Changing for the better, one bite and (deep) breath at a time.

Tuesday, April 23, 2013

Nutrition After Baby

It's great to be back!  Thank you for all of your love and support for our family during the birth of our daughter, Hannah Grace, who was born on January 30th, 2013.  She arrived weighing in at 7 lb. 15.5 ounces, 20.5 inches long, and 8 days past her due date.  I had an unmedicated, doula-assisted hospital birth and was in labor for over 24 hours.  It was quite the whirlwind but went exactly as I had hoped, and for that I am so grateful.

Here's our little family, about a half hour after birth.  I was a bit misty-eyed having just starting nursing for the first time.  As you can imagine, it was something I had thought and dreamed about for many years, and we were so lucky that it was off to a good start.

Here's our Hannah girl, one day old:

So sleepy!  She still loves to nap through much of the day.  In fact, she's napping in her swing as I type!

She loves to smile, and her happiness is infectious.

This little devilish grin is going to cause trouble in a few years...
OK, one more...

Can you tell I'm a proud mama?  I am really lucky to not have to go back to work full time.  I no longer work at the medical device company and can devote all of my effort - when I'm not with Hannah - to private practice.  I am excited to consult with a few different businesses and their clients, including people struggling with eating disorders, pregnant women, busy athletes, and executives.  I am now able to see private Nutrition Transitions clients without the restriction of a separate full time job.

I have written about nutrition as it relates to fertility and pregnancy before, as I went through each stage myself.  If you haven't checked out my other posts about these topics, please start at the links below:

Prepping for Pregnancy
Nutrition in the First Trimester
Food Diary of a Pregnant Dietitian
Healthy Solutions for Pregnancy

Healthy eating need not take a back seat when the baby is born.  Good nutrition is imperative during the postpartum period, especially during recovery.  A woman's body goes through a lot during birth - sleeplessness, fluid and blood loss, physical strain from pushing, and mental/emotional exhaustion.  I personally dealt with nausea and vomiting all throughout labor, which further increased my fluid and nutrition needs. Yup, it's normal.  Nope, it's not fun.  (Interestingly, just minutes after Hannah was born I was ravenous and thirsty, and I was able to tolerate anything I ate and drank from there on out.) Furthermore, the sleeplessness that ensues while baby is young make it that much more important for mom to stay well nourished.  Excessive fatigue AND lack of nutrients are not a good combo.

Breastfeeding also increases a woman's hydration and nutrition needs.  Once my milk came in about 2 days after Hannah's birth, I noticed an immediate increase in my appetite and thirst.  My body was putting together the pieces to make nourishing, life-sustaining breast milk, and it required all of the building blocks to do so.  The first few days of a newborn's life a woman's body makes colostrum, which is a thin, yellow-ish substance that is perfect for a baby's teeny tummy until mom's body creates milk.  Colostrum is truly liquid gold, as it is full of antibodies, nutrients, proteins, growth factors, and a host of other goodies that pack a powerful punch in a small volume - perfect for a baby's immature digestive system.  Now that I'm making enough milk to feed a quickly growing baby and store 5+ ounces a day in the freezer, I am especially aware of what I'm taking in so that I can sustain my milk supply and supply Hannah with the nutrition she needs.

Here are my tips - from personal and professional experience - for good once baby is here:

1. Trust your body and your instincts.  Having your first child opens the door for a smattering of emotions: excitement, elation, fear, anxiety, wonder, worry and self-doubt.  It's easy to second guess yourself, especially when you hear horror stories about traumatic births, breastfeeding problems, colicky babies or marital issues post-baby.  When it comes to all things in mama-hood, especially feeding in nutrition, trust your gut.  If something doesn't feel right to you, it probably isn't.  I really wanted a medication-free birth and had specified that I would drink water instead of have a preservative-laden IV for fluids during labor.  However, after vomiting intermittently for 12 of my 24 hours of labor, I demanded IV fluids.  I knew that I wouldn't be able to keep down any water, and my biggest concern was my baby's hydration status and my own strength after losing fluids and electrolytes.  The moment the IV was placed, I felt immediately invigorated and ready to tackle the last few hours of natural birth.

