Digestion & Nutrition

Study Group Module

Digestion and Nutrition National Midwifery Institute, Inc. Study Group Coursework Syllabus

Description: This module explores digestion and nutrition in the context of midwifery care from preconception through well person care. It includes recommended reading materials in print and online, and asks students to complete short answer questions for assessment, long answer questions for deeper reflection, and learning activities/projects to deepen your hands-on direct application of key concepts.

Learning Objectives: ● Understand how foods nourish the body. ● Identify the six nutrients necessary in the diet. ● Identify the eight essential amino acids. ● Identify nutritional sources of proteins, fats and carbohydrates. ● Identify the critical differences between unsaturated fat, saturated fat, and trans-fats. ● Identify daily dietary requirements of proteins, fats and carbohydrates. ● Identify fat soluble vitamins and the daily intake limits of each. ● Establish a basic understanding of a variety of nutritional systems or eating habits: ● Identify the importance of B-12 in the vegan diet. ● Understand how stress blocks the absorption of nutrients from the diet. ● Demonstrate your understanding of a nutritional diet. ● Identify the social services available in your area to provide food to pregnant and breastfeeding women/gestational parents. ● Draft practice guidelines for nutritional counseling with your own clients. ● Create nutritional reference sheets for client use. ● Demonstrate appropriate dietary counseling for clients within the context of your preceptor’s practice. ● Identify how digestion is affected by pregnancy. ● Identify the digestive organs of the human body, and describe their function. ● Understand and describe the processes of human digestion. ● Identify and describe the processes of metabolism. ● Identify the role of probiotics in healthy digestion. ● Understand the concept of the human microbiome. ● Understand the implications of oral health and identify the basic practices of oral hygiene and support during pregnancy.

Study Group Module: Digestion & Nutrition

Learning Activities: ● Research and read appropriate study sources, seeking out additional study sources where needed ● Complete short answer questions in attached module document for assessment ● Complete long answer questions for deeper reflection in attached module document for assessment ● Complete learning activities listed in attached module document for assessment ○ Nutrition resource sheet for clients ○ Reflection on keeping a diet journal ○ Research local, regional and national resources ● Submit work to Study Group Course Coordinator ● Reflect on feedback from Study Group Course Coordinator and re-submit work as needed

Study Sources (print): The following texts are recommended for completion of this module. Use them to cross reference and build a more comprehensive understanding. Using keywords from the Learning Objectives, search the index. Read those pages listed, and read the chapter in which they are found. Establish a context for the information so that you understand how other topics are related. In addition, read the chapter headings in the Table of Contents, and flip through each text to familiarize yourself with the content of chapters. As you work through Study Group modules, you will eventually read each text in its entirety. ● Holistic Midwifery, Vol. I, II, Frye ● Varney’s Midwifery ● Myles Textbook for Midwives ● Human Anatomy and Physiology, Marieb ● The Natural Pregnancy Book, Romm ● Breastfeeding: A Guide for the Medical Professional, Lawrence & Lawrence

Optional • Herbal for the Childbearing Year, Weed • The Natural Pregnancy Book, Romm • Nourishing Traditions, Fallon • Real Food for Pregnancy, Nichols

Study Sources (online): See NMI website Digestion and Nutrition module web resources section for current online study sources for this module.

Related Modules: ● Breastfeeding/Chestfeeding © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Digestion & Nutrition

● Diversity Awareness ● Fertility and Conception ● General Pregnancy and Postpartum Ailments ● Gestational Diabetes ● Hypertension ● Labwork and Other Clinical Assessments ● Digestion ● Liver ● Basic Life Science ● Postpartum Care ● Renal System

Submitting Module for Assessment: Study Group modules are accepted electronically in PDF format only. We encourage you to submit modules as you complete them throughout each quarter of enrollment.

Please email your completed Study Group module to: Study Group Course Work Instructor [email protected]

Once your module has been emailed to us, you will receive an email confirmation that we have received it. Study Group modules are reviewed and returned in digital format as PDF documents. Modules can take up to 1 month from submission to be reviewed and returned to you. We will return your module as an e-mail attachment. Each module includes an Evaluation Sheet at the end of the pdf. The module’s page on the student portal also includes a link to a fillable online module evaluation sheet. Please take the time to fill out the module evaluation sheet and return it to us for each module, it helps us to improve our course work.

