Health & Fitness Needs During Lactation
Body image is among the
greatest concerns of women during the first year after
childbirth. The desire to
lose weight and tone muscles
in the postpartum period is common concern
after child birth in
today's society. Weight reduction can be difficult for anyone at anytime, but a
mother who is trying to return to her pre-pregnancy weight is also challenged
with additional stresses of increased
child care commitments, less rest and sleep, household
responsibilities, and, possibly, returning to work outside the home. A woman
trying to be successful at
weight management while breastfeeding
will need the support of her family, friends, employer, and medical caregiver.
This article provides preliminary recommendations for diet and exercise
programming for breastfeeding women who have the desire and, in consultation
with their health care provider, have determined that weight management is
Nutrition during Lactation
significant energy demands upon the mother, causing the additional expenditure
of more that 500 calories per day. The recommended diet is at least 1,800
calories per day, the minimum recommended intake for lactating women. The food
eaten should consists largely of complex
carbohydrates, low in
sugar, and contains the
necessary meat and dairy products to meet minimum safe nutritional intake
guidelines (United States Department of Agriculture [USDA]). No effort should be
made to deliberately restrict total calorie intake, and women should feel free
to eat to satiety when they are hungry but to refrain from becoming overly full.
There is a need to make use of dietary exchange list to simplify
meal planning and
facilitates eating and recording food intake. The exchange list represented
below consists of six groups of foods classed together because of similar
calorie content and percentage of carbohydrates, protein, and fat. The numbers
and types of exchanges eaten should be recorded after each meal in a daily food
log to keep a written track of the daily food intake. The strength of this type
of dietary recommendation, which uses exchange lists, is that it allows the
woman to plan and prepare her own menus based on the type of foods she and her
The diet should be composed of approximately 60% of carbohydrate (<=10% of which
is composed of refined sugars), 20%
protein, and 20–25% fat
(<=33% of which is composed of saturated fats.) Eat three or more meals per day,
and eat snacks of fruit, vegetables, and grains whenever hungry.
Prescribed Daily Diet
Select skim products of milk, yogurt, etc.
Choose lean cuts of meat and other sources of protein such as
beans and legumes.
Limit fat intake to mostly unsaturated oils.
Fresh fruit is preferred over juice and canned.
1 cup raw
This is the most difficult to eat enough of; fresh is best.
1 slice/1/2 cup
Choose whole grain products.
It is important to dispel the myth that it is acceptable to eat as much as
desired of any food touted by manufacturers as low-or non-fat. Foods in this
category (particularly snacks and desserts) are often found to be high in
refined sugar and calories. This diet is also nutritionally sound and conducive
to a lifelong pattern of healthful eating by the woman and her family. Vitamin
and mineral supplements are not necessary but may be taken at the discretion of
the woman and her health care provider, especially if her food choices provide
marginal dietary intake of calcium, magnesium, zinc folate, and vitamins B6 and B12. Excessive drinking of
beverages with high sugar, caffeine, or alcohol content is discouraged.
Exercising during Lactation
postpartum woman can begin a full exercise program as soon as she receives
approval from her medical caregiver. This is typically after 6 weeks, although
this is not based on studies of a woman’s overall healthbut principally on the length of time it
takes for the uterus and softened ligaments to return to their normal
pre-pregnancy state (American College of Obstetricians and Gynecologists [ACOG],
1994). Each woman is different, and no blanket recommendation as to when to
start can be given.
Guidelines for an effective exercise program :
lactating woman needs to avoid excessive
stretching and lifting
of heavy weights, however, since laxity of joints and tissues may continue
after the initial 6-week postpartum period. This is due to increased
secretions of relaxin and progesterone during pregnancy, resulting in softened
ligaments, cartilage, and the cervix to prepare for delivery. These hormones
do not return to pre-pregnancy baseline levels for several months in the
breastfeeding mother, so she needs to be especially cautious. The muscles
needing the greatest attention are those that may have shortened during
pregnancy and may include those of the
lower back, hip
inner thighs, and calves. Best results are achieved when flexibility exercises
are done following the aerobic phase of the workout and before strength
important to monitor vaginal discharge (lochia),
which normally occurs for the first 6 weeks. If during activity the color of
the discharge changes from rust or whitish yellow to bright red, exercise must
be stopped. If the bleeding continues for more than 1 hour or recurs
frequently during or after a
workout, the woman’s health care provider should be
consulted (ACOG, 1994).
