Adequate vitamin D levels are very important during pregnancy and lactation. In addition to the classical role of vitamin D in calcium and phosphate absorption and metabolism, vitamin D during pregnancy protects against infection, helps ensure proper fetal development, and reduces the risk of adverse pregnancy outcomes. How vitamin D protects against infection is discussed in another blog. Infection during pregnancy has been linked to adverse effects on fetal development, so is to be avoided if possible.

Vitamin D helps with fetal development not only through calcium and phosphate effects but also through effects on gene expression. Vitamin D affects the expression of hundreds of genes, turning some on, turning others off. Since fetal development is controlled to a large extent by genes, this is a very important role for vitamin D.

A number of adverse pregnancy outcomes have been linked to low vitamin D levels. One study found that the risk of primary Cesarean section delivery increased as vitamin D levels decreased. One role of vitamin D is to strengthen muscles, which may help explain why vitamin D reduces risk of primary Cesarean section delivery.

Several studies have reported increased risk of gestational diabetes for those with low vitamin D levels. Vitamin D also reduces risk of both type 1 and type 2 diabetes mellitus.

Lower vitamin D levels are also associated with increased risk of pre-eclampsia.

Other studies have found links between vitamin D deficiency and both preterm delivery and small birth weight. These effects are more common among black-Americans, who have lower vitamin D levels than white Americans primarily due to having darker skin. Black-Americans are also more likely to have infants with rickets.

Another frequent development during pregnancy is periodontal disease. Those who develop periodontal disease during pregnancy often have adverse pregnancy outcomes. There is mounting evidence that vitamin D reduces the risk of periodontal disease. Thus, periodontal disease during pregnancy can be considered a warning sign of vitamin D deficiency.

The benefit of high vitamin D levels during lactation is that the nursing infant gets its vitamin D directly from the mother rather than having to take supplements.

Most of the findings just discussed are from observational studies. Health policy makers prefer randomized controlled trials to observational studies. One such trial was reported in 2011. The pregnant women were given as much as 4000 IU/d vitamin D3. The researchers found that it took 4000 IU/d to increase vitamin D levels to above 40 ng/ml, which was high enough to raise the active form of vitamin D to the optimal level. The active form of vitamin D activates gene expression and protects against infection. There were no adverse effects such as extra calcium in the blood or urine. They also found that those taking 4000 IU/d had significantly reduced risk of primary Cesarean section delivery and pre-eclampsia. They had too few women enrolled to find significant results for other pregnancy outcomes.

Okay, breast feeding mamas: how many of you have heard about lactogenic foods? As someone who struggled to maintain a steady supply of breast milk, many lactogenic foods—foods said to possibly help boost milk production—became my go-to ingredients in those early months following each of my sons’ births. While there isn’t much research on the impact that specific foods have on breast supply, there’s strong anecdotal evidence that they work, and good old fashioned passed down wisdom, too. So much so that many professional lactation consultants and doctors believe that lactogenic foods can be helpful.

If nothing else, lactogenic foods happen to be plain good for you (and baby!). They include barley, almonds, oats, buckwheat, fennel, ginger, legumes and nutritional yeast, all of which can be used to make nutritious snacks for the whole family, even when mom isn’t breastfeeding.

I recently whipped up these super natural Cowboy Cookies for a breastfeeding mama friend who’s just had a baby. Most cowboy cookies are super sweet treats hefty enough to fuel the Wild West on sugar alone. They are usually packed with coconut, nuts, chocolate chips and loads of butter and sugar.

My delicious and totally satisfying version swaps coconut oil for part of the butter, is lower in sugar and has fewer chocolate chips than most traditional cowboy cookie recipes. I also pack mine with super healthy fixin’s including high-protein hemp seeds, lactogenic oats and nutrient dense walnuts.

There’s certainly no guarantee that these delicious sweets will improve milk supply but, if you’re going to make cookies for a new mom in your life or, really, anyone, you might as well make it these healthier treats. And, bonus: kids love them, too!

Keep in mind that the most important thing for breastfeeding mamas to do is maintain a balanced diet that’s high in protein, calcium, vitamins and minerals and drink lots of water. I’d say that they should get lots of rest too (because they should), but we mamas know how that goes! Also remember that most women only need 500 extra calories to support breastfeeding.

Dr. Greene’s Answer:

Nursing while pregnant is usually very safe for all three of you.

Brooke, when women realize they’re pregnant while still breastfeeding, they often wonder whether the nursing will affect the unborn baby or the pregnancy, whether they will still make enough nutritious milk for the current child, and how the normal breast changes of pregnancy fit in.

