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Effect of epidural on breastfeeding

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Epidurals are a popular choice for pain relief during labour.

Around one-half of low-risk women giving birth to their first baby at private hospital have an epidural, and around one-third when giving birth at a public hospital.

Around one-third of low-risk women giving birth to subsequent babies at a private hospital have an epidural, and around one-tenth when giving birth at a public hospital.

One study found that among women who breastfed previously, those who were randomly assigned to receive a higher drug dose epidural were more likely to have ceased breastfeeding after 6 weeks compared to women who were randomly assigned to a lower drug dose epidural or no epidural.

It's unclear if epidurals directly affect breastfeeding.

However, it's possible that epidurals have several indirect effects on breastfeeding.

Here are 6 ways epidurals may affect breastfeeding and what you can do about it:

Note: BellyBelly is pro-informed decision making. It's most beneficial to be fully informed about the possible ways in which pain medication during labour may impact breastfeeding. This can help mothers to reduce the risk of any complications or issues, as well as prepare them and their babies for a healthy breastfeeding journey. BellyBelly understands that sometimes epidurals are needed. We support all mothers, no matter what birth choices they decide upon.

#1: Delaying Milk 'Coming In'

A recent study showed a direct link between pain medications (including epidurals) used during labour and a delay in a mother's milk 'coming in'. In fact, it was found that women who had labour pain medications were 2-3 times more likely to notice a delay in their milk 'coming in' compared to women who did not use labour pain medications and delivered vaginally.

Spending as much time in skin-to-skin contact with your baby as possible, and watching out for and feeding your baby often (e.g. when he shows early feeding cues) can help your milk to 'come in'.

#2: Dampening Of A Baby's Feeding Behaviours

Breastfeeding is instinctive for babies. They display a series of typical feeding behaviours when placed on their mother's chest that enable them to seek their mother's breasts and begin feeding.

A baby is typically alert and eager for the first hour or two after birth. This is when nature intends for a baby to have his first breastfeed. When a baby's feeding behaviours are functioning optimally, this helps a baby to be able to do find his mother's breasts and in doing so get breastfeeding off to the best start possible.

A baby's feeding behaviours may be dulled by pain medication exposure during labour.

Skin-to-skin contact between you and your baby can help your baby's feeding behaviours to work well. So doing this as often as possible can help a great deal.

#3: Causing Breast Swelling

A common side effect of epidurals is causing blood pressure to drop. To try to counteract this side effect, intravenous fluids are given to the mother.

The use of IV fluids during labour may result in generalised swelling, including of the breast. Any swelling of the breast can make it harder for a baby to attach to the breast. If your baby is having trouble attaching, a lactation consultant or Australian Breastfeeding Association counsellor will be able to provide you with some helpful suggestions about what to do.

Also, IV fluids given to the mother in labour cross the placenta to the baby and this can artificially elevate a baby's birth weight. This may make it appear as though the baby is losing 'too much' weight when the baby is really just shedding the excess fluid. In such a situation, a mother's confidence in breastfeeding can be affected and it could lead to unnecessary supplementation.

#4: Disruption To A Mother's Natural Oxytocin Release

An epidural inhibits the mother's release of natural oxytocin.

Natural (not synthetic) oxytocin encourages bonding between a mother and her baby. This bonding can help with getting breastfeeding going well. Spending as much time as possible in skin-to-skin contact with your baby after the birth can help to overcome any disruption to the natural oxytocin release.

Also, epidurals increase the need for synthetic oxytocin. This may be to help counteract the slowing down of labour that is more likely with epidurals. It may also be epidurals interfering with a mother's natural oxytocin release.

Synthetic oxytocin also interferes with a mother's natural oxytocin release and its use means the need for IV fluids. These things may be why synthetic oxytocin use has been associated with an increased use of bottle-feeds and a shorter breastfeeding duration.

#5: Pain Due To Increased Instrumental Delivery

Epidurals increase the risk of instrumental delivery (e.g. forceps, vacuum). This can lead to pain and stitches for the mother, and pain, bruising and swelling for the baby. These things can make early positioning and attachment to the breast harder.

A midwife, lactation consultant or Australian Breastfeeding Association counsellor can help provide suggestions to help with the positioning and attachment of your baby at the breast.

#6: Mother and Baby Separation

Epidurals commonly cause a fever in women. There is a possibility the mother's fever could be due to a uterine infection (even if the more likely cause is an epidural).

