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by Lynette Thomas
(Article appeared in "Keeping Abreast" Sept-Dec 1996 Issue)

The question facing an expectant mother who is still breastfeeding her older child is not should she, but can she, if she wishes, continue to breastfeed.  The answer is that she can.  Whether or not she wants to is her own decision which she will need to base on various factors in her lifestyle.

If I find I am pregnant while still breastfeeding my older baby or toddler, what should I do?

You may decided to continue breastfeeding and, if so, you will need to make doubly sure that your diet is sufficiently nutritious for both your pregnancy and the continuing lactation.

Some mothers have no hesitation in deciding to wean if they feel that nursing while pregnant will prove a drain on their energy and patience.  Indeed, if you feel very tired, ill or generally resentful about your child's continued nursing, a policy of gradual weaning is best.

In either case, you may find your child losing interest, possibly because there may be a decline in the quantity of milk due to hormonal changes brought about by pregnancy.

Isn't there a risk of miscarriage or premature labour if breastfeeding continues?

Although it is known that suckling at the breast can produce weak uterine contractions, there have been no studies carried out to show any link between breastfeeding and miscarriage or premature labour.  However, if you have a history of either of these conditions you would be wise to postpone pregnancy until weaning is completed.  Follow your doctor's advice if you are at all concerned and you feel you are a "high-risk" case.

Does breastmilk lose its nutritive qualities during pregnancy?

In the first few months, there is very little change, but then with the increased development of the placenta and the change to higher levels of the hormone oestrogen, the production of milk may decline.  This usually occurs around the second to the fifth month.  However, the quality of milk makes up for the reduction in quantity, so that the milk produced is richer in fats and vitamins.  It can therefore provide just as much nutrition as before.

As long as the mother is getting an adequate diet, neither she nor her developing foetus need suffer nutritionally if lactation continues during, and beyond pregnancy.

Won't the newborn baby miss out on the advantages of receiving colostrum?

Colostrum, the rich anti-infective substance produced by the breasts in the later months of pregnancy, will be present even if you continue to breastfeed.  This in itself may encourage your older child to wean spontaneously as he finds the composition and taste different from before.

How can I encourage my older child to wean?

Assuming the oungest your child will be is around 10 months, breastmilk will be providing part, but not all, of his nutritional requirements.  He should, by this time, be having a variety of food, probably much the same as the rest of the family.

Therefore breastfeeding will be giving him a lot of emotional comfort, so when you wean you will need to find ways of making up for this.  Give more personal attention at the times when you would have been nursing - change your routine so that you are out of the house when you know he might want a feed.  Make time for other activities - a walk in the park or to the shops - and if feeding to sleep has become routine, try getting father to deal with bedtimes instead, substituting the reading of a new book for the usual feed.

Whatever strategies you use to wean, do make sure it is gradual, particularly if your child is still having quite a lot of milk.  This will help him get used to the idea and will also prevent you from getting engorged.  Be flexible about weaning, but generally try to eliminate one feed per week so that the whole process takes from one to two months.  Remember that abrupt weaning can be stressful for yourself and your child, and can also be uncomfortable for you.

My breasts are usually very tender in early pregnancy.  Will breastfeeding make them worse?

As mentioned above, sudden weaning may make your breasts engorged so you should avoid the possibility of this happening.  Otherwise, do as you would in any pregnancy and wear a bra with good support and wide straps, preferably non-elastic.  You may find cold compresses take away the feeling of tenderness.

A few women complain of sore nipples.  This is due to hormonal changes.  How sore the nipples are and how long the soreness lasts obviously varies from mother to mother, but there is no harm trying out the various methods of overcoming the problem, for example, feeding in different position and exposure to sun and air for short periods.

What if I decide to continue to feed both my baby and my older child?

This is known as "tandem feeding", and there is no reason why you should not do it, although you do need to take your own circumstances into consideration, and be prepared for some conflicting feelings towards him at times, yet at other times you may feel happy that you are still able to fulfill a need.

Of course, for the newborn to thrive he must have priority over the first child when it comes to feeding.  The fact that the older child is also feeding will not deprive your baby.

You should bear in mind your own needs for a good diet and adequate rest.  if you find it is wearing you down too much - making you tired, uncomfortable and irritable - it is in your best interests to wean.  Let your common sense guide you.

Most people in developed countries nowadays are surprised to see older babies and toddlers suckling at their mother's breasts, although it is quite common to see children up to 4 years and even older walking around with bottles and arousing little public attention or comment.  Given this fact, a pregnant mother who is seen nursing will undoubtedly be a source of some unasked for comments.  Even more so the woman who decides to tandem feed.  So you may well prefer to restrict your toddler's feeding times to the privacy of your own home.  If your child asks for a feed while your are out, you can either explain that from now on you only feed at home, or, if the situation demands, find a private place where you will not attract attention and feed there.

Hopefully I ahve shown that both breastfeeding during pregnancy and tandem feeding afterwards are possible, but that they require tremendous reserves of energy, resourcefulness and patience from the mother.  So unless a mother has these reserves, gradual weaning should take place during the pregnancy and well before the expectant mother feels it becoming a strain to continue nursing.  In special circumstances, though, such as when a toddler has been hospitalized, is recovering from an illness or a stressful family event, continued nursing can of course provide emotional comfort and a feeling of security in times of extreme distress.

There are advantages and disadvantages and each mother should be free to decide what she wants to do in this regard, according to her own and her child's needs.

Lynette Thomas is a mother of 2 children, aged 13 & 10 years. 
She has been a member of the Group since 1983, and a counsellor since 1986.  She has actively served on the BMSG(S) Committee in various capacities, including being President for 2 consecutive terms from 1991 to 1994.

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