Monday, April 26, 2010

Breast-Feeding During Pregnancy: A Painful, Controversial Choice

By Erica Kain

I had a positive pregnancy test when my first daughter was just 9 months old, and I immediately called my ob-gyn to share the news.

“Stop breast-feeding,” she told me, and dutifully, I weaned my daughter that night.

A week later, when I miscarried what turned out to have been a chemical pregnancy, I had two things to mourn: the baby I’d expected, and the nursing relationship I’d ended with my daughter.

I wondered, even if the pregnancy had continued, was it necessary to wean her? Why would my doctor have said that?

What I’ve learned since that day has changed my mind entirely about nursing during pregnancy. In fact, if I am lucky enough to get pregnant while breast-feeding, I’d want to continue the nursing relationship, even extending into a “tandem nursing” situation after the baby is born.

Why don’t pregnant women breast-feed more often?
In all my years of playing with my young children in parks, I have never once seen an obviously pregnant woman breast-feeding. Why not?

Many times, apparently, it’s very painful.

According to Wendy Haldeman, one of the founders of the Los Angeles–based The Pump Station, it can hurt to breast-feed during the first trimester. “The nipple soreness is just somethinLinkg the mother has to endure,” she tells me. “Some can; others find it is just too painful to continue.”

Local mothers who attempted nursing while pregnant agreed with Haldeman. “By the time I was about 2 months pregnant, nursing became excruciatingly painful,” Amanda, a local mom, tells me. “I almost cried every time I went to nurse, it hurt so bad. I ended up weaning my son at that point.”

Milk supply can also diminish. “My experience is that if the first baby is over a year, the milk supply is not as much of a concern,” Haldeman says. “Infants under 9 months of age frequently need to be supplemented with formula because the mother simply can’t produce enough milk.”

Basically, your body begins producing a different quantity and quality of milk sometime in the second trimester. This is spelled out in Breastfeeding for Dummies by Sharon Perkins, RN, and Carol Vannais, RN:

“Somewhere between four and eight months of pregnancy, your milk does start changing from mature milk back to colostrum, the first type of milk that you gave your baby. The colostrum usually tastes a little different than mature milk, so you may find your baby not as interested in this new menu item and starting the process of weaning.”

But if I could bear the pain and my baby could bear the “new menu item,” is it a good idea from a medical perspective?

Will nursing hurt my unborn baby?
“In most circumstances,
breast-feeding can be continued during an uncomplicated pregnancy,” says Pamela Berens, MD, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of Texas Health Science Center, at Houston, who researches lactation and breast milk.

However, she explains that if your health-care provider has instructed you not to have intercourse, then you may not want to reconsider breast-feeding.

Apparently, both orgasm and breast-feeding trigger a release of oxytocin, which some women may want to avoid, as it can cause uterine contractions. “The increased oxytocin could be problematic in the patient that is experiencing preterm labor,” Dr. Berens says.

Dr. Berens advises that women with a history of preterm labor, placenta previa, or a “classical” C-section uterine incision consider weaning. However, these reasons occur later in pregnancy, so the mother wouldn’t need to wean abruptly in her first trimester.

Also, Dr. Berens recommends weaning for women with severe hypertension (high blood pressure), severe vascular or renal disease, or a prior “growth restricted” infant (a cautionary recommendation based on what Dr. Berens describes as a “small body of research that suggests that the weight of the infant born to the mother that breast-fed during her pregnancy may be very slightly reduced”).

Could nursing cause a miscarriage?
Though no research has found any increased risk of miscarriage in women who continue
breast-feeding during pregnancy, women might want to consider weaning if they are experiencing bleeding during early pregnancy, says Dr. Berens.

But be sure to confirm the pregnancy is viable. “If the pregnancy has already miscarried or is ‘non-viable’ (meaning no fetus has formed or the fetus has no heartbeat), then there is no benefit to weaning,” Dr. Berens says.

If only I’d heard that sound advice four years ago! Armed with this knowledge, I know that for any future pregnancies, I’ll hold on to my nursing relationship with much more confidence.

"Breast-Feeding During Pregnancy: A Painful, Controversial Choice." Erica Kain, April 21, 2010


Anonymous said...

And also don't forget re-lactation. Relactating is possible for many people. Some even enable lactation after adopting! If the child still has a suckling reflex, even dry-nursing for comfort can be helpful.

I'm am 19 weeks pregnant and nursing my 17 month old on cue. I was lucky to miss out on nipple sensitivity and hope to tandem nurse when the new baby arrives.

I just want mamas to know that even if their milk dries up or if they have to wean temporarily due to pregnancy complications or pain, relactation is definitely and option and it doesn't hurt to try!


Anonymous said...

I continued nursing my 7 month old until I was about 10 weeks pregnant. It was very painful and I lost most of my milk immediately when I got pregnant. I tried stepping up pumping, tea, oatmeal, and herbs. Nothing helped, I maybe produced enough for one meal all day. It was heartbreaking to have to stop nursing her but my body decided for me. I still miss it. She is thriving and happy but I wish I had been able to continue nursing for at least a few more months.
Good article, thank you.