Pregnant or breastfeeding women who don't feel well enough to fast during Ramadan, or are worried about their health or their baby's wellbeing, have been advised to talk to their physician and get a general health check before deciding to fast.
Many Muslims are of the opinion that pregnant or breastfeeding women should not observe fasting during Ramadan. This is because Islam exempts them, small children and ill people from fasting.
Pregnant women who are willing to fast during Ramadan should seek their doctor’s advice throughout the month to make sure that fasting is not affecting their baby. It is important for pregnant women to follow up with their doctors before they decide to fast. While they are fasting, they should ensure to take rest frequently throughout the day and also ensure that they get the right nutrients and calories when they break their fast each evening. They should also ensure to consume up to three liters of water at Suhoor and Iftar. Pregnant women should also avoid sweets and other sugary snacks usually consumed after Iftar.
There are some concerns that fasting may affect how well a baby grows in the uterus (womb), or that fasting may be linked to premature labor. Some studies suggest that more babies are born early if their mums fast during Ramadan. If Ramadan coincides with summer, this means hot weather and long days, which puts pregnant women at greater risk of dehydration due to low fluid intake and this could induce premature labor and subsequently lead to preterm births.
It is not medically advisable for those women who have pregnancy complications such as diabetes, high blood pressure or anemia to fast. Pregnant women with these underlying conditions should avoid fasting in order to protect themselves and their unborn babies from any further unwanted complications.
Other implications of fasting for otherwise healthy pregnant women could include nausea, low birth weight, dizziness and slow metabolism. Fasting pregnant women should contact their doctor as soon as possible if:
- They are not putting on enough weight or are losing weight.
- They become very thirsty.
- Urinating less frequently or if their urine becomes dark-colored and strong-smelling. This is a sign of dehydration, and it can make them more prone to urinary tract infections or other complications.
- They develop a headache or other pains or a fever.
- They become nauseous or start vomiting.
Fasting pregnant women should also contact their doctor straight away if:
- There is a noticeable change in their baby’s movements, such as if their baby is not moving around or kicking as much.
- They notice contraction-like pains. This could be a sign of premature labor.
- They feel dizzy, faint, weak, confused or tired, even after they have had a good rest.
If any of the instances above occur, women should break their fast immediately and drink water. They should also contact their doctor immediately. There is usually an increase in the number of women visiting the emergency department during Ramadan due to fasting and pregnancy.
Because it is highly recommended that women whose babies are aged 0-6 months breastfeed their babies exclusively (feeding babies only with breast milk without supplementing with water and other food) such women may not be able to fast. Mothers of older babies who are already taking supplementary food in addition to mother’s milk can fast, as scientific literature proved that fasting for 24 hours or less will show very little changes in the amount of breast milk produced and in its composition.
If women are exclusively breastfeeding their babies, they are not expected to fast during Ramadan. Most Muslim scholars believe that women who are breastfeeding have permission not to fast. Such mothers who wish to fast need to assess their general medical condition by consulting a physician and reporting the medications they might be using to boost their breast milk supply before making a decision to fast. This will help avoid any complications that could cause harm to them and their baby while breastfeeding between Iftar and Suhoor.
Fasting may cause fatigue and dehydration (especially during hot weather and long fasting days) which will impact a woman’s ability to breastfeed effectively. To maintain a continuous flow of milk and ensure breastfeeding is a success, women should be physically and mentally prepared, keep cool, eat healthy food, drink enough fluids (three liters or 13 cups daily), get at least two hours of rest prior to feeding their baby and they should ensure an average of eight hours of sleep during the night. Women should also ensure that they are fulfilling the basis for successful breastfeeding by avoiding stress, holding the baby comfortably and helping the baby latch to the breast properly.
Breastfeeding women need to ensure they are eating a balanced diet and up to 500 extra calories in addition to the normal daily recommended amount of 2000 calories for females. Lots of fruits, vegetables and foods rich in minerals and calcium are also recommended.
If a fasting lactating woman begins to notice any signs of dehydration (feeling very thirsty, dizzy, weak, very tired, fainting, having a severe headache, passing dark-colored strong smelling urine) she should break her fast by taking sweet fruit juice or salt-water solution and rest. If she still feels unwell after 30 minutes, she should consult her doctor.
Though fasting should not impact the quality and quantity of milk, if a fasting mother is worried that her baby is not getting enough milk, especially when the baby cries constantly, has fewer wet diapers, passes green-colored stool, or has weight loss, she should stop fasting and immediately contact her doctor or a lactation consultant.