The following is reprinted from The Pregnancy After 30 Workbook (Gail Sforza Brewer, editor), 1978, (p. 6).

See here for the food groups and serving sizes in the Twin Brewer Pregnancy Diet

See here for the Twin Pregnancy Brewer Diet Basic Plan Weekly Record for printing and putting on your refrigerator

See here for "They Are What You Eat--Nutrition in a Plural Pregnancy"

"Who Runs a Higher Risk? A Consultation About Childbearing After 30" (by Victor Berman, M.D., and Salee Berman, R.N.)

...The general impression that a multiple pregnancy automatically presents a higher risk for mother and babies is not an accurate one. Of itself, such a pregnancy does not have to be any more complicated than a single birth. The nutrition of the mother is probably the most important factor in the success of a twin pregnancy. Unfortunately, many physicians have not been trained to view pregnancy as a nutritional stress; so they do not see the twin pregnancy as an exceptional challenge to the mother's daily dietary habits. There are two placentas, or one very large one, to be serviced, two babies to be completely formed, and an elevated metabolism throughout the body. When these needs are met by a diet adequate for twin gestation (we recommend a minimum of 140 to 150 grams of protein and 4,000 calories per day), the mother can expect to carry her babies to term and deliver them at a normal weight (not less than 5 1/2 pounds). When her nutritional needs are met, she does not have to worry about metabolic toxemia, a condition for which mothers of twins are also supposedly high risk.

In our practice, we schedule twin births for the hospital rather than our birth center because of the increased likelihood that the babies will be in unusual positions for birth. This is primarily a problem of "traffic management" since there are two babies and often two placentas for the mother to deliver. We are accustomed to our mothers giving birth to seven- and eight-pound twins, by the way, so the traditional concerns about immaturity in twins seldom confront us. Mother and babies stay the minimum amount of time in the hospital, often just a day or two, and are treated like all other normal cases postpartum.

We strongly advise mothers of twins to breast-feed because of the greatly enlarged uterus and larger placental site which m ush heal after birth. Nursing causes the uterus to contract rhythmically, clamping blood vessels at the placental site, thus reducing the chances for postpartum hemorrhage. Another benefit for the mother is that her uterus will have returned to its original shape and position in the pelvis by the standard six-week postpartum checkup. Nursing also simplifies the daily baby care routine while providing a built-in time for the mother to rest. This approach to infant care smoothes the postpartum course for mother and babies.

Of course, preexisting medical diseases can complicate pregnancy.

It depends, of course, on the disease we're dealing with. Generally speaking, the severity of the disease and the specific medical management required by the individual woman are the critical factors to be considered when pregnancy is contemplated. The four most common diseases which tend to appear as a person gets older are diabetes, heart disease, kidney disease, and hypertension. They frequently occur in combination. Each can have an adverse effect on the outcome of pregnancy if it is not managed correctly.

A thorough medical history and physical examination before pregnancy is the best course to take. Sometimes, though, women with these diseases become pregnant without planning it; they may not even realize they have a problem. Sometimes it is discovered at the first prenatal visit. In most cases, if the disease is identified early, it can be controlled successfully during pregnancy so the moter and baby do well.

The Pregnancy After 30 Workbook available here

See here for YouTube videos of homebirth, waterbirth, VBAC, & natural birth of multiples

See here for the best treatment for pre-eclampsia in multiple pregnancies

See here for more information on the hazards of the over-medicalization of normal childbirth

The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy (Gail Sforze Brewer with Thomas Brewer, M.D.), 1983, (p. 223).

Note from Joy: Unfortunately, some areas of the "alternative medicine" community have followed mainstream medicine in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties. Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant women to watch which herbs they are taking.

See here for more information on the hazards of using herbal diuretics in pregnancy

It is obvious that a twin pregnancy imposes a greater nutritional stress on a woman than a single one. As a result, it is commonly observed that pregnancies with twins or more are complicated by metabolic toxemia of late pregnancy, abruptions of the placenta, premature labor and delivery, and low-birth-weight and small-for-gestational-age babies with more congenital anomalies, especially central nervous system disorders like mental retardation, cerebral palsy, epilepsy, and learning disorders.

The mother with twins must eat more good foods and take more salt and water to maintain a greatly expanded blood volume throughout the entire gestation (a 100 percent expansion is to be desired) in order to perfuse two placentas.

