It’s Ramadan at the moment and my baby just turned 5 months old. I was determined to fast every day but alas things don’t always go according to plan. So in an attempt to rescue my Breast milk supply, I decided take a break from fasting for a day to rest and replenish.
Firstly, there is an Islamic concession for pregnant and breastfeeding women. I think understanding this is important as you embark on your journey. There is a huge emphasis placed on the importance of breastfeeding in Islam and so there is never a time that you should feel compromised in terms of your own heath as well as your child’s while you are fasting. (Here is a fatwa/Islamic ruling relating to breastfeeding and fasting)
My little one is still exclusively breastfed (read this article on why I am waiting for her to hit six months before I introduce solids) and she is fed on demand and so it has been a bit of a challenge maintaining good supply as well as not causing myself to feel completely depleted.
Here are some tips that I found helpful in my own research on making my breastfeeding journey successful during Ramadaan
Calories matter
As the days march on during Ramadan I tend to eat less. This was a revelation to me when I started tracking my caloric intake and realised that I was actually eating less than the recommended amount of at least 1800 kcal a day.
So here’s a reminder to eat enough, making sure that the calories you are consuming are nutrient dense. Prioritise real food over processed food. If all else fails, fruit smoothies with full fat/double cream yogurt are a great way to increase your energy intake healthily without it making you too full. My typical Suhoor meal consists of yogurt and rolled oats/granola with almonds , chia seeds and a seasonal fruit. I then have an egg with half a slice of whole wheat bread OR half an avocado with salt and lemon. I then drink a cup of instant coffee (terrible advice here… but this is my crutch in life) , lots of water and a glass of coconut water.
Prioritize hydration
I am absolutely terrible at this mainly because I don’t like waking up at night to empty my bladder. However, I have found that slow and steady does, indeed, win the race. So, small sips during iftaar, tarweeh and before bed trump massive amounts all at once at suhoor time. I love reminders and measurables, so setting up alarms for fluid intake is something that has helped me.
Early signs of dehydration include mental fogginess, dark urine, fast heart beat, dry lips, low milk supply, headaches.
Avoid caffeine
Or at least reduce your caffeine intake. Caffeine has a duiretic (water losing effect) on you which can lead to worsening dehydration which in turn can negatively affect your breast milk supply.
Diet
The general principles of a balanced diet apply here. I would not recommend any further restrictive diets during fasting for example; diets that limit carbohydrates or other big food groups. Eat a balanced, well portioned meal at both suhoor and iftaar. This should include a protein, carbohydrate (preferred low GI, high fibre, unrefined sources) and healthy fat.
Feeding on demand
This is more of a general breastfeeding recommendation but still valid while fasting. Breastfeeding is a symbiotic relationship where if either party has a need they will signal to the other for a feed. For example if your baby wants to feed for any reason (hunger, tiredness, comfort, illness) you will offer the breast. In the same way, if the mama has a need (full breasts, engorgement, needing to connect) they will offer the breast. This doesn’t stop while fasting. Feeding on demand (and even more frequently) will ensure adequate milk supply.
Galactogogues (a food or drug that promotes or increases the flow of a mother’s milk.)
While diet, hydration and feeding on demand are the main foundational tenets of good milk supply, there are some herbs/natural supplements that can support your body as well. I chatted to Nadia Maheter, who was my doula during my last pregnancy. She is also a postpartum care provider who makes her own herbal products aimed specifically at supporting women post partum. (This is her http://thedoulaeffect.co.za)
These are her top recommendations for natural adjuvants for breastfeeding support:
Oat straw: anxiety and nervous system recovery. Supports the mother as a whole.
Red raspberry leaf: herb, uterine tonic, fortifying breast milk, rich in elemental nutrients
Stinging nettle: high in iron, enriches milk, increases milk supply
Alfalfa sprout: rich in vitamins C, B and K, adds creaminess to milk, assists with satiety in babies.
Moringa: hailed as a superfood. Also a galactogogue. Rich in iron, vitamin A and K. Contraindicated in those who are trying to conceive.
Fenugreek: needs to be taken in large amounts. caution for those who are prone to low blood sugar levels as it can cause relative hypoglycaemia.