So, babies born to mothers with a fever are often assessed for infection (sepsis). This can involve the baby being taken to special care nursery until the test results are known. If a mother and her baby are separated after birth, this can make establishing breastfeeding more difficult.

If you and your baby are separated, you could remind the staff that breastfeeding is important to you. You could ask them if your baby could be brought to you for feeds. Or, you could ask if you could be taken to your baby. Or, if you don't have a drip in place, you could just go to your baby by yourself. Being with your baby helps you both feel calmer, and helps with bonding and your milk supply.
Your Birth and Your Baby
When it comes to giving birth, it can help to be as informed as possible, so that if faced with any challenges, we can be more ready to tackle them.

If you decide to try alternative pain relief options for labour, take a look at BellyBelly's article about natural pain relief options.

...

Remember, no matter what events occur during the birth of your baby, they need not stop you from breastfeeding your baby successfully (whatever that may mean for you). At the first sign of troubles, seeking help quickly is key. A lactation consultant or a breastfeeding support organisation is a great place to start.

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6 Ways Epidurals May Affect Breastfeeding | BellyBelly

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Epidurals are a popular choice for pain relief during labour. Around one-half of low-risk women giving birth to their first baby at private hospital have an epidural, and around one-third when giving birth at a public hospital.

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Drugs in breastmilk Facebook page

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The Breastfeeding Network Drugs in Breastmilk information service

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The Breastfeeding Network Drugs in Breastmilk Information Service UK PO Box 11126, PA2 8YB 英国，Paisley, Renfrewshire

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Breastfeeding in public

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Breastfeeding Welcome Bromley. 309 likes · 1 talking about this. Making it easier for women to breastfeed when out & about in Bromley. Twitter@BromleyBFW

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Vitamin D

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Alcohol

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Caffeine

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In this article

Does the caffeine I have get into my breastmilk?

Yes. When you have anything with caffeine in, whether it's coffee, tea, cocoa, or a bar of chocolate, a small amount of caffeine enters your bloodstream. Once the caffeine is in your blood, about one per cent of it ends up in your breastmilk (Briggs et al 2011).

How much caffeine can I have when I'm breastfeeding?

The NHS recommends you keep your caffeine intake below 300mg a day (NHS 2016). Here's a guide to the amount of caffeine in drinks:

one mug of filter coffee: 140mg

one mug of instant coffee: 100mg

one mug of tea: 75mg

one can of energy drink: up to 80mg

one 50g plain chocolate bar: up to 50mg

one cola drink (354ml): 40mg

(NHS 2016)
It can be tough to resist the boost caffeine gives you in the weeks and months after having a baby, when exhaustion takes over.
Breastfeeding on demand can also make you feel thirsty, so it's tempting to drink cup after cup of tea and coffee, just to keep you going. See the section, "What can I have instead of caffeinated drinks?" below for alternatives.

Watch out for other ways caffeine can get into your diet. Energy drinks can be loaded with caffeine, so it's best to cut them out altogether (NHS 2015, 2016).

Espresso-based coffee drinks, such as cappuccinos and lattes, can be higher in caffeine than you think, depending on where you buy them and how many shots of espresso you ask for (Crozier et al 2012).

Some cold and flu remedies contain caffeine, too (NHS 2015, 2016).

Will caffeine harm my baby?

If you have about 200mg of caffeine day, it's unlikely to harm your baby (Briggs et al 2011, Santos et al 2012). Caffeine in your breastmilk is more likely to unsettle your baby. So, if your baby seems restless, or finds it difficult to sleep, try cutting back on or cutting out caffeine to see if it makes a difference (James 2011, OTIS 2011).

Most of our knowledge about the effects of caffeine on babies comes from how premature babies are cared for. Caffeine has been used safely for many years to help premature babies breathe (James 2011, Picone et al 2012). However, when these babies have been given too much caffeine it causes them to be wakeful, restless or irritable (Briggs et al 2011, FDA 2014, More 2009).

Likewise, research on breastfed, full-term babies suggests that if their mum has more than a moderate amount of caffeine, it may disrupt their sleep. But we can't be sure if these sleep problems are definitely linked to caffeine in their mum's milk (Santos et al 2012), as it's common for babies to go through phases of waking up.