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

For each extra baby, we recommend 500 calories and 30 grams of high-quality protein more than the Brewer Basic Plan. This is easily obtained by adding four more exchanges to Group 1 on our diet, or two more exchanges to Group 4 [Protein Combinations--see "The Diet" page on this website]. Toward the end of pregnancy it is difficult to keep up the adequate diet. Again, small frequent feedings must be resorted to and the mother must be encouraged constantly to eat enough to maintain her pregnancy until term. However, the well-nourished mother with twins is sure to gain more weight than traditions allow. It is common for such a woman to gain 50, 60, or even 70 pounds. If the diagnosis of multiple fetuses is not made, then the traditional, rigid weight limitation will do a great deal of harm by severely limiting the mother's intake of foods and salt.

It has been widely taught in U.S. obstetrics that overdistention of the uterus by multiple fetuses is the cause of premature labor and delivery. Often the babies charged with overdistending the uterus only weigh 2 or 3 pounds each! However, we are seeing women on our twins diet having 7- and 8-pound babies right at term, so clearly the mere distention of the uterus is not related to premature labor in multiple gestation.

An excellent book detailing progressive management of twins and more is Having Twins by Elizabeth Noble (Boston: Houghton Mifflin, 1981). It is the only book on the subject that deals concretely and positively with the nutritional challenges of multiples.

The Brewer Medical Diet for Normal and High-Risk Pregnancy available here

The following is a portion of the "Chapter 1" reprinted from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.

"The Complete Pregnancy Diet: Meeting Your Special Needs", by Gail Sforza Brewer (p.14)

CORRECTIVE ALLOWANCES

Agnes Higgins, past president of the Canadian Dietetic Society and director of the Montreal Diet Dispensary [as of 1983], has developed a procedure for estimating calorie and protein requirements in excess of the pregnancy levels we've already established as a baseline. She emphasizes that any of the following factors increases a mother's nutritional needs:

As a corrective allowance, Mrs. Higgins and her staff counsel mothers to add twenty grams of protein and two hundred calories to their basic daily pregnancy diets for each condition listed above (an individual mother may be experiencing more than one of these stress conditions).

Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding one quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream pies and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase the protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or meat substitute as detailed on the diet list. A sample daily menu plan for a mother expecting twins would look something like this:

Twin Brewer Pregnancy Diet (click for details)

You must have, every day, at least:
(plus 30 g protein and 500 calories for each additional baby):

Group 1 (milk and milk products)--8 choices
Group 2 (calcium replacements)--as needed
Group 3 (eggs)--2 choices
Group 4 (protein sources)--12 choices
Group 5 (dark green vegetables)--2 choices
Group 6 (whole grains, starchy vegetables & fruits)--5 choices
Group 7 (potato)--1 choice
Group 8 (vitamin C sources)--3 choices
Group 9 (fats and oils)--5 choices
Group 10 (vitamin A sources)--1 choice
Group 11 (liver)--Optional
Group 12 (salt and sodium sources)--unlimited, to taste
Group 13 (water)--unlimited, to thirst
Group 14 (snacks)--4 or more
Group 15 (supplements)--as needed

See here for more details on serving suggestions and portion sizes

See here for twin diet checklist for printing and putting on your refrigerator

Generally speaking, these conditions result in an increased appetite; however, women who are working, moving their households, or under emotional stress sometimes fail to pay attention to their bodies' signals for more food. Calling special attention to their extra needs by assigning specific goals for extra protein and calorie consumption makes it much less likely that their nutritional needs will go unfulfilled.

At the Montreal Diet Dispensary, underweight is defined as weighing five per cent or more less than the weight recommended for your height in the Table of Desirable Weights of the Metropolitan Life Insurance Company, a standard used for thirty years. You should use the column for a "large frame" as the company recently disclosed that they have been underestimating all the optimal weights on the chart by ten per cent ever since they first published it! If you really do have a large frame, use the standard for the next taller height.

