenalin, your body will block the secretion of insulin from your pancreas while increasing the release of stored glycogen from your liver--thus giving you a higher blood sugar than you would ordinarily have. This reaction is called the "Fight or Flight" mechanism, and its purpose is to supply your muscles with high levels of glucose, so that you can protect yourself from some kind of threat, by using those muscles to fight the threat or run away from the threat. When you end up not using that glucose to fight or run, you end up with high blood sugars for the GTT.

A more reliable test for checking how your body is handling blood sugars is the "Hemoglobin A1C". This test is often used to monitor whether diabetics are dealing with their blood sugars well. It is also a test that requires no fasting and no carbohydrate-loading foods or fluids, a part of the GTT which puts the pregnant body through an unnatural metabolic gymnastics which is not healthy, in my opinion. The Hemoglobin A1C is also a test which shows what the blood sugars have been like for the previous 3 months, and not just in the most recent hour or two or three. It is also a test which is not affected by any emotional upsets which you may experience in the minutes or hours before your blood is drawn.

See here for more information on the Glucose Tolerance Test and "gestational diabetes"

See here for information about the Hemoglobin A1C test (remember that this source is referring to Type 1 diabetes, not "gestational diabetes")

See here for a very good article by Dr. Michel Odent, "Gestational Diabetes: A Diagnosis Still Looking For a Disease?"

See this article for more information on gestational diabetes: "The Emperor Has No Clothes", by Henci Goer

Q: Will increasing water intake during the end of pregnancy help with water retention?

Most likely just increasing your water intake alone will not reduce your edema.

Edema in pregnancy comes from more than one cause. Physiological edema comes from the normal mechanics of pregnancy--the weight of the baby and uterus in the pelvis restricting the flow of the blood from the legs back to the heart--and a hormonal process of fluid retention in preparation for possible blood loss after the birth. It can also be a sign of a healthy pregnancy.

Pathological edema, on the other hand, can reflect "protein/calorie, sodium, and/or related dietary deficiencies or a medical disorder unrelated to pregnancy. Differential diagnosis as well as a thorough dietary history can invariably determine the origin of the edema."

See here for the source of this quote, and for more information about edema in pregnancy.

See here for additional information on swelling in pregnancy

If your edema comes at least partially from a nutritional cause, you can help yourself by increasing more items in your diet besides water. You can increase the amount of calories, salt and protein in your diet as well.

The increased calories will help your body to use your protein intake for cell-building (baby cells, uterine cells, and blood cells) and for blood volume expansion (which helps prevent PIH and pre-eclampsia), instead of burning your proteins for the calories it needs just to carry out daily bodily functions.

The increased salt intake will help your cells absorb the glucose that they need to function. Salt also helps create osomotic pressure in your bloodstream, which pulls fluid out of your ankles and fingers and face, and back into your blood stream--which also helps to increase your blood volume and prevent PIH and pre-eclampsia.

The increased protein intake helps your liver to create more serum albumin, which also increases the osmotic pressure in you bloodstream, pulling fluid out of your ankle/finger/facial tissues and expanding your blood volume to further assist in the prevention of PIH and pre-eclampsia.

It is true that extra "water retention" (edema) can be a sign of your blood volume being too low. And it is true that you may need more fluids. But just drinking water may not solve the problem. Without extra calories, salt, and protein, there still may not be enough osmotic pressure in the bloodstream to hold all that extra water that you're drinking where it needs to be--in the bloodstream. Without an increased level of osmotic pressure in the bloodsteam, you may just pee out most or all of that extra water that you're drinking.

See here for more information about the importance of salt in pregnancy

See here for more information about drinking water in pregnancy

Q. Is HELLP syndrome caused by a genetic disorder?

No, I do not believe that HELLP syndrome is caused by a genetic disorder. I realize that there may be mainstream doctors who do believe that HELLP syndrome is caused by a genetic disorder, but from what I have read and understood of what Dr. Brewer researched and wrote, it seems that there is a more plausible cause of HELLP syndrome.

The liver has many tasks. It has at least 500 metabolic functions, and pregnancy puts a lot of stress on the liver. But the liver is designed to deal with the stress of pregnancy, as long as the mother eats well enough to provide all the nutrients that the liver needs in order to continue working well and dealing with the stresses of pregnancy in a good way.

One of the most important tasks that the liver needs to keep up with during pregnancy is that of making serum albumin to help the mother's blood volume to expand by 60%. When the liver doesn't get enough nutrients to keep the blood volume adequately expanded, one of the results is that the liver becomes damaged.

