Ramadan for the Breastfeeding Mother

UPDATE: 

We have included the Women & Ramadan Booklet produced by MUIS for public reference at the end of the article.

By Khatim Hamidon
Vice-President, BMSG

With the coming of Ramadan tomorrow, many Muslim mothers would definitely feel the anxiety of managing fasting with breastfeeding. In this write-up, we will discuss how breastfeeding mothers can prepare themselves for Ramadan. We also acknowledge that there are concessions in Islam about fasting for the pregnant and breastfeeding mothers. We urge you to consult your religious teachers with respect to the rulings on fasting and paying back the fast for breastfeeding and pregnant mothers.

Counting Calories

On average, a woman needs about 2,000 calories a day. If she is exclusively breastfeeding a baby, she would need an extra 300 to 500 calories. If she consumes a lot less calories than this, her milk supply may be affected.

How many extra calories that she needs also depends on her activity level, body fat reserves, her nutritional status and the type of food she is eating (e.g. processed food is not calorie-dense and hence won’t help her store energy).

Furthermore, it also depends on the demand – how much her baby takes, how many babies she is feeding and if she is also pregnant. Of course, if she is tandem-feeding twins, she would need double the extra calories, which is 600 to 1,000 more calories. Do consider the age of your baby if you decide to fast.

As for water, it is important for the mother to take sufficient fluids. On average, we need to drink approximately 1 litre of water for every 20 kg of body weight. Breastfeeding mothers need about 3 litres of water a day. Some people erroneously believe that during confinement, mothers should avoid drinking a lot of water. This is untrue, as it may affect her milk supply.

Knowing the above facts, how then can breastfeeding mothers prepare themselves to manage fasting in Ramadan?

 

Preparing to Fast

Breastfeeding mothers must prepare adequately to start fasting for Ramadan: physically, mentally, spiritually.

Hopefully by preparing in terms of food intake, this may ensure that she has enough intake and milk supply to last throughout the day. Preparing to fast is only being fair to her body and her baby.

  1. Water is important to avoid dehydration. We often suggest to mothers to do water parades after the start of sunset, which is to drink at least a cup every half hour while she is awake, to avoid feeling bloated. She can also eat juicy fruits like watermelon and oranges, and soups, which account for the daily fluid intake as well.
  2. Aim for food that make you sustain more energy throughout the day. Take food with high fibre, low glycemic index and which are less or not processed. Instead of white rice, take brown rice.
  3. Fruits and vegetables remain an important part of your diet with at least four servings a day. Dates remain as important as ever for its high fibre content and complex sugars to sustain your energy level.
  4. If you can’t take rice so early in the morning for the pre-dawn meal (sahur), you can make power shakes, like mangoes with baby spinach and chia seeds, or yoghurt, honey and oats.
  5. Some mothers find that natural health supplements and lactogenic food might help them with energy levels and milk supply, such as habbatus sauda’ (black seed). Please note that supplements are just that: to supplement your diet and not a full substitute.
  6. Avoid foods and drinks that are overly processed, oil-laden and sugar-laden, as they won’t help you sustain yourself. These foods may also burden your digestive system since they are harder to digest.
  7. Throughout the day, try not to over-exert yourself if you can help it. Prioritise what you need to do to conserve energy.

Besides taking care of food intake, some moms acclimatise their bodies slowly to fasting, by having “test fasts” before Ramadan to see how they will take to fasting during the month. Some will find it helpful to take alternate days to fast – be it for the whole month, or for the first week. Some moms will attempt to fast the whole month and break their fast early if they get unwell or feel that they babies may benefit more from a mother who is not fasting.

When to break your fast during the day

Be in tune with your body and with your baby, so that you won’t miss the signs if you need to break your fast early.

 

Signs that you should probably break your fast:

  • Signs of hypoglycemia such as giddiness, cold sweat, shivering, pale face, fatigue
  • Signs of dehydration such as inadequate supply of milk, headache, dizziness, irritability, dry skin

Whenever you feel that any of the above impedes your function and your ability to care for your baby, it’s time to break your fast.

 

Signs of dehydration for your baby:

  • restlessness and being fussy at the breast (perhaps due to less supply or flow of milk)
  • less wet diapers than normal
  • listlessness
  • dried, chapped lips, mouth and skin
  • eyes and fontanelle (soft spot on baby’s head) appear sunken
  • sleepiness (due to less energy)
  • weight loss is a VERY late sign of dehydration

You do not ever want your baby to reach this level – be responsible. You are your baby’s source of food and comfort, so take charge.