Undernutrition means any protein deficit between what you're used to getting from your food and the minimum adequate pregnancy requirement (eighty to a hundred grams per day). The Higgins nutrition intervention method uses a twenty-four hour diet recall, a technique you can use on your own to see how close your regular diet has been coming to what you actually need. You will need to write down everything you've eaten for the past twenty-four hours (pick a typical day for you), including all snacks, all beverages, and all second helpings. Note what the food was, how much you ate, then consult the Protein-Calorie Counter (see Appendix) to check the amount of protein contained in those portions of those foods. For each gram of protein you lack, add that to your personal protein goal, plus an additional ten calories to free that protein for its most important work in pregnancy: keeping you own tissues healthy and building those of your unborn baby. If you come up with a deficit of ten grams of protein, then, you also need to add a hundred calories to your basic requirements.

If you take supplemental vitamins and minerals, brewer's yeast, wheat germ, or other dietary supplements (such as protein drinks, powders, or pills), be sure to take them with meals, since their absorption is enhanced in the presence of complete foods, which provide enzymes necessary for their metabolism. Many people turn to these nutritional aids when they find they have significant nutritional problems in pregnancy; however, it's important to keep in mind that a pill two or three times a day cannot substitute for the foods on the Complete Pregnancy Diet list. These preparations must be viewed strictly as supplements to a good diet, not the diet itself. There are many factors in food substances, such as enzymes, that are not contained in pills or powders, and there may be other substances in foods that are essential to human life that have not yet been isolated by nutrition scientists. So relying on the protective foods on the diet list is the best guarantee of satisfactory pregnancy nutrition.

This food record chart should help you keep track of your daily progress on the diet. Just check off each requirement as you meet it, day by day, week by week, month by month.

See the Brewer Pregnancy Diet Basic Plan Weekly Record here

Eating for Two, by Gail Sforza Brewer and Isaac Cronin, available here

The following menu is reprinted from Right from the Start: Meeting the Challenges of Mothering Your Unborn and Newborn Baby, by Gail Sforza Brewre (Krebs) and Janice Presser Greene, 1981.

	Eating for Three: Sample Daily Menu for Twin Pregnancy For a complete discussion of twin pregnancy, including nutritional management, read Having Twins (Boston: Houghton Mifflin, 1980), by Elizabeth Noble, R.P.T. Breakfast 4 oz. orange or grapfruit juice 2 eggs 2 slices whole grain bread or muffins butter 8 oz. "super milk" (whole milk with 1 cup powdered nonfat milk--not protein powder--mixed in to give extra protein) Morning Snack--you may feel like eating every couple of hours 2 oz. Swiss cheese whole grain crackers medium apple,peach, or other fresh fruit 4 oz. tomato juice or real lemonade Lunch 4 oz. hamburger with lettuce, tomato, and mayonaise whole grain roll or 2 slices whole grain bread 8 oz. "super milk" 1/2 cup potato salad or beans 1 cup vegetable soup Mid-afternoon Snack 1/2 cup cottage cheese in a raw pepper or tomato 1 cup chicken or beef broth whole grain croutons or bread sticks Dinner 8 oz. "super milk" 1/2 cup fruit cocktail (variety of fresh, frozen, or canned fruits) 6 oz. chicken (two breasts, three legs) 1 cup brown rice (cooked in chicken broth rather than water to absorb extra protein) 1 cup green salad with dressing butter 1/2 cup broccoli or spinach 1/2 cup carrots or squash Evening Snack 1 cup pudding (made with "super milk") or egg custard 1/4 cup salted nuts Middle-of-the-night Snack (when you have to get up to go to the bathroom) choice of: milk, cheese, hard-boiled egg, yogurt, 2 oz. meat, nuts, peanut butter on whole wheat toast (focus: extra protein) Salt to Taste, Drink to Thirst: your requirements are even greater because of the extra baby you're growing! Goal: a minimum of 30g additional protein (130 g total) and 500 extra calories above the basic pregnancy diet, plus all other vitamins and minerals; these needs could be met simply by adding a quart of milk a day to the basic Brewer Diet.

Right from the Start: Meeting the Challenges of Mothering Your Unborn and Newborn Baby available here

Having Twins And More: A Parent's Guide to Multiple Pregnancy, Birth, and Early Childhood, by Elizabeth Noble here

The following is reprinted from The Very Important Pregnancy Program, 1988, by Gail Sforza Brewer (Krebs) (p. 126).

