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Dr. Brewer's Prenatal Nutrition Class

The following is reprinted from Metabolic Toxemia of Late Pregnancy, by Thomas H. Brewer, M.D., 1966 & 1982. Please note that at this point (1963) Dr. Brewer was in the early years of developing his nutrition plan. In the years after this, he went on to develop two vegetarian versions of the Brewer Diet, and he also came to discover that even "cutting back" on salt by any amount could prove hazardous to a healthy woman and her pregnancy. Also, if you check out the "The Diet" page of this website, you will find that Dr. Brewer also encouraged pregnant mothers to eat plenty of healthy carbohydrates, fruits, and vegetables.

Hamlin of Australia became convinced of the role of malnutrition in causing toxemia of pregnancy; he gave lectures to women in his prenatal clinics at the Women's Hospital, Sydney, with a remarkable lowering in the incidence of severe MTLP. His theory was based on the idea that Australian women were eating too much carbohydrate, and in his efforts to reduce their carbohydrate intake, he encouraged them to take in more high biological quality proteins. In his lectures he used such statements as: "Visit the butcher and not the baker!" and "Put down the bread knife and pick up the butcher knife." Hamlin gave the lectures himself because he realized the importance of authority as a psychological force in altering adult human behavior. For this reason, I think it is important at this time for a physician to give the prenatal nutrition lectures whenever possible.

With strong clinical, physiological and biochemical evidence that metabolic toxemia of late pregnancy is directly caused by malnutrition during pregnancy, I began in July, 1963, a clinical research project in our county prenatal clinic at Richmond, California. My challenge was not only to tell the pregnant women what they should be eating, but to tell them in such an effective way that they would actually alter their dietary habits and follow our the instructions in daily life. To accomplish this I began giving a group lecture each week to those prenatal patients visiting the clinic for the first visit. Then with each individual patient on her subsequent visits (and I see about one half of all prenatal patients for the regular follow-up visits) I would reinforce the initial educational lecture with questions concerning how well she was following the prescribed diet and also encouraging her at each visit to eat more high biological quality protein foods within the range of her economic limitations. To attempt to give some scientific answer to the question: How does prenatal care as practiced in the United States today lower the incidence of toxemia and other complications? I have not used diuretics nor salt restriction in these patients except on two occasions. I have not stressed to the patient the importance of "total weight gain" but rather stressed consistently the importance of good nutrition. The following is the basic text of the lecture to a group of new prenatal patients on their first clinic visit each Monday morning for the past twenty-six months.

Good morning, I'm Doctor Brewer in obstetrics. I want to spend a few minutes talking with you about your diet in pregnancy. Why? Because eating a good, well-balanced diet during pregnancy is the most important thing you can do to help us help you to have a healthy pregnancy and a healthy, strong baby.

Why do I want to talk with you about diet in pregancy? Well, for many years I worked with pregnant women in the South, in the city-county hospitals like Charity Hospital, New Orleans, Louisiana, and Jackson Memorial Hospital, Miami, Florida. There I saw a large number of women suffering severe complications of pregnancy such as high blood pressure, swelling, abnormal bleeding, premature deliveries. I became convinced from talking to these women and from doing some chemical studies on their blood that most of their troubles came from not eating the right kind of diet when they got pregnant.

What was wrong with their diets? The main thing that was wrong was that they didn't have enough milk, eggs and meat, the so-called "protein" foods that you especially need when you're pregnant. Many of the women I talked with at Cherity Hospital in New Orleans had only one kind of meat in their diets and it was this:

(I take from a paper bag a piece of salt pork and hold it up.) This is salt pork, or "fat back" and if you look at it real carefully, you can see a tiny streak of lean there, but mainly it is nothing but a chunk of fat. These poor women ate this cooked with greens, beans, black-eyed peas. I'm not saying it doesn't taste good or even that it hurts you to eat it once in awhile--but it is bad if it's the only kind of meat you have in your diet. So many of these women I talked with had no lean meat, no eggs, no milk at all in their diets. A lot of them ate laundry starch and river clay, too.

Well, what should you be eating when you're pregnant?

(I take from the same paper bag a small carton of dry nonfat skim milk and hold it up)

Milk is one of the most important foods you can take when you're pregnant. Why? Well, milk is a food that Nature provides for young growing things, baby animals, and it has nearly all the food substances in the right amounts that a baby needs to grow up strong. The baby inside you growing now was formed from the union of a sperm cell with a tiny egg from your ovary, and in three months or so it grows into a tiny human baby, and for the last six months of your pregnancy it simply has to grow up inside your womb until it weighs seven or eight pounds and is ready to be born.

The baby growing inside your womb gets its food from your blood stream by means of the placenta, or "afterbirth," where little loops of the baby's blood vessels are bathed in your blood, and the food substances from your blood pass over into the baby's blood vessels and then into its body. It seems a matter of common sense that if you drink a quart of milk every day, you will be feeding the baby inside you a good food for it to grow up healthy and strong. You don't have to drink this dry skim milk, you can drink any kind of milk but it must be a quart every day. I show you this dry skim milk because it is the cheapest kind of good protein food you can buy; if you buy a big box of it, you can get a quart of milk for about eigth cents [1963]. How many of you already drink a quart of milk every day?

What else besides a quart of milk do you need to eat every day when you're pregnant?

(I take from the same paper bag two chicken eggs.)

You ought to eat two eggs every day. An egg has in it all the food substances that a tiny chick embryo needs to grow up into a complete baby chicken; it is probably even a better food than milk. It has some of the best proteins and iron. How many of you eat two eggs every day? If you don't particularly like milk or eggs, you should eat them like they were medicine when you're pregnant, and also when you nurse your baby.

