Let the beautiful, chaotic, wondrous journey of motherhood begin! Your nine months of pregnancy are finally over, and you just delivered a gorgeous baby. Now the real work of motherhood starts. If this is your first child, enjoy the fact that ignorance is bliss. If it is your second or third, or more, you know exactly how much work is involved in raising children, but you also know that the rewards far outweigh the hardships.
“Nine Months Later” is about you—yes, you. Being a new mom is not easy. We are here to help. If you want to eat healthfully while breastfeeding, read about the nutrients you need for optimal breast milk. If you need help salvaging your figure and getting back into your prepregnancy wardrobe, we can give you tips for weight loss. And, if you think you may have the “baby blues” or postpartum depression, please read on. You’re not alone.
Breastfeeding ain’t easy, but it’s worth it… if it works for you. And, there is no shame or self-punishment if it does not. Formula feeding is a healthy alternative. To keep the spotlight on breastfeeding, research shows that it offers many health benefits for infants and mothers, as such as protection against common childhood infections and disease risk, and healthy weight gain for baby. Breastfeeding duration of at least two months was associated with reducing the risk of sudden infant death syndrome (SIDS), and breastfeeding does not need to be exclusive to confer this protection.1 Research also shows that very early skin-to-skin contact and suckling may have physical and emotional benefits.2 Other studies suggest that breastfeeding may reduce the risk for certain allergic diseases,3 asthma,4 obesity,5 and type 2 diabetes.6 It also may help improve an infant’s cognitive development.7 However, more research is needed to confirm these findings. In short, by consuming the proper nutrients, a nursing mother can produce nutritionally balanced breast milk that greatly enhances her baby’s physical and mental development.
Every mom-and-baby breastfeeding pair is unique, and their challenges are unique, too. Certain situations, such as some of those below, may require the need for a lactation consultant and additional help along the way. In this section, we will focus only on the nutritional side of breastfeeding, not the physical mechanics or other issues.
• Mothers nursing multiples
• Mothers breastfeeding while pregnant (tandem nursing)
• Mothers with diabetes who nurse
• Obese or underweight nursing mothers
• Teenage nursing mothers
• Mothers nursing babies born with a cleft palate, premature babies, hospitalized babies, or any other babies with special needs
• Mothers with inverted nipples
• Mothers who have had breast surgery or have breast issues
Many moms ask whether breastfeeding will “really” help them lose weight after delivery. The short and easy answer is yes. While you’re pregnant, your body automatically layers on fatty tissue to give you ample fat stores to support breastfeeding your newborn. If you chose to breastfeed, this extra padding will gradually disappear as your body adjusts to its new role as a milk factory. The fact is that moms naturally burn calories to make breast milk each time they nurse. Most nursing mothers find that even while consuming additional calories to support breastfeeding, their weight drops gradually and naturally. Losing about 1 to 2 pounds per month is the norm. Key point: Do not diet while breastfeeding, unless otherwise advised by your doctor or care team.
Some new moms wonder how breastfeeding will affect their daily meals. Will they need more calories, carbohydrates, fat, and protein? If you’re eating a well-balanced diet with ample calories to satisfy your hunger, and you are getting enough liquid to stay well hydrated, especially after each nursing session, you probably don’t need any major changes to your diet. One of the wonders of breast milk is that it can usually meet your baby’s nutritional needs even when you’re not eating “perfectly.” But, just because your baby won’t be harmed by your occasional dietary lapses doesn’t mean that your body won’t suffer. The adage applied to pregnancy also goes for breastfeeding: Your body will feed your baby first. When your nutrient intake is inadequate, your body draws on its reserves, which can eventually become depleted.
How many calories do moms need is another common question. There’s no onesize-fits-all answer. In general, 2,000 to 2,500 calories per day are needed, and a minimal intake of no fewer than 1,800 calories per day. Your body is working around the clock to make breast milk for your baby, burning about 500 extra calories daily in the process. But this number may need to be adjusted based on milk volume, your rate of weight loss, extreme amounts of physical activity or exercise, and any special situations.
Instead of counting calories (unless your doctor has recommended you do so), we suggest that you follow your hunger as a guide to how much you need to eat. Many breastfeeding moms feel surges of hunger, whereas others may feel hungry all the time. Eating small meals with healthy snacks in between—the way you did during pregnancy—is a good way to keep your hunger in check and your energy level high. Here are some guidelines.
• Inform your OBGYN and your child’s pediatrician in advance of delivery that you will be breastfeeding. Explain any dietary restrictions or special needs you may have.
• Continue taking all of your prenatal vitamins and any supplements prescribed by your doctor as long as recommended, usually for 6 months. Do not self-prescribe vitamins or supplements (synthetic or herbal), because large doses may be toxic. And remember that vitamins and supplements do not replace real food.
