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How do midwives and moms handle laboring at home with preeclampsia?

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Is it possible to have preeclampsia and labor at home or is it too dangerous? My blood pressure has suddenly become high and Im 34 weeks with my first baby. I dont have preeclampsia yet but my mom and sis both had it.I am planning to labor at home without a midwife and then deliver in the hospital. I am worried that my blood pressure and possible preeclampsia during labor will hinder this. I just ordered a blood pressure wrist moniter so I know when my blood pressure is too high. Any advice is appreciated.
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by on Feb. 22, 2013 at 11:10 PM
Replies (31-40):
Corina1987
by on Feb. 24, 2013 at 3:06 PM
I hope it stays that way or gets better! I dont want to get preeclampsia. I dont like or agree with alot of what the nutritionist at the hospital told me. I think she is the only one there. I cant really ask for her advice.The swelling is only occasional but if it gets worse I will ask about that supplement Thank you for your help!


Quoting GoodyBrook:

 




Quoting Corina1987:

Im 34 weeks. The only thing the gyn said was to reduce salt intake. I dont have any proteins in my urine. I think my blood pressure was 133/83. Occasionally i get swelling in my legs/hands. Thanks for the info.



Quoting GoodyBrook:


In my state you risk out of a midwife's care at 140/90.  They are required to take you in for a consult with an OB at that time.



What other signs of pre-e do you have? 



Typically an induction is the route most OBs will go if you are beyond 37 weeks.  Prior to this they will try to treat your high blood pressure with medication until the baby reaches "term." 





 If you have rising blood pressure and no other signs, it doesn't sound like you are pre-eclamptic yet.  GREAT!  (Likely your diagnosis will be Gestational Hypertension, rather than Pre-Eclampsia).


OBs have a great wealth of information, but nutrition isn't high on their list.  Limiting salt is NOT common practice anymore, but when the OB went to his nutrition class it probably still was.  Before you take his advice and limit salt, I'd recommend you consult a nutritionist who is familiar with pre-natal care.  The nutritionist can advise you on foods that you can eat that will help manage your blood pressure...


To address your swelling, you might want to consult a midwife or nutritionist or naturopath who is familiar with the supplement called Butcher's Broom.  I began taking it at 35 weeks, and it eliminated my swelling by improving my circulation.  It sounds like a scary supplement to take if you read about it on WebMD etc., but if you look at European studies, you'll see that it's a common supplement for women to take as it has wonderful benefits in addition to lessening swelling...  (In my case the bottle recommends 2 tablets per day, but I was told to take 9.  Within the first few days my swelling was down, and within the week it was gone!)


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Corina1987
by on Feb. 24, 2013 at 3:15 PM
Thank you for your help. Ive had swelling sometimes but it comes and goes.The gyn said I am gaining too fast but I assumed it was water.I will be looking out for those other signs. I always have a long list of questions lol. Its betterto be prepared with every outcome even if its scary, I agree with you. I will see if I can ordee that book.


Quoting Terpsichore:



Quote:

Thank you for sharing, What is a normal heart rate for the baby? 

120-160 beats per minute I believe, with 140 being average. It fluxuates during contractions. May I suggest having a list of questions available to ask at your next prenatal appointment. My mother thinks I'm scaring myself by asking the doctor these questions, I think I'm preparing myself for possibilities in advance.


Quote:

It is scary to not know if you and the baby are in danger when you are home.


 

Tell me about it. I think I'll talk to my doula about a doppler.


Quote:

My blood pressure was 133/83, I think. I havent had any proteiņs.

From what I've been reading, high blood pressure without protein spilling or other signs is hypertention (PIH = pregnancy-induced hypertention). One of the books I have been reading is "When Pregnancy Isn't Perfect" by Laurie A Rich, published 1996. From the book:

"The American College of Obstetricians and Gynecologists (ACOG) defines hypertention as a systolic blood pressure of at least 140mm of mercury and a diastolic blood pressure of at least 90mm  of mercury. ACOG also defines hypertension as a rise in systolic blood pressure of 30mm of mercury over normal for the individual, and 15mm of mercury in diastolic pressure over normal."

Signs PIH may be progressing to preeclampsia:

"Swelling of the hands, face, feet, and legs." Particularly the upper half of the body, as many women have some degree of water retention in pregnancy. 