Please follow these formatting guidelines when submitting modules: ● Your first initial and last name in title of PDF, along with name of module. Example: “ERyanFirstStage.pdf” ● Title of module on the document’s front page ● Your name on the document’s front page ● Provide the text of each question, followed by a blank line and then your thoughtful answer (without the question, you have commentary without context) ● Blank line between the answer for a question and the next question: question, blank line, answer, blank line, question, blank line, answer… ● Please leave margin space for our comments! ● Don’t use script or cursive writing style text ● Font size not smaller than 12 ● Credit sources of direct quotes

Completion Requirements and Feedback: In order to complete this module for graduation purposes from National Midwifery Institute you must review all resources, complete the attached short answer questions for © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Digestion & Nutrition

assessment, long answer questions for deeper reflection, and learning activities/projects, and submit them as detailed above. Upon return to you, your coursework may have feedback or ask for additional information or exploration on certain topics. Your work will be evaluated n the following Rubric (pasted below). You must achieve a minimum score of 7.5 in order to move on to your next module, though we encourage all students to strive for a 10.

Level 1 Level 2 Level 3 Level 3 Student (0 Points) (1 Point) (1.5 points) (2 points) Exceeds Score Not Adequate Developing Meets Basic Expectations Adequacy Expectations

Completion of -Module not -Major -All aspects of -All aspects of module module completed Elements of module elements present and prompts and module are elements answered completely elements missing present, with some minor questions unanswered or missing

Demonstrates - Lack of - Responses - Responses - Responses are clear, Comprehensi comprehension are unclear are clear and well written, and and do not reflect basic reflect in-depth on of module reflect basic comprehension comprehension of content and comprehension of module module content and concepts of module content and concepts. Added concepts concepts subpoints and additional reflections demonstrate a deeper knowledge and curiosity. Analysis - Key terms not -Inaccurate -Accurate - Accurate definitions defined definitions of definitions of of key items key items key items -Strong connections -Limited -Connections made between connections made between evidence, subtopics made between evidence, and clinical experience evidence, subtopics and subtopics and clinical clinical experience - experience Incorporation of original ideas and incorporates some clinical experience in responses where possible

Study Group Module: Digestion & Nutrition

Level 1 Level 2 Level 3 Level 3 Student (0 Points) (1 Point) (1.5 points) (2 points) Exceeds Score Not Adequate Developing Meets Basic Expectations Adequacy Expectations

Evidence - No research -Research not -Research is -Research is abundant evidence used used present but -Research is -Research not limited compelling and clearly -Research relevant to connected to presented is communities served questions weak or not by midwives asked in relevant to module communities served by midwives Engagement -Evident study -Evident study -Evident that -Evident that study with Learning sources were sources were study sources sources were fully not utilized partially utilized were fully utilized and Resources utilized independent research was undertaken -Full incorporation of original ideas, personal analysis and incorporates relevant clinical experience in all areas possible

Skills Following are excerpts from the NMI forms for assessment of midwifery skills, which include all skills identified and required by NARM. Review the following skills and consider how they each relate to the content of this module. If you are currently working with a preceptor, take this opportunity to focus on these areas. During Supervised Primary Care you will formally evaluate these skills together using the NMI forms Form 52 - Assessment of Student’s Midwifery Skills and Form 53 - Student Self-Assessment of Midwifery Skills.2. General Health care Skills: J. Recommends the use of vitamin and mineral supplements 1. Prenatal Multi-Vitamin, 2. Vit. C, 3. Vit. E, 4. Folic Acid, 5. B-Complex, 6. B-6, 7. B-12, 8. Iron, 9. Calcium, 10. Magnesium 3. Maternal Health Assessment: K. Recognizes and responds to potential prenatal complications by: 1.Identifying pregnancy-induced hypertension 2. Assessing, educational and counseling for pregnancy-induced © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Digestion & Nutrition

