1. Session 39 Nutrition of lactating mothers and their health and fertility

2. Source of Energy and Nutrients in Breastmilk From mother reserves From food which mothers eat 39/1 500 Calories 200 Calories

3. Effect of Mother’s Nutrition on Breastmilk Production 39/2 WELL NOURISHED MODERATE UNDERNUTRITION SEVERE UNDERNUTRITION

4. Example of extra food needed each day by a breastfeeding woman 60g rice(1 fistful)240 Calories 30g dahl(½ fistful)120 Calories Green vegetables (1 fistful) 1 banana90 Calories 7.5 ml oil(1½ teaspoonful)50 Calories 39/3

5. Helping a Sick Mother to Breastfeed Any sick woman If admitted to hospital If she has fever If feels too unwell or unwilling to breastfeed If extremely ill If mentally ill When mother recovers Ask “Do you have a breastfeeding baby?” Encourage her to continue Admit baby with her Give plenty to drink Help her to express her breastmilk Feed baby by cup Consider expressing her breastmilk Feed baby by cup Find helper to care for mother and baby together Help her to increase her breastmilk or relactate 39/4

6. Mother’s Medication and Breastfeeding Breastfeeding contraindicated :Some anticancer drugs Radioactive substances (temporarily) Continue breastfeeding: Side effects possible Monitor baby for drowsiness Psychiatric drugs and anticonvulsants Use alternative drug if possible Monitor baby for jaundice Chloramphenicol, tetracycline, metronidazole Sulphonamides, cotrimoxazole, dapsone Use alternative drug (May decrease milk supply) Oestrogen containing contraceptives Thiazide diuretics Safe in usual dosageMost commonly used drugs 39/5

7. Breastfeeding Delays Pregnancy While no menstruation: Up to age 6 months Good protection From 6-12 months Partial protection After menstruation returns: No protection Breastfeed fully Breastfeed frequently day and night Breastfeed frequently day and night (with complementary feeds) Use another family planning method 39/6

8. Lactational Amennorrhea Method (LAM) No other family planning method needed if : No menstruation AND Baby LESS than 6 months old AND Baby fully breastfed Use other family planning FP method if : Menstruation has returned OR Baby MORE than 6 months old OR Baby not fully breastfed 39/7

9. Complementary Family Planning Options for Breastfeeding Women 39/8 1 st choice2 nd choice3 rd choice Non-Hormonal Methods  LAM  Condoms  Diaphragm  Spermicides  Intrauterine Devices  Natural Family Planning  Vasectomy  Tubal Ligation Progestin-Only Methods  Mini-pills  Injectables  Implants Methods Containing Estrogen  Combined Oral Contraceptives  Combined Injectables