Trusting your body is extremely important during breastfeeding.  When a newborn feeds almost constantly, as they tend to do with easily-digestible breast milk, it's easy to assume that you're not making enough milk or that your milk isn't adequately nourishing.  However, when you think about it, if you needed to double your weight in 6 months, you would have to eat almost round the clock as well!  Breastfed babies eat frequently because the milk doesn't sit heavily in their teeny tummies and instead can be very easily utilized for fuel and growth.  Formula fed babies seem more full and satisfied (and can often sleep longer through the night at first), but this is because formula takes longer to digest.  Think about how you feel when you have a very heavy meal in your belly - it sits like a rock.  If your baby is gaining weight and having enough wet diapers, he is getting enough food.  Plus, adding formula only decreases your breast milk supply, as your baby is not emptying the breast and telling your body to make more.  Breastfeeding is definitely a commitment and takes a lot of patience at the beginning, but it's really, really worth it, so trust your body that it knows what to do.  Most of the time, it does.  (Again, it is extremely important to listen to your instincts and work with your pediatrician and lactation consultant if you have any questions or concerns about breastfeeding or if baby's growth or feeding doesn't seem right.)

This is Hannah just moments after finishing a feeding.  Even while "milk drunk," she would flash a side smile, as if to say thanks for the grub.

2. Don't worry too much about fitting in your skinny jeans, especially if you're nursing.  Your body goes through a lot after baby.  You are still recovering from birth, and depending on the experience you had it can be somewhat rough on you physically.  The last thing you need to worry about is weight loss, especially in the first 6 weeks.  

I was lucky to have a great birth experience, despite the fact that I was in labor for 24 hours and was vomiting intermittently for about half that time.  I felt weak and a bit dizzy for almost a week after Hannah was born, and I had to be careful to not stand for too long or do much more than feed baby, feed myself, and rest.  It was imperative that I eat regular meals and snacks and drink plenty of fluids to help my body heal and make sure my milk came in.  It was surprisingly difficult - I remember my mom literally hand feeding me sushi and meatballs during the Super Bowl while I nursed because it was easy for me to focus on the baby and forget about feeding myself.  Plus, when you're learning to breastfeed, you definitely need two hands, and I found it hard to eat!  However, I can't stress enough how important adequate calories, protein, and fat are after baby to help your body heal and assemble breast milk.

In the first few months following birth, don't worry too much about losing your pregnancy weight quickly.  If you're breastfeeding it will likely come off either quickly or slowly, but don't be discouraged if you don't notice big changes immediately.  Starting a rigorous exercise program and/or severely restricting calories can affect the quality and quantity of your milk.  My doc was comfortable with me starting easy exercise when I felt ready because I was healing so well, but I waited until almost 6 weeks to take my first Karve class and did only brisk walking or free weights prior to that.  (Most doctors don't allow any exercise until after the 6 week check-up.)  

I was a very unique case in that I shed many of my 25 pregnancy pounds within the first week due to fluid and blood volume loss (and delivery of an 8 pound baby), and I just reached my pre-pregnancy weight 11 weeks after birth.   However, the scale is never a great indicator of body composition.  My body is much different than it was before - my hips are wider and everything is softer.  I am still working on building back muscle tone that I lost, and my abs may never have the strength they did before. You know what?  I'm OK with it.  With regular activity, breastfeeding, and balanced eating my body will settle at a place that's good for me at this point in my life, and all of these physical changes are a great reminder of the gift I have been given.  Not every woman, however, has this same experience, and many of my clients stay at a higher weight or larger size(s) for many months or years after having a child.  As much as it is important to take care of yourself and your body, no special event or pair of jeans are worth sacrificing your health, sanity, or breast milk in those early months.

3. Let people help - and feed - you.  One thing I learned in my Birth Journey workshop with doula Dianne Hamre was that if people want to come visit the baby during the first few weeks, they must bring food.  Of course, we didn't ask that of anyone, but most people did just so.  We were so grateful to be well fed during a time where we didn't quite know how to prepare anything for ourselves.  Some wonderful people even made freezer meals for us to store, and both sets of parents cooked up a storm and brought us food from our favorite restaurants.  

Grandpas hard at work in my parents' kitchen:

First sushi in 9 months!

Both grandmas did my grocery shopping during the first few weeks as well - they were so sweet to abide by my rather specific list!  When Hannah was about 10 days old, I decided I needed to go to Whole Foods just to feel normal.  My mom came with me to push the stroller while I manned the cart.  I'm just now feeling more comfortable figuring out how to grocery shop with a baby - it's somewhat challenging when they can't sit up in a cart - but it's getting so much easier.  Up until about a month ago, my family was still bringing me lunch at least 3 days a week.  It was a great way for us to bond, plus they loved holding Hannah so I could eat!