Fennel: seeds or root. Tastes amazing as a tea, adds volume to breast milk.
I really hope this has helped somewhat in your breastfeeding journey. This, Ramadaan, is the month of mercy and so let us show ourselves as moms a little bit of the mercy we so readily pour out to everyone else in our lives. Remember that every effort is rewarded (Insha Allah).
(Named after two of our grandmothers, my sister and after Aaishah bint Abu Bakr, the wife of the Prophet and “mother” of the muslims)
Most birth stories start at the beginning of the first contractions. That’s a really good place to start. However, to fully understand all that encompasses Aa’ishah’s birth I have to start at how we came to choose a home birth… or rather how it came to choose us.
Preamble:
2016. When I was still in my maiden years, birth was mystical to me and incredibly scary. In the hospital, I had seen too many undignified deliveries and so many birth traumas, that choosing a traditional hospital birth was never an option for me. When I fell pregnant with my first we chose to travel the road of pregnancy with a midwife as our primary care provider. She was a real pioneer in the birth space and helped us prepare holistically for our roles as new parents. Choosing this path really propelled us from our “auto-pilot pre-parent” existence into a world of conscious birthing and conscious living.
Fast forward to 2020: After having a necessary but still beautiful emergency caesarean section, I had a powerful and redemptive VBAC at Genesis Clinic (in Joburg). This was a truly transformative experience for me… I felt utterly invincible after my VBAC. Then at the beginning of 2022, we had a surprise pregnancy. It was our first pregnancy here in the Western Cape and our first without our midwife and very supportive obstetrician. I struggled to visualise the birth that I desired taking place in a hospital. I had not considered home birth as an option at this point as I’d had a c-section before and didn’t even know that having an HBAC (home birth after caesarean section) was something I could do. We then travelled to Johannesburg and saw our midwife to get some advice; we told her that we were planning on upending our family at the end of the pregnancy so we could deliver with her at Genesis Clinic, we asked if she would consider doing online consultations with us and we would continue to see a care provider in Cape Town in person to ensure continuity of care. I remember her smiling at us and not giving a direct answer to our request. Instead she initially mused about third-borns and what a wild card they could be. She challenged us to look at all the third-borns in our families and notice how they did things, how they often had a flare for the dramatic, how they come to entertain and be surprising. We discussed how it would work if we did end up coming to Johannesburg, we went through some practical things like what would happen with the kids, where would we stay? Where would I spend my early labour? How would we get oxytocin flowing between my husband and I if we weren’t in our comfort zone? There was a lot of back and forth but ultimately we realised that it didn’t make sense to go that route especially considering my older children and how settled and happy they were in Cape Town. We had a tearful goodbye with our midwife and it was hard to close off that chapter, but we knew it was for the best. I then consulted with a gynaecologist and obstetrician in CPT. I told her about my previous births and pregnancies and how I related so much more to the midwifery model of care. She asked me if I’d considered a home birth, that I had a good chance of having a successful one because I had already laboured with my scar before successfully. She said she would be my back up obstetrician if I needed.
We then met with two midwives and connected instantly with Susan. One funny side story was that we think she may have delivered my husband as she worked at the, then, Joburg Gen Hospital and was one of the midwives who assisted in the water labours and birth. This strange but amazing side story sealed the deal for us and Susan was our midwife from then on.
I was added to a homebirth whatsapp group which was so crucial in helping me gain the insight and confidence for a homebirth. The rest of my pregnancy moved along without any issues and we were excited to experience a birth in our home. After all our research and prep work, it was beginning to make more and more sense and homebirth became an almost obvious choice for us.
