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Your Pregnancy The First Nine Months (PCP1)

THE FIRST NINE MONTHS

A healthy pregnancy lifestyle for your baby’s first nine months

At conception your baby begins to develop according to a genetic “blueprint”. Things such as the gender, hair and eye color as well as physical build and even to a certain extent, personality.

In order for your baby to reach his or her full genetic potential, you must provide the proper environment. Basically, strive to be a happy and healthy mom, avoid things that are harmful to you and your baby and maintain a healthy diet and exercise program.

Even when you do all these things, to the best of your ability, there is no guarantee of a perfect outcome. Babies are human and humans are not perfect.

Pregnancy is the time to make positive lifestyle changes to optimize your baby’s environment, to help you through the coming months and through labor, birth and the rest of your life.

FOUR MAJOR POINTS TO REMEMBER THROUGHOUT YOUR PREGNANCY

1. Eat Healthy foods

2. Develop a positive attitude

3. Get daily exercise

4. Learn to relax

Good nutrition is the single most important thing a woman

can do for herself and her baby!

Eat Healthy Foods:

Eating healthy is very important during pregnancy.The old saying of eating for two does not really apply for the modern woman.There's no magic formula for a healthy pregnancy diet. In fact, during pregnancy the basic principles of healthy eating remain the same — get plenty of fruits, vegetables, whole grains, lean protein and healthy fats. Understand which nutrients you need most and where to find them.

A healthy pregnancy diet will:

promote your baby's growth and development and assist baby to have good brain cell development and iron stores for the first 4-5 months of life.

assist you in gaining the appropriate amount of weight for your pregnancy. The expected weight gain is based upon your starting BMI.

provide the building blocks for the birth of a full term baby (38-42 weeks) with a healthy birth weight. (7-9 pounds)

help you feel better, have increased resistance to infection and increase your stamina.

reduce digestive discomforts common to pregnancy such as nausea, constipation and heartburn.

decrease the risk of complications during pregnancy such as diabetes, high blood pressure and anemia.

prepare you for the physical demands of labor.

achieve a good foundation for breastfeeding.

See Food Safety in Pregnancy information at the end of this section!!

Six Basic Nutrients Required for Good Health

Carbohydrates

Carbohydrates can be grouped into two categories: simple and complex.  Simple carbohydrates are sugars whereas complex carbohydrates consist of starch and dietary fiber. Most calories (55-60%) should come from carbohydrates.  A pregnant woman needs 300-500 extra calories per day. Sources of carbohydrates include grain products such as breads, cereals, pasta, and rice as well as fruits and vegetables.

Protein   80-100 grams a day

These are the essential building material for new growth. The need in pregnancy almost doubles. Adequate protein intake is also important for a healthy immune system.  Because protein is a source of calories it will be used for energy if not enough carbohydrate is available due to skipped meals, heavy exercise, etc.  Main sources of protein are animal products like meat, fish, poultry, milk, cheese and eggs and vegetable sources like legumes (beans, lentils, dried peas, nuts) and seeds.

Fat

The fat in food includes a mixture of saturated and unsaturated fat.  Animal-based foods such as meats and milk products are higher in saturated fat whereas most vegetable oils are higher in unsaturated fat.  Dietary fat does play an important role in a healthy diet.  Fat maintains skin and hair, cushions vital organs, provides insulation, and is necessary for the production and absorption of certain vitamins and hormones.  Sources include butter, oils dressings and mayonnaise.

Vitamins

Vitamins help to regulate chemical reactions in the body.  There are 13 vitamins, including vitamins A, B complex, C, D, E, and K.  Because most vitamins cannot be made in the body, we must obtain them through the diet.  Pregnant women need a good balance of vitamins and a few needs to be increased such as folic acid, vitamin C and D.

Minerals

Minerals are components of foods that are involved in many body functions. For example, calcium and magnesium are important for bone structure, and iron is needed for our red blood cells to transport oxygen.  In pregnancy, there is an increased need for calcium (1200mg daily) and iron (30-60 mg daily) Like vitamins, minerals are not a source of energy and are best obtained through a varied diet rather than supplements.