Even if you don't have a lot of family in town, take advantage of those who offer to feed you during the first few weeks of your baby's life.  Most of the time, these wonderful souls know just what it feels like to go through this experience and want to help in one of the most important ways.  This was my favorite post-baby gift of food from some dear friends:

If you have time (and energy) while pregnant, double up on some recipes so you have enough to freeze.  I made Crockpot Turkey with Bulgar, Feta and Olives, Great Northern Bean Soup, Baked Polenta with Spinach and Chicken Apple Sausage, and Chicken and Butternut Squash Millet Risotto before baby and stuck extras in the freezer.  We were still eating off our stash over a month after Hannah was born!  I always made sure to have bagged spinach, cherry tomatoes, avocados, and Bragg's Healthy Vinaigrette on hand so I could throw together a salad with an entree.  We also enjoyed takeout using gift cards we were grateful to receive, and if I was especially tired I would call Jimmy John's to get sandwiches delivered. 

Now that Hannah is older and does well being worn in the Ergo or playing in her little gym on the kitchen floor, I am able to make more meals from scratch.  I still employ the same techniques I used when I was pressed for time while working multiple jobs pre-baby: make plenty of crockpot meals, double recipes and freeze (or refrigerate) extras for later, assemble casserole-type dishes and refrigerate for 24-48 hours before popping in the oven, and use one type of prepared food (say, cooked chicken) for many different meals (in fajitas or atop salads or bean soup).

4. Continue taking your prenatal vitamins (and other prenatal supplements).  This is especially imperative while nursing.  As I did during pregnancy, I currently take the following:

2 Nordic Naturals ProDHA fish oils (1,000 mg DHA)
1 Seroyal HMF Forte probiotic
4 Innate Response Baby & Me Trimester III/Post-partum (2 am, 2 pm - 4 is the serving size of this whole-food multivitamin/mineral)
4 Dr. Ben Kim Greens
4 drops Bio-D Mulsion Forte (8,000 IU - vitamin D is still low despite high supplementation)

I sometimes take extra minerals if I'm not getting much calcium in my diet, and I have started playing around with different types of probiotics (S.B.C. by Douglas Labs and Reuteri) because of their importance during breastfeeding - more in a future post.  

At minimum, I recommend that all pregnant women take a high quality DHA supplement (preferably from fish oil, but know how it is processed), a probiotic, a prenatal vitamin/mineral, and vitamin D if blood levels are low.  This may seem like a lot of pills to swallow, but so many of us do not get these key nutrients in our diet.  Research is consistently suggesting how important DHA, probiotics, and vitamin D are to a developing baby.

If you have questions, concerns, or would like to purchase professional grade supplements, please contact me

4. Focus on lots of veggies/fruits, high quality protein, and plenty of fat.  I always advocate for balanced eating at any stage in life.  After baby, especially while breastfeeding, protein and fat are  crucial.  Protein needs are still increased during lactation (to about 20 grams more than pre-pregnancy), which is why it's a good idea to eat protein-rich foods at each meal.  Sustainably raised chicken, beef, turkey, and other meats, eggs, beans, lentils, nuts, seeds and dairy products all great protein sources.  I usually don't recommend soy, especially soy protein isolate or non-organic (genetically modified) soy products, because of their effects on the thyroid and endocrine systems.

Breast milk is made of 50% fat, which is why maternal fat intake is crucial.  (I know what you're thinking..."I have to eat fat?  Darn it!")  Even though it's debatable whether the amount of fat in breast milk changes with maternal diet, it is well documented that the types of fat do.  Mothers who eat more inflammatory omega-6 fatty acids in the form of corn, soy and other vegetable oils make breast milk that's lower in healthy monounsaturated fat.  I strongly urge breastfeeding women to stick to foods high in monounsaturated fatty acids (olive oil, avocados, almonds), omega-3 fatty acids (walnuts, fatty fish, flaxseed, chia seed), and quality saturated fats (coconut oil, pasture butter, eggs, raw organic cheese, and grass-fed beef).   

Veggies and fruit provide a wide range of vitamins, minerals, and plant chemicals that help baby's organs, bones, and brain grow.  Plus, they're high in water content, which helps mom with fluid needs.  I try to make one refrigerator-friendly salad each week so I have something quick and easy to grab.  Salads usually don't require two hands to eat, and if I top them with protein I have a complete meal.  Check out my Kale Waldorf Salad, Raw Kale Salad, and Peanut Coleslaw.  They all keep in the fridge with dressing for about 3 days.  Keep durable fruits like apples and oranges in the refrigerator, and don't discount frozen fruits like berries, peaches and papayas that can be thrown in a smoothie or thawed and spread on whole grain bread with almond butter as a wholesome alternative to jelly.

