Nutrition and Lactation
The postpartum period begins after the
delivery of the baby and ends when the mother's body has returned as
closely as possible to its pre-pregnant state. This period usually lasts
six to eight weeks.
The postpartum period involves the mother progressing through many
changes, both emotionally and physically, while learning how to deal
with all the changes and adjustments required with becoming a new
mother. The postpartum period also involves the parents learning how to
care for their newborn and learning how to function as a changed family
A mother needs to take good care of herself to rebuild her strength.
You will need plenty of rest, good nutrition, and help during the first
Every new parent soon learns that babies have different time clocks
than adults. A typical newborn awakens about every three hours and needs
to be fed, changed, and comforted. Especially if this is their first
baby, parents - especially the mother - can become overwhelmed by
exhaustion. While a solid eight hours of sleep for you may not happen
again for several months, the following suggestions may be helpful in
finding ways to get more rest now.
- In the first few weeks, a mother needs to be relieved of all
responsibilities other than feeding the baby and taking care of
- Sleep when the baby sleeps. This may be only a few minutes rest
several times a day, but these minutes can add up.
- Save steps and time. Have your baby's bed near yours for feedings
- Many new parents enjoy visits from friends and family, but new
mothers should not feel obligated to entertain. Feel free to excuse
yourself for a nap or to feed your baby.
- Get outside for a few minutes each day. You can begin walking and
postpartum exercises, as advised by your physician.
- After the first two to three weeks, introduce a bottle to
breastfed babies for an occasional night-time feeding. This way,
someone else can feed the baby, and you can have a longer period of
A mother's body has undergone many changes during pregnancy, as well
as with the birth of her baby. She needs to heal and recover from
pregnancy and childbirth. In addition to rest, all mothers need to
maintain a healthy diet to promote healing and recovery.
The weight gained in pregnancy helps build stores for your recovery and
for breastfeeding. After delivery, all mothers need continued nutrition
so that they can be healthy and active and able to care for their baby.
Whether they breastfeed or formula feed, all mothers need to eat a
healthy and balanced diet with vitamins and minerals. Most lactation
experts recommend that breastfeeding mothers should eat when they are
hungry. But many mothers may be so tired or busy that food gets
forgotten. So, it is essential to plan simple and healthy meals that
include choices from all of the recommended groups from the food
Although most mothers want to lose their pregnancy weight, extreme
dieting and rapid weight loss can be hazardous to your health and to
your baby's if you are breastfeeding. It can take several months for a
mother to lose the weight she gained during pregnancy. This can be
accomplished by cutting out high-fat snacks and concentrating on a diet
with plenty of fresh vegetables and fruits, balanced with proteins and
carbohydrates. Exercise also helps burn calories and tone muscles and
Along with balanced meals, breastfeeding mothers should increase fluids.
Many mothers find they become very thirsty while the baby is nursing.
Water, milk, and fruit juices are excellent choices. It is helpful to
keep a pitcher of water and even some healthy snacks beside your bed or
Lactation is a physiological process. Human breastmilk
is nature's perfect recipe for your babies growth and development. This
special blend of nutrients nourishes your baby and provides a unique
balance of fats, vitamins, minerals, sugars and proteins. Breastmilk
empowers your baby with disease fighting immunoglobulins to help protect
baby during those early vulnerable first weeks of life.
Breast-fed babies have fewer illnesses because human milk transfers
to the infant a mother's antibodies to disease. About 80 percent of the
cells in breast milk are macrophages, cells that kill bacteria, fungi
and viruses. Breast-fed babies are protected, in varying degrees, from a
number of illnesses, including pneumonia, botulism, bronchitis,
staphylococcal infections, influenza, ear infections, and German
measles. Furthermore, mothers produce antibodies to whatever disease is
present in their environment, making their milk custom-designed to fight
the diseases their babies are exposed to as well.
A breast-fed baby's digestive tract contains large amounts of
Lactobacillus bifidus, beneficial bacteria that prevent the growth of
harmful organisms. Human milk straight from the breast is always
sterile, never contaminated by polluted water or dirty bottles, which
can also lead to diarrhea in the infant.
Human milk contains at least 100 ingredients not found in formula. No
babies are allergic to their mother's milk, although they may have a
reaction to something the mother eats. If she eliminates it from her
diet, the problem resolves itself.
To maximize the benefit of your breastmilk a nursing
mother must practice good nutrition. Breastfeeding is a learned behavior
that needs a supportive environment. Nutrient needs of the mother during
breastfeeding include increased need for energy, vitamins and minerals,
and water. Iron supplements may be necessary. Exercise is important.
well during pregnancy and lactation requires a few adjustments to
general good health dietary guidelines. A woman's need for calories,
protein, vitamins, minerals and water all increase. Each woman will
require different amounts of foods providing key nutrients to achieve
the desired pregnancy weight gain and pregnancy support. Age, weight,
activity level, and metabolism all influence how much you will need to
eat for optimum weight gain, health, and fetal development or breastmilk
If you eat too little while breastfeeding,
you may not produce as much milk. When breastfeeding a single baby 300-500
calories per day should be added to the diet. When feeding
twins an extra 600-1000 calories per day should be
added to your diet. Total caloric intake when lactating is 2300-2500
calories for singleton and 2600-3000 calories for twins
Obviously calcium for milk production comes from the mother. When
calcium levels in mom's blood are not adequate for her needs and those
of her child, calcium deposited in her bones is withdrawn for milk
In fact, if something is lacking in mom's current diet, mom's body
will dip into her reserves of nutrients to keep breast milk
nutrient-dense. However, you are going to need your body to be healthy
for a long time to take care of your growing child, so don't short
Be assured that the composition of nutrients in human milk is
consistent. A nutrition shortage for mom is more like to reduce the
quantity of milk than the quality of the milk for baby.
