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.

1. 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.)

1. Try to avoid these things that have been found to decrease milk supply: stress, anxiety, fatigue, illness, smoking, and combined estrogen/progesterone oral contraceptives.

1. 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.

1. 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.

1. 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. http://www.uptodate.com/online/content/image.do?imageKey=pedi_pix/rda_fo1.htm. 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.

1. 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!

1. 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.)

1. 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.

1. 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 http://www.fda.gov/Food/FoodSafety/Product-SpecificInformation/Seafood/FoodbornePathogensContaminants/Methylmercury/ucm115662.htm

1. 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

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.  Please check it out at:

http://www.mayoclinic.com/health/breast-cancer-early-stage/BC00001

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.

Dr. Diana Farid

Something was in the air this last week… or in the water… either way, every mom I know seemed to be in a state of exhaustion! Not so unusual you might say, kids are exhausting! A joy and a treat but EXHAUSTING! Throw in a well meaning but “2 steps behind” husband who needs a detailed “spell it out” kind of list in order to get basic tasks done (faster to just do it yourself kind of deal) and you can’t help but wonder how it is that women traditionally live longer than men?!

There shouldn’t be a title “Superwoman”, all women are SUPER heroes in my book! Don’t get me wrong, I love men and I know that in a team (which we all know a family is) you don’t want every player to have the same skill set, complimentary talents and balancing dynamics are the beauty of a healthy relationship, men are magnificent and when they are “one of the good ones” they are irreplaceable! However, woman are my inspiration and i find even the simplest of days or the most chaotic sequence of errands enjoyable when spent with a good lady friend.

My dear friend and mother of two year old twin boys (resembling circus acrobats or slapstick clowns more than little boys), greets me most mornings with a text that reads “urggghhhhhh!”, I couldn’t agree with her more! I used to think I was a morning person, that was when my morning started with a slow roll into the day. Even when my toddler was a baby and still had night feeds, it seems like it was less of an effort to peel my eyes open and un-glue my head from the pillow (oh, my pillow, my trusty friend who I don’t see enough of). Maybe it’s a boy thing, but the 2year old energy is a source of a huge amount of laughter… conspicuous wrinkles and dark circles around my eyes!

I am of course not just babbling on about how tiring it is to be a mom in order to be negative or even cranky about it, being a mom truly is the greatest bounty and source of joy I have ever experienced, every single wrinkle and fatigued muscle is totally worth it! I do however think that sometimes we need a little push in the direction of self-care and maybe even a good friend to give us permission to go do something 100% totally just for yourself!

Sometimes, stepping outside, walking round the block is enough and sometimes something more involved like a mani/pedi or a spa day is more appropriate! How about taking a fun dance class or sipping a slow latte in a boutique coffee shop while scribbling a “train of consciousness” on the back of your shopping list!

There is a reason massive corporations give their workers scheduled breaks through out the day and I can guarantee it’s not because they have a conscience! Burn-out ends up costing more in efficiency and quality, we are so much more productive and effective if we have a few moments in the day where we can be still and re-energize our spirits.