Ramadan for Breastfeeding Mothers: to fast or not to fast?

By Inggita Shin | 30 June 2024 |

Ramadan and Breastfeeding

Alhamdulillah (all praises to Allah) for Ramadan.

Ramadan is the holiest month of the Islamic calendar, the month of mercy and blessings, when the first verses of Al-Qur’an were revealed to Prophet Muhammad SAW. Muslims across the globe rejoice and are excited to embrace this month, as the rewards for all acts of worship (including the Ramadan fasting) are multiplied in blessings. For breastfeeding mothers, sometimes this turns into a question for themselves: should I fast this Ramadan? If I do, will it be safe for myself and my baby?

Breastfeeding Guidance

In the verses Al-Qur’an, breastfeeding is revealed as a child’s given right from Allah and as the way of nourishing a baby. Some examples of the Qur’an verses are in QS Al Baqarah 2:2331 and QS Luqman 31:142. It is narrated within the verses that mothers may breastfeed their children for two complete years for whoever wishes to complete the nursing (period). This description aligns with current World Health Organization (WHO) breastfeeding recommendations to breastfeed until 2 years and beyond; with breastfeeding to be exclusive for the first 6 months of life then to continue with nutritious complementary food.

Fasting and breastfeeding

It may be helpful for mothers to know that intermittent fasting in Ramadan will not affect their breast milk. Several studies have investigated the effect of fasting and reported that breastmilk retains its major nutrients (carbohydrate, protein, and fat) during fasting4,5. There are significant changes to minor nutrient content (magnesium, zinc, sodium, potassium, phosphate)5,7 but this is temporary and does not adversely affect infant growth in short-term3,5,6. A mother’s body will adapt to any dietary changes4,9,10 and will use stored calories to continue optimal milk production.

Breastfeeding mothers are exempt from fasting in Ramadan – but of course, mothers can choose to fast if there is no negative impact on the health of the mother and baby. Each mother can consider her own (and her baby’s) personal situation before deciding to fast or not to fast8, as each dyad (mother and baby couple) has their own health status and situation which may differ from others. If a mother is assured of the health of herself and her baby, she can decide to fast. If she has concerns that fasting may affect the overall health of herself and her baby, she can consider not fasting. Breastfeeding mothers can be categorised as “having sickness/ill” if her and/or her baby’s health status is affected, which may not allow her to fast during Ramadan.

With Allah’s blessings and mercy, He gives an exemption so as not to burden breastfeeding mothers. In QS Al-Baqarah 2:184:

“Whoever among you is sick/ill or on a journey (and not fast), then (he shall made up fast) a (like) number of the days (missed); and those who are not able to do it (with hardship), to feed a poor person”.

As baby grows

In general guidance, mothers are to recover their health in the first few weeks after birth until the bleeding (nifas blood) stops and is not to fast during this period. During the first 6 months, when breastfeeding is the exclusive food for the baby, many mothers find fasting is not as feasible because often the mother needs the energy to recover and nourish both her body and her infant simultaneously. Hormonal influences during this early time can increase thirst, and many mothers report added feelings of thirst while breastfeeding during this period.

When baby is between 6–12 months old, WHO recommends that breastmilk remains the primary source of nutrition for the baby. This means no reduction in the frequency or number of breastfeeds as complementary foods are introduced into the diet. Breastfeed the baby first before offering complementary foods as they do NOT replace nutritionally superior breastmilk compared to mashed fruits/vegetables or minced meat or porridge. Continuing to meet the appropriate nutritional needs of a baby this age with following the recommendation from WHO will mean that many mothers may reasonably choose not to fast during this time.

Some babies may choose to eat more often as they reach 12 months old, and mother can reassess their (her and her baby’s) own situation. Babies this age are often moving more active, and sometimes (not always) may breastfeed less frequent during the day, thus prefer to feed more during the calm of night. Depending on the circumstances, a mother can try fasting and see how it goes. If all goes well, then alhamdulillah (all praises to Allah).

Alternatively, at times baby may ask to breastfeed more during the day, or the mother may suddenly feel unwell/dizzy/headache/ disoriented. If this happens, it is advised to break the fast as soon as possible. Allah Knows our intention, and Allah Knows we tried. It is essential to prioritise recovering the health of the mother (and baby) before deciding to try fasting another day. It is okay to play it by ear, taking it day by day. Some mothers may try to fast for 1 day and not fast for 2 days; fast for 2–3 days per week, or change the pattern depending on their situation. If a breastfeeding mother has medical concerns or takes regular daytime medication, it is recommended that she consult her health professional before making a decision about fasting. Whichever decision mothers make, the first and foremost is to continue to respond to early feeding cues and breastfeed each time, day and night.

