Body image is among
greatest concerns of women during first year after childbirth. The desire to lose weight and tone muscles in 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 home. A woman trying to be successful at weight management while breastfeeding will need support of her family, friends, employer, and medical caregiver.This article provides preliminary recommendations for diet and exercise programming for breastfeeding women who have desire and, in consultation with their health care provider, have determined that weight management is necessary.
Lactation places significant energy demands upon mother, causing additional expenditure of more that 500 calories per day. The recommended diet is at least 1,800 calories per day, minimum recommended intake for lactating women. The food eaten should consists largely of complex carbohydrates, low in fat and sugar, and contains 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 daily food intake. The strength of this type of dietary recommendation, which uses exchange lists, is that it allows woman to plan and prepare her own menus based on 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 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 woman and her family. Vitamin and mineral supplements are not necessary but may be taken at discretion of 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 length of time it takes for 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 initial 6-week postpartum period.
It is important to monitor vaginal discharge (lochia), which normally occurs for first 6 weeks. If during activity color of discharge changes from rust or whitish yellow to bright red, exercise must be stopped. If bleeding continues for more than 1 hour or recurs frequently during or after a workout, 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 two vertical abdominal muscles are separated (diastasis recti). This condition can be
caused during pregnancy by enlarging fetus pushing against 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 navel and, while contracting abdomen, palpating firmly. If more than 2.5 cm (two finger widths) separate two muscles, a modified crunch (performed by crossing arms over abdomen and placing hands alongside abdominal muscles. As abdomen is contracted, hands are squeezed inward to keep muscles from moving out laterally. Otherwise, crunch is done in supine position with knees bent. This puts spine and hips into a pelvic tilt, which supports and protects 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
