A Healthy Pregnancy Is Not Just About Nutrition with Prenatal Nutritionist Haley Miskowiec
Do your doula clients leave their prenatal appointments with a million unanswered questions and “band-aid solutions” for each of their pregnancy symptoms?
In Episode 47 of the Birthworker Podcast, I'm joined by Haley Miskowiec from Prenatal Nutritionist, who is sharing her insight and experience from working as a fertility and pregnancy dietician serving women from preconception all the way through postpartum.
In this interview with Haley, we chat about:
The impact that inadequate nutritional education requirements for OBs and midwives have on our doula clients…
Exactly how the hospital system isn’t set up to have meaningful conversations between patients and providers…
The biggest misconception in prenatal nutrition and how it’s causing harm to pregnant women and their babies…
… and a whole lot more!
Haley Miskowiec: I'm Haley Miskowiec. I'm a registered dietician and I specialize in pre and postnatal nutrition, and I've worked with women in all stages of their motherhood journey. So that's anywhere from preconception into the postpartum space for probably now over eight years. I actually looked up how long I've been a dietician for, and honestly, my entire career I've worked with women, infants and children up to the age of five. So when it comes to why did I choose to specifically focus on prenatal nutrition, I kind of always say that I think this path really chose me.
I did my dietetic internship. I was hired into the Women, Infant and Children program, and so kind of started my career there. I really fell in love with helping women be healthy, feel good, and feel confident in their pregnancy too because there's so much misinformation out there.
It's just so crazy to me that we get to this really crucial time period, but at the same time, food is so vital and is a normal thing that we all need to survive. Something about when it comes to pregnancy, I actually go down to the fear monologing a lot that we are given, but this vital thing that is a normal part of our life just becomes a very overwhelming, scary, worry, guilt, confusing space for women.
To me, it's just incredible when you give women reassurance and actually talk about the evidence that we have, whether it's food safety, how to be eating, how empowered they feel, and how confident then they feel. It's a hard part when our guidelines take so long to get updated. You're given so much different direction from different avenues, whether it's Google, maybe you see three different midwives or three different doctors, because that's how that practice that you're at works. So being able to have that conversation and really talk with women, and even when it comes into the infant and children's space, to give women back that confidence that they deserve to have during this journey to make them know that they are in control, and they are doing the best that they can, for some reason, just always sticks with me and just puts a fire in me as well.
I feel like that's one of the reasons why. And then at the same time with being a dietician, the research just really supports this space. We want to start seeing a decrease around chronic illnesses and diseases. Preconception space is somewhere that we can make a huge impact in, and that can be for our long term, but also our babies' long term and a third generation. As women, we get the power to set up the health of our future grandchildren, because we're the ones that are giving our children the health of their eggs and the health of their sperm. So it's a space where there's so much great impact that we can do.
At the same time, it's also not something that is part of our high school curriculums. We scare kids into not wanting to engage in sexual intercourse, but we don't talk to them too about the importance of what it looks like and that power they have. Those would be the big reasons why I decided to focus in on here, along with who I am. I also am from Minnesota, studied in North Carolina, so love the East Coast. And I'm a huge fan of traveling, so I love getting into other cultures and experiencing that food connection, because we know food is not just about nutrition in general, but it's also about our access, our traditions and everything like that. It's really interesting to me to see all those connections and even looking at family structures and being like, "Oh, that's why you really love that food, because it was something that you did every week with someone who was special to you."
Kyleigh Banks: Wow. You just made prenatal nutrition sound so fun through all of that. I absolutely love how you talk about your passion of really centering women as the ones who are in control, and really helping them tune into their intuition and feel confident in themselves because that goes way beyond pregnancy, birth, and motherhood. It impacts every aspect of their life. So that's really cool that you've brought that into feeding ourselves in pregnancy specifically, and getting ready to sustain life. Very cool. Do you still work for WIC?