5. Drink up!  Breastfeeding requires a ton of water.  There have been days where I have hardly gone to the bathroom if I hadn't had enough fluid, but thankfully it never affected my milk supply.  Now I guzzle down water all day, plus I also have one Kombucha and one large iced green tea.  Some caffeine is OK, but too much can be passed to the baby and can be dehydrating, so stick to just a few cups o' joe (or tea) when nursing.  I also do about 2 glasses of red wine a week.  Alcohol does pass into breast milk, but it clears in a few hours.  So, if you have a drink just after (or during) a feeding there is less of a risk.  The rule of thumb is that if you are feeling the effects of alcohol and your baby nurses, he or she may receive small amounts of it too.  According to the AAP, 1-2 drinks by mom are safe for a breastfed baby.  If you hadn't had any alcohol in 9+ months, 1-2 drinks are plenty! 

6. Work with a lactation consultant, even if everything seems OK.  Demand one at the hospital.  Meet with one within baby's first week. Breastfeeding can go from great to difficult pretty quickly if baby doesn't have the latch down just right.  The good news?  A lactation consultant can usually spot a problem from a mile away and can help a new mom troubleshoot any nursing issues.  Far too many people stop breastfeeding because they lack the knowledge and support to continue.  (In fact, check out this awesome post about 10 myths about breastfeeding.)  Yes, breastfeeding is one of the most natural and beautiful things of life - but it is a skill that has to be learned by both mother and baby.   There was a time when everyone breastfed, so family members and friends would teach mom what to do.  We all still need that help and encouragement, and a lactation consultant, preferably one with the IBCLC (international board certified lactation consultant) credential.  Your pediatrician may also be helpful if they are well trained in breastfeeding, like our ped Dr. Agarwal of Agave Pediatrics, but most will recommend a LC.

I saw the wonderful, amazing Amey Clark at Babymoon Inn twice during the first few weeks to deal with a fast letdown and oversupply, which was causing Hannah to slide off the breast and cause nipple damage (read: OWWWW!).  She was so understanding and helpful, and after following her advice I was completely healed and had some great strategies to mitigate our issues.  We were only in the hospital for 24 hours so never got to work with a LC there, but we did have a great postpartum nurse who was really helpful with teaching me different breastfeeding holds and ensuring a good latch.

This is our first time nursing.  I had thought about what this experience would be like for years, and I was so glad Hannah latched on right away and went to town!  She continues to be a great eater and knows how to tell me she's done - she throws her head back, smacks her lips, and exhales deeply.  So dramatic.

By the way, breastfeeding may seem like more work than formula feeding at first, but it is far easier, cheaper, and oh so much healthier once you are in your groove.  Of course, every baby must eat and each mom has to choose the best way to do that, but I urge new mommies to at least try breastfeeding.  Aside from having a baby, it is by far the coolest thing my body has ever done.  I'm still in awe of the fact that not only did my body create this little creature from almost nothing, but it can now sustain her exclusively for 6 months and in conjunction with solid foods for 1-2 years!  If that's not enough, there are some slightly selfish reasons to do it too...

7. Pay attention to baby's response to breast milk.  Let's talk a bit about poop.  I know, it's gross, but as a dietitian I discuss it (often in great detail) with most of my clients.  Plus, if you're reading this as a mom-to-be, you will experience this and many other really gross things, so be prepared.  

Breastfed baby poop is supposed to be yellow after the first few weeks once the meconium cleared baby's system.  Fortunately, it doesn't smell nearly as bad as formula poop, and many say it doesn't smell at all.  Sometimes it can turn green for a host of different reasons, including a hindmilk/foremilk imbalance, jaundice, sensitivity to something in mom's diet, or for no reason at all.  We had ruled out serious issues and assumed her poop was green because of my high intake of spinach and kale (it does happen!).  After speaking with another mom, however, I decided to eliminate dairy from my diet, and what do you know...yellow poop all around.  Funny enough, I personally felt a lot better not eating dairy!  My digestive tract seemed so much healthier, and my allergies greatly decreased.  I was only eating one serving of cheese daily and 2 or 3 lattes a week, but apparently that was enough to affect both Hannah and myself.  I won't go without cheese forever, but for right now I'm staying away as much as possible.  I'm not sure if Hannah was ever bothered by her green poop, but I feel better knowing that her digestion has been optimized.

Sometimes it's necessary to eliminate certain foods while breastfeeding, but fortunately it's not forever.  The most common culprit is dairy, so if you notice excess gas or spitting up, green poop, or a skin rash, consider cutting out dairy for a week to see what happens.  You may be pleasantly surprised in more ways than one!

It's all worth it for this smile, no?