"A sudden increase in weight." More than two pounds a week or six pounds a month.

"A headache that won't go away. This isn't a headache that lasts just a few hours. It must linger no matter what you do to relieve it. With preeclampsia, such headaches are very serious; severe headache almost always precedes the first convulsion of ecampsia."

"Visual disturbances." From slight blurring of vision to partial or full blindness, another very serious symptom.

"Pain in your upper right side and shoulder."


Quote:

How did they know your labor wasnt fast enough? I heard women laboring for days. 

It would have been ok if I could have gotten sleep, but I was unable to. We did try things both to speed up labor and for me to get sleep (not at the same time).  Without sleep, my body didn't have the strength to have good contractions. That's a personal experience and has nothing to do with your pregnancy.  


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Corina1987
by on Feb. 24, 2013 at 3:18 PM
Also i got a at home baby heart moniter called angel sounds that gave me alot of peace of mind before i could feel him move. It doesnt give you a heart rate though.Those are expensive.


Quoting Corina1987:

Thank you for your help. Ive had swelling sometimes but it comes and goes.The gyn said I am gaining too fast but I assumed it was water.I will be looking out for those other signs. I always have a long list of questions lol. Its betterto be prepared with every outcome even if its scary, I agree with you. I will see if I can ordee that book.




Quoting Terpsichore:




Quote:

Thank you for sharing, What is a normal heart rate for the baby? 

120-160 beats per minute I believe, with 140 being average. It fluxuates during contractions. May I suggest having a list of questions available to ask at your next prenatal appointment. My mother thinks I'm scaring myself by asking the doctor these questions, I think I'm preparing myself for possibilities in advance.



Quote:

It is scary to not know if you and the baby are in danger when you are home.



 

Tell me about it. I think I'll talk to my doula about a doppler.



Quote:

My blood pressure was 133/83, I think. I havent had any proteiņs.

From what I've been reading, high blood pressure without protein spilling or other signs is hypertention (PIH = pregnancy-induced hypertention). One of the books I have been reading is "When Pregnancy Isn't Perfect" by Laurie A Rich, published 1996. From the book:

"The American College of Obstetricians and Gynecologists (ACOG) defines hypertention as a systolic blood pressure of at least 140mm of mercury and a diastolic blood pressure of at least 90mm  of mercury. ACOG also defines hypertension as a rise in systolic blood pressure of 30mm of mercury over normal for the individual, and 15mm of mercury in diastolic pressure over normal."

Signs PIH may be progressing to preeclampsia:

"Swelling of the hands, face, feet, and legs." Particularly the upper half of the body, as many women have some degree of water retention in pregnancy. 

"A sudden increase in weight." More than two pounds a week or six pounds a month.

"A headache that won't go away. This isn't a headache that lasts just a few hours. It must linger no matter what you do to relieve it. With preeclampsia, such headaches are very serious; severe headache almost always precedes the first convulsion of ecampsia."

"Visual disturbances." From slight blurring of vision to partial or full blindness, another very serious symptom.

"Pain in your upper right side and shoulder."



Quote:

How did they know your labor wasnt fast enough? I heard women laboring for days. 

It would have been ok if I could have gotten sleep, but I was unable to. We did try things both to speed up labor and for me to get sleep (not at the same time).  Without sleep, my body didn't have the strength to have good contractions. That's a personal experience and has nothing to do with your pregnancy.  



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lustfull
by on Feb. 24, 2013 at 3:20 PM

 go to the hospital
i had preclampsia and my blood pressure was high,and it got so bad after a while i was forced to have oxygen and ended uo in icu

Corina1987
by on Feb. 24, 2013 at 3:22 PM
1 mom liked this
I was looking up foods with magnesium . I always eat cereal so thats good. I have to eat more sun flower seeds again and all the other foods. I wish they would have given me extra magnesium supplements from the start since preeclampsia runs in my family.


Quoting TTC2Long:

You should get 400-800mg of magnesium per day. I doubt your prenatal has that. I take my multivitamin in the am and multimineral, with calcium and magnesium, in the pm. The reason is that iron and calcium block the absorption of the other, so if they are both contained in the same vitamin, they cancel each other out. Also. If your vitamins are from synthetic sources, rather than food-based, you're only getting a fraction of what is on the label.

