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How to eat well in the fourth trimester

There are many factors influencing how you feel and function during the fourth trimester or the postnatal phase. A healthy diet is just one piece of the jigsaw puzzle but eating well has many benefits. It supports your recovery, helps your immune system to work effectively, supports your overall mood and wellbeing and, if you choose to breastfeed, supports milk production (1). This post provides an overview of dietary considerations and tips to help you achieve a healthy diet when time is often not on your side.


What is a healthy diet for new mums?

A healthy diet for new mums is similar to any adult female but with some additional requirements if you are breastfeeding (see below). As a reminder, a healthy diet is one that is balanced and contains a variety of different foods. This means it will cover off all of your nutritional requirements from the macronutrients – carbohydrates (including fibre), fats and proteins and a range of micronutrients – vitamins, minerals and polyphenols.

What do I need to eat if I am breastfeeding?

If you choose to breastfeed, there are a few additional nutritional requirements beyond the general advice of eating a healthy, balanced diet. These include:

Increased calcium – an extra 550mg per day is required to support milk production and to replace any depletion in your calcium stores as a result of the pregnancy (2). Include calcium-rich foods in your diet e.g. milk, cheese, yoghurts. If you are plant-based choose calcium-enriched options.

Increased zinc - an extra 6mg per day is required if breastfeeding a baby under 4 months and an extra 2.5mg per day if your baby is over 4 months. Zinc plays a role in the function of our immune system (3) and is found in beef, shellfish, fish, beans, lentils, tofu, nuts and seeds.

Omega-3s – evidence suggests that a diet rich in omega-3s results in omega-3 rich breast milk, which is important as it supports brain development in babies (4). Sources of omega-3 includes nuts, seeds and oily fish e.g. salmon, sardines, mackerel, trout. Try and incorporate one-two servings of oily fish per week (N.B. the advice is to not eat more than two portions due to a potential risk of contamination from pollutants in the water).


Increased water/fluids– you will need to drink more fluids and remember to drink the fluids before a headache begins. It is difficult to quantify just how much you’ll need as it depends on the amount of milk produced, how hot it is and exercise levels but the European Food Safety Authority recommend around 10-12 glasses of water in comparison to 8 glasses for adults in general (5).


Increased energy– your body needs around an extra 500 calories (kcal) per day (6). Therefore it is recommended that you eat a bit more than usual while breastfeeding - a few healthy snacks or a small meal will help meet this extra demand.


How can I make sure I’m eating healthily?

Consuming enough food and healthy, balanced meals can be difficult with so much going on. Juggling life with a newborn can leave you with less time to focus on your nutrition and tiredness has an impact on our food choices (7). Here are some practical tips to help you.

1. Ask a friend/family member to bring/prepare a meal rather than bring a present. And if your baby is no longer a newborn and presents have dwindled, if your guests ask if they can bring anything – be honest!

2. Get your husband/partner involved in food prep the night before e.g. soups or overnight oats (recipe available below). Overnight oats are a filling and nutritious breakfast that take a couple of minutes prep the night before. Soups are a fantastic way to increase your vegetable intake (important for overall health including your immune system). Remember that shop-bought soups are also fine.

3. Always have snacks on you when you go out – e.g. fruit, nuts, cereal bar, trail mix – if you start to feel signs of hunger, get munching! By eating little and often it will help to keep your blood sugars stable and prevent reaching for less healthy snacks because you are famished.

4. Stock up on the basics/essentials that can be thrown together to make quick, easy and nutritious meals.

· Carbohydrates - e.g. packets of rice, quinoa, other grains, bread, wraps

· Proteins – e.g. roasted chicken, lentils, salmon, hummus, different cheeses, yoghurts

· Fats – e.g. cheese, nuts, avocados

· Vegetables – e.g. tomatoes, peppers, cucumber, carrots

· Fruits – e.g. bananas, berries, apples, oranges, satsumas, grapes (anything that doesn’t involve lots of prep)

· Seeds e.g. mixed bags to add to salads, soups and overnight oats

· Ingredients for nutrient-rich smoothies e.g. fruit, vegetables, coconut water, yoghurts.

