A 2003 photo of Reyana Abrahams-Ewing competing in a marathon a few months into her third pregnancy offers a telling snapshot of her life: She’s a mother, veteran of 16 marathons and a professional nurturer of pre-term babies.

As a registered dietitian at Kaiser Permanente hospitals in Oakland and Hayward, she assesses the nutritional needs of all patients, but her tiniest charges are found in the Neonatal Intensive Care Unit (NICU). Some of them weigh little more than a pound, their existence made all the more fragile because they literally do not know how to eat.

“While most full-term babies arrive with the reflex to find the breast and nourish themselves, preemies struggle to coordinate sucking and breathing,” said Abrahams-Ewing, who grew up poor in apartheid South Africa, where she recalls being one of many reared on a diet lacking in nutrition.

Babies are considered premature if they’re born three or more weeks before their due date. An infant that arrives at 26 weeks of a 38- to 40-week gestation is typically going to be in the NICU’s surrogate womb for a good portion of what would have been its third trimester. Similar to the warm and toasty world inside Mom, the infant is initially kept in a completely covered incubator until it’s about 32 weeks old, and then moved to an open crib, simulating the transition it would have made into the world as a full-term baby, said Abrahams-Ewing. The more premature it is, the more severe the health challenges may be. “More infants die from preterm-related problems than from any other single cause,” according to the Centers For Disease Control.

“From the very beginning, we have to make up for the fact that [babies are] not getting the fluids and nutrition they would get in utero,” said the dietitian, who knew at 11 years old that she wanted a career related to health.

On call at Kaiser where she works three to four days a week, she comes in at 7 a.m. to review charts, and then makes rounds with the rest of the medical team. She observes a baby’s weight trend, the circumference of its head, as well as the length of its body, to get a sense of how much it’s growing. She checks for any feeding intolerances, and analyzes urine and stool to determine if the baby is digesting enough calories and protein.

Using all the gathered information, Abrahams-Ewing continues to order nutrition formula for an IV bag until an infant can sustain its weight gain solely on tube-feedings of breast milk, which begin on the second day.

Meanwhile the dietitian keeps the mother in the loop, providing her with post-partum nutrition information, while encouraging her to pump breast milk every two to three hours. If she’s unable to, some may be supplied from an area breast milk bank.

“Breast milk is the baby’s first vaccination,” said Abrahams-Ewing. “It has so many properties, such as antibodies, vitamins, minerals, protein and fat, which help the baby survive outside of the uterus,” and breastfeeding ultimately “makes the baby a better eater,” she added, since the flavors of the foods the Mom eats come through her milk, expanding the infant’s palate.

Her Own Early Years

“Growing up we ate a lot of fried foods and pastries… The diet back home is mostly high fat and high sugar,” Abrahams-Ewing recalled of her childhood South Africa in the 70’s and 80’s. That unhealthy nutritional combination is not uncommon within many American communities. During her youth, her home country was segregated by race, and non-whites had fewer rights, were subjugated to harsh government rule, and enjoyed few of the spoils of their diamond-rich country.

It was at 11 years old that Abrahams-Ewing read a book that proved a game changer for her: Eat to Win: The Sports Nutrition Bible. It motivated her to pursue two life goals: study nutrition and play tennis.

Her mother had played league tennis, and Abrahams-Ewing took up a racquet at 4, had her first lesson at 9, and quickly ascended in the sport. Eat to Win made her a stronger competitor, and planted the seed in her mind that she could help everyone gain that edge in life.

Though she went on to become among the top-ranked junior in singles, doubles and mixed doubles, her prospects were severely stunted by South Africa’s racist laws. Undaunted, her father was determined to find her a ticket out. Though he had no connections to then-Atlanta Mayor Andrew Young and the late tennis great Arthur Ashe, he wrote them letters, imploring them to find his daughter a college tennis scholarship in the United States, so she could pursue her passions.

His letters spoke of all the titles she had won, and how dominant a player she’d become, including travels to the United Kingdom and the United States for tennis tournaments. Young and Ashe’s responses, however, didn’t seem particularly encouraging. They wrote back something like, “[We’re] very impressed with your daughter’s achievements. We wish her well!”

Behind the scenes, though, gears turned. Ultimately, her father heard from Chuck McCuen, then-tennis director at Georgia State University, who offered Abrahams-Ewing a full-ride athletic scholarship to the school. She played No. 1 singles for three years, and earned all-Conference and all-American honors for four years. In 1993, she graduated with a Bachelor’s of Science in nutrition, and continued to play in International Tennis Federation league tournaments. But by 25, her professional tennis career was done.

In the mid-90s, she relocated to Southern California and earned a graduate degree; her master’s thesis addressed the advantages of breastfeeding, and how to manage it amid life’s dizzying demands.

A Dietitian at Work and Home

Abrahams-Ewing is nearly as strict with her daughters’ nutrition as she is with the babies she tends to at Kaiser.

“It’s my job to procure, prepare and provide healthy food,” she said, sounding every ounce the registered dietitian. Her children help with shopping, so there’s buy-in. But she’s no short order cook. “If there’s salad for dinner, the girls don’t have to eat it, but that’s it. There are no alternate choices. It’s this or hunger,” she said.

She’s aware that a lot of children are snacking their way to obesity, which can lead to lifelong health problems. Abrahams-Ewing battled a weight challenge herself following the birth of her second child, when she had difficulty shedding 30 pounds. She took up running as a way to lose the weight. Now, even her daughters, Vera, Salma and Mina, and her husband, Vince, join in the fun.

“The marathons almost always have kids races, so they started running with us. It’s just part of our [family’s] lifestyle now,” said Abrahams-Ewing. The girls attend a private school where the emphasis is on tennis, as she and Vince believe that sports teach them the value of endurance and preparation.
The bar the Ewings set for their daughters parallels the goals the dietitian has for the preemies who come under her care in the NICU: To endure the challenging circumstances of their birth, so they can one day take on the world.