Besides a quart of milk and two eggs every day, you ought to eat lean meat twice a day, a green leafy vegetable and a yellow or red vegetable every day and some kind of citrus fruit or juice like an orange or grapefruit or lemon every day. In general you ought to eat a well-balanced diet and not eat too much fatty foods nor too many sweets nor drink too much pop. Cheese is a good source of protein, especially cottage cheese.

Now there are a few special problems that often come up to keep you from eating a good diet during pregnancy.

1. Many women have morning sickness in early pregnancy but it passes away after a few weeks. If it doesn't, you tell us about it in the clinic and we'll give you some medicine to help. Then about six or seven month along, many pregnant women begin to have heartburn, indigestion, nausea, vomiting. If any of these symptoms come up, be sure to tell us because we want you to have this good diet right up to the day you go into labor.

2. During the last month of pregnancy, as the baby is getting to be fairly big, you may find that your stomach doesn't hold as much as before. We had women in here not long ago who gave birth to twins, and each weighed seven and one half pounds. You can imagine how crowded her stomach was. If you need to, you can eat six or eight small meals during the day and even a snack when you wake up in the middle of the night.

3. Some of you may be a little on the heavy side and may be put on a diet. If this happens, don't forget that you still need the quart of milk, two eggs, lean meat, vegetables and fruit every day no matter what other people tell you. Your baby growing inside you can't afford to diet, and you have to furnish it the right foods every day just like you have to feed it properly after it's born. Also if your feet start to swell (and this happens in about 50 per cent of normal women) at some time during your pregnancy, you may be put on a low salt diet. Again remember that even if you cut back on salt and salty foods, you still need these good foods we've been talking about for the baby.

When I came out here to the San Francisco Bay Area, I found that women are generally better off than in the South. Complications of pregnancy aren't so common, but when they do occur, it is usually possible to find that the woman for some reason hasn't been eating a good diet. I want to tell you about one young woman whom I saw in our county hospital in San Francisco while I was working at the University of California.

She was twenty years old and she came here from a foreign country to go to college. She lived with a family and helped look after their children during the day and went to college at night. She wasn't married, and when she got pregnant, she was very ashamed. She decided to hide her pregnancy as long as possible by starving herself. Instead of drinking a quart of milk every day as she should have, she only had one cup of milk three times a week. And she ate no meat and not an egg; she ate vegetables, potatos and rice. Toward the last part of her pregnancy she began to swell, but she still didn't seek any prenatal care.

When she went into labor, the family called an ambulance. On the way into the hospital in the ambulance she had a fit, a convulsion, which is one of the signs of toxemia of pregnancyshe had developed. Her baby delivered shortly after she reached the hospital, and it died. We treated her for the toxemia and she got well in a few days. It was while she was recovering from the toxemia that she told me the story I just told you. When I told her how important good diet and prenatal care are for the pregnant woman, she promised never to do such a foolish thing again.

I'm not trying to frighten you; it is just that I have seen so many young women like this trying to hide their pregnancies, not eating right, not coming to prenatal clinics when they get pregnant, that I want you to profit from their unfortunate experiences. Pregnancy, in general, today is a very healthy state for women who eat right and get prenatal care. If you eat right and keep your clinic appointments, you'll have the best chances of having a strong, healthy baby and of staying in good health yourself. Are there any questions about your diet in pregnancy?

If you have any questions that come up during your pregnancy or any special problems about your diet, be sure to tell us during your clinic visits. You already have been given some vitamin capsules and some iron tablets to take, but let me emphasize that the best vitamins you get are in a well-balanced diet and the best iron is in meat and eggs. Remember, a quart of milk every day, two eggs every day, and lean meat twice a day are so important for you to have a healthy, strong, full-term baby and to stay healthy yourself.

This is so important that if it happens that there is an extra piece of meat on the table at supper after you've all been served... and later your husband reaches for it, tell him: "Wait a minute, I'm pregnant and I'm supposed to have that. The doctor said so; he told me to tell you that you can have another potato but that I need the meat specially."

Thank you.

On follow-up visits I ask each of my patients if she has been following the diet as discussed in the lecture, and I encourage her to eat better when it's indicated. The results of this program have been excellent. Approximately one thousand patients have heard the lecture, and not one case of severe metabolic toxemia of late pregnancy has developed in our clinic patients. In the first 235 patients who have delivered and whose hospital records I have studied, there has been no MTLP. Seven patients developed a mild hypertension while in labor which subsided within six to forty-eight hours postpartum. Four patients developed proteinuria associated with a urinary tract infection, and there was no other proteinuria. There have been four infants under 2500 gm [about 5 1/2 lbs] (one of these had a twin which was over 2500 gm) and only one premature weighed under 1800 gm [about 4 lbs]. There was one 234 gm [about 8 oz] macerated stillborn [meaning it had passed away quite awhile before the stillbirth]. This premature rate is less than 2 per cent.

These women in my clinic are on the bottom of the socioeconomic scale, and over 50 per cent of them are Negroes. In the group of 235 patients delivered, seventy-three were primiparous [pregnant for the first time], many only fourteen, fifteen, and sixteen years of age, yet not one developed MTLP. Among a similar group of primiparous patients delivered at Jackson, Mississippi, in the University of Mississippi Hospital, 35 per cent developed toxemia (Michael Newton, 1964). It is scientific to conclude that when every pregnant woman in Mississippi has adequate nutrition, metabolic toxemia of late pregnancy will disappear as it has among my prenatal patients at the Richmond Health Center in Richmond, California.

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