Postpartum Nutrition - The 4th Trimester
My son was born unexpectedly at 35 weeks’ gestation on April 11th, 2018. I know just how difficult those first few weeks postpartum can be. Whether you experienced a vaginal delivery, a cesarean section, had a baby start out in Neonatal Intensive Care (NICU), had complications during birth, and are breastfeeding or formula feeding, the postpartum period can be exhausting and emotional regardless of the birth story. On top of it all, a new mom requires rest, hydration, and good nutrition to support birth recovery and to supply energy to care for the newborn baby.
The consensus is that most women can meet their postpartum nutrient needs from food. Yeah, sure, in theory! It’s amazing just how much time and energy it takes to nurse your baby, pump your breasts, prepare bottles, clean and sterilize equipment, use the washroom to void or have a bowel movement, take a shower when you’re in pain, change your clothes, try to nap, and chat to a few friends or family throughout the day. All this while keeping your baby alive and growing! Looking after your own nutritional intake can be a stretch some days and really takes a back seat. Support from loved ones is incredibly important to ensure meals and snacks are available to mom, and that she receives plenty of reminders and opportunities to eat and drink.
We hear so much about nutrition during pregnancy, but rarely do we think to follow up with nutrition after birth. And while the difference in nutrient needs may be minimal, there are some important considerations.
A general recommendation is to continue taking your prenatal supplement for six weeks after birth. The additional iron is useful to replace iron lost during childbirth and postpartum bleeding. If you are anemic, gave birth to twins, or follow a vegan diet, you should consult a dietitian or health care provider about a longer term supplementation plan. After the prenatal supplement runs out, I recommend to continue taking a women’s multivitamin with folic acid, calcium, iodine, magnesium, and iron to help make up for days when nutritional intake may be a little less than ideal.
Vitamin D is a nutrient that helps the body to absorb calcium and phosphorous, both of which play a role in building and maintaining strong bones and teeth and preventing osteoporosis. Health Canada recommends that adults up to 70 years of age (including during pregnancy and lactation) receive at least 600 IU vitamin D, but not more than 4000IU daily. There are very few food sources that contain enough vitamin D to meet this requirement, and Canadians may not produce enough in the skin due to reduced sun exposure during the winter months, and the use of sunscreen in summer months. Your needs don’t actually change during pregnancy or lactation compared to pre-pregnancy and most prenatal supplements will contain at least 600IU vitamin D. As soon as you stop taking the prenatal supplement, be sure to include a daily vitamin D supplement, even through the summer months. Most supplements will come in 1000IU doses per tablet and taking 1000 to 2000IU daily is safe and acceptable.
Nutrient Needs During Lactation
Lactation is an energy expensive process. A breastfeeding woman requires roughly 500-600 additional calories (more energy than required in your 3rd trimester) just to keep up with milk production for the first 6 months postpartum. A woman can make up these extra calories from both nutrient-dense food sources and from utilizing the fat stores built up during pregnancy. Overall, nutrient needs during lactation depend primarily on the volume and composition of milk produced and on mom's current nutritional status.
Generally, breastfeeding women have higher needs for vitamins A, calcium, iron, folate, zinc, and protein. However, lactating women who take in adequate calories are likely to meet the recommended dietary allowances (RDAs) for all nutrients. If nutrient intake is lower than the total demand for both maternal maintenance needs and milk production (because of low energy intake, low nutrient density of the diet, or both), the mother's body will mobilize available nutrients from her own body tissues during lactation.
It’s interesting to note that although the recommended daily allowance for calcium is the same as pregnant and non-pregnant women 19-50 years at 1000mg daily, 250–350 mg of calcium is transferred daily from the mother to the neonate through breast milk. While a low calcium intake will not affect the concentration of calcium in human milk, its effect on the mother's long-term bone density is uncertain, especially if the duration of breastfeeding is long. So it’s worth ensuring your calcium intake is adequate.
Iron needs during lactation are greatly reduced compared to pregnancy. Unless there was excessive blood loss at delivery, the total demand for iron during lactation is even less than when non-pregnant while the woman’s regular period has not yet returned. However, once her period resumes, monthly iron losses will be similar to pre-pregnancy losses during menstruation.
