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[Adapted from The Nursing Mother's Companion, by Kathleen Huggins. Copyright © 2005, used by permission of The Harvard Common Press.]

Ensuring the Purest Milk

A mother may occasionally wonder if her milk is entirely safe for her child. Most frequently, this concern arises because she needs to take medication. Although most medications pass into the breast milk, the vast majority pass in only small amounts and are considered safe for the nursing infant. For more information call the University of California, San Diego, Drug Information Service at 900-226-7536 (consultation costs 4 dollars for the first minute and 2 dollars and 50 cents for each additional minute; calls average one to three minutes each).

More and more questions have arisen about the environmental pollutants we are exposed to, such as insecticides and other toxic chemicals. Many of these substances are stored in fatty tissues of the body, and, as a result, small amounts may be detected in breast milk. Experts on the subject, however, have been unable to identify any risks to the baby from such amounts, and most believe that the nutritional and immunological benefits of breast milk far outweigh the possible risks of environmental pollutants. Sadly, our children receive even greater exposure to some of these chemicals in the womb than they do at the breast.

If you want to minimize your baby's exposure to toxic chemicals, follow these guidelines during pregnancy and as long as you are breastfeeding:

• Stop using pesticides in the home, in the garden, and on pets.
• Avoid exposure to organic solvents, which are in paints, furniture strippers, gasoline fumes, non-water-based glues, nail polish, and dry-cleaning fumes. Air dry-cleaned clothes outdoors before wearing them, and avoid permanently moth-proofed garments.
• Adopt a diet low in animal fat, including butterfat.
• Avoid eating fish species that have been found to have high levels of mercury and PCB, including shark, swordfish, and king mackerel, and fish caught in contaminated waters, especially the Great Lakes. The U.S. Food and Drug Administration says that pregnant women can safely eat 12 ounces per week of all other types of cooked fish, but recommended limiting consumption of grouper, marlin, and orange roughy. The Environmental Working Group is even more conservative; this nonprofit organization suggests also completely avoiding fresh tuna, sea bass, Gulf Coast oysters, marlin, halibut, pike, walleye, white croaker, and largemouth bass, and eating no more than one serving a month of canned tuna, mahi mahi, blue mussels, Eastern oysters, cod, Pollock, Great Lakes salmon, Gulf Coast blue crab, wild channel catfish, and lake whitefish. Safe fish and shellfish, with mercury levels lower than .2 parts per million, include farmed trout, farmed catfish, fish sticks, shrimp, pollock, wild Pacific salmon, haddock, summer-caught flounder, croaker, clams, flatfish, mid-Atlantic blue crab, freshwater sport fish, and scallops. Check with your state or local health department about the safety of local species.
• Carefully wash or peel fresh fruit and vegetables.
• Avoid crash diets, which can increase the excretion of toxic substances into breast milk.
• If you work with chemicals, ask your doctor to refer you to specialist who can advise you about their safety.

Breast milk is a complete source of nutrition for your infant up until 4-6 months of age. It also conveys multiple substances that provide increased protection against certain infections. Research has indicated IQ levels may be higher in children who were breastfed, possibly due to levels of DHA (an essential Omega 3 fat) in breast milk. The American Academy of Pediatricians (AAP) policy on breastfeeding indicates that breastfeeding ensures the best health, developmental, and psychosocial outcomes. The AAP recommends breastfeeding your infant for the first twelve months, or longer if desired. If you choose to breastfeed, your body will be making your baby's nutrition. Therefore, it is essential that you continue the healthy eating habits you have adopted during your pregnancy. It is also important to continue to avoid caffeine, alcohol, cigarette smoke, medications, some herbs, and environmental toxins as many of these substances are passed through the breast milk and may affect the health of your infant.

Lactating women continue to need higher levels of calories, protein, and certain nutrients than non-pregnant women. Much of the extra calories will be produced in your body from the fat stores accumulated during pregnancy. There is an increased need for protein (65g), Vitamin A, Vitamin C, the B Vitamins, and many of the minerals. Recommended calcium intake remains the same as during pregnancy (1200mg per day). It is generally recommended that you continue to take you Prenatal Multivitamin during lactation. Discuss vitamin supplementation during lactation with your doctor or nurse-midwife.