• Do not take any medications, prescription or over-the-counter, without your doctor’s approval. Breastfeeding women should not use Retin-A or Accutane.
• Avoid all alcohol, but if you really need a drink, make sure to consume it after you’ve nursed, to allow a couple of hours for the alcohol to metabolize. The alcohol reaches your baby through your breast milk.
• Follow a well-balanced, varied diet that contains nutrient-dense foods. Your baby will taste the foods you consume, so if you eat healthfully, don’t be surprised if your baby develops a taste for peas, carrots, spinach, squash, and peaches.
• Consume about 500 extra calories per day (or about 200 calories above your pregnancy caloric intake) for the duration of breastfeeding.
• Eliminate or severely limit caffeine to no more than 1 to 2 cups of coffee or tea per day. The caffeine passes into your breast milk. If you need energy, consume protein, go for a walk, or take a few deep breaths of fresh air.
• Drink 8 fluid ounces of water each time you breastfeed, or at least 6 to 8 cups of water per day. This, along with increased fiber, will help avoid constipation.
• Vegetarians and vegans should be able to meet all of their nutritional needs adequately, although certain supplements will be needed. As a vegetarian, you need to eat foods that contain vitamin B12 (such as eggs or dairy), eat foods fortified with vitamin B12, and/or take supplements. If you are on a vegan or macrobiotic diet, or any other diet that does not include animal products, be sure to get enough B12, calcium, iron, protein, and other nutrients that may be lacking. You may need to get advice from a registered dietitian or your doctor.
• Follow the same EPA guidelines on fish safety as you did for pregnancy. Avoid high-mercury fish, such as shark, tilefish, and mackerel, and limit canned white tuna to 6 ounces per week. See here for more information.
• As your wallet and availability allow, choose organic products, free of pesticides, hormones, antibiotics, and chemicals as much as possible.
• Follow the same guidelines for sugar substitutes as during pregnancy. Basically, avoid saccharine. Safe choices include stevia, Splenda, and agave nectar. Natural sugar food sources, such as brown sugar, honey, pure maple syrup, and dried fruits, are always the best.
What are your daily nutritional requirements for breastfeeding?
As with pregnancy, the nutritional guidelines for breastfeeding may appear daunting on paper, but rest assured that certain nutrients in breast milk are fairly consistent, regardless of what a mother eats. A mother’s body channels her nutrients into her breast milk, even if it means depleting her own stores. Remember to eat lots of lean protein. Consume calcium with every meal and snack. Consume whole-grain complex carbs with fiber and nutrients. Eat healthy fats, such as olive oil and avocados. Eat iron-rich foods. Fuel up with potassium-rich foods. And, keep in mind the basic nutrition pairs for optimal absorption: vitamin C + iron and vitamin D + calcium. The following are some of the most important nutrients for breastfeeding and how they help your baby grow.
SOME IMPORTANT NUTRIENTS FOR BREASTFEEDING WOMEN AND THEIR BABIES8
NUTRIENT: Calcium
PREGNANCY RDI: 1,000 mg
LACTATING RDI (AGES 19 TO 50): 1,000 mg
BABY’S DEVELOPMENT: Bones, muscles, and nerve function
NUTRIENT: Choline
PREGNANCY RDI: 450 mg
LACTATING RDI (AGES 19 TO 50): 550 mg
BABY’S DEVELOPMENT: Brain development
NUTRIENT: Copper
PREGNANCY RDI: 1,000 mcg
LACTATING RDI (AGES 19 TO 50): 1,300 mcg
BABY’S DEVELOPMENT: Iron absorption
NUTRIENT: Iodine
PREGNANCY RDI: 220 mcg
LACTATING RDI (AGES 19 TO 50): 290 mcg
BABY’S DEVELOPMENT: Thyroid functioning and metabolism
NUTRIENT: Omega-3 DHA
PREGNANCY RDI: 300 mg
LACTATING RDI (AGES 19 TO 50): 300 mg
BABY’S DEVELOPMENT: Physical and cognitive development
NUTRIENT: Potassium
PREGNANCY RDI: 4,700 mg
LACTATING RDI (AGES 19 TO 50): 5,100 mg
BABY’S DEVELOPMENT: Kidney, cardiac, digestive, and muscular function
NUTRIENT: Protein
PREGNANCY RDI: 71 g
LACTATING RDI (AGES 19 TO 50): 60 g
BABY’S DEVELOPMENT: Building your baby’s body
NUTRIENT: Vitamin A
PREGNANCY RDI: 770 mcg
LACTATING RDI (AGES 19 TO 50): 1,300 mcg
BABY’S DEVELOPMENT: Healthy vision, skin, cell development, and immunity
NUTRIENT: Vitamin B12
PREGNANCY RDI: 2.6 mcg
LACTATING RDI (AGES 19 TO 50): 2.8 mcg
BABY’S DEVELOPMENT: Red blood cells, nerve function, and metabolism
NUTRIENT: Vitamin B6
PREGNANCY RDI: 1.9 mg
LACTATING RDI (AGES 19 TO 50): 2.0 mg
BABY’S DEVELOPMENT: Cell formation, nervous and immune system function
NUTRIENT: Vitamin D
PREGNANCY RDI: 500 IU
LACTATING RDI (AGES 19 TO 50): 200 IU
BABY’S DEVELOPMENT: Bones
NUTRIENT: Vitamin E
PREGNANCY RDI: 15 mg
LACTATING RDI (AGES 19 TO 50): 19 mg
BABY’S DEVELOPMENT: Protects cells from damage and boosts immunity
NUTRIENT: Zinc
PREGNANCY RDI: 11 mg
LACTATING RDI (AGES 19 TO 50): 12 mg
BABY’S DEVELOPMENT: Organ development, muscles, eyes, skin, and genetic expression
What are the nutritional requirements for breastfeeding multiples?