Water

Water is a vital nutrient for good health.  Most of our body weight (60-70%) is made up of water.  Water helps to control our body temperature, carries nutrients and waste products from our cells, and is needed for our cells to function.  It is recommended that adults drink 8 glasses of fluid daily (or more in hot weather or during physical activity).  This fluid does not have to be water alone.  It can also be obtained from juice, milk, soup, and foods high in water such as fruits and vegetables. Caffeine-containing beverages (coffee, tea, cola) don't count because caffeine is a diuretic, making us lose water. A great plus for water in comparison to the other fluids is that it hydrates our body without extra calories

You should get the right nutrients and vitamins for pregnancy health and your baby’s development. A few nutrients in a pregnancy diet deserve special attention. Here's what tops the list:

Folate and folic acid — Prevent birth defects

Folate is a B vitamin that helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. The synthetic form of folate found in supplements and fortified foods is known as folic acid. Folic acid supplementation has been shown to decrease the risk of preterm delivery.

How much you need: 800 micrograms of folate or folic acid a day before conception and throughout pregnancy.

Good sources: Fortified cereals are great sources of folic acid. Leafy green vegetables, citrus fruits, and dried beans and peas are good sources of naturally occurring folate

Calcium — Strengthen bones

You and your baby need calcium for strong bones and teeth. Calcium also helps your baby grow a healthy heart, nerves, and muscles as well as develop a normal heart rhythm and blood-clotting abilities

Calcium can also reduce your risk of hypertension and preeclampsia. And if you don't get enough calcium in your diet when you're pregnant, your baby will draw it from your bones, which may impair your own health later on.

How much you need: 1,000 milligrams a day; pregnant teenagers need 1,300 milligrams a day

Good sources: Dairy products are the best absorbed sources of calcium. Nondairy sources include broccoli and kale. Many fruit juices and breakfast cereals are fortified with calcium, too.

Vitamin D — Promote bone strength

Vitamin D also helps build your baby's bones and teeth.

Vitamin D deficiency is common during pregnancy. Inadequate vitamin D can lead to abnormal bone growth, fractures, or rickets in newborns.

Some studies link vitamin D deficiency to a higher risk of pregnancy complications such as gestational diabetes, preeclampsia and preterm birth and low birth weight, but more research is needed to confirm these links.

The symptoms of a vitamin D deficiency can be subtle. They may include achy muscles, weakness, bone pain, and softened bones, which may lead to fractures.

How much you need: 600 international units (IU) a day

Good sources: Fatty fish, such as salmon, is a great source of vitamin D. Other options include fortified milk and orange juice.

Protein — Promote growth

Protein is crucial for your baby's growth, especially during the second and third trimesters.

How much you need: 71 grams a day

Good sources: Lean meat, poultry, fish and eggs are great sources of protein. Other options include dried beans and peas, tofu, dairy products, and peanut butter.

Iron — Prevent anemia

Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy your blood volume expands to accommodate changes in your body and help your baby make his or her entire blood supply — doubling your need for iron.

If you don't get enough iron, you might become fatigued and more susceptible to infections. The risk of preterm delivery and low birth weight also might be higher

How much you need: 27 milligrams a day

Good sources: Lean red meat, poultry and fish are good sources of iron. Other options include iron-fortified breakfast cereals, beans and vegetables.

Food sources of calcium

Milk and other dairy products are top sources, as are canned fish and calcium-fortified cereal, juice, soy and rice beverages, and bread. Not all brands are fortified, so check labels.

1/2 cup firm, calcium-set tofu: 253 mg

3 ounces canned pink salmon, with bones and liquid: 181 mg

1 cup cottage cheese (1 percent milk fat): 138 mg

1/2 cup vanilla soft-serve frozen yogurt: 103 mg

1 cup raw kale, chopped: 100 mg

1/2 cup turnip greens, boiled: 99 mg

1/2 cup vanilla ice cream: 84 mg

1 cup raw bok choy, shredded: 74 mg

Food sources of vitamin D

Fish liver oil, fatty fish, and eggs all contain vitamin D. But not many other foods contain vitamin D naturally, so a lot are fortified with this important vitamin. Be sure to check labels: Some cheeses, yogurts, and cereals are fortified while others aren't. (All milk is vitamin D fortified.)