What we do know is that the younger your baby is, the longer it takes him to clear caffeine from his system (James 2011, Drugs.com 2014). That's because your baby's liver and kidneys are still immature. By the time your baby is nine months old, he should be able to eliminate caffeine from his system at a similar rate to you (Drugs.com 2014).

Are there other reasons to avoid caffeine while breastfeeding?

If you have the circulatory disorder Raynaud's phenomenon, it's best to avoid caffeine. Raynaud's happens when your blood vessels constrict, making your fingers, toes and other extremities cold and tingly (NHS 2015) because they're getting less blood.

It's a common condition, and is thought to affect 10 million people in the UK (NHS 2015) .

Raynaud's can also affect your nipples. Caffeine makes the constriction of your blood vessels worse, making breastfeeding painful (NICE 2014). The pain may be sharp, shooting or stabbing (Barrett et al 2013).

What can I have instead of caffeinated drinks?

You could try decaffeinated tea or coffee. Water, perhaps flavoured with a slice of lemon or lime, or a glass of skimmed or semi-skimmed milk, are also good alternatives. If you like hot drinks, warmed, no-added-sugar squashes work well.

Herbal teas are another option, though check the caffeine content of teas on the packet. For example, redbush tea does not contain caffeine, but green tea does (Mayo Clinic 2014).

If you still want the occasional coffee or tea, there's no need to cut it out completely. Instead:

Brew tea for less time. Steeping your teabag for just one minute instead of five minutes reduces the caffeine by as much as half.

Switch from brewed coffee to instant coffee, as it's slightly lower in caffeine. If you don't mind the (lack of) taste, you could also make instant coffee weaker still by using only half a teaspoon of coffee.

Swap from hot chocolate or cocoa to a hot malt drink instead.

Last reviewed: December 2015

Next review: December 2018

References

ACOG.2013. Breastfeeding your baby: frequently asked questions. The American College of Obstetricians and Gynecologists. www.acog.org [Accessed December 2015]

Barrett ME, Heller MM, Fullerton Stone H, et al. 2013. Raynaud Phenomenon of the Nipple in Breastfeeding Mothers: An Underdiagnosed Cause of Nipple Pain. JAMA Dermatology 149(3): 300-6. archderm.jamanetwork.com [Accessed December 2015]

Briggs G, Freeman RK, Yaffe SJ. 2011. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Lippincott Williams & Wilkins

Cooke L, Fildes A. 2011. The impact of flavour exposure in utero and during milk feeding on food acceptance at weaning and beyond. Appetite 57(3):808-11

Crozier TWM, Stalmach A, Lean MEJ, et al. 2012. Espresso coffees, caffeine and chlorogenic acid intake: potential health implications. Food Funct 3(1):30-3

Drugs.com. 2014. Caffeine citrate. www.drugs.com [Accessed December 2015]

Hausner H, Bredie WL, Mølgaard C, et al. 2008. Differential transfer of dietary flavour compounds into human breast milk. Physiol Behav 95(1-2): 118-24

James J. 2011. Can Consuming Caffeine While Breastfeeding Harm Your Baby? An Interview with Ruth Lawrence, PhD. J Caffeine Research 1(4): 192-4

Mayo Clinic. 2014. Caffeine content for coffee, tea, soda and more. www.mayoclinic.org [Accessed December 2015]

NHS. 2015. Raynaud's phenomenon. NHS Choices, Health A-Z. www.nhs.uk [Accessed December 2015]

NHS. 2016. Breastfeeding and diet. NHS Choices, Health A-Z. www.nhs.uk [Accessed February 2017]

NICE. 2014. Breastfeeding problems. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. cks.nice.org.uk [Accessed December 2015]

OTIS. 2011. Caffeine and pregnancy. Organization of Teratology Information Specialists. www.mothertobaby.org [Accessed December 2015]

Picone S, Bedetta M, Paolillo P. 2012. Caffeine citrate: when and for how long. A literature review. J Matern Fetal Neonatal Med 25(S3):11-4

Santos IS, Matijasevich A, Domingues MR. 2012. Maternal caffeine consumption and infant nighttime waking: prospective cohort study. Pediatrics 129(5):860-8

Trabulsi JC, Mennella JA. 2012. Diet, sensitive periods in flavour learning, and growth. Int Rev Psychiatry 24(3):219-30

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In this article Yes. When you have anything with caffeine in, whether it's coffee, tea, cocoa, or a bar of chocolate, a small amount of caffeine enters your bloodstream. Once the caffeine is in your blood, about one per cent of it ends up in your breastmilk (Briggs et al 2011).

