Nutrition and Breastfeeding Articles

By Emma McShane & Nicole Bando
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WEIGHT LOSS AFTER PREGNANCY
There is a lot of pressure from society on women to ‘bounce back' to their pre-pregnancy weight, however, this is not realistic nor recommended. Some of the weight gained during pregnancy is used to fuel breastfeeding, which is why breastfeeding can help a woman gradually return to her pre-pregnancy weight. Weight loss is recommended at the rate of around 2kg loss per month, as this does not affect breast milk production. It takes 9 months to grow a baby, so it is expected to take 9-12 months to return to pre-pregnancy weight. It helps to be patient, realistic and kind to the incredible body capable of growing a child. Restricting eating can affect not only a mother’s health but can reduce milk supply and impact a woman’s bone health. 
 
Aim to be intuitive with eating (e.g. listen to hunger cues), choose whole foods from the core food groups and avoid too many high sugar and high fat treat foods to help weight loss to occur gradually. See these posts on a woman's special needs whilst breastfeeding: www.nicolebando.com/blog/nutrition-during-breastfeedi and www.nicolebando.com/blog/meal-snack-ideas-for-new-parents
 
Gentle exercise has been shown in multiple studies to effectively help with post pregnancy weight loss. Exercise can help to boost overall health and wellbeing too. It is important to let the body recover after birth, and when ready, commence gentle exercise to strengthen your bones and muscles, improve sleep and stress levels, help to lose weight, and improve mental wellbeing.
 
SPECIAL DIETS/SITUATIONS:
 
VEGAN & VEGETARIAN DIETS:
Mothers who are vegan or vegetarian are at high risk of nutrient deficiencies, in particular; protein, iron, calcium, Vitamin B12, and omega-3 fatty acids. These nutrients can mostly be obtained from plant-based products, except for Vitamin B12, which is mainly found in animal products. In some cases, a blood test to check levels, and a B12 supplement may be required.
 
INTOLERANCES/ALLERGIES:
Some babies may have intolerances or allergies to proteins present in their mother’s breast milk. The most common allergies are cow’s milk, soy, eggs, peanuts, and tree nuts. Avoidance of the particular protein in the mother’s diet may be needed. However, each mother and baby duo is different, so seek medical advice from a doctor and dietitian before excluding food group(s). If a mother needs to exclude a particular protein, the nutrients from that food will need to be replaced with alternative foods (e.g. alternatives to cow’s milk for adequate calcium).
 
 
CLOSE PREGNANCIES & MULTIPLE BABIES:
Mothers who have close pregnancies are at higher risk of nutrient deficiencies, as the nutrient reserves in the body may not have been fully replenished before the next pregnancy. Iron is at most risk of deficiency, as the body may not have had time to fully replenish the stores lost during pregnancy. Supplementation of this nutrient, as well as calcium, magnesium, zinc, and essential fatty acids may be needed but it is important to seek support and guidance from a dietitian who can accurately assess your dietary intake and blood levels of these nutrients. Women who have had multiples (e.g. twins) have greater demands for nutrition and need an additional 2000kJ in energy, per baby, as well as increased vitamin and mineral needs.
 
BARIATRIC (WEIGHT LOSS) SURGERY:
There have been multiple studies that have investigated the impact of bariatric surgery on breastfeeding. People who have had bariatric surgery may be at greater risk of nutrient deficiencies, as the surgery can change how nutrients are absorbed, so it is important to check levels of vitamins and minerals before, or at the start of pregnancy, to see if supplementation is needed.  A study investigating the composition of breastmilk, comparing nourished mothers who had undergone weight-loss surgery and those that had not, found there was no significant difference in nutrient composition between the two. This, however, takes into account that it is important to still consume a balanced diet. As some bariatric surgeries may result in ongoing complications e.g. reflux or reduced food consumption or absorption, which all may affect nutrient intake, it is important to seek support from a dietitian.
 
PREMATURE OR LOW BIRTH WEIGHT BABIES:
Breastfeeding is important in babies who are premature or of low body weight as breastfeeding can reduce the risk of the baby developing medical complications. The production of milk components starts in pregnant women before 22 weeks of pregnancy, so even with very premature babies, most mothers can produce colostrum. Breastfeeding may be difficult if a baby is in the neonatal intensive care unit, requiring some mothers to express breastmilk. There are multiple barriers for both mother and baby to overcome when breastfeeding a premature, or low birth weight baby, such as a delayed or traumatic start to breastfeeding, and maternal stress. Recent studies however have shown that there is a higher rate of breastmilk feeding amongst very low birth weight infants, often due to mothers recognising the fragile health of their baby and the benefits of breastfeeding.
 
