Ramadan and Breastfeeding: To fast or not to fast?
Isn't that always the question...in every mommy group, mosque or playdate gathering.
Before we start, full disclosure: My goal as an IBCLC is to provide you with evidenced based information so YOU can make an informed decision. I am not a scholar and I am not here to tell you whether you should or should not fast, but I am simply giving you knowledge that I have gained over my years of research from both an Islamic perspective and that of an International Board Certified Lactation Consultant (IBCLC). If you have concerns beyond what I have discussed here you can reach out to me regarding breastfeeding concerns or reach out to your Imam regarding Islamic rulings.
The two months before the start of Ramadan are months of preparation. Every year, around this time, I hear the same resounding questions and concerns from my fellow sisters, “How do you all breastfeed and fast?”, “Am I exempt from fasting since I am breastfeeding?”, “Will my milk supply drop?” Let me tell you, the struggle is real!
Sawm (fasting) is one of the 5 pillars in Islam and is mentioned in the Quran.
“The month of Ramadan [is that] in which was revealed the Qur'an, a guidance for the people and clear proofs of guidance and criterion. So whoever sights [the new moon of] the month, let him fast it; and whoever is ill or on a journey - then an equal number of other days. Allah intends for you ease and does not intend for you hardship and [wants] for you to complete the period and to glorify Allah for that [to] which He has guided you; and perhaps you will be grateful.”
( Al-Baqarah 185)
I find it so heartening that as a lactation consultant when we refer to breastfeeding we often refer to it as a ‘journey’, we also discuss the uncertainty of the journey and the various paths available to take. For many, breastfeeding can also be a struggle. Remarkably, in the Quran eight ayahs (verses) from seven surahs (chapters) discuss breastfeeding and mother’s milk.
"And mothers[should] breastfeed their children for a total of two years. [This sentence] is for those who want to complete breastfeeding duration."
"and we recommend man [to] his parents of kindness. His mother got pregnant with him with great burden and gave birth to him with suffering. Getting pregnant and breastfeeding duration is 30 months for complete growth."
This verse from Surah Al-Ahqaf supports the newer notion of an infant’s first 1,000 days – which is defined as being from the point of conception through 2 years of age – as the most important time for development and growth (https://thousanddays.org/why-1000-days/). It is amazing to me that this concept has existed for over 1500 years in Islam.
There are many aspects to consider when deciding to fast or not, namely determining what our duties are, the importance of those duties, and rights we are obligated to fulfill towards our children. There are provisions in place within Islam for when parent’s own milk is not available and milk sharing may be necessary. There are also exemptions in place regarding pregnancy and breastfeeding when it comes to fasting. Many scholars interpret that the needs of the child and their rights are first and foremost, if fasting at any time causes physical harm to the worshipper, or the fasting person is so fatigued and unable to complete their daily duties then fasting is discouraged. The same is advised for breastfeeding. If breastfeeding causes harm to the mother and child then families are encouraged to seek alternative options.
This is often a difficult time for those who can’t fast and want to feel the spirit of Ramadan. For the 9 (and counting) years I have experienced pregnancy and breastfeeding I have missed many fasts, needed to break my fast, and I have also chosen to fast every few days or partially for some days. There are many cultural perceptions when it comes to not fasting and pressure you may feel from your families or communities. In reality, this is between you and Allah (SWT). You know what your child’s needs are, you know what your bodily limits are and just like with anything parenting related; you know yourself and your baby best. What works for some may not work for all.
A few years ago, I heard a concept that resonated with me and gave me comfort. The concept is having Niyyah (Intention) in everything we do. When we have Niyyah consciously in every action, we are intentionally heightening the spiritual connection to every single task we complete. What better time to implement this practice than the month of Ramadan; the holiest month in Islam, when all good deeds are amplified? Subhan’Allah! Even normally mundane, everyday tasks, can hold more significance during the month of Ramadan if we have intention behind our actions. Breastfeeding with niyyah holds an abundance of reward, you are fulfilling your parental rights to your child and providing them with rizq (sustenance), directly from your body. Having conscious intention in even the smallest of actions can enhance the spiritual connection during Ramadan.
First, I want to start by discussing WHY human milk is important:
Ayahs from the Quran have defined the importance of human milk, the benefit, that it is the best food for babies and helps protect them. Modern science has only further proved what Muslims have known for centuries regarding human milk.
Human milk is naturally designed specifically for your baby, it changes over time as the needs of your child change. It contains fats, proteins and carbohydrates in just the right quantities to promote optimal growth and development. Human milk contains nutrients and vitamins, some of which are directly impacted by your diet.
Human milk contains stem cells (just like in cord blood), these are organ specific cells, meaning that these cells from your milk travel to every organ in your baby and they start multiplying to help your baby grow and develop. Human milk drives brain development.