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Corina1987
by on Feb. 24, 2013 at 3:24 PM
1 mom liked this
Thank you for forwarding all this great nutritional info!


Quoting doulala:

We need salt though--    Diet is very relevant!
:-)

Quoting Corina1987:

Since the high blood pressure has been brought on by pregnancy, I dont think there is much I can do. Im not having salt anymore. Ive been eatting fruits,veges the whole time. How else can I avoid problems?





Quoting doulala:

Monitoring is good, but even better might be prevention so you can avoid problems.   Are you working on improving your health?





A study conducted at Harvard
University found that by eating at least 75 grams of protein per day,
pregnant women could prevent diseases of pregnancy such as preeclampsia
(metabolic toxemia of late pregnancy).
During pregnancy a woman's
blood volume increases as much as 40 to 60 percent, and in order to
reach this necessary level and maintain it, a woman's body needs
adequate protein, salt, calcium, potassium and water from her diet.


Here is the rest:


 


 


 


Nutrition during Pregnancy   by Amy V. Haas


The single most important thing that you can do for your baby is to
eat a healthy, well-balanced diet. A well-balanced diet is one that
includes foods from all food groups in appropriate amounts, so as to
ensure proper nutrition. Proper nutrition ensures that all essential
nutrients (carbohydrates, fats, protein, vitamins, minerals and water)
are supplied to the body to maintain optimal health and well-being. Good
nutrition is essential for normal organ development and functioning;
normal reproduction, growth and maintenance; for optimum activity level
and working efficiency; for resistance to infection and disease; and for
the ability to repair bodily damage or injury. While pregnancy is a
normal alternative condition for the female body, it is stressful, and
all nutritional needs are increased in order to meet the needs of the
pregnancy.


Dr. Tom Brewer found through more than 30 years of research that each
day, pregnant women need a well-balanced, high-quality diet that
includes 80 to 100 grams of protein, adequate salt (to taste), and water
(to thirst), as well as calories from all of the food groups. The World
Health Organization recommends that a pregnant woman eat a minimum of
75 grams of protein per day, but protein is just a marker for a
nutritious diet. It must be obtained from a wide variety of whole food
sources in order to get all of the important nutrients a woman needs
during pregnancy. While the government's food pyramid is a good example
of a well-balanced diet, pregnant women need more protein and calories
in general. This means including:


  • 2 to 3 servings of meat, fish, nuts or legumes, and tofu
  • 2 to 3 servings of dairy (milk, eggs, yogurt, cheese)
  • 2 servings of green vegetables; 1 serving of a yellow vegetable
  • 3 servings of fruit
  • 3 servings of whole grain breads, cereals, or other high-complex carbohydrates
  • salt to taste
  • 6 to 8 glasses of clean, filtered water each day.

While this may seem like a lot of food, it will supply the 2000 to 3000 calories needed per day to make a healthy baby.


saladA
study conducted at Harvard University found that by eating at least 75
grams of protein per day, pregnant women could prevent diseases of
pregnancy such as preeclampsia (metabolic toxemia of late pregnancy).
During pregnancy a woman's blood volume increases as much as 40 to 60
percent, and in order to reach this necessary level and maintain it, a
woman's body needs adequate protein, salt, calcium, potassium and water
from her diet. In April of 1996 the Journal of the American Medical Association
published an article indicating that calcium may also help reduce the
incidence of preeclampsia. Other recent research indicates that pregnant
women need adequate folic acid (a B vitamin) to prevent neural tube
birth defects such as spina bifida. The Food and Drug Administration now
recommends that breads and pastas be fortified with folic acid to
ensure that all women of childbearing age get enough of it. Four hundred
micrograms of folic acid a day is recommended. This can be obtained by
eating whole grain breads, citrus fruits and dark green leafy
vegetables.