Good nutrition at this time is vital to cope with the energy demands of expressing and or breastfeeding, to maintain supply and provide energy to cope during a stressful time, and to replete nutrient stores used during pregnancy. Follow the general nutrition advice set out above. If you have experienced a bumpy start to breastfeeding, seek guidance from a lactation consultant.
 
NAUSEA & VOMITING IN PREGNANCY:
Some women experience severe nausea/vomiting during pregnancy that can affect the quality and quantity of food consumed. It is important during this time to eat high-energy and protein foods such as eggs, dairy, and meats/meat alternatives. Try having cold foods, as hot foods and their smells can exacerbate nausea. If nausea/vomiting continues, seek advice from a doctor and dietitian to see if supplementation of specific nutrients is needed. A woman who has experienced severe nausea and vomiting in pregnancy may be at greater risk of vitamin and mineral deficiencies and will need extra help to replenish her stores. 

By Emma McShane & Nicole Bando 

Nutrition whilst breastfeeding is vital to optimise the health of both mother and baby. New motherhood is a very busy time, and many women put their own health last.  A woman’s remarkable body will produce the live, biodynamic, complete food that is breastmilk that evolves with her baby’s growing needs. Milk production is robust and will only be affected in very extreme circumstances. The average woman produces 750mls of breastmilk per day, from 1-6 months. Fat stores accumulated during pregnancy are used to fuel milk production when baby arrives, though this does not cover all of the energy needed to produce breastmilk. Some elements of breastmilk are impacted by a woman’s diet and those that follow a vegetarian or vegan diet, are at greater risk of vitamin and mineral deficiencies.
 
DID YOU KNOW?

• Adequate nutrition can help with coping with a new baby and the adjustment to motherhood, mood, and energy levels. Restrictive eating during breastfeeding can impact mood, milk supply, overall coping, and bone health.

• Certain nutrients in breastmilk, such as lactose and protein are fairly constant, however the fat content of breastmilk changes according to how empty the breast is. The types of fatty acids and quantities of iodine and Vitamin B12 are also affected by the mother’s diet.

• A mother’s varied diet exposes baby to different flavours and tastes, which will help baby to accept a wider range of solid foods, including fruit and vegetables.

• Regular nutritious meals and snacks are important to nourish both mother, and baby. There is no need to aim for dietary perfection.

 
ENERGY:
An extra 2000kJ per day is needed for a breastfeeding mother, though this can change depending on individual needs. This is equivalent to a serving of spaghetti Bolognese with cheese (1 cup pasta and ½ cup sauce), or a bowl of porridge with apple, yoghurt, and nuts (½ cup uncooked oats, made with 1 cup of milk, 1 apple and a handful of nuts) or a combination of snacks throughout the day, such as yoghurt (¾ cup), popcorn (small packet/1 cup), crumpets, and peanut butter (1 crumpet with 1 tb of nut butter). Studies show that not eating enough can directly impact milk supply and composition, so a wholesome diet is vital to fuel both mother and baby.
 
FLUID:
Breastmilk production requires fluid, so a breastfeeding woman requires more fluid than usual. The amount depends on various factors such as weather conditions, activity levels, and the food eaten. Be guided by your body, and ensure you’re drinking water consistently throughout the day.
 
CAFFEINE:
Caffeine transfers directly into breastmilk, so avoid large quantities of caffeinated drinks when breastfeeding. 1% of caffeine enters breastmilk and peaks an hour after consumption. A newborn baby can take up to 160 hours to process caffeine, however by 6 months that drops to 2-3 hours, so an older baby is able to better tolerate caffeine. A morning latte or a few cups of tea across the day might not cause any issue, but observe baby; a mother may consider changing to a decaffeinated tea or coffee if she notices that her baby is very wakeful after her morning coffee. A moderate amount of caffeine a day, such as two cups of coffee (latte or espresso), three cups of instant coffee or four cups of tea is usually fine. Remember that sources of caffeine include: cola, chocolate, tea, guarana, and energy drinks.
 
Caffeine can also affect the let-down (the milk ejection reflex) and worsen nipple vasospasm (occurs when blood vessels tighten and spasm, causing nipple pain).
 