- Vitamin D-If mother/infant not exposed to sunlight or diet low
- Vitamin D, breastfed infants need to be supplemented 5-7.5
- Vitamin B12-If mother is a vegan, infant will be B12
deficient, even if mother shows no sign of deficiency.
- Vitamin K-Very low risk for developing hemorrhagic disease, but
all infants are given 0.5-1mg injection of 1-2mg oral Vitamin K.
- Usually adequate for 6 months, unless infant is supplemented
with food too quickly.
- Solid food may decrease iron absorption and the diet may need to
Vitamin levels in breast milk can be affected by maternal intake as
well as length of lactation . Vitamin A decreases as lactation
progresses from 2,000mg/L to as low as 300mg/L. Low doses of exogenous
Vitamin A (<15mg/day) seem to have little effect, but larger doses
(>15mg/L) will increase vitamin A concentration in breast milk.
Unless maternal intake is marginal to poor, the amount supplied is
adequate and supplementation is not necessary.
Breast milk contains about 0.1-1.0mg/L of vitamin D and metabolites,
which roughly represents approximately 1.5 to 6 percent of maternal
plasma concentrations. Maternal intake does not seem to predict the milk
content, but low maternal vitamin D plasma levels may limit transfer
into breast milk. Mothers who have restricted intake of foods rich in
vitamin D, such as strict vegetarians, and those who are exposed to
limited sunlight may have critically low plasma levels. In this case,
the infant may need vitamin D supplements of 10mg/day.
Vitamin E is present in high concentrations in colostrum (8mg/L) and
decreased to 3 to 4mg/L in mature milk. Vitamin E concentration in
breast milk is responsive to maternal intake; supplementing the infant
is usually not necessary, provided the mother has adequate intake.
Vitamin C is usually found in adequate concentrations of about 100mg/L
of breast milk in well-nourished mothers. Intake less than 100mg/day may
decrease milk content, but doses over 100mg/day will not increase it.
Vitamin C content in breast milk is eight to ten times higher than
maternal plasma concentration.
The quantity of vitamin K in breast milk is approximately 0.8 to
1.0mg/L, and this can be increased to 60mg/L with maternal
supplementation of 5mg/day. Vitamin K supplementation for newborns may
be recommended for infants at risk for hemorrhagic disease. A single
intramuscular (IM) dose of 1 to 5mg IM can be given to the mother 12 to
24 hours before delivery, 0.5 to 1mg can be given within one hour of
birth, or 2mg orally can be given to the infant. Higher doses may be
needed if the mother has been taking anticoagulants.
Thiamine is present in low concentrations in early milk at a
concentration of 20mg/L, but the concentration increases significantly
in mature milk to 175-250mg/L, which is adequate for the infant.
Riboflavin concentrations are high in early milk and decrease to
400-600mg/L in mature milk. The amount of niacin present is dependent
upon maternal intake, rising from 0.5mg/L in early milk, to 1.8 to
2.0mg/L in mature milk, and possibly reaching as high as 6mg/L with
higher intake. Vitamin B6 starts low in colostrum and increases as much
as ten-fold from 0.09 to 0.31 mg/L in mature milk. Vitamin B6 levels in
breast milk increase with increased maternal intake, but may be reduced
in women who have been using oral contraceptives for an extended period
Vitamin B12 and folate are usually found in excess because they are
secreted bound to whey proteins. In well-nourished mothers, vitamin B12
concentrations are adequate (0.5 to 1.0mg/L) and supplementation has
little effect. However, levels as low as 0.05 to 0.75mg/L have been
reported in cases of women who were strict vegetarians, malnourished, or
had hypothyroid-induced pernicious anemia. Infant supplementation would
be recommended in such cases. Folate concentrations usually remain
adequate in breast milk in spite of maternal plasma concentration or
intake. The average folate concentration in breast milk ranges from 80
Unlike vitamins, minerals do not seem to correlate
with maternal intake or maternal plasma levels. Phosphorous seems to be
highest in early milk, at 147mg/L, decreasing to 107mg/L in mature milk.
Calcium increases from 259mg/L to 290mg/L and magnesium increases from
248mg/L to 330mg/L. It has been speculated that these three minerals in
these concentrations are important in bone remodeling occurring in
Copper, iron, and zinc concentrations seem to be strongly related to
liver stores of the mother accumulated during the third trimester.
Maternal intake has very little effect on them. Copper and iron
concentrations start high in early milk, leveling off to 0.3mg/L of
each. Zinc also starts higher (4mg/L), declining to 1.1mg/L at 6 months
postpartum, and decreasing still to 0.5mg/L after 1 year. Both iron and
zinc have a high bioavailability in breast milk, but the bioavailability
of copper is unknown.
Manganese declines from 6mg/L after 1 month of lactation to 3mg/L after
3 and 6 months, but is much better absorbed than the manganese found in
infant formulas. Selenium is strongly influenced by maternal selenium
status. It tends to be high early in lactation (40mg/L), decreasing in
mature milk. Iodine in breast milk varies according to maternal intake
and geographic region. In iodine-sufficient areas, the breast milk
content is approximately 150mg/L, and in iodine-deficient areas it can
be as low as 15mg/L.