Pregnancy and Lactation

Good nutrition during pregnancy and lactation

Good nutrition habits need to be started prior to pregnancy and maintained throughout life especially during pregnancy and lactation phase.  Obtaining the right amount of nutrients from food is vital to accommodate your needs and the baby’s needs.  Healthy eating and physical activity will help you to stay healthy during your pregnancy as well as contribute to the healthy growth and development of your baby.  During pregnancy, a woman needs more nutrients than when not pregnant.  To get enough nutrients, emphasis should be placed on eating a variety of local and seasonal vegetables, fruits, wholegrains, meat, fish, eggs and plant protein foods aiming for the best food quality.  Avoid food that are high in sugar, saturated fats and salt.  There is no need to eat for two, as used to be thought.  Multivitamin or prenatal supplementations may be taken on the advice of your doctor.

Frequently Asked Questions on Breastfeeding
How often do I need to feed my baby?
Breastfeeding should be on demand for the first few days, as long as your baby wants.  In the first 24 – 48 hours, babies do not tend to feed very often but then become quite demanding for a day or two to catch – up.  Following the feeding pattern, breastfeeding can be frequent during the early weeks.  It is calculated that your baby requires at least 8 feeds in 24 hours, although often young babies tend to feed more frequently.  Your baby can feed even up to 14 times in 24 hours.

My baby is having a bowel movements every 3 days.  Is my baby constipated?
There is a wide variation in bowel movements of breastfed babies.  These vary from ten times a day to once a week.  Your baby is unlikely to be constipated provided there is an adequate number of wet nappies (about 8 wet nappies in 24 hours once milk supply comes in.  i.e. baby is feeding well) and is gaining adequate weight and the consistency of the stools is yellowish, rather loose and soft.  When bowel movements are less frequent, they should be abundant.

Do I need to change breast during a feed?
No, at the start of a feed the milk does not contain much fat.  The type of milk is known as foremilk and it quenches your baby’s thirst.  As the feed progresses, the fat content of human milk increases and is known as hindmilk.  Hindmilk satisfies your baby’s hunger.  When your baby drops your breast spontaneously appearing satisfied, offer the second breast.

What should I eat when breastfeeding?
Breastfeeding mother should aim to eat a varied balanced diet having the right proportions is considered essential during lactation.  Breastfeeding mother should aim to include around 500 calories extra per day.  The Healthy eating the Mediterranean way-Dietary Guidelines for Maltese Adults is a guide to eat a healthy diet even during breastfeeding.   

Do I need to give extra fluids in between breastfeeding?
Breast milk contains all the fluids a baby needs. Juices are not recommended.

Is nipple soreness normal?
Nipple soreness is normal in the first few days but there should be no signs of damaged skin or bleeding.  Better positioning at the breast may be indicated.

How can I tell if my baby is latched on properly?
Comfortable seating:  Comfortable seating in an armchair enables you to have your feet firmly on the ground whilst keeping your back straight.  Sit or lie in a comfortable position prior to latching on your baby to your breast.

Positioning of your baby:  Your baby’s shoulder and chest should be turned towards the breast.  Your baby’s nose should be level with your nipple, then tease your baby’s lips with your nipple and as your baby opens the mouth wide, bring baby towards it.  Your baby should have a mouthful of your breast.  Check whether your baby is sucking effectively or simply comfort sucking on your nipple.  Always bring your baby to your breast, never take your breast to your baby.  Once latched you will see some areola (areola is the brown circle surrounding the nipple) by your baby’s upper lip but you should see much less near the bottom lip.

My baby is 4 days old.  Why have my breasts become very uncomfortable?
This normal discomfort means that your milk has come in.  It usually lasts for around 3 days after which your breast becomes softer and comfortable.  Engorgement occurs when the breast becomes very hard and painful.  It can be caused by abruptly stopping breastfeeding.  Some mothers may even experience engorgement because of irregular breastfeeding times.   The best relief occurs with feeding your baby and then applying warm and cold compresses to your breast between feeds.  Expressing small quantities of milk approx. 10 cc whenever your breast feels painful, relieves it and keeps your nipple and areola soft so that your baby can form a teat for feeding.

One of my breasts feels painful and there is redness and swelling where I feel the pain.  What should I do?
A full breast forces milk through the ducts into the surrounding breast tissue, causing inflammation, swelling redness and pain.  If for some reason, milk cannot be removed from the breast efficiently, an infection is likely to develop within the breast, known as mastitis.  If milk enters the blood stream, it can even cause fever and flu-like symptoms.  A course of antibiotics is necessary if symptoms are still present after 24 hours but it is important to continue breastfeeding.  Allowing the breast to become full will increase the discomfort and worsen the infection.

I am not feeling well, can I continue to breastfeed my baby?
Yes, by the time you feel symptoms your body would have started to produce antibodies to fight that infection.  These antibodies will then be present in your breastmilk helping to protect your baby from that infection.  It is important that you inform your doctor that you are breastfeeding so that any prescribed medication will be compatible with breastfeeding.  Avoid buying over the counter medications.

My baby was doing well but since yesterday he never seems satisfied and my breasts feel soft and empty?
This is known as a growth spurt and occurs every so often.  Your growing baby needs to increase the amount of milk.  The only way your breast can be facilitated to produce more milk is by bringing your baby to breast to feed very frequently for a few days.  Subsequently you will notice that your baby settles again.  You may also feel your breast fuller.

I need to return to work when my baby is 3 months old.  Is it worth starting breastfeeding?
Yes, breastfeeding and working can be combined in different ways.  You can express breastmilk for the carer to feed the baby and breastfeed directly when not at work.  Your breasts do adjust but you may need to express small quantities at first to relieve full breasts during the absence from your baby.  Breastfeeding can be very special to a working mother as only she can give that to her baby, so their special bond continues.  Check with your employer whether a breastfeeding room is available at your place of work so that you can express milk during working hours.

How long should I breastfeed for?
The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months.  This means that no other food and/or drink except breast milk should be given for the first six months, your baby should be gradually introduced to single-ingredient, pureed food with a smooth consistency while continuing the same amount of breastfeeds.
WHO recommends that breastfeeding continues even into the second year of life and beyond (as long as mother and baby want to) accompanied by an increasing diet of solid foods.

Generally, no food should be eliminated from your diet but if you think that a food might be affecting your baby and make him unsettled, it is best to talk to your family doctor.  Mothers with a history of allergy benefit from avoiding any of the foods that are commonly associated with allergy such as cow’s milk, nuts and corn, shellfish, wheat and citrus fruits.  Try eliminating any of these foods, one at a time and see if your baby’s condition improves.  It may take up to ten days for it to clear from your baby’s system.  The good news is that breastfeeding lessens your baby’s chance of developing a sensitivity or allergy towards these foods later in life.

Caffeine may cause your baby to become irritable and sleepless.  Reducing your intake of coffee, tea, cola drinks and chocolate may reduce your baby’s irritability.

Contact us on:
Parentcraft:                                                                            2545 5124
Breastfeeding Walk in Clinic                                                  2545 4445/7
Health Promotion and Disease Prevention Directorate         2326 6000