Wong Hui Juan, Nutritionist IBCLC
Postpartum confinement following childbirth is a traditional practice and the length of the period varied according to different cultural background from 30 days to 100 days. The first three months postpartum is also known as the “forth trimester” where both the mother and infant learn the skills of breastfeeding. Most of the Asian women continue to practice traditional practices that are generally passed down inter-generationally during this period (Withers et al., 2018).
Majority of mothers express their worry of low milk supply that subsequently causes supplementation with formula milk and early cessation of breastfeeding. It is crucial to consider the maternal and infant health status, sucking, proper latch, feeding frequency and support to overcome the contributing factors. There are many galactagogues or substances that is reported to stimulate milk production either pharmacological or non-pharmacological (natural: that are usually food or botanical herbs). Recent systematic reviews show that there is limited evidence that milk-boosting medications may increase milk volume and that natural milk boosters may improve milk volume and infants’ weight but the supporting evidence is uncertain (Foong et al., 2020).
Among the natural oral galactagogues that are more familiar in Malaysia would be black cumin (Nigella sativa), fenugreek, ginger, moringa, oats, papaya (green), quinoa, sesame, red raspberry leaf and etc. Some researches have shown how it might work and there are also possible harms that varies according to individuals. In Western countries, only ripe papaya fruit flesh is normally eaten and it is an excellent source of pro-vitamin A and vitamin C. In South-East Asia, both ripe and green papaya is consumed either raw as salad or cooked (Ikram et al., 2015). In Turkey, majority of women believe that plenty of fluid intake would increase their milk production (Ergol et al., 2016) and with the viral trending of lactation cookies, herbal teas, dates and fennel, it is no harm of trying similarly like eating salad while trying to lose weight but caution on alcohol consumption and priority should be emphasis on the basic of supply and demand. The less you breastfeed or expressing, the less milk supply will be due to the feedback inhibitor in lactation “FIL” in short.
Some of the common food taboos in Cambodia, China, India, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Singapore, Thailand and Vietnam include avoid “cold” food and drink certain “hot” drink (Withers et al., 2018). All mother are suggested to eat and drink according to their need and no need to avoid specific food as long as eat in balance and moderate (Nutrition Division MOH Malaysia, 2019). According to the Recommended Nutrient Intake for Malaysian (NCCFN Ministry of Health Malaysia, 2017), non-breastfeeding mother energy requirement is 1800-2000 kcal/ day, while breastfeeding mother require 2300-2500 kcal/ day if their infant is below 6-months. If the breastfeeding mother body mass index is more than 24.9 kg/m2 and intended to achieve ideal body weight status, she may omit the increment of extra 500kcal/ day and remain 1800-2000 kcal/ day.
Confinement diet tips:
- Start with easily digestible food and gradually return to regular diet toward the end of confinement.
- Eat local and seasonal fresh produce whenever possible
- Eat in moderate amount and avoid big portion that might cause discomfort
- Avoid empty calories and have more nutrients-dense food such as green leafy vegetables, whole grains, fruits and nuts
- Drink to quench your thirst to avoid dehydration
Food recipe during breastfeeding mothers
Green Papaya Fish Soup
6 cups water
200g fish of your choice (grouper/ seabass etc)
4-5 slices of ginger
5-6 red dates (without sulphur)
1 small green papaya (peeled, seeded, cut into medium chunks)
¼ cup goji berries
Salt to taste
1-2 teaspoon of sesame oil
Instructions:
1. Place all the ingredients in a soup pot except goji berries and salt (to be added at the end).
2. Bring the water to a boil and lower the heat to let it simmer for 1 hour.
3. Don’t stir the soup too much to avoid the fish break into small pieces.
4. Lastly add goji berries and let it cook for 5 minutes before turn off the heat.
5. Season with salt and serve immediately.
References
References
Ergol, S., Koc, G., & Kurtuncu, M. (2016). A Review of Traditional Knowledgen on Foods and Plants Supposed to Increase Lactation in Pregnant Women: A Descriptive Study. African Journal of Traditional, Complementary and Alternative Medicines, 13(3), 27–32.
Foong, S. C., Tan, M. L., Foong, W. C., Marasco, L. A., Ho, J. J., & Ong, J. H. (2020). Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database of Systematic Reviews, 2020(5). https://doi.org/10.1002/14651858.CD011505.pub2
Ikram, E. H. K., Stanley, R., Netzel, M., & Fanning, K. (2015). Phytochemicals of papaya and its traditional health and culinary uses - A review. Journal of Food Composition and Analysis, 41, 201–211. https://doi.org/10.1016/j.jfca.2015.02.010
NCCFN Ministry of Health Malaysia. (2017). Recommended Nutrient Intakes for Malaysia 2017. In Ministry of Health Malaysia.
Nutrition Division MOH Malaysia. (2019). Manual Pembimbing Penyusuan Susu Ibu untuk kegunaan Kumpulan sokongan penyusuan susu ibu.pdf.
Withers, M., Kharazmi, N., & Lim, E. (2018). Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery, 56(March 2017), 158–170. https://doi.org/10.1016/j.midw.2017.10.019
