Postnatal Nutrition: What You Actually Need

The headline: there is no postnatal diet

The NHS is explicit: “you do not need to follow a special diet while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet with a variety of foods every day.” It repeats the point elsewhere: if you are breastfeeding and a healthy weight for your height, “you do not need to eat a special diet.”

What changes after birth is not the composition of a good diet but the difficulty of achieving it, and a small number of specific supplements and cautions that do have evidence behind them. NICE NG194 lists nutrition and diet among the topics to be discussed at postnatal contacts.

What the plate should look like

The NHS's list for breastfeeding women is the general healthy-eating pattern:

• At least 5 portions of different coloured fruit and vegetables a day — fresh, frozen, tinned or dried — with no more than one 150ml glass of unsweetened juice or smoothie.
• Starchy foods such as potatoes, bread, pasta or rice, choosing higher fibre or wholegrain varieties where possible.
• Plenty of fibre. The NHS gives the postnatal reason directly: “after having a baby, some women have bowel problems and constipation, and fibre can help with this.”
• Protein foods: beans, pulses, fish, eggs and lean meat.
• Dairy or fortified dairy alternatives, for calcium and protein.
• Plenty of fluids — the NHS suggests having a drink beside you when you settle down to feed.

On fish: aim for at least 2 portions a week, one of them oily. But the NHS caps oily fish at 2 portions a week for all women, and shark, swordfish and marlin at no more than 1 portion a week for all adults.

The supplements that are actually recommended

Vitamin D

This is the one national guidance singles out. The NHS: “everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10mcg of vitamin D during the autumn and winter months.” Its breastfeeding-specific page goes further: “if you're breastfeeding, you should consider taking a 10mcg daily vitamin D supplement.”

Your baby needs their own. The NHS: “if your baby is only having breast milk (no first infant formula top-ups), you should give them a daily vitamin D supplement of 8.5 to 10mcg.” Vitamin D is found in oily fish such as salmon, sardines and mackerel, in red meat and in some breakfast cereals, “but it's hard to get enough from food alone.”

What else

The NHS says you can usually get all the other vitamins and minerals you need from a varied, balanced diet. On a restricted diet such as a vegan one, you may be advised to include foods and drinks with added vitamin B12 or take a B12 supplement. Its general postnatal page notes that if you are breastfeeding you can take supplements containing folic acid, vitamin C and vitamin D.

Iron, if you lost blood

This is the gap most nutrition advice misses. NICE NG194 requires midwives to assess for symptoms and signs of anaemia at postnatal contacts. NICE NG192 tells clinicians to inform your GP if follow-up investigations are needed after discharge, “for example, a repeat full blood count if there has been a large amount of blood loss”. The HSE notes that the risk of needing a transfusion at caesarean birth is higher if you were anaemic beforehand, and that “if a blood test shows that you have anaemia, your doctor or midwife may recommend that you take an iron supplement.” Exhaustion that does not lift is worth a blood test, not just an early night.

Caffeine and alcohol

The NHS: caffeine reaches your baby through breast milk and is a stimulant, so a lot of it “may make your baby restless and keep them awake”. It is honest about the evidence — “there's not enough information to say how much caffeine is too much, and babies respond to caffeine differently” — but advises reducing intake, especially while your baby is under 6 months. Caffeine is in coffee, tea, chocolate, some soft and energy drinks, and some cold and flu remedies.

Weight, and what not to do about it

The NHS: “if you're breastfeeding and you're overweight, the best way to lose weight is by eating a healthy, balanced diet and taking regular, moderate exercise, such as a brisk walk for 30 minutes each day. This will not affect the quality or quantity of your breast milk.” If you join a weight-loss group, tell them you have recently had a baby and whether you are breastfeeding, so the advice you get suits you. NICE NG194 lists nutrition, diet, physical activity and weight among the topics a midwife should raise at postnatal contacts, so it is a legitimate thing to bring up rather than something to sort out privately.

Making it possible when you have a newborn

The NHS's time-saving suggestions are worth more than any superfood list: cook more than you need and freeze the extra portions; use tinned and frozen fruit and vegetables, which count towards your 5 A Day; keep raw vegetables such as carrots and celery for snacking; steam vegetables and fish; and take people up on the offer of a home-cooked dinner. Its snack list for breastfeeding is fruit with unsalted nuts, lower-fat and lower-sugar yoghurt, hummus with bread or vegetable sticks, fortified wholegrain cereals with lower-fat milk, and milky drinks.

Money, if that is the constraint

The NHS points to the Healthy Start scheme: if you are more than 10 weeks pregnant or have a child under 4 and are eligible, you get a card loaded with money for milk, fruit, vegetables and pulses, and can use it to get free vitamin supplements. It also notes that “you're entitled to free NHS prescriptions for 12 months after your baby is born”, using a maternity exemption certificate — and you can still apply for the certificate at any point in those 12 months if you did not do so in pregnancy.

When to call

Speak to your GP, midwife or health visitor if:

• You are exhausted, breathless on mild exertion, or unusually pale — possible anaemia, which NICE expects to be assessed after birth.
• You have constipation that will not shift. The NHS says to talk to a midwife or GP, and that a gentle laxative may help; NICE recommends considering laxatives for anyone taking opioids after a caesarean.
• You are on a restricted diet and unsure about B12, iodine or calcium.
• You are worried about your weight, or want help losing weight safely while breastfeeding.
• You think something you are eating is affecting your baby — the NHS suggests talking to your GP or health visitor, or calling the National Breastfeeding Helpline on 0300 100 0212.

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, or 111 in New Zealand) if you collapse, become severely breathless, or have chest pain.