Another of the liver's most important tasks during pregnancy is manufacturing essential clotting factors to prevent abnormal bleeding during pregnancy, labor and postpartum. When the liver becomes damaged in pregnancy, from an inadequately expanded blood volume for example, one of the liver functions that can become compromised is this manufacture of essential clotting factors, and thus we see the development of HELLP and abnormal bleeding. So it is the Brewer perspective that eating the Brewer Pregnancy Diet can prevent the development of the HELLP syndrome in pregnancy.

However, there can also be many other causes of postpartum hemorrhage and clotting disorders. Some of the causes of postpartum hemorrhage are the birth traditions, procedures, and interventions that are commonly used in most hospitals in the U.S. I can also believe that some of the causes of abnormal pregnancy bleeding or clotting and postpartum hemorrhage could be genetic in origin, but it is my opinion that it would not be accurate to call those disorders HELLP syndrome. Please read more about this point of view through the following link.

See here to read more about the Brewer perspective on HELLP syndrome

I also believe that it is quite probable that for many women who experience HELLP, the situation could result from a complex combination of causes. For example, the process could start out with abnormal bleeding or clotting from a genetically-caused clotting or bleeding disorder unrelated to HELLP. Then the mother's blood volume could start to fall from an inadequate calorie intake (possibly through morning sickness, or stress, or strenuous work conditions, or an attempt at weight-gain control), from the use of herbs with diuretic properties, from inadequate salt intake, or from salt loss through hot weather or exercise, or all of the above. This falling blood volume could start the process of liver damage and increasing edema and rising BP. In addition, the falling blood volume could also slow the flow of blood behind the placenta to such an extent that the blood in this placental lake could start to clot. As her doctors might respond to this situation with antihypertensive drugs, sedatives, and/or further salt or calorie restriction, these treatments could cause her liver damage to continue to increase until she could finally develop HELLP, with potentially life-threatening bleeding in the third stage of labor and postpartum as the placenta is birthed and involution begins. In such a situation, it could be easy for a doctor who did not agree with the Brewer point of view to present the situation as simply a genetic clotting disorder.

"Pregnant exercise 'unsafe'"

Read more.......

"Women who exercise during pregnancy face risk of pre-eclampsia, researchers warn"

Read more.......

"Exercise in pregnancy linked to fatal raised blood pressure condition"

Read more.......

I realize that there are mothers who may feel very angry with Dr. Brewer, or with Gail Brewer Krebs, or with me, for having this point of view and for trying to help mothers to prevent HELLP in their own lives with the use of this diet. I understand that these mothers may disagree with this point of view so completely that they believe that we may be doing other mothers harm by teaching them this diet. I feel badly that our trying to spread the word of this kind of hope brings pain to the mothers who believe this information to be harmful, but I don't know how to care for both the mothers who want this information and those who don't at the same time. However, I do commit myself to do the only thing that I know how to do in this situation, and that is to respond to everyone with compassion and sensitivity.

Having said that, I would hate for any mother to feel that she was being blamed for having contracted HELLP syndrome. Neither Dr. Brewer, nor Gail Brewer Krebs, nor I have ever intended for mothers to feel blamed for their illnesses. In his writings, Dr. Brewer always laid the blame squarely in the laps of the doctors who neglected to take detailed diet histories on their patients, who neglected to learn about the important role of nutrition in pregnancy, who refused to believe the full scope of the effects of inadequate nutrition in pregnancy, and who declined to spend the time and effort to educate and coach and support their patients in their efforts to eat well.

See here for a comparison between the Brewer Diet and the ACOG diet

See here for more information about adjusting the Brewer Diet to meet your unique needs

See the bottom of this page for additional information about adjusting your diet to fit your circumstances

I urge all mothers who have suffered the effects of this neglect to not take the blame onto themselves, even if they later come to believe that nutrition could have been a factor in the development of their complication. I would guess that every mother from time immemorial has found ways to feel guilty about things they wish they'd done differently in their pregnancies, labors, and parenting years, including me--and some of those things can be potentially life-threatening. But we cannot hold ourselves responsible for information that we did not have, role models that we did not have, or energy, skills, or presence-of-mind that we did not have, at any given point in time.

So I encourage any of you who have suffered HELLP syndrome, or other complications of pregnancy which you may wish that you had handled differently, to not carry the burden of guilt in that regard. I encourage you to chalk it up to doing the best you could with what you had at the time, and to living and learning as we go through life. For as long as we live we will never be perfect, and we will always have more to learn. With time and practice, as we grow and mature, hopefully we become more skilled at and comfortable with accepting our past mistakes with peace and grace, and moving forward to develop other ways of doing things. Hopefully my life will be enriched in that way as well.

