BREASTFEEDING DURING PREGNANCY AND TANDEM NURSING

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Finding out you are pregnant does not necessarily mean that you need to stop breastfeeding your toddler. Many mothers choose to continue breastfeeding throughout pregnancy, while some decide to wean. If you continue breastfeeding through your pregnancy, you may find yourself breastfeeding both an infant and an older sibling. Many mothers have found this arrangement, called “tandem nursing,” to be a good way of meeting the needs of both children. Your local LLL Leader can give you more information on breastfeeding while pregnant and/or tandem nursing. The resources below will help you to explore your feelings about breastfeeding both your new baby and your “older” baby, so you can decide what is best for you and your family.

 

Is it safe?
Changes during pregnancy

Nipple sensitivity while breastfeeding through pregnancy
Milk supply and colostrum
The practicalities of tandem nursing
The emotional side of tandem nursing

 

IS IT SAFE?

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You may be wondering if continuing to breastfeed through the pregnancy will affect the health of your unborn baby. It may be reassuring to know that in an uncomplicated normal pregnancy there is no evidence that continuing to breastfeed will deprive your unborn child of necessary nutrients. Another typical concern is that the hormone oxytocin, released by nipple stimulation while breastfeeding, could possibly trigger early labour. However, there is no evidence to suggest a connection between miscarriage and breastfeeding in a normal pregnancy. According to author Hilary Flowers, the uterus is “deaf” to oxytocin throughout pregnancy, and its sensitivity to this hormone only increases around the onset of labor (Hilary Flowers, Breastfeeding Today).

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Researchers Madarshahian and Hassanabadi (2012), compared rates of success in reaching full-term delivery and newborn birth weights between two groups of pregnant women with more than one child: those who breastfed during pregnancy and those who did not. Results of this study found no significant difference in babies born at full-term or non-full-term between the two groups; birth weight was also unaffected. The researchers concluded that breastfeeding during normal pregnancy is safe, and “does not increase chances of untoward maternal and newborn outcomes. Overlap breastfeeding is a personal decision for mothers”. This research purposely excluded high-risk pregnancies. If you are expecting multiples, or considered to be at risk for miscarriage/early delivery, discuss your options with the health professionals supporting you.
 

CHANGES DURING PREGNANCY

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Needing extra rest is normal in pregnancy. Breastfeeding your toddler while lying down may help you get extra rest during your pregnancy. Childproofing one room with a mattress or pallet on the floor would allow you to continue to rest if your toddler goes off to play.

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NIPPLE SENSITIVITY WHILE BREASTFEEDING THROUGH PREGNANCY

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“I’m about 8 weeks pregnant and still breastfeeding my 15-month-old daughter. She likes to stay latched when sleeping.

Are there any tips to deal with the nipple sensitivity? At the moment latching her is causing me a lot of anxiety.”
 

Some mothers experience nipple sensitivity or nipple pain during this time. This is not an easy situation as nipple sensitivity is mostly related to the hormonal changes of pregnancy. Some mothers find the sensitivity to be unbearable; sometimes feeling fidgety and impatient for the breastfeeding session to end; some may develop a breastfeeding aversion which may also lead to weaning.

The experience seems to be variable with a percentage of mothers who don’t seem to experience any sensitivity. Sensitivity may also change through the pregnancy, either getting better or worse.

Pain or sensitivity is often reported to be worse at the beginning of a breastfeed before milk has started to flow. Once milk starts flowing, the increased lubrication, and the pain-relieving properties of the hormone oxytocin may help improve the sensation.

Sometimes pain or sensitivity worsens towards the end of the breastfeed, as the child relaxes his latch, or as the breast becomes emptier.

Below we share tips and suggestions from other mothers who have breastfed through pregnancy:

1. Not waiting too long to breastfeed
Some mothers experience increased soreness if they have waited too long to breastfeed. Often the first morning breastfeed after a longer period of sleep is reported to be more painful. Shorter, more frequent breastfeeds help some moms to manage.

2. Not waiting till your baby is too hungry
Offering breastfeeds before your little one asks, may prevent less intense sucking.

