Now that you’ve given birth, are you eating for two? Sounds like an odd question, but this may be more important for breastfeeding moms after the delivery than before it!
We’ve all heard that euphemistic description of our eating habits during pregnancy right? “I’m eating for two.” To an extent, this is true. Our energy and nutrient demands are increased while pregnant. But surprisingly, nature has it that even when we lack optimal intake, our babies get what they need from us while in the womb. We literally become the source of building blocks for our babies, either directly from what we eat, or from the stores that we have in our body. And that’s part of the reason why you may not need to gain as much weight as you think during pregnancy. In fact, around a 25-pound gain, give or take 5 pounds given the weight you start out at is just fine.
It turns out that eating for two after baby is welcomed into the world is not a bad way to think about our nutritional and energy needs while breastfeeding. Once we deliver baby, our bodies sprint to secreting milk after being at the starting gate of milk production for 40ish weeks. And as the weeks turn to months of breastfeeding, we’re going to need some specific nutrients to keep milk production steady and strong through the marathon that ends in weaning.
Let’s be honest here…at least I will be. I remember that feeling, twice now, of recovering from delivery and feeling absolutely spent, and then, “What? Having to breastfeed?!” I was tired from being pregnant and not sleeping before birth, tired from the labor, and could not find a comfortable position to sit in because of, oh let’s say “healing issues.” I was so excited to breastfeed, and had my own ups and downs in the beginning. I got through them with a combination of some old fission tooth grinding and expert help. But, there were certainly those times that I just thought, “Are you kidding me? Give even more?” It felt like every known and unknown orifice of my body had been ordered to ooze something. I know, this isn’t a lovely visual, but seriously, I know you know what I mean. I couldn’t find a comfortable position to sit it, let alone sit and feed…but I was determined and stubborn… and for me it worked out to breastfeed, so I continued on.
I didn’t expect the real physical need I would have for simple things like WATER, right away. I didn’t expect the almost animal like need and craving to eat immediately when hungry. But my experience through this process reinforced what my brain knew for years but my heart was finally understanding. And that is that when it comes to breastfeeding, I really was eating for two, and despite my accidental and sometimes forgetful eating habits, my body was going to make milk, and how I felt about it would be a secondary concern.
To help you get through this time with hopefully fewer sudden craving episodes, here is some simple and vital information about our nutritional needs during lactation.
1. Don’t worry if you miss your pre-natal vitamin, skipped breakfast, or didn’t drink enough water today, your milk production quantity and quantity will stay the same, though you may be grouchy. Lactation can take small hits. It’s deficiencies that are consistent over longer periods of time that can deplete your stores and create detrimental changes to your milk supply and composition.
2. How much milk are you making? If you are healthy and your baby is only getting its nutrition from your breast milk, you are likely making between 750-800ml (about 25 ounces) of milk a day. Though there still can be a wider range of normal as much as plus or minus 400 ml. Later in lactation, after 6 months, milk volumes have a greater variation because of the variation of weaning times for different moms. (Pregnancy and Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. National Academy Press, Washington, DC, 1991.)
3. Try to avoid these things that have been found to decrease milk supply: stress, anxiety, fatigue, illness, smoking, and combined estrogen/progesterone oral contraceptives.
4. You don’t need to worry about these things affecting how much milk you make: your age, weight, or body fat, how many times you’ve given birth, weight gain during pregnancy or the amount of aerobic exercise you do.
5. Keep taking your pre-natal vitamins. The amount of vitamin content in the milk we make is decreased if we are vitamin deficient and improves with supplementation.
6. Breastfeeding women require more nutrients than they did while pregnant. Check out this table to see the specific protein, vitamin and mineral recommended daily allowances for your age during lactation. According to the Institute of Medicine, you will need 25 extra grams of protein, in addition to extra vitamins and minerals including A, B, C and E, zinc, iodine and selenium. Eating a healthy amount and variety of foods, supplemented by your prenatal vitamin should provide you with the appropriate amount of nutrients.
7. Interestingly, calcium, phosphorous and magnesium dietary requirements do not change during lactation compared to non-lactation. This is because our body gets what it needs by taking these minerals out of our bones and getting rid of less of these minerals in our urine. Studies have found that supplementing these minerals doesn’t change how our body gets these minerals, and once we wean and resume our menstrual cycle, our body restores our bones with the calcium, phosphorous and magnesium it took out!
