This article was written in collaboration with Dr Mary CHONG and Ms Marjorelee COLEGA.

Dr Chong is Assistant Professor at the Saw Swee Hock School of Public Health, National University of Singapore and Principal Investigator at the Singapore Institute for Clinical Sciences, A*STAR. Ms Marjorelee Colega is Senior Research Officer at the Singapore Institute for Clinical Sciences, A*STAR.

After a laborious process of childbirth, knowing what to eat is necessary in your postpartum recovery process. You may be unsure if there is a need to follow a traditional Asian confinement diet and be overwhelmed with information on the do’s and don'ts. Most of these confinement practices are backed by tradition in the Chinese, Malay and Indian cultures and often have little or no solid scientific basis. Nursing mothers should make healthy choices with a balanced diet of fruit, vegetables, grains, protein foods and dairy each day as this may impact on the amount of certain nutrients given to your newborn while breastfeeding. Aside from having a nutrient-dense diet, certain herbs and spices, and supplements will also be beneficial to new mothers in postpartum healing.

Here are 8 questions and answers to support you with the journey.

1. What Are Some Healing Foods You Should Include In Your Postpartum Diet?

During your postpartum recovery, having a balanced and healthy diet will help your body to heal and certain types of foods that are high in protein and rich in iron are encouraged as they are believed to help provide replenishment to the mother to accelerate her recovery. Most importantly, ensuring you get adequate nourishment is key to regaining strength in the pre-pregnancy state and breastfeeding your newborn baby.

A nutritious diet should include the following:

  • Foods sources rich in protein and iron such as animal offals and innards, red meat (pork, beef, lamb, mutton), poultry (chicken, duck, turkey) as well as seafood (fish, crab, lobster). These are important for recovery and making up for blood loss during delivery.
  • Oily fish such as salmon, sardine, trout or mackerel is highly recommended as it is a good source of protein and is also loaded with fats called EPA and DHA, which are crucial to your baby’s brain development and may help prevent postpartum depression1. It is recommended to eat at least 2 servings of fish per week with each serving around 1 palm-sized of fish (90g or equivalent to a quarter plate portion).
  • Dairy foods such as milk, cheese, and yogurt provide key sources of calcium and vitamin D, which are important for you and your baby’s bone health.
  • Whole grains carbohydrates like brown rice, oats, whole-wheat breads help keep your energy levels up and provide your body the calories it needs to produce the best-quality milk for your baby. These wholegrain alternatives also contain important nutrients such as folic acid, iron, and fibre for your baby’s health and your well-being.
  • Plant-based sources of iron including dark green vegetables (such as watercress, spinach, kailan, broccoli), legumes and pulses, tofu and soya, and brown rice. Nuts, seeds, and dried fruit, such as raisins and prunes are good snacks that are rich in iron. However, remember that your body does not absorb iron from plant-based sources as easily as iron from animal sources. Hence, if you are taking a vegetarian or vegan diet, you will need to consume a lot of these plant-based foods to obtain sufficient iron intake.
  • Vitamin C from certain fruits and vegetables helps your body to better absorb the iron from your food. Good sources of vitamin C include fruits like oranges and kiwifruits, or non-citrus fruits such as papaya, guava, mangoes and strawberries. Vegetables such as red and green bell peppers, tomatoes and dark green leafy vegetables are also good sources of vitamin C. To help your body better absorb the iron from your food, it is important to consume adequate vitamin C as it can help the iron absorption process. Vitamin C is particularly important if you are taking a vegetarian or vegan diet, as the iron in vegetables and other plant-based foods is not as easily absorbed as the iron from animal-based foods.

2. What Kind of Fruits and Vegetables Can You Eat To Prevent Your Body From Being Too ‘Cooling’?

According to Traditional Chinese Medicine (TCM) practices in postpartum recovery, mothers are recommended to consume ‘Yang’ foods, which are considered warm or hot in nature (not in temperature) to restore balance and strength, compensate for blood loss, increase breast milk production, and decrease the incidence of blood clots and cold wind in the body. ‘Yin’ foods are restricted from the diet as they are considered to be cold (not in temperature), sour, and bitter in nature.

