Breastfeeding - Health And Other Factors
Breastfeeding is often a positive and rewarding experience for mothers, though it may also be challenging or difficult, particularly at first. A breastfeeding mother must continue to take care of her baby and herself, as she did during her pregnancy.
In general, lactating women should get nutrients from a well-balanced, varied diet, rather than from vitamin and mineral supplements. Eat generous amounts of fruits and vegetables, whole grain breads and cereals, calcium-rich dairy products, and protein-rich foods (meats, fish, and legumes). Make sure you are getting enough calories.
Breastfeeding Daily Food Guide
- Milk, Yogurt and Cheese - Eat at least 4 servings
- Meat, Poultry, Fish, Dry Beans, Eggs and Nuts - Eat at least 3 servings
- Vegetables - Eat at least 3 to 5 servings
- Fruits - Eat 2 to 4 servings; Choose two foods high in Vitamin C and Folic Acid, and one food high in Vitamin A
- Bread, Cereal, Rice and Pasta - Eat about 6 to 11 servings
- Fats, Oils, and Sweets - Go easy!
This is just a general guideline, and you may need to eat more than this based on your size and activity level.
Nursing mothers need enough fluids to stay hydrated -- most experts recommend drinking enough fluids to satisfy thirst. Eight 8-ounce servings (64 ounces) of fluid such as water, milk, juice, or soup is a good goal, but be careful not to drink too much juice as this tends to be a sugar-rich but nutrient-poor source of fluid.
Breastfeeding mothers can safely eat any foods they like. Some foods may flavor the breast milk, but babies rarely react to this. If your baby is fussy after you eat a certain food, try avoiding that food for a while, then try it again later to see if it is a problem.
Don't limit your diet excessively. Make sure you are getting enough nutrition for yourself and your baby. If you become overly concerned about foods or spices causing problems, try to remember that entire countries and cultures have diets that contain foods that are extremely spicy. In these cultures, the mothers nurse their infants without problems.
It is possible that some highly allergenic foods (strawberries, peanuts) may be passed into breast milk, increasing the risk of a later food allergy in the baby. If there is a strong history of food allergies in your family, discuss this with your pediatrician.
Caffeine, Alcohol, and Smoking
A nursing mother can safely consume moderate amounts of caffeine (equal to 1 to 2 cups of coffee per day) without causing harm to her baby. But any more caffeine than that may cause agitation and difficulty sleeping for your baby.
Since alcohol has been found in human milk and can interfere with the milk ejection reflex, it’s better not to drink alcohol and nurse your baby at the same time. It takes about 3 hours to clear the alcohol from a single drink (1 oz of liquor, 12 oz of beer or 5 oz of wine) from your system. A couple of glasses of wine per week is generally acceptable, but try to time your drinking to immediately follow a feeding. This way most of the alcohol will be out of your system before you need to feed again.
If you are a smoker, this is a great time to quit for yourself and for your baby. Nicotine and other chemicals from cigarettes are found in breast milk. If you are unable to quit, try to limit the number of cigarettes as much as possible, change to a brand with low nicotine, and visit your doctor regularly. If you can’t quit, it’s worth knowing that one large study suggests moms who smoke and breastfeed have healthier babies than moms who pump and bottle feed. Of course, you should also be careful to avoid smoking around your baby to prevent lung injury from second-hand smoke.
Drugs In Human Milk
Many medications (prescription and over-the-counter medications) will pass into the mother's milk. Most of them are safe, but check with your pediatrician before taking any medications. Do NOT stop taking any prescribed medication without speaking first to your doctor.
The American Academy of Pediatrics' Committee on Drugs releases a periodic statement with a list of drugs and their compatibility with breastfeeding. Your obstetrician and pediatrician are both likely to be familiar with this publication and can answer your concerns about breastfeeding while taking medications.
Most breastfeeding women do not have normal menstrual periods in the first few months after their baby is born. This is called lactation amenorrhea. Although the risk of pregnancy is less for a woman who is breastfeeding and hasn’t yet gotten her period, pregnancy CAN occur during this time. Breastfeeding should not be used for contraception, since failure is likely.