Q: I went for the routine ultrasound scan my midwife wants at the twentieth week and we found twins! Now, all of a sudden, I'm being transferred out of the midwife's care. I have to attend a high-risk clinic every two weeks and I'm supposed to stay in bed (only potty privileges) at home until I reach the thirty-sixth week. The doctor is urging me to enter the hospital for even closer supervision, saying that if I need drugs to halt a premature labor, I'll be in the best possible place. Also, they'll be able to pick up any problems, like high blood pressure, as soon as they start. I have two other children, ages six and three, and can't imagine leaving them in someone else's care for the next four months. At the same time, I don't want to jeopardize my new babies either. Is there any way to safely avoid this hospitalization?

Definitely. In our experience, women who meet the extraordinary nutritional stress of carrying twins are not at high risk for premature labor or underweight infants, the two common complications of multiple pregnancy that have your midwife and doctor most worried. Failure to provide adequate nutrition for the second baby is the most common cause of these problems.

Your diet needs to be upped for multiples. As we have emphasized for mothers with single babies, the key to sustaining your pregnancy is to keep your blood volume expanded to the level needed to supply your placenta(s). With twins, that's double the amount of blood you had before you became pregnant! And, as your abdomen becomes progressively more crowded with babies, it becomes doubly difficult for you to eat everything you need for all three of you. You run out of room just when the nutritional stress reaches its peak. It's the same problem anyone with a good-sized baby faces in the last month of pregnancy, but you get there six to eight weeks earlier! You need extra calories and protein every day for each additional baby. You can do this by simply adding four exchanges to Group 1 on the Brewer diet or two exchanges to Group 4. Have a nutritious bite of something every time you feel you can, as you will not be able to eat traditional full meals for quite a while. It may also feel better to sleep propped almost completely upright--better breathing and less heartburn as the babies push progressively upward.

Putting mothers of multiples to bed only aggravates the problem, in my opinion, since it's common knowledge that when you reduce your activity, you also reduce your appetite--just what you don't need when you're striving to obtain every gram of protein, every calorie, and every vitamin and mineral you can. It's true that limiting your activity sharply "saves" some calories that in theory are available to promote the growth of your second baby. But the dwindling of your appetite after a few days of total bed rest only serves to compromise the nutrition of both babies.

Stay as active as you desire. Usually by the seventh month or so, nature slows you down automatically because of the increasing pressure from the weight of the babies, the very loose ligaments of your back that may cause nonstop backache, and the considerable swelling in your feet and legs as the heavy uterus settles into the pelvis and restricts the return of blood from your lower body. Eat small, high-protein meals every hour or two. Twice-a-day naps become the rule rather than the exception. Elevating your legs four or five times a day help relieve your discomfort from swelling (on some days it may feel like you have little water balloons around your ankles!). And, of course, keep adding extra salt. Your heart has a tremendous load of extra blood to pump, the second amniotic sac needs to be filled with salty waters, your second baby needs sodium for its cells to function normally, and your legs will start cramping every night if your sodium intake isn't adequate. Even more important, your blood volume will start to decrease if you start to get behind on sodium, triggering an early labor.

Because it's clear that a falling blood volume is a major factor in premature labor, researchers have been experimenting recently [1988] with expanding the blood volume (using a variety of agents to accomplish this, including albumin) to stop labor that starts too soon. Robert C. Goodlin, M.D., of the University of Nebraska Medical School, Department of Obstetrics and Gynecology, reported his work along these lines with over 300 patients in an article, "The Significance, Diagnosis, and Treatment of Maternal Hypovolemia as Associated with Fetal/Maternal Illness" published in Seminars in Perinatology (vol. 5, no.2, April 1981). Goodlin and co-workers also noted that irregularities in fetal monitor tracings can sometimes be improved by increasing blood volume through slow intravenous infusion of albumin.

This work is important because it targets the primary disturbance involved in so many premature labors, not only in twins. Why not prevent the onset of the hypovolemia (reduced blood volume) in the first place? And that is the task facing every expectant mother and her medical consultants. If you eat well enough to keep your blood volume optimally expanded, you won't require hospitalization until you go into labor at term with strong, normal-sized babies to deliver.

