Tuesday, July 15, 2014

Breastfeeding and Pregnancy

Pregnant moms can definitely keep nursing.
By Glenni Lorick, IBCLC
It happened again this week. A mom dropped by to see me and was pretty upset because her OB had told her to wean her baby since she was pregnant. He was an older doctor and had explained to her that he doesn't want his patients breastfeeding during pregnancy because of the risk of preterm labor. I immediately asked her if he had told her to refrain from sexual intercourse. When she said "No," I told her that based on the research, breastfeeding during pregnancy is fine for her.

Why Would Anyone Say Not to Keep Breastfeeding?

It is true that when baby is nursing, the hormone oxytocin is released. This is the hormone responsible for your milk letting down. Oxytocin acts on myoepithelial cells, the kind of cells that line your milk glands and also the kind of cells surrounding your uterus, causing them to contract. Some moms may feel a tingle or quick sharp pain in the breast signalling the oxytocin release; others don't feel anything, but they notice that baby begins to gulp. Since oxytocin is the hormone responsible for causing the contractions of labor, many doctors have historically assumed that it was unsafe to stimulate oxytocin production during pregnancy before it was time for the baby to be born.
Nursing can be a great source of comfort for a toddler

The problem with this thinking, however, is that oxytocin release also occurs during orgasm. So if it is safe for a pregnant woman to have sex, then it is also safe for her to breastfeed. In fact, research has shown that there are different types of oxytocin receptors in the breast and uterus. The uterine receptors are not "ready" to receive oxytocin until the end of the pregnancy when it is time for labor to begin. So unless a pregnant woman is late in pregnancy with a specific condition that would preclude the onset of labor, there is no medical need to wean.

Recent studies indicate that oxytocin is responsible for a wide variety of human responses including social bonding, stress reduction and even bonding between spouses. In light of the fact that for a normal, healthy pregnancy it poses no danger whatsoever, there is really no solid evidence-based reason for an OB to tell a mother she must stop nursing.

 

Why Would Anyone Continue to Breastfeed?

Sometimes a mother will get pregnant before her baby is a year old, and she doesn't want to put him on formula. Many times a mother just isn't ready to wean her toddler. The health benefits of extended breastfeeding for both mother and baby are myriad. Some toddlers have specific medical needs that make it critically important for them to continue receiving breast milk with all its antibodies and healthy enzymes.

Nursing can help everybody take a good nap!
Tandem nursing (where a mother is nursing an older child as well as a new baby) provides a very unique bond between siblings and is often a wonderful way to help the older child adjust to having a new baby in the home. Some mothers express concern that there won't be enough milk for both babies, but actually the opposite is true. Having an older nursling who suckles well can actually help increase a mother's milk production because breast milk is produced on a demand/supply basis.

Practical Considerations

There are some practical questions that need to be addressed when contemplating breastfeeding during pregnancy.
  • Pregnant mothers are often very tired during the first and third trimesters. If you have a toddler who is still nursing, it is very easy to just take an afternoon nap together. Nursing is still a wonderful way to comfort and quiet a busy toddler, and when combined with a comfortable bed in a quiet, dark room, Mother and child can both get the rest they need to recharge! 
  • Many mothers do notice some nipple discomfort early in the pregnancy. In fact, for some mothers this may be one of the first indicators of a new pregnancy. It is very important that the older nursling have a good latch and not practice "gymnurstics."
  • Your milk supply may decrease during pregnancy, and your milk may actually taste saltier to your baby because as supply decreases sodium concentration in breast milk increases. Some toddlers will notice the difference and may self-wean because of it. Others, however, just take the changes in stride. Those who do self-wean may actually show renewed interest in nursing after the new baby is born.
  • Your nutritional status is especially important if you are both pregnant and breastfeeding. You need to be sure that you are eating a healthy, well-balanced diet with lots of good long-chain fatty acids. If you are both pregnant and breastfeeding, you need about 800 extra calories a day!



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