The AAP (American Academy of Pediatrics) recommends exclusively breastfeeding
your baby for the first six months of life, with no solids or supplements, and
continuing to nurse throughout the first year of life and beyond. During the
period of exclusive breastfeeding, it is very unlikely that you will become
pregnant. However, as more and more mothers recognize the advantages of long-term
nursing and natural weaning, more of them will become pregnant while they are
nursing their baby.
The mother facing the decision of whether to wean or continue nursing
during her pregnancy often has mixed emotions, and may get conflicting advice
from friends, family, and health care providers. The most common concern is
whether continuing to breastfeed will put the expected baby at risk in some
way. There is no evidence to suggest that nursing while pregnant endangers the
fetus during a normal pregnancy. If a mother has previously delivered a premature
baby, develops signs of pre-term labor, or is carrying multiples, there is concern
that a hormone released during lactation (oxytocin) may stimulate contractions
and trigger a premature labor. In these special situations, mothers are often
advised to wean their older child. Research suggests that the uterus is not
receptive to hormonal stimulation from oxytocin until around 24 weeks gestation,
so it is generally safe to consider nursing until about 20 weeks, even in these
special situations. There is almost never a need to wean abruptly during pregnancy.
The mother who is deciding whether to continue nursing during her
pregnancy has several factors to consider: her medical history, her physical
and emotional comfort level, the nursing child’s age, and his need to nurse.
If the pregnancy is progressing normally, then the decision of whether to continue
to breastfeed is more an individual ‘parenting’ decision rather than a ‘medical’
decision.
There is no evidence that nursing during a pregnancy will cause miscarriage
during the early months. Miscarriage occurs spontaneously in about 16-30 percent
of all pregnancies, so it will sometimes happen while a mother is nursing. The
nursing mother should not add the burden of guilt to the pain of losing a baby
to miscarriage.
Nursing during pregnancy will not deprive the fetus of essential
nutrients, and will not create a harmful “drain” on the mother’s body. During
pregnancy, it is always important to eat nutritiously, gain weight appropriately,
and get adequate rest. A well-nourished mother should have no problem providing
enough nutrients for both her unborn baby and her nursing child. Breastfeeding
provides several opportunities each day for the expectant mother to take breaks
and rest while her toddler nurses or naps.
Due to hormonal changes, most mothers will experience some degree
of nipple soreness during pregnancy, which can make nursing very uncomfortable.
Nipple soreness is the most common reason given for weaning during pregnancy.
The soreness usually is most pronounced during the early months of pregnancy.
Since the cause of the soreness is hormonal, there is no real treatment other
than time. Some mothers find relief by reducing the time the baby spends at
the breast, limiting nursing sessions to nap and bed-time,and others find that
reminding the toddler to “open wide” while latching on may reduce soreness.
During pregnancy, most mother’s milk supply will decrease due to
hormonal changes. During the second trimester, the milk will begin to change
to colostrum. Both the quantity and the taste of the milk change dramatically
during this time, and many babies will wean themselves when the milk changes.
If you are nursing a baby younger than 6 months when you become pregnant, you
will need to carefully monitor his growth and weight gain, and supplemental
feedings may be necessary. Older babies who are eating solids will usually show
an increased appetite for other foods as your milk supply decreases.
Some babies don’t seem to care whether they are getting a lot of
milk when they nurse. That’s where the emotional component of breastfeeding
becomes a factor. Babies vary in their need for oral satisfaction, physical
contact, closeness to mother, and willingness to have those needs met in ways
other than nursing.
Some toddlers continue to find breastfeeding very important all
the way through the pregnancy and after the birth of the new baby as well. Nursing
siblings who are not twins is called “tandem nursing”. In our culture, this
concept is unusual, although other in many other cultures it is a common practice.
It is not unusual to have mixed feelings about nursing during pregnancy or tandem
nursing. Negative feelings are common, due to physical discomfort and fatigue,
as well as feeling “touched out” after nursing for so many months. For the mother
who finds herself resenting the older baby’s demands, and has difficulty focusing
enough attention on the new baby, weaning may be the best choice. She should
try to wean gradually, nursing the new baby when the toddler is occupied with
other things, and substituting special activities and snacks for nursings. Dads
can be a big help with this process.
When they choose to tandem nurse, many mothers find that a unique
closeness develops between their nursing siblings. Sharing at the breast can
reduce the jealously and sibling rivalry that often accompanies the arrival
of a new baby.
Because the older child is receiving nourishment from foods other
than breastmilk, the newborn should be allowed to nurse first, ensuring that
he gets lots of colostrum. Nursing a toddler can help relieve engorgement. Because
the toddler will nurse more vigorously than the infant, the mother may find
that she produces an oversupply of milk. If this occurs, and the newborn chokes
when attempting to nurse, she may want to let the toddler nurse briefly before
putting the new baby on the breast. Within a short period of time, the milk
supply will adjust to the needs of the two siblings, just as it would if the
mother were nursing twins or triplets. The two nurslings can be fed at the same
time, or separately - whatever works best for you.
There are no special concerns about hygiene. The nipple secretes
an enzyme that reduces bacterial counts, and breastfed babies are born with
immunities to most germs found in their home environment. Most germs involved
in common illnesses are contagious for days before symptoms appear, so tandem
nursers have been exposed by the time you know one of them is ill. If you are
dealing with a serious illness, one that is very contagious, or thrush, you
may want to limit each child to one breast temporarily.
Sometimes a toddler who was weaned before the new baby’s arrival
will decide that he wants to nurse again. Often a discussion of how he used
to nurse, but now he’s a “big boy” and can eat grown up food, will suffice.
If he is insistent about it, it is probably best to let him try. Most of the
time toddlers who have weaned have forgotten how to nurse, and will lose interest
quickly. Allowing him to nurse until he feels more secure about his new position
in the family can be a good idea.
Tandem nursing is not for everyone. If it is not working out well,
mothers should wean the older child without feeling guilty about it. It is important
to give the older baby lots of extra cuddling and attention so that he knows
that although he is losing the comfort and security of the breast, he is not
losing his mother’s love.
If a mother does choose to tandem nurse, she can find it very gratifying
for everyone involved. Knowing that she nursed her baby until he outgrew the
need is a very rewarding feeling, and can result in increased security and self-esteem
in the child who weans when he is ready to move on to the next stage of his
development, and not just because his mother became pregnant.
About the Author
Anne Smith, anne@breastfeeding-basics.com
http://www.breastfeeding-basics.com
Anne Smith is an IBCLC – International Board Certified Lactation Consultant
and La Leche Leader since 1978. More importantly, she is a mother to 6 breast
fed kids with twenty plus years experience of counseling nursing mothers. Her
site, www.BreastfeedingBasics.com
, provides expert advice and solutions to breast-feeding problems and gives
basic information on how to breast feed. Anne also features her recommended
breast feeding products and breast pumps.
if you have any questions or comments!