Here are some of the best food sources of vitamin D:

3 ounces canned pink salmon: 465 IU (11.6 mcg)

3 ounces canned mackerel: 211 IU (5.3 mcg)

3 ounces canned sardines: 164 IU (4.1 mcg)

8 ounces orange juice, fortified with vitamin D: 100 IU (2.5 mcg)

8 ounces low-fat milk, fortified with vitamin D: 98 IU (2.5 mcg)

1 cup cereal, fortified with vitamin D: 40 to 50 IU (1.0 to 1.3 mcg)

one large egg yolk: 37 IU (0.9 mcg)

Iron in pregnancy

There are two forms of iron: non-heme iron, which is found in plants (as well as in meat, poultry, and fish), and heme iron, which is found only in animal products. Heme iron is easier for your body to absorb. (Iron-fortified foods and supplements provide non-heme iron.) To make sure you're getting enough, eat a variety of iron-rich foods every day.

Common sources of heme iron: Common sources of non-heme iron:

Red meat, poultry, and fish are all good sources

of heme iron.

3 ounces lean beef chuck: 3.2 mg

3 ounces lean beef tenderloin: 3.0 mg

3 ounces roast turkey, dark meat: 2.0 mg

3 ounces roast turkey breast: 1.4 mg

3 ounces roast chicken, dark meat: 1.1 mg

3 ounces roast chicken breast: 1.1 mg

3 ounces halibut: 0.9 mg

3 ounces pork loin: 0.8 mg

1 cup iron-fortified ready-to-eat cereal: 24 mg

1 cup fortified instant oatmeal: 10 mg

1 cup edamame (boiled soybeans): 8.8 mg

1 cup cooked lentils: 6.6 mg

1 cup cooked kidney beans: 5.2 mg

1 cup chickpeas: 4.8 mg

1 cup lima beans: 4.5 mg

1 ounce roasted pumpkin seeds: 4.2 mg

1 cup cooked black or pinto beans: 3.6 mg

1 tablespoon blackstrap molasses: 3.5 mg

1/2 cup raw firm tofu: 3.4 mg

1/2 cup boiled spinach: 3.2 mg

1 cup prune juice: 3.0 mg

1 slice whole wheat or enriched white bread: 0.9mg

Tips for Improving Pregnancy Nutrition

Eat enough food to get the recommended calories (energy) for pregnancy. You only need 300-500 extra calories per day during your pregnancy.

Limit the amount of “junk food” you eat. Foods that are high in sugar and or fat but have little or no other value. For example French fries, candy, kool aid, chips dips and high fat salad dressings. (try salsa or yogurt on your salad instead.)

Try to select a wide variety of foods to give balanced nutrition. Eat food as close to their natural state as possible Raw fruits and vegetables are best.

Make the dietary changes gradually. Decrease sugar and fat, increase fruits vegetables and whole grains.

Distribute your meals throughout the day. Plan on 6-8 small meals per day. Try not to go longer than a few hours without food.

Tips for Nutritious Eating

Try meats baked, broiled or roasted rather than fried

Limit added sauces and gravies

For breakfast prepare your hot cereal with mild rather than water

Add cottage cheese or yogurt to low fat granola

For dinner, toss some grated cheese on your salad

Look for iron fortified whole grain cereals

To help absorb iron, eat fruits and vegetables high in vitamin C

Eat soups and stews made with lean meat and beans

Try small amounts of dried fruits like raisins or prunes for snacks

Be careful about portion sizes.

Your Mood and Food

Sometimes we eat too much or too fast. Sometimes we eat too little or eat junk. Vitamins depletion can cause anxiety, gastric upset, and insomnia. These factors can contribute to your baby’s ability to handle stress.

