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Saturday, July 14, 2012

Ramdan - Fasting with Child (ren)





This is a re-post from last year's Ramadan. The information is still the same and insha'Allah of benefit to some of you. Thank so much for all of your well wishes. Ya Sin and I are enjoying our lie-in. I hope to return to this space more regularly soon!  An early Ramadan Mubarak to all of you. Please keep us in your du'as. 

Ramadan's many lights and gifts will be here in a matter of weeks. One of the questions I am often asked by pregnant and nursing women is whether or not they should fast in Ramadan. This post is not meant to encourage or discourage women from fasting, rather it is to provide information that can help mothers stay healthy if they decide to undertake even a few days of fasting.

Many women say that they would rather fast when everyone else is fasting instead of making their fasts up later. If you are one of those women, I hope this can help prepare you physically for the fast of Ramadan. Studies conducted about pregnant women fasting in Ramadan have found no adverse outcomes in the baby's birth weights, length, and head circumference. The fast of Ramadan also has not been found to adversely effect milk supply in lactating women, although it can alter the content of breast milk, but without affecting infant growth.

Pregnancy can be a challenging time to fast depending on when the fast falls in your gestation. Nina Planck, a real food expert and author, has written a wonderful book called Real Food for Mothers and Babies that breaks up pregnancy's nutritional needs by trimester. Planck says that in the first trimester, when the organs of your baby are developing, your embryo needs minerals to become a strong fetus. The bones and muscles are doing most of the growing in the second trimester, so your baby needs calcium and protein rich foods. In the third trimester, the eyes, brain, and nervous system are rapidly developing; fats high in Omega 3's will aid this growth.

If we base our Ramadan diet on Planck's demarcations, what are the best foods to nourish you and baby in each trimester? Fasting in Ramadan offers us only a few exchanges with food, so we need to make each of these encounters nutrient dense and filled with what our growing babes need. You will notice a theme throughout my recommendations and that is good fats and protein. Good fats include, coconut oils, olive oils, fish oils, butter, and tallow. Your baby's development needs cholesterol. You need good fats and protein to support this. This duo also supports mother's in their health and well being through pregnancy, therefore you will see multiple mentions of healthy fats and proteins.

In the first trimester many women often need to eat constantly to keep nausea at bay. Others do better with no food. Either way, your baby has to grow. If you choose to fast during this time, I really like a few foods to help you out. Much of nausea comes from hunger. When you eat, eat foods filled with protein and good, healthy fats. For the suhoor, the morning meal before dawn, try any of the following:

  • Smoothies with egg yolks, coconut oil, milk, and yogurt and lots of fresh fruit. The fruit will give you plenty of the micro-nutrients which your baby's organs need and the yolks, oils, and yogurt will give you good fats and proteins for fuel throughout the fast.
  • Eggs are a great suhoor meal for pregnant women. Make an omelette with lots of vegetables -- again this will give you a mix of micro-nutrients and protein.
  • Oatmeal with lots of butter, cream, milk, or coconut milk. Add nuts and fruits for a complete suhoor.
  • I do recommend eating at least three times a day in Ramadan, the suhoor meal, an iftar meal, and then again about an hour before going to bed. This still provides the same caloric intake, albeit not at the regular times you usually eat.

The first trimester is a big adjustment. Take it easy and don't push yourself to exhaustion. Read my post on the first trimester, where you will find many tips that you can do while fasting. I personally think essential oils, like lavender, ginger, and geranium go a long way in helping with nausea, fasting or not. Also, fresh air can alleviate nausea for many women. Get out and go for a walk right before you break the fast.

When Ramadan falls in the second trimester, it is perhaps the easiest time for you to fast while pregnant; the nausea has mostly passed, and you have regained some of your energy but don't yet feel uncomfortable from the weight of your baby. Here are some general tips for fasting and breaking your fast in the second trimester.

