Bone Health During Pregnancy and Breastfeeding - Postnatal Nutritional Depletion

As a Nutritionist I can say I ate a well balanced diet during pregnancy, although I indulged in extra ice cream and treats, as you do... But when my daughter was 9 months old I suffered a very severe ankle break from an incredibly insignificant slip on a stair inside my home! We have carpet on our stairs and while carrying my baby downstairs my right heel slipped on one of the steps and I fell backward. It was a very slight fall (baby was 100% fine) but somehow three bones (two outer and the back bones) smashed and my leg was unable to stay in the ankle socket - so my leg was pointing left while my foot was pointing right...I knew it was very broken!

(scroll down for more photos post op- **Not for the squeamish) 

I called 911, ended up in the ER at VGH to have my ankle set back into place with a splint until surgery the following morning. Surgery lasted 4 hours and included 2 plates and a bunch of screws to correct the structure of my ankle.

If you've broken an ankle you likely know how horrible it is! I was completely laid up for 6 weeks and only half functional for another 2 weeks. At about 8/9 weeks post surgery I was finally able to ditch the crutches and able to then carry baby again, along with clean up, cook etc.

Being unable to fully care for my kids and take care of my home was SO hard! I would call myself type A. I am constantly doing something and forever tidying up! So sitting in bed or on my couch staring at toys and messes all over my home was torture. I am forever grateful that my husband stepped up the way he did and worked from home to take care of our kids and me! This was likely the most challenging 9 weeks of my parental life.

Postnatal nutritional depletion is a thing and when we are pregnant and breastfeeding baby takes calcium from us, making our bones a little more fragile than usual. The National Institute of Arthritis and Muscoskeletal and Skin Diseases explains that " During pregnancy, the baby growing in its mother’s womb needs plenty of calcium to develop its skeleton. This need is especially great during the last 3 months of pregnancy. If the mother doesn’t get enough calcium, her baby will draw what it needs from the mother’s bones. So, it is disconcerting that most women of childbearing years are not in the habit of getting enough calcium. Fortunately, pregnancy appears to help protect most women’s calcium reserves in several ways:

  • Pregnant women absorb calcium from food and supplements better than women who are not pregnant. This is especially true during the last half of pregnancy, when the baby is growing quickly and has the greatest need for calcium.
  • During pregnancy, women produce more estrogen, a hormone that protects bones.
  • Any bone mass lost during pregnancy is typically restored within several months after the baby’s delivery (or several months after breastfeeding is stopped)"

Also that "Breastfeeding also affects a mother’s bones. Studies have shown that women often lose 3 to 5 percent of their bone mass during breastfeeding, although they recover it rapidly after weaning. This bone loss may be caused by the growing baby’s increased need for calcium, which is drawn from the mother’s bones. The amount of calcium the mother needs depends on the amount of breast milk produced and how long breastfeeding continues. Women also may lose bone mass during breastfeeding because they’re producing less estrogen, which is the hormone that protects bones. The good news is that, like bone lost during pregnancy, bone lost during breastfeeding is usually recovered within 6 months after breastfeeding ends"

 

Some foods high in calcium include:

  • dark green, leafy vegetables, such as broccoli, collard greens, and bok choy
  • canned sardines and salmon
  • tofu, almonds
  • good quality dairy products (ex. full fat Greek yogurt, feta cheese)

 

It is important to note that vitamin D3 is necessary for proper calcium absorption. Recommended intake for both are as follows

 

Foods that contain vitamin D3 include:

  • egg yolk
  • cheese
  • fatty fish (tuna, salmon, mackerel)
  • beef liver

Supplements are beneficial for therapeutic purposes to address deficiency but foods are incredibly effective at increasing nutrient stores. Think about it this way - foods are natural and will contain other things that will make it easier for our bodies to absorb and use said food, whereas a synthetic supplement may not be as easily used by our body. That being said vitamin D3 in our lovely, rainy Vancouver climate is a supplement I suggest most of us take between October and May when we don't see much sunlight. If you are a vegetarian/vegan vitamin D supplementation will be extra important.

VGH offers a free physio program which I found to be incredibly beneficial. The therapists were incredibly knowledgeable and kind. At 10 weeks post op they showed me my x-rays from the day I broke it, to current and I was able to see all of the hardware holding my ankle together (2 plates and about 15 screws) as well as the new bone forming! The physio therapist told me that I was healing much better than would be expected at the 10 week mark, which was SO GREAT to hear!! She said they find that moms who have to get back to good health seem to heal faster - makes sense!

My recovery diet included whole foods, a TON of bone broth (eaten alone and added to soups/sauces), very little sugars (honey/coconut sugar/maple syrup), and I added collagen peptides to my smoothies and some morning coffees.

I hope this helps any mama who may find themselves in this same position!

 

https://osteoporosis.ca/bone-health-osteoporosis/calcium-and-vitamin-d/

 https://www.bones.nih.gov/health-info/bone/bone-health/pregnancy