Ramadan and Breastfeeding

by Nor Kamariah Mohamad Alwi, BE, MIT, IBCLC

Ramadan is the most holy month of the year for Muslims. During the month, those who follow Ramadan abstain from eating, drinking, and sexual activities between sunrise and sunset. Additionally, they practice being extra patient, kind, and generous throughout the four weeks. These observances can have an impact on breastfeeding so it is important that International Board Certified Lactation Consultants® (IBCLCs®) understand how to best provide guidance to families.

Muslims scholars, or “ulama,” have been discussing breastfeeding while fasting for decades. Many rulings or “fatwas” have been issued to address this issue, enabling women to make wise decisions for themselves. Muslim women are encouraged to refer to the rulings of their respective local scholars to determine the options most suitable for their situations.

While fasting during Ramadan is not obligatory for all breastfeeding women, here is some guidance that I have found useful in my practice with clients in Malaysia who choose to fast during this time:

• STAYING HYDRATED: Daily water intake is very important to keep the body sufficiently hydrated. It is recommended to drink bit by bit throughout the permitted time, from sunset to early sunrise. Drinking too much just before fasting will just fill up the bladder and gets urinated out soon after, resulting in the mother feeling thirstier for the rest of the day.
• EATING WISELY: Eating well-balanced food, including proteins and complex carbohydrates, during “suhoor” – the meal right before the start of a fasting day – is very essential. This will provide the energy that mothers need for the rest of the day, until the breaking of the fast.
• BREAKING THE FAST: As the fasting day ends, mothers should break her fast as early as possible, by eating natural high-energy foods, to quickly regain energy. A common option among the muslim community (which is also culturally recommended) are black dates. Mothers can opt for creative preparations such as blending the dates with milk.
• HANDS-ON BREASTFEEDING: For mothers who are breastfeeding directly throughout the day, some will notice that their baby became a bit fussier at the end of the fasting day, as the mother’s body is impacted by the fast. Additionally, the milk ejection reflex can slow down due to the stress of the fast. When breastfeeding at this point, breast compressions while feeding will help drain out milk from the back of the breast. Mom will notice improved milk transfer, which can satisfy the baby faster.
• EXPRESSING MILK: Expressing milk (for mothers who have to be separated from their baby) can be a varied experience. Some mothers find no change at all in terms of the quantity of expressed milk, especially in the first half of the day. However, some may find that the yield of milk collected at the end of the day is lower compared to earlier in the day. When this occurs, the mother needs to stay calm and understand how milk supply is produced. When milk is expressed from the breast regularly, a new milk supply will be produced. However, when the amount of body liquid reduces as part of the effects of fasting, the quantity of breast milk can be a bit lower than the usual, and mothers will find that their milk at this point usually looks thicker.

At any point in time during a fasting day that a mom feels too lethargic, it is important for her to carefully consider her condition, as well as her baby’s condition, before deciding to continue the fast. Consult with the local scholars and doctors, on how to deal with such situations.

Are there any religious and/or cultural implications that you find useful in your practice?

Nor Kamariah Mohamad Alwi resides in Bandar Baru Bangi, Selangor, Malaysia. She created the online breastfeeding support forum susuibu.com in 2004 and is a co-founder and President of Malaysian Breastfeeding Peer Counselors. She is on the Local Governance Task Force Coordinator for World Alliance for Breastfeeding Action (WABA). Kamariah is working with IBCLCs to establish a Malaysian Lactation Consultant Association. She is currently a private practice lactation consultant. (Read more about Kamariah in her ILCA Board of Directors nominee profile.)