  • If you can, try to switch your nights and days. During the day, stay inactive and rest as much as you can. If you need to do anything active, like clean or cook, wait until shortly before the sun sets so that you can eat and drink soon after.
  • Try fasting every other day.
  • Do gentle exercises like yoga, tai chi, or walking shortly before the sun sets.
  • Don't skimp out on sleep! This is hard in Ramadan, especially during the summer months, but try your best not to exhaust yourself.
  • Because protein and calcium are important this trimester, be sure to include lots of protein rich foods in your meals. Meats, broths, eggs, and lentils are wonderful and healthy choices.
  • Calcium rich snacks can be eaten between iftar and bedtime. Almonds, warmed milk with cinnamon, ginger and a pinch of sugar, yogurt with fruit.
  • Dates, the traditional food to break the fast with, are an excellent way of revitalizing the body after a day of fasting. High in potassium, iron, anti-oxidants, and other minerals, they are also perfect as a second trimester treat.
The third trimester is perhaps the trickiest time to fast. There have been studies that have found that fasting in late pregnancy causes a state of 'accelerated starvation.' We should know that our bodies are working hard during this time; the baby's nervous system is developing connections between neurons, its brain folds are forming rapidly, and its gaining more and more motor control each day. All this while it is packing on half a pound every week. All of this requires an enormous amount of caloric input, so it makes sense that this trimester would be a difficult time to abstain from food. Also, labor could begin at any moment in this trimester. Beginning labor with a caloric deficit is adding an extra challenge to the challenging physical task of labor. Despite that, some women will fast. Whether or not you fast, here are foods that help build healthy brains for your baby:

  • Try eating fish when you break your fast. Fish is easy to prepare and full of healthy fats well suited for growing noggins. Check out Seafood Watch for more information on which fish is best for you and the environment.
  • I love herbal infusions in pregnancy. They are especially great for women facing the great task of birth, and subsequent mothering. Alfalfa, red raspberry leaf, nettles, and oatstraw are wonderful third trimester choices. Drink them mixed or separately. They contain an amazing amount of minerals and micro-nutrients, all of which saturate your tissues and muscles with nutrients that help them work efficiently in labor.
  • Egg yolks, butter, whole fat milk, and all other foods rich in cholesterol can be considered brain food. So go ahead and have eggs and toast with lots of butter for suhoor. Your baby will be smarter;)!

Staying hydrated is actually a bigger concern than caloric intake for fasting pregnant and nursing women. Abstaining from water all day can be a real challenge while pregnant and/or nursing. I suggest that when you eat in the morning and in the evening, drink an electrolyte drink, preferably not Gatorade as it has tons of sugar and other undesirable preservatives. Try this mixed in your water. Coconut water is another refreshing way to replenish your electrolytes. Vitamin Water and Re-Charge are also good choices. Electrolytes help the water replenish and hydrate you. Without them it often seems that the water just rushes through you!


Nursing and fasting is often more difficult than pregnant while fasting. That is simply because while nursing, you also have to change diapers, push the stroller, and carry and nurse the baby. There is more work involved! All of the above recommendations can apply to nursing women. Along with a few of these:

  • Add one tablespoon of coconut oil a day. You can eat it directly off the spoon. Lauric acid is the main ingredient in coconut oil. Lauric acid is a medium chain fatty acid, the primary component in breast milk. This can help keep your breast milk full of the nutrients your baby deserves.
  • Focus on hydration. You will feel thirsty due to the hormones of breastfeeding, primarily prolactin. When you are not fasting, always keep a bottle of water with you and electrolytes are a must. The above mentioned studies have found that lactating women hydrate more than non-lactating women in Ramadan. Remember that and drink to thirst.
  • Stay away from the fried offerings always so present at iftar gatherings. Often they are fried in unhealthy fats full of trans-fats. Trans-fats are easily transferred to breast milk. Be mindful of healthy fats and fulfill your fat cravings in other healthier ways such as butter, meats, fish, and eggs.

Ramadan, however, is not only about the physical fast. Fasting also takes place on the spiritual plane. Fast from the fast-paced world for your baby's sake. Slow down and retreat deep into the stillness of spiritual practices and a beautiful remembrance. This more than anything is what nourishes mothers and babies, whether or not they fast during Ramadan. I pray you all have a blessed month full of vast openings and a renewed closeness to God. Please remember me in your prayers.






21 comments:

  1. i'm curious about the fiqh of fasting for pregnant women. Can you have the intention to fast every other day and know with certainty that it is counted towarda ramadhan?