3. Offering a few sips of water before breastfeeding an older child (older than 6 months)

4. Encouraging gentle suckling
Speak to your little one and praise him for breastfeeding and suckling more gently.

5. Encourage more comfortable latching
Look into your little one’s eyes and speak to her and ask her to open her mouth “nice and wide”. Bring her body in close to yours “tummy to tummy”.

6. Try side-lying breastfeeding
The side-lying position can be helpful for both you and your child, with both of your bodies being supported by the bed, and less ‘holding” for you to do.

7. Minimize distractions during breastfeeding
It may help to stick to a particular area/bed/chair for breastfeeding.

8. Encourage “no wriggling” or gymnastics while breastfeeding
"If you want to have boobie/milkies then be gentle, no kicking/biting/pinching otherwise we will stop."

9. Be firm but gentle in saying “no twiddling” of the other nipple
Toddlers often twiddle the other nipple trying to encourage milk flow. Twiddling behaviour may increase during this time as milk production slows down during the pregnancy. It may help to have a replacement object or toy that the child can twiddle.

Some mothers report a change once colostrum starts being produced again towards mid- or late pregnancy. Until then some other suggestions from mothers are:

10. To visualise milk flowing in abundance

11. To distract yourself by reading a book, listening to music, having a conversation with someone or watching something

12. To drink more water

Dehydration seems to increase nipple sensitivity for some mothers.

13. To time your child out
"Let's sing a song then when the song is done let's go get you a nice snack/drink."
 

Putting boundaries in place is a gentle parenting technique which teaches little ones to also respect "mommy's needs". As a breastfeeding mother, you are most in tune with when your child "really needs to breastfeed" and when you can push those boundaries a bit. It takes consistency and patience.

From the "Womanly Art of Breastfeeding Book" by LLL International :

“Is It Okay to Limit Some Nursing Behaviors?
Discipline issues related to nursing come up more often as nursing toddlers grow. What if your child is becoming very demanding and insisting on nursing NOW? Should you put some limits on how often and where nursing can happen? Every nursing relationship is different. you’ll be able to draw on your understanding of your child’s personality and needs in teaching nursing manners. Maybe your child is overtired and hungry and has “lost it,” and breastfeeding right away is just what she needs to get back on an even keel. Maybe she needs a reminder of something you previously agreed on—that you’d nurse at home, for example, but not in the mall. Maybe she’s just bored and needs a distraction. Maybe it means you need to rethink the limits you’ve set. You may have thought it would work to wait until after you drove your daughter home from day care to nurse again, but now she’s telling you that she needs to nurse right away and can’t wait to get home. Maybe she’s had a bad day and needs that extra source of reconnection with you. Nursing continues to be a place where both of you learn about negotiation, patience, acceptance, exceptions, and compromise— big concepts for a little person. But nursing is a familiar, reassuring relationship in which to learn them.”
 
Whether to wean or not is up to each mother but many moms choose to continue through pregnancy and beyond to tandem breastfeeding. It doesn't have to be an all or nothing approach now. There are also mothers who wean and then resume breastfeeding of the older child later on. The breastfeeding relationship changes as the family dynamics change but breastfeeding can still be an amazing mothering tool providing bonding and soothing for the toddler who is also picking up on the changes happening within the family.

Follow your heart, your feelings and responses may feel like they're all over the place.Take things one day at a time and be gentle on yourself.
 

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MILK SUPPLY AND COLOSTRUM

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Women who breastfeed while pregnant often find their milk supply decreases around the fourth or fifth month (sometimes earlier than that). The composition of your milk will also change slightly. These changes are associated with normal hormonal changes during pregnancy, and breastfeeding more frequently or pumping won’t increase production in the same way it would do if you were not pregnant. If your breastfeeding baby is less than a year old, watch his weight gain to be sure he is getting enough to eat. It’s also not uncommon for the flavor of your milk to change. These changes may prompt some older toddlers to breastfeed less often or to wean entirely.

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According to Breastfeeding Answers Made Simple, by Nancy Mohrbacher (2010), “the older breastfeeding child will not deprive the newborn of colostrum by breastfeeding during pregnancy […]. No matter how often or long he breastfeeds, colostrum will still be available after birth for the newborn”. The hormones that maintain a pregnancy are found in breastmilk, but these are not harmful to the breastfeeding child.