Waiting…
I finished up with work at the beginning of October and the anticipation began. 37 weeks became 38 weeks which became 39 weeks and still; no baby. I had delivered both my previous babies at 39+ and so the anxiety started to set in. In my mind, the stakes were high and the pressure was on to go into spontaneous labour as a medical induction was not an option for me. 39 weeks glacially became 40 weeks. The messages started pouring in, half a dozen every day, from well-meaning friends and relatives: When is baby coming? Aren’t you concerned about going overdue? Baby must be too comfortable. You should try *insert every conceivable natural induction method*. Which we already were: walking/hiking every day, pineapples and dates by the truckload, sex, chiro, yoga, Miles circuit, red raspberry leaf tea, homeopathy, acupuncture, moxabustion (basically burning my toes, this will still go down as “weirdest-shit-i-did-to-get-baby-out”). Eventually we decided that we should do a “stretch and sweep” at 40 weeks. Susan reminded me that it had a 25% success rate at inducing labour and so I left her feeling optimistic. I went to bed that night excited and hopeful. When I woke up the next morning still pregnant I felt devastatingly disappointed. I cried. Decided that I was probably going to be pregnant forever… or that I was headed for a caesarean section. Every day after that felt like a marathon to get through. Every morning I would wake up and would need to pull myself together: remind myself of baby’s innate wisdom, of my body’s innate wisdom, of Allah’s infinite wisdom. Every morning I would tell myself: Due dates are man-made. My body knows how to grow this baby and it will know when and how to birth this baby. I reminded myself that “Verily Allah is with the patient”. It was the longest three days of just waiting in anticipation. Days of stretching and trusting, stretching (my mind, my heart, my capacity for patience) and trusting some more.
And then on the Thursday of my 41st week pregnant the wheels started to fall off. What was meant to be a precautionary visit to a maternity unit for a biophysical profile sonar and non-stress test to check baby’s overall wellbeing, turned into an anxiety trigger. We saw a sonographer who didn’t really grasp the reason around why we were there and during the scan she casually threw words around like “You’ve got too much amniotic fluid”and “the baby is in a posterior position” (my first born was POP and so I worried) in between bursts of “Oh she’s got such cute cheeks”. She didn’t check my placenta for aging and she didn’t reassure us at all. We left their feeling confused not really knowing what all of this meant. I messaged my gynae who also didn’t know how to advise us based on what the scan showed: Why was my amniotic fluid index so high? Was this a late onset gestational diabetes? Was the scan reliable? She asked me to do a fasting sugar and asked to see us the very next day.
I wondered if this was the end of our homebirth journey. Was she calling us in to tell us she couldn’t back us up anymore? That I was too high risk now? Sue reminded me that objectively and according to her best understanding that I was fine and baby was fine. “Go see your gynae, hear her out” she told us. My fasting sugar was normal the next day… I knew it would be but I was still anxious, our doctor squeezed us in during her tea break and the first thing she said to me was, “You look good and I’m not worried, due dates don’t bother me at all”. She did a scan and my amniotic fluid measured completely normal (the sonographer had over-estimated it by 13cm!) Baby’s position was optimal, a beautiful LOA, she was engaged, and my cervix was 3 cm dilated. We breathed. I asked her to do another stretch and sweep. She told me to relax, go for a long walk, have a bath. We chatted about perhaps taking some castor oil, we went through the pros and cons, I wasn’t sure. She said she would see me again next week and we would take it one step at a time. She said she didn’t want to discuss an elective caesarean section at this point because it wasn’t necessary now. I felt heard and held. She reminded me that having knowledge of something isn’t always helpful especially when you have so little control over it. She told me to try and shut off my doctor brain and Tawakul Allah (place my trust in Allah).
The rest of the day I had some Braxton Hicks contractions, a bit of a bloody show but nothing else. I put my girls to bed that night and sang to them, the baby liked this too. I messaged one of the other moms in our homebirth group and we were both commiserating with one another, both of us deciding that we were done doing things and we were just going to rest now. Just before bed on a complete whim I decided to take some castor oil with a bit of orange juice. I got into bed with my husband, we laughed a lot and did as much as we could to get some oxytocin flowing. Before closing my eyes that night I prayed: “Oh Allah, Your wisdom is infinite. We plan but you are the best of planners. I surrender to this process. This baby will be born as You have written and not how I have willed it”. And I slept a deep, restful sleep.