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  2. Thank you so much this post helped me a lot both as mom and as a midwifery student.

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  3. wow, great advice...mashallah...I'll be sure to spread this along. Personally when I was pregnant with my son, ramadan fell right at the b/g of my last trimester and between that and juggling school I definetly did NOT fast although i met sisters who suggest I fast because after all-everyone else is and that even though I was like 7 months pregnant...I could and should still fast. I was like, um, thank you very much...but...no way...I'd rather not pass out and what about the baby! My husband was also like NO WAY! No fasting for you! Ditto for nursing, I only nursed 1 yr cuz my son only wanted it 1 yr, but I also didnt fast that yr either. While I know that the fast of ramadan is required...I think since we are allowed to NOT fast during this time and obviously there is a good reason-the babies and ours health, safety and everything else, we should take that as a blessing and just not fast.

    Allahu alim.

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  4. @thrifty hijabi...i'm no faqeeh,so i'm not sure of the fiqh. i have however, seen many women do some variation during the month - every other day, every mon and thurs, every weekend when hubby is home ot help, etc..

    @faisa - jazakallah and hooray for another midwife in the ummah!

    @ umm ibrahim- thanks for your comment and spreading it along. i'm sorry that you had such a hard time with fasting. i think fasting is easier for some people and harder for others. i found the studies on pregnant and nursing fasting women quite interesting in that it showed that it is a physical challenge and obviously we all handle these in our own unique way.

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  5. Great post! I tried fasting one year when my dd was 4 months old, and I actually felt like my milk supply was less and my dd stopped gaining weight for the next few months. It might not have been as a result of fasting, but with my current baby, i plan on breaking my fast more often than i did the first time around. Studies really show that fasting doesn't affect supply of milk? But make up of milk? so perhaps less fatty?

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  6. Also, any harmful effects to using the Emergen C electrolyte solution?

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  7. Jazakallah khair for this post. It was very beneficial and this just shows the importance of having Muslim women work in the areas of birth, Doulas and Midwives! The religious and cultural importance of these issues is something expectant and nursing mothers hold very close to their heart and often stress about, I am so happy you posted about this so I have a resource to link Mom's back to- Alhumdulilah!

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  8. @fatima - no no harm at all from electrolytes. they are a wonderful cure for many ailments in pregnancy!

    @umm zakariya - thank you for your sweet comment. we really do need more muslim women in the birth field, just like yourself!

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  9. I fasted through both pregnancies - the first was when I was ready to pop and I felt no adverse affect of fasting with babe in utero. But the second - oh my - I had just found out that a little bean was hiding and so was about 5 or 6 weeks. After one week of fasting and having white outs through blood pressure problems I gave in and stopped fasting. As Qur'an states, Islam did not come to punish us but to purify us, and each of us know how much we can bear.

    Lovely post.
    XX

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  10. @qalballah - white outs are a definite sign to break the fast. someone told me today about a woman who was in her 3rd trimester, refused to break her fast, and had to be taken to hospital for an iv! not exactly what i think allah meant when prescribing fasting for us! thanks for your comment. insha'allah your ramadan is going well!

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  11. I had some issues/questions about the first part of your article, where you talked about how fasting doesn't have a significant impact on pregnancy/breastfeeding, citing a few scientific publications.

    Currently, 3 of the four links work.

    From the first article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1590265/pdf/archdisch00895-0047.pdf) (that's used to claim that "pregnant women fasting in Ramadan have found no adverse outcomes in the baby's birth weights, length, and head circumference"), I don't think the researchers even asked the women if they had fasted during ramadan? Instead, they used archival data, assuming that any woman who was muslim (based on the first three letters of her last name) had fasted during ramadan and analyzed the birth weight of their child in relation to when ramadan was that year. Secondly, the years they analyzed were 1964 (first day of ramadan january 16th) to 1984 (ramadan begins may 31st), but the hours fasted were vastly different throughout that time period. They admit there's an insignificant decrease in birth weight, but failed to take the number of hours fasted into consideration (ie, is fasting longer hours correlated with decreased birth weight? If so, grouping the long hour fasters with the shorter hour fasters could diminish the results of decreased birthweight). Not that I'm sure it would matter, though, because, as I mentioned, they didn't ask the women if they had fasted during ramadan.