Fasting Guidance

When deciding to fast during Ramadan, there are few things that mothers can try to help ensure both breastfeeding and fasting go smoothly and well:

1. Stay hydrated:

Maintain daily water intake and drink small amounts often between iftar (sunset) and suhoor (meal before sunrise). Drinking too much water all at once on suhoor may fill the bladder too quickly and it is voided out soon after before fasting starts, thus you may feel thirstier11. If possible, avoid caffeine, tea, or chocolate as these may increase thirst.

2. Eat wisely:

Don’t miss iftar and suhoor meal! Lessen the salt where possible since it may dehydrate you. A weekly meal plan may help mothers to plan nutrient-dense meals. For suhoor: complex carbohydrates (whole grain, brown rice, granola, quinoa, etc.) can help you feel fuller for longer compared to simple carbohydrates (white rice, pasta, noodles, white bread). Include protein, vegetables, fruits, and good fats such as fish, avocado, and eggs. A nutrient-dense iftar meal with high water content (eg. smoothies’ dates with milk, green smoothies, broth with legumes) will help recover your energy more quickly. Cooking big batches and freezing them in small batches can be time-saving option. When possible, choose healthy snacks (such as mixed nuts, dates, and fruits with nut butter) in between iftar and suhoor. Sometimes fried food and sugary treats are unavoidable, so we can choose to have these treats after ensuring we start with a healthier balanced meal.

3. Avoid over-exertion:

Plan your daytime activity wisely, take it easy and reduce heat exposure as much as possible. Choose calm activities that you can do indoors. For stay-at-home mothers, make time to rest in-between chores and lower the expectations, you don’t need to do everything. Involve your family and support people to contribute and help for tasks that needs to be done. Your body needs the rest as you are also providing nutrition for your infant. Ramadan is a special time of the year; you can choose to use the energy saved after rest to do ibadah (worship) also.

4. During breastfeeding:

Sometimes, the ‘physical stress’ that a mother’s body feels during fasting may affect the LDR (let-down reflex/ the bodily reflex that helps the milk flowing out from the breast): LDR may slow down a bit and some babies may fuss a little more. This is temporary and you can help your body release the milk. Breasts are glands and work in a similar way to salivary glands. When we feel stressed/tired/scared/unwell, the mouth feels “drier”, but the saliva is never gone. If we swallow the saliva, the gland will make more saliva.

Some ideas to help are hold and shape the breast throughout breastfeed, breastfeed in a calm/quiet area, breastfeeding while lying down sideways, and take conscious deep breaths and drop the shoulders. These suggestions can help relax and calm the mother’s body, thus having a positive effect to the LDR and breastmilk flow.

5. Expressing breastmilk:

Some mothers are expressing their breastmilk during this time for many reasons. Like breastfeeding, the aim of expressing is to collect the milk when the LDR/let down happens. The same suggestions to encourage an LDR will work for expressing. Some things to consider if expressing are sometimes ‘physical stress’ that the mother’s body feels during fasting may slow down the LDR, and sometimes the milk collected may look a little bit different – both are appropriate body response to fasting.

Expressing is different to having baby feed from the breast, so an extra expressing session may be helpful during fasting. Some mothers find that after having their iftar meals, they feel the tension relaxes and the LDR/milk flows more easily as they feel more comfortable.

6. Night feeds:

Prolactin (hormone related to breastmilk production) is naturally at its highest level between 1-5AM. Continuing to breastfeed baby through the night signals your body to continue making the milk that baby needs. Many breastfeeding mothers find that breastfeeding lying sideways at night (following the Safe Sleep Seven guidelines12,13,14) helps them manage the night breastfeeds while continue resting13,14. Having a bottle of water on the bedside table helps easy access for regular water intake for mothers in the permitted time between Iftar and suhoor.

7. General guidance:

It’s essential for mothers to listen to what their bodies tell them and to be attentive to their baby’s needs. Mothers can observe the baby’s output to ensure adequate intake: clear and not smelly urine and soft frequent stools. If a baby consistently having concentrated and smelly urine when mother is fasting, or if the breastfeeding mother feels dizzy/ unwell/headache/disoriented at any time during fasting, urgently break the fast and take steps to rehydrate yourself with a moderate quantity of fluid (water with salt and sugar, or sugary drink, or rehydration fluid). The health of you and your baby are the priority and there is no need for feelings of guilt.

Allah does not make Ramadan fasting a burden for us, and Allah has created mothers to provide breastmilk as the normal way to nourish their babies. Breastmilk is a baby’s given rights from Allah – Allah Knows this and thus makes exemptions for breastfeeding mothers. There are other ways we can do to worship/ibadah and earn the rewards/blessings during Ramadan if, based on our health situation, we decide not to fast: dhikr, reading the Qur’an, taraweeh and sunnah prayers, giving charity, etc. Tending to our babies, children, and family is also a way of worship when we make the intention because of Allah.

