In a message dated 7/19/01 7:59:50 PM Eastern Daylight Time,
[log in to unmask] writes:

<< Secondly,  I agree with Kathy
 Dettwyler's comments regarding the nutrition assessment and lactation.  In
 fact, I came to work the next day armed with my Ruth Lawrence book and the
 pages regarding maternal malnutrition and its lack of linkage to mom's milk
 supply.   >>

Now, I freely admit that I don't know what your JCAHO examiner was looking
for when talking about nutrition for breastfeeding mothers, so I may be
speaking off base here.  I also have no hospital experience, as my experience
is community based.

I work as a nutritionist for WIC, and although it is true that good nutrition
is not required to breastfed, there *are* many ways to include nutrition in a
relevant manner for breastfeeding mothers., ways that are actually relevant
and would make your examiner happy.  I think of the all the things I end up
talking about often with mothers. Here are a few I came up with.

1.  Most new mothers are worried about losing that weight postpartum.  We
specifically ask all new mothers if they are worried about their weight.
(They fill out a questionaire before they talk to us for their initial
appointment after the baby comes.)  We talk about how severe calorie
restriction isn't a good idea, because they need to eat to have energy to
take care of their baby and to aim to lose weight gradually.  This is a
chance to remind mothers that breastfeeding will help their uterus contract
to prepregnancy size faster and they will feel thinner faster!

2.  Many women have still heard that certain foods are *bad* for their baby,
or that certain foods might bother their baby. There is a chance to involve
nutrition by discussing this issue with mothers.  I personally tell mothers
that women all over the world eat all kinds of things and still successfully
nurse babies.

3.  Low hemoglobin/hematocrit.   We all know many postpartum women end their
pregnancy with inadequate iron stores.  For a woman with severe blood loss in
delivery it makes sense to follow her long enough to make sure her milk comes
in without problem.   I find in WIC that some woman discontinue vitamins or
prescribed Iron supplements postpartum, because of a belief that the vitamins
will increase her appetite and prevent her from losing that weight.  (This is
a common belief  among Hispanic women.)

4. Woman who have diabetes (or gestational diabetes) and breastfeeding are a
special opportunity to involve nutrition!  I educate my sugar intolerant
mothers that breastfeeding has been shown to help maintain blood sugars on an
even keel, and reduces the risk that their child may develop diabetes later
in life.

5.  Woman with certain medical conditions may need special support to help
maintain nutrition while breastfeeding.  (For the woman's optimal health, not
the baby's).  Cystic Fibrosis; woman with eating disorders and perhaps
altered perceptions of body images are a couple of instances that come to
mind quickly. For a woman who normally has trouble maintaining body weight,
she might need to pay extra attention to diet while nursing for her own sake.

6.  Woman who are strict vegans need to have counseling to make sure that
they are providing enough vitamin B-12 in their milk.

7. Woman with a history of family milk allergies--it may be advisable for
some woman to avoid dairy products while nursing, and she will need special
help to make sure shes getting adequate calcium. (again for her own sake).
This is a chance to tout some of the recent studies showing that
breastfeeding can be good for bone health from some of the remineralization
of bones that occurs during the weaning period!

8. Woman with new babies are often very busy and do not eat regularly.
Sometimes I find this is magnifed with the breastfeeding mothers because of
the need for more frequent feeds for the baby.
 I ask all my new mothers about their support systems, and suggest that they
ask their support people to help take care of the mother, making sure she
eats, etc, so she can concentrate her energies on nursing and her baby.  If
the support person is present with the mother when I see her I suggest it
myself. <smile>  I suggest that the new mother keep easy to prepare and
nutritious foods on hand so she doesn't have to stress over good nutrition.
(I often suggest yogurt, fruit, cheese and crackers, sandwiches). By the way,
when I see my prenatal women, I talk with them about making sure they will
have a support system in place for themselves postpartum.

In retrospect, I would have to say, (from my biased chair here as a
nutritionist), that nutrition while breastfeeding is important.  I tell my
mothers, if you aren't eating well, it won't hurt your baby, or your
milk,,,but it isn't the best thing for YOU, and your health is important to
you and your baby.  A healthy vibrant mother with good energy and nutrition
is going to be able to effectively care for her baby much better.   A woman
with good energy will be more likely to continue breastfeeding than one not
feeling well from poor nutrition.

June Rychlik
WIC Nutritionist, Lawrence Massachusetts
11 more days until I write the IBCLC exam. *gulp*

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