ALCOHOL
The safest option while pregnant and breastfeeding is to avoid alcohol altogether, as it can reduce breastmilk production and impact baby’s growth and development. Alcohol is present in breastmilk in the same levels as the bloodstream and it takes approximately 2-3 hours for the mother’s body to clear the alcohol in one standard drink. This time increases with each drink consumed. So if choosing to consume alcohol, wait around 2 hours before breastfeeding. Any milk expressed before the 2-hour window will need to be discarded, as it is not safe for the baby to consume. If there are times where a mother plans on drinking more than one standard alcoholic drink, plan ahead and express some breast milk beforehand to feed baby during this time. Below are two links to resources for further information:

• NHMRC Infant Feeding Guidelines
• Feed Safe App

MIXED FEEDING:
Any amount of breastfeeding increases a woman’s dietary requirements, however given the wide variation in breast milk production when mixed feeding, it can be difficult to estimate. A woman should use her appetite as a guide and may require additional foods from the core groups. A dietitian can help to guide this.

DO CERTAIN FOODS INCREASE BREASTMILK PRODUCTION?
Oats: Many women wonder if oats or lactation cookies help with milk supply, however, there is no clear evidence to support this.
Fenugreek: There is poor quality and limited evidence to suggest that fenugreek increases milk supply.
Breastfeeding with good attachment, flexibly and frequently is the best way to protect milk supply.

IMPORTANT NUTRIENTS:

By Emma McShane, Dietitian, August 2021

What is Mastitis?
Mastitis is inflammation of the breast tissue, affecting 10-25% of breastfeeding women. The majority of cases occur during the first 6 weeks of breastfeeding, however mastitis can occur at any time during the breastfeeding journey. Mastitis can be caused by engorgement or inadequate milk removal from the breast, resulting in a blocked duct. This causes the milk blocked behind the duct to be forced into the nearby breast tissue, causing inflammation. This inflammation is known as mastitis and can lead to infection. Fast and supportive treatment is needed, as mastitis can lead to early weaning from the breast, or complications such as a breast abscess if left untreated.
 
Mastitis may occur due to latching problems, sucking issues, sleepy babies, oversupply, or hurried feeds, including limiting a baby’s time at the breast. These factors can affect how much milk is drained from the breast.
 
How do I prevent Mastitis?

• Ensure your baby is well-positioned and attached to the breast.
• Make sure your bra is loose and there is no pressure on your breasts e.g. clothing or fingers while feeding.
• Feed on demand, offering flexible and frequent access to the breast, as missed feeds or long intervals between breastfeeding can increase your risk of developing mastitis.
• Relax whilst breastfeeding to help encourage your milk flow.
• Gently massage the breast by stroking towards the nipple whilst your baby feeds.
• If your breasts become uncomfortably full, wake up your baby to feed them. If they do not want to feed, express a small amount for comfort.
• Hand express to empty the breast.
• Practice good hygiene, and if using a breast pump, clean this often, as this will help to prevent contamination.
• Check your breasts frequently for lumps, pain, or redness.
• Alternate from which breast you begin each feed, as this will help to ensure one breast is drained well at every second feed.
• Let your baby finish when they’re ready to ensure they have taken the most milk out of the breast. Avoid timing your baby at the breast.
• If you choose to wean your baby, make sure you do this slowly as rapid weaning can cause mastitis.
• Stress, fatigue, vigorous exercise, or overall poor health and nutrition can increase your risk of mastitis, so self-care and adequate nutrition is essential.

 
Symptoms:
Please note that some mothers do not get the early signs of a blocked duct, and feel that mastitis comes on ‘out of the blue’. 

Treatment:
It is important that if you feel a blocked duct coming on, to start treatment immediately. The most important part of treatment is to allow for effective milk removal, regularly. 

• It is important to drain the breast often, but gently.
  
