Hey Laura, tell me about breastfeeding during pregnancy

HVW writes:

My son is 18 months old and nurses 4-5 times a day, and seems to be in the process of cutting back on his daytime nursing in the past few months. My husband and I are tentatively planning to try for #2 starting in the next few weeks. My son was conceived on the first “try” but you never know how long it will take. My goal is to nurse my first son for at least 2 years, although at this age I do not mind if I end up having to supplement some with cow’s milk or other dairy products (he does eat cheese at this time but I don’t give him cow’s milk).

I know that often pregnancy reduces or dries up milk supply. I have seen a variety of data on how many women do lose their milk supply during pregnancy; from your experience or research how common would you say this is? Also, I am wondering what the best recommendations are to maintain a decent milk supply as long as possible if I become pregnant. Are there any herbs or dietary changes that can help, or would it help to boost