Well, yes and no. The thing is, what I was carrying at that time were my prenatal vitamins. I never took any vitamin pills before I got pregnant. My diet sufficiently provided all the nutrients and minerals I needed. But pregnancy changed all that. After all, my body was carrying and nurturing another body (in my case two bodies since I was carrying twins) and I needed all the help I could get it terms of vitamin supplements. This would ensure that the baby(ies) get all they needed to develop and grow normally without starving mommy in the process.

What Are The Prenatal Vitamins We Need?

According to the recommendations of the American College of Obstetricians and Gynecologists, we need higher doses of vitamins and minerals during pregnancy. Most of these we can get in a proper healthy diet while avoiding certain foods, but sometimes we need extra supplementation for others.

Those vitamins that are sufficiently available from our daily diet, thus not routinely recommended for supplementation during pregnancy are:

• Vitamin A, available from green leafy and yellow-orange vegetables

• Vitamin B-1 or thiamine, available from milk and whole grains. Vitamin B-2

• Vitamin B-2 or riboflavin, available from green vegetables, dairy products, eggs and fish.

• Vitamin B-6, available from most vegetables you eat

• Vitamin B-12, available from animal proteins

• Vitamin C or ascorbic acid, available from fruits and vegetables

• Vitamin D or the sunshine vitamin, available from exposure to sun and vitamin-D-fortified milk

• Vitamin E, available from animal fats and proteins

• Vitamin K, available from green leafy vegetables, tomatoes, dairy products, and eggs

• Niacin, available from poultry, fish, and nuts

Some vitamins and minerals are not sufficiently available in our daily diet for many reasons. Thus, in order to ensure the well-being of both mom and baby, supplementation is recommended.

Most Commonly Prescribed Prenatal Vitamin Supplements

• Folic acid/folate is available in vegetables and grains but in small amounts. In the US and many countries, flour is fortified with folate, the synthetic version of folic acid. However, even this fortification is not sufficient for pregnant women, thus folic acid supplement is highly recommended during pregnancy. Folic acid deficiency has been linked to neural tube defects in fetus (e.g. spina bifida) and to maternal megaloblastic anemia. If you are planning to get pregnant, taking folate supplements in advance is advisable. The recommended daily allowance (RDA) of folate supplement for pregnant women is 0.6 mg. In women who had a previous child with neural tube defects, the RDA may even be increased up to 10 mg.

• Iron is available in our daily food but the absorption in the gastrointestinal tract is rather inefficient. Iron is essential for the production of hemoglobin that enables our blood to transport oxygen. In a pregnant woman, hemoglobin is very important in supplying blood to the placenta and the fetal tissues. Iron deficiency anemia is a common complaint during pregnancy. Thus, iron supplementation is highly recommended, with an RDA of 30 mg.

• Calcium is essential in the synthesis of bones. It is not surprising that as the baby grows in the uterus, the calcium requirement of the mother also increases. The RDA for calcium in pregnant women is 1200 mg.

I remember that I took my vitamin supplements each separately. However, nowadays, there are certain formulations which put the needed nutrients (and then some) in one multivitamin pill. According emedicine WebMD, the standard prenatal vitamin pill should contain the following:

• Iron – 30 mg

• Zinc – 15 mg

• Calcium – 250 mg

• Vitamin B-6 – 2 mg

• Folate – 0.4 mg

• Vitamin C – 50 mg

• Vitamin D – 5 mcg

The formulations, however, can vary and in some cases and may be customized to a woman’s specific nutritional needs. The following situations, for example, require special supplementation considerations.

When Special Supplementation May Be Needed

• Vegetarian diet – When a woman is vegetarian or vegan, then she would need supplementation of vitamins the she can only get from animal fats and proteins (e.g. Vitamins B12 and E).

• Lactose intolerance – Women who are lactose intolerant and therefore cannot drink milk or eat dairy products may need extra calcium supplementation.

• Cultural and behavioral considerations – In some countries, women may have minimal exposure to the sun, e.g. women in Muslim countries wearing the veil, or those intentionally avoid the sun for aesthetic or medical reasons. In such cases, pregnant women are usually prescribed vitamin D supplements.In developed countries, some women, especially the very young, might have the fear of having the so-called “baby fat” during pregnancy and would therefore try to cut down on their food intake. In these cases, obstetricians as well as family members should watch out for eating disorders to make sure the baby is not starved.

Multiple Pregnancies

Multiple growing babies require more vitamins and minerals than just one. I remember that when I was carrying my twins, my doctor had to increase my supplementation at a certain point. Folate and iron supplements may be increased and Vitamin B-6 supplement may be prescribed.