    I don't have access to the full articles for the other two publications (sigh. to be a student again!), so I can't comment on the methodologies of those two. But the conclusion from the second study (http://www.ncbi.nlm.nih.gov/pubmed/6643131)(used to argue that "the fast of Ramadan also has not been found to adversely effect milk supply in lactating women, although it can alter the content of breast milk, but without affecting infant growth"; the "without affecting infant growth" part is linked to the third and last study)reads:

    Quote
    "Ramadan-fasted (1900 h) glucose values from women in late pregnancy (3.01 +/- 0.11 mmol/l) were significantly lower than all other groups (P less than 0.01) and were 15 per cent (P less than 0.01) lower than overnight-fasted values from similar subjects. Ramadan-fasted free fatty acid and beta-hydroxybutyrate levels were significantly higher (P less than 0.05) and alanine values were significantly lower (P less than 0.05) in late than in early pregnancy. [b]It is concluded that the phenomenon of 'accelerated starvation' occurs when women in late pregnancy fast during Ramadan. The possible consequences of this failure to maintain glucose homoeostasis are discussed with reference to the poor outcome of the actual pregnancies studied." End Quote


    [Note: However, they did say -- "Values for the lactating women were not significantly different from the non-pregnant, non-lactating controls despite the additional metabolic stress of lactation."; I don't know what this means? How different SHOULD they be? I'd assume drastically, otherwise it's basically saying there's no difference between the non-lactating women and lactating women, right?).

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  12. (continued)

    The results and conclusion from the last article (http://www.ncbi.nlm.nih.gov/pubmed/16732795)(saying that "The fast of Ramadan ... can alter the content of breast milk, but without affecting infant growth") mention infant growth, but not infant nutrition (that being said, i can't access the full article so i can't comment on whether or not that's in there):

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    The results showed that during Ramadan, zinc, magnesium and potassium levels in breast milk decreased significantly (P<0.05). The mother's weight increased approximately 1 kg after Ramadan. Changes in body mass index of the mother were not statistically significant. A significant decrease in vitamin A intake was observed after Ramadan (P < 0.05). During Ramadan, energy and most nutrient intakes except protein and vitamins A and C were found below daily recommended dietary allowances necessary for lactating women.
    CONCLUSIONS:
    Ramadan fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. There were significant differences in some of the micronutrients such as zinc, magnesium and potassium. The nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. For these reasons, it would seem prudent to excuse lactating women from fasting during Ramadan. End Quote



    Again, I haven't read the last two articles in their entirety, but I do really strongly feel like the studies have been misunderstood or misconstrued. I appreciate that resources were posted for people who choose to fast, as well as eating tips to ensure that they can gain the best nutrition for themselves and their baby while fasting, should one choose to do so. But I don't think we should claim that there's scientific evidence showing that it's not harmful to the baby or pregnant mother to fast 14 hrs... especially without presenting the data in its entirety (ie, "the macronutrient composition of of breast milk was not altered due to Ramadan fasting, but but there were significant decreases in many nutrients present in breastmilk.").

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  13. Salams and thank you for ur insightful post. I just have a few concerns with this whole fasting while pregnant or nursing thing. We are judged on our intentions, and the same goes for fasting as well. So when a pregnant or nursing woman chooses to fast because she would rather fast along with her family or community than making up the days later on her own, is she really fasting for the right reasons?
    Also, Im sure fasting during long summer days as compared to short winter days does have some kind of effect on the unborn fetus. I am now 14 weeks pregnant and this is my first time. I have been reading up a lot beinf pregnant and the thing I keep coming across over and over again is the importance of nutrition and staying well hydrated. So as it is the middle of summer, and I do not have the leisure to become nocturnal, I am without a doubt not planning on fasting. I probably would be able to handle the difficulties of fasting but I am not willing to expose my little munchkin to any stress that may cause it any harm! Especially since if their is any damage to the fetus from malnutrition or dehydration I would never know until delivery or later since many abnormalities do not present theamselves until later in life. I do pray that Allah sees my intentions as pure and I do plan on getting into the Ramadan spirit in other ways. I wish you all a Ramadan Mubarak and pray that you all have a wonderful month filled with 3ibada, taqwa and the highest of iman :)

