The following is reprinted from What Every Pregnant Woman Should Know, a book on the Brewer Diet, by Gail Sforza Brewer [Krebs] and Tom Brewer, MD, first published in 1977. This excerpt is found in the chapter titled "The Afflicted Child: Preventing Low Birth Weight".

Abruption of the Placenta (p. 94)

Abruption of the placenta (its premature separation from the wall of the uterus before the baby is born) is one of the most lethal complications in obstetrics. Traumatic abruption is the unfortunate result of an accident in which the mother suffers puncture wounds to the abdomen. This freak occurrence could happen to anyone, well nourished or not. Typically, however, abruption is a severe manifestation of malnutrition. Seen most frequently among the poor, medical literature reports case after case of recurrent abruptions in the same mother. Abruption often accompanies underlying metabolic disease, such as MTLP.

Any degree of abruption is an immediate hazard to the baby's survival. Once the placenta has separated, no oxygen can be transferred to the baby. Toxic wastes soon build up in the baby's tissues. The brain can only survive eight minutes of oxygen deprivation without irreversible damage. Roughly 50 percent of babies die before mothers with this complication can reach the hospital. Immediate delivery is the only treatment. An attempt is made to save the baby if possible, at the same time attention is being given to minimize the internal blood loss and resulting shock which can kill the mother, too.

Nontraumatic abruptions do not occur in well-nourished women. Good nutrition early in pregnancy fosters secure implantation of the placenta on the uterine wall. Continued good nutrition assures that the placenta will grow to meet the demands of the developing baby.

What Every Pregnant Woman Should Know available here

Salt in Pregnancy

	High Salt Diet	Low-Salt Diet
Toxemia	37/1000	97/1000
Perinatal deaths	27/1000	50/1000
C-section	9/1000	14/1000
Abruptio placenta	17/1000	32/1000

The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy (first published in 1983), excerpted from the chapter titled "The Brewer Medical Diet for Pregnancy: The Basic Plan".

Each time you become pregnant, you must grow and nourish a new placenta. Therefore, each pregnancy presents a unique nutritional challenge. By following the program outlined in this book in cooperation with your doctor or midwife, you will be able to meet your nutritional challenge and avoid the serious problems that result from failure of your blood volume to expand normally--placental malfunction, premature separation of the placenta from the wall of the uterus (placental abruption), metabolic toxemia of late pregnancy, and premature labor.

The Brewer Medical Diet for Normal and High-Risk Pregnancy available here

The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy (first published in 1983), excerpted from the chapter titled "High Risk Pregnancies".

A placenta abrupts when it separates prematurely from the site where it implanted on the uterine wall. Abruption commonly occurs in women suffering from metabolic toxemia of late pregnancy (MTLP), which is discussed later in this chapter. Both diseases are caused by underlying poor nutrition--maternal diets during pregnancy that fail to meet the nutritional needs of the individual in question. Protein, vitamin C, and folic acid deficiencies have been identified in some women with abruptions of the placenta. However, as we have already noted in connection with several other pregnancy problems, the chances that anyone will have a single nutrient deficiency are virtually impossible outside of a laboratory setting. Consequently, the best protection against an abruption is not the simple addition of protein or vitamin C or folic acid on a selective supplementation basis, but rather the provision of all the nutrients needed to support normal pregnancy development. That simply translates into eating an adequate diet every day throughout the pregnancy.

The placenta can abrupt during pregnancy or during labor. The placenta is anchored to the wall of the uterus by strands of connective tissue that run from the surface of the placenta deep into the surface of the uterus. These strands are like guy wires that hold a circus tent in place: They need to have enormous tensile strength to hold up under stress and strain. In the case of the circus tent, the stress might be a gale-force wind. During pregnancy, the connective tissue strands must respond to the gradual, but thirty-fold, growth of the uterus itself and, of course, during labor, they must hold fast during the hours of powerful contractions necessary to accomplish the birth of your baby. When the strands cannot withstand these stresses, the placenta shears off from its moorings, and internal bleeding results. The baby loses its sources of oxygen and food. Abruption is one of the most dangerous complications in obstetrics and a major cause of stillbirth.

The connective tissue strands holding your placenta secure are composed of collagen, a protein substance that is strongest when you are well nourished. If your diet does not keep up with the demands of your pregnancy, defective collagen synthesis leads to weaker connective tissues and the threat of abruption.

We have counseled numerous women who have experienced two or more abruptions and lost their babies. When they corrected their diets, they were able to carry their subsequent pregnancies to term with no abruptions. Good nutrition made the critical difference.

