Breastfeeding through pregnancy and beyond

By Bronwyn Warner, ABA Counsellor

So you're pregnant and still breastfeeding your baby or toddler. You may be wondering if you can continue to breastfeed though your new pregnancy, and even beyond. Perhaps you have been told you must wean. Or maybe you know others who have breastfed through subsequent pregnancies and wondered how it all worked.

Your second and later pregnancies are a special time. You may feel more confident in your role as a mother. Your body has given birth and continued to nourish your baby, completing the natural reproductive role. You could also be apprehensive - how could you love another child as you love your first? Or perhaps you are worried about the physical demands of being pregnant and then having two children to look after. The Australian Breastfeeding Association uses the term 'tandem feeding' to describe concurrent breastfeeding of siblings who are not twins. The children may feed together or at separate times.

As your baby grows into toddlerhood and beyond, your milk is always nutritious and the best food your child could have. If your child's feeds have reduced over time, the immunological benefits are still very valuable. Sometimes a mother, or her child, prefers to wean gradually over the course of the pregnancy, however many are happy to continue, especially if the baby is still quite young or the pregnancy is unexpected. Continuing breastfeeding can also mean an extra rest period or more for you through the day, especially during the first trimester.

Carissa, Caia & Chenzi

All women's bodies are different, but many find they can conceive even while they are breastfeeding. Sometimes introducing solids or other supplements to breastmilk is enough to trigger ovulation. With other women, it takes long breaks between feeds, of four or more hours, or their baby starting to sleep through the night.

What about my unborn child?

You may be concerned about the viability of the pregnancy if you continue to feed. In a normal, healthy pregnancy, with no previous history of miscarriage in the first 20 weeks or preterm labour after 20 weeks, there is no evidence to suggest breastfeeding is threatening to a pregnancy.1,2 If you do miscarry, it is unlikely to be because you are breastfeeding.

Sometimes you may be told that breastfeeding is taking 'the goodness away from the unborn baby'. The reality is your unborn baby has first call on all the nutrients it needs, and may even be healthier than normal, as you may eat better and take better care of yourself during the pregnancy. The other worry people may have is your newborn may be deprived of colostrum. Some mothers do restrict their toddler to one side only during late pregnancy, but it appears the breast reverts to making colostrum automatically without mum having to do anything to help it do so.3

Your body may start to make colostrum during the pregnancy of its own accord, or this may occur if your child stops feeding for a while. The taste of colostrum may encourage weaning, at least temporarily, as it is saltier than mature milk. Other breastfeeding children don't mind at all. Be aware that colostrum is a natural laxative (to help the newborn pass the meconium), so bowel motions may become far more liquid. This won't harm your child at all. 

As you are normally advised to adjust your diet to allow for additional nutritional needs during pregnancy or breastfeeding, obviously, it is important to do so while doing both. There is little research on the requirements of a tandem breastfeeding mum, but we understand that our bodies are able to adjust metabolism so we don't need to consume extra large quantities of vitamins and minerals etc. The Australian Breastfeeding Association booklet Looking after Yourself contains the guidelines for healthy eating. ABA booklets are available from Mothers Direct.

How will I feel?

There are various possible side effects to breastfeeding while pregnant. Some mums report their morning sickness being worse during a feed, possibly due to hormonal release in the body, hunger, thirst or tiredness, among other things. You may experience nipple tenderness, as a result of pregnancy hormones, which for some mums can be excruciating. This may last a trimester or longer, or not at all. Paying careful attention to positioning and attachment can relieve the discomfort - lying down to feed may be an option for you. Other mums, despite the pain experienced, continue anyway as the benefits of continuing to breastfeed outweigh any negatives they encounter. Most mums note that this nipple tenderness disappears entirely at birth. Some mothers report that the tenderness is worthwhile, as they have found it helps to reduce problems, such as nipple trauma, after the baby is born.

How will my older child feel?

While you may be feeling positive about feeding two children - meeting their nutritional and emotional needs - how could your older child feel? Many older siblings feel a special bond with the baby, as they are both sharing something very special and important. This can help lessen any feelings of jealousy and resentment, as he's not being left out. More importantly, he's still able to have the one thing that may be most important to him - a breastfeed with mummy.

What about my milk supply?

If your baby is under nine months of age, you eat a healthy well balanced diet and offer the breast whenever your baby seems to be interested, you may find your supply is maintained. Breastmilk remains a major part of your baby's diet. If you feel your baby isn't getting enough breastmilk, you may want to speak to your health adviser. Some mothers find their supply diminishes in response to the hormones in pregnancy.3

To wean or not to wean?

If you choose to wean your baby who is under 12 months of age, you will need to speak to your medical adviser about a suitable substitute. An older baby may be able to drink other liquids from a cup, avoiding the need to introduce a bottle. If your child is old enough, you could explain that you are feeling sick or that your nipples are sore. You could delay feeds, or your child could feed for a shorter period. The Australian Breastfeeding Association booklet, Weaning, has information and suggestions on weaning children of all ages. ABA booklets are available from Mothers Direct.

If your baby or child chooses to wean during pregnancy,2 it is normal to feel guilty - 'Did I hasten the process?' or grief at the end of the relationship. It may help to try and focus on the new baby and the relationship you will have together. Some mothers report that their 'weaned' child returns to the breast after the baby is born.

It may be that your baby isn't ready to wean, no matter what you try. Perhaps reassessing your needs at this time may help. You could try weaning more slowly or try to encourage shorter feeds. You may even decide not to wean.

Why tandem feed?

Carissa, Chenzi & Caia

You may have read or been told that 'mothers only feed older children for their own sake'. Of course, this isn't true (except perhaps in an emotional and health sense). It can be a wonderful experience tandem feeding or feeding an older child. There are few things more satisfying than watching your children holding hands while breastfeeding together. The Australian Breastfeeding Association's booklet Breastfeeding through Pregnancy and Beyond and Norma Jane Bumgarner's Mothering your Nursing Toddler are good sources of information, encouragement and support. Both are available for purchase from Mothers Direct.

What about the practicalities?

You could feed both your children at the same time, or one after the other, or at completely different times. You may find that your toddler wants to feed all the time, especially once your milk comes in, and you have a plentiful supply. You may be happy to accommodate this, at least at first, while other mums find it important to limit their toddler's feeds. Only you can decide what works for you. You could try sitting up to feed, perhaps with cushions to help prop you, or maybe laying down to feed will work. There are many ways to tandem feed.

Because you are producing more milk than a mother feeding a singleton, you may find your newborn has difficulty coping with your let down reflex. Changing your feeding routine may help. Perhaps you could offer one side to your toddler, then, after he has stimulated your let down reflex, attach your newborn. ABA's booklet Breastfeeding through Pregnancy and Beyond has many more ideas on the logistics of tandem feeding, as well as many other considerations not mentioned in this article.

We suggest you speak to your medical adviser about breastfeeding through pregnancy and afterwards. The Australian Breastfeeding Association has trained counsellors who can offer you information and support in your decision.

References

  1. Ishii H 2009, Does breastfeeding induce spontaneous abortion? J. Obstet. Gynaecol 45(5): 864-868.
  2. Moscone SR, Moore MJ 1993, Breastfeeding during pregnancy. J Hum Lact 9(2):83-88.
  3. Marquis GS, Penny ME, Diaz JM, Marin RM 2002, Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy. Pediatrics 109(4):e56-e56.

© Australian Breastfeeding Association Reviewed July 2015