For more info about prenatal vitamins, check out:

• Prenatal Nutrition from WebMD

• Prenatal Vitamins: American Pregnancy Association

• Nutrition During Pregnancy: ACOG Education Pamphlet AP001 — American College of Obstetricians and Gynecologists.

I never had any doubt about how I was going to feed my babies. Of course I was going to nurse them! What I don’t know is where my initial determination and enthusiasm came from. Neither my mother nor my grandmother nursed and it wasn’t as if I had grown up seeing women breastfeed. In fact, I can’t recall a single instance during my childhood in which I saw a woman put a baby to her breast.

Most of what I knew about breastfeeding wasn’t as relevant to me personally, as it was politically. In college I had read about the causes of malnutrition in the developing world and the insidious efforts of multinational corporations to convince women that formula was superior to breastmilk. So even though I would have access to clean water, refrigeration and money to pay for formula, I wanted nothing to do with formula. Moreover, I thought of my body’s ability to bear and nourish children as a great source of power and pride. Why would I let some company rob me of that or convince me that my milk was inferior? Nursing was actually the one aspect of having a newborn that I was most looking forward to. I would put my baby to my breast and voila! She would nurse. Moreover, I was prepared to nurse my child wherever and whenever necessary. I believed strongly – and still do – that breastfeeding needed to become more visible and would only become the cultural norm when nursing mothers come out of the nursery.

Now, years later after having nursed two children, I realize how incomplete my understanding of breastfeeding was. My first epiphany was that nursing does not always happen easily. My initiation into motherhood was built around a baby who adamantly rejected my breast for almost six, grueling weeks. It involved a brief but scary bout of newborn dehydration, supplementing my incipient milk supply with a soy-based formula, (causing me to become less dogmatic) and expressing my milk every three hours around the clock with an electric pump. I spent many days in tears, wondering if I would ever be able to nurse her at all.

With the help of a supportive family and a dedicated and smart lactation consultant, my daughter finally began to nurse. At first we could only do so in one position requiring no less than four pillows. But gradually my daughter and I learned together and we became more confident, carefree and flexible. I’ll never forget the night I awoke to discover her latched on to my breast, eyes closed, cheeks gently moving in and out. Bliss.

The second thing I learned is that there is no single or correct way to nurse and there is no “right” way to feel about nursing. Moreover, what works for one baby does not always work for another. Nursing my firstborn (after our rocky start) was calming and relaxing for her, regardless of where we were. But my second was a rather aggressive nurser and easily distracted, making nursing in public difficult. I discovered that sometimes nursing in private really was necessary, political statement be damned! Today I remain as personally and politically committed to nursing as ever, but my beliefs are tempered with the realization that each woman’s experience is her own.

Perhaps the most important thing I learned, though, is that breastfeeding is not simply a matter of providing nutritional and immunological benefits to one’s child and it encompasses many things that are difficult, if not impossible, to learn in a “how-to” book. I had to discover on my own that nursing can really be about how we mother our children.

My daughters nursed not only when they were hungry, but also for comfort. They nursed when they were hurt, tired, frustrated or cranky. And they nursed for the pure joy and delight it gave them to be enveloped by my body, to feel my skin against theirs. For my first daughter, in particular, nursing was the center from which she gained the security and confidence to explore her world. And although I once had vowed never to nurse a child who could ask for it in words, I could find no reason to force her to wean from something she so dearly loved. And for the most part, that I did to. It was only during my second pregnancy, when nursing became too physically painful, that I had to wean her completely.

Several more years of nursing later, I was ready to burn my nursing bras and reclaim my body as my own. But I love that I was able to provide my children with something that gave them not just optimum nutrition, but supreme satisfaction. I love that I was able to watch every ounce of tension in their bodies drain away after five sucks at my breast. And I sometimes miss the humor that often accompanies a nursing toddler, the way they once enjoyed a snack of cookies and milk, the mantras they would chant in honor of my breasts. I miss the kind of intimacy that we shared, a connection that started out so primal, so basic and turned into a love affair unlike any other.

My experiences have strengthened my resolve to work toward creating a culture in which breastfeeding is the norm. But I also realize that each woman must feed her children based on the unique circumstances of her life. Nursing in a formula-feeding culture isn’t always easy — it sometimes requires strength, determination, and tenacity — not qualities typically used to describe nursing mothers. But for me, the journey was well worth it!

About the Author
Barbara L. Behrmann, Ph.D. is a writer, researcher, and author of The Breastfeeding Café: Mothers Share the Joys, Secrets & Challenges of Nursing. She is a frequent speaker around the country and is available for talks, readings, and conducting birthing and breastfeeding writing circles. The mother of two formerly breastfed children, Barbara lives in upstate New York. Visit her website at www.breastfeedingcafe.com.