Breastfeeding When You Are Pregnant - How Safe Is It?

Sophie has just found out she’s pregnant. She’s excited but anxious. You see, she’s still breastfeeding her 14 month old, Mia, and she isn’t ready to wean. However, she’s concerned about how breastfeeding will affect her pregnancy and her unborn baby.

Although Mia isn’t breastfeeding a lot in comparison to a younger baby, Sophie knows ‘booby’ (as Mia calls it) is still important for Mia’s immunity and nutrition and above all, comfort. A few minutes at the breast is an easy ‘pick me up’ (literally) for Mia when she falls over or falls apart emotionally. It’s also a great soother as she is cutting her molars. Sophie had planned to breastfeed Mia for at least two years as recommended by The World Health Organization, knowing that this isn’t just a recommendation for women in deprived circumstances: in one study of infants from 12 to 23 months (Dewey 2001) the author concluded, “Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”

How breastfeeding affects your unborn baby

For mothers like Sophie, concerns about breastfeeding while pregnant tend to focus on whether breastfeeding their current baby or toddler will deprive their unborn baby of nutrients. This can be even more of a concern if, like Jacqui, you have fallen pregnant while breastfeeding a younger baby. Jacqui’s baby, Luke, is only six months old and has just started tasting family foods so breast-milk is still an important part of Luke’s diet.

Whatever the age of your current baby or the extent of his breastfeeding, your unborn baby will have first ‘dibs’ on all the nutrients it needs but because of your pregnancy hormones, your milk supply is likely to reduce. If you are breastfeeding a younger baby when you fall pregnant, you may find that with more frequent feeds and healthy nutrition, you can maintain an adequate milk supply. If your milk supply reduces substantially, you may need to supplement. With a toddler, you will need to offer more foods and drink to make up for the reduced breastfeeding.

Although you may be advised to boost your supply with herbs, this isn’t safe. For instance, fenugreek, a herb that is often suggested to boost milk supply, is a uterine stimulant so should be avoided during pregnancy. However, you can eat foods that have natural galactagogue effects such as oats and lactation cookies as long as they don’t contain herbs.

How breastfeeding affects your pregnancy

Another concern women have when breastfeeding during pregnancy is whether breastfeeding can cause miscarriage or premature labour. Although nipple stimulation releases oxytocin into the bloodstream as it signals your breasts to eject milk and it can also signal uterine tissue to contract (this reduces postpartum bleeding), there is no evidence that this poses risks to your pregnancy. This is because, during pregnancy, less oxytocin is released in response to nipple stimulation and ‘oxytocin receptor sites’ the uterine cells that detect the presence of oxytocin and cause a contractions, are sparse up until 38 weeks, increasing gradually after that time, then boosting significantly as labour begins.

In her book, ‘Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond’ author Hilary Flower explains, “ oxytocin receptor sites in your uterus are sparse, down regulated and blocked by the presence of progesterone, a pregnancy hormone. “ This means that until your pregnancy is at term your uterus is in protective mode, supporting your unborn baby. Of course, if you have a high risk pregnancy or you are concerned about breastfeeding affecting your pregnancy, it is important to discuss this with your health care providers.

How breastfeeding during pregnancy affects you

Breastfeeding during pregnancy means you are nourishing two babies and this places extra demands on your own body for nutrients and energy so it’s important to take care of yourself. Some women report their morning sickness as being worse although for others, it’s not an issue. As well as changing hormones, nausea can be due to hunger, thirst and tiredness so try to eat small amounts frequently, drink to your thirst and rest as much as possible.

The natural nipple tenderness of pregnancy can make breastfeeding painful in the early weeks so pay close attention to how your baby or toddler is attaching. It’s also natural to have feelings of aversion while breastfeeding your toddler, especially if breastfeeding is painful. With a toddler, you can shorten breastfeeds by telling your toddler, “we will count to ten, then you can have a cup of water/ we will play with the ball/ go to the park (create a diversion).”

To wean or not to wean

Many women happily breastfeed well into a pregnancy, others wean sooner and then there are women who continue to breastfeed both infants together. This is a personal choice that depends on your own health, energy and resources as well as how breastfeeding works for you and your child.

Women often ask, if I breastfeed up to the birth, will my newborn be deprived of colostrum? Again, you can relax, Your body knows exactly how to provide for your newborn. Your post birth hormones will release colostrum so your baby will get this precious first immune boost. And, even during pregnancy you can produce colostrum as well as mature milk.

With one of my own pregnancies, my toddler nursed less and less frequently and my pregnancy hormones affected my supply so that one day, he simply smiled and told me, ‘no more milk.’ This toddler asked to breastfeed along with the new baby but as he sucked he got a mouthful of milk from a strong ‘let-down’ . He screwed up his face and said, “Uck! Baby can have that.”

With my daughters, my toddler decided during pregnancy,’ the baby can have that side.” The side she continued to nurse off produced mature milk and the side she stopped feeding from dried up then started producing colostrum – completely independent of each other. I continued to breastfeed through pregnancy then tandem nursed my daughters. Of course this isn’t everyone’s cup of tea and I won’t pretend it was easy. Although there were lovely moments when they held each other’s hands as they drank, there were times when I felt completely overwhelmed as though I was a piece of meat being grappled by two little puppies. For my girls though, nursing together was a beautiful bonding time, it eliminated any sibling resentment and even as adults, they are the best of friends.

Whatever you choose – to wean or not to wean – remember the mantra, ‘gradually with love.’ You don’t have to make a decision with any urgency and it will be much easier for you and your little one(s) if there is no pressure around ending this precious relationship.