The Brewer Medical Diet for Normal and High-Risk Pregnancy available here

Placenta (p. 50)

As Figure 8 shows, it is also the action of your uterus that separates your placenta and expels it in the third stage of labor. This organ allows nutrients and oxygen to pass from your bloodstream into your baby's and also permits the removal of waste products from the baby's body. The placenta originated in cells from the fertilized egg. Enzymes on the surface of the ovum dissolved away a tiny portion of the surface of your uterine wall, opening a few arteries and veins in the process. With each beat of your heart, from that moment until your placenta comes away from the wall of your uterus, those arteries spurt jets of nutrient- and oxygen-rich blood against the surface of the placenta. This is the only blood supply to this most important organ, and only what is present in your bloodstream can nourish it and your developing baby.

The placenta is firmly anchored to the wall of your uterus by threads of collagen throughout and by a seal around its margin. Because of this, the blood that swirls up against the placenta stays in a "lake," continuously bathing the placental tissue. This blood does return to your heart after spending some time in the "lake," via the open veins that now function like the drain in you tub or shower stall: the pooled blood is pushed into the veins by the force of new blood coming into the "lake" from the open arteries. Technically, this sort of blood supply is termed an a-v (arterio-venous) shunt, meaning that the blood passes directly from arteries to veins without first passing through capillaries (the usual way things are done in the body).

Since the supply of blood encourages and supports placental growth, and a larger placenta requires more blood to keep it functioning optimally, ever-increasing amounts of blood are required as pregnancy advances to satisfy the needs of the placenta. If you are carrying a single baby, your blood volume will expand approximately 60 percent (if you eat well enough) to service your placenta. If you have twins (and therefore a double placenta or two separat placentas), your blood volume must expand by 100 percent or more to stay even with the demand. A falling blood volume or a blood volume that is below the needs of your pregnancy is recognized as a major cause of premature labor, underweight babies, and high blood pressure during pregnancy. When you recognize the importance of keeping your blood volume up and your placenta healthy (even though you can't see it or feel it), you will have a strong inducement to stay on your excellent pregnancy diet every day.

See here to better understand the evolution of the mainstream medical perspective on nutrition and salt in pregnancy

Nine Months, Nine Lessons available here

The following is reprinted from Metabolic Toxemia of Late Pregnancy, by Thomas H. Brewer, M.D., 1966 & 1982.

"Toxic Abruptio Placentae"--(p. 61)

Premature separation of a normally implanted placenta often occurs in our southern states among women in our lowest socioeconomic class associated with severe MTLP [metabolic toxemia of late pregnancy]. I will refer to this as "toxic abruptio placentae," for I consider it one of the severe manifestations of the underlying metabolic disease. I think it is directly analogous to the abruptions of the placenta which McKay has produced by feeding pregnant rats a low protein, high oxidized fat diet. Hibbard of Liverpool has recently reported evidence that abruptio placentae in his area associated with folic acid deficiency. He did not note a high correlation with MTLP, and this suggests that the woman who develops MTLP in our southern states associated with abruptio has multiple dietary deficiencies and/or the specific bacterial flora in her GI tract may be particularly biochemically malignant, that is, certain strains of bacteria may produce more potentially toxic compounds than others and thereby make greater demands on the liver and damage it more easily. There is strong evidence that good nutrition will prevent this toxic abruption of the placenta. Recently I talked with an obstetrician who has practiced here in the San Francisco Bay Area for over twenty years and has not had one of his private patients develop this sometimes lethal complication. It is possible to see two or three such cases come in during a thirty-six-hour shift working in our big city-county hospital labor units in the South.

It is a clinical teaching passed from resident to resident in our southern hospitals that when you first encounter a patient with a toxic abruption, you are "already three units (1500 ml) of blood behind." These women undoubtedly have markedly contracted blood volumes before they have the abruption and begin to bleed, either externally or behind the placenta. This contracted blood volume plays a role in the pathenogenesis of the abruption. It has long been observed clinically that these women develop signs of blood-loss shock "out of proportion" to the amount of blood lost. These women occasionally develop anuria associated with renal cortical or tubular necrosis, and this must be caused by a prolonged period of inadequate renal blood flow. For these reasons it is necessary to be liberal in transfusing these women and to avoid procrastination in getting them delivered if their lives are to be saved. The use of intravenous human serum albumin to expand plasma volume and to improve renal plasma flow in these women needs to be investigated.