Q: What causes blood clots to form behind the placenta?

A: When the placenta first implants on the inner uterine wall, it secretes enzymes which dissolve the ends of the capillaries which come to the inner surface of the uterus. As a result, the open ends of the arterial capillaries spout little fountains of blood behind the placenta, and the open ends of the venous capillaries return the blood to the mother's heart, like little bathtub drains. This is called an arterial-venous shunt. A lake of blood forms behind the placenta, and the baby's capillaries in the placenta, which remain intact (like little loops), are continually bathed in this lake of the mother's blood. Through this process, oxygen and nutrients pass from the mother's lake of blood, through the baby's capillary walls, and into the baby's blood stream, and waste products pass from the baby's capillaries to the mother's blood.

As the placenta grows, the lake of blood behind the placenta needs to grow, and the mother needs to grow more blood in order to keep this lake of blood well-supplied. By the end of the pregnancy, she needs to grow her blood volume by 60% for a singleton pregnancy (about 2 quarts/liters of blood) and 100% for a twin pregnancy (about 3.5 quarts/liters of blood). In order to help her body to increase her blood volume in this way, the mother needs to eat a daily minimum of 2600 calories, salt to taste, and 80-100 grams of protein for a singleton pregnancy, and more than that for a multiple pregnancy.

When the mother's blood volume fails to keep up with the growth of the placenta, through inadequate food intake, loss of salt and fluids (from over-heated conditions or herbal diuretics), or through lifestyle conditions which use up extra calories, the flow of blood through the a-v shunt behind the placenta slows down. The blood that is supposed to be spurting out of the open arterial capillaries behind the placenta like little fountains, slows to a trickle, and the blood flowing through the lake of blood behind the placenta to the open venous capillaries slows down to such a very slow rate that it begins to clot, as blood always does when it is not flowing at a good rate.

The best way to prevent this clotting behind the placenta is for the mother to eat according to the recommendations of the Brewer Pregnancy Diet, plus making daily adaptations, increasing the minimum levels of the Basic Plan to accommodate her personally unique lifestyle and needs. By doing this, she will enable her body to continually expand her blood volume to normal levels, and maintain it at a well-expanded level for the rest of the pregnancy--keeping the little capillary fountains spurting at a good pressure, and the little capillary drains draining at a good rate, and the lake of blood behind the placenta flowing at a good pace so that it doesn't begin to clot.

The following is reprinted from Metabolic Toxemia of Late Pregnancy, by Thomas H. Brewer, M.D., 1966 & 1982.

"Toxic Abruptio Placentae"--(p. 61)

"Elisabeth Ramsey and her co-workers have given us a clear, scientific picture of how the placental circulation works. Maternal blood enters the intervillous space by small uterine veins on the floor of the intervillous space. Thus, the placenta has been shown anatomically to be an arteriovenous shunt, a condition for which have had good evidence from clinical pysiological observations. Any conditions which will lead to clot formation in the intervillous space may be regarded as playing some role in the pathogenesis of abruption.

The following factors occur in severe MTLP [Metabolic Toxemia of Late Pregnancy/Pre-Eclampsia] and can play a role in promoting the formation of a clot behind the placenta:

1. Reduction in velocity of blood flowing through the intervillous space associated with arteriolar spasm (of uterine spiral arterioles);

2. Increased viscosity of maternal blood associated with hemoconcentration, hypoalbuminemia, and hypovolemia;

3. Increased fibrinogen concentration of maternal blood associated with hemoconcentration and probably hepatic injury; and

4. Widespread endothelial injury of unknown cause which can damage the fetal cotyledons and release thromboplastin to trigger the clotting mechanism.

See here for more information about the role of low blood volume in clot formation and abruption of the placenta

Q: Can you eliminate water weight gain in pregnancy?

You can certainly try, and many people have tried for many decades, and many people still do. Doctors have often used prescription diuretics and low-salt diets, to try to eliminate pregnancy edema ("water retention"), and the mothers themselves sometimes try herbal diuretics. But it is only a very unhealthy pregnancy which does not include some water weight gain, and all that these various attempts succeed in doing is lowering the mother's blood volume and triggering a variety of complications.