Too much sugar can give you a sugar “high” followed by a “low” that leaves you exhausted.

Excess fat intake disrupts body metabolism, reduces oxygen availability making us feel sluggish. This triggers insulin production to store the excess and can cause gas and heartburn.

Too much salt can increase fluid retention and swelling and lead to a loss of potassium which triggers the stress response.

Excessive caffeine can directly stimulate the release of stress hormones which cause jitteriness, anxiety and increase blood pressure.

The Secret is BALANCE and MODERATION- think about what you eat, decide if you really need it or want it and is it good for your growing baby.

Stress is a part of everyday life and it is not bad in itself.We need some stress to get us up in the morning and to help us meet goals and grow and change.Stress can be harmful when it is excessive and too much stress can make you sick.Pregnancy brings some stresses of its own to deal with

Body Changes:There are multiple changes in your body which occur during pregnancy. Every one deals with these changes differently. Weight gain and the change of her shape may be welcomed by some women but other women might finds these changes difficult to deal with and cause self-image problems.

Worries and Fears: You are bringing a new life into this world. It is normal to think about your growing baby and even worry about the baby’s health or even the sex of the baby. Fears of the unknown like labor and birth are very common. You would not be human if you did not have some degree of fears. Even for second and third time moms there are fears of the effect this new baby will have on the other children and how they will respond. The growing family thinks about adjusting to the increase expenses or child care for work.

Relationship changes: Couples find there are many changes to experience during and after pregnancy. Embracing your roles a “parents” may be challenging. Each of you has a change in your roles as partners. There will be changes in sexual desire as well as lifestyle changes that baby will bring. Sexual intimacy is a normal part of life and in a healthy, normal pregnancy; each couple should decide what is best for their relationship. New parents make new grandparents. The entire family has a new role and you may find that well-meaning friends and family provide all type of “advice”.

Relationships can be affected in many ways during and after pregnancy.The Midwife Group and Birth Center is fortunate to have Dr. Marion Marsh PhD (psychologist and counselor) as part of our team.Dr. Marsh is available for couples, families or anyone who needs her help.This is a free service available to all our active clients.

There is also help available for anyone experiencing domestic violence.

It is how you choose to deal with the normal stress in life and pregnancy that will be the key to your happiness.

Lifestyle Choices

Start out each day with a positive thought. Don’t get out of bed until you have had one. Say it out loud if you can. For Example: “Birth is a normal healthy event” or “I trust my body to labor smoothly and efficiently”. Each day make a conscious effort to emphasize the positive and disregard the negative.

Do something you enjoy each day. Determine which activities enrich and energize your life and do more of these activities; hobbies, games, gardening, reading, needlework or cooking are fine examples. If you like sports, pets, arts and crafts shopping or even just soaking in the tub, make a point to do these things.

Set realistic goals. Make a list of your tasks and prioritize them. Try to complete one task at a time. Review the list of all the things you think you should do and ask yourself “why?” If you spend all your time on the things that you think you should do, you may find yourself with no time to do the things you want or need to do.

Establish routines. Routines lend predictability to life. Eliminate some of the chaos and reduce the amount of energy it takes to complete daily tasks. Children especially respond better when they know what to expect.

Get enough sleep. Have a regular bedtime, Take short naps to make up for interrupted sleep.

Whatever name you call it, meditation, solitude, reflection take a time out for yourself.

Look for the humor in situations. Laugh, giggle, share jokes and play. Don’t take yourself too seriously.

Have contact with nature. Get outside, stargaze, walk barefoot in the grass or listen to the water flowing to help affirm your connection with nature.

Box your worries. Sort your worries into categories. Things you can and those you cannot control and things that are important and those that are not important. If something is important and you can do about it- take action. If it is unimportant or you can’t do anything about it – let it go. Mark Twain said: “Worry is interest paid in advance on a debt you may never know.”

