Jack Newman, MD, FRCPC; Andrea Polokova, MA, MEd
As I stand up to leave after showing a woman how she can tell whether or not her 3 week old baby is drinking at the breast, she makes an almost inaudible comment: “I haven’t eaten all day.”
“I am sick and tired of eating just boiled chicken, boiled potatoes, peeled apples and a piece of banana. I wish I could have coffee.” And with a naughty sparkle in her eyes she adds: “Or chocolate.”
New mothers are willing to go great lengths to ensure that they can breastfeed and that their babies are safe. Sometimes they believe that if they “sacrifice” enough, they will be successful. This “sacrifice” frequently finds expression in long and diverse lists of what breastfeeding mothers can, or rather, cannot eat. Such lists of foods “forbidden” to breastfeeding mothers are found on the internet as well as doctor’s offices and hospitals and when mothers – trying desperately to get everything right – combine them, they end up having very restricted diets that make them desperate and may lead to their questioning whether breastfeeding is really worth it.
Formula companies know this full well and so they don’t hesitate to join the host of organizations in informing mothers about the “dangers of eating” all sorts of foods. Even respectable institutions such as the Mayo Clinic spread this fear of food among breastfeeding mothers:
“Certain foods or drinks in your diet could cause your baby to become irritable or have an allergic reaction. If your baby becomes fussy or develops a rash, diarrhea or congestion soon after nursing, consult your baby's doctor. (Our comment: Consulting “your baby’s doctor” often ends up with even more dietary restrictions for the mother).
And the Mayo Clinic continues: If you suspect that something in your diet might be affecting your baby, avoid the food or drink for up to a week to see if it makes a difference in your baby's behaviour. Consider eliminating food made from cow's milk, peanuts, soy, wheat, eggs or corn. Some breast-feeding women say that avoiding spicy or gassy foods, such as onions or cabbage, can help — but this hasn't been proved through research.”
It’s remarkable that when it comes to breastfeeding and limiting what breastfeeding mothers cannot do, even something that “hasn’t been proved through research” is worth mentioning. Not only that – when reading this, one gets the impression that breastfeeding is an inherently dangerous and life-limiting activity. With regard to spicy food – ask Indian women or other women who live entirely on spicy food, what do they eat?
And so breastfeeding mothers come to fear food while worrying whether their limited diets might mean that their milk is deficient in nutrients and their baby will suffer. Some mothers take the formula companies’ messages to heart and wonder whether formula would in fact be more nutritious than their own breastmilk.
The main reasons for mothers to limit their diets seem to be:
1) Worrying about their baby’s “tummy ache” or “colic” and crying and being awake all night with a screaming baby because the mother dared eat a slice of tomato. (This argument is particularly powerful as babies cry rather often and so there is always a crying episode that can be chalked down to eating something “wrong”.)
So here is the truth: Many babies cry more than usual because they would like more breastmilk. This doesn’t mean that the babies are not gaining weight well. In fact, even if the baby is gaining well, the baby might want more. There are several reasons why a baby might get less than he would want. For example, mothers are told they must feed the baby on just one breast at a feeding, so the baby gets the “hindmilk”, the “high fat milk” that comes towards the end of the feeding. But if the baby is no longer drinking, the baby is not getting high fat milk. Click Really good drinking, Nibbling and “Borderline” drinking to watch videos showing babies drinking well, or not, or something in between.
Another reason is that often babies are not allowed to breastfeed as frequently as they would like and mothers are being told not to put the baby to the breast earlier than every 3 or 2 hours. Thus, some babies cry because they want to breastfeed and mothers think it’s not the time yet and they are making babies “wait”. This becomes more pronounced in the evening (“colic” time) as many babies may want to feed more often in the evening than in the morning, for example.
Some babies don’t get as much as they would like because they are not latched on well.
And why does the baby not latch on well? Because of:
- “Technique” of positioning and latching the baby on.
