Nursing during Pregnancy
By Ruth Lufkin
From LEAVEN, Vol. 31 No. 3, May-June 1995, pp. 35-36
Ed. Note: We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
A mother who finds herself pregnant while breastfeeding presents special challenges to the LLL Leader she contacts. The mother may be worried and upset. She may have been advised by her doctor or by friends and relatives to wean. Indeed, she may have decided to wean, and may be asking how quickly and how smoothly to accomplish it. On the other hand, she may be wondering whether it would be harmful to continue nursing her child. Perhaps she has heard about nursing through pregnancy and tandem nursing and would like to consider these options. She may even feel pressure to keep nursing, especially if her baby is less than a year old.
We can reassure the mother that over the years La Leche League has had contact with many mothers who have happily nursed through pregnancy with no ill effects. In some parts of the world nursing through pregnancy is not even questioned. It is culturally accepted; health care professionals and mothers have experience with it.
LLL has also helped many mothers who chose, for a variety of reasons, to wean during pregnancy. Medical reasons such as uterine pain or bleeding, a history of premature delivery, or mother's continued loss of weight during pregnancy may cause a mother to consider weaning during pregnancy. (LLLI's new pamphlet "Approaches to Weaning," No. 125, can be helpful.) It is important that the mother remain in close communication with her health care provider during her pregnancy.
Our challenge as Leaders is to help a mother identify her feelings and preferences as well as carefully present advantages and disadvantages so she can make a decision that suits the needs of her family and her baby. We can support both those who choose to wean in the face of another pregnancy and those who continue to nurse.
How old is the nursing child?
When the child at the breast is only a few months old, the mother may be more inclined to continue breastfeeding than when the nursling is older, more verbal and less dependent on nursing. However, children mature at different rates. While one child may be ready to wean at a certain age, another may not be. A child whose need seems intense early in the pregnancy may wean happily a little later.
Is the child's continued nursing a habit or a genuine need?
The Leader can make valuable suggestions to help the mother answer this question. By discussing the fact that breastfeeding is just one way to meet the child's needs and suggesting other ways of providing love and closeness, the Leader can reassure the mother, leaving her free to come to her own decision.
Mothers may also experience physical responses to their pregnancy, such as sore breasts or nipples, which affect their decision to continue nursing. Feelings of restlessness or a negative reaction to their older child may surprise them. If so, they will be interested to hear that some scientists theorize there is a natural biological impulse to wean during pregnancy. A father's feelings can be extremely influential, also, and should not be overlooked in discussing the mother's circumstances.
Mothers are likely to ask: Will the hormones of pregnancy be harmful to the breastfeeding baby or toddler? and Will breastfeeding during pregnancy deprive the unborn child of needed nutrients? THE BREASTFEEDING ANSWER BOOK points out that the hormones that maintain pregnancy are found in very small quantities in human milk but are not harmful to the breastfeeding child. The baby in utero is exposed to these hormones at a much higher level than the nursing child. Usually the pregnancy affects breastfeeding rather than the reverse, as most women report a reduction of milk supply during pregnancy while nursing an older baby. While noting that some mothers find it necessary to consume extra calories while breastfeeding during pregnancy, THE BREASTFEEDING ANSWER BOOK reminds us that a well-nourished mother should have no difficulty providing for both the unborn baby and the nursing child if he is more than a year old. If the nursling is younger, the mother will need to watch his weight gain and provide additional solid foods as needed if her milk is not sufficient.
Many mothers wonder whether uterine contractions stimulated by breastfeeding pose a danger to the unborn baby or increase the risk of a premature birth. There is no documented danger to mother or fetus when mothers breastfeed through a healthy pregnancy. Unfortunately, miscarriage and premature birth do happen in a percentage of all pregnancies, whether a mother is nursing another child or not. When there are problems, it is only human to look for somewhere to place blame. All too often, breastfeeding is a handy scapegoat when things go wrong.
While there are no formal research studies specifically examining the relationship between continuing to nurse through pregnancy and pregnancy problems, the vast number of women in contact with LLL over many years constitute a large, informal study population. If the practice of continuing to nurse through pregnancy were responsible for significantly increased pregnancy problems, it would surely have become apparent in our LLL population.
Considering the absence of scientific data on this topic, it seems reasonable to wonder on what evidence doctors and others base their opposition to pregnant women breastfeeding? Mothers can be encouraged to ask those who object to the idea for studies or clinical experience to back up their recommendations. There have been studies showing that nipple stimulation could initiate labor in the third trimester, but the types of stimulation used were significantly more vigorous than one would get from nursing a toddler. It has also been theorized that an accustomed level of nipple stimulation from breastfeeding or lovemaking may not have the same effect as the techniques used in these studies.
Should a woman be more cautious about breastfeeding while pregnant if she has a history of miscarriage? Yes, in the opinion of the LLLI Health Advisory Council. However, if a woman is showing signs of threatening miscarriage (bleeding, contractions) there is no guarantee that ceasing breastfeeding will save the pregnancy or that continuing to breastfeed will result in the loss of the fetus. The parent's feelings and thoughts should be the only determinant in deciding whether or not to continue breastfeeding a toddler when the pregnancy is threatened. In some situations the mother may feel that her nursling's needs are so intense that she will continue to meet them by breastfeeding and leave the resolution of the pregnancy to nature. In others she may wish to do everything possible to try and save the pregnancy, including stopping breastfeeding. The mother may feel that she is forced to choose between the needs of her older baby and the life of the fetus. The Leader can provide her with information and sympathetic support, respecting the mother's right to choose the course of action that seems most compelling to her.
When a mother is considering nursing through pregnancy, help her learn all she can. Invite her to attend LLL meetings, borrow pertinent books from the Group library and talk with other mothers with similar experiences. Remind her that there is no absolute answer in this situation but she can decide the right course of action for her family. Encourage her to give herself time to decide.
If she feels she must wean her older child, affirm her loving approach to mothering and offer her support. If she chooses to continue nursing through her pregnancy, encourage her to be flexible and take the situation day-by-day. Review the variety of physical and emotional reactions she may experience: from herself, from her child, from others. Again, affirm her loving approach to mothering and offer her support.
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