Human Milk Oligosaccharides (HMO) are a prebiotic/probiotic that feeds the good bacteria in your babies’ stomach. These good bacteria help to protect your baby from bad bacteria which can multiply in the stomach and intestines if the good bacteria cease to exist. Science has only been able to replicate 2 strains of HMO but in one sample of human milk there is anywhere from 50-350 strains of HMO.
There are white blood cells in every drop of human milk which helps your baby fight off viruses and bacteria. Human milk also contains high levels of immune factors that live specifically in the intestines and lungs which means your baby is at a decreased risk for respiratory illnesses or diarrhea. Human milk is antiviral, antibacterial, antifungal, and antiparasitic.
Your milk changes as your baby grows and changes. It contains about 88% water, so babies stay very well hydrated if they are feeding effectively and transferring milk properly. They get all of their nutritional and hydration needs from your milk.
The most abundant form of immune factors in milk, lives in the intestines and in the respiratory system which is especially important right now due to the spread of coronavirus, which is a virus that affects the respiratory system.
Being in a state of lactation also provides benefits for YOU! It lowers your risk of breast cancer, ovarian cancer, uterine cancer, heart disease, heart attack, stroke, high blood pressure, high cholesterol, and diabetes. All these risk reductions are dose dependent, meaning the longer you are in a state of lactation the more protection you receive.
All major health organizations recommend exclusive breastfeeding (no other food or water) for the first 6 months of life, continued breastfeeding for up to 1-2 years or as desired by mother and infant. Even when solids are generally introduced around 6 months, human milk remains the most important part of an infant’s diet up to 12 months of life. Even after 12 months, human milk does not lose nutritional value and is still vitally important for parent and baby. These recommendations fall in line with what Allah (SWT) has recommended in the Quran in regards to breastfeeding duration.
Some things to consider:
Do you fast regularly? Fasting is a way of conditioning the body and building discipline. If you have been fasting for many years on a weekly basis your body may be well conditioned and may withstand the difficulties of fasting while breastfeeding. Likewise, if you have been unable to fast regularly your body may not be as conditioned as it once was and fasting may be more difficult while breastfeeding. It could also take a stronger toll on your body and consequently your milk supply. Carefully consider this aspect before engaging in regular fasting while your baby is under 12 months of age.
Is your child under 6 months? Babies at this age still have an immature gut and cannot handle cow’s milk protein (dairy milk). If milk supply is compromised, donor human milk or formula would be the alternative options. If your child is under 6 months, they are solely dependent on your milk supply as it is not advised to start solids younger than 6 months. Fasting at this time and potentially compromising milk supply can be difficult for many families both financially, physically and emotionally.
Is your child under 12 months of age? If your child is between 6 months to 12 months and taking solids, they may begin to breastfeed less often. Every breastfeeding relationship is different however, and some babies still breastfeed very frequently during this time. Human milk from 6 months to 12 months is still the majority of an infant’s diet and solids are in addition to human milk, not in place of human milk. Your baby should still breastfeed on demand as often as needed and solids can be offered in between or after breastfeeding sessions.
Is your child 12 – 18 months of age? Babies begin to increase the amount of solid food they take and may begin eating 3 meals a day and some snacks at this time. Babies still need about 24 ounces of milk per day whether it be human milk or an animal/plant based milk. Human milk during this time still provides optimal nutrition and does not lose nutritional value. You can begin offering small amounts of water with meals.
Why does fasting impact milk production and breastfeeding? It isn’t the lack of food during waking hours, even those living in food insecure areas can produce milk but often the lack of water can reduce milk supply despite frequent feeding. Fasting and breastfeeding can make you feel more fatigued and tired than normal, these overwhelming feelings can make it difficult to perform optimally during the day with prayers and the demands of Ramadan. Allah does not give us more than we can bear and following through with our obligations should not cause undue hardship or cause us or our children harm. If we are struggling to perform our obligations while fasting such as sustenance to our children, religious obligations during Ramadan, and daily responsibilities then I recommend talking with your religious leader about your situation.
The research on breastfeeding and fasting is scarce but what research we do have indicates that nutritionally the milk does not change all that much in composition of macronutrients (fat, protein and carbohydrates). The composition of micronutrients can change, the ones most often affected based on research is magnesium, zinc and potassium. These micronutrients are derived from the diet of the lactating parent. The other factor that was noted to change was the volume of milk. For those participating in intermittent fasting (8-12 hours) for a day or two at a time did not experience a significant decrease in volume but the person practicing continued fasting especially when done in 12+ hour increments did result in lower milk supply especially when the fasts were done for multiple consecutive days. This was directly related to hydration. In some cultures, research showed those that “super hydrated” during evening hours did not experience a drop in milk supply.
