Nutrition Counseling For The Postpartum Woman Who Is Not Breastfeeding
Nutrition guidelines for the non-breastfeeding woman are the same as those for pregnancy and the postpartum breastfeeding woman, but with a few important differences. The patient is likely to have had nutrition counseling during her pregnancy, so may not need very detailed instruction, but review of the basic nutrition principles and exercise guidelines is important.
Do nutrition and weight evaluation.
The weight goal is to return to the patient’s prepregnancy weight, unless a different goal is agreed upon by the provider or nutritionist and patient. Weight loss should be gradual, about one to two pounds per week or less.
Evaluate if the patient is still taking her prenatal vitamin daily and the prescribed amount (if any) of supplemental iron. It is generally recommended to continue with the prenatal vitamins postpartum until they run out of them and to continue with iron supplements as directed by provider.
Important to teach on first visit:
q Exclusive breastfeeding will help the patient lose weight that was gained during pregnancy, but if the non-breastfeeding woman puts proper attention to diet and regular exercise, she will be able to return to her prepregnancy weight.
q Review exercise level - 30 to 60 minutes per day of walking is recommended, most days of the week (unless atypical discomforts or contraindicated by doctor; other types of exercise may be OK; the walking should be in addition to regular chores); it is important for exercise to be regular, and it should be a lifetime habit for overall physical and mental health; regular exercise is important for preventing weight gain, and for preventing diseases such as diabetes, hypertension, heart disease, etc.
q Eat 3 meals per day. Don’t skip meals. Snacks between meals are optional.
q To avoid deficiencies and help with weight loss - it is important to avoid processed foods that are low in nutrition and eat foods that are rich in nutrition (this is also important even if they are already at their desirable weight).
q Foods that usually have no nutrition or very little nutrition are sugary foods and sugary drinks. They should be avoided. (point out those eaten on their food recall or food diary)
q Also, limit fruit juice to 4 ounces per day or less - fruit juice will ruin the appetite for more nutritious foods (point out any excess fruit juice they drank on their food recall or food diary)
q Give them a list of sugary foods and sugary drinks that should be avoided – it is best to keep these out of the house so they are not a temptation:
cakes, cookies, candies , ice cream, chocolate, sweet breads, lollipops,
popsicles, Jello, flan, sugary cereals, flavored yogurts, (Hispanic favorites:
’pan dulce’, ‘arroz con leche’),
and sugary drinks:
soda , Gatorade, Koolaid, fruit punch, Sunny Delight , Tampico, Tang,
Caprisun, lemonade, instant iced tea from powder, bottled iced tea,
Powerade, Kern’s, Schnapple, Quik, ‘high energy drinks’, (Hispanic favorites:
‘agua de jamaica’, ‘agua de tamarindo’ , ‘horchata’, ‘maicena’, ‘atole’,
‘champurrado’, ‘Chocomil’, ‘Jackult’ ‘aguas de fruta’),
“and there are many more”
q Teach the WIC (Women, Infants, and Children Supplemental Food Program) Daily Food Guide for Pregnancy/Breastfeeding (Guia de Alimentación Diaria), but reduce by one the number of recommended servings from the grain group and by one the recommended number of servings from the protein group.
Refer to ‘servings needed’ as a minimum on a daily basis.
Emphasize avoiding sugary foods and sugary drinks and limiting fruit juices to
4 ounces per day or less.
Healthy foods are divided into 5 different food groups: (point to the handout and the appropriate columns as you teach the principles i.e. ‘servings needed’ column and ‘serving sizes’ column
Fruits - 2 or more every day
Vegetables - 3 servings or more daily
Grains - 6 servings or more daily,
Preferably whole grains – this is not always addressed on the first visit in order not to overwhelm the patient; you can address whole grains on the first visit or on a follow-up visit depending on time, patient’s educational level, etc.
Milk & Milk products---3 servings or more daily
Check and see if they use whole (3.5%), reduced fat (2%), lowfat (1%) or nonfat
milk (0%).
Encourage them to change to lowfat or nonfat milk.
If low in the milk group, and depending on time, patient’s educational level, etc. discuss the importance of calcium for the pregnant woman’s bone health/strength. Ask her if she knows what nutrient/mineral in the milk group (calcium) is important and why it is important. During breastfeeding much calcium is used for milk production - thus, it is important that they consume the 3 recommended servings daily.
Protein - 2 servings or more
May be important to teach on the first visit:
q Sugary foods and sugary drinks and too much fruit juice will hamper the goal to
return to prepregnancy weight and may cause further weight gain
(as well as being a major cause of deficiencies).
q Eating the daily recommended 3 servings of vegetables is an important
source of fiber, phytochemicals (plant chemicals), antioxidants, and vitamins
and minerals, and helps with weight management
q Choose foods lower in fat more often. Ask them if they know which foods are high in fat. Wait for a response from them. Give them examples of high fat foods (butter, oil, cream, margarine, lard, fried foods, red meats) and low fat foods (vegetables, fruits, legumes, chicken, nonfat milk). Use lowfat cooking methods (bake, broil, roast, barbecue, steam, poach) or use only small amounts of fat in cooking.
q If you are eating the minimum number of recommended servings on the Daily Food Guide, and not eating sugary foods or sugary drinks or more than 4 ounces of fruit juice per day, and doing the recommended amount of exercise, and still not losing weight, you can further limit fats and high fat foods, or increase the level of exercise. If this still doesn’t result in appropriate weight loss you can reduce the number of grains eaten to two to five per day, or the number of the protein group to 1 to 1 ½ per day. If you do reduce the intake of the recommended amounts on the Daily Food Guide your daily prenatal vitamin or other daily multivitamin with mineral supplements will help reduce the chance for developing nutrient deficiencies
Optional teaching for first visit:
q If you avoid sugary foods and sugary drinks and fruit juice, you will have more appetite for the nutritious foods found on the Daily Food Guide (point to all the foods on the handout). That will result in better health with less chance of infections, discomforts, illness, etc.
q Water is the best beverage.
q Have fruit available/eat fruit instead of the sugary foods or sugary drinks.
q If you are not used to eating vegetables, try different vegetables and different vegetable recipes. If you like only 1 or 2 or 3 types of vegetables, it’s okay to
eat the same ones every day.
q Eat whole grains instead of processed grains (examples of whole grains include 100% whole wheat bread, brown rice, 100% rye or 100% whole wheat crackers, oatmeal, 100% whole wheat pasta, corn tortillas)
Information for the professional:
q if they are eating the recommended number of fruits and vegetables every day, they are likely to get a good amount of vitamin C. (you can show them on the Daily Food Guide the section for Vitamin C rich fruits and vegetables)
q Dark green versus iceberg lettuce: Iceberg lettuce is mostly water, so we can’t count it as a serving of vegetables, however dark green leafy vegetables are rich in iron, folic acid, and many other vitamins and minerals including calcium.
Optional teaching for first visit:
q The importance of exercise postpartum:
- along with proper diet, it helps to lose weight that was gained during the pregnancy
- it helps all the hormones work better, we feel better and have less chance of developing diabetes, hypertension, heart disease, etc.
- after achieving the prepregnancy weight, exercise is important to help maintain that weight; maintaining a normal weight is important to help prevent diabetes, hypertension, heart disease, etc.