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Some mothers express concern that their toddler may be taking milk meant to nourish their baby. These mothers may take comfort in the fact that breasts are marvellous organs that can adjust their production to meet the demands placed upon them–if they are asked to produce enough milk for two, they usually do! Also, most toddlers breastfeed considerably less frequently than an infant, and can get most of their nutrition from other foods.

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THE PRACTICALITIES OF TANDEM NURSING

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During the first few days, Nancy Mohrbacher (2010), suggests to give the newborn first priority at the breast, so the baby can get the nutrient and antibodies present in the colostrum. The older child who tandem breastfeeds may also help minimise engorgement and help increase milk supply.

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Some children will ask to breastfeed more often in the early weeks, because they see their newborn sibling breastfeeding. Many want to breastfeed every time the baby does; this increase in breastfeeding frequency may change the way his stools look (they could become more similar to those of an exclusively breastfed baby, yellow and soft). Besides food and immune protection, breastfeeding provides the older child with comfort and closeness at this time of change. Many mothers suggest allowing an adjustment period of perhaps a few weeks. After that time, if you are feeling overwhelmed, you can try telling the older child that you prefer to be able to really pay attention to him/her while breastfeeding, and request that he/she wait until the baby is done before he/she breastfeeds. This will not eliminate the constant double-nursing, but may very well cut it down.

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Nancy Mohrbacher (2010) suggests that there is no need to have any special breast hygiene measures during tandem nursing, just “reasonable cleanliness. Even in the case of the older sibling having a minor illness, both children (and the whole family) will already have been exposed to the bacteria or virus causing the illness, by the time visible symptoms appear. The exception would be a serious or highly contagious illness; in this case, it may be worth “assigning” one child to each breast.

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After the new baby is born, it’s not unusual for a weaned child to want to taste the milk or ask to breastfeed again. Some may not remember how to suckle, others will complain about the taste and there will be some who would be happy to resume a breastfeeding relationship. If you do not want to breastfeed the older sibling, you could offer a taste of your milk in a cup or spoon.

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If you decide you want to wean your toddler, it’s easiest to proceed gradually. The approach of “don’t offer, don’t refuse” is one that has worked for many mothers. See if you can anticipate when your child is likely to ask to breastfeed and offer a distraction or a healthful snack instead. Avoid sitting in your favourite breastfeeding spot. Be sure you give lots of extra hugs and attention. For more ideas on weaning, see our article: Weaning – I Want To.

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THE EMOTIONAL SIDE OF TANDEM NURSING

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(The following is an extract from the article “Love, limits and tandem nursing” by Hilary Flower, first published in New Beginnings, Vol. 20 No. 3, May-June 2003, p. 86)

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The decision to breastfeed two children after the new baby is born is a personal one. If pregnancy hormones don’t disrupt breastfeeding too much, breastfeeding can be a special way for you and your older child to stay connected while you contemplate the changes to come. Similarly, breastfeeding your toddler alongside your newborn can be a special way for you to stay connected with your older child during this exciting-and somewhat disorienting-time in your family life.

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But if your breastfeeding relationship comes under strain for whatever reason, adjustments may be necessary. Be aware of some red flags that may indicate your breastfeeding relationship needs your help:

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• You feel yourself withdrawing from your breastfeeding child.

• You hear an irritated tone in your voice when you say “Yes.”

• You feel you have no choice when it comes to breastfeeding.

• You are prone to snapping at your child while breastfeeding.

• You are getting exasperated enough to consider weaning on the spot.

 

If you see these signs, re-visit your decision about weaning or continuing to breastfeed. If the answer is weaning, it will be a good decision for both of you. If the answer is that continued breastfeeding is definitely worth it, you may find that your attitude becomes more positive. A renewed conviction that continued breastfeeding is for the best, combined with a little self-care, may go a long way toward soothing a frazzled soul and body. Setting limits that take your own feelings into account is a big part of self-care, and self-care is the key to enjoying mothering!

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Limits can help in other ways as well. Breastfeeding is an exchange between two hearts. A gentle “no” when breastfeeding feels wrong creates the possibility of a clear “yes” for a session when you are truly up for it. Taking your own feelings seriously and allowing yourself to freely choose when to offer breastfeeding can maintain the openness and joy of breastfeeding for both you and your nursling.

