Hummous and Enchiladas Make Beautiful Babies, Too!
by Valerie El Halta

[Editor's note: This article first appeared in Midwifery Today Issue 25, Spring 1993.]

If you had asked me to be your midwife in 1978, I would have come to our initial interview armed with vitamin charts, diet lists and food diaries—all in my well meaning attempt to get you to eat foods I thought were best for you. I probably would have made you feel that if you were to slip and have a Big Mac, your baby would surely be brain damaged.

I sincerely apologize to those of you who dutifully filled out those diaries and for any stress I may have placed upon you despite my best intentions. Since then, I have come to believe that good nutrition comes in many interesting and brightly colored packages and its definition varies greatly among countries and regions. Now, I emphasize the healthy foods with which my client is familiar and those that make her feel good while growing a healthy baby. No more food diaries.

Does this mean I no longer emphasize the importance of good nutrition? Of course not. I just want to keep it simple enough so Mom will eat well, not be burdened by too many restrictions and not be made to feel guilty.

First I ask my client, "What do you like to eat?" Then we try to optimize her diet from those foods. In this way, we have devised a simple formula which almost guarantees a healthy pregnancy and a beautiful baby.

We ask our clients to follow this simple formula: Every time you are hungry, eat a protein, a raw fruit or vegetable and a whole grain, then anything else you want. We also encourage her to eat three meals a day plus two snacks and drink plenty of water. This is the basis of our advice.

We provide the mother with a list of foods which supply a high protein content and suggest she aim for 80 to 100 grams of protein a day. There are of course special circumstances requiring more counseling, which we are happy to provide.

I have learned in working with women of many different ethnic and cultural backgrounds that we can provide the best care when we take the time to understand individual eating preferences and assist the woman to make the most of her natural diet. To tell an Arabic woman to eat more peanut butter and cottage cheese is ridiculous. She knows her baby needs to have labneh (yogurt cheese) and hummous (garbanzo beans and tahini). Not only is it valuable to take the time to learn about ethnic dietary habits, but it also helps the mother feel you care about her.

Lebanese women have a fondness for a dish called "Kebbee Nayeh" which is ground raw lamb mixed with bulgar wheat. Although this dish turns my stomach, I try to be diplomatic as I advise the women that raw meat is not good to eat during pregnancy. We have an inordinate number of women with positive titers for Toxoplasmosis as a result of this food choice, but as they have had it for so long, we have had no adverse outcomes despite the high titers.

Eating habits vary not only from country to country but also among regions. In the United States, there are many social and environmental factors which influence our food choices. Stephanie Sorenson, a Hutterite midwife, worries her women have too much fat in their diet (a ladle of butter goes over everything), while a sister midwife in the midwest complains her clients can't get enough fresh fruits and vegetables. In Michigan, you aren't suppose to eat the fish from the Great Lakes anymore, and in California, it's politically correct to be vegetarian, while in Chicago, you had better eat beef! Despite the variations, women can provide adequate nutrition for themselves and their babies with foods which are available to them.

Maria had come to Santa Ana from a village deep within Mexico to work in the strawberry fields with her husband. She found me when she was seven months pregnant. As I attempted to take a brief history from her, I found this was her seventh pregnancy. She had three beautiful daughters but had lost three sons who were either born prematurely or died shortly after birth. "They were very small," she said to me with tears in her eyes. She was frightened that if she had another boy, he would die too.

As I carefully examined her, I found her fundal height to be appropriate for her dates, the fetal heart was strong and regular and she appeared generally healthy except she was quite underweight. I asked her about her eating habits and soon found she had a very poor appetite and often she was so tired after a long day of work she had difficulty eating at all. I explained to Maria that if I were to do her birth it was very important for her to feed her baby so he would be strong and healthy.

Since her appetite was so poor it was important for me to find out what her favorite foods were, as a lengthy discussion of "food groups" was inappropriate here. Her husband told me she loved chicken. Great! (Chicken just happens to be my personal favorite baby grower.) Maria promised me she would eat at least three times a day even if to do so was like taking medicine. I told them I would help them with the birth if she would eat chicken every day until the baby came. She thought that was very funny but agreed to do as I asked.

When the time came for her baby to be born, she had gained 15 lbs. and delivered a nine pound, full term baby boy. They named him Pedro. Shortly after the birth, her husband took me into the kitchen, opened the cupboard and showed me many carefully folded up take-out boxes from Kentucky Fried Chicken. Bargain completed.

One of the difficulties faced by immigrant women is the lack of availability of the foods to which they are accustomed. Or, they may feel the foods they see advertised on television represent the "American" diet and therefore must be superior, so they try to adapt with sometimes sad consequences.

When women came to El Paso from the Mexican interior, we seldom had nutrition related problems as they were robust and healthy from their diet of rice, beans, fresh vegetables, corn tortillas and cheeses. However, when we dealt with the women who had grown up on the border where the diet of choice is "Doritos and Coke," there were many more problems with their pregnancies and births. It was sometimes difficult to make them understand the traditional Mexican diet was superior.

We also needed to be sensitive to their economical status. It was fine to advise Lucy that she needed to eat more protein, but we needed to be prepared to help her get it if she could only afford enough beans to feed her children.

Here, at the Garden of Life, it is not unusual for a woman to come to us a week or two before her baby is due. We have had women come from Zaire, Saudi Arabia, Yemen, Lebanon, Abu Dhabi, Jordan, Egypt, Mexico, Romania and many other parts of the world. It is important for us to help them feel at home here so their labor won't be impeded.

One of the best ways I have found to communicate is kitchen talk. In most cultures, woman talk is still centered in the kitchen, and when a woman is far from home, kitchen talk brings memories of mother, grandmother and aunties, making us not seem so foreign to them. We can establish a rapport with women much faster by discussing various recipes for stuffed squash than if we can name the president of her country.

In working with women from many different cultures, I have found that when women understand the importance of "feeding their babies" prenatally, I have had little difficulty in gaining their cooperation in making the best of their natural diets. Women want to have healthy babies. It is our job to teach them they can.

Valerie El Halta, midwife, is retiring after 28 years and close to 3,000 babies. She offers gratitude and appreciation to all who have supported her through these years as friends, clients, teachers and students.

You may order Midwifery Today Spring 1993 as a back issue.

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