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Dinner for Two: Nursing through Pregnancy and Tandem Nursing

Mary Hensel never planned to nurse two children at once. In fact, when she became pregnant with her second child, she assumed her then 18-month-old son would wean.

It didn't happen. Hensel, of Waukesha, Wisconsin, nursed through her pregnancy and began tandem nursing—breastfeeding siblings of different ages contiguously—after her second son was born. It wasn't always easy, but she has no regrets. "When nursing works, it can be part of an amazing bond between you and your children, and between your children themselves," says Hensel.

"We tend to think of breastfeeding during pregnancy and tandem nursing as a bizarre and rare thing," says Hilary Flower, author of Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond and founder of NursingTwo.com.

The social stigma against extended breastfeeding makes women unlikely to disclose the fact that they are nursing a toddler at all, let alone nursing through a pregnancy or nursing two siblings at once, notes Flower. "It's a hidden but common experience, and it's only going to become more common, as more and more women heed the American Academy of Pediatrics guidelines about the importance of nursing at least up to—and ideally beyond—the one year mark."

Why Many Moms Keep Nursing

"The major incentive for moms to tandem nurse is to avoid weaning the older nursling unnecessarily," says Flower. Breast milk can be a wonderful source of nutrition for toddlers, full of important nutrients and fats. Breast milk also boosts a toddler's immune system, providing antibodies to disease that are available from no other source.

And breastfeeding is about more than food. "Breastfeeding is a relationship, a give and take between a child and his mother that is special," says Jack Newman, MD, FRCPC, a pediatrician and the author of The Ultimate Breastfeeding Book of Answers.

Krissi Danielsson, of central California, agrees. At 30 weeks pregnant, she is still nursing her two-year-old daughter. "I don't want to forcefully take something away from her that she is deeply bonded to," says Danielsson. "To her, the act of nursing seems like snuggling a precious blankie or teddy bear for other kids ... and I doubt any reasonable parent would force a young child to give up a treasured comfort object."

How Pregnancy May Affect Nursing

Breast milk usually decreases in supply as a pregnancy progresses, and some women will notice a reduced supply as early as the first month. Toward the end of pregnancy, supply often picks up as the breasts begin to produce colostrum. After the baby is born, mature milk comes in within a few days.

How do nursing toddlers typically react to these changes? "Every child is different, and there's no predicting the response," says Norma Jane Bumgarner, author of Mothering Your Nursing Toddler. Some toddlers may wean on their own, while some may nurse more than ever. Sometimes toddlers who wean during pregnancy decide to start breastfeeding again after the baby is born.

Bumgarner advises women to stay flexible. "Don't decide that you're going to tandem nurse, because that's a decision you don't get to make by yourself," she says. "Just decide that you're open to tandem nursing if the opportunity arises."

Can Nursing Affect Your Pregnancy?

Will nursing have an impact on your pregnancy symptoms? Maybe. "For every pregnancy woe, it seems there is a breastfeeding-during-pregnancy equivalent that can crop up," says Flower. However, it's important to keep in mind some women experience no problems at all—and many women will experience problems whether they continue to nurse or not.

Nipple soreness is a common pregnancy complaint, and nursing can aggravate this. "I had horrendously sore nipples during the first trimester, to the point that I'd be wincing for about 15 seconds every time my daughter latched on," says Danielsson. She found that using lanolin cream after each nursing session helped.

Nausea can worsen as well, and in some women it is even brought on by nursing. Conversely, others report less overall morning sickness during pregnancies where they nursed. "This has not been verified statistically, but it's intriguing; it was true for me," says Flower.

What about pregnancy mood swings? Some mothers must cope with waves of irritation while breastfeeding. "I did notice a slight reluctance on my part at times to want to feed my daughter, and it was odd since in my heart and mind I was very pro-tandem feeding," says Alison Ashwell, of southern France, who nursed her oldest during her second pregnancy. "I came to the conclusion later that it was hormonal, as I spoke to other women in the same situation and they mentioned similar feelings."

Is it Safe?

Preterm labor—and whether breastfeeding triggers it—is a common worry. It's well known that nursing stimulates the release of the hormone oxytocin. Among other things, oxytocin causes uterine contractions. In fact, nipple stimulation is often used in women at term to help speed up labor.

But according to Flower, research on the uterus strongly suggests that nursing during a healthy pregnancy is quite safe. Before term (around 38 weeks), several hormones block oxytocin from reaching the oxytocin receptors on the uterus. In addition, the receptors themselves are sparse (they will increase almost 300 fold once labor starts). Finally, the oxytocin receptors are "down-regulated" during most of pregnancy. This means that special proteins that help the oxytocin receptors respond strongly to oxytocin are largely missing. "The pregnant uterus is well protected from the effects of oxytocin, layer after layer of protection, until it's time for labor to commence," says Flower.

For maximum safety, it's important to have an obstetrician or midwife you can talk with. "Although in the great majority of pregnancies, continued nursing is just fine, difficult nursing or weaning choices do occasionally arise when a pregnancy becomes high risk," notes Bumgarner. "You want an advisor you can trust to know the difference."

Sometimes such an advisor is hard to find. "I am embarrassed to say how many patients I told to wean just because they were pregnant," says Brooke Schumacher, MD, an OB-GYN and La Leche League Leader. "I had no specific training on this, of course, nor did I get more information on it before I gave the advice."

Then she became pregnant with twins while her toddler daughter was still breastfeeding. "I knew my two-year-old wasn't ready to wean," she says. "She really needed nursing, although it was a bit of an endurance test for me." Her husband, who is a high-risk obstetrician, helped her sort out their medical concerns. The pregnancy went smoothly, and after her twin sons were born, Dr. Schumacher tandem nursed three children for over a year.

Occasionally, pregnancy problems do make nursing inadvisable. "I would be concerned about anyone with a history of preterm labor, preterm birth, incompetent cervix, and anyone who has a cerclage or is on medication for preterm labor," says Dr. Schumacher. "I would be very concerned about a mother who is underweight herself, or a baby who is not growing well in utero."

Is it for You?

If you're weighing the decision to continue nursing through pregnancy or tandem nurse, reach out. Support and advice from other moms is invaluable. "It's so helpful to get a sense of the wide range of experiences people can have," says Flower. Local La Leche League groups can be great places to meet other women who have tandem nursed.

If your caregiver isn't supportive of breastfeeding during pregnancy, find out what his or her concerns are, what they are based on, and whether the caregiver has ever had a patient who breastfed through pregnancy before. "Often, the physician is just inexperienced or uninformed, and can use some tactful education," says Flower. "The main thing, I think, is to show respect for the physician's experience while gently offering the opportunity to learn more."

Whether you decide to continue nursing or wean, Flower says there's no right or wrong way to proceed. "Trust yourself; the choices can be very complex ... but each mother really is in the best position to make the best choice for her and her family."