Labour:
I woke at 3AM that morning with some pain in my pelvis and lower back. I tried unsuccessfully to go back to sleep but then noticed a rhythm to the pains and decided I would start to time them. I was alone in my room as my husband was sleeping next to Yaseerah (our toddler). I timed a few of the surges and was surprised when I saw how regular they were. I didn’t feel pain, just tightening. According to my labour app, my surges were now 2 -4 minutes apart and I received a pop up notification telling me that I should consider heading to the hospital. I smiled. I felt a deep sense of relief that we didn’t have to go anywhere this time. I had the option of choosing a pain intensity with each surge: green, orange or red. When I scrolled through the app there were mainly green smiley faces and one or two orange faces and so I felt that this was definitely established labour but I didn’t feel I needed to wake anyone yet. I wanted to get into “the zone” myself as long as possible, I also wanted my husband to get some more sleep and so decided I would only wake him up when it was time for fajr (morning prayers). I thought this was probably a good time to get all my labour stuff ready: I fetched my earphones in my baby sister’s room told her to go back to sleep. I started prepping my room; put on my music, lit up the candles, started carbo-loading (date balls, bananas) and drank lots of coconut water. After about 30 minutes I noticed the surges change. During each peak I felt an intense need to poop. I had two loose stools. My fajr alarm went off and I decided to wake Zunaid. I went to the girls’ room, put on some white noise and whispered for him to wake up. He said he’d wake up in 10 minutes. I whispered that I needed to talk to him. “Now?!” he grumbled. I went back to our room to bounce on my ball and he came stumbling in carrying our toddler Yaseerah on his hips. They were both very sleepy , “she wants to sleep here” Zunaid said. “Okay well I think I’m in labour. My contractions are about 4 minutes apart but I feel good, not really in any pain right now”. I watched Zunaid’s face turn from dazed to bright eyed with the biggest smile spread across it. He asked me what I needed right now from him and I told him that he should go get ready for fajr and I’ll call him when I need him. I then took Yaseerah back to her room and whispered, “Mummy’s in labour so I want you to go sleep in your bed. I’ll wake you up when it’s time to meet your baby sister”. She climbed into my arms and just said “okay”… no protest at all and went back to sleep.
By the time Zunaid came out of the shower it was about 04h15 and my contractions were getting more intense. I had been doing some hypnobirthing breath work and had gotten into a deeper relaxation state. The candles, the smells, the dark room and my music instantly made me feel relaxed and calm. The playlist I used for my previous birth was playing and it sent me into a bit of a trance. Zunaid started filling the bath and we decided that it was time to call our doula, Nadia. We told her what was happening and that we wanted her to make her way here but that she should take her time. Zunaid then went to masjid across the road for congregational prayers. He didn’t tell me; he only said that he was moving the cars so our birth team could park in our driveway. I laugh now but had I known then that he left I would have panicked knowing that he wasn’t in the house. But in retrospect I realise he needed the grounding and blessing from those prayers. I prayed too and during my sujood (prostration) I could feel a shift happen. When I was done I called Sue. Zunaid was not yet back so I made the phone call myself, I told her I was okay, that this was definitely labour but that I wasn’t sure whether she should come now since things only started a short while ago but that I also progressed very quickly with my previous birth. During our call I had a contraction and she heard me breathing through it. “I think I’ll come through now. See you in a bit.”
Zunaid was back in time for the next contraction. I told him that I need counter pressure on my sacrum… that really eased the intensity during the plateau of the surges. I noticed my breathing getting louder, I was now instinctively roaring through my contractions. I remember thinking that my girls would be so excited to hear this… we’d been practicing in the bath throughout my pregnancy. Nuha said I should roar like a lion, Yaseerah said I should grunt like a Gorilla.
Things turn up a notch:
Another surge. “Zunaid please put pressure on my sacrum… wait stop… don’t touch me. I need to poo… “. Labouring on the toilet… nothing happens. Another surge with a deep pressure in my bum, a poo again? It’s the castor oil. On the toilet, no poo again. It clicks… the baby is descending. Is this the fetal ejection reflex? A short moment of panic. “Zunaid call Sue again, I think the baby’s coming. Sue answers, she’s pulling into the drive way already.
I centre myself. “Try to relax between contractions”, I tell myself. “Your breathing is everything right now”
I get into a rhythm, swaying back and forth. I see Susan at my bedroom door. She smiles and kisses me on the cheek. “You’ve come all this way on your own”, she says. I smile. Another surge. I point to my lower back… she applies pressure… it feels so great when she does that. “Do you need to check me now?” I ask Sue. “No I don’t”, she says, “You’re almost there”.