Women’s bodies do an amazing job of providing fabulous nutrition to their babies – even if they are not eating a lot themselves during the weeks of normal morning sickness. When the tide turns, though, and they start to feel better, it’s important to eat plenty of good healthy food to supply the nutrients Mom needs – as well as the kids.

Nursing while pregnant can trigger uterine contractions, but these usually are unrelated to miscarriages or early labor. Nursing causes the release of oxytocin, which can stimulate contractions, but at levels too low to ripen the cervix.

Women who are at especially high risk of miscarriage or early labor, though, and who have been advised not to have sex (which also releases oxytocin) may do better if they stop nursing. There are other physical reasons to choose to stop, but these are uncommon.

Usually women are able to maintain their milk supply if they’re able to drink plenty of fluids, get some rest, and the demand remains high – either from nursing or from pumping. Extra fluids, rest, nursing or pumping may help.

Fenugreek is often used to increase milk supply – but I don’t recommend its use during pregnancy. It’s likely unsafe and might be associated with early labor.

Breastfeeding is one of the best gifts you can give your baby. Here are five tips for making it as easy as possible:

1. Be Good to Yourself — The frequency of feeds varies as your baby grows. Early on feeding may be very frequent. Later, your baby may not need to feed as often, but no matter the frequency, it can take a lot of moms’ time and energy. While breastfeeding, be especially good to yourself and realize that during this window in time the most important thing you are doing is caring for your baby. Everything else can wait.
2. Drink Lots of Water — This helps you make the amount of milk your baby needs. Before sitting down to feed your baby, fill a large glass or stainless steel canteen with water so you can drink while your baby drinks.
3. Treat Yourself to a Nutritious Diet — I recommend continuing to take prenatal vitamins while nursing and being sure to eat healthy amounts of real food – this is great for mom and baby.  As an added bonus, the flavors mom eats come through breastmilk as a wonderful way to introduce baby to a rich variety of tastes.
4. Take Advantage of Your Hormones – Every time you nurse, hormones are generated that make you drowsy after nursing and take a nap when the baby naps. You are not being lazy. You are taking care of yourself so you can take care of your baby.
5. You’re Not Alone — If you have trouble nursing, call an expert for help. A Certified Lactation Consultant is an invaluable resource. You might also want to connect with a La Leche League volunteer or an experienced family member or friend. Getting the encouragement you need could make a world of difference.

Unless they’ve been living in a cave, women these days KNOW that breastfeeding is better for their babies. They just do.

So why isn’t every new mom getting on the train to lactation station? Sure, some have had surgeries or other medical problems that preclude them from the task, but for most? I theorize it’s something totally different altogether…

Deep down, many women cannot disassociate breastfeeding from SEX.

There, I said it.

Don’t believe me? These are all actual quotes from my subscribers:

• “I just can’t breastfeed. I have been conditioned throughout my entire life to see breasts as nothing more than an erotic, sexual objects.”
• “I grew up as a Baptist in the south. My mother thinks that breastfeeding is disgusting, perverted & selfish. I’m sure she’s praying that I’ll fail [at it].”
• “The thought of having an innocent little baby sucking on my boob seems so sexual that it makes me feel dirty and perverted.”
• “When I told my boss I had to go pump, he said, “that’s disgusting, your baby’s gonna be a perv. Why can’t you just bottle feed like everyone else?””
• “My husband has a major issue with it. He had my breasts all to himself until baby came along and now he’s jealous!”

People don’t like to talk about this particular issue; it’s awkward, personal, icky.

You’re much more likely to hear a woman say something like “my breasts belong to me and are not for sharing.” Ok, fair enough… but what’s really going on is something deeper.

Shameful, yet… verrrry sexy

Breasts connote two things in America: shame and S-E-X.

As girls growing up, we are taught to always hide our breasts. My friend Ashley laughs as she recalls what her mom taught her, “Later on, all the boys will try to touch them. Don’t let them. They are your PRIVATE parts.”

Any mention of milk? Sustenance? Feeding a baby, errrr… anything like that? Nope.

Janet Jackson has a costume malfunction and OH MY GAWD, we’re never letting our kids watch the Superbowl ever again! That was one powerful nipple.

And boobies take center stage when it comes to sex appeal in the media. I don’t think you need any convincing on this point. Just look at any billboard or magazine.

So it’s no wonder that some women are aghast when they are confronted by the concept of “shoving their fun bags into their baby’s mouth”, as one reader described it.

For nearly everyone else in the world, boobs really aren’t a big deal. Ever seen a Hooters in Spain? No way.