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  14. @fny21 - thanks for reading so thoroughly. i appreciate your comments my intention in writing this blog is not to encourage pregnant or nursing muslim women to fast, they have been doing so for over 1400 years. there is the option, and what a mercy, to opt out of the fast for mothers who are pregnant or nursing. however, in my experience serving muslim mothers for over ten years, the majority will indeed fast while nursing or pregnant at some point. it is my hope that this blog post is a means for them to undertake the fast safely and in the best of health for both them and their baby. the studies which i have included are not a means to encourage or discourage fasting. i do believe that the studies show that yes, some physiologic changes do occur in mothers, but that ultimately, these changes do not affect fetal growth. specifically with nursing, the nutritional value of the milk is constantly in flux, and easily remedied by eating. a mother must be severely malnourished in order to do affect her nursling's nutritional status, she is the one rather who takes the hit. and if you read under the third trimester section, i do refer to my apprehension when women fast during this trimester, and to the study that found an 'accelerated starvation' occurred in the mother. i understand that this year the fast is particularly long for us in the west, which is why posts like this are even more necessary. on a personal note, after over seven years of being pregnant, or nursing during ramadan, i have fasted and not fasted. it is an individual choice between a woman and her Lord. I pray that this post is a benefit for those who choose. Jazakallah khair sister, and a very blessed Ramadan to you and yours.

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  15. @lysistrata - mabrook on your pregnancy! i pray it is easy for you and a means of drawing nearer to your Lord. i wasn't implying that your niyah for fasting is for other than Allah. i apologize if this was the impression. i believe that one can balance many factors when making a decision, but still make a niyah for only Allah. Allahu alim. Ramadan Mubarak to you and the little one. May Allah fill it with openings.

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  16. salaams, i am 27 weeks pregnant with my 3rd child and have diabetes which is controled by both tablets and insulin pens, i would really like to fast this ramadhan as i have always done so but the fasts here are 20 hours long and i am unsure as to how fasting long hours may affect me or the baby, do you have any specific advise for women with gestational diabetes?

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  17. @fbadat90 - mabrook on your pregnancy and ramadan karim! fasting with diabetes is not recommended in pregnancy. if i were your midwife, i would advise against it. may allah make another means for you, of drawing near to Him in this blessed month. jazakallah khair!

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  18. Assalamau alaikoum wa rahmatullaah wa barakatuh , I am 14 weeks pregnant with my second child alhamdulillaah. I am in Tunisia and this ramadaan is really really hot in here and the fast are 15 hours long. I have fasted 5 days so far because i really could not cope many days. I feel so exhausted since around 10 am. However, I am alsways confused about if I should carry on or break the fast. Scholars say that the mother can break her fast if she fears for her child...I find this so 'general' sometimes because, how can I really know if my fasting is harming my baby (unless i have a specific condition). I think being very tired in a hot summer day in Tunisia while fasting is pretty normal..but, how can I know my baby is being affected? appreciate your help. Excellent post actually allahummah barik. Umm Yasmeen

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  19. I'm 5weeks pregnant and I fast for last 15days but These days I fell that my stomach is burning and I'm getting hungry every second and really want to fast what should I do am I hurting my babie I stop fasting but I fell guilty that I don't fast and at the same time I fell that I'm hurting my babie please help what should I do asalamu calaykum

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  20. Asa, i live in pakistan, and have been searching for a muslim midwife for some time now. Homebirth by choice is unheard of where i live. So i am having a lot of difficulty in finding a midwife. Do you know of any muslim midwifes who are willing to travel to pakistan??

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  21. Salam alykum,
    I know this post is old, but maybe you know more, since this is your profession. I breastfeed and supplement. Will I have to fast Ramadan, as I know it will affect my supply and what little I am able to give and him take. I hope you can answer this, if not, could you please guide me to someone who can offer my the correct opinion. I've been trying to look for an answer, but I am still coming up short :(

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