 

Breaking Your Fast

So you have prepared for fasting, but for some reason you cannot continue for any of the reasons above – it’s okay. Every person is unique and has different strengths, threshold and limitations.

There is reason why women are given rukhsah (concessions or keringanan in Malay) to break their fast, when breastfeeding and/or pregnant. It is a rahmah (mercy) from Allah. He knows, in His infinite wisdom, that He made certain people with certain limitations, and wants them to take advantage of any consolation that He has awarded to special people – and that is perfectly normal and nothing to be ashamed of.

Continuing to fast despite all of the signs of extreme dehydration is harmful to you and/or your baby. What is important is what is happening at the present moment. If you can’t fast now, you can pay fidyah (the monetary penalty for not paying back missed fast by the next Ramadan) or pay back your fast at a different time later on in the future when you are more capable.

This is especially important for mothers whose babies are less than six months of age. During this period, an exclusively fed baby is recommended to take nothing but his mother’s milk, as per World Health Organization (WHO) guidelines.

Ramadan is not merely just for fasting; it is a month of ‘ibadah (worship). There are other acts of worship that a mother can do to attain the rewards of this holy month. In fact, with proper intention, taking care of yourself and your baby is an act of ‘ibadah as you are fulfilling an amanah (responsibility bestowed by God).

For more information on legal rulings of fasting for Muslim women, please refer to the following links. More links will be updated soon:

April 2018 Newsletter: Counsellor Spotlight – Shana Shang

By BMSG Editorial Team

As part of recognising the work of our volunteer counsellors, we will be featuring our counsellors regularly in our monthly newsletter. Our counsellors come from all walks of life, which adds diversity to our counselling team. This month, we feature Shana Shang, a Traditional Chinese Medicine (TCM) Practitioner and mother of two girls.

Shana (bottom left) with her family.

 

Tell us more about yourself!

My name is Shana Shang. I have two children. I am a registered nurse and also a certified TCM physician. I am currently working as a TCM physician at a local clinic here. I meet a lot of breastfeeding mothers at my clinic and that was one of the push factors in helping me decide to become a volunteer counsellor. I have since been a volunteer counsellor with BMSG since March 2017.

 

What inspired you to become a volunteer counsellor?

It is not a special moment or event that inspired me to become a volunteer counsellor, but rather it was my own breastfeeding experience and struggles that brought me all the way here. I remember feeling so lost in trying to latch, and caring for my first child, and I nearly went into depression because of that.

When I had my second child, I encountered mastitis and struggled with finding proper treatment for it. My past experiences has taught me that emotional support, knowledge and resources are really valuable for breastfeeding mummies in Singapore, regardless whether you are a new or veteran mother. Every breastfeeding experience with each child is different. I have since discovered my passion in helping breastfeeding mummies due to my experience.

 

Shana (standing 2nd from right in black) with her batch of then trainee counsellors in 2017.

How do you juggle between your responsibilities at home, at work, and your counselling duties?

As I am occupied with patients on the weekdays, I am scheduled for Facebook counselling on one weekend and WhatsApp counselling on one weekday. There are times where I will need to attend to the needs of my family during the course of my rostered shift; I struggle just like any other working mother as weekends are precious for my family and me. Fortunately, my fellow counsellors will step in and help whenever they are available. Indeed, they make such a great team. From time to time, I also facilitate the breastfeeding workshops run by BMSG together with my other counsellors. Though it has been very busy for all of us, I thoroughly enjoy the camaraderie with the BMSG team and we look forward to helping the women we meet along the way.

Interested to become a volunteer breastfeeding counsellor with BMSG? Training sessions are conducted once a year. Intake for 2018 has closed but if you are interested in the training for 2019, email your interest to office@breastfeeding.org.sg.

April 2018 Newsletter: Inducing Lactation – An Adoptive Mum’s Story

As told to the BMSG Editorial Team

At the end of 2017, we chanced upon Janet (not her real name) who had made known her intentions to induce lactation. This is her story of how she had managed to breastfeed her adopted daughter after getting support from medical professionals, experts and her family.

My husband and I had decided to adopt a child last year. I first heard that it is possible to induce lactation without having given birth from my aunt, when we shared with her our adoption plans.  This made me very curious so I started doing research on general information about it on the Internet.

I had also read a lot about the benefits of breastmilk for the baby’s health and I had imagined that the bonding experience was extremely priceless.  I had read that it wouldn’t be easy but I decided that I would love to give it a try. However, I was clear that I didn’t want to put too much pressure on myself.

 

Different Ways to Induce Lactation

There are few different methods to try depending on your situation and the amount of time you have to prepare before the baby arrives.