Sadly, something has been lost in this country. We must re-brand the breast in America.

Your Turn, Hollywood

Whether we like it or not, we are deeply influenced by what we see in the media. When is the last time you saw a woman breastfeeding in a movie, TV show, or commercial? Probably never.

However, we’re now seeing celebs coming out in support of the cause.

Let’s hope these displays of support help us reach the tipping point of acceptability in the mainstream culture.

The Full Picture

Recent research has revealed new benefits to breastfeeding – namely, reduced rates of cancer in baby AND mom.  Who knew?

So, in celebration of Breastfeeding Awareness Month, I present this infographic on Breastfeeding in America. This is NOT about shaming women who formula-feed, it’s about education, moral support and de-stigmatizing. For many, it’s simply about overcoming fear.

Interestingly, babies tend to suck more vigorously when a new flavor is introduced into their mothers’ diet (even if the mothers don’t notice the change in nursing, researchers can measure it). The babies’ bodies seem eager to learn new flavors. When that flavor has been repeated a few times, nursing returns to normal, suggesting that babies have indeed learned the new flavor.

Though the ability of breast milk to provide babies with exposures to a series of specific flavors is exciting, perhaps even more exciting is the ability of the variety of flavors in breast milk to help kids be more accepting of vegetables in general.

One interesting study looked at breastfed babies versus exclusively formula-fed babies and how quickly they learned to enjoy their first pureed vegetable. The babies were given either peas or green beans every day for ten days. Both groups of babies could learn to like the veggies with repeated exposures. But the breastfed babies learned to like them faster, even though their mothers hadn’t focused on either of these flavors during nursing. And after the full ten days of the experiment, the breastfed babies still tended to eat more of the veggies than did their counterparts with limited flavor experience.

Learn more in Feeding Baby Green Chapter 6, The First Months
Sullivan, S. A., and Birch, L. L. “Infant Dietary Experience and Acceptance of Solid Foods.” Pediatrics, 1994, 93: 271–277

As you might expect, different flavors appear to take a different amount of time to enter breast milk. In one recent study, researchers gave breastfeeding mothers capsules of banana, caraway seed, licorice, or menthol flavors, and tested their breast milk to see when the flavors arrived and when they left.

Banana peaked and was gone within an hour. Caraway and licorice peaked in two hours and diminished after that. Menthol remained at fairly stable levels from about two to almost eight hours. The timing varied a fair amount from woman to woman, but all four flavors were gone from all of their breast milk by eight hours after the mother swallowed the flavor.

Learn more in Feeding Baby Green Chapter 6, The First Months
Hausner, H., et al. “Differential Transfer of Dietary Flavour Compounds into Human Breast Milk.” Physiology and Behavior, 2008, 95: 118–124.

Flavors in human breast milk have been shown to influence babies’ early flavor preferences. One famous landmark study showed the power of prenatal carrots to increase acceptance of carrots by babies after birth. That same study also included women who just drank ten ounces of carrot .juice four times a week for three consecutive weeks sometime during the first two months of nursing. Their babies had both increased acceptance and enjoyment of carrots when they were later introduced directly, compared to their peers.

It’s not just the intrinsic flavors of vegetable that come through breast milk, but seasonings and spices as well.

Repeated exposure to a flavor in a positive context can help children learn to enjoy it. Breastfeeding is your last opportunity to offer these tastes through the uniquely nurturing and comforting context of your own body, before you start putting them on a spoon or in babies’ fingers.

I remember, not long ago, seeing many children with ear infections every day I was in the office – children that were often up screaming the night before. Today it’s not surprising to go an entire day in clinic without seeing a single one.

Visits to doctors’ offices for ear infections more than doubled between 1975 and 1990, from about 10 million per year to about 25 million per year. They kept increasing through about 1994, when they started to decline steadily by about 5% per year, now at their lowest level in three decades.

Over thirteen years, office visits for ear infections in kids under age 6 dropped from about 640 visits per 1000 children per year to about 380 visits. The drop for hospitalized children being diagnosed with an ear infection is even steeper. And the annual price tag for ear infection treatment in the US has fallen by about $2 billion.

Why the dramatic disappearance?

Several things have changed since the early 1990s. Air pollution, linked to ear infections, fell significantly after the Clean Air Act of 1990. Breastfeeding, protective against ear infections, increased modestly from less than 2/3 of babies starting on mother’s milk to more than ¾ today. A vaccine that may help prevent some ear infections came into wide use in 2002.