Haley Miskowiec: No, I no longer work for WIC. My private practice is something that I do in my spare time. My full-time role, I actually work for public health. I work on policy, systems, and environment changes within our emergency food systems and our school systems, just because as I have noticed with working in the Women, Infant and Children program, one of the biggest things is unless we work on changing our policies, systems, and environments, I can give advice to anybody all day, but if you live in a food desert, your access isn't there. We've got to make some of those bigger changes to really make more impacts on why we're seeing such a rise in chronic illnesses too. So that's the multifaceted issue that we have, and that's what I do for my full-time position.
Kyleigh Banks: Mh-hmm. I am curious, I have actually never seen an obstetrician. I think I've seen a gynecologist once in my life. I just saw a midwife throughout my entire pregnancy. I think from talking with my clients and just being in this space that women when they're going to their care providers, they're really not talking with people who have a deep understanding of nutrition. Is it right to assume that most obstetricians do not have that deep knowledge of nutrition?
Haley Miskowiec: That is correct. Your obstetrician has to really be self-passionate in nutrition. It's not a requirement of their medical schooling. They're expected to know so many things that they really have to seek that out. I would even say as a dietician, I was educated on every possible part of nutrition, and I had to decide that I wanted to spend my energy and education specifically in the pre and postnatal space. So even if you would've caught me eight years ago, a lot of my knowledge was still very general and basic, and a little bit of each slice of pie.
When I am talking to obstetricians, the biggest thing that they always say to me is, I've had one or two courses of nutrition, and so I've never really thought about the impact of that. But at the same time, there are obstetricians out there that are very passionate about the nutrition connection. Then in that space, they are very knowledgeable, but it is not part of their schooling that they have to take.
Kyleigh Banks: It's more self-motivated, yeah, a passion, and then they would go into it. That's really fascinating. I think it's doing moms a disservice. I'm sure you would agree.
Haley Miskowiec: Yeah. I mean, even my own experience, it was kind of crazy to me on the lack of information I was given about nutrition and its impact on pregnancy, and at the same time how generalized it was, like, “Try to eat this many servings of this food group and try to eat this many servings of this food group.” Even with my first appointment, the fact that I wasn't experiencing severe nausea was something that my midwife was very uneasy about. I don't know how many times she said to me, "Okay, so when the nausea comes, then you can just take Unisom and B6.” And at the same time, "Oh, so you're taking a prenatal, right?" But that was it. Not, “Which prenatal are you taking?” or any of that type of space.
I honestly felt like I walked out of that appointment feeling like I was going to get more nausea than I had, because it had been so drilled into me. I feel like in Minnesota we have a really good focus in our healthcare system with nutrition being part of it, but there's still so much missing. And the pamphlet I got, I just looked at thinking, “If I didn't have the education and background I do, how in the world would I even navigate this?”
Kyleigh Banks: Yeah. Do you find it hard to give recommendations to a general group of people? Is nutrition something that really needs to be specific based on someone's lifestyle and tailored to them?
Haley Miskowiec: Well, the thing is, at the end of the day, we're not robots. We all don't function the same. So I always tell women, your journey is your journey. We all have different comparability levels with things. Some of us have different pros and cons with things, and that all plays a role in what our diet really looks like in that pregnancy space. The generalized advice too, it doesn't all make the impact. When we talk about nausea, yeah, B6 and ginger are great things to help with nausea, but at the same time, if a mom's blood sugars aren't stable, and it's the way that she's building her meals and snacks, or it's the fact that she is having these huge gaps between the time that she's feeding herself, that's going to be what we need to work on rather than just getting B6 and ginger in her, right?
What I have found in my practice is really looking at each person individually and going, "Okay, what is going on in your specific situation that we can tie to what kind of things are going on?" At the same time, everyone has different morals and ethics and reasons to why they eat the way they do. And honestly, as a dietician, I feel like it is my job to walk into a conversation with every female within the fact of respecting what those look like for her, and having conversations on what's going to work best for them and what they feel comfortable with.
Some people are going to look at me and be like, "Yeah, DHA sounds great Haley. I understand it’s great for brain development and all these other things that come from it, but I'm not eating fish if my life depended on it." And that's just a spot then where that person needs an individualized plan on, okay, so how are we going to get this crucial nutrient in then if it's not realistic for you to be eating those things? Because nothing comes good out of us forcing ourselves to eat things that our body doesn't want, nor doesn't enjoy.
