Recently I was asked for some advice concerning "the critical nutritional, medical and lifestyle changes to consider for (the) final trimester" of pregnancy. Being the rabble rouser that I am, I really couldn't take that question at face value. I felt I had to address what I think are some of the real issues of pregnancy, especially if they have not been considered until the third trimester! I thought maybe you might find something of use in my comments. What follows is an edited version of my somewhat rambling response:
Hmm. That's a BIG question.
I always recommend the book Birthing From Within. It has associated childbirth classes if you can find an instructor (try the Birthing From Within website for listings)--they are the only ones I recommend (other than the ones I teach, of course!) There is also a workbook, if you can't find classes and want more hands-on work. Pam England's approach is emotional/psychological/spiritual preparation for birth and parenting, not about learning some artificial breathing pattern. Special Delivery is another good book, also written by a midwife. It also has a workbook available.
I believe that how we are pregnant and how we birth is usually how we parent--therefore it IS important to have a good birth. Not that it's destiny (I know people who have had awful births who are wonderful parents and vice versa) but that a pattern is often set. It is easier to learn and change before the baby is born! And then we can allow ourselves to be open to learning from our kids, from the circumstances, since we have been learning on ourselves. Honestly, a great pregnancy, wonderful birth and successful (not "easy") parenting are about letting go. They are about surrendering to the process, listening to our intuition, allowing our own strength determine what happens--instead of giving away our power to "experts" (even me, though I came by my expertise honorably, though experience . . .) No one can birth vaginally while trying to control the process--it just won't happen. And little humans come equipped with their own agendas--from day one! So I tell moms that pregnancy is a perfect time to practice, to give in to the sensations, the experience of having another being inside their bodies (I mean, how incredible is that?)
So, that's all first and foremost. Pregnancy being a time of "other-ness"--not being this (maiden) or that (mom). A time to ponder the absolutely unfathomable nature of being a vessel of creation. So just be there, in that Zen place that no one else could understand--it is an opportunity to experience Consciousness, if we let that happen. Don't mean to get all Existential on you, but, splitting hairs about supplements hardly matters if we are stressing about which character the nursery is going to be decorated with . . .
I guess you could call those "lifestyle changes" of the "stop and smell the roses" sort. On a practical level, I think most women have no idea how strong their attachment will be once the baby is here, and therefore don't prepare to be home for long enough. Or for always . . . It creates a lot of heartache later, and can cascade into a lot of unfortunate decisions (put baby in daycare, baby gets sick all of the time, antibiotics are given, ear tubes are inserted . . .and yes, it all starts at the beginning, like dominoes). And most families can live on one income if they really analyze it in glaring light (I won't go into that now, but I can . . .). And I do talk about this with women. Midwifery is not just about the physical, it is about really hearing what women need and want, about helping to clarify expectations, about being a mirror and a support.
"Medical" is not the right word to use with pregnancy. Birth is a normal life passage, not a medical event. Midwives are not medical caregivers (by law!) Birth is the only normal thing that happens in a hospital--everyone else is there for sickness or injury . . . Would you eat or have sex in a hospital just because there is a small element of risk? (Very small, in real terms, for birth. Most problems are iatrogenic.) If by "medical" you mean "physical," I would say that eating well and maintaining a comfortable level of activity are important. One does not need to stretch the perineum unless there is scar tissue (from a previous episitomy, for example) or "toughen" nipples, or any of the many things recommended. If one has a caregiver, they are monitoring the physical basics (that's all doctors have time for anyway)--meaning blood pressure, blood sugar, signs of toxemia, etc.
I do usually recommend that a woman attend La Leche League meetings while pregnant, to identify the available support system in advance. It also helps to bring the father, which some meeting allow and some don't. Nursing is natural, but it does not always come naturally, and we don't have the right cultural supports in place, where we have seen aunts and sisters nurse their babies . . . I don't think much of LLL's nutritional info--that's not their forte--but they absolutely know nursing. Hospitals, doctors and their staff are forever undermining breastfeeding, so we have to actively combat that. And I think just about every one can nurse successfully with help.
Nutritional: This is huge, and luckily most women are really motivated during pregnancy. Cravings are often very accurate in identifying needs and sensitivities--the trick is figuring out which is which! There's a pretty good outline of a pregnancy diet on the WAPF website, and the recommendations at the Brewer website, are important--somewhere between the two, with allowances for each individual, is a good start. Protein is hugely undervalued--the Brewers found that toxemia could basically be avoided or reversed with adequate protein and salt to taste (the details are on the website)--and they were not even addressing food quality--that's where WAPF comes in.
I find that women know what their bodies need a lot of the time, but they often don't listen to that voice. I used to have heartburn like fire with each pregnancy and I KNEW that bread was causing it. But somehow I didn't look at the bigger picture and even try taking wheat out of my diet until a year after my fifth baby was born! I wasted so much time, and maybe contributed to their allergies, eczema, asthma, etc. I have had many vegetarians admit to meat cravings. I have had clients with very odd pica cravings (ice is common--usually related to lack of calcium, but sucking on a watch? We think that was anemia-related. It takes some research and some lab work, but usually it's a good clue)
It should go without saying that whole foods are preferable. But it can be a hard sell when a woman is fatigued, trying to arrange maternity leave, fearing the birth, etc. I just know that it is easier to get in the habit NOW. Maybe starting with a few herbal infusions (oatstraw and raspberry leaf are two great pregnancy teas), substituting them for water throughout the day. Maybe learning to cook enough to freeze an extra meal is a good place to start. Talking through what kind of a mom she wants ultimately to be often helps put the cooking and whole foods ideas into perspective . . . (in other words, you are in this for the long haul, and it may seem like more work, but the payoff is great--and the work doesn't get any easier after the baby is born!)
We often (as friends or as midwives) set up a list of friends who will provide meals after the birth. One friend organizes the list and calls everyone when the baby is born, telling each one which day they will provide dinner. They bring a dinner that is big enough for leftovers for lunch, so the family only has to do simple things for breakfast. We also suggest short (15 minute) visits in which some job is done (sweep the kitchen, start a load of laundry, etc) It is good for the mom to think about this now--again, she will have no idea how valuable this will be! Best if it lasts at least two weeks and takes dietary quirks into consideration.
In my first pregnancy, someone told me "don't be afraid to ask for or take help." It's good advice! We all have to get over ourselves and act like a community . . .
I see I didn't talk about supplements. I don't use them really. Though Yellow Dock for iron is almost miraculous (see Wise Woman Herbal for the Childbearing Yearby Susun Weed for more about herbal pregnancy support). Mostly I use real food! There is usually a whole food that will help address a deficiency, as long as the quality is good.
There's so much more to say, but let this be a start. If there is interest, I can call on my training in midwifery, my work consulting with pregnant and new moms, and my personal experience as the mom of many. There are quite a few aspects to this life passage that deserve our attention, and even if you have no kids (and aren't planning any) there are parallels to other areas of our lives where we are moving away from "newfangled" methods (the ones mislabeled as "conventional") toward traditional ones (not "alternative"--that language is a way of marginalizing what has been with us throughout the ages!) At a gathering the other day, we--a group of homeschooling moms--came to the realization that this is all the same issue: how we birth, educate, feed and heal our families. So let's keep the conversation going!