by Laura Jessup – Oregon, USA
Hilary Flower. Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond. 2nd edition. USA: Hilary Flower (self-published). 2019. ISBN 9781542652896. Paperback, 383 pages.
Especially in times of public health crises, families value the immune support of breastmilk as well as its emotional and relational aspects, and may wish to continue breastfeeding their young children through pregnancy. Tandem nursing is the focus of Hilary Flower’s Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond, second edition, which was recently published. Expanding on Flower’s 2003 classic first edition, this second edition shares stories from over three hundred families, and cites numerous references on extended breastfeeding and breastfeeding during pregnancy — reassurance that tandem nursing can be both practical and safe.
What makes this second edition different
Adventures in Tandem Nursing is, according to Flower, “…the first and still the only full-length comprehensive book on overlapping pregnancy and breastfeeding and tandem nursing.”  Flower defines tandem nursing as “to breastfeed two children who are not twins, not necessarily at the breast simultaneously.”  For families who wish to continue nursing through pregnancy, and who wish to nurse the new baby while still nursing an older child, this book provides an in-depth overview of tandem nursing, along with some breastfeeding basics thrown in.
Flower organizes her second edition into two sections: “Breastfeeding during Pregnancy” and “The Tandem Adventure.” This edition includes new chapters on high risk pregnancy and closely spaced babies, and cites research throughout, with nearly 230 citations — including peer-reviewed studies from journals such as The Lancet and Pediatrics. Flower is clearly dedicated to supporting families who wish to tandem nurse. Not only families, but also healthcare professionals who support families, will gain insight and information from this book.
This book offers abundant information on tandem nursing such as specific and detailed information on positioning for a deep, comfortable and effective latch. For that reason, books such as The Womanly Art of Breastfeeding  and Breastfeeding Made Simple  would be essential companion books for tandem nursing families. As this second edition is self-published, Flower describes the book as “hours of solo effort on my end, and crowd-sourcing of experiences, wisdom, and support from interested parents and readers around the world.” 
Useful and reassuring tips
In every chapter you will find ideas, suggestions, and many stories and photos of moms tandem nursing that create a feeling of connection, normalcy, and gentle humor. You can easily spot mothers’ stories as they are placed in boxes with a different background than the main text.
Working parents will appreciate reassurance that, “Mothers who have a good method of nursing two at once stand the best chance of being able to relax while reconnecting with their children after work.”  Flower dedicates an entire chapter to “Adopting a Tandem Nursling” to support parents who want to breastfeed their adopted or fostered child. Bonding with your child and increasing milk supply are the main focus of this chapter, with a special mention of the cultural aspects of being milk siblings. The chapter “Positions for Tandem Nursing” offers sketches of nursing positions and photos of tandem nursing in various indoor and outdoor scenarios, accompanied by the stories of mothers. Chapters also offer ideas to reduce toddler nursing sessions and night weaning, which can be particularly useful when a mother is experiencing breastfeeding agitation and aversion.
Throughout many chapters, Flower emphasizes self-care and mindfulness to carefully balance the needs of children and parents in a nursing relationship. She writes, “Remember that more is not always better. Your child needs generosity from you, but it’s not in your child’s interest to take more than you can really give. [. . .] It is important to model for your child that you take care of yourself and that your needs are important, too.” 
Of concern to many families and healthcare providers is the possibility of preterm contractions, which Flower addresses in several chapters. While reading about the hormonal shifts during pregnancy, breast stimulation and milk production, and the many stories shared by tandem nursing families, I found myself reflecting on my own experience with preterm contractions.
Personal reflections on the tandem nursing journey, from all over the world
The only time during my pregnancy that I ever experienced preterm contractions was a time of overwhelming grief. When I was six months pregnant with my second child, a tragedy struck our family. My brother’s child died suddenly in his sleep at nearly three years old. I remember vividly the March funeral, the snow falling on cherry blossoms that day, the service in the wooden church, the crowded room of family and friends crying out with grief. I remember sitting on the hard pew and realizing that I was starting, for the first time, to experience preterm contractions. I realized I needed to leave immediately. I rushed out, clutching my belly and sobbing. In the church bathroom alone, I began to breathe deeply and calm down. Then the contractions lessened. Later that evening, my toddler snuggled in my arms, as I nursed I felt the soothing hormones of breastfeeding. It was then that I felt comfort and reassurance, with the baby kicking inside me and my toddler safe in my arms.
The many personal stories in this book — shared by contributors who are from countries and cultures throughout the world — remind the reader that continuing to nurse a child through a new pregnancy can provide immune support, tender nourishment, and thoughtful transition to that growing family.
As with many aspects of parenting, tandem nursing is not always easy. Flower includes many stories of challenges and successes. For example, one mom in Italy recalls, “The first month was so difficult with a lot of what I call ‘15 minutes of panic’ during the day, times when everybody was crying and I did not know how to calm them down,” and that at two months “we found our equilibrium.”  In addition, a mom in New Zealand shares, “On the worst nights, my husband would arrive home at 7 p.m. to a house in chaos with three tired crying inhabitants! On the good days he arrived home to a sleeping baby, dinner half-prepared and then forgotten, a toddler in the bath, and the house still in chaos, but no one in tears!” 
In “Is Breastfeeding during Pregnancy for me?” Flower outlines potential advantages of tandem nursing: a healthier toddler, efficiency, help draining plugged ducts, and more rest. Personally, I would add to that list true joy. I can still recall, during my years of tandem nursing, the relief I felt when my toddler worked to drain a painful plugged duct, and the joy I felt on those many days when I would sing to and nurse my two children after lunch. For this book’s comforting tone, reassuring stories, and thorough references, I feel profound gratitude.
Laura is a teacher, an International Board Certified Lactation Consultant, and a La Leche League Leader in Oregon, USA. In her spare time, she is active in her local lactation association. She enjoys hikes with her two daughters, gardening with her husband, and scratching behind the ears of their two old nanny goats.
1. Hilary Flower. Adventures in Tandem Nursing: Breastfeeding during Pregnancy and Beyond. 2nd edition. USA: Hilary Flower (self-published). 2019; Preface page xx, 289, 150-151, 208, 219, 309, 381.
2. La Leche League International. The Womanly Art of Breastfeeding. 8th revised edition. Edited by Diane Wiessinger, Diana West and Teresa Pitman. New York, USA: Random House/Ballantine Books. 2010.
3. Nancy Mohrbacher and Kathleen Kendall-Tackett. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers. Oakland, California, USA: New Harbinger Publications, Inc. 2010.