Although common ‘Yin’ foods include fresh fruits and vegetables2, they should be an integral part of your postpartum diet as they are rich in vitamins and minerals to help heal wounds and stitches from delivery and reduce scarring. These nutrients are antioxidants that help in protecting the body from harmful free radicals that cause disease. The fibre in fruits and vegetables is important for proper bowel function and increases beneficial bacteria which supports strong immunity.

If you have chosen the TCM recommendation, you may opt for vegetables and fruits that are more neutral and neither ‘heaty’ nor ‘cooling’ in nature. Examples of these vegetables include carrots, mushrooms, cauliflower3, kailan, spinach, lotus root, long beans, snow peas, french beans, broccoli, onions, pumpkin, or seaweed. Suggested fruits are grapes, apples3, papaya, guava, strawberries, kiwi, peach, blackberries, cherry, guava, mangoes, longan, red dates, black dates, Medjool dates.

Always aim to consume 2 servings of fruits and 2 servings of vegetables daily.

3. Are There Any Spices and Herbs Useful for Your Postpartum Recovery?

There are different types of herbs and spices used across various cultures that are believed to help you recover and ‘restore’ your body condition after childbirth4. Here are some traditional spices and herbs that have been known to be beneficial to include in your postpartum diet:

  • To keep your body ‘warm’, ginger and garlic are two heat-inducing ingredients commonly used across the three cultural confinement diets. They are also known to have anti-inflammatory properties and can help with boosting one’s immune system.
  • Indian herbs and seed herbs like saffron, fenugreek, as well as curcumin present in curry dishes have previously been reported to be effective in alleviating depressive symptoms1. In a local study, mothers who have consumed confinement diets containing herbs tended to be lower risk of postpartum depression1.
  • An increase in breastmilk production5 is seen with the consumption of herbs and spices such as fenugreek, ginger and turmeric, although the evidence is not well-established.
  • As a nursing mother, you can include herbs and spices to your diet as they increase the variety of flavours in your breastmilk. Hence, your baby is introduced to the variety of flavours before they start on solid foods as they have developed a taste of flavoured foods6.

However, spices and herbs should be taken in moderation and always seek advice from a healthcare professional before consuming any herbal products or supplements as they may not always be safe or effective.

4. Is It Necessary for You To Take Postnatal Supplements and Is It Safe if You Are Breastfeeding?

Most of the nutrients that are needed during pregnancy remain important during the postpartum period, particularly for those mothers who are breastfeeding. Supplementation of vitamins such as B12, D, calcium or omega-3 fatty acids may be necessary if you are likely not getting enough of these nutrients if you are vegetarian, vegan, lactose intolerant or do not have sufficient exposure to sunshine.

It is recommended that you check with your healthcare provider for recommendations on multi-vitamins.

5. Can You Take Drinks High in Caffeine During Your Postpartum Recovery? Should You Consume Traditional Herbal Drinks Instead of Plain Water as Some Say Drinking Plain Water Would Increase Water Retention in the Body?

Studies7 show that caffeine appears in breastmilk rapidly after being ingested by the breastfeeding mother. Although there is insufficient data to give evidence-based recommendations on exactly how much caffeine is safe for the lactating mother, caffeine is a stimulant that is well-known to cause babies to become irritable, fretful, and restless, with difficulty falling asleep. If your baby is not sleeping well or generally irritable, you should avoid caffeine altogether. Remember that caffeine is found not only in coffee but also in strong teas, cola and energy drinks. Even if you are not breastfeeding, it would be best to limit your caffeine intake, so that it does not interfere with your sleep.

In order to produce adequate breast milk for the baby, it is important to have sufficient fluids by keeping well-hydrated during the confinement period. Women who are breastfeeding but not sufficiently hydrated will have decreased milk supply. Lactating women are encouraged to drink about 12 glasses of water per day. Plain water is the best, although you can vary your options by occasionally taking juices or traditional brewed drinks such as red date tea. However, do note that some of these drinks contain high amounts of sugar so they are best limited to one glass per day. You should also aim for at least 2 glasses of milk a day to provide you and your baby with adequate calcium, vitamin D and protein if you are able to.

