• Adequate fluid intake during lactation is desirable to maintain maternal health, but supplemental fluids consumed in excess of natural thirst have no effect on milk volume.

RECOMMENDATIONS FOR CLINICAL PRACTICE

  • Advise women that the average rate of weight loss post partum (0.5 to 1.0 kg, or 1 to 2 lb, per month after the first month) appears to be consistent with maintaining adequate milk volume. If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.

  • The level of physical activity needs to be considered when advising women about adequacy of energy intake during lactation. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although brief fasts (lasting less than 1 day) are unlikely to decrease milk volume. Liquid diets and weight loss medications are not recommended.

  • Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.

  • If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.

  • Actively discourage cigarette smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.

  • Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee.

  • Because the early management of lactation has a strong influence on the establishment of an adequate milk supply, breastfeeding guidance should be provided prenatally and continued in the hospital after delivery and during the early postpartum period.

  • Promote breastfeeding practices that are responsive to the infant's natural appetite. In the first few weeks, infants should nurse at least 8 times per day, and some may nurse as often as 15 or more times per day. After the first month, infants fed on demand usually nurse 5 to 12 times per day.



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