When it comes to breastfeeding, the biggest question that mums have is ‘what do I need to eat to make sure I make enough for my baby’. There are so many things that play into what allows a mother to start and maintain breastfeeding, and this can bring to the surface so many varied emotions depending on a mums' experience of it all.
From the months, and days before labour and delivery, to the very first contact with that precious little bundle of joy, there can be so much going on and so many emotions that flood us. In those very first moments, there can be many variables that impact the capacity to breastfeed.
From delayed initiation due to a stressful delivery, to recovery from a caesarean section, there can be a lot going on. And while most full-term healthy infants are born with basic survival reflexes - like the rooting reflex (remarkably being able to find the nipple within minutes of birth), sucking, swallowing, gag and cough reflex - feeding is as much a learning experience for baby, as it is for mummy.
The benefits of breastfeeding for both mum and baby are well known, and there is plenty of evidence to support breastmilk being superior to any other alternative. But what human milk is actually made of?
The overall nutritional content of breastmilk is generally consistent across populations, independent of a mother's nutritional status – a survival mechanism to allow babies to thrive, even where food is scarce. Mature breastmilk contains, on average, 1% protein, 3.5% fat, 7% carbohydrate (with the naturally occurring lactose sugar), and as well as fluid, vitamins and minerals, and other immune and bioactive substances. However, of all the macronutrients, fat is one that fluctuates most with what mum is eating. So a focus on healthy fats and a balanced diet is much more important than a “low fat” or weight loss diet for baby and mum's health.
Similarly, most vitamins and minerals are also consistent across various dietary intakes of mothers, and the average Australian diet will usually provide adequate amounts for breastmilk. However, there are some nutrients which may need supplementation to ensure breastmilk has adequate amounts. Some considerations are vitamin D (depending on exposure to sunlight, and if mum or baby is more dark-skinned), vitamin B12 (especially for those eating a vegan or even vegetarian diet), and iodine (which is largely important for the growth and brain development of baby). If you are ever unsure, speak to your doctor or dietitian to check if you or your baby require any supplementation.
Beyond nutrition, breastmilk remains a dynamic fluid that changes with each feed and throughout the lactation process. Other constituents of breastmilk include anti-infective factors (like immune system proteins including white blood cells) as well as enzymes and growth factors that aid the development of baby's maturing digestive system. All of these things together really make breastmilk the golden drop when it comes to infant nutrition.
Milk makin' strategies.
The nutrients in breastmilk are either made in the cells of the breast, or taken from the diet or mum’s body stores. When it comes to milk production, generally speaking, supply equals demand. The more regular the feeds, the more the body will produce. Both regular daytime and night time feeds are required to establish milk supply. Even though the broken sleep can feel like it is the worst thing in the world, know that it is actually a good thing to stimulate the hormone prolactin to establish sufficient milk production, and this phase will pass! If you are demand feeding, you will generally be supplying your baby with what they need. There are a few signs to know if your baby is getting enough breastmilk.
The average energy requirements of a breastfeeding woman 2,000-2,100 kJ/day and fluid needs to focus on replacing the average of 700mL lost in breastmilk on top of the usual amount required to remain hydrated. However, this varies a lot depending on a mother’s level of milk production, physical activity levels and rate of weight loss after birth. So many mums are eager to get back to their pre-pregnancy bodies, but it is so important to focus on the right foods, rather than restricting it to a point that it impacts on energy and breastmilk production.
There are so many tales of breastmilk cookies and particular foods or herbal remedies that will help to increase milk supply. Before considering any medical or alternative medicines to help with supply, it is extremely important to speak to your doctor as the impacts on mum and bub are very important to consider. The focus instead should be on a variety of food groups, with an increase in line with the recommendations in order to to meet breastfeeding energy and nutrient needs.
The key increases for breastfeeding are:
Vegetables: increase from five serves (both prior to and during pregnancy) up to 7.5 serves per day.
Grains: increase from 6 serves outside pregnancy, then to about 8 serves in pregnancy, to 9 serves for breastfeeding. This can seem like a lot of food, but the focus should be on good quality whole-grains and cereals, alongside the other food groups, to manage the extremes of hunger when establishing breastfeeding! Keep in mind that since 2009, any commercial bread product is required by law to fortify using iodised salt to support the populations’ needs. However, any products classed as ‘organic’ are not required to do so.
The toll of not being able to breastfeed.
Whilst most women want to and actually initiate breastfeeding, there can be many challenges with continuing. For those who are struggling, the most important thing is to have the right information and support. Support to ensure that you are doing everything to meet the demand (from positioning and attachment, to knowing how regularly and long to feed for, to managing mastitis, or even medical management to support breastmilk production).
It also takes a huge amount of support from family, friends and medical team to make a well-informed decision about alternatives to breastfeeding when it just isn’t working for you or your baby. For a lot of mums, there can be a lot of guilt associated with this decision. It is understandable given the emphasis and expectations placed on breastfeeding. Whether you are including supplementary formula feeds alongside breastfeeding, or your baby is solely on formula, know that you are doing the best you possibly can for you and for your baby.
For me, the journey of breastfeeding has been a process I have loved. From the initial feeds in the hospital, to the 3am feeds, it has all been something else! My little man thrived on breastmilk exclusively for about 5 months, whilst experimenting with some pureed foods at around 4.5 months. Continuing breastfeeding after returning to work certainly had a lot of challenges, and now that we are almost at his first birthday, we are down to minimal breastfeeding and focusing on a great variety of solids. Part of me is so glad that I get to retire the breast pump, and part of me feels a like I'm falling short of my own expectations to continue breastfeeding for longer.
Reflecting on this, it seems like an intuitive reaction as a parent, to want to do the best you possibly can. As mothers though, we should focus on what we have achieved, firstly through pregnancy and birth itself, whether you were able to breastfeed for a year or even one day. At the end of it all, there is a lifetime to come of caring for and loving our children in the best way possible. So let’s keep focused on the positives of what is to come.
Photo credit: @duvet_days