Adequate fluid intake during lactation is desirable to maintain maternal health, but supplemental fluids consumed in excess of natural thirst have no effect on milk volume.
Advise women that the average rate of weight loss post partum (0.5 to 1.0 kg, or 1 to 2 lb, per month after the first month) appears to be consistent with maintaining adequate milk volume. If a lactating woman is overweight, a weight loss of up to 2 kg (˜4.5 lb) per month is unlikely to adversely affect milk volume, but such women should be alert for any indications that the infant's appetite is not being satisfied. Rapid weight loss (>2 kg/month after the first month post partum) is not advisable for breastfeeding women.
The level of physical activity needs to be considered when advising women about adequacy of energy intake during lactation. Intakes below 1,500 kcal/day are not recommended at any time during lactation, although brief fasts (lasting less than 1 day) are unlikely to decrease milk volume. Liquid diets and weight loss medications are not recommended.
Since the impact of curtailing maternal energy intake during the first 2 to 3 weeks post partum is unknown, dieting during this period is not recommended.
If alcohol is used, advise the lactating woman to limit her intake to no more than 0.5 g of alcohol per kg of maternal body weight per day. Intake over this level may impair the milk ejection reflex. For a 60-kg (132-lb) woman, 0.5 g of alcohol per kg of body weight corresponds to approximately 2 to 2.5 oz of liquor, 8 oz of table wine, or 2 cans of beer.
Actively discourage cigarette smoking among lactating women, not only because it may reduce milk volume but because of its other harmful effects on the mother and her infant.
Discourage intake of large quantities of coffee, other caffeine-containing beverages and medications, and decaffeinated coffee.
Because the early management of lactation has a strong influence on the establishment of an adequate milk supply, breastfeeding guidance should be provided prenatally and continued in the hospital after delivery and during the early postpartum period.
Promote breastfeeding practices that are responsive to the infant's natural appetite. In the first few weeks, infants should nurse at least 8 times per day, and some may nurse as often as 15 or more times per day. After the first month, infants fed on demand usually nurse 5 to 12 times per day.