As long as junk food and excessive sweets (sugar) are avoided, or
kept to a minimum, weight gain should not be an issue. The diet listed
above (or something similar) should provide all of the necessary
nutrients, and a woman should have little problem obtaining everything
she needs. A "whole food" is one that is unprocessed and is as close to
its natural state as possible. While vitamin supplements are very
popular these days, there are risks to taking supplements of certain
vitamins while pregnant (i.e., vitamin A), and others are simply poorly
assimilated (i.e., calcium or iron). The B vitamins, for example, must
be taken in congress (B complex supplement), as absences,
insufficiencies or excesses of one or another can cause problems. Check with your care provider before taking anything while pregnant.
Vitamins and minerals should be obtained from natural, whole sources
whenever possible, to ensure quality and proper assimilation by the
body. A qualified nutritional expert should assess special dietary
needs.


Cravings for foods are common in pregnancy and, in theory, can
indicate a need or deficit in a diet. Cravings for healthy foods can be
indulged, but cravings for non-food substances such as clay or laundry
starch, a condition known as "pica," can be harmful and should be
reported to your care provider.


eggsMilk,
eggs and other dairy products are inexpensive sources of calcium and
protein. For those who are vegetarian, or simply to provide variety in
an omnivorous diet, soy products, beans and nuts can be substituted.
Dark green vegetables provide carbohydrates, water, bulk fiber, vitamins
A, C, and B, calcium, iron, and magnesium; the darker green, the
better. It is best to eat these vegetables raw whenever possible, but
steaming or baking will also retain most of the nutrients. Citrus and
berry fruits provide a great deal of vitamin C, and yellow fruits and
vegetables such as cantaloupe, sweet potato, carrots and mango are good
sources of vitamin A. Both of these vitamins are important for fighting
infection, boosting the immune system, cell structure development and
preventing placental detachment (abruption). Zinc is another important
mineral for pregnant women, as it aids in supporting the immune system.
According to the Journal of the American Medical Association, zinc also helps to improve birth weight and certain aspects of fetal development.


While a vegetarian diet is a good, healthy choice when well balanced,
vegetarians do have to work harder to obtain all the protein needed to
increase their blood supply. If a woman follows a strict vegan diet, it
may be even more difficult to get the necessary protein, but it is
possible with diligence. See the supplemental reading list for sources
of information on this subject.


 


Good Sources


meat fryingProtein:
chicken, fish, beef, pork, turkey, tofu, nuts, legumes (beans), milk,
eggs, cottage cheese, whole grains, wheat gluten, soy cheese


Whole grains: brown rice, kasha (buckwheat groats),
whole oats, whole wheat bread, whole grain cereals, quinoa, wild rice,
wheat gluten, wheat germ, whole wheat pastas


Fruits: strawberries, kiwi fruit, apples, oranges, bananas, mangos, cantaloupe, pears, grapefruit, plums, nectarines, and peaches


Green vegetables: spinach, broccoli, zucchini, dark green lettuces, kale, Swiss chard, green beans, asparagus, arugula, lambs lettuce


Dairy: milk, yogurt, hard cheese, cottage cheese, egg


Other good whole foods: baked potatoes, sweet potatoes, carrots, squash, green peas, soy products, corn


Iron: red meats, organ meats, eggs, fish poultry,
blackstrap molasses, cherry juice, green leafy vegetables, dried fruits
(raisins, apricots, etc.)


Zinc: pumpkin seeds, squash seeds, sunflower seeds,
seafood, organ meats, mushrooms, brewer's yeast, soybeans, eggs, wheat
germ, meats, turkey


Folic acid: spinach, asparagus, turnip greens,
Brussels sprouts, lima beans, soybeans, organ meats, brewer's yeast,
root vegetables, whole grains, wheat germ, bulger wheat, kidney beans,
white beans, salmon, orange juice, avocado, milk


Trained and certified as a Bradley® Method Childbirth Educator in 1995, Amy Haas'
educational history includes a Bachelor of Arts in Sociology from
Plattsburgh State University of New York. For the past six years she has
taught Bradley® classes to pregnant families, empowering them to make
healthful decisions. Amy's article, "How to Stay Healthy and Low Risk
during Pregnancy and Birth" appeared in the Winter 2001 issue of Having a Baby Today. The original version of this article was shared through The Rochester Birth Network.