Nursing multiples is definitely a challenge, so don’t be afraid to ask for help at any point along your journey. Your pediatrician, lactation consultant, doula, or care team who have experience with multiples can offer support. The calorie math is simple for breastfeeding twins: If one baby = about 500 calories above your prepregnancy needs, two babies = about 1,000 additional calories. You may need to increase your calorie intake as your babies grow and get hungrier. Or decrease them if you supplement your nursing with formula, and later, solids. Talk to your doctor and pediatrician about any extra supplements you and your baby may need.
Are there ways to improve my milk flow?
When you’re in the early days of caring for a breastfed baby, nothing can be more stressful than worrying whether you’re producing enough breast milk. It can seem like every cry, hiccup, burp, or whimper from your baby is a signal he or she isn’t getting enough milk. Here is some basic advice that will hopefully put your mind at ease and improve your milk flow.
Supply and demand: Your milk output is primarily based on supply and demand. Milk production is based on how many times each day your milk is drained from your breasts. The more you breastfeed or express (pump) your milk, the more milk you will make. While eating well is excellent for you (it boosts your energy and resistance to illness among other things), a “perfect” diet is not necessary to produce high quality breastmilk.
Sleep and rest: A good night’s sleep or a great nap can do wonders for your milk supply. When you’re burning the candle at both ends (yes, you, Supermom!), your body gets worn down. Being as rested as possible can help your body boost milk production. Stay hydrated: Research has not yet found a link between the fluids a mother drinks and her milk production. The simple guideline is drink according to thirst. To make life easy, keep a container of water where you usually breastfeed. A signal that you may need to drink more fluids is if your urine is dark yellow instead of a light, straw color.
Why is vitamin D so important for my baby?
In 2000 and 2001, studies on rickets (a softening of the bones in children caused by a lack of vitamin D) among breastfed infants in North Carolina, Texas, Georgia, and the mid-Atlantic region of the United States prompted researchers to take a closer look at whether all breastfed infants were getting adequate amounts of vitamin D. Based on their findings and other data, in 2003, the American Academy of Pediatrics recommended a daily supplement of 200 IU (5 mcg) of vitamin D for all breastfed infants and all nonbreastfed babies whose daily intake of vitamin D-fortified formula or milk is less than 500 ml. If you have any concerns, consult your child’s pediatrician.9
Does my baby’s fussiness mean that I’m consuming the wrong foods?
A fussy baby is likely not related to something you’ve eaten; almost all babies have fussy periods. Signs of your baby’s intolerance or an allergy to a certain food can include fussiness, dry skin or eczema, congestion, bloody stool, diarrhea, vomiting, rash, and wheezing. If you think your baby has an allergy, or if you have a family history of allergies, consult your baby’s pediatrician.
In general, there are no specific foods that every breastfeeding mother must avoid. Some common culprits that may cause gassiness in your baby include garlic, onions, cabbage, broccoli, cauliflower, beans, and spicy or acidic foods. It takes between two and six hours for certain foods to affect the taste and composition of your breastmilk, so if you suspect a food is affecting your baby, chart it but keep in mind this time lag. Avoid that food for a few days or weeks, then try it again and record your baby’s response. You’ll find your baby’s nursing groove—we promise!
What are some challenges obese women face?
Severely overweight and obese mothers often experience increased challenges when it comes to breastfeeding. In fact, studies indicate that they are more likely to experience difficulty with the mechanics of nursing, which may be one reason they are less likely to start breastfeeding in the first place, or more inclined to breastfeed for a short duration. Studies show that obese mothers also tend to take longer to produce sufficient milk, possibly because of a lower prolactin (a milk-producing hormone) response to suckling. If you are overweight and are experiencing any difficulties, please (please!) don’t give up before seeking support.