Nutritional Deficiency in Pregnancy

Complications	Control Group (750)	Nutrition Group (750)
Preeclampsia	59	0
Eclampsia	5	0
Prematures (5 lb. or less)	37	0*
Infant Mortality	54.6/1,000	4/1,000

It is most unfortunate that even as Goodlin and others evaluate the place in emergency obstetrical therapy for plasma expanders, the U.S. Food and Drug Administration approved the use of ritodrine (the generic name for a drug marketed under the trademark Yutopar) for preterm labor. If your doctor is talking about drugs to stop premature contractions, this is most likely the one used. As its name suggests, Yutopar stops labor by paralyzing the uterus, thereby preventing it from contracting and dilating the cervix. It is only effective in doing this when cervical dilation has not progressed past 4 centimeters, effacement is less than 80 percent, and membranes are still intact.

Any drug powerful enough to subdue established uterine activity has to have equally powerful side effects. Ritodrine does not work selectively on uterine muscles. It also interferes with the normal activity of the heart, intestines, blood vessels, and lungs. For this reason women receiving ritodrine experience frightening disturbances in heart rate, blood pressure, and breathing. Some women have felt as though they were about to collapse because of shortness of breath and a racing heartbeat. These are not merely psychosomatic reactions to the stress of finding oneself unexpectedly in labor. Reports of maternal and fetal deaths attributable to ritodrine therapy are on the rise in the medical journals.

Significantly, even the leading obstetrical textbook, Williams Obstetrics (17th ed.; East Norwalk, Conn.: Appleton & Lange, 1984), finds little to recommend ritodrine, despite the six-page, full-color spreads promoting the drug to the medical profession that now appear regularly in the same journals claiming that it is the answer to our high national rates of low-birth-weight infants and premature labors. In fact, after reviewing the research studies done to date on ritodrine, the text concludes: "Ritodrine treatment in the Danish multi-center study did not produce any recognized beneficial effects on the newborn infants when compared to those mothers who received 'standard treatment.' On the contrary, according to Kristofferson and Hansen (1979), the condition of the infants at birth tended to be worse in the ritodrine group." This outcome is not surprising since ritodrine passes through the placenta into the baby's circulation and exerts the same effects on the baby's organs that it does on the mother's.

Ritodrine (Yutopar), according to the manufacturer's prescribing information, is not supposed to be given to anyone with hypovolemia. Since most mothers with preterm labor are hypovolemic, that would seem to limit the drug's use, but in many hospitals that caveat does not seem to be taken very seriously. Ritodrine is also not supposed to be used when the the membranes are ruptured, when the mother is suffering preeclampsia or eclampsia (another term for metabolic of late pregnancy), or when she has an overactive thyroid, heart disease, diabetes, or hypertension. Yet almost daily one hears of women with these problems who are being advised to start Yutopar therapy.

It's important for you to know that with twins you are far more likely to notice the so-called Braxton-Hicks contractions, which "tune up" the uterus for labor, much earlier than would occur in a mother carrying only a single baby. Furthermore, you may have weeks of painful spasms of the round ligaments that hold your uterus in place (they tend to tighten when you move suddenly). Neither of these situations would be indications for any therapy other than perhaps resting for awhile and applying a warm compress or heating pad over the protesting ligament. You need not live in fear that every twinge you feel will result in the premature birth of your babies. If you are eating well enough for the demands of your multiple pregnancy, your uterus will be strong and your cervix quite capable of staying contracted until you are well within the usual time for giving birth (38 to 42 weeks of gestation is the typical range used by most obstetricians). When women really follow the Brewer twins regimen, they commonly carry 12 to 16 pounds of babies to term with no difficulty other than the physical strain of the bulky weight of the abdomen.

An editorial in the British Medical Journal of January 13, 1979, titled "Drugs in Threatened Preterm Labor," suggests that for some mothers and babies, ending pregnancy prior to term may even be to the good: "The tacit assumption that inhibiting preterm labour is necessarily beneficial should not go unchallenged. Indeed, preterm labour may often be nature's best option, in that the precipitating cause may be acute or chronic impairment of placental function."

In other words, if the mother and babies are being threatened by a falling blood volume to the extent that vital organs cannot function normally, preterm labor is a way out of an impending metabolic crisis, a life-saving measure for the mother. To paralyze a uterus trying to evacuate itself under these circumstances does a disservice both to the mother and to the babies, who would be forced to remain in an undernourished state for the duration of the therapy (in some cases a month or more). If they are born and cared for in a highly skilled neonatal intensive care unit with breast milk provided as part of their nutrition, they might actually fare better, though we are far from happy with this eventuality and recognize the hazards posed by neonatal intensive care.