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Medicines and drugs

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations. BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Please use the below links for more information

We are constantly reviewing the information available on drugs and breastfeeding as new research is conducted. Therefore, from time-to-time the information on this website may be updated - please be sure to check regularly for any new information and changes to the drug information fact sheets and leaflets.

What is the Drugs in Breastmilk Information Service?

The original Drugs in Breastmilk Helpline was set up by BfN in response to the number of calls we were receiving that concerned medication.

In 2017 we noticed that majority of enquiries from parents and professionals to the Drugs in Breastmilk Helpline were coming via email or social media. As a charity operating on reducing funds we need to run the service in the most efficient and effective way possible without compromising the needs of parents. As a result we decided to run the Drugs in Breastmilk service via email and social media enquiry only.

You can still access information on taking prescription drugs while breastfeeding by sending a private message via our Facebook page or via . Please provide as much information as possible (age of baby, dose, frequency and name of medication or drug). All enquiries are answered as soon as possible by one of our small, volunteer team of qualified pharmacists or breastfeeding supporters. As we can't guarantee a response time, in an emergency situation, please do not wait for our reply, but access help from a trained healthcare professional.

If you call the old Drugs in Breastmilk helpline 0844 number, you will hear a recorded message with information about where to access alternative support. Calls won't be answered live and there is no voicemail service available.

If you still have the Drugs in Breastmilk helpline number on any materials or web pages please could you remove it and replace it with the following information:
'If you have specific questions about medications or treatments, please message the Drugs in Breastmilk information service Facebook page or email druginformation@breastfeedingnetwork.org.uk. If you require breastfeeding support, please call the National Breastfeeding Helpline on 0300 100 0212."

The service is open to mothers and professionals. As the time available to deal with breastfeeding support of mothers is limited, professionals are encouraged to find out the information to enable them to support the mothers themselves.

Evaluation of the Drugs in Breastmilk Information Service

In 2019, BfN commissioned Swansea University to undertake an evaluation of the DIBM service we offer. The executive summary of this report can be found and the full report can be found .

Become a Friend of Drugs in Breastmilk

Please click here for more information on how you can help support this vital service.

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Drugs In Breastmilk - Is It Safe? - The Breastfeeding Network

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An increasing number of mothers and health professionals have sought to find more information on the levels of medicines passing through milk to the baby. Standard reference books such as the British National Formulary (BNF) provide little information for professionals and parents to make decisions on individual situations.

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Exercise

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By Kelly Bonyata, IBCLC

Moderate exercise improves a mother's health and has a positive effect on her emotional well-being. Some of the benefits include:

Higher level of cardiovascular fitness

Improved blood lipid profiles and insulin response

A feeling of well-being from improved energy and reduced stress levels

Enhanced maternal-infant relationship

Alleviation of depression symptoms in those with major depressive disorders

Research has shown that moderate exercise does not affect milk supply, milk composition, or baby's growth. Exercising to exhaustion may have a short-term effect on lactic acid and IgA content of a mother's milk (more details below).

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Does exercise affect milk supply or nutrient content?

No. Studies have shown no difference in milk production or nutrient composition or babies' weight gain. One study showed a slight increase in milk supply for the women who exercised regularly, but because of the small size of the study this increase may not be significant.

Does exercise affect immunologic factors in milk?

A couple of small studies have shown that there is no difference in immunologic factors after moderate exercise, but that IgA levels are decreased short-term after exhaustive exercise. Most breastfeeding mothers do not exercise to exhaustion, but for those that do so and breastfeed soon after, a decrease in IgA levels in one feeding per day is unlikely to be significant.

More details: In 1997, a study by Gregory et al found that IgA levels in breastmilk were decreased for a short time (10-30 minutes) after mom had exercised strenuously ("exhaustive exercise"), but that levels had returned to normal within an hour. They also observed that IgA levels increased after the breast had been emptied, whether or not mom had been exercising strenuously. In 2003, Lovelady et al looked at immunologic factors (IgA, lactoferrin, lysozyme) in breastmilk after moderate exercise, and found no difference in the milk of exercising and non-exercising mothers.

Does lactic acid increase in breastmilk after exercise?