8. Whatever your age, you will need about 500 extra calories of energy a day to provide milk for your baby. For the first 6 months of breastfeeding, about 170 of the extra 500 calories your body needs, it gets from your own body stores. After the first 6 months, the extra 500 calories will come straight from what you eat. (Hint: This is where the “eating for two” bit comes into play. You need to eat more! Not double now, but more.)
9. If your baby is exclusively breastfed, she will need a vitamin D supplement (at least 200 IU daily) to make up for less sun exposure that babies have now, as a result of our efforts to decrease skin cancer risk.
10. To avoid the potentially increased exposure of your baby to mercury (which may adversely affect a baby’s developing nervous system), do not eat the following seafood: shark, swordfish, king mackerel, or tilefish because they contain high concentrations of mercury. More information can be found at the fda.
11. There isn’t a need to avoid fish all together though. And in fact I suggest maintaining a diet that includes some fish because fish provide a large amount of essential fatty acids including omega-3 fatty acids that are important in brain development. The Institute of Medicine suggests that up to 12 ounces a week of fish and shellfish with the lower concentrations of mercury are fine. These are fish like: shrimp, canned light tuna, salmon, pollock, and catfish. Avoid albacore (white) tuna because it has more mercury than canned light tuna. And, eat no more 6 ounces a week of albacore tuna or local fish that has been caught by family or friends.
With some of this information now tucked away in your brain cells, I hope you enjoy the extra 300-500 calories you will need a day, and take wonder in how these nutrients and energy transform into the dreamy development of your little one!
Thursday, September 17, 2009
Persistence
So you have decided to breastfeed. Great! There is mounting evidence of the benefits of breastfeeding. You have surrounded yourself with all the great books with the facts and tips on getting it done. Super! But the decision and understanding are only part of the picture when it comes to breastfeeding.
Persistence plays a key role in our production of milk and in our baby’s feeding. This is because our production of milk is based on a feedback loop. To more fully understand this feedback loop, and how persistence plays a role in successful breastfeeding, let’s start with a basic understanding of the structure of our breasts and how milk is made.
What the breast is made of? Take some liberty here and imagine you are in Napa valley, in the middle of a vineyard between two rows of ripe grape trees. You pull a perfect stem of grapes off the vine. As you follow the main stem down, it branches smaller and smaller and eventually leads to the grapes. Imagine now that you have pulled a number of stems of grapes off the main vine. Now, hold them together in one hand between your fingers with the grapes hanging down, each by the main stem.
The inside of our breasts can be thought of as having this same general structure. Here is the analogy: each grape is a pool of milk surrounded by milk making cells. The skin of each grape and the stems are like little ducts lined with skin and muscle like cells that push the milk up to larger and larger ducts or stems. Where all the main ducts come together is like the area of stems you are holding between your fingers. These main ducts come together at our nipples then lead out. This entire structure of “grapes” or milk glands and ducts is about the same size in all women. The difference in breast size is caused mainly by the difference in the amount of fat and connective tissue that surrounds the milk ducts and glands in various women. Muscle lies under our breasts and covers the rib cage. Viou la! A milk-making machine.
There is a wonderful short slide show on the mayo clinic website that I think illustrates breast anatomy very well.
Now that we have a picture in our minds of the structure of our breasts, let’s explore the function of milk making:
While pregnant, our breasts gear up to make milk. Early in pregnancy the hormones progesterone and chorionic gonadotropin help to stimulate the growth and development of milk glands in our breasts. Toward the end of pregnancy, our breast glands secrete colostrum – a liquid we secrete in the first 3 days after giving birth that is rich in nutrients and immune supporting substances. After delivery, the level of progesterone drops suddenly and allows for the breast to be fully sensitive to the effects of the milk making and secreting hormones respectfully, prolactin and oxytocin.
Prolactin and oxytocin are made in a gland in our brain called the pituitary. Prolactin stimulates the milk making and oxytocin stimulates the release of the milk by stimulating muscle like cells in the breast to contract and empty the milk stored in the breast. But, if the brain doesn’t get the right signals, it won’t continue to make the levels of prolactin and oxytocin necessary to maintain milk production and secretion. And this is why persistence is REALLY important: In order to continue to make and secrete milk – the breast needs to be emptied of milk regularly and the nipple needs to stimulate regularly. Otherwise the breast won’t send the appropriate signals to the brain.
If you think about this, it makes sense from a “save your energy” perspective. If the brain sees, “the milk isn’t being used…it must not be needed…let’s focus on other things…” it will stop programming our bodies for the feeding function.