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Remember that more is not always better. Your child needs you to honour your bottom-line limits. If breastfeeding is for comfort, the emotional quality of the exchange is of great importance. It is hard to disappoint your child, especially during a difficult family transition. But as the mother you understand something that your child does not-you are protecting your child from the mixed messages and resentment that can build up when you say “yes” but really mean “no.” In this way, loving limits serve your child as much as you, even when your distress is the initial catalyst.

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An increase of maternal voice in the breastfeeding relationship can evolve gradually and naturally. It is important to show your child that you take care of yourself and that your needs are important, too. This can be a meaningful way for a child to begin to learn to respect the needs of others. One mother tandem nursing her older daughter said:

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I am very careful not to lose myself in this process, because then what would I be teaching her? I cannot be a good mother if I’m resenting her all the time. So as gently as I can, I do let her know when I need space. We try to compromise how “close” we are during those times. For instance, if she wants to nurse but I just can’t handle it right then, we’ll sit closely and quietly for a little bit. Or we talk about how sometimes she feels grumpy and wants to be alone, and so do I.-Bianca K., Ohio

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Necessary boundaries around breastfeeding can provide a rich learning experience for your child. You can support your child in coming to terms with a reality that is not exactly as he wishes but one that is still “safe.” After all, there is no limit on your love.
Once you begin experimenting, you will find a limit that works best for you and your child, even if it’s not ideal for either of you. Two-way compassion is the key. Ask yourself what level will allow you to:

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• Genuinely enjoy breastfeeding your child?

• Feel glad you’re still breastfeeding?

• Open your heart most fully to your child?

 

When you consider your child’s desire to continue breastfeeding, what level of bresstfeeding can you live with? What is going on for your child emotionally right now? Is this a relatively tranquil and settled time for your child, or will there soon be a better time to institute changes? If you feel your child is mature enough, engage him or her in problem solving this with you. Your child may surprise you with a generous offer or an innovative solution. Giving your child some voice in the nature, the level, or the pattern of reductions can help him feel empowered and valued in his relationship with you. Age-appropriate limits allow the breastfeeding relationship to remain workable for both parties.

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Considering and validating children’s feelings does not always mean that they should do everything their way. In my case, setting some limits saved the nursing relationship with my older child when we were tandem nursing. If I had not limited him, I probably would have weaned him. It does not have to be an all or nothing situation. As it was, by limiting his nursings to times that I could deal with, we were able to enjoy it more, and our nursing relationship lasted much longer.

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Generous but realistic boundaries are a balance between respecting your own needs and those of your child, on behalf of your fundamental relationship.

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Recently, I’ve talked with Sarah, my three-year-old, about preferring to nurse only one of them at a time. I’ve explained that this feels better for me. I’ve explained to Sarah that I want to continue to nurse her as long as she needs it. In order to do this, we need to make sure that both of our bodies feel good about it. This means nursing for a shorter time (to avoid the ring of teeth marks around my nipples) with lots of snuggling or doing other things that we enjoy together. Sometimes this also means waiting until seven-month-old Malcolm is happy playing while we nurse. I feel that Sarah is learning healthy boundaries about our bodies and that she is capable of choosing to feel relaxed and happy. She is also learning that she is able to do this by means other than nursing.-Wendy M., Ontario, Canada

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Good communication is essential. Many mothers find a low-key but direct way to let the child in on what’s happening for them.

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I think my nurslings understand my feelings in an intuitive way, and they are more cooperative when I am honest, but clear and firm. -Cheri S., Minnesota

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Many mothers take great pains to keep the baby and their pregnancy out of their explanations, not wanting the child to blame the problem on the baby. Some explain that it has to do with the pregnancy. And similarly, many mothers take extra care to help the toddler know it wasn’t his fault, either. Pregnant mothers often say, “Mama’s nee-nee’s are sore, tired, or hurting,” or “Too ouchy, nursey all done.” You may even put Band-Aids on your breasts and explain that you have “owies.”