Birth control choice should be discussed with your health care provider. Barrier methods (condom, diaphragm), progesterone contraceptives (oral or injectable), and IUDs have all been shown to be safe and effective. Combination progesterone/estrogen contraception is generally not started until the milk supply is established, usually at 4 weeks postpartum.
Estrogen-containing birth control methods are not recommended for breastfeeding women after delivery, because they may affect milk supply.
Women can get pregnant while they breastfeed, although some women will find that their menstrual periods don't return while they are nursing. This is due to hormonal changes, which suppress ovulation. However, it is impossible to predict when ovulation and menstruation will resume. In fact, some women ovulate and conceive again before their period resumes.
Working Outside The Home
Mothers face unique obstacles in maintaining adequate milk supply once they return to work. With planning, commitment, and skilled use of a breast pump, breastfeeding mothers can maintain their milk supply and continue breastfeeding after returning to work.
A maternity leave is helpful for establishing your milk supply and breastfeeding skills before returning to work. Start stock-piling milk a few weeks before you go back to work, and store it in the freezer. Most women find they aren’t able to pump as much as their baby needs in the first week back at work, and having extra milk in the freezer helps ease the transition.
Before your first day back, scout out places where you can pump at work. An ideal work place would provide a private room with a comfortable chair for breastfeeding moms. If you have your own office and can close the door, it’s often easiest to pump there – just close the door and let your colleagues know to knock before they come in. If you don’t have that kind of privacy, see if you can borrow a colleague’s office, or find an unused conference room or office. If all else fails, you can resort to a folding chair in a bathroom stall, but explore other options first.
For efficiency, your best bet is to get a double electric pump. These are more expensive, but they allow you to pump both breasts in 10 to 20 minutes, allowing you to get back to work – and, ultimately, home to your baby – much more quickly!
To simplify your life, buy several sets of pump parts and bring them to work in plastic bags. That way, you won’t have to wash and dry pump parts during the day.
Maintaining Your Milk Supply
Here are some tips which have worked well with many breastfeeding mothers who work an 8-hour day outside the home:
- If you plan to return to work, introduce your baby to bottle-feeding several weeks before you go back to work. This allows plenty of time to establish good feeding habits. Starting bottle-feeds before 2 weeks of age often results in nipple confusion -- the baby has difficulty changing between the different sucking patterns required for the different types of feeding.
- Two weeks before you return to work, buy or rent an efficient and comfortable breast pump and start building up a supply of frozen milk. If the day you return to work arrives and you don't have a freezer full of breast milk, one bottle of formula fed to your baby will be an adequate supplement. After returning to work, express milk 2 or 3 times a day, every 2 to 3 hours to continue exclusively breastfeeding. If you can only get one break a day and you are unable to pump a full day's allotment in one pumping, a supplemental bottle of formula may be needed. Be aware, however, that feeding formula decreases the need for breast milk, and your milk supply will decrease accordingly.
- If your baby is sleeping through the night, consider pumping before you go to bed at night. It’s a good time to watch your favorite TV show and stockpile some extra milk.
- Nurse your baby immediately before leaving in the morning and immediately upon return from work in late afternoon. Many mothers find that their babies nurse more frequently in the evenings on days they work. Feed on-demand when you are with your baby.
- If possible, arrange to nurse your baby at lunch time.
- Try to breastfeed exclusively when you are with your baby (evenings, nighttime, weekends).
- Delegate and share household responsibilities with other members of the family.
There are a number of breast pumps on the market, with varying degrees of comfort, efficiency, and cost. Most require time to develop the skills to use them. Pumps may be hand-operated (manual), battery, or electrically-operated.
The most dependable, efficient, and comfortable pumps are electric, have intermittent action (creates and releases suction automatically), pump both breasts at once, and require minimal training.
When you start using a pump, remember that this is not a “no pain, no gain” situation. If you’ve adjusted the pump setting so that you are in pain, you won’t get more milk – you will just get bruised nipples!
Your local lactation consultant can help you make realistic plans and guide you to a supportive breast pump supplier. A listing of lactation consultants is available at www.breastfeeding.com.
Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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