Do “mini checkups”. While driving or doing chores notice how you feel. If you feel anxious or

Choose to be happy

3. Exercise

Exercises for pregnancy and birth focus on limbering, toning and strengthen the three “B’s”. Back, Belly and Bottom. These are the muscle groups that are the most affected by pregnancy and birth.

Favorite Exercises: Swimming, Brisk walking, yoga, weight lifting, low impact aerobics.

Fit Tips: Remember to be aware of body mechanics. Slow your pace and move smoothly through your exercise program. Include your abdominal muscles as well as Kegal exercises.

Benefits: Boosts your mood, increases your energy, control your weight and helps you get ready for labor.

Work out gear: Nothing special- loose layers, supportive bra and supportive and properly fitting shoes

4. Learn to Relax

Relaxation can be learned. Learning to achieve relaxation (decreased muscle tension; decreased nervous system activity) is a useful life skill. It is particularly beneficial during pregnancy, childbirth and the early months of parenthood.

Objective: staying relaxed through each contraction in labor is the short term goal; becoming a more relaxed person is the long term goal.

Assume a comfortable position lying on your side or sitting. If you are sitting, keep the spine straight, feet on the ground and shoulders relaxed.

Close your eyes if it feels more comfortable.

Bring your attention to your belly. Feel it rise when you breathe in and fall when you exhale.

Keep the focus on your breathing as is you are riding the waves of your own breathing.

Every time you notice your mind has wandered off the breath, note what it was that took you away and then bring your attention back to your belly and the breath. You may have to do this several times.

Practice this exercise at a convenient time every day for approximately 15 minutes whether you feel like it or not. Make time for this exercise and incorporate it into your day for one week and see how it feels to incorporate this discipline into your life.

There are numerous resources for relaxation and you might find one type of relaxation technique more effective than others. Consider yoga or hypnobirthing to help with relation techniques.

Other Things to consider during your pregnancy

If you are not in PCP session- it is recommended that you register for a Birth Class and or Breast Feeding class offered at the Birth center or other locations.

You may want to consider hypnobirthing classes or prenatal yoga.

You may find chiropractic care or prenatal massage helpful for your back leg or hip pain.

Please visit your dentist for regular check ups

There are referral agencies available for help with abuse; physical, mental or sexual abuse.

The CDC recommends that all pregnant women have

a flu shot (during flu season- in any trimester)

Tdap- tetanus, diphtheria and pertussis vaccine booster between 27-36 weeks od pregnancy

Please visit the CDC website: www.cdc.gov for more information.

It has been suggested that taking probiotics may decrease the likelihood of colonizing group B strep in your vagina. It is recommended that you take a probiotic with at least 20 billion count and at least 5 strains of beneficial bacterial every day. It appears to be beneficial to take one brand for about 2-3 months and then switch to another brand, then alternate. A whole foods diet with plenty of raw/fermented fruits and vegetables along with yogurt/kefir with active cultures is recommended.

Please “Like” and follow our Facebook page and share with your friends. We will send out messages or events on this page.

There is a Facebook page developed by friends of the Midwife Group called “Savannah Birth Center Groupies”. This page is administrated by moms like you who are supportive of our birth center and midwifery care. They can be a great resource and network for pregnancy, birth and breastfeeding resources in the local area.

Common Discomforts during Pregnancy

The hormonal and physical changes of pregnancy result in enormous changes in a woman’s body. To give you some perspective, your body at the end of pregnancy produces more estrogen in one day than a non-pregnant woman produces in 3 years! Following are some common discomforts experienced during pregnancy and what you can do at home to help alleviate symptoms.

Nausea & Vomiting:

Diet: Eat a bedtime snack, preferably protein (cheese, peanut butter). Try keeping a juice box and some dry crackers at the bedside. Take a sip of juice and a bite of cracker before lifting your head off the pillow in the morning. Repeat every 5 minutes for 20 minutes before getting out of bed. Avoid drinking liquids with meals, instead, drink between meals. Try potato chips and lemonade, it works!

Rest- Try to nap whenever you can. Fatigue can make symptoms worse. This is why some women experience worsening symptoms in the evening.