They include using ‘the Pill’, which causes your body to mimic pregnancy, and the medication Domperidone, which causes a rise in your prolactin levels, which is responsible for milk production. (*BMSG Note: It is necessary to use these medications under the supervision of a doctor or a qualified lactation consultant.)

Another way is to go natural and only use stimulation via using a pump.

 

Kickstarting the Journey: Finding the Right Support

I had also discovered that getting the advice of a Lactation Consultant (LC) would be valuable so I searched around for one and chanced upon the Mother and Child Clinic, which was run by International Board Certified Lactation Consultants (IBCLCs). They were agreeable and we had a meeting, and I found them really helpful and supportive.  

They provided ample information about lactation, how it works, how to go about inducing it and also gave me recipes for lactation cookies and smoothies. I then bought an electric breast pump and went on my way to stimulate my body to begin the lactation process.

I decided that I would start on the natural route as I did not have much time to try to mimic pregnancy and was also unsure about consuming Domperidone.  Much to my surprise, twelve hours after beginning, I got my first drops of milk!

 

Challenges
Unfortunately after a few days of pumping, I could not keep up with my pumping schedule as I had to leave home for long hours at a time.  I discovered that it would be challenging for any mother who chooses to pump till the day baby arrives as consistency in stimulation is key to sustaining my supply.  Pumping every two hours proved to be challenging, so I began a schedule of pumping every three to four hours instead.

I watched my breasts change over the course of the first week I began pumping.  They felt a little fuller and heavier and the areolas also felt a bit different.  While I didn’t produce a significant amount then, I managed to get a pool of milk each time that I accumulated together with earlier batches.At that stage, while I pumped, I also did a lot of massage and stimulation with my hands. The LC explained that this was probably more effective than pumping alone.

The Plan

We had to do some planning for when baby came along. I had been given strict instructions to go to Mother and Child and check in with my LC immediately once baby arrived. She would help us set up the Supplemental Nursing System (SNS) and teach us how to get baby to latch. If I didn’t produce 100%, it wouldn’t matter.  Any amount of breastmilk is helpful to an infant. The most important thing for me was to bond with my baby and if I didn’t end up producing enough for all her feeds, I could always rely on the generous ladies on the Human Milk for Human Babies Singapore (HM4HB Singapore) page to help my little one flourish from their milk donations.

 

When Baby Arrived

We brought our daughter home at two weeks old and she is now 12 weeks old. We first attempted to use the SNS but it proved to be quite challenging for me. Upon reflection, I felt I would have been able to build up more of a supply if I had more time to pump and if I could have used the SNS optimally as she would have spent more time at my breast.

However, I am mostly at home alone and don’t have domestic help, so it’s hard to find time to do all the extra pumps. I top up whatever amount of milk I can produce with donated breast milk from people I trust. I am happy to say that I currently produce around 80% of my daughter’s breastmilk needs while 20% comes from donated milk. The night time and early morning feeds do not require top ups but the afternoon and early evening feeds definitely do!

I had also attempted to use Domperidone to increase my supply eventually. However, other mothers may find it more helpful if they start the full protocol of induced lactation whereby you take the contraceptive pill for several months before baby arrives. Unfortunately, I had difficulties finding a doctor who could support me in this aspect.

One of the most amazing things that has happened was that my daughter’s birth mum had actually provided our daughter with colostrum, which is an incredible gift from a birth mother who is placing her baby for adoption. She’s really had a lucky start to life with her nourishment despite her unfortunate circumstances of losing her birth mother.

I, too, feel so blessed to be able to nourish her from my own body like my biological child and the bonding experience has been amazing. I also continue to work together with the LCs at Mother and Child, and they have been ever so supportive and provided me with so much information.

It has been such an amazing experience and I am thankful for all the support and help we have received. I was asked why it was important to me to breastfeed her. Once I realised that breastfeeding was possible, I felt a responsibility to give her the very best of what I can. We had both already lost so much and it gave us back something powerful. An emotional connection, the very best nutrition and I can only hope it helps to heal some deep wounds she would carry.

Janet’s baby is now 12 weeks old.

I was asked why it was important to me to breastfeed her. Once I realised that breastfeeding was possible, I felt a responsibility to give her the very best of what I can. We had both already lost so much and it gave us back something powerful. An emotional connection, the very best nutrition and I can only hope it helps to heal some deep wounds she would carry.

Useful Resources for Inducing Lactation:

  1. The Newman Goldfarb Protocol for Induced Lactation
  2. Relactation & Induced Lactation Resources on KellyMom