2–6 weeks, more strenuous
abdominal strengthening exercises can be done.
Before starting to do
or partial sit-ups, it is important to check to see if the two vertical
abdominal muscles are separated (diastasis recti). This condition can be
caused during pregnancy by the enlarging fetus pushing against the abdominal
wall. Interestingly, Boissonnault and Blaschak (1988) reported that diastasis
recti was absent in all women who had exercised regularly before pregnancy. A
woman can do a self-check by placing two fingers above the navel and, while
contracting the abdomen, palpating firmly. If more than 2.5 cm (two finger
widths) separate the two muscles, a modified crunch (performed by crossing the
arms over the abdomen and placing the hands alongside the abdominal muscles.
As the abdomen is contracted, the hands are squeezed inward to keep the
muscles from moving out laterally. Otherwise, the crunch is done in the supine
position with the knees bent. This puts the spine and hips into a
pelvic tilt, which supports and protects the lower back), which includes a
stabilizing measure, is recommended.
For some of best post-natal abdominal exercises log on to
Kegel should also be performed simultaneously after a modified crunch to
support the pelvic floor, which receives downward pressure from the
contracting abdominals. The spine should be slowly curled forward while the
head and shoulders are lifted 15–20 centimeters and the
waist kept flat on the
floor. The feet should be unrestrained to avoid using the assistance of the
hip flexors. The movement is performed with outstretched arms held straight
toward the knees to emphasize the rectus muscles and then rotated diagonally
to the opposite knee to involve the obliques. As greater strength is gained
over time, the arms can be folded across the chest and eventually held
alongside the head to increase resistance.
overcome inertia, the movements should be smooth,
without sudden jerks.
One to 3
months following childbirth, a complete vigorous workout can be performed,
including aerobic exercises for stimulating the cardiovascular system,
exercise using the body’s own weight, machines and hand-held weights for
developing overall muscular strength, and stretching exercise for improving
Drinking plenty of
before, during, and after exercise is important. This practice helps prevent
dizziness from either hypovolemia or hypoglycemia.
non-weight-bearing aerobic activities, such as
stationary cycling and
(e.g., swimming, aerobics, and
recommended & are best during the early recovery stage. Jogging before
involution of the uterus to its pre-pregnant size causes excess weight to push
down on the pelvic floor. Pelvic organs, most frequently the vagina and uterus
but sometimes the bladder or rectum, may protrude when support is inadequate.
Ligaments surrounding the joints also need time to recover from the increased
laxity from pregnancy. It is a good idea to wait 3 to 6 months before jogging.
Heavy breasts may also be difficult to support against bouncing.
heart rate maximum of between 135–150 is recommended during the first
few months postpartum (ACOG, 1994). A 5-minute warm-up should precede working
at the prescribed heart rate. A duration of 10–15 minutes is appropriate to
start with, working up gradually to 45 minutes within a month. If walking is
chosen, good shoes with adequate foot support are a must to avoid shin splints
or other orthopedic problems. Cross training (alternating activities) is an
effective method for preventing overuse workout syndrome injuries.
recommended that 8–10 different
strengthening exercises utilizing the major muscle groups be done at
least twice a week. If a machine on which resistance can be adjusted is used,
the setting should be heavy enough to allow at least 8–12 repetitions,
depending on the exercise. Upon completion of a set, the sensation in the
muscles should be one of moderate fatigue. The set should be stopped two to
three repetitions shy of maximal fatigue. This assures an adequate overload
stimulus but protects against overdoing. It is recommended that two sets of
each exercise be done with a 1- to 2-minute break between sets. If desired,
after 1 to 2 months of consistent workouts, a woman can perform a
circuit-style weight program in which she advances from one exercise to the
next with only a 15-second pause between exercises. Besides strengthening the
muscles, this format also provides a significant cardiovascularstimulus.
regimen of physical exercise, coupled with eating a low-fat diet, may be
undertaken during lactation without detrimental effects to the health of the
mother or to the growth of the infant. The benefits of weight and
fat loss, especially from the lower body, and improved mental
outlook and long-term prevention of certain chronic diseases clearly outweigh