Feet on a scale

Maybe you’ve already had bariatric surgery. Or you’re thinking about having bariatric surgery. Maybe you’re wondering about how that might affect you, your baby, or your milk composition and volume. But if you’re hesitant to start breastfeeding after bariatric surgery, get the facts I learned in my recent interview with Allison Childress, RD, PhD. 

Know your options for bariatric surgery 

Nowadays, options for bariatric surgery include:

  • Gastric sleeve (sleeve gastrectomy)
  • Roux-en-Y gastric bypass
  • Duodenal switch 

The duodenal switch has the greatest impact on nutrition for mothers who are breastfeeding after bariatric surgery. The gastric sleeve option presents the least threat. Nevertheless, there are a few nutrients that are especially important.

Take your supplements

You cannot consume enough food to meet all of your vitamin and mineral requirements. Take your vitamin and mineral supplements for your own sake, and your baby’s sake.

Your milk composition can be entirely adequate

  • Vitamin B-12 is important for brain development and development of healthy red blood cells. 
  • Vitamin D is a fat-soluble vitamin that is important for healthy bone development and to prevent rickets
  • Zinc is a mineral that is important for eye and brain development. (And, zinc is lower in human milk in the later part of the first year after birth.)

Whether or not you’ve had bariatric surgery, these three factors affect milk composition:

  • Dietary intake
  • Nutrient stores
  • Alteration in nutrient utilization 

Any or all of these factors can impact the composition of your milk. But remember, the human species is rigged for survival! In most cases, if you don’t have enough vitamins or minerals in your milk, they will be “stolen” from your body and move into your milk to nourish your baby. That’s why taking the supplements is important. However, we have good evidence that bariatric surgery does not affect milk composition. 

Your milk volume can be entirely adequate

Seemingly all mothers worry about whether they have enough milk. Milk volume for mothers who are breastfeeding after bariatric surgery is probably just fine unless they aren’t getting enough calories. Any breastfeeding mother who consumes fewer than 1500 calories per day will have less milk volume within about one week.

(Note: Do not confuse this with the impact of a brief fast, i.e., for religious reasons. That does not pose a problem.)

Wait awhile before getting pregnant

Try to postpone pregnancy for at least one year. (And, even if you’ve had trouble getting pregnant in the past, remember that weight loss is likely to increase your fertility!) According to Dr. Childress, you’ll lose about 50-60% of your excess weight in the first year.

Ideally, for a number of reasons that Dr. Childress explains, you should wait 2 years before becoming pregnant.

Learn about foods to consume

Like any nursing mother, you’ll need to consume extra calories when you’re breastfeeding after bariatric surgery. But consuming large volumes of food might not appeal to you.  

Select nutrient-dense foods. If you’re a busy mom looking for nutrient-dense foods that require little or no preparation, Dr. Childress suggests “weaving in” these foods throughout the day:

  • Nuts
  • Nut butters
  • Avocados
  • Cheese
  • Hummus
  • Lean proteins

Learn about foods to avoid.

Any sugary drinks — juices, soft drinks etc. — or anything sugary, might make you feel really awful. “Dumping syndrome” occurs when you consume these.

You might want to avoid dry, stringy pieces of meat. Try chopping them and adding a little broth. 

Latch and positioning may be problematic

After losing a lot of body fat, excess skin tissue on your breasts and nipples may interfere with effective positioning and latch. Hence, you may need to seek professional help when breastfeeding after bariatric surgery.   

Drink enough water

Drinking “extra” water doesn’t magically make more milk. But the human body needs water for every physiologic process. Drink about 64-80 ounces (approximately 2 to 2.5 liters) of water each day. 

Recognize signs of nutrient deficiencies in your baby

If you’re breastfeeding after bariatric surgery and taking your prescribed supplements, you and your baby are probably fine. But you may see nutrient deficiencies in your baby before you see changes in your lab values. 

Vitamin B-12 is especially concerning. Notice if your baby has extreme fatigue, vomiting, anemia, failure to thrive, or insufficient muscle tone to achieve developmental milestones. (Or, you might see regression.) With swift and effective help, these symptoms can resolve within a week.  

Get help, follow-up, and monitoring

If you’re thinking about becoming pregnant, return to your surgeon and the dietitian who works with him. Be sure that they monitor your Vitamin A, B-12, folate, iron, and phosphorous. 

Take heart when breastfeeding after bariatric surgery!

With professional help, regular monitoring, and compliance with your prescribed supplements, breastfeeding after bariatric surgery is the ideal way to feed your baby! 

Let me know your experience, whether you’re a parent or a professional, in the comments below.

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