After all is said and done, it is far better to prevent hypovolemia than to have to improvise some sort of therapy for it and its attendant complications. Keep eating, rest when you feel like it, and refuse any drugs that are not absolutely essential to your health. In this way, you will maintain your nutrition, the key to preventing hypovolemia.

The Very Important Pregnancy Program available here

The following is reprinted from Metabolic Toxemia of Late Pregnancy (Thomas H. Brewer, M.D.), 1966 & 1982, (p. 95).

Eating for Three: Twin Gestation

It is widely accepted that multiple pregnancy is associated with a higher incidence of a host of complications of pregnancy, including metabolic toxemia of late pregnancy, hydramnios, prematurity and anemia. Much emphasis has been placed by certain authorities on "uterine overdistention" produced by the increased number of fetuses. Since the large majority of twin gestations are not associated with MTLP, it seems reasonable to suspect that factors other than uterine overdistention are at work in this disease, which is common in single-fetus pregnancies. It is obvious that a twin pregnancy imposes a greater nutritional burden on a woman. If she has a borderline diet, the extra fetus can readily enhance the state of nutritional deficiency. A twin gestation usually is associated with a larger placenta, which produces more steroid hormones for the liver to detoxify. Bengtsson and Ejarque have recently reported a woman with twin gestation whose placental production of progesterone in a twenty-four-hour period was calculated from isotope dilution techniques to be 520 mgm. We are accustomed to think of 100 mgm of progesterone as a potent physiological dose.

It has been shown that hospitalization during the last trimester improves the obstetrical the obstetrical performance of women with multiple pregnancies and lowers their premature rate. I think that the improved nutrition made available to such women in the hospital plays a significant role in this. While it may not be practical or necessary to hospitalize such women with multiple pregnancy, it is important to emphasize to each woman the importance of her taking a good diet with emphasis on high biological quality proteins and vitamins, contained in fresh vegetables. Once the unscientific fear of "obesity" and "weight gain" is banished, the physician will feel more comfortable and certain in telling the woman with twins to "eat for three."

Metabolic Toxemia of Late Pregnancy available here

See "VBAC Triplets at Home!"

See "The Twins"

See this article on the risks of ultrasound in pregnancy, and others, on my "Other" page.

Tips for breastfeeding twins and other multiples here

Having Twins (Elizabeth Noble) available here

See here to better understand the evolution of the mainstream medical perspective on nutrition and salt in pregnancy

See here for more of this 2004 interview with Dr. Brewer from Townsend Letter

Anne Frye, CPM
Portland, Oregon
www.LabrysPress.com
www.AnneFrye.com
www.midwiferybooks.com
503-255-3378
(Pacific time--three hours earlier than EST)
afryemdwf@gmail.com

Anne provided full maternity care for women seeking homebirths for 14 years. When she studied to be a midwife, she was trained to use the Brewer diet as a primary means of optimizing each woman's chance of achieving a healthy pregnancy. In working with a poor immigrant population on the Texas/Mexican border she saw first-hand what a powerful tool diet can be to make this possible. Since that time she stopped actively practicing and focused on teaching as well as authoring professional-level textbooks with an emphasis on preventive care, including the nutritional management of pregnancy. Her textbooks include Understanding Diagnostic Tests in the Childbearing Year, Holistic Midwifery, A Comprehensive Textbook for Midwives in Homebirth Practice, Vol I Care during Pregnancy and Vol II Care of the Mother and Baby during Labor and Birth and Healing Passge: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth. These texts are available through her website. She also regularly offers consultations to care providers of all kinds as well as mothers who have questions about diet in pregnancy, troubleshooting preeclampsia, nutritional support for multiple gestation, interpretation of laboratory results, as well as other issues. Feel free to call her if you would like to talk to someone who has first-hand experience regarding the value of nutrition in ensuring a healthy pregnancy.

Prevention of Convulsive MTLP (Eclampsia)

	Number of Pregnancies	Cases of Convulsive MTLP (Eclampsia)
Tompkins 1941	750	0
Hamlin 1952	5,000	0
Bradley 1974	13,000	0
Davis 1976	500	0
Brewer 1976	7,000	0
Total	26,250	0

Perinatal Support Services: pregnancydiet@mindspring.com