The point of me explaining this is that knowing how milk production happens will allow you to make appropriate decisions for yourself when it comes to breastfeeding. Why? You will undoubtedly be given well-meaning advice that will be detrimental to successful breastfeeding because it will compromise the physical persistence needed to maintain the stimulus-response cycle of lactation and just as importantly, the mental persistence you need to get over the challenges that come with breastfeeding. Here is an example.
After having her first child, Amanda is excited to start breastfeeding her baby girl, Cory. She positions Cory appropriately and Cory sucks, seemingly well…. but after the first few days of life, still seems hungry after feeds. Even though breast milk may not come in until day 5 of Cory’s life, particularly since Cory is her first baby, and she is getting valuable colostrum by breastfeeding, some loved ones tell Amanda to give Cory some formula in an effort to satisfy Cory’s hunger. Unfortunately, this addition of formula to Cory’s diet, especially in the early weeks of life and breastfeeding, may cause Amanda to have a reduction in milk supply, even if Amanda continues to breastfeed. Because of the positive feedback loop of suckling stimulating hormone release, stimulating milk production, helping to fill Cory’s belly, if Cory doesn’t empty the breast of the milk that is there, Amanda’s brain won’t know that Cory needs more milk and won’t release the hormones to make it. This is how the vicious cycle of a lower and lower milk supply can happen. And when it does, we sometimes blame our low milk supplies on our own body’s inadequacies…. when it may well be a very normal and adequate response to a lack of enough stimulation.
Remember this story when you are in Amanda’s position. Persist in your efforts and you and your baby will be on your way to wonderful breastfeeding experience.
Persistence plays a key role in our production of milk and in our baby’s feeding. This is because our production of milk is based on a feedback loop. To more fully understand this feedback loop, and how persistence plays a role in successful breastfeeding, let’s start with a basic understanding of the structure of our breasts and how milk is made.
What the breast is made of? Take some liberty here and imagine you are in Napa valley, in the middle of a vineyard between two rows of ripe grape trees. You pull a perfect stem of grapes off the vine. As you follow the main stem down, it branches smaller and smaller and eventually leads to the grapes. Imagine now that you have pulled a number of stems of grapes off the main vine. Now, hold them together in one hand between your fingers with the grapes hanging down, each by the main stem.
The inside of our breasts can be thought of as having this same general structure. Here is the analogy: each grape is a pool of milk surrounded by milk making cells. The skin of each grape and the stems are like little ducts lined with skin and muscle like cells that push the milk up to larger and larger ducts or stems. Where all the main ducts come together is like the area of stems you are holding between your fingers. These main ducts come together at our nipples then lead out. This entire structure of “grapes” or milk glands and ducts is about the same size in all women. The difference in breast size is caused mainly by the difference in the amount of fat and connective tissue that surrounds the milk ducts and glands in various women. Muscle lies under our breasts and covers the rib cage. Viou la! A milk-making machine.
There is a wonderful short slide show on the mayo clinic website that I think illustrates breast anatomy very well.
Now that we have a picture in our minds of the structure of our breasts, let’s explore the function of milk making:
While pregnant, our breasts gear up to make milk. Early in pregnancy the hormones progesterone and chorionic gonadotropin help to stimulate the growth and development of milk glands in our breasts. Toward the end of pregnancy, our breast glands secrete colostrum – a liquid we secrete in the first 3 days after giving birth that is rich in nutrients and immune supporting substances. After delivery, the level of progesterone drops suddenly and allows for the breast to be fully sensitive to the effects of the milk making and secreting hormones respectfully, prolactin and oxytocin.
Prolactin and oxytocin are made in a gland in our brain called the pituitary. Prolactin stimulates the milk making and oxytocin stimulates the release of the milk by stimulating muscle like cells in the breast to contract and empty the milk stored in the breast. But, if the brain doesn’t get the right signals, it won’t continue to make the levels of prolactin and oxytocin necessary to maintain milk production and secretion. And this is why persistence is REALLY important: In order to continue to make and secrete milk – the breast needs to be emptied of milk regularly and the nipple needs to stimulate regularly. Otherwise the breast won’t send the appropriate signals to the brain.
If you think about this, it makes sense from a “save your energy” perspective. If the brain sees, “the milk isn’t being used…it must not be needed…let’s focus on other things…” it will stop programming our bodies for the feeding function.