hypertension with: a) Nutrition/hydration assessment, b) Administration of calcium/magnesium supplement c) Stress assessment and management, d) Non-allopathic remedies, e) monitor for signs and symptoms of increased severity, f) Assessment for drug abuse, g)increased frequency of maternal assessments 3. Identifying preeclampsia 4. Collaborating and managing preeclamptic mothers 8. Identifying and dealing with pre-term labor with: B) Consultation and/or treatment including: 1) Increase of fluids, 2) Non-allopathic remedies, 3) Discussion of the mother’s fears, 4) Food to be eaten at least every two hours, 5) consumption of alcoholic beverage, 6) Evaluation of urinary tract infection, 7) Evaluation of maternal infection 4. Labor, Birth and Immediate Postpartum F. Assesses general condition of mother and newborn by: 8. Facilitating breastfeeding by assisting and teaching about: a) positioning for mother and baby, b) skin-to-skin contact, c) latching on, d) adequate maternal hydration, e) adequate maternal nutrition, adequate maternal rest, g) feeding patterns, h) maternal comfort measures for engorgement, i) letdown reflex, j) milk expression 5. Postpartum G. Performs maternal four- to six-week postpartum checlk-up assessing for: 1. Postpartum subjective history 2. Lochia 3. Return of menses 4. Physical condition by performing an examination including assessment of: a) vital signs, b) systems function, c) breastfeeding, condition of breast and nipples, d) muscle prolapse of vagina and rectum (cystocele, rectocele, etc.), e) strength of pelvic floor, f) condition of uterus, ovaries and cervix, g) condition of the vulva, vagina, perineum and anus

Study Group Module: Digestion & Nutrition

Digestion and Nutrition National Midwifery Institute, Inc. Study Group Coursework Short Answer Questions

Short Answer Questions 1. Identify the organs of the digestive system and describe their function. Commented [1]: Is here a question 1?

Study Group Module: Digestion & Nutrition

2. What 3 types of muscle makes up the GI tract?

3. Describe metabolism

4. Digestion begins with oral health and research shows that oral health is linked to pregnancy outcomes. Midwives now need to include this in their care. a. Define gingivitis. b. Define periodontal disease.

5. Familiarize yourself with the following practices. Review the list and find 3 that you are the least familiar with. Identify and discuss the key intentions behind 3 of the practices. Would you recommend them to a pregnant person? a. baking soda and hydrogen peroxide, Oil pulling, waterpik, toothpicks, use of herbal oils for gum health, use of Myrrh Gum powder or tincture, use of Xylitol

6. How can compromised oral health cause problems in pregnancy?

7. Identify how digestion is affected by pregnancy.

8. How does slowed peristalsis benefit mother/gestational parent and baby during pregnancy? What are less positive side effects?

9. What is the cephalic phase, or reflex phase, of gastric secretion? 10. Why is chewing your food thoroughly so important?

11. What is the make up of saliva?

12. Where is protein digestion begun?

13. Explain to a client the cause of heartburn in pregnancy and list 3 simple remedies

14. List the probiotics that are supportive of digestion.

25. Do you have experience with consciously including probiotics in your diet?

Nutrition

17. List the six nutrients required in every diet.

18. What three functions do these six nutrients achieve?

19. What are enzymes and what do they do?

20. Discuss fat-soluble vitamins. a. What does ‘fat-soluble’ mean? © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Digestion & Nutrition

b. Name the fat-soluble vitamins. c. How are fat-soluble vitamins measured? d. What must you be aware of with fat soluble vitamins?

21. What pregnancy and postpartum issues are related to vitamin D deficiency?

22. B Vitamins a. What do B vitamins accomplish in the body? b. Describe the necessary content of a B-Complex vitamin supplement. c. What food sources contain vitamin B-12? i. Identify the diets that may need to supplement B-12.

23. Vitamin C a. What does vitamin C accomplish in the body? b. How long is vitamin C stored in the body?

24. What does vitamin K accomplish in the body?

25. What do minerals accomplish in the body?

26. Macrominerals: Where are then found? What are they and how are they measured?

27. When someone is pregnant how much ______do they need in their diet? a. Calcium b. Magnesium c. Phosphorous d. Iron e. Protein

28. Where does iron exist in the body? And what does it accomplish in the body?

29. If someone is anemic, what dietary changes might you suggest?

30. Which pregnancy complications may a diet: a. deficient in calories contribute to? b. deficient in protein contribute to? c. deficient in iron contribute to? d. deficient in folate contribute to? e. excessive in sugar contribute to?