May this information help breastfeeding mothers decide about fasting depending on their personal and health circumstances during Ramadan.

Ramadan Mubarak to you. May you reap the rewards of this beautiful month and may the blessings and mercy of Allah flow to you always.

Author:

Inggita Shintowati, IBCLC. MHM. MBBS (S.Ked). MD. Cert IV. Breastfeeding Education (Counselling)

Updated 12 February 2024.

*This article is also available in Breastfeeding Advocacy Australia Facts-Sheets FACTS SHEETS (breastfeedingadvocacyaustralia.org)

Read article in Bahasa Indonesia (Indonesian) here.

Article above is a general information.

If you need a personalised lactation discussion/consultation, you are welcome to BOOK A SESSION here.

References:

  1. Surat Al-Baqarah [2:233] – Surat Al-Baqarah [2:233] – The Noble Qur’an – القرآن الكريم (quran.com)
  2. Surat Luqman [31:14] – Surat Luqman – The Noble Qur’an – القرآن الكريم (quran.com)
  3. Khosdel, A., Najafi, M., Kheiri, S., Taheri, E., Nasiri, J., Yousofi, H., Jafari, A. (2007). Impact of Maternal Ramadan Fasting on Growth Parameters in Exclusively Breastfed Infants. Iran Journal of Paediatric, 17 (4), 345–352.
  4. Bener, A., Galadari, S., Gillett, M., Osman, N., Al-Taneiji, H., Al-Kuwaiti, M., & Al-Sabosy, M. (2001). Fasting during the holy month of Ramadan does not change the composition of breast milk. Nutrition Research, 21(6), 859–864. https://doi.org/10.1016/s0271-5317(01)00303-7
  5. Rakicioglu, N., Samur, G., Topcu, A., & Topcu, A. A. (2006a). The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatrics International, 48(3), 278–283. https://doi.org/10.1111/j.1442-200x.2006.02204.x
  6. Al-Qahtani, A., Mohamed, H., & Ahmed, A. (2020). Knowledge, attitude and practice of Saudi women in Najran area towards breastfeeding during Ramadan. Sudanese Journal of Paediatrics, 42–48. https://doi.org/10.24911/sjp.1061569847908
  7. Salah, E. T., Malik, N. M. E., Hassan, M. S., Mohammed, I. A., Mohamed, M., Mohamed, M. O., & Elmadhoun, W. M. (2016). How does the fasting of Ramadan affect breast milk constituents. Sudan Journal of Medical Sciences, 11(1), 17–22.
  8. Ertem, I. O., Kaynak, G., Kaynak, C., Ulukol, B., & Gulnar, S. B. (2001). Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan. Child: Care, Health and Development, 27(6), 545–554. https://doi.org/10.1046/j.1365- 2214.2001.00226.x
  9. Bzikowska-Jura, A., Czerwonogrodzka-Senczyna, A., Olędzka, G., Szostak-Węgierek, D., Weker, H., & Wesołowska, A. (2018). Maternal nutrition and body composition during breastfeeding: Association with human milk composition. Nutrients, 10(10), 1379, 1-15. https://doi.org/10.3390/nu10101379
  10. Aumeistere, L., Ciproviča, I., Zavadska, D., Andersons, J., Volkovs, V., & Ceļmalniece, K. (2019). Impact of maternal diet on human milk composition among lactating women in Latvia. Medicina, 55(5), 173, 1-12. https://doi.org/10.3390/medicina55050173
  11. World Health Organization. (n.d.). WHO EMRO | Eat healthy throughout all your life | Nutrition site. World Health Organization – Regional Office for the Eastern Mediterranean. http://www.emro.who.int/nutrition/healthy-eating/index.html#ramadan
  12. Red Nose Australia. (2021). Co-sleeping with your baby. https://rednose.org.au/downloads/CosleepingGuideforParents_ Mar21.pdf
  13. Blair, P. S., Ball, H. L., McKenna, J. J., Feldman-Winter, L., Marinelli, K. A., Bartick, M. C., Young, M., Noble, L., Calhoun, S., Elliott-Rudder, M., Kair, L. R., Lappin, S., Larson, I., Lawrence, R. A., Lefort, Y., Marshall, N., Mitchell, K., Murak, C., Myers, E., . . . Wonodi, A. (2020). Bedsharing and breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, revision 2019. Breastfeeding Medicine, 15(1), 5–16. https://doi.org/10.1089/bfm.2019.29144.psb
  14. Zimmerman, D., Bartick, M., Feldman-Winter, L., Ball, H.L. (2023). Physiological Infant Care – Managing Nighttime Breastfeeding in Young Infants: The Academy of Breastfeeding Medicine Protocol #37, 2023. Breastfeeding Medicine, 18 (3), 169-167 +attachment. https://doi.org/10.1089/bfm.2023.29236.abm
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