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I tried very hard not to tell Jake that he hurt me, or that nursing hurt me, rather that certain actions hurt. I didn’t want Jake to be afraid of nursing. I would tell him that Mommy wasn’t in the mood to nurse, and we could nurse again in a little while. Or that he could nurse only if he was very still, and didn’t wriggle or kick, because being wriggly hurt Mommy’s tummy.-Sarah G., Texas

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Meanwhile, the tandem nursling’s mother may be faced with the question, “Why does the baby get to breastfeed all the time but not me?” Such a question can really tug at your heart, since you want to provide your child every possible reassurance that he or she has not been displaced from your heart. And a mother can’t help but worry that saying “no” will fuel resentment of the baby or feelings of rejection. And yet, communicating openly and non-defensively with your toddler around the “double standard” of breastfeeding your newborn can be a rich opportunity for you to process the shifting realities of your relationship with the older child. Mothers may say:

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• “Newborn babies can only eat ‘nursie,’ and they need it in order to grow.”

• “Big boys and girls get to eat special foods, such as apricots and toast, that babies can’t eat because they don’t have teeth. In fact, babies aren’t allowed to eat things like that at all!”

• “You used to breastfeed all the time when you were a baby, too.”

• “Someday the baby will be able to eat other foods and will be breastfeeding less.”

 

Your child may benefit from the opportunity to understand better what is happening-chances are he has noticed that something was different. The main thing your child probably wants to know is that it he is not at fault. Children do not want to cause their mothers’ pain.

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My two-year-old did not know about nausea, so I told her I was sore, which she understood. At first, she became distraught when I told her I was too sore to allow her to nurse, so I “gave in.” I then realized why she was distraught-she thought it was her fault that I was sore. I explained to her that I was sick and that my breasts were sick and would get better if she did not nurse. From then on, she was contented to cuddle with me instead of nursing, and to fall asleep like that. She would ask to go on the breast just once in the evening, but she would simply put her mouth around each nipple once for a few seconds. She simply needed to know that I would not stop her.-A.E., Scotland

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Remember to acknowledge and praise your child when he does find a way to take your needs into account.

Short and sweet can be easier to manage when nursing is painful or hard to juggle. Some pregnant and tandem nursing mothers have reduced the duration of feeds by saying to their child:

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• “We’ll breastfeed for a count of 10. Shall we count butterflies or dinosaurs?”

• “You may breastfeed for the length of the ABC song.”

• “You can breastfeed for a few minutes and then you may have some water in this special cup.”

• “You can breastfeed while I count to 10-who will finish first, me or you?”

• “I am turning over the egg timer, and when the sands are all down, we’re done for now.”

• “Just a few more sips.”

 

Give your child choices whenever possible, and don’t be surprised if your toddler finds unexpected ways to participate in reductions once he gets the idea. One toddler instituted “nursie for second,” in which she momentarily put her little mouth to the breast.

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Saying, “Yes, but later” can be a gentle way to extend the interval between nursing sessions, and particularly helpful to the younger child for whom the word “no” may sound like “never.” As you reduce the number of sessions, you and your nursling may find that working toward a set policy works well.

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Gradually, we reduced nursing times to something Brennan could say and understand. Once in the morning, once at naptime, once at bedtime. It became our little song. If only I could count the times one of us recited this to the other! -Crystal O., South Carolina

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With experimentation and some patience on both sides, mothers and children can often keep the breastfeeding relationship moving in a direction that is helpful for the larger mother-child relationship.

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ADDITIONAL RESOURCES

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Breastfeeding and Pregnancy
Hilary Flower (2003) Adventurers in Tandem Nursing: breastfeeding during pregnancy and beyond. Published by La Leche League International. ISBN: 9780912500973

La Leche League Great Britain, Pregnant and Breastfeeding? https://www.laleche.org.uk/Pregnant-and-Breastfeeding/?/

 

REFERENCES

Madarshahian F., Hassanabadi M. (2012) A Comparative Study of Breastfeeding During Pregnancy: Impact on Maternal and Newborn Outcomes
Journal of Nursing Research, 20 (1) p 74-80. doi: 10.1097/JNR.0b013e31824777c1
Mohrbacher (2010) Breastfeeding Answers Made Simple, Hale Publishing, ISBN-10: 0984503900
Flower H. (2016) Breastfeeding during pregnancy and tandem nursing: is it safe? Recent research, Breastfeeding Today, 11 April 2016

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*Parts of the contents of this page was generously supplied by La Leche League International