But the strongest link, according to a May 2011 study from researchers at Harvard University, came from a drop in tobacco smoke inside children’s homes. We’ve known since the 1990’s that exposure to second hand smoke causes millions of ear infections every year. In 1993, most US children were still exposed to tobacco smoke in their own home. Today only 14 percent of kids live in a home where smoking is allowed inside – a change big enough to account for the difference.

Four thoughts for responding to this good news.

1. If you smoke, smoke outside.
2. Keep the air in your home fresh. Avoid cleaners with harsh fumes. Consider houseplants to clean the air. Open windows when practical.
3. Given the option, breast feed. After weaning, choose foods that support healthy gut bacteria.
4. If your child does get an ear infection, choose a gentle treatment first, if appropriate. Antibiotics are wonderful, when needed, but each time they are given it makes another ear infection more likely. With more resistant bacteria.

Alpert HR, Behm, I, Connolly GN, Kabir Z. “Smoke-free households with children and decreasing rates of paediatric clinical encounters for otitis media in the United States.” Tobacco Control. May 2011; 20:207-211.

Bhattacharyya N and Shapiro NL. “Air quality improvement and the prevalence of frequent ear infections in children.” Otolaryngology – Head and Neck Surgery. Feb 2010; 142:242-246

Two weeks after giving birth to my now five and a half month old son I sent an email to all my mommy-to-be friends titled The Inconvenient Truth. The purpose of my email was to tell them everything I wished I’d been told prior to giving birth (about labor, not to scare, but to prepare them) but more importantly about the challenges of breastfeeding.  I read a recent post by a friend of mine that reminded me that I wanted to share my experience with other moms-to-be in hopes of giving them the best chance of having a great breastfeeding experience.

Firstly, there is a lot of societal pressure surrounding breastfeeding today. Moms are made to feel that if they choose not to breastfeed they are somehow not giving their child the best chance at life.  While it is well documented that breastmilk is the most nutritionally beneficial food source and specifically designed for each child, there are many reasons why breastfeeding might not be the right option for you, and your child. It is your choice whether or not to breastfeed and whatever you choose, for whatever reason, it is okay.

I had made the choice to breastfeed well before the birth of my son. I took a class (which I highly recommend), learned a few things, did some additional research but really thought I was just going to have to suffer through a few sore nipples and presto my son and I would be in breastfeeding bliss.  Well, that is not exactly what happened. While breastfeeding is natural, the majority of women have a tough time with everything from the latch to milk supply.  I had a pretty tough labor and birth experience and to this day I believe breastfeeding is more difficult. While the teacher in my class mentioned at one point you should try to stick it out for 6 weeks until giving up as did all the research I read, they really glazed over the reasoning. What I’ve outlined below is everything I wish had been told prior to starting to breastfeed so I was more prepared.

Take a Class – This is very important. The baby doesn’t naturally know how to latch and contrary to what most believe the baby doesn’t suck from the nipple. The baby “latches” with his top lip just over the nipple and the bottom lip well under the areola with the tongue pushing the milk out of the nipple and into the back of your baby’s throat.  I think its important to understand how this works so you can visualize what you are trying to teach your child to do.  Since you most likely will take the class prior to giving birth you won’t have a baby to practice with, but it gives you an idea of what is supposed to happen and a few tips and tricks.

Relax – Stress does not help produce milk and certainly does not help the baby feel comfortable enough to learn.  For the first few weeks while you both are learning and you are working to regulate your milk supply, find a comfortable chair/rocker, in a calm environment and nurse there every time.  It also helps to use a pillow to support your baby in the early days. My favorite is MyBrestFriend. I also liked to play soothing music. Baby lullabies work great too and the baby likes it.

Sleep – To produce enough milk you need enough sleep. Although it is difficult, try to block out the distractions of the world and sleep when your baby sleeps.  Forget about the laundry and chores and focus on sleep, which will give you good milk, which your baby will eat to satisfaction and then sleep longer. It’s a great cycle.

Eat Right and Drink Water – You burn an enormous amount of calories breastfeeding. It’s a great way to lose weight quickly when you leave the hospital. But in order to produce adequate milk you need to take in more calories than normal.  Protein is very important. It’s also important to drink LOTS OF WATER.  I estimate I drank 90 ounces a day. Breastfeeding is very dehydrating so always have a glass of water handy while you nurse.

Surround Yourself With Supportive People – The women that have the most success with breastfeeding are surrounded by supportive people. Have your spouse, significant other, caretaker or parents that already support you in your choice to breastfeed help you through the tough times. I also found it helpful to take them to any breastfeeding classes, lactation consultant appointments and breastfeeding support groups.