31. What is the difference between saturated and unsaturated fats?

32. Give healthy guidelines for the consumption of cooking oils and fats.

33. What are healthy fats and how are they related to fat-soluble vitamins? © National Midwifery Institute, Inc. Revised 2018

Study Group Module: Digestion & Nutrition

34. List the essential amino acids.

35. What concerns do you have about a pregnant vegetarian diet? Pregnant Vegan diet

36. What does a craving for sugary foods often indicate?

37. What is “pica”? And what does pica indicate?

38. What did you learn about pica after reading “Pica as a Culture Bound Syndrome” (NMI Online resources for Nutrition module)?

39. How can optimal nutrition assist healthy conception?

40. How can optimal prenatal nutrition maintain a healthy pregnancy including mitigating pregnancy discomforts, growing an healthy baby and maintain overall health?

41. How can optimal prenatal nutrition help prepare for labor and birth?

42. How can optimal prenatal nutrition help prevent perineal tearing during birth?

43. How can optimal prenatal and postpartum nutrition help ease a smooth postpartum for the birthing person? Including breastfeeding/chestfeeding

Digestion and Nutrition National Midwifery Institute, Inc. Study Group Coursework Long Answer Questions for Deeper Reflection

Questions Requiring Longer, More Thoughtful Answers: (number continued from previous section). 44. What effect does stress have on the absorption of nutrition from the foods eaten? Explain the physiologic process. With this understanding of stress in mind, how does this affect the advice we give to stressed pregnant people?

45. Explain the concept of the Human Microbiome and its relationship to health & pregnancy in particular .

46. How do you help a client understand if they are getting enough protein? Calories?

47. What do you look for in a prenatal vitamin? What are the most important components?

Study Group Module: Digestion & Nutrition

48. Briefly discuss MTFHR and the role of nutrition in pregnancy with MTHFR.

49. Discuss the role of folate in pregnancy. And discuss the difference between folate and folic acid. Which do pregnant women/gestational parents need to consume?

50. Your client Delpha has been very moody, cranky and tearful. Delpha brings the diet journal, and reports that she stopped eating meat 8 most before conception. As you review the diet together, you notice that she has fruit juice several times a day, cereal in the morning, cookies in the afternoon and ice cream before bed. She eats a light lunch, usually a salad with saltine crackers. Her dinner includes some green vegetables but mostly potatoes or pasta which are both covered with cheese. What is your advice to her? And what is your follow up plan?

51. Identify and discuss 2 current diet trends that your clients might be adhering to. How could these affect pregnancy?

52. Discuss how you counsel clients about their diet in pregnancy. What is your approach? What do you emphasize?

53. Discuss your understanding of multicultural diets. If a client eats a traditional diet from a culture you are unfamiliar with, how do you learn about what they are regularly consuming?

54. Discuss the nutritional benefits of organic foods.

55. If a client cannot afford to buy all foods organic, what are the more important ones?

Digestion and Nutrition National Midwifery Institute, Inc. Study Group Coursework Projects/Learning Activities

Projects(send completed projects with the rest of your course work for this module) (number continued from previous section). 56. Nutrition Chart for Clients: Create a practical list or chart for reference showing the nutritional needs during pregnancy and breastfeeding, and foods in which they are most abundant. Include a few details of the benefits of each nutrient. This can be a handout or something you will have on your website.

57. Self Awareness project: Keep a diet journal for yourself for one week. a. What changes can you make to improve your own nutrition? b. Did you notice an increased awareness of what you were eating (and possibly why you were eating it) as you kept your diet journal? c. Did this bring up any issues for you? What did you learn about yourself and

Study Group Module: Digestion & Nutrition

your diet? d. Did recording what you were eating have an effect on the foods you chose to eat? e. How do you think this experience will help you in your counseling with other women regarding their diets?

58. Research the local, state, and federal programs available in your area to aid in providing food to pregnant and breastfeeding women/gestational parents. Identify the qualifications for receiving support and the local contact information. Create a referral list to provide for your clients.

Image Source http://www.maureekai.com/2016/07/24/what-you-cant-digest-will-infest/