Kyleigh Banks: Yeah, seriously. And I'm that person. If you would have told me, "You have to eat fish at least a couple times a week for your health," I'd be like, "I guess I'm unhealthy. I'm not going to do it anyway". And so it's funny because especially people like me, it would help to have different options to choose from and more of a specialized recommendation than someone just telling me, like you said, eat fish a couple times a week. It's just not going to happen. So rather than my option being get the DHA or not get the DHA, because I'm not eating fish, there are other ways out there to get DHA, even if it just looks like in pill form, there are other ways to do it rather than just those general recommendations.
Haley Miskowiec: I think that at the same time, that's a spot too where you're going to feel guilty. "I can eat this fish so I can't get the DHA in, therefore my baby's brain development is going to be impacted and I'm the worst mom on the planet because I can't do these things." It's a black spiral hole we start going down, so it’s one of those things that when you have someone who goes, "Okay, we have option A, B, or C, which one fits you?" It takes away that guilt. Then you're like, "Oh, I'm still getting it in. I'm just not getting it in the other ways that are recommended because I have multiple options." I think at the same time too, we all have different pregnancy journeys. Even if you've had one pregnancy, two pregnancies, three pregnancies, the majority of the time I hear they don't look the same.
I've only had one pregnancy journey, so to be continued on my personal experience. But with the women I've worked with, I continuously hear, "I never had nausea with my first pregnancy, but I am crippled by my nausea with this second pregnancy." It's always different. Another thing to consider is that food is impacted when those symptoms become part of the picture, and we have to maneuver and adapt around that space. You might be too nauseous even to smell fish, like hello food aversions. So there also might be a time in your pregnancy where we might need to rely on a supplement, but then maybe later on you are okay to eat things like fish, for instance. Then in your third trimester, it might look different too.
That's the thing with these pregnancy symptoms, they come and go, and once one goes, one of them starts trying to sneak in. Not everyone has the same symptoms. Some women will tell you they had every symptom that's possible in pregnancy and others will only have a couple. Both are very valid pregnancy experiences. It's just really that adaption. I always say it's different for everyone. I have clients who have hyperemesis gravidarum, and that is a whole different ballgame for us. When it comes to that nausea, we have a whole different ballgame that we're playing and we have to lay a foundation versus what we're looking at when it comes to just your typical nausea during pregnancy. Really having that individualized approach is so important because like I said, we're not all robots and we're not all the same person.
Kyleigh Banks: Yeah. We've been talking about nausea a lot. Are there any other pregnancy symptoms that can be linked back to nutrition?
Haley Miskowiec: Yeah, there's so many on constipation. Where is your fiber looking like? How is your hydration? I'd say nutrition and lifestyle really can impact a lot of your pregnancy symptoms. It's not always just solely nutrition. Same for headaches, what does your hydration look like? Hydration doesn’t always mean drinking some water. Sometimes we can drink water, but our body actually needs sodium, potassium, magnesium, and a lot of those needs increase during our pregnancy. We might not be getting enough of those for our body to actually be taking in the water and to have that true hydration status, as I like to explain it to women. That also plays into constipation.
Then you look at heartburn. Usually, there are foods that trigger heartburn, but there are also mindful eating practices around meals and snacks that can be very beneficial to heartburn too. We can't turn our eye to the fact that relaxin is the hormone that's relaxing all of our muscles, so your sphincter on your stomach is going, "Ooh, I can open!" And so that acid likes to come back up, but we can eat smaller meals. We can really make sure that we're chewing our food really well so there's not as much digestion that has to go on in our stomach because our mouth is really the first place that digestion starts to happen. That is the first place where those enzymes are really released.
We have a culture and a society where we're always eating as fast as we can, and we're not really even allowing ourselves to even come out of the fight or flight mode so our body can really prioritize and be able to digest food properly, which doesn't help when you have heartburn or bloating. Same with the constipation and gas.