To alleviate water retention, limit your salt intake by using less table salt, seasoning and sauces, and consume less processed foods such as fast foods, biscuits and savoury snacks.

If you are keen to take traditional herbal preparations, consult a registered TCM physician before consuming any, to ensure that they are safe during breastfeeding.

6. Is It Safe To Eat Chinese Confinement Dishes That Are Cooked With Rice Wine or Other Types of Alcohol? Can You Also Consume Tonic Wines?

Although there is an assumption that all alcohol evaporates when heat is applied during cooking, some alcohol may still be left behind8 depending on the cooking method and cooking time. Studies show that alcohol levels remained high in breastmilk for a few hours after a lactating mother takes alcohol-based foods or drinks9. It is recommended that you only breastfeed or collect/store breastmilk for feeding at least 3 hours after ingesting foods prepared with rice wine or other types of alcohol.

Consuming tonic wine during confinement is believed in TCM practice to help expel the cold from the body and promote circulation10 because the Chinese believe that it is ‘poh’ (nourishing) and will strengthen and warm the body after the stress of childbirth, However, new mothers should not regard alcohol as essential to recovery. In fact, nursing mothers should avoid alcohol altogether, because it will be passed on to their baby through breast milk11.

Occasional light drinking while breastfeeding has not been shown to have any adverse effects on babies. On average, it takes about 2-3 hours for the alcohol from a glass of wine or beer to leave your system. If you do wish to drink alcohol, you may consider expressing your breastmilk beforehand and store it for your baby’s next feed, or wait for a few hours after drinking to breastfeed.

Related: Confinement Practices and Myths

7. Would Eating Collagen Hotpot Be the Same as Consuming Pig Trotters and Chicken Feet, Which Are Typically Served During Confinement?

From the perspective of TCM, chicken feet and pork trotters are good sources of collagen and can help improve blood flow and boost breastmilk supply after childbirth. However, these foods contain high amounts of fats and cholesterol. Similarly, collagen-based soups, which are usually made of double-boiled pork bones, chicken feet, cartilages and pork skin are high in fat, cholesterol and sodium. Excessive intake of these foods increases your cholesterol levels and may impact your risk of heart disease and other metabolic diseases.

The good news is that collagen can also be naturally found in animal flesh like meat and fish that contain connective tissues. Eating high-protein foods like fish, poultry, eggs, legumes, soy, and foods containing zinc and vitamin C such as wholegrains, fruits and vegetables can encourage collagen production in our own bodies12.

8. Should You Eat a Lot More Food, Since Production of Breastmilk Requires More Caloric Intake?

The diet of breastfeeding mothers has a major impact on milk production and quality. New mothers must adjust their caloric and fluid intake to make breastfeeding possible. If you eat a balanced diet based on ‘My Healthy Plate’ together with 500 kilocalories added to your diet, you will be able to meet your basic nutritional needs during breastfeeding, which supports your baby’s growth and development, while protecting your own nutrient stores13.

If you gained weight during pregnancy, the extra calories from these stores will naturally be utilised to produce the breastmilk your baby needs from birth to 6 months. If you lost the weight gained during pregnancy, you will need to eat an extra 400-500 calories per day. Once your infant is introduced to weaning foods from 6 months old, you will produce less milk and you can reduce your calorie intake accordingly.

Visit Parent Hub, for more useful tips and guides for a healthy pregnancy.

The article has been endorsed by the following representatives, listed in alphabetical order by institutions: A/Prof Daisy Chan (Chairperson, Chapter of Neonatologists, College of Paediatrics and Child Health Singapore), A/Prof Tan Lay Kok (Obstetrics & Gynaecology, KK Women's and Children's Hospital), Dr Moira Chia Suyin (Consultant, Department of Paediatrics, KK Women’s and Children’s Hospital), Ms Adeline Kooh Seok Koon (Asst Director, Nursing (Maternity), Mount Alvernia Hospital), Dr Angelia Chua (Family Physician Consultant, National Healthcare Group Polyclinics), Prof Lee Yung Seng (Group Director, Paediatrics, National University Hospital), Ms Susan Kok (Senior Asst Director, Nursing, Gleneagles Hospital, Parkway Pantai Group), Ms Helen Cruz Espina (Senior Lactation Consultant, Raffles Hospital Pte Ltd), A/Prof Yong Tze Tein (Head & Senior Consultant, O&G, Singapore General Hospital), Ms Fonnie Lo (Asst Director, ParentCraft Centre (Clinical) and Lactation Consultant, Thomson Medical Pte. Ltd).