Sources:


  • Dunne, Lavon J., ed. 1990. The Nutrition Almanac. 3rd ed. New York: Nutrition Search, Inc., McGraw-Hill Publishing.
  • Brewer, Gail Sforza and Tom Brewer. 1985. What Every Pregnant Woman Should Know: The Truth about Diet and Drugs in Pregnancy. New York: Penguin Books.
  • Frye, Anne. 1993. Understanding Diagnostic Testing in the Childbearing Year. 5th ed. Portland, OR: Labrys Press.
  • Frye, Anne. 1995 Summer. Unraveling Toxemia. Midwifery Today 34: 22–24.
  • Frye, Anne. 1995. Holistic Midwifery, Vol. 1. Portland, OR: Labrys Press.
  • American Medical Association. 1996 Apr 10. JAMA. 275(14).
  • American Medical Association. 1995 Aug 9. JAMA. 274(6).

Other Recommended Reading:


  • The Brewer Pregnancy Hotline by Gail Sforza Krebs and Dr. Tom Brewer (http://ebooks.kalico.net/)
  • Pregnancy, Children, and the Vegan Diet, by Michael Klaper, MD
  • Diet for a Small Planet, by Frances Moore Lappé
  • The Birth Book, by William Sears, MD, and Martha Sears, RN
  • The Pregnancy Book, by William Sears, MD, Martha Sears, RN, and Linda Holt, MD

 


 


 


 



Brewer Diet   to protect against pre-eclampsia, toxemia, and have a healthier pregnancy:


http://www.blueribbonbaby.org/






The Brewer Pregnancy Diet


Dr. Tom Brewer was a pioneer in women's health. At a
time when doctors were trying to treat symptoms of Preeclampsia, Dr.
Brewer attacked the problem at its cause: poor nutrition. He learned
very quickly that when a woman is given the tools to make good
nutritional decisions, she will eat healthy.


Dr. Brewer first recommended his pregnancy diet to
women in his practice in the 1960's. He served women from a very poor
community whose families had passed on seriously flawed cooking and
eating habits. When he implemented his program, the health of the women
and babies was better than that of their well educated neighbors. During
his 12 years in practice over 25,000 women experienced healthy
pregnancies with his diet. Dr. Brewer's research demonstrates that good
nutrition can help prevent still birth, premature birth, preeclampsia,
anemia, placental abruption, infection and miscarriage.


The Brewer diet is built around ensuring you adequate
amounts of protein every day. Proteins are broken down into amino acids
by your body and used to repair and build body tissues and organs. Your
baby will be built from these amino acids. It is the minimum
recommended food you should eat every day, if you need more food eat
more.


Unlike carbohydrates which can be stored as fat, your
body has no mechanism to store extra protein. The unused proteins are
broken down until they can be made into fate and the unique protein part
is excreted from the body. If you do not eat enough protein to repair
your body and build your baby, your body will begin to break down its
own tissues to get building blocks for your baby and neither you nor
your baby will have what you need to keep your bodies healthy. Contrary
to popular belief, you cannot build a baby from the extra stores of fat
on your hips.


Every day you need just about .4 grams of protein for
each pound of body weight (0.8g of protein per kilogram of body
weight). So a 140 pound woman should eat about 56 grams of protein a day
when she is not pregnant. When you are pregnant, your protein needs
increase. Dr. Brewer recommended aiming for 80 to 100 grams of protein
every day while pregnant.


Eggs and Milk


To eat this much protein, Dr. Brewer recommended
building your daily menu around 2 eggs and 4 cups of milk. Milk and eggs
are inexpensive, readily available, provide high quality protein and
can be prepared in a variety of ways. In addition to the protein, eggs
and milk provide a variety of vitamins and minerals and are a good
nutritional value for the number of calories they contain. By starting
with 2 eggs and 4 servings of milk, you will already have 32 grams of
protein every day.


Beans and Meat


In addition to the eggs and milk, you should eat 2
additional servings of high protein foods each day. Choose the protein
foods you prefer to eat. Lean meats such as turkey, chicken, pork, lamb,
beef or fish are all acceptable. Depending on the type of meat or fish
you choose, you will have around 25 grams of protein per 3 ounce
serving. Vegetable proteins are also acceptable when they are properly
combined, however they do not provide the same volume of protein per
serving so you may need to eat more food to reach the recommended 80-100
grams of protein per day.