The point of me explaining this is that knowing how milk production happens will allow you to make appropriate decisions for yourself when it comes to breastfeeding. Why? You will undoubtedly be given well-meaning advice that will be detrimental to successful breastfeeding because it will compromise the physical persistence needed to maintain the stimulus-response cycle of lactation and just as importantly, the mental persistence you need to get over the challenges that come with breastfeeding. Here is an example.
After having her first child, Amanda is excited to start breastfeeding her baby girl, Cory. She positions Cory appropriately and Cory sucks, seemingly well…. but after the first few days of life, still seems hungry after feeds. Even though breast milk may not come in until day 5 of Cory’s life, particularly since Cory is her first baby, and she is getting valuable colostrum by breastfeeding, some loved ones tell Amanda to give Cory some formula in an effort to satisfy Cory’s hunger. Unfortunately, this addition of formula to Cory’s diet, especially in the early weeks of life and breastfeeding, may cause Amanda to have a reduction in milk supply, even if Amanda continues to breastfeed. Because of the positive feedback loop of suckling stimulating hormone release, stimulating milk production, helping to fill Cory’s belly, if Cory doesn’t empty the breast of the milk that is there, Amanda’s brain won’t know that Cory needs more milk and won’t release the hormones to make it. This is how the vicious cycle of a lower and lower milk supply can happen. And when it does, we sometimes blame our low milk supplies on our own body’s inadequacies…. when it may well be a very normal and adequate response to a lack of enough stimulation.
Remember this story when you are in Amanda’s position. Persist in your efforts and you and your baby will be on your way to wonderful breastfeeding experience.
Relax
Rarely does a week go by when I don’t get a call from a friend asking me a question about a health issue, and usually it’s about kids. And, why not? I am a doctor, specializing in family medicine. My professional life rides on how much I know about health and how well I convey that information. So, it’s a part of my life that has become quite normal. The amount of questions I got rose sharply though after my friends started having kids, no surprise. And it reminds of why I went into medicine in the first place…
We were all about 12 years old, hanging out, and my girlfriends and I were having a grand time. My friend’s younger sister ran into the room crying with a scraped knee. Most of the girls would have rather run in the other direction, and did. Dealing with blood is not high on the list of a young girl’s fun activity list. But I relished in the chance to comfort, clean and apply the necessary band-aid to the wound. No life saving feat, but fun in my book. It was one of my first public shows of a desire to help and has, in part, translated itself into me connecting to you through Titi.
At Titi, we want you to be nourished. Let me help guide you through the maze of information out there, and hopefully give you some understanding and peace when it comes to the health of moms and children. Nourish yourself with some great information while online with Titi!
I will also alert you to the best resources I know of on particular health topics so that you don’t have to be Google freaked out when you put that search word in and don’t know which link to muddle trough first.
Let’s start out with what I think is the fundamental question about feeding our children in those early months and years. “How should I feed my baby?” For healthy children, this seems almost too fundamental to discuss: nipple, of some form, with milk behind it, into mouth of baby. But this seemingly simple “how” has become the topic of much writing and discussion. Breastfeeding, at least for a year, is what the American Academy of Pediatric supports. This leads many breastfeeding moms to ask: “How often?, How do I know my baby is getting enough?, What about the pain I sometimes feel?”. For others, this goal is practically, physically, mentally, or emotionally just not possible. So then we turn to formula, and we are introduced to more questions: “which one, how often, and how much?”
Thankfully, there are some simple and sound resources to help us answer these questions. Check out the links below for some great answers to these questions. In the coming months, I will help translate this information for you as well. But here’s what I think is the real bottom line to many of our feeding questions for our children: RELAX. I know, this is much easier said than done when a sensitive infant is in our care. But I have found this to be fundamental to most of the conversations I have with my patients and friends on the topic. Here are the key notions that will help you relax:
1. Your baby will tell you when she is hungry, usually by being upset.
2. Your baby will tell you when she is done eating, usually by turning away from the food source.
3. Unless advised by your doctor for treatment of a problem, do not push your baby to finish her food.
4. If your baby is gaining weight, urinating transparent urine and having regular non-bloody bowel movements, your baby is likely getting enough to eat.
5. Do not use food as a reward or punishment. This will also increase the chances that your baby will develop an unhealthy relationship with food.
What’s the point of this simple advice? I have seen it forgotten over and over again. The point is to create a healthy experience with nourishment, weather the source be breast or bottle or both. Your baby learns how to manage its needs for nourishment by how you respond to her feeding time. If it is full of force and stress, and she cannot dictate when she should start and stop, she may be on the road to having an unhealthy relationship with food.