Supplements- Vitamin B6 (pyridoxine) up to 200 mg per day and doxylamine 25 mg (Unisom) twice daily

Aromatherapy- Ginger, Peppermint, mandarin, pettigrain, sweet orange, lavender.

Acupressure (Sea Bands) Bracelets that put pressure specific points on the wrist.

Constipation:

Drink lots of water or herbal tea (8-10 glasses) and increase fiber by eating 2 servings of fresh fruit (especially dried fruit such as apricots and prunes) and 4 servings of vegetables every day. Try prune juice or hot tea; fiber supplements (such as Metamucil) with extra water or you may take Colace 100mg once or twice per day.

Exercise- Daily exercise in the form of walking or jogging can help a sluggish GI tract.

Hemorrhoids:

Herbal Supplements

Witch hazel pads (Tucks) or apply wet or dry baking soda to relieve itching, lemon juice or vinegar to reduce swelling or bleeding. You may also try compresses made of essential oils like Comfrey, Cypress, Frankincense, Lavender or Myrrh. Other options include ice packs, or warm sitz baths for 15‐20 minutes, followed by 1 minute of a cool sitz bath 4-6 times per day. You can add the above mentioned essential oils or Epsom salts.

Medications: Stool softeners including Colace, Preparation H, and Anusol or their generic equivalent.

Round ligament and symphysis pubis pain:

Change positions slowly, especially from lying to sitting to standing.

Prop a pillow or a small rolled towel under your belly when you lie on your side and put another pillow between your knees.

Take a warm bath.

Wearing a supportive pregnancy belt can be helpful in stabilizing the bones and ligaments of the pelvis.

Performing daily pelvic tilt exercises can help strengthen your pelvic muscles.

Chiropractic care by a practitioner who specializes in pregnancy can also help realign the pelvic bones.

Heartburn & Indigestion:

Eat small, frequent meals, rather than 3 large meals; avoid drinking fluids with meals (drink them in between meals). Minimize acidic or greasy foods. Antacids that contain both magnesium and aluminum and are low in sodium - Mylanta, Gaviscon, or Tums (Tums contain only calcium and may cause rebound heartburn if used for long periods)

Dietary supplements-Papaya enzyme; peppermint or ginger tea

Herbal remedies-Slippery Elm

Aromatherapy-Lemon or orange essential oils – 4 drops each into teaspoonful grape seed oil base; massage into chest and upper back or put in bath to breathe in the vapors.

Back Pain & Sciatica

Maintain good posture and use good body mechanics when changing positions or lifting heavy items.

Pelvic rocking exercises

Chiropractic care

Warm bath or heating pad on low

Extra-‐strength Tylenol 2 tablets as needed every 6 hours

Wear a pregnancy support belt

Headache:

Extra rest

Extra-strength Tylenol (or generic) 2 tablets every 6 hours as needed.

Apply heat or cold packs to your head, eyes, or along the back of the neck.

Seek chiropractic care if needed.

Essential oils/aromatherapy/herbs- Peppermint mixed with eucalyptus; Bergamot; lemongrass; lavender; ginger or ginger tea; chamomile or rose hip tea.

Leg Cramps

Stay hydrated, eat a well-balanced diet rich in fruits and vegetables.

Avoid excess dairy as this can lead to calcium, magnesium imbalance.

Avoid excess phosphate intake (soft drinks, calcium phosphate).

Increase potassium (eat a banana every day); try a magnesium supplement.

Exercise daily

If you do experience cramps, stretch your leg out and bend ankle with toes toward your head. For muscle soreness after a severe cramp, try Arnica gel or lotion rubbed into the calves.

Varicose Veins

Avoid prolonged standing or sitting

Lie on left side, elevate legs slightly

Support stockings

Dizziness and lightheadedness

Move slowly, especially when rising

Avoid prolonged standing or sitting

Drink plenty of fluids

Wear support hose to prevent blood pooling in the vessels of the lower legs

Eat well-balanced, small, frequent meals throughout the day rather than 3 large meals.

Swelling

Avoid prolonged standing or sitting.

