Health & Fitness Needs During Lactation

Author: Ms Namita Nayyar

Body image is among the greatest concerns of women during the

first year after childbirth. The desire to lose weight and tone

muscles in the postpartum period is common concern after child

birth in today's society. Weight reduction can be difficult for

anyone at anytime, but a mother who is trying to return to her

pre-pregnancy weight is also challenged with additional stresses

of increased child care commitments, less rest and sleep,

household responsibilities, and, possibly, returning to work

outside the home. A woman trying to be successful at weight

management while breastfeeding will need the support of her

family, friends, employer, and medical caregiver.

This article provides preliminary recommendations for diet and

exercise programming for breastfeeding women who have the desire

and, in consultation with their health care provider, have

determined that weight management is necessary.

Lactation places significant energy demands upon the mother,

causing the additional expenditure of more that 500 calories per

day. The recommended diet is at least 1,800 calories per day,

the minimum recommended intake for lactating women. The food

eaten should consists largely of complex carbohydrates, low in

fat and sugar, and contains the necessary meat and dairy

products to meet minimum safe nutritional intake guidelines

(United States Department of Agriculture [USDA], 1995). No

effort should be made to deliberately restrict total calorie

intake, and women should feel free to eat to satiety when they

are hungry but to refrain from becoming overly full.

There is a need to make use of dietary exchange list to simplify

meal planning and facilitates eating and recording food intake.

The exchange list represented below consists of six groups of

foods classed together because of similar calorie content and

percentage of carbohydrates, protein, and fat. The numbers and

types of exchanges eaten should be recorded after each meal in a

daily food log to keep a written track of the daily food intake.

The strength of this type of dietary recommendation, which uses

exchange lists, is that it allows the woman to plan and prepare

her own menus based on the type of foods she and her family

prefer.

The diet should be composed of approximately 60% of carbohydrate

(<=10% of which is composed of refined sugars), 20% protein, and

20-25% fat (<=33% of which is composed of saturated fats.) Eat

three or more meals per day, and eat snacks of fruit,

vegetables, and grains whenever hungry.

It is important to dispel the myth that it is acceptable to eat

as much as desired of any food touted by manufacturers as low-

or non-fat. Foods in this category (particularly snacks and

desserts) are often found to be high in refined sugar and

calories. This diet is also nutritionally sound and conducive to

a lifelong pattern of healthful eating by the woman and her

family. Vitamin and mineral supplements are not necessary but

may be taken at the discretion of the woman and her health care

provider, especially if her food choices provide marginal

dietary intake of calcium, magnesium, zinc folate, and vitamins

B6 and B12. Excessive drinking of beverages with high sugar,

caffeine, or alcohol content is discouraged.

Exercising during Lactation

A postpartum woman can begin a full exercise program as soon as

she receives approval from her medical caregiver. This is

typically after 6 weeks, although this is not based on studies

of a woman's overall health but principally on the length of

time it takes for the uterus and softened ligaments to return to

their normal pre-pregnancy state (American College of

Obstetricians and Gynecologists [ACOG], 1994). Each woman is

different, and no blanket recommendation as to when to start can

be given.

Guidelines for an effective exercise program :

A lactating woman needs to avoid excessive stretching and

lifting of heavy weights, however, since laxity of joints and

tissues may continue after the initial 6-week postpartum period.

It is important to monitor vaginal discharge (lochia), which

normally occurs for the first 6 weeks. If during activity the

color of the discharge changes from rust or whitish yellow to

bright red, exercise must be stopped. If the bleeding continues

for more than 1 hour or recurs frequently during or after a

workout, the woman's health care provider should be consulted

(ACOG, 1994).

After 2-6 weeks, more strenuous abdominal strengthening

exercises can be done. Before starting to do crunches or partial

sit-ups, it is important to check to see if the two vertical

abdominal muscles are separated (diastasis recti). This

condition can be

caused during pregnancy by the enlarging fetus pushing against

the abdominal wall. Interestingly, Boissonnault and Blaschak

(1988) reported that diastasis recti was absent in all women who

had exercised regularly before pregnancy. A woman can do a

self-check by placing two fingers above the navel and, while

contracting the abdomen, palpating firmly. If more than 2.5 cm

(two finger widths) separate the two muscles, a modified crunch

(performed by crossing the arms over the abdomen and placing the

hands alongside the abdominal muscles. As the abdomen is

contracted, the hands are squeezed inward to keep the muscles

from moving out laterally. Otherwise, the crunch is done in the

supine position with the knees bent. This puts the spine and

hips into a pelvic tilt, which supports and protects the lower

back. ), which includes a stabilizing measure, is recommended.

