Dr. Marjorie Greenfield
Specializing in pregnancy and birth.
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 Ask Dr. Greenfield
Pregnant While Breastfeeding | | | QUESTION | | | Dear Dr. Greenfield,
My 17-month-old son is still breastfeeding. We had weaned down to two long (20-minute) and two short (10-minute) sessions a day. I am eight weeks pregnant (and I was on birth control!). The pediatrician said there was no reason to wean cold turkey. However, I have heard from several people that breastfeeding while pregnant requires more extra calories to provide for the baby and milk for my toddler. Also I heard that nursing after 20 weeks can cause preterm birth. I am concerned about getting adequate nutrition. How much do I need to eat (I am 5'2", 120 lbs)? And can it cause preterm labor? Thanks in advance.
— Mommabear in Hubert, NC | | | ANSWER |
February 8, 2002 | | | Dear Mommabear,
Well you do have your hands full--and aren't you fertile--breastfeeding and using birth control and still getting pregnant! I hope you are coping with this turn of events.
The greatest factor to consider in deciding what to do is how do you feel. There is no need to wean your child suddenly. For healthy low-risk mothers there isn't any medical risk to breastfeeding through pregnancy. While nipple stimulation may cause some uterine contractions, there is no evidence that preterm birth is more likely in low-risk moms who are still nursing. On the other hand, it may be easier on you to wean your son now, rather than after the baby comes. Or you can continue to nurse your son, as long as that feels right. Lots of women nurse through pregnancy and then breastfeed both the new baby and the older child after birth. This is called tandem nursing. It often happens, though, that the older child weans himself partway through pregnancy, or that the milk supply diminishes, and the child seeks nutrition elsewhere.
If you are getting exhausted, or find that you can't keep up the calorie intake and fluids necessary for breastfeeding plus pregnancy, it is time to wean down. You can tell if you are keeping up by listening to your appetite, eating when you are hungry, drinking lots of fluid, and watching that you gain seven to ten pounds in the first half of pregnancy and a half pound to a pound each week after that.
So really there isn't one right answer. You should do whatever makes you feel the most comfortable. Your son has had a good start, and will do fine with whichever choices you make. It is very common to feel a sense of loss when you are going to have a second child--loss of the intensity of the relationship with your firstborn, loss of his role as your only baby, and sad anticipation of his sorrow at being "displaced." And sometimes your own feelings of sibling rivalry or displacement come into play. Even though it sounds counter-intuitive, some mothers getting ready for their second babies almost have to go through a grieving process as they prepare for these changing roles and relationships.
It may be hard to set limits if your son doesn't want to wean, or you may feel ambivalent about taking this away from him. Sometimes sadness or guilt can motivate a parent to stop setting limits for their toddler, just when he needs them most. If you decide to decrease or discontinue nursing and are having difficulty, talk to your pediatrician or family doctor about ideas for your specific situation.
As you can see, the issues really aren't medical but personal. Hopefully you can find a solution that feels right to you and that ultimately helps your 17-month-old to continue to feel secure and loved as you help him grow into his new role as a big brother. I hope that this answered some of your questions. Good luck!— by Marjorie Greenfield, M.D. |
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