Nutrition In The Puerperium
The puerperium is the period after delivery when all the physiological changes in the mother revert back to its pre-pregnant, or normal state. This usually takes about six weeks.
Pregnancy is an anabolic state in which the body tries to conserve proteins and essential foods for the developing fetus. On the other hand, the puerperium is a catabolic state: to revert back to normal, it has to shed what is unnecessary and retain what is needed.
It must be appreciated that during pregnancy, the growing fetus has called upon the mother’s reserves, especially her elemental stores, such as iron, calcium, zinc etc for its own. The mother must put these things right during the puerperium.
If the mother is not breast-feeding, no great adjustments need to be made. A healthy diet with nutritional supplements, especially iron and calcium, will suffice. Remember: an over-enthusiastic diet can lead to unhealthy and unsightly weight gain.
But there is a caveat to this. If there were complications during the pregnancy, such as excessive bleeding, or surgery was performed, like for a cesarean section, extra supplements may be necessary if she is to recover from anemia. Iron, folate and vitamin supplements, and foods rich in proteins and energy are recommended.
If the mother is breast-feeding, a proper nutritional balance is vital because an exclusively breast-fed baby depends on breast milk completely.
Foods For Breast-Feeding
Breast milk’s constituents come from the mother’s diet, but if that is not enough, it will come from the mother’s body stores. But the remarkable thing about breast milk is that even in the face to close famine conditions, breast milk supply will be maintained, albeit, a lower supply.
An interesting study was done in Africa among breast-feeding women during seasons of plenty and good nutrition (the dry season) and seasons of hardship and poor nutrition (the wet season). All the lactating mothers lost weight during the wet season and had a lower volume of breast milk per feed. There was also a slight difference in the protein and energy content of the milk, but a significant difference was seen in the amount of fat and in the vitamin Bs and folate.
An adequate calorie intake is important. It has been estimated that a woman who breast-feeds her infant exclusively uses about 500 calories or more a day just producing milk. Thus, a daily intake of 3000 calories should be aimed for.
Consuming less than 2000 calories per day could result in a weight loss in the mother of about a pound a week.
There are no foods that are absolutely contraindicated during breast-feeding. What the mother needs is an adequate supply of all the nutritional elements – proteins, fats and especially vitamins. The baby may show sensitivity to particular foods that the mother eats, but this is difficult to predict.
A word of caution: Most drugs are excreted in breast milk. The general rule, therefore is to AVOID drugs as far as possible. If in doubt, consult a doctor.
It is common knowledge that smoking is bad for both mother and baby. This includes passive smoking. The milk supply will not only decrease, but the nicotine can cause restlessness in the infant.
It is not uncommon for nursing mothers to consume a little alcohol, especially at night. By trial and error, they will discover that both mother and baby usually sleep more soundly after a small intake of alcohol at night. But there is a downside to this. If carried too far, it may become addictive and when the practice is stopped, there may be withdrawal symptoms in the baby.
Coffee is a common beverage for most women. But if too much is consumed, the caffeine may cause irritability and sleeplessness in the infant. Moderate consumption, say one to two cups per day, usually produces no effect.
Notwithstanding the above, the proof of the pudding is in how the baby responds.
So how do you know your baby is doing okay? On average, a breast-fed baby doubles its birth weight in five to six months. By one year, the typical breast-fed baby will weigh about two and a half to three times its birth weight.
Do not be put off by appearances: breast-fed babies tend to be leaner than bottle-fed infants. But by two years, the difference is not evident.
Another clue is in the diapers. About five to six wet disposables and two to five soiled ones per day suggests an acceptable amounts of input for a new-born that is more than a week old.
After two to three months, stool frequency is a less accurate measure of intake as some infants may go for a few days between stools. The other thing to do, if you want to be scientific about the intake issue, is to weigh the baby before and after feeds.