Research has not shown a noticeable increase in lactic acid buildup after moderate exercise (50% & 75% intensity). The lactic acid in breastmilk does increase somewhat if mom exercises to maximum (100%) intensity, also described as exhaustive exercise. This increase may be present up to 90 minutes post-exercise. There are no known harmful effects for the baby.

Will baby refuse the breast after mom exercises?

Most studies have found no difference in acceptance of the breast, even after maximum intensity exercise.

Although a highly publicized 1992 study indicated that baby might fuss or refuse expressed milk from a mom who had been exercising at 100% intensity, the results were questionable because the babies were fed the milk by dropper (unfamiliar to these babies), and the mothers reported that the babies had not had problems with nursing after exercise in the past. A more recent study showed no change in infants' acceptable of mom's milk an hour after exercise, even for the moms who exercised at maximum intensity (and thus did have a slight increase in lactic acid in their milk).

If baby seems to object to the taste of mom's milk after strenuous exercise, keep in mind that it might have nothing to do with the exercise - baby might be distracted or objecting to the salty taste of sweat on your breast, etc. If this happens consistently, mom might try expressing a little milk (3-5 mL from each breast) before nursing baby, postponing feeding for a half hour to let the lactic acid levels subside, and/or decreasing workout intensity a bit in the future.

Exercise guidelines for breastfeeding mothers

For your own comfort, you may wish to nurse before exercising and wear a good, supportive bra (especially during strenuous exercises such as running, jumping, etc).

Some babies don't like nursing when mom has been sweating (due to the salt on mom's skin) so you may wish to rinse your breasts or take a shower before nursing.

If you regularly lift weights or do other exercises involving repetitive arm movement and you develop plugged ducts, cut back and start again more slowly.

Keep yourself hydrated.

Additional information

More exercise-related FAQs

The Active Mommy Conundrum: Can Exercise Harm Breastfeeding? (see also Part 2) by Taryn Barrette, RD and Jane Heinig, PhD, IBCLC

Research

Daley AJ, et al. Maternal Exercise and Growth in Breastfed Infants: A Meta-analysis of Randomized Controlled Trials. Pediatrics 2012. doi: 10.1542/peds.2011-2485. Published online June 18, 2012.
"It appears that mothers can exercise and breastfeed without detriment to the growth of their infants, but this is based on limited evidence, and more research is required before this finding is confirmed."

Lovelady C. Balancing exercise and food intake with lactation to promote post-partum weight loss (Review). Proc Nutr Soc. 2011 May;70(2):181-4. Epub 2011 Feb 24.
"Moderate aerobic exercise of 45 min/d, 5 d/week improved cardiovascular fitness, plasma lipids and insulin response; however, it did not promote post-partum weight loss. Breast milk volume and composition were not affected. The effect of exercise with energy restriction in overweight women on the growth of their infants has also been studied. At 1 month post-partum, women restricted their energy intake by 2092 kJ/d and exercised 45 min/d, 4 d/week for 10 weeks. Women in the diet and exercise group lost more weight than the control group (4·8 (sd 1·7) kg v. 0·8 (sd 2·3) kg); however, there were no differences in infant growth. Based on the current evidence, it is recommended that once lactation is established, overweight women may restrict their energy intake by 2092 kJ/d and exercise aerobically 4 d/week to promote a weight loss of 0·5 kg/week."

Blumenthal JA, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007 Sep-Oct;69(7):587-96. Epub 2007 Sep 10.
"The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD."

Su D, Zhao Y, Binns C, Scott J, Oddy W. Breast-feeding mothers can exercise: results of a cohort study. Public Health Nutr. 2007 Oct;10(10):1089-93. Epub 2007 May 22.
"Exercise does not affect breast-feeding outcomes at the usual levels of activity undertaken by mothers. Breast-feeding and exercise are important for maintaining and promoting health, and this study provides reassurance to health professionals wishing to encourage mothers to continue both behaviours."

Bopp M, Lovelady C, Hunter C, Kinsella T. Maternal diet and exercise: effects on long-chain polyunsaturated Fatty Acid concentrations in breast milk. J Am Diet Assoc. 2005 Jul;105(7):1098-103.
"These results suggest that women consuming adequate amounts of LC-PUFA can exercise moderately without decreasing the LC-PUFA in their breast milk."

