Gastric Bypass Surgery and Breastfeeding

By Krista Gray, IBCLC. Last updated October 14, 2013.

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Some women who are severely obese may have bariatric surgery.  There are two main types – restrictive (where a band restricts the size of the stomach and thus food intake) and malabsorptive (where a portion of the small intestines is actually removed).1

Gastric bypass surgery is of most concern with breastfeeding with the malabsorptive surgery as parts of the small intestines have been removed.  Though digestion begins in the mouth with saliva, a significant amount of nutrients from food and beverages are absorbed in the small intestines.

Still, whether a woman has had restrictive or malabsorptive bypass surgery it is possible to go on to safely and exclusively breastfeed her baby.

Nutritional Impact of Breastmilk vs. Formula

Human milk is unique and amazing and, unless a mother is severely malnourished, the very best option for her baby. Breast milk is more than just nutrition but a living substance that greatly benefits both a breastfeeding mother and breastfeeding baby.

Breast milk benefits don’t just last while an infant is breastfeeding; they impact her health over the course of her life.  In fact, breast milk reduces obesity levels, not just as a baby but throughout the course of a person’s lifetime!

There is no formula, no matter how healthy and fresh the mammalian milk source, which comes close to human milk for human babies.  Every species’ milk is different and made especially for that animal.

Therefore, to consider supplementing with formula simply because a mother’s diet is not considered healthy or optimal is a slippery slope and gives a baby a nutritional source with well-known and documented health risks that can negatively impact the course of her life.  It is a serious decision and should be weighed accordingly.

What nutritional concerns should breastfeeding mothers have?

Depending on the phase of caloric restriction, the risks for possible deficiencies can be higher or lower.  The more recent the surgery, the greater the chance of insufficiency.  There are several vitamins and minerals that have been raised as possible areas of inadequacy, with Vitamin B12 being the most likely to be compromised.

Other vitamins and minerals to watch closely include iron, Thiamin, Folate, Vitamin D, Vitamin A, and calcium.  It is also important to ensure breastfeeding mothers are eating adequate protein – 65 grams/day are recommended.2

How long should I wait following surgery to have a baby?

Most health care providers recommend waiting 12-18 months following surgery before becoming pregnant.  This helps a woman’s body to recover from surgery and get past the most restrictive phases of eating.

If a woman does become pregnant within 12-18 months following surgery, she will need to be even more diligent to follow nutritional recommendations from her healthcare provider.  Prenatal vitamins containing 1 mg Folate, 500-1000 micrograms of crystalline B12, calcium and citrate in amounts of 1200-1500 mg/day,  Vitamin D,  and 40-65 mg ferrous iron is important.

Some doctors will recommend taking prenatal vitamins in addition to a woman’s daily multivitamin.3

What should I eat while breastfeeding?

All breastfeeding mothers have increased caloric needs while breastfeeding.  In fact, many mothers will lose weight during the first six months following having a baby just from breastfeeding and healthy eating without any special dieting.

It is important for mothers who have had bariatric surgery to eat adequate calories and nutritious foods each day.  This will include well balanced snacks, meals, and appropriate vitamin and mineral supplements.

Taking in at least 65 grams of protein each day is important.  Make sure to work closely with your healthcare provider, and follow the nutrition guidelines closely, to ensure you are getting adequate vitamins and minerals following surgery.  If one is available in your area, try to work with a doctor who has experience with bariatric nutritional needs and lactation.

How can I ensure breastfeeding success?

Excellent lactation support following birth will help you to get breastfeeding off to the best start possible.  While having maternal nutritional support is important, breastfeeding support for mother and baby is too.  A natural birth with plenty of skin-to-skin time is a wonderful start for mother and baby.

Feeding your baby often and on demand, following her feeding cues is essential.  If a mother has large breasts and a small baby, make sure to get extra lactation support in the beginning.

Follow your infant’s weight gain in the beginning to ensure he is taking in adequate nutrition; watching his wet and dirty diapers are important. Finally, relax and enjoy breastfeeding.  Stress can impede milk production and worrying will not solve any problems. This is an exciting time in your life and you are giving your baby the best nutritional start possible.

Show 3 footnotes

  1. La Leche League International (2012) Bariatric Surgery and Lactation. The Breastfeeding Answer Book. Accessed October 14, 2013 via www.llli.org/docs/0_babupdate/03bab_bariatricsurgeryandlactation.pdf.
  2. Stefanski, J. (2006) Breastfeeding after bariatric surgery. Today’s Dietitian, 8, 47-50.
  3. Stefanski, J. (2012) Breastfeeding after weight loss surgery presentation.  www.walc.net/wp-content/uploads/2012/11/Stefanski-Lactation-presentation-10-12.pdf via Kominiarek, MA, & Kilpatrick, SJ (2005) Bariatric surgery and the ob/gyn patient. Contemporary OB/GYN 50(3):76-88.
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