- Use of artificial nipples such as bottles and nipple shields and
- The baby has a tongue-tie. Some tongue-ties are obvious, but many tongue-ties are more subtle and require an evaluation that goes farther than just looking, but includes feeling under the baby’s tongue as well and knowing what to feel for. Unfortunately, few health professionals, including lactation consultants, know how to evaluate whether or not the baby has a tongue-tie.
- The mother has had a decrease in her milk supply. Late onset decreased milk supply is common and can cause late onset sore nipples. Why? When the milk flow slows, the baby tends to slip down on the nipple and/or pulls at the breast.
And can these problems be fixed without the mother going on a restricted diet or going on special “mother formula” or putting the baby on special formula? Yes, yes, yes!
Get help from someone who knows what they are doing with regard to breastfeeding.
2) Worrying about allergic reactions while at the same time not being sure how to tell whether something is an allergic reaction.
So what is an allergic reaction? No, not the rash on the baby’s face or on his chest. No, not the fact that the baby is spitting up. In fact, the exclusive breastfed baby only rarely has allergy to a foreign protein in the mother’s milk. The presence of cow milk protein, or soy protein or shell fish protein in the milk is not bad; it’s good! It comes out in the milk in only tiny amounts accompanied by antibodies and multiple other immune factors, which actually decrease the risk of the baby having an allergic reaction and “immunize” the baby against allergy.
3) Worrying that their baby might “get” some wrong food “via” breastmilk.
This is just not true.
4) Absurd things that mothers are told include statement such as “don’t drink carbonated drinks because your baby will have gas” or “don’t drink coffee because your baby will be up all night”.
Breastmilk does not contain gas bubbles. The amount of caffeine in breastmilk after the mother has a cup or two of coffee is tiny and not likely to cause the baby to be up in the night, as shown by a study, which had mothers drink 300 mg of caffeine a day without any untoward effect on the babies.
5) Questions from breastfeeding mothers asking “May I eat this?” cover anything green tea, spices, garlic, onions, nuts, fish, sea food, oranges, steak, cream and sugar.
Mothers should eat what they want. From the moment of conception, babies are becoming familiar with what their mothers eat which in turn prepares them for eating the same food themselves. Babies drink small amounts of amniotic fluid during pregnancy and then go on to drink breastmilk, all of which prepares them to eat normal food their mothers eat. The idea of “special diets” during pregnancy, breastfeeding or the first months of “solids” (Why not call it simply “food”?) is not scientific and only plays into the hands of formula companies that make special formulas for pregnant women, for breastfeeding women and then special baby food for babies starting solids.
6) And there are the “big offenders” which even many staunch supporters of breastfeeding don’t dare eat such as beans, peas, cauliflower and cabbage.
Here is one mother’s story of how this fear of eating in breastfeeding women starts: “I was two days postpartum and have just finished breastfeeding my baby. I took a piece of melon just as a nurse opened the door and said: ‘Don’t!’ I froze and saw her pointing at the melon.”
Another mother phoned me just to ask whether she could have some whipped cream on her cake and yet another wondered whether her baby would be fat if her (the mother’s) sugar intake was high. People sometimes act as if eating an orange or drinking a cup of coffee meant the baby is effectively doing the same and getting the same as the mother. So here is a secret: Breastmilk is produced from the mother’s blood.
The answer to all questions is that breastfeeding mothers should eat a normal, unrestricted diet, should stop worrying about eating peas or garlic, and shouldn’t start out their breastfeeding experience eating a limited list of foods for the first few weeks or months. If mothers give up their fears and start eating normally, they don’t need vitamin supplements or special “mother” formulas produced by formula companies to “improve their diets”. The general recommendation based on a thorough review of all studies available is:
“There are no special dietary requirements during pregnancy and lactation. Women should be advised to eat a nutritious well balanced diet. … The nutritional status of mothers does not adversely affect their ability to breastfeed.”
2. European Commission/Karolinska Instituet/WHO Unit for Health Services Research and International Health: Infant and young child feeding: standard recommendations for the European Union, 2006.