Lovelady CA. The impact of energy restriction and exercise in lactating women (Review). Adv Exp Med Biol. 2004;554:115-20.
"Exercise improves cardiovascular fitness, plasma lipids, and insulin response in lactating women. However, exercise alone, without caloric restriction, does not promote weight loss. Once lactation is established, over-weight women may restrict their energy intake by 500 kcal/day to promote a weight loss of 0.5 kg/week without affecting the growth of their infants. Moderate exercise does not affect maternal immune status or levels of sIgA, lactoferrin, and lysozyme in human milk. Further research is needed to determine the effect of exercise and energy restriction on maternal bone health and immune status and composition of human milk."

Lovelady CA, Fuller CJ, Geigerman CM, Hunter CP, Kinsella TC. Immune status of physically active women during lactation. Med Sci Sports Exerc. 2004 Jun;36(6):1001-7.
"The results of this study suggest that women may exercise moderately during lactation and increase their fitness level without impairing their immune function."

Rich M, Currie J, McMahon C. Physical exercise and the lactating woman: a qualitative pilot study of mothers' perceptions and experiences. Breastfeed Rev. 2004 Jul;12(2):11-7.
"The main themes to emerge from the content analysis of the qualitative data included perceived well-being from improved energy and stress levels, and weight control."

Cary GB, Quinn TJ. Exercise and lactation: are they compatible? (Review) Can J Appl Physiol. 2001 Feb;26(1):55-75.
"Human studies suggest no detrimental effect of exercise during lactation on milk composition and volume, infant growth and development, or maternal health. Studies also demonstrate improved cardiovascular fitness in lactating, exercising women and suggest a quicker return to pre-pregnancy body weight and a more positive sense of well-being, compared to sedentary controls."

Lovelady CA, Williams JP, Garner KE, Moreno KL, Taylor ML, Leklem JE. Effect of energy restriction and exercise on vitamin B-6 status of women during lactation. Med Sci Sports Exerc. 2001 Apr;33(4):512-8.
"Energy restriction and exercise from 4 to 14 wk postpartum in overweight, breastfeeding women consuming adequate dietary intakes and 2.0 mg of supplemental vitamin B-6 does not adversely affect vitamin B-6 status or infant growth."

Babyak M, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000 Sep-Oct;62(5):633-8.
"Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time."

Gregory RL, Wallace JP, Gfell LE, Marks J, King BA. Effect of exercise on milk immunoglobulin A. Med Sci Sports Exerc. 1997 Dec;29(12):1596-601. This study observed short-term decreased IgA levels in breastmilk after exhaustive exercise. "Milk IgA concentrations increased significantly in both exercise and resting control groups after the breasts were emptied, suggesting that breast emptying stimulated milk IgA synthesis. The results provide evidence that exercise alters milk IgA and IgA1 concentrations for 10-30 min after exhaustive exercise, but recovers by 1 h, and provide additional support for exercise effects on the mucosal immune system."

Lovelady CA, Nommsen-Rivers LA, McCrory MA, Dewey KG. Effects of exercise on plasma lipids and metabolism of lactating women. Med Sci Sports Exerc. 1995 Jan;27(1):22-8.

Prentice A. Should lactating women exercise? Nutr Rev. 1994 Oct;52(10):358-60.
"After 12 weeks, aerobic capacity was significantly higher in the women who had exercised than in the controls, but no differences in body weight, body fatness, energy expenditure, or resting metabolic rate (RMR) were noted. The exercise program had no effect on breast milk output or composition or infant weight gain. This demonstrates that recreational exercise sufficient to improve cardiovascular fitness without substantially altering energy balance does not adversely affect lactation performance."

Lovelady CA, Lonnerdal B, Dewey KG. Lactation performance of exercising women. Am J Clin Nutr. 1990 Jul;52(1):103-9.
"Exercising women differed significantly from control subjects in maximum oxygen consumption, percent body fat, total energy expenditure, and energy intake. There was no difference between the groups in plasma hormones or milk energy, lipid, protein, or lactose content. Exercising subjects tended to have higher milk volume (839 vs 776 g/d) and energy output in milk (538 vs 494 kcal/d). Thus, there was no apparent adverse effect of vigorous exercise on lactation performance."

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Exercise and Breastfeeding * KellyMom.com

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Does exercise affect milk supply or nutrient content? No. Studies have shown no difference in the volume or composition of the milk or babies' weight gain. One study showed a slight increase in milk supply for the women who exercised regularly, but because of the small size of the study this increase may not be significant.