Elevate feet as frequently as possible throughout the day.

Avoid tight shoes.

Drink lots of water and herbal teas (8-‐10 glasses per day).

Eat foods that have natural diuretic properties (remove excess fluid from the body) such as watermelon, parsley, grapes, leafy greens and lemons. Drinking water or green tea with lemon is especially beneficial.

Vaginal Discharge

There is no prevention as this is normal.

Normal hygiene measures for comfort are all that is necessary.

Do not douche. Wear cotton underwear. Sleep without underwear.

Do not wear constrictive clothing.

Do not use irritating sprays or creams that have harsh chemicals or perfumes as these can upset the normal skin pH and cause rashes and infections.

Remember that the unborn baby cannot take what it needs and only gets what is available. There are certain foods that you need to be aware of that may be harmful during pregnancy.

The foods of most concern are certain fish, meat, milk, cheese, and raw foods. Because these are important parts of most diets, you will want to learn to choose the right foods.

Refer to this handy chart for food safety guidance.

Don’t Eat These Foods	Why	What to Do
Soft CHEESES made from unpasteurized milk, including Brie, feta, Camembert, Roquefort, queso blanco, and queso fresco	May contain E. coli or Listeria.	Eat hard cheeses, such as cheddar or Swiss. Or, check the label and make sure that the cheese is made from pasteurized milk.
Raw COOKIE DOUGH or CAKE BATTER	May contain Salmonella.	Bake the cookies and cake. Don’t lick the spoon!
Certain kinds of FISH, such as shark, swordfish, king mackerel, and tilefish (golden or white snapper)	Contains high levels of mercury.	Eat up to 12 ounces a week of fish and shellfish that are lower in mercury, such as shrimp, salmon, pollock, and catfish.
Raw or undercooked FISH (sushi)	May contain parasites or bacteria.	Cook fish to 145° F.
Unpasteurized JUICE or cider (including fresh squeezed)	May contain E. coli.	Drink pasteurized juice. Bring unpasteurized juice or cider to a rolling boil and boil for at least 1 minute before drinking.
Unpasteurized MILK	May contain bacteria such as Campylobacter, E. coli, Listeria, or Salmonella.	Drink pasteurized milk.
SALADS made in a store, such as ham salad, chicken salad, and seafood salad.	May contain Listeria.	Make salads at home, following the food safety basics: clean, separate, cook, and chill.
Raw SHELLFISH, such as oysters and clams	May contain Vibrio bacteria.	Cook shellfish to 145° F.
Raw or undercooked SPROUTS, such as alfalfa, clover, mung bean, and radish	May contain E. coli or Salmonella.	Cook sprouts thoroughly.

Be Careful with These Foods	Why	What to Do
Hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry	May contain Listeria.	Even if the label says that the meat is precooked, reheat these meats to steaming hot or 165° F before eating.
Eggs and pasteurized egg products	Undercooked eggs may contain Salmonella.	Cook eggs until yolks are firm. Cook casseroles and other dishes containing eggs or egg products to 160° F.
Fish	May contain parasites or bacteria.	Cook fish to 145° F.
Meat: Beef, veal, lamb, and pork (including ground meat)	Undercooked meat may contain E. coli.	Cook beef, veal, and lamb steaks and roasts to 145° F. Cook pork to 160° F. Cook all ground meats to 160° F.
Meat spread or pate	Unpasteurized refrigerated pates or meat spreads may contain Listeria.	Eat canned versions, which are safe.
Poultry and stuffing (including ground poultry)	Undercooked meat may contain bacteria such as Campylobacter or Salmonella.	Cook poultry to 165° F. If the poultry is stuffed, cook the stuffing to 165° F. Better yet, cook the stuffing separately.
Smoked seafood	Refrigerated versions are not safe, unless they have been cooked to 165° F.	Eat canned versions, which are safe, or cook to 165° F.

Please refer to the information provided on our website www.themidwifegroup.com under “links” for information on “Food water and product safety” and information about the safety of fish and shellfish in our area.

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