So let’s start this relationship between our baby and food out to be a healthy one. Look for my blogs every few weeks on the Titi website to help guide you. Together, let’s tend to the scrapped knees of motherhood, both our children’s and our own!
For information on breastfeeding, check out:
1. Familydoctor.org by the American Academy of Family Physicians.
2. The Nursing Mother's Companion by Cathleen Huggins
3. La Leche League
For information of feeding with formula, check out:
1. familydoctor.org
2. Also, I just read a great article: Infant Formula, by Dr. Nina R. O’Conner published in the April 1st issue of the American Family Physician. Unfortunately, right now, it’s only available by subscription, but it will be available for free in about a year. And, you can likely read it at a university or medical library near you. Either way, I look forward to digesting and sharing with you some pearls of information from this article and other late breaking articles like this one in the blogs to come.
Dr. Diana Farid
(originally posted July 2, 2009 on www.titicollection.com)
We were all about 12 years old, hanging out, and my girlfriends and I were having a grand time. My friend’s younger sister ran into the room crying with a scraped knee. Most of the girls would have rather run in the other direction, and did. Dealing with blood is not high on the list of a young girl’s fun activity list. But I relished in the chance to comfort, clean and apply the necessary band-aid to the wound. No life saving feat, but fun in my book. It was one of my first public shows of a desire to help and has, in part, translated itself into me connecting to you through Titi.
At Titi, we want you to be nourished. Let me help guide you through the maze of information out there, and hopefully give you some understanding and peace when it comes to the health of moms and children. Nourish yourself with some great information while online with Titi!
I will also alert you to the best resources I know of on particular health topics so that you don’t have to be Google freaked out when you put that search word in and don’t know which link to muddle trough first.
Let’s start out with what I think is the fundamental question about feeding our children in those early months and years. “How should I feed my baby?” For healthy children, this seems almost too fundamental to discuss: nipple, of some form, with milk behind it, into mouth of baby. But this seemingly simple “how” has become the topic of much writing and discussion. Breastfeeding, at least for a year, is what the American Academy of Pediatric supports. This leads many breastfeeding moms to ask: “How often?, How do I know my baby is getting enough?, What about the pain I sometimes feel?”. For others, this goal is practically, physically, mentally, or emotionally just not possible. So then we turn to formula, and we are introduced to more questions: “which one, how often, and how much?”
Thankfully, there are some simple and sound resources to help us answer these questions. Check out the links below for some great answers to these questions. In the coming months, I will help translate this information for you as well. But here’s what I think is the real bottom line to many of our feeding questions for our children: RELAX. I know, this is much easier said than done when a sensitive infant is in our care. But I have found this to be fundamental to most of the conversations I have with my patients and friends on the topic. Here are the key notions that will help you relax:
1. Your baby will tell you when she is hungry, usually by being upset.
2. Your baby will tell you when she is done eating, usually by turning away from the food source.
3. Unless advised by your doctor for treatment of a problem, do not push your baby to finish her food.
4. If your baby is gaining weight, urinating transparent urine and having regular non-bloody bowel movements, your baby is likely getting enough to eat.
5. Do not use food as a reward or punishment. This will also increase the chances that your baby will develop an unhealthy relationship with food.
What’s the point of this simple advice? I have seen it forgotten over and over again. The point is to create a healthy experience with nourishment, weather the source be breast or bottle or both. Your baby learns how to manage its needs for nourishment by how you respond to her feeding time. If it is full of force and stress, and she cannot dictate when she should start and stop, she may be on the road to having an unhealthy relationship with food.
So let’s start this relationship between our baby and food out to be a healthy one. Look for my blogs every few weeks on the Titi website to help guide you. Together, let’s tend to the scrapped knees of motherhood, both our children’s and our own!
For information on breastfeeding, check out:
1. Familydoctor.org by the American Academy of Family Physicians.
2. The Nursing Mother's Companion by Cathleen Huggins
3. La Leche League
For information of feeding with formula, check out:
1. familydoctor.org
2. Also, I just read a great article: Infant Formula, by Dr. Nina R. O’Conner published in the April 1st issue of the American Family Physician. Unfortunately, right now, it’s only available by subscription, but it will be available for free in about a year. And, you can likely read it at a university or medical library near you. Either way, I look forward to digesting and sharing with you some pearls of information from this article and other late breaking articles like this one in the blogs to come.
Dr. Diana Farid
(originally posted July 2, 2009 on www.titicollection.com)
Subscribe to:
Posts (Atom)