Every person’s body is different. Try to think about what will realistically work for you and your baby, it is great to hear what other's have experienced but the reality is that nothing is linear when it comes to breastfeeding. Listen to your body and watch your baby. If you are someone who struggles with milk supply to begin with, has a medical condition that could complicate lactation/milk supply - this is a factor to carefully consider. For some, milk supply may rebound within a day or two once rehydration begins, for others they may never be able to recover their milk supply. There are no guarantees that any Lactation Consultant or provider can give you regarding whether your milk supply will recover from a state of dehydration. There are strategies that can be implemented at that time, I recommend reaching out to a Lactation Consultant. Carefully consider the age of your child and the risk versus the benefits that this would have for your family so you can make a decision that works best for you.
Warning signs of dehydration to look for:
Parent: dark concentrated urine, foul smelling urine, headaches, dizziness, decreased urine output
Baby: dehydration/low milk intake – dry lips, dry mouth (tongue and mouth should be pink and wet), decreased wet diapers (by one week should be 6-8 wet diapers per 24 hours – one sunset to the next), foul smelling urine, dark yellow urine, increased lethargy/fatigue, not satisfied at the breast when previously was, avoiding the breast/breast refusal when previously was not an issue, weight loss/poor weight gain, by 4-5 months you may see 4-5 wet diapers per day and perhaps 1-2 stools per day.
Signs that you may be experiencing low milk supply:
Your baby is nursing more frequently than usual (cluster feeding/growth spurts have been ruled out), please follow up with an IBCLC
Your baby doesn’t seem satisfied at the breast
Your baby seems increasingly frustrated at the breast
Your baby’s wet and soiled diapers have decreased (normal output is 6-8 wet diapers and 3-4 poopy diapers in 24 hours for the first 4-6 weeks, after that wet diapers 6-8 per 24 hours and stools can be frequent or less frequent but should be occurring on a regular schedule; by 4-5 months you may notice 4-5 wet diapers and 1-2 stools)
Breasts feel less full in between feeds
What others have found to be helpful while breastfeeding and fasting during Ramadan:
Start fasting on Sunnah days a month or two prior to Ramadan to help get your body ready and figure out a rhythm prior to the start of Ramadan
Eat foods that have high water content along with drinking water – avoid sugary drinks such as juice and soda
Limit caffeine – caffeine is a diuretic and can promote water loss
Follow the sunnah – 1/3 food, 1/3 water, 1/3 air to fill the stomach
Fasting every other day or every 2 days, they still enjoy the community aspect of fasting, but it gives their body time to recover hydration and often non-consecutive fasting days reduces the risk of dehydration and permanent low milk supply
Fasting half days – the fast may not count as a full fast but some may still feel a connection with Ramadan and fellow Muslims
“Super hydrating” at night
Continue to breastfeed frequently and on demand
Reverse cycling – babies will breastfeed mostly at night and sleep more during the day with more scant feedings. This applies mainly to older babies as newborns still need to breastfeed frequently around the clock. May not be feasible for those that work during daytime hours or have lots of daytime obligations as it typically requires the parent to be awake during the night and sleep during the day unless safely bedsharing. May also be difficult to switch established schedules or switch babies back to a normal schedule if reverse cycling is implemented.
Strategies to maintaining milk supply while fasting:
Hydrate, hydrate, hydrate! Try to incorporate foods that are high in water such as melons and cucumbers.
Incorporate Sunnah foods! Dates are nutritionally dense and great for energy. Eating high calorie, high protein foods that come in smaller portions can be beneficial.
I love following @zainab_fitforallah on Instagram. She always posts helpful tips on nutrition, sunnah foods and foods for hydration especially around Ramadan.
I know some are going to hate on this one but… lay off the samosas. Seriously though, fried foods are not nutritionally dense, they are mostly carbs and will not provide you with sustained energy for very long. Limit to 1-2 a day if you can!
On demand, frequent breastfeeding
Incorporate hand expression to promote more milk removal – more milk removal means more milk produced
If you have decided not to fast, please know:
You are not alone; talk to others who have been through Ramadan and not able to fast to share experiences and find support
You can still feel the spirit of Ramadan with the right mindset and goals
Having niyyah in every action has rewards as well and can enhance the Ramadan experience if you have decided not to fast
Have niyyah every time you breastfeed and consider the rights you are fulfilling to your child and the major obligation you are fulfilling during one of the holiest months of the year. Knowing how important breastfeeding is to you and your baby may provide some comfort when unable to focus on other aspects of Ramadan.
Feeding a fasting person is the same reward as if you had fasted yourself
Making up fasts at a later date, donating money to a hungry person or helping a fasting person break their fast are all ways to receive reward and feel the spirit of Ramadan
Set realistic expectations
If you have older children, this is a perfect time to start some new ramadan traditions. Get older children involved and excited to participate!
Whatever your decision, my goal for you is that it be an informed decision and that YOU feel good about that decision. Careful planning, preparation, niyyah, and knowledge to make the right decision for you and your family. Ramadan can still be a special and rewarding time with or without fasting.
May Allah make this Ramadan easy for you and accept all our fasts and good deeds. Insha’Allah you enjoy this Ramadan and all the blessing it comes with. Ameen