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July 13, 2016

There is a lot of conflicting advice about what you can and can’t do while breastfeeding. Writer Annabel McAleer went to the experts to find out the facts.

Hands up if your partner brought sushi, soft cheese or both to your bedside after your baby finally made its way into the world? With bubs safely outside your body, there are heaps of reasons to feel relieved – and being able to eat whatever you like is a big one.

But for breastfeeding mums, after the relief comes the realisation that your body is still not 100 per cent your own, only this time you haven’t been given any helpful booklets to tell you what isn’t okay to consume. So we’ve gone to the experts to find out the facts you need to know.

Does what I eat change the nutrients in my milk?
The food you eat has no effect on the basic composition of your breast milk, such as how much fat is in it or how many antibodies it contains, says Winsome Parnell, an associate professor at the University of Otago’s Department of Human Nutrition. Just eat as healthily as you can manage overall, she advises, so that you replace the nutrients in your body that may have been depleted in your pregnancy, especially calcium. The antibodies in your breast milk do vary, but not in response to your diet. Amazingly, they adjust depending on what your baby needs, explains Katie Hinde, an associate professor at the Center for Evolution and Medicine at Arizona State University in the US. Breastfeeding is more of a two-way process than most of us realise: some of your baby’s saliva is sucked back into your nipple when she’s latched on, which tells your body to produce any particular antibodies your baby’s immune system needs. Cool huh?

garlic

So last night’s garlic bread didn’t cause my baby’s nappy explosion this afternoon? 
It’s unlikely, but possible. If you’ve eaten a strong flavour or a whole lot of any one food in particular, you might find that 24 hours later your baby is restless and uncomfortable, says Dr Parnell. But for that to happen, a microscopic component of that food has to first pass through your gut where food is digested, then your breast milk system, then through your baby’s own gut barrier. These three filters will usually protect your baby from being affected by something in the food you eat. If you do notice a reaction from your baby about 24 hours after you eat something out of the ordinary, it is best to avoid eating a lot of that food in future.

My friend told me breastfeeding helped her lose weight, but I still can’t zip up my party dress. Why?!

The energy it takes for a body to produce a millilitre of breast milk doesn’t vary, says Dr Parnell, which means your weight still depends on your diet and activity levels. Some breastfeeding mothers find they’re super tired or always hungry, so they conserve energy by resting, or they eat extra calories. Other mums are more active – particularly those with older children.

If your baby is still a newborn, your breast milk production will increase as your baby grows, in proportion to how much he suckles, says Dr Parnell. This means that the more months you breastfeed, the more energy (aka calories) your body will expend on the process. If your friend is frequently breastfeeding an older baby or toddler, her body will be making more milk, which burns more energy.

Can my baby tell if I’ve been eating spicy food? 

Flavours from the food you eat can sometimes arrive in your breast milk – but only sometimes, and only for some mothers, says Dr Parnell. It happens when small molecules from a food manage to pass undigested through two physical filters: first through your intestinal barrier, and then through the cellular system that makes your breast milk. Many mothers may never experience this, says Dr Parnell, which explains why breastfeeding mums aren’t given lists of foods to avoid. So dig in to that bowl of bhuja mix – but keep an eye on your baby’s appetite tomorrow. If she seems less interested in feeding, you might be best avoiding it in future.

Is it truly okay to have a glass of wine with dinner?

Alcohol gets into your breast milk very soon after you have a drink, at the same time it appears in your blood stream. Levels of alcohol in breast milk peak
30 to 60 minutes after one drink, and after two to three hours there won’t be any alcohol in your milk.

If you have a newborn who sometimes demands cluster feeding it’s best to avoid alcohol altogether. Be aware that if you do choose to feed your baby within this peak time, he will probably drink less milk, due to alcohol suppressing the ‘feel good’ chemical oxytocin in your body, which enables the let-down process. It can also mildly sedate your baby.

If you do drink more than a glass or two it is better not to breastfeed again until you no longer feel any affects of the alcohol. Use previously expressed milk or formula instead. Because alcohol is not stored in breast milk there is no reason to ‘pump and dump’.

What about if I’m in pain, is it okay to use pain relief?

pillss

It’s actually okay to take the majority of prescription and over-the-counter medicines if you really need to when you’re breastfeeding. All medicines transfer into breast milk to some degree, writes Dr Thomas Hale, author of Medications and Mother’s Milk, but it’s rare that a breastfed baby will receive a “clinically relevant” dose.

You can research the breastfeeding safety of any medication online by looking it up in the LactMed database, maintained by the National Library of Medicine in the US. This will give a fuller picture than reading the package insert, because many pharmaceutical companies protect themselves by saying medication shouldn’t be taken while breastfeeding, even if independent studies suggest it’s safe.

To minimise your baby’s exposure to any medicine, take the minimum dose straight after breastfeeding and, if possible, before your baby’s longest sleep. Avoid the ‘sustained release’ and extra-strength versions of over-the-counter medicines, and choose products with just one or two active ingredients rather than those treating multiple symptoms.

coffee

If I have coffee will it cause another sleepless night for me and my baby?

One or two cups of coffee is considered ‘clinically insignificant’ to a breastfed baby. That’s 60–180mg of caffeine, or one espresso (80mg per shot), two instant coffees (60–80mg per cup), one energy drink (80–160mg), a few cups of tea (55mg per cup) or cans of Coke (38mg), or a whole lot of chocolate (10mg per 50 grams).

Remember to consider the amount of caffeine you’ve had from all of these sources when deciding whether to have another cuppa, as well as your own sensitivity to caffeine. If an extra coffee in the late morning keeps you awake half the night, you may be a slow metaboliser of caffeine, so keep your intake on the low side. If your baby is brand new then aim low too: newborns can take 80 hours to metabolise caffeine; at six months it takes just a few hours.

What about medicinal herbs?

It seems logical to think that because herbal remedies are natural, they’re safe. But there is little established scientific information on many herbal remedies, particularly when used in combination, and the levels of active ingredients they contain can be quite variable. It’s best to treat herbal remedies the same as other medicines: seek expert safety advice, only take them if you really need to, and minimise your baby’s exposure. Also, if a healthcare provider asks if you take any medication, make sure you mention herbs and supplements too.

What are the affects of smoking on breastmilk?

Smoking tobacco can decrease your milk production, and increase colic for babies whose mothers smoke five or more cigarettes a day. Other risks increase sharply if you smoke more than 20 a day, according to La Leche League.

If you are a smoker, be aware that it takes 95 minutes for your body to get rid of just half the nicotine from one cigarette. Cover your hair while you smoke, and change your top and wash your hands and face afterwards.

Obviously, babies will absorb a large amount of nicotine (as well as tar, carbon monoxide and other chemicals) if they’re in the same room as people smoking, so never let that happen.

For advice on how to quit smoking visit quit.org.nz or talk to your midwife or GP.

Main sources 

  • La Leche League International llli.org/nb.html
  • infantrisk.com and mommymeds.com from theTexas Tech University Health Sciences Center
  • ‘Medications and breastfeeding: current concepts’ by Frank J. Nice and Amy C. Luo
  • healthychildren.org from the American Academy of Paediatrics
  • Dr Winsome Parnell (PhD), Associate Professor in the Department of Human Nutrition, University of Otago in Dunedin

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