• Feed frequently, starting on the affected breast.  This is not the time to wean your baby as symptoms can worsen. Allow your baby to drain the breast and also make sure that you are offering the unaffected breast. The milk is safe for your baby to drink.
• Change feeding positions as this may help to clear the blockage. You can try positioning your baby at the breast with their chin or nose pointing to the blockage, as this will help drain the affected area.
• Gently massage your affected breast, as this will help to improve drainage and symptoms.
• Ensure good positioning and latch. A lactation consultant can help you to achieve this.
• Use cold packs on the affected breast, as this can help to reduce swelling and relieve pain. 
• Use warm heat packs sparingly just before bed (only for a few minutes), to help trigger your let-down to help clear the blockage.
• It is very important to get as much rest as possible.
• Simple analgesia can be taken as needed such as paracetamol or ibuprofen.
• When treated promptly, a blocked duct should clear in 24-48 hours. 
• If the blockage is not clearing within 24 hours, seek advice from your doctor, as antibiotics may be needed if an infection occurs. Please note that antibiotics only treat an infection, not the cause of the blockage. 
• Milk supply can sometimes be affected when mastitis is occurring, so look out for signs that your baby is getting enough milk including urine and stool output, and that your baby is putting on weight.  A change in supply can be addressed with frequent and effective feeding.
• A Lactation Consultant can check your baby's positioning at the breast to prevent mastitis & blocked ducts.
  
• Breast ultrasound can be an adjunct to treatment to help clear the blocked duct.  

 
Nutrition:
 It is very important to keep up your fluids, which means consuming >2 litres per day

• Breastfeeding is a demanding process on the body that requires more energy and protein than usual. Other important nutrients include iron, iodine, and calcium. A dietitian can help you to meet your requirements.
• Try to eat regular meals & snacks across the day, even if feeling unwell.
• Simple meal and snack ideas include: Scrambled eggs with toast and chopped vegetables, baked beans on toast, roasted chickpeas, vegetable sticks and hummus or cheese and crackers.
• Below is the Australian Guide to Healthy Eating recommended serves for each food group during breastfeeding.

 
Are probiotics helpful?

• Scientific trials have found inconclusive results on the benefits of probiotics to prevent or treat mastitis. There is an emerging field of research to suggest that probiotic use may help to prevent mastitis, however further research needs to be conducted in this area to reach a conclusion.

As part of planning for a glowing pregnancy, have you considered your diet? It's true that supplementation with key nutrients is important, but a nutritionally complete diet during pregnancy and breastfeeding helps to lay the vital foundations for a healthy mother, foetus and eventually, a thriving family. This is important to reduce the risks of chronic disease later in life, in both the mother and child.

New research is emerging that nutrition plays an important role in the pre- conception period and can also affect fertility. Despite having more information at our fingertips than ever before, as a population our diet has never been worse. We are constantly bombarded with myriad information about nutrition and it is little wonder that we are confused about what to eat.

The latest data from the Australian Health Survey shows that less than 7% of Australians are eating enough vegetables and that a significant portion of our daily calories (35%) comes from discretionary items. These are foods that are not essential to a healthy diet and are high in refined sugar, fat and alcohol. Yet, we have heard the argument that the Australian Dietary Guidelines (ADG’s) don’t work, and this is simply because we are not following them. The ADG’s aren’t designed to be a ‘one-size-fits-all’ approach. They are evidence-based and provide us with a brilliant framework for living a healthy lifestyle without the merry-go-round of fad diets, or the latest buzz in superfoods. Perhaps they just need to sound a little more glamorous.

All foods are fabulous in their own right and there are many ways that the guidelines can be tailored by a dietitian to fit in with a range of lifestyles, cultures, taste preferences and life stages to suit the individual; sounds a little bespoke, doesn’t it?
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Boosting vegetable intake by 1-2 serves (half to one cup) per day has many health benefits and can be done relatively easily. For example: 

• Add canned legumes to salads, soups and slow-cooked meals during winter. Legumes are super food powerhouses, replete with fibre, iron and protein. They are low in fat, have a low glycaemic index and on top of these great benefits, are cheap.
• Try one new recipe a week and add in an extra vegetable that isn’t on the list of ingredients. 
• Snack on cut-up vegetables and dips such as hummus or tzatziki (food safety is an important consideration in pregnancy, avoid dips containing raw egg). 
• Try avocado with tomato on wholegrain toast for breakfast, for a brilliant source of mono- unsaturated fatty acids, lycopene, vitamin C, fibre and beta-carotene. Boost iron and folate with a scattering of basil leaves. 
• Add a handful of spinach or rocket to any meal for a boost of folate, iron, vitamin C and fibre 
• Avoid pre-cut vegetables and ensure all fresh produce is washed to avoid listeriosis

To plan for a healthy pregnancy and make sense of the nutrition information, come and visit me at NEST Elsternwick for personalised advice on how to make the best start for you and your family.