Nursing While Pregnant
It is very rare to get pregnant during the period of exclusive breastfeeding. However, sometimes it happens and the mothers have to decide whether they will continue nursing during pregnancy or weaning the baby. It will bring mixed emotions and they may get conflicting advice from family, friends and health care providers.
The mother who decide to continue breastfeeding during pregnancy has several factors to consider:
1. Her medical history
During a normal pregnancy, there is no evidence that nursing can put the expectant baby at risk. However, if a mother ever had any bleeding or miscarriage before, 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.
In the other hand, mothers with history of miscarriage or preterm labor can still nursing while pregnant if the miscarriage or preterm labor has no relation with weak uterus and the fetus is in a good health condition. There is no evidence that nursing during a pregnancy will cause miscarriage during the early months. It occurs spontaneously in about 16-30% of all pregnancies, so it might happen to a nursing mother too. If it happens, the nursing mother should not add the burden of guilt to the pain of losing a baby to miscarriage.
Based on research, 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 situation. If the expectant mother experiences any intense contraction during nursing, stop immediately and contact the health care providers.
2. Her physical and emotional condition
It’s clear that the mother need more nutrition during pregnancy and even more if nursing while pregnant. So for that mother that is breastfeeding while pregnant, she needs an approximately extra 800 calories (500 for breastfeeding + 300 for pregnancy). A well-nourished mother should have no problem providing enough nutrients for both her unborn baby and her nursing child. Nursing while pregnant will not deprive the fetus of essential nutrients nor risk the physical condition of the mother.
Due to hormonal changes, most expectant mothers will experience nipple soreness which can make nursing very uncomfortable. Nipple soreness is the most common reason given for weaning during pregnancy. Some mothers find relief by reducing the time the baby spends at the breast, limiting nursing sessions to nap and bed-time,and ask the child to “don’t bite and open wide” while latching on. Pumping breastmilk also can minimize the nipple soreness and contraction rather than directly breastfeed the child.
Hormonal change also can decrease most mother’s milk supply. During the 2nd trimester, the milk will begin to change to colostrum that make quantity and the taste of the milk change dramatically during this time, and many babies will wean themselves when the milk changes.
Besides physical, emotional condition of the mother also need to be maintained in a comfort level, because it will affect breastmilk production and might affect the fetus condition. Confidence and happiness will enhance breastmilk production while stress will reduce it significantly. Eat nutritiously, gain weight appropriately, and get adequate rest are important to maintain good physical and emotional condition of the expectant mother.
3. Age of the nursing child and her need to nurse
If the nursing child is less than 6 months, the child is still in exclusive breastfeeding period and her need to nurse is maximum. The mother need to carefully monitor her growth and weight gain, and supplemental feedings may be necessary.
If the child is 6-12 months, the mother can maximize the role of complementary food (MPASI), especially if the breastmilk production is reduced after 2nd trimester of pregnancy.
If the child is more than 1 year, besides maximizing MPASI, the child also can have additional UHT milk in her diet if necessary.
Some children don’t seem to care whether they are getting a lot of milk when they nurse because the most important thing for them is ‘the bonding’. They have various needs for oral satisfaction, physical contact, closeness to mother, and willingness to have those needs met in ways other than nursing.
Some children continue to breastfeed after their younger sibling is born, that’s what we called “tandem nursing”.
Here are some advantages of tandem nursing:
– The older child can have breastmilk until they are 2 years or more and still can get the health benefit of breastmilk.
– Tandem nursing can reduce the jealously and sibling rivalry that often accompanies the arrival of a new baby.
– The older sibling can help relieve the mother’s problem of nursing such as engorgement that usually happens in the early days after delivery.
– Tandem nursing also will maintain ‘the bonding’ between the mother and both children. Many mothers find that a unique closeness develops between their nursing siblings.
Here are some tips for tandem nursing:
- Both children can be fed at the same time, or separately – whatever works best for them. If the mother need to nurse both children in the same time, the younger baby need to be put in comfort position before the older one and ensure that the older children’s position will not disturb the younger one. If separately, the newborn should be allowed to nurse first, ensuring that he gets lots of colostrum because the older child is already receiving nourishment from foods other than breastmilk. Pumping the breastmilk before giving it to the older child is also a good idea.
- When tandem nursing, don’t forget to use the moment to communicate the importance of sharing and caring to the older one.
- Regarding the hygiene, there are no special concerns because the nipple secretes an enzyme that reduces bacterial counts, and breastfed babies are born with immunities to most germs found in their home environment. If the mother have a serious or very contagious illness, she may want to limit each child to one breast temporarily.
- Since nursing more than one child, the mother will quickly feel more thirsty and hungry. Therefore, need to put extra calories in healthy diet and drink plenty of water.
- Sometimes a toddler who was weaned before the new baby’s arrival decide to nurse again. If she is insistent about it, it is probably best to let her try. It is a good idea allowing her to nurse until she feels more secure about her new position in the family. Most of toddlers who have weaned have forgotten how to nurse, and will lose interest quickly.
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 with the help from the father.
Both nursing while pregnant and tandem nursing are 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 child extra cuddling and attention so that she knows that although she is not brestfeed anymore, she is not losing her mother’s love.