The room suddenly feels busy. Zunaid is moving in and out with bags of stuff. Susan is checking the baby’s heartbeat. Zunaid is next to me whispering something important; I don’t remember what he’s saying but I remember that it helps me get through the surge. I’m noticing them being busy but I’m also not fully aware. “I want to get into the water”, I say. The pool’s only half full. They try adding buckets of water from elsewhere in the house. I get into the water. Sheer bliss! Between surges I tell Sue how happy I am that I finally get to use a birth pool… I tell her that my two previous births didn’t allow for that. I recline for a short while but it’s long enough for me to reset and ready myself for the next surge. This surge is really intense. I remind myself that I accept this pain because it brings me closer to meeting my baby. My waters break… lots and lots of thick meconium.
Sue sees the flicker of panic on my face. “Your baby is fine” she says, “But I think it will be better if you come out of the water and labour on the bed.”
I climb onto the bed facing the headboard, grabbing onto the edge of the wood. I have one surge in a squatting position. Too sore, too intense. I shout, “I really can’t do this!” I know I can though, I know I must… but somehow I need to say something, anything… and so I say I can’t. “I can’t’, I can’t, I can’t,” I start saying on repeat and louder each time. My voice sounds low and hoarse.
“You’re so close,” Sue says, “She’s in your birth canal. 2 or 3 more surges and she’ll be in your arms”.
I breathe in this news and it gives me renewed strength. My energy shifts… I am not in a trance anymore, I’m relaxed but more awake and alert. I need to shout… I need to be loud… to somehow release the intensity of all of this. Plans of quietly breathing out my baby have been abandoned.
A surge. I feel a deep stretch and then a burn, my ring of fire. Another surge. “OW! It’s so sore!” I shout. “She’s right here”, Sue tells me. I put my hand on my perineum. I feel Aa’ishah’s head. It’s true. I move from squatting into a tripod position, it makes me feel stronger. One more surge and I feel her emerge. I look in between my legs and see her in a pool of dark green fluid. She doesn’t cry at first. I see Sue gently coax her with some light blowing, not yet touching her. “Can I hold her?” I ask, trembling slightly. Sue hands her to me. She doesn’t cry at first, but she’s got good tone and her eyes are wandering. I touch her head to my chest and then I hear it… loud, reverberating. I cry that makes my heart sing.
Nadia, our doula, arrives then with a huge smile on her face.
There’s a bit of an awkward move around to get me to lie down. I place Aa’ishah on my chest, her cord still attached and pulsating. A short while later I feel a warm gush of blood and Sue applies some gentle traction and the placenta in delivered still attached to my baby (and without any artificial syntocinon). What a beautiful sight! Sue checks my perineum, no tears.
For, what seemed like a long time, we just soaked in that moment: Me, Zunaid and our precious baby. The cord stops pulsating and Sue clamps it, Zunaid cuts it finally. He makes the athaan (call to prayer) into little Aa’ishah’s right ear: Allahu Akbar (God is the Greatest)… La ilaha iLalah (There is none worthy of worship except Allah). Zunaid and I can’t stop smiling at each other; our eyes well up with tears of the deepest gratitude.
Some time passes and I feel like I want to shower. Nadia helps me up and into the bathroom, the hot feels amazing and seeing the blood flow into the drain feels ceremonious. When I come out of the bathroom, there are clean sheets on the bed and Aa’ishah is on her daddy’s chest. We hear a little giggle from outside the room door and we see Yaseerah walk in with the biggest smile on her face. “Is that my baby sister?”, she asks. Ten minutes later Nuha (our 5 year old) wakes up to some new sounds and wanders into our room too, wanting to know if the cry she heard was what she thought it was. My younger sister (who was petrified at the thought of labour and a home birth) walks in too, in disbelief that she missed the whole thing… but so happy to meet her niece nonetheless.
Nadia brings in some tea. Zunaid and I take turns sipping from one cup. It is the best cup of tea I have tasted. I look around and am just completely in awe of the scene I am witnessing. I just gave birth and am now in bed with my husband and children, having a cup of tea. It feels so surreal but also like the most natural thing in the world.