Which of the following should the nurse recommend the client to increase in their diet during lactation?

Signs That a Breastfed Baby Is Being Well Nourished

• Your baby nurses at least 8 to 16 times in 24 hours, or every 2 to 3 hours. Your baby may be fussy once or twice a day. At these times, he or she wants to nurse often for several hours before seeming full. This is called cluster feeding.
• Your baby wets at least 6 cloth or 5 disposable diapers and has at least 1 bowel movement in 24 hours. This occurs by 1 week of age.
• You can hear your baby swallow milk while nursing or you can feel your baby swallow when lightly touching his or her throat.
• Your breasts seem softer after nursing.
• Your baby gains 4 to 8 ounces a week after the first week. There is no need to weigh your baby at home. Your baby’s doctor will do this for you. You may notice that your baby has outgrown his or her clothing.
• Your baby has regained his/her birthweight by 10 to 14 days after birth.

Factors Which Can Cause Your Milk Supply to Decrease

• Your baby feeds fewer than 8 to 16 times in 24 hours. Milk production is affected by how well the breast is drained.
• Your baby has a very weak suck, or has an improper latch.
• Giving bottles of formula or water after nursing. Most babies will suck on a bottle after nursing. This just means they need to suck. It does not mean they are still hungry. Babies cry or fuss for many reasons, such as being tired, bored, wet, hot or cold.
• Giving solid foods too early and/or before you breastfeed. Most babies do not need solid foods for the first 6 months if they are breastfeeding 8 to 16 times a day.
• Smoking can cause a decreased milk supply and interfere with the letdown reflex. Here are some things you should do:
  • Try to quit or cut down.
  • Smoke after nursing, not before.
  • Don’t smoke in the same room with your baby.
• Beginning birth control pills too soon can decrease your milk supply. Wait at least 6 weeks before taking birth control pills and then use only the mini-pill (Progestin). If you still notice a decrease in your milk supply, talk to your doctor about other birth control options. Other medications may also affect milk supply. Check with your doctor. (Refer to PI-682, Breastfeeding and Birth Control: You Have Options.)
• Mothers who are exhausted may notice a decrease in milk supply. To keep yourself from getting too tired:
  • Sleep or relax when your baby sleeps.
  • Eat balanced diet that includes high-protein food.
  • Drink when you are thirsty so that your urine is pale yellow in color. Both under and excessive over hydration can decrease milk supply.
  • Take an iron supplement if your healthcare provider says you are anemic.
  • Talk with your doctor or nurse midwife about the need for vitamin supplement.
  • Accept help when it is offered.
• Use nipple shields and pacifiers with caution.
• A breast flange that is too small or too large in size can hurt your milk supply.
• Pregnancy
• Breast reduction surgery may reduce milk supply.

If You Notice Your Milk Supply Is Low

You can increase your milk supply by:

• Nursing your baby often. Nurse every 2 hours during the day and every 3 to 4 hours at night (at least 8 to 16 times in 24 hours). If your baby will not nurse, use a good quality double electric breast pump to increase milk production. Pumping after breastfeeding signals your body to produce more milk.
• Nurse your baby at least 15 minutes at each breast. Do not limit nursing time. If your baby falls asleep after one breast, wake him or her and offer the second breast. A few babies may benefit from nursing at one breast per feeding to increase the fat content of the feeding. Switch nursing- switching breasts several times during a feeding has been shown to increase milk supply.
• Gently massage breast before and during feedings.
• Use relaxation techniques to reduce stress and promote the flow of breast milk.
• Provide skin to skin time with your baby for about 20 minutes after feeds. This “kangaroo care” has been shown to increase milk supply.
• Be sure baby is positioned and latched correctly.
• Offer both breasts at each feeding.
• Try breast compression during the feeding to help drain the breast.
• Pump immediately after breastfeeding during the day. Rest at night. Some mothers find that they get more milk if they pump for 5 minutes, rest for 5 minutes, and pump for another 10 minutes.

Talk to your doctor about using medication or the herb fenugreek.

Works Cited

Wambach, Karen and Riordan, Jan “Breastfeeding and Human Lactation”, Fifth edition, Jones & Bartlett, 2016.

The nutrition requirements for breastfeeding are similar to pregnancy, and women are recommended to continue eating similarly to how they were eating during their pregnancy. However, a breastfeeding woman needs 200 more calories per day than she did during pregnancy, and it is important that the calories come from nutritious foods. Breastfeeding women usually lose 1 to 4 pounds per month without restricting their calorie intake.

Protein Needs

While breastfeeding you should eat two to three servings of protein each day. A serving is equal to 3 to 4 ounces of meat, fish or poultry. Good sources of protein include:

• Meat
• Poultry
• Seafood
• Eggs
• Cheese
• Milk and yogurt
• Cottage cheese
• Tofu
• Dried beans

A note about seafood: The Food and Drug Administration (FDA) recommends that nursing mothers not eat shark, swordfish, king mackerel or tilefish because of their high mercury content.

Calcium Needs

The suggested daily intake of calcium for breastfeeding mothers is 1,300 milligrams per day. Reading nutrition labels can help ensure that you are getting enough calcium. For example, one cup of milk or yogurt contains 300 milligrams of calcium. The best sources of calcium are:

• Milk
• Yogurt
• Hard cheeses
• Calcium fortified orange juice
• Calcium fortified tofu

For more information, please see Calcium Content of Foods and Getting Enough Calcium.

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Iron Needs

Iron also is important for breastfeeding mothers. If you are 18 years of age or younger, you should get 10 milligrams of iron per day. For those over 19, the suggested daily intake is 9 milligrams. Good sources of iron include:

• Meat
• Poultry
• Seafood
• Dried beans
• Dried fruit
• Egg yolks

As mentioned above, it is important not to eat shark, swordfish, king mackerel or tilefish because of their high mercury content.

Vitamin C Needs

Nursing mothers need slightly more vitamin C than they did during pregnancy. If you are 18 years of age or younger, you should get 115 milligrams of vitamin C per day. If you are 19 or older, you should get 120 milligrams per day. Good sources of vitamin C include:

• Citrus fruits
• Broccoli
• Cantaloupe
• Potato
• Bell pepper
• Tomato
• Kiwi
• Cauliflower
• Cabbage

Multivitamins

Breastfeeding mothers need to take some sort of daily multivitamin that contains 100 percent of the recommended dietary allowance (RDA). If you wish, you can continue to take your prenatal vitamin or mineral supplement – however, it contains much more iron than needed for breastfeeding. If you have problems with constipation or stomach upset, switch to a general multivitamin that contains 100 percent of the recommended dietary allowance (RDA).

Water Needs

While breastfeeding you should drink at least 8 cups of water each day. Have a glass of water each time you nurse your baby. In addition to water, other good liquids are juice, milk, broths, herb teas and soups.

Exercise and high temperatures will increase your need for liquids. Therefore if you are active or it is warm, make sure you keep hydrated and drink even more water.

Other Tips

Limit high-caffeine foods and beverages, such as coffee, tea and some sodas. It is a good idea to limit your intake of highly caffeinated foods and drinks to 8 ounces a day.

Avoid alcohol, cigarettes and street drugs. Also, it is important that you do not use any medications that are not approved by your health care provider, even those available over the counter.