Vegetables


Dr. Brewer also recommended you eat one or two
servings of fresh green leafy vegetables every day. Green vegetables are
rich in vitamins and minerals and provide folate. This includes the
leafy greens such as mustard, collard and kale, dark lettuces, cabbage
and broccoli. A serving of leafy vegetables is 1 cup.


In addition to the green vegetables, you should eat a
yellow or orange vegetable 5 times a week. This can be squash, carrots,
sweet potato, rutabaga or any other yellow or orange vegetable. You
should also have two sources of vitamin C every day, such as a whole
potato, large green pepper, grapefruit, orange, strawberries, papaya or
tomato. A serving of vegetables is 1/2 cup chopped raw or cooked. The
serving size of fruit is 1 medium piece or 1/2 cup of canned or chopped
fruit. This will average out to about 5 servings of fruit and vegetables
per day.


Whole Grains


The Brewer diet also includes 5 servings of whole
grains or whole grain products every day. These include oatmeal, barley,
brown rice, whole grain cereals, whole grain breads and other less
common grains. A serving of a grain is 1/2 cup of the grain, 1/2 cup of
pasta or rice, 1 slice of bread, 1 tortilla (or 1/2 if they are large),
or 1 oz of a ready to eat cereal.


Dr. Brewer believed this was the minimum amount of
food needed to maintain a healthy pregnancy. If you are hungry for more,
eat more but do not try to consume less in an effort to control your
weight gain. The amount of weight you gain is not an indicator of the
nutritive value of your diet. Concentrate on choosing good healthy foods
and eating enough to satisfy your body's needs.


Many women read the Brewer pregnancy diet and become
concerned it recommends too much food to eat in one day. However, when
compared to the food guide pyramid (the recommended eating plan from the
United States Government), it only requires an extra milk and protein
each day.


Remember, the serving size
is not the same as what you may be used to considering a helping. One
slice of bread is one serving of a grain, so when you use two slices for
a sandwich you are having at least two servings (and more with many of
the larger bread products available).


Dr. Brewer concluded his diet by recommending you
salt your food to taste and drink water enough to quench your thirst.
Your body needs both salt and water to function properly.


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mrs.hartman12
by on Feb. 24, 2013 at 3:29 PM
From my understanding my midwife friends encourage healthy high protein diet for prevention, but they transfer if it develops.
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TTC2Long
by on Feb. 24, 2013 at 3:37 PM
1 mom liked this
Get a suppliment!

Quoting Corina1987:

I was looking up foods with magnesium . I always eat cereal so thats good. I have to eat more sun flower seeds again and all the other foods. I wish they would have given me extra magnesium supplements from the start since preeclampsia runs in my family.




Quoting TTC2Long:

You should get 400-800mg of magnesium per day. I doubt your prenatal has that. I take my multivitamin in the am and multimineral, with calcium and magnesium, in the pm. The reason is that iron and calcium block the absorption of the other, so if they are both contained in the same vitamin, they cancel each other out. Also. If your vitamins are from synthetic sources, rather than food-based, you're only getting a fraction of what is on the label.

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FrumpyMama
by Silver Member on Feb. 24, 2013 at 6:02 PM

I would attack your diet and exercise first. Stop eating anything that is known to be a bp trigger, make sure you are take a stroll every day.  My midwives recommended me taking magnesium to help keep it lower as well. There are a lot of things to do, but if you start suffering sudden severe headaches you need to get to the hospital immediately. 

FrumpyMama
by Silver Member on Feb. 24, 2013 at 6:05 PM
1 mom liked this

Natural Calm is your best bet because of how quickly it's absorbed.

Quoting TTC2Long:

Get a suppliment!

Quoting Corina1987:

I was looking up foods with magnesium . I always eat cereal so thats good. I have to eat more sun flower seeds again and all the other foods. I wish they would have given me extra magnesium supplements from the start since preeclampsia runs in my family.




Quoting TTC2Long:

You should get 400-800mg of magnesium per day. I doubt your prenatal has that. I take my multivitamin in the am and multimineral, with calcium and magnesium, in the pm. The reason is that iron and calcium block the absorption of the other, so if they are both contained in the same vitamin, they cancel each other out. Also. If your vitamins are from synthetic sources, rather than food-based, you're only getting a fraction of what is on the label.


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