One of the main functions of the pregnant body is to preserve the pregnancy and nourish the baby. The body's ability to do this well depends a great deal on its ability to increase the mother's blood volume. Normally, this blood volume is expected to increase by 50-60%, over the course of the pregnancy. For a woman with a pre-pregnant weight of 130 pounds, this would be a increase of about 2.1 quarts of blood (from about 3.5 quarts at the beginning of the pregnancy to about 5.6 quarts at the end of the pregnancy). In order to accomplish this blood volume expansion, the mother needs to eat extra calories, extra salt, and extra protein, and drink extra fluids that are nutritious. So part of the weight gain of a healthy pregnant mother is the extra water held in her bloodstream for the purpose of expanding her blood volume.

Often what people are referring to when they ask questions like this one is the water that they can see, rather than the water that is being carried in the mother's bloodstream, which they can't see. They are often referring to the "water retention" which they see in the mother's swelling, or edema, in her ankles, fingers, and/or face. This kind of "water retention" can mean several different things.

Swelling of your ankles/fingers/face can simply be a sign of your body getting ready for labor, creating your own IV fluid supply, so to speak. Or it can be caused by the weight of the baby and uterus restricting the flow of the blood through your legs, as it returns to your heart. Or swelling of your ankles, fingers, or face can be a sign of pre-eclampsia, or toxemia. Or it could be simply a sign of a blood volume that is less than optimum for your stage of pregnancy. The healthy swelling can look the same as the unhealthy swelling. The easiest way to tell the difference between healthy swelling and unhealthy swelling is to ask yourself what you've been eating.

You can use the "Weekly Checklist" page to evaluate your diet, to see if any of your edema is the unhealthy kind of "water retention". If you scroll down to the second half of the page, you can see a variety of circumstances which create an extra need for calories, salt, and protein, to reduce your extra edema.

The Weekly Checklist for the Basic Plan of the Brewer Pregnancy Diet

Salt in Pregnancy

	High Salt Diet	Low-Salt Diet
Toxemia	37/1000	97/1000
Perinatal deaths	27/1000	50/1000
C-section	9/1000	14/1000
Abruptio placenta	17/1000	32/1000

TABLE 25
CONSEQUENCES OF SALT RESTRICTION

	# of Women Perinatal Mortality Rate % Toxemia % Edema % Placental Infarcts Restricted Salt Intake 1,000 50.0 9.7 28.7 1.3 Increased Salt Intake 1,019 26.5 3.7 16.0 3.2

TABLE 26
ASSOCIATION OF ABSENCE OF EDEMA
WITH PREMATURE DEATH

	# of Women # of Still- Births # of Neonatal Deaths Perinatal Mortality Rate No Edema of Hands or Face 2,268 33 40 32.2 Edema of Hands or Face 1,890 15 10 13.2

See here for the chapter that these tables were taken from.

See more about swelling in pregnancy here

Q. Do diuretics cause you to sweat?

No. Diuretics cause your kidneys to excrete more of your fluids in your urine.

The kidneys filter out about 170 liters of your fluids a day. Then they reabsorb about 168 liters of that fluid, leaving about 2 liters a day to pass out of your body as urine. If you take a diuretic, your kidneys get stimulated to lose more of your fluids in your urine than they normally would.

In a situation where the person has a kidney disorder or a cardiac illness, they might develop a blood volume that is abnormally expanded, which puts a great stress on the body. So sometimes they are given a diuretic to cause the kidneys to lose more of their fluids in the urine, so that their blood volume can be lower and at a more normal level.

In a normal, healthy pregnancy, the body is working very hard to increase the blood volume, so that the placenta can be well-serviced. When the placenta grows, as pregnancy progresses, or when it is larger (or there is more than one placenta) due to multiple babies, even more blood is needed to keep the placenta(s) functioning well enough to sustain the pregnancy and the baby(ies). The blood volume usually increases about 60% for a singleton pregnancy. So in the normal pregnancy, in the absence of kidney disease or heart disease, we do not have a situation of an abnormally expanded blood volume. Instead, we have a situation where the blood volume is in a state of continually needing to increase to the next level. And when symptoms such as rising BP and pathological edema start to show up, they are usually signs that that blood volume increase is lagging behind--and we have an abnormally contracted blood volume.

Giving diuretics to a pregnant woman who is having swelling in her ankles or fingers or face, or a rising BP, therefore, is causing the kidneys to eliminate more fluids at the very time when her body is saying that she needs to be increasing the fluids in her blood stream. Increasing the mother's loss of fluids in that way at that point in time could lead to pre-eclampsia, HELLP, abruption of the placenta, stroke, coma and death in the mother, and to the premature birth, or even death, of the baby. This is very serious business. That is why I try to discourage mothers from using herbal diuretics in pregnancy.