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General Guidelines for Breastfeeding Women

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Nutrition recommendations Fluids, food restrictions, vitamins, weight loss Exercise, hygiene, rest Alcohol, drugs

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Tobacco, caffeine, medications Contraception Progestin, periods, breast pumping

The period of lactation is a relatively brief and very special time in a woman's life that is fondly remembered with a measure of pride. During this unique phase in the childbearing cycle, a breastfeeding mother will need to take some extra care to assure that she produces and provides to her infant abundant, high-quality milk. Unfortunately, many misinformed women decline to breastfeed because they worry that they don't "know all the rules" or they fear they will have to make drastic changes in their lifestyle to accommodate nursing. Actually, most women find that few modifications in their daily life are required to breastfeed successfully. The few who do need to make significant lifestyle changes almost always discover that the rewards of nursing their baby far outweigh any temporary inconvenience in their usual routines. Once you survive the early weeks of new parenthood and get breastfeeding well established, you'll begin to appreciate just how convenient it can be to fit a nursing baby into your life. And the healthy practices you adopt while breastfeeding can become the foundation for a lifetime of increased health consciousness. A Healthful Diet for Lactating Mothers Because human milk represents the ideal food for young infants, it's only natural to focus first on the type of diet a mother needs to consume in order to produce nutritious milk for her baby. Concerns about the adequacy of their diet cause many women to doubt the quality of their milk. But a mother's diet doesn't have to be perfect in order for her to make adequate milk and to nourish her baby well. Human milk produced by women all over the world is amazingly uniform in its composition. When mothers are poorly nourished, the quantity of milk they produce may be reduced, but the quality of milk tends to be fairly consistent. The process of lactation assures that human milk will have the right amount of nutrients-even at the mother's expense, if she doesn't eat a balanced diet on a given day. Keep It Simple and Build on Your Success Since lactation follows pregnancy, chances are good that you already are familiar with the basics of sound nutrition. If you gained at least twenty-five pounds during your pregnancy and delivered a baby weighing more than about six and a half pounds, you probably already have an adequate diet. Just keep up the good work! Women who require additional nutrition counseling include those who gained less than twenty pounds during pregnancy or who gave birth to a baby weighing less than six pounds at term. Other women who should receive special dietary advice include those who are underweight with little body fat; who are on restricted or specialized diets; who have chronic health problems (such as diabetes) or medical conditions causing malabsorption (such as cystic fibrosis or inflammatory bowel disease); who suffer from eating disorders; or who delivered twins.

Specific Nutrition Recommendations for Breastfeeding Women Eat three balanced meals a day and nutritious snacks. Consume a variety of foods in as natural a form as possible to obtain the calories, protein, vitamins, minerals, and fiber you need for optimal health. Eat plenty of fruits, vegetables, and whole-grain breads and cereals. Limit your intake of sugar, salt, fat, and highly processed foods. The Food Guide Pyramid shown on page 180 has replaced the former Four Food Groups as a suggested outline for daily eating. Because most American diets are too high in fat and saturated fat, the Food Guide Pyramid emphasizes food choices that help reduce fat intake. The layout of the guide visually reinforces the relative number of servings from each of the five major food groups. The largest number of daily food choices (six to eleven servings) should come from the bread and grain group. Wholegrain breads and cereals contain more vitamins and minerals and provide more fiber to prevent constipation. At least five servings of fruits and vegetables (two to four servings of fruits; three to five servings of vegetables) are recommended each day-most Americans fall short of this recommendation. Fruits and veggies are a nutritious, low-fat source of calories, vitamins, minerals, and fiber. Make an effort to eat vitamin A-rich produce often, such as carrots, spinach, sweet potatoes, and cantaloupe. Three servings of milk or other dairy products are suggested for breastfeeding women (four servings for teen mothers). Recent evidence has confirmed the importance of adequate calcium intake in the prevention of osteoporosis (brittle bones) in later life. Dairy products are the best source of dietary calcium. Milk and milk products also provide protein, vitamins, and minerals. If you don't like milk or have a milk allergy or milk intolerance, I advise you to get nutrition counseling and, if deemed necessary, to take appropriate supplements to replace essential nutrients in milk. Lactating mothers also should eat three servings of meat, poultry, fish eggs, nuts, or dry beans each day. Meat or meat alternates provide protein, vitamins, iron, and zinc. The small tip of the Pyramid serves as a reminder that fats, sweets, and soft drinks should be consumed only sparingly. While your body is producing breast milk, it requires more calories than usual. Most lactating women will need to consume about 500 additional calories above their normal prepregnancy food intake. An individual mother's calorie requirements can vary widely depending upon her basic metabolism and level of activity. Nutrition experts recommend that breastfeeding women consume 2,700 calories per day. However, recent studies of healthy lactating women in the industrialized world showed their actual intake of food to be approximately 2,200 calories per day while breastfeeding, or about 15 percent less than the recommended value. Most nursing mothers will need to consume at least 2,200 calories per day to provide necessary nutrients and to maintain milk production. At this level of calorie intake, a lactating mother can still expect to lose weight gradually during the course of breastfeeding. This is because the body contributes an additional 500 calories each day from body fat stores to help subsidize lactation. Thus, it is nature's plan to store up extra fat during pregnancy so it will be available to contribute to lactation after delivery. Body fat stores are decreased during breastfeeding, particularly in the thighs and hips.