During four years of residency at Jackson Memorial Hospital, where I helped care for a number of severely ill women with toxic abruptio placentae, certain ideas occurred to me concerning the pathogenesis of this serious complication. What are the common biochemical and physiological conditions associated with MTLP which could lead to the premature separation of a normally implanted placenta? Elisabeth Ramsey and her co-workers have given us a clear, scientific picture of how the placental circulation works. Maternal blood enters the intervillous space by small uterine veins on the floor of the intervillous space. Thus, the placenta has been shown anatomically to be an arteriovenous shunt, a condition for which have had good evidence from clinical pysiological observations. Any conditions which will lead to clot formation in the intervillous space may be regarded as playing some role in the pathogenesis of abruption.

The following factors occur in severe MTLP and can play a role in promoting the formation of a clot behind the placenta:

1. Reduction in velocity of blood flowing through the intervillous space associated with arteriolar spasm (of uterine spiral arterioles);

2. Increased viscosity of maternal blood associated with hemoconcentration, hypoalbuminemia, and hypovolemia;

3. Increased fibrinogen concentration of maternal blood associated with hemoconcentration and probably hepatic injury; and

4. Widespread endothelial injury of unknown cause which can damage the fetal cotyledons and release thromboplastin to trigger the clotting mechanism.

Much clinical interest has been focused on hypofibrinogenemia in abruptio placentae, but it develops in a relatively small percentage of cases. I agree with Pritchard that this hypofibrinogenemia is related to loss of fibrin from the blood. In some women the liver is unable to synthesize fibrin fast enough to keep up with the loss. Hypofibrinogenemia has recently been reported in a variety of bleeding complications of pregnancy including placenta preavia, abortion, ruptured ectopic pregnancy and postpartum hemorrhage. Further research will elucidate this question.

It is of much practical clinical importance for the obstetrician to view toxic abuptio placentae as one of the manifestations of an underlying metabolic disease, for then it will emphasize in his mind the vital importance of a careful differential diagnosis of third trimester hemorrhage. The basic differences between the mechanical separation of the marginal sinus, as the cervix begins to efface and dilate and a toxic abruption associated with profound physiological and biochemical abnormalities will indicate the greatly increased hazards to both mother and infant in the latter case. It will be understood why it is a definite mistake to classify bleeding from a ruptured marginal sinus, which is a mechanical problem, as a "first degree abruption." This indicates that it might progress into a "second degree" or "third degree" abruption. Likewise, any degree of abruption associated with MTLP will be seen clearly as an immediate hazard to fetal survival, for the placenta may abrupt totally at any time when conditions develop as outlined above. Among our impoverished and malnourished women in the southern states with severe toxic abruptio placentae, approximately 50 per cent have already had intrauterine fetal deaths before they reach the labor unit. An alert resident staff is often responsible for saving the life of an infant when fetal haert tones are not heard on admission, immediate delivery is likewise indicated to minimize maternal blood loss, shock and damage to the maternal kidneys which can lead to death.

Metabolic Toxemia of Late Pregnancy available here

Note from Joy: While the use of amphetamines and diuretics may no longer be considered the mainstream treatment of choice for the symptoms of toxemia, other methods of weight control in pregnancy and treatments for toxemia are currently in vogue which are equally hazardous to both the baby and the mother. And unfortunately, the hazards of these current treatments are no more recognized by the mainstream practitioners of today than were the hazards of the earlier use of amphetamines and diuretics by the practitioners of yesterday. I have been witness to some of the current hazardous treatments, just within the past 5-10 years.

I worked for a homebirth midwifery practice for several years. For most of that time, all the midwives were supportive of the use of the Brewer Diet by the clients of the practice. The last year of my time there, we got a new midwife on staff who was very opposed to the use of the Brewer Diet. Whenever we got a new client who was the least little bit on the plump side, she would apparently tell her to get a little more exercise and eat a little less carbohydrates. When her blood pressure would start to creep up, she would tell her to cut back on her salt a little bit. No amount of my trying to explain the Brewer insights to her made any headway. As a result, within the first six months of her being on staff, we had 2-3 clients who had to be hospitalized with blood pressure problems and premature labor, as I recall, which was very uncharacteristic of our practice.

So it is very important that we not dismiss the historical accounts that Brewer has documented for us. We need not look down our noses at his reports of the starvation-amphetamine-diuretic practices of the physicians around him in his early days, and his efforts to stop those practices. We have our own faulty treatments in our own time, which are based on the same faulty thinking, and are just as hazardous as the treatments that he witnessed.

In addition, unfortunately, some areas of the "alternative medicine" community have apparently followed mainstream medicine in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties. Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant women to watch which herbs they are taking.

See here for more information on the hazards of using herbal diuretics during pregnancy

Perinatal Support Services: pregnancydiet@mindspring.com