5. Don’t restrict yourself, if you fancy a piece of cake, have it. Just try not to eat the whole cake. The important thing is to aim for a balanced diet across the week and some cake fits within a balanced diet. Nutrition/what you are eat should be thought about in weekly terms not daily. If you’ve not eaten well for a couple of days, don’t panic and try to eat more healthily when it suits.

6. Keep things simple – remember that you shouldn’t always aim for perfection in this phase of life. Cutting corners is fine. Likewise, having more numerous smaller meals is also ok if that fits better with feeding your baby. Smaller, simple meal ideas include boiled eggs (eggs are a very good source of protein and other nutrients) and toast, hummus or guacamole with vegetable crudités, baked beans on toast or peanut butter on toast. If you are eating a healthy breakfast and dinner, don’t worry so much about what you have for lunch as long as you are eating something.

7. Eat to fuel and nourish yourself, not to lose weight - bouncing back to your original body size and shape post baby can be high on the priority list. But this is not the time to start dieting. Your body needs sufficient energy to get through the day and the many roles you are fulfilling. Your body also needs a balanced, healthy diet and reducing calorie intake or restricting food groups (other than due to intolerances associated with breastmilk e.g. dairy) will not allow you to do this.

8. Stay hydrated - consuming enough fluids is incredibly important especially if you are breastfeeding. The production of milk further dehydrates your body and being so busy, many women simply forget to keep the hydration levels up and become very thirsty. To stay hydrated always have a water bottle with you when you leave the house and keep glasses or water bottles around the home in spots where you like to breastfeed. If you aren’t partial to the taste of plain water, try adding flavours to it (e.g. mint, lemon or berries) or no added sugar squash.


9. Try to remember to prioritise your own care. If you’re not eating properly it has a knock on effect. Your baby and your family need you to be functioning as well as you can. Don’t be afraid to ask for help when you need it.

Overnight oats recipe

A few minutes prep the night before gives you a tasty and nutritious breakfast option (protein and fat from the milk, yoghurt and chia seeds, slow-release energy and fibre from the oats and some of your 5/day target). There are so many different combinations - nuts, dried fruit, defrosted fruit, fresh fruit, tinned fruit, honey, maple syrup, seeds, coconut. The basic can be found here and adapted to suit your own preferences. It keeps for two days in the fridge so you can make double and have breakfast sorted for two days.


References:

1. van der Pligt P, Ball K, Crawford D et al.(2016) Maternal dietary intake and physical activity habits during the postpartum period: associations with clinician advice in a sample of Australian first time mothers. BMC Pregnancy and Childcare, 16(27). https://doi.org/10.1186/s12884-016-0812-4

2. Department of Health (1991) Report on Health and Social Subjects 41 Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. London: DOH.

3. Bonaventura P et al.(2015) Zinc and its role in immunity and inflammation. Autoimmunity Reviews, 14(4).

4. Innis SM (2007) Fatty acids and early human development. Early Hum Dev. 2007 Dec;83(12):761-6. Epub 2007 Oct 24.

5. European Food Standards Agency (EFSA) (2010) Scientific Opinion on Dietary Reference Values for water. EFSA Journal 8(3):1459.

6. Scientific Advisory Committee on Nutrition (2011) Dietary Reference Values for Energy. London:TSO. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/339317/SACN_Dietary_Reference_Values_for_Energy.pdf

7. St-Onge MP (2013) The Role of Sleep Duration in the Regulation of Energy Balance: Effects on Energy Intakes and Expenditure. Journal of Clinical Sleep Medicine, 9(1), 73–80. http://dx.doi.org/10.5664/jcsm.2348


#postnatalnutrition #newbaby #nutritionformums #fourthtrimester #postnatalsupport #postpartumnutrition #postpartumnutrition #newmumsupport

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