Normally from the fourth month of pregnancy a woman`s body produces hormones which stimulate the growth of milk ducts. By the fifth or sixth month of pregnancy, the breasts are ready to produce milk. How does a lactating mother cope with the problems that might arise? Will a lactation consultant help? This article takes you through the process of lactation and the benefits it affords to a newborn.

What is lactation? The lactation process begins in a mother when the hormone oxytocin is produced in response to the birth of a new baby. Both uterine contraction and lactation process more or less begin simultaneously. The milk produced is primarily controlled by the hormone prolactin, which relies upon the length of time the infant nurses at the breast.

Significantly, lactation provides the much needed nutrition for the new born baby. The first milk a breast fed baby receives is called colostrum which contains high amounts of white blood cells and antibodies than mature milk. This colostrum is rich in immunoglobulin A. This helps to coat the lining of the baby`s immature intestines. Germs trying to enter the baby`s system are also prevented. Food allergies are also kept away. After the initial two weeks, colostrum gives way to mature breast milk.

Hormones influencing lactation


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Progesterone influences the growth of alveoli and lobes. It is observed that progesterone levels normally drops after childbirth, thereby triggering milk production aplenty. Milk duct system gets stimulated with estrogen which drops at the time of delivery and continues to remain low for the first couple of months of breast feeding. This is the reason why feeding mothers are recommended to avoid estrogen based birth control methods as this would reduce a mother`s milk production. Oxytocin helps contract the smooth muscles of the uterus during and after birth. After birth, this contraction squeezes the newly produced milk into the duct system. More importantly, oxytocin is essential for milk ejection reflex and let-down to occur.

Evolution of breast milk Lactogenesis I:

This is the stage during the latter part of pregnancy when the breasts produce colostrum which is a thick yellowish fluid.High levels of progesterone inhibit most of the milk production.

Lactogenesis II: This is the stage of copious milk production due to abrupt withdrawal of progesterone after the delivery of the placenta. The high prolactin levels stimulate the milk production.

Lactogenesis III: This is the most controlled stage of milk production when the supply is firmly established. The more milk is removed from the breasts, the more the breast will produce milk. Much depends on how the baby feeds and how it is able to transfer milk from the breast.

Induced lactation It is sometimes possible in a woman who has never been pregnant to induce enough lactation to breastfeed. This is called `induced lactation`. This is how adoptive mothers breastfeed. The fact is if a woman`s nipples are consistently stimulated by either a breast pump or suckling, the breasts have the capacity to produce enough milk to enable her feed the baby.

Lactation tends to adjust according to the demand.Significantly, there is little or no significance in the composition of the breast milk whether the lactation is induced or natural. Drugs, especially atypical antipsychotics such as Risperdal causes lactation in both women and men.

Lactation consultant A mother of a new born may need certain advice or assistance on breast feeding. In such cases a lactation consultant should be of help. She can provide the lactating mother with proven tips and techniques to enable milk flow freely.

Such a lactation consultant is specially trained to assist breast feeding mothers. Lactation consultants need not necessarily be certified, but normally they are licensed practical nurses who are professionals and have completed nurse training with a license to help mothers breast feed.

How could a lactation consultant help?


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Breast feeding as such is a challenging task. Sometimes coupled with emotional trauma and milk supply issues, is becomes even more indomitable to handle especially for young mothers. A qualified lactation consultant can help through such difficult times and render the much needed emotional support and advice to get the breast milk flowing freely and regularly. A lactation consultant can help if the baby is being nursed effectively. In case the baby is not, then less milk is likely to be produced as the woman`s body produces milk in accordance to the demand. A lactation consultant will advise the mother to breast feed more often as this helps to increase the milk supply. A lactation consultant advises on several techniques that could be used to increase the supply of milk. She shall advise on switching of breasts during feeding times, either to feed from both breasts, or switch back and forth during feeding time. A lactation consultant advises on exclusive breast feeding rather than supplement with formula foods. A mother could be advised to use breast pump in increase the supply of milk when not feeding the baby. Supplements could be used (Milk thistle or Fenugreek) to induce, augment and maintain lactation.

Breast milk production Feeding or expressing the milk more frequently definitely increases the supply of milk. But it happens that when babies undergo a `growth spurt` the level of supply seem to suddenly become inadequate.

A well-rested mother promotes a good let-down reflux which is essential for good milk production. It is imperative that feeding mothers pay enough attention to their diet as a nutritious diet with adequate protein facilitates milk production. The normal reasons for low supply of breast milk are:

Not pumping enough milk

Inability of the infant to transfer milk effectively; this could be due to deficit in the jaw and mouth of the baby, digestive inability of the infant, poor latching technique, maternal endocrine disorders, hypoplastic breast tissue, and inadequate calorie intake/malnutrition of the mother.

Diet tips for the lactating mother Certain substances in the mother`s diet could enter the milk and reach the child`s stomach. Keeping this factor in mind, a lactating mother has to plan her diet very well. Three glasses of milk daily is essential for the health of both the feeding mother and the suckling baby.

Lactating mothers should well be aware of the fact that any food that causes indigestion and does not suit the mother`s system will affect the infant and cause diarrhea, stomach ache, cold and other ailments.

Adequate consumption of pulses, vegetables and milk must be ensured for proper lactation. In general sour foods and cold drinks could be avoided.

According to the National Institute of Health, lactating mothers need 1,500 mg/day of calcium. It is necessary to pay attention to this fact in the diet. The lactating mother can consume medicine only on medical advice as these could reach the child and cause irreparable damage.