For some of best post-natal abdominal exercises log on to

http://www.womenfitness.net/postnatal.htm

A Kegel should also be performed simultaneously after a modified

crunch to support the pelvic floor, which receives downward

pressure from the contracting abdominals. The spine should be

slowly curled forward while the head and shoulders are lifted

15-20 centimeters and the waist kept flat on the floor. The feet

should be unrestrained to avoid using the assistance of the hip

flexors. The movement is performed with outstretched arms held

straight toward the knees to emphasize the rectus muscles and

then rotated diagonally to the opposite knee to involve the

obliques. As greater strength is gained over time, the arms can

be folded across the chest and eventually held alongside the

head to increase resistance.

To overcome inertia, the movements should be smooth, without

sudden jerks.

Regular breathing is necessary. Exhalation should occur as the

muscles tighten and inhalation as the muscles relax.

More abdominal exercises can be found at:

http://www.womenfitness.net/programs/strength/exercises.htm#ABDOM

INAL

One to 3 months following childbirth, a complete vigorous

workout can be performed, including aerobic exercises for

stimulating the cardiovascular system, resistance exercise using

the body's own weight, machines and hand-held weights for

developing overall muscular strength, and stretching exercise

for improving joint flexibility.

Drinking plenty of fluids before, during, and after exercise is

important. This practice helps prevent dizziness from either

hypovolemia or hypoglycemia.

Walking and non-weight-bearing aerobic activities, such as

stationary cycling and water exercise (e.g., swimming, aerobics,

and jogging) are recommended & are best during the early

recovery stage. Jogging before involution of the uterus to its

pre-pregnant size causes excess weight to push down on the

pelvic floor. Pelvic organs, most frequently the vagina and

uterus but sometimes the bladder or rectum, may protrude when

support is inadequate. Ligaments surrounding the joints also

need time to recover from the increased laxity from pregnancy.

It is a good idea to wait 3 to 6 months before jogging. Heavy

breasts may also be difficult to support against bouncing.

A heart rate maximum of between 135-150 is recommended during

the first few months postpartum (ACOG, 1994). A 5-minute warm-up

should precede working at the prescribed heart rate. A duration

of 10-15 minutes is appropriate to start with, working up

gradually to 45 minutes within a month. If walking is chosen,

good shoes with adequate foot support are a must to avoid shin

splints or other orthopedic problems. Cross training

(alternating activities) is an effective method for preventing

overuse workout syndrome injuries.

It is recommended that 8-10 different strengthening exercises

utilizing the major muscle groups be done at least twice a week.

If a machine on which resistance can be adjusted is used, the

setting should be heavy enough to allow at least 8-12

repetitions, depending on the exercise. Upon completion of a

set, the sensation in the muscles should be one of moderate

fatigue. The set should be stopped two to three repetitions shy

of maximal fatigue. This assures an adequate overload stimulus

but protects against overdoing. It is recommended that two sets

of each exercise be done with a 1- to 2-minute break between

sets. If desired, after 1 to 2 months of consistent workouts, a

woman can perform a circuit-style weight program in which she

advances from one exercise to the next with only a 15-second

pause between exercises. Besides strengthening the muscles, this

format also provides a significant cardiovascular stimulus.

Women must be careful when stretching after childbirth because

the joints and soft tissues have increased laxity. This is due

to increased secretions of relaxin and progesterone during

pregnancy, resulting in softened ligaments, cartilage, and the

cervix to prepare for delivery. These hormones do not return to

pre-pregnancy baseline levels for several months in the

breastfeeding mother, so she needs to be especially cautious.

The muscles needing the greatest attention are those that may

have shortened during pregnancy and may include those of the

lower back, hip flexors, chest, hamstrings, inner thighs, and

calves. Best results are achieved when flexibility exercises are

done following the aerobic phase of the workout and before

strength exercise.

Conclusion

A regular regimen of physical exercise, coupled with eating a

low-fat diet, may be undertaken during lactation without

detrimental effects to the health of the mother or to the growth

of the infant. The benefits of weight and fat loss, especially

from the lower body, and improved mental outlook and long-term

prevention of certain chronic diseases clearly outweigh any

risks.

About the author:

Namita Nayyar, creator of WF, has studied in-depth about

nutrition, both normal and therapeutic and exercise. President

of Women Fitness (WF), she is the author of all five "on-line

books" of complete fitness and has designed the customized

strength training, cardiovascular training and flexibility

training programs for women to assist them in achieving their

health and fitness goals. She has trained many women in this

field.

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Health & Fitness Needs During Lactation

Article : Health & Fitness Needs During Lactation