Importance of Fibre
Fibre is key to support comfortable bowel movements, which may have been altered relating to the changes in your pelvic floor from pregnancy and childbirth. But fibre-rich foods also play an important role in energy levels and mood stability due to their effect on slowing the digestive process. Fibre helps to keep you feeling satisfied between meals, and fibre-rich foods tend to associate with other beneficial nutrients like those found in fruits, veggies, nuts, beans, and whole grains. Daily recommended fibre intake is at minimum 25 grams.
Postpartum Weight Loss
For the first 6 weeks, just rest! Ignore any pressure (wherever it may come from - media? Family? Friends? Self induced? Fitspo hashtags?) to lose the “baby weight”. Your body changed drastically over the past 9 months - building fat stores for growth and development of the fetus, to withstand labour and delivery, and for postpartum recovery and lactation needs. Pregnancy and childbirth can change so many things about your body, including your new “normal” postpartum weight status. A woman’s body weight after pregnancy may very well remain above her pre-pregnancy weight, which is normal and should almost be expected. This does not mean a woman is less healthful, less beautiful, or less valuable.
Start with gentle movement that feels good on your body. I recommend seeing a pelvic floor therapist and/or a personal trainer who specializes in postpartum recovery.
As a dietitian who has supported many women over the past 6 years with perceived weight issues and weight loss goals, I have seen the negative effects that dieting can have on a woman’s self esteem, body image, issues with weight cycling, and consequently her long term health status. Nurture your body while allowing a natural transition in weight status without a focus on size, the scale, or numbers since research shows these do nothing to improve self esteem nor long term health status. It’s important to note that restricting calories too much and too quickly can affect milk supply and consequently infant growth if you’re breastfeeding. A calorie restricted diet will also compromise your own recovery, energy levels, and muscle mass too.
Putting it Altogether – Stocking up with my Top Go-To Foods
You will not always have the time or energy to plan and eat 3 square meals. With assistance from family and friends (don’t be afraid to ask them for help!), stock your home with nutrient-dense foods that are easy to prepare or snack on with one hand when time and energy are limited. Have something to eat every 2-4 hours in order to maintain mental and physical energy, energy requirements for lactation, and nutrient needs for recovery. Pro tip: if you struggle to remember to eat, set a timer on your phone as a reminder to assess your thirst and hunger levels. Below are a few of my favourite, low-maintenance food items:
- Frozen avocado pieces - added to a smoothie or thawed and mashed into a guacamole dip (eat with veggies, crackers, or tortilla chips)
- Nuts such as almonds, cashews, pecans, walnuts, or peanuts
- Trail mix made with dried cereal, dried fruit & nuts
- Canned tuna or salmon - for easy lunches like tuna melts, or tuna on crackers. (Hint: “light” tuna is lower in mercury because it consists of small, skipjack tuna. The smaller the fish, the lower the mercury)
- Turkey Bites (processed yes, but nice to have once in awhile as an easy protein source)
- Individual yogurt containers (or yogurt tubes that can be frozen and eaten like a Freezie)
- Home made cookies (pack them with oatmeal, seeds, and/or dried fruit to boost nutrients like iron, protein, and fibre)
- Individual cheese packs or cheese strings
- Washed, peeled, and cut raw carrots, celery, peppers or cucumbers
- Washed cherry tomatoes, snap peas, fresh green beans, or radishes
- Hummus or tzatziki dip to go along with fresh veggies or crackers
- Fresh strawberries, grapes, cherries, bananas, mandarin oranges, or apples
- Frozen berries, pineapple, or mango
- Canned peaches or pears
- Hard-boiled eggs
- Peanut butter or almond butter
- Whole rice, corn, wheat, or rye crackers - to have with hummus, guacamole, nut butter, or salsa
- Fruit smoothie packs: ½ cup frozen fruit + handful of spinach + 1 tbsp of hemp seeds - make into Ziploc bags, store in the freezer, then add yogurt and milk to make a smoothie
- Whole grain toast or bagels - avocado toast with an egg; PB toast with fruit on top; cheese toast with sliced tomatoes
- A few of your favourite comfort or “party” foods for good measure - Mine? Chewy type candies like gummy bears, chocolate, and ice cream!
The 4th trimester is a tough one so be kind to yourself! Try not to stress about the “baby weight”, trust your body to adjust naturally, and don’t place unrealistic expectations on yourself such as “getting back” the same body (or lifestyle routines) you had pre-pregnancy. Ease into exercise carefully and seek support from a trained professional. Call on family and friends to help make food readily available and to help remind you to eat and hydrate. Rest up, momma, and enjoy your new babe!
Submitted by Brooke Bulloch, RD