Postpartum Nutrition – Your Road To Recovery.

References

1) Teo, C., Chia, A.-R., Colega, M., Chen, L.-W., Fok, D., Pang, W., Godfrey, K., Tan, K., Yap, F., Shek, L., Chong, Y.-S., Meaney, M., Chen, H., & Chong, M. (2018). Prospective associations of maternal dietary patterns and postpartum mental health in a multi-ethnic Asian cohort: The growing up in Singapore towards Healthy Outcomes (GUSTO) study. Nutrients, 10(3), 299. https://doi.org/10.3390/nu10030299

2) Liu, Y. Q., Petrini, M., & Maloni, J. A. (2014). “doing the month”: Postpartum practices in Chinese women. Nursing & Health Sciences, 17(1), 5–14. https://doi.org/10.1111/nhs.12146

3) Weng, W., & Chen, J. (2009). The eastern perspective on functional foods based on traditional Chinese medicine. Nutrition Reviews, 54(11). https://doi.org/10.1111/j.1753-4887.1996.tb03811.x

4) Teoh, Chin & I, Aizul & M, Wan & Ang, S & Z, Nurul & I, Nor & Rohana, Jaafar. (2013). Herbal Ingestion During Pregnancy and Post-Partum Period is A Cause For Concern. The Medical journal of Malaysia. 68. 157-60.

5) Bumrungpert, A., Somboonpanyakul, P., Pavadhgul, P., & Thaninthranon, S. (2018). Effects of fenugreek, ginger, and turmeric supplementation on human milk volume and nutrient content in breastfeeding mothers: A randomized double-blind controlled trial. Breastfeeding Medicine, 13(10), 645–650. https://doi.org/10.1089/bfm.2018.0159

6) Forestell, C. A. (2017). Flavor perception and preference development in human infants. Annals of Nutrition and Metabolism, 70(Suppl. 3), 17–25. https://doi.org/10.1159/000478759

7) U.S. National Library of Medicine. (2021, April 19). Caffeine. National Center for Biotechnology Information. Retrieved March 30, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK501467/?report=reader

8) AG Data Commons: Providing Central Access to USDA's Open Research Data. Ag Data Commons | Providing Central Access to USDA's Open Research Data. (n.d.). Retrieved March 30, 2022, from https://data.nal.usda.gov/dataset/usda-table-nutrient-retention-factors-release-6-2007/resource/d9e87bbb-d4db-4665-a0a1-3db85fe72f40

9) Chien, Y.-C., Liu, J.-F., Huang, Y.-J., Hsu, C.-S., & Chao, J. C.-J. (2005). Alcohol levels in Chinese lactating mothers after consumption of alcoholic diet during postpartum “doing-the-month” ritual. Alcohol, 37(3), 143–150. https://doi.org/10.1016/j.alcohol.2006.02.001

10) Thomson Medical. (n.d.). TCM wisdom on confinement food. Retrieved March 30, 2022, from https://www.thomsonmedical.com/article/tcm-physician-shares-wisdom-confinement-food/

11) Eu Yan Sang. (n.d.). Beware these 6 confinement myths. Retrieved March 30, 2022, from https://www.euyansang.com.sg/en/beware-these-6-confinement-myths/eysfertility1.html

12) Harvard T.H. Chan School of Public Health. (n.d.). Collagen. The Nutrition Source. Retrieved March 30, 2022, from https://www.hsph.harvard.edu/nutritionsource/collagen/

13) Health Promotion Board. (n.d.). An eating guide for breastfeeding mothers. Retrieved March 30, 2022, from https://www.hpb.gov.sg/article/an-eating-guide-for-breastfeeding-mothers