And then fatigue, we see a lot of that tied back to balancing meals. B vitamins, iron levels, and what do those really look like? Then with leg cramps and restless leg syndrome, there's a lot of magnesium and iron that's tied into those. So I mean, that's just a little short list of some of the common ones. But our healthcare system fails to really look at how can we correct these things within a nutrition and lifestyle space before reaching for medications. Because we know with heartburn, we can take Tums, but we never think about the fact of, okay, but now we're adding calcium to the picture too, and that calcium plays a role in inhibiting our iron absorption. Sometimes heartburn is too little acid, but sometimes it's too much acid. We have to figure that out too. Tums can make it worse.
I'm not saying it's our providers because I really think it's a systems issue when it comes to the fact that our healthcare providers do not have the time to sit down with you and have these conversations, to really look at all of your puzzle pieces and go, "Okay, I think this is what we need to start trying to do to see if we can then correct that." But then at the same time, in the beginning of your pregnancy, you don't see your provider for another four weeks. So great, I tried doing that, but it didn't work. So there's no one to help you then come in and go, oh okay, so that didn't work. Okay, phase two, plan B.
Our system is so set up for reactive care. Here's a quick medication to hopefully fix it, but no conversation on other things you can be trying to do ahead of time. I know that that’s really hard for women because there are a lot of women who are okay with taking medications, but they would like to have the option to discuss their nutrition and lifestyle things that they could try first before leaning on a medication.
Kyleigh Banks: Mh-hmm, yeah. I feel like most women are in a hard space because they want to have those conversations, but they're not sure who they can turn to. If they're going to their provider at their first appointment 8 weeks or 12 weeks, sometimes they get really excited to have these conversations, but like you said, when a provider can only spend 7 minutes with a woman, there's no time for those conversations. It's not until something bad happens and we need to react that the system allows for time to be made for those situations. It's hard.
Haley Miskowiec: Yeah, and it's crazy. I don't know about you, but honestly, when I've ever sat in a physician's office, you can tell when they're getting to the end of their time that they have with you, they're like, oh yeah, quick answer, quick answer. You're like, okay, you're giving me all the nonverbal cues that you need to get out. So just go, at that point.
In pregnancy, you have so many things going on, and a doctor also comes in with a different agenda. How is the health of your baby? How are you medically? How does everything look from that standpoint? I hear so often that women get dismissed for their symptoms. Even clients that I've worked with who have hyperemesis gravidarum, they're just dismissed as like, "Oh, this is just a normal part of pregnancy, you'll get through it."
We’re supposed to just put our heads down, look forward, and just soldier through it when there are so many things we can be doing to allow that female to have a feel-good pregnancy. I could go on for days in the preconception space of how you don't really get the time to even look at everything going on to make sure you're setting yourself up in the most optimal way for your pregnancy either. I was told like, "Oh, you're almost ready. Well good, you are healthy." I'm like, "You don't even know. You assume I'm healthy."
Kyleigh Banks: You didn't even ask.
Haley Miskowiec: Yeah. And so we'll just take your birth control out. We'll take it out. Just have a cycle, then start trying. And I'm like, there's got to be way more to this picture. That sounds way too easy. It's like that saying, if it sounds too easy, it probably is too easy. Or if it sounds too good, it probably is too good. That was how I felt after that appointment. I was like, now I'm supposed to take a prenatal 3-6 months beforehand. I know that space. How am I correcting any deficiencies, hormonal birth control depletes things. I've been on birth control for 14 years prior to pregnancy. I don't even know what my cycle looks like. And there was no conversation.
Kyleigh Banks: Oh, you're healthy. Just try, yeah.
Haley Miskowiec: Just take it out and start trying. And then you wonder why people are heartbroken when at the same time, that's another systems issue of, just have sex and you're going to get pregnant, but no conversation on there's five days a month where you can actually get pregnant out of 31 of them. You're like, "I thought I could get pregnant on all of them." That's how I was told since I was 14. So yeah, there's no strategery here. I don't think that's what I want to do.
Kyleigh Banks: Something's missing.
Haley Miskowiec: Exactly. But again, I mean, that's where I feel like if I wouldn't be working in the space I am, I would've been like, "Okay, sounds good," versus questioning. I feel like there are multiple spots where we really could be taking more time with women to really have that conversation. It stinks that our healthcare system has gotten on a reactive side versus a proactive side.
Kyleigh Banks: Yeah, it's like they've put it on the moms to reach out for that kind of care and reach out for that kind of support and put a couple of hurdles in the way. So when they do reach out for that kind of support, it's hard to get. But yeah, in a perfect world, our care providers, our healthcare providers, would be on top of these kinds of things and help us proactively rather than reactively.
Haley Miskowiec: It's one of those things that if preconception only, we're decreasing the fact of them having common complications during pregnancy. We're decreasing the chances of high blood pressure, we're decreasing the chances of gestational diabetes, we're doing those things, versus now all of a sudden they're flagged at 24 weeks because they have gestational diabetes, but we didn't do anything prior to help them not get that diagnosis. And there are so many things that are developed before you even get a positive pregnancy test, the neural tubes are almost closed. A lot of organs have already formed, all these things. Yet once a woman miscarries, we as women now feel like it was like we did something wrong, but we were never told what do we need to be doing for our body to feel safe enough to prioritize our reproductive system. There's no conversation in that space, but it's all on us. And then we're the ones who are traumatized.
Kyleigh Banks: You have to figure it out on your own, yeah.
Haley Miskowiec: Yeah.
Kyleigh Banks: It's your fault, figure it out.
Haley Miskowiec: Yeah, and then we're later on going, “You have this diagnosis,” instead of even trying prevention... Both of those complications uncontrolled can cause a downward spiral effect. And we could have really prevented that by really taking the time with the female, looking at her lab work, talking to her about prenatals, talking to her about diet changes and what she could be adding, lifestyle, and all that stuff. Even stress management. There are a lot of things that play into it that we really could be focusing on ahead of time just to prevent those things coming down.
Kyleigh Banks: Yeah. I kind of see this as an amazing point for birthworkers and childbirth educators and doulas, who a lot of times are the first person a pregnant mom is reaching out to, to just have the conversation like, "Hey, you don't have to just sit back and wait for something bad to come up before you start changing your lifestyle. There are things that you can do now to set yourself up for a healthy pregnancy and a healthy motherhood journey even. So what an important conversation to have. As birthworkers, as a doula myself, what should I be informing that mom of? Should I be referring her out to go see a dietician for maybe just a consult to get more specialized care?
Haley Miskowiec: I never think that it's a bad idea to do that, because then that dietician gets the opportunity to really talk with that woman about where they are, what their situation looks like, what are their goals, and then what that looks like for them, and how can that dietician support them in that space? And that way, at least as a female, I walk away from that conversation really knowing also too, when do I need to turn? A lot of times, even with clients that I work with, during our pregnancy period though, I'll talk to them about postpartum, but at the same time, we don't always know what we need when we're not there yet. So sometimes that conversation looks like, "These are the things that can come up during your postpartum journey. These are the things that I, as a dietician can really help you navigate and support you in. So that way, you don't have to do that alone."
Sometimes even that dietician, getting that opportunity to say, hey, if your nausea does really kick up, or if you start having symptoms, or you're having a hard time figuring out how to meet the needs of your pregnancy, sometimes some women just really need to know what do I need to add? What supplements are going to be beneficial for me? I mean, there's this huge misconception that every prenatal is made the same. Just taking a prenatal means that... there you go, you're on it. But there are some prenatals that have bogus ingredients, for a lack of a better word, and really low amounts of things too that for someone who may not be at a spot during their pregnancy where they're able to eat well, that might not actually be helping enough.
Sometimes really poorly put-together prenatal vitamins can actually be something that's also triggering symptoms. There are prenatals that women will not be able to take because it triggers their nausea and stuff like that. So really just having that initial conversation so she also still feels confident in that space, and can ask questions too. We still always have lots of questions where Google's a horrible spot to go to. Sometimes even in that initial conversation with a dietician, you can have that conversation on, "I'm feeling really anxious about eating this," or, "I'm feeling anxious about eating that, drinking this. Are these things, okay?" Because the second we get that positive pregnancy test, we sit there going, "Ooh, can I drink this? Ooh, can I eat that?" We start questioning everything that's going towards our mouth, and then it's good to also just get that peace of mind around things and really understand what's going on.
Kyleigh Banks: Mh-hmm, I love that. What do your programs look like? Do you do consults? Do you have programs?
Haley Miskowiec: Yeah, so I do consult. I will say that a lot of times, depending on where you are in your journey, we can chit-chat about what looks best for you. But at the end of the day, I have my Nourish Baby and Me Foundations program, which is for anyone who is in that trying to conceive space, through postpartum. It's never too early or too late to really start working on your nutrition or lifestyle to really have that healthy pregnancy and give baby that healthiest start to life. So I have that program. It's got three different parts to it. I've got a curriculum part of it, coaching with me, which is very individualized to fit your needs based on where you are, what you're looking for, what your goals are, and then community, other women who are being given the same information, are going through the same things you are. So that way it's not just me you're getting support from, but also a tribe of women who are there to also help guide you as well.
That is really the basics of really my Nourish Baby and Me Foundations program. I made it so that you're not searching Google for hours. You have a straightforward answer, you have resources at your fingertips. You have me to go through this roller coaster and teach you how to adapt through everything, just so that way you know at the end of the day, when that baby is here, that you did everything that you possibly could that is in your control to give that baby its healthiest start to life. I am going to be your biggest cheerleader to remind you that you are the chosen mom for your child, and there are no days that you aren't a good mom, because every day you're a good mom, because we fill ourselves with so many expectations that our children just don't even have on us.
I think we always need to be reminded of that. We are always enough and we are always doing the best we can, and we can only do the best we can with the knowledge we have at that time. As we learn, we can just do better. So yeah, that's really what my program looks like.
Kyleigh Banks: I love it. And I love that women are going to have a chance to have more than a 7-minute conversation with someone who knows what they're talking about, someone who really cares and really can spend that time, whether it's in the community or just through the curriculum.
Haley Miskowiec: Yeah. And I love navigating those spaces with women too. There are so many decisions we have to make in pregnancy that we don't really know what we feel deep down about what's the best decision for us. I love navigating that space with women so that way they just really feel that they're confident. I tell people all the time, you can just tell your healthcare team like, "Ooh, I just need to talk to my dietician about that, and then I'll come back with an answer". So that way you can have that safe space for us to just chit-chat and talk it out, and then you can come up with what your answer is.
Because sometimes when you sit in that doctor's office, it's intimidating. I felt intimidated during mine, and I was just like, "Ugh, yes?" I mean, I don't know about you, but when they throw, "So should we do genetic testing? Do you want to do genetic testing?" And I'm like, someone tell me the pros and cons of doing all these things.
Kyleigh Banks: Yeah, right? I need more time.
Haley Miskowiec: Yeah. I always say you can tell them that it's my fault that you need more time, and then me and you can chit-chat and have a good conversation so you can go into your next appointment just really feeling confident with your answer and knowing that that is the best choice for you and your pregnancy. So I love navigating that, just because there are so many options sometimes, and so many different things that you're hearing from other people while you're pregnant on what is the right choice.
There's not one right choice. There's not even one right choice in parenting, right? The right choice is the choice that feels good to you, works for your family and works for you. That's the right choice. There are a million ways to do things, but the right one is what works and feels good to you. And that is what I hope that women just take away from our time together, is just that they have that power, they have that control and that this is their journey, and so they are in control of that space.
Kyleigh Banks: It's so much bigger than healthy eating. It is so much bigger than that.
thank you for listening
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Meet your host, Kyleigh Banks, a side-gig doula turned CEO of a multi-six-figure birth-focused business. Her passion? Teaching birth nerds, like you, how to build an incredibly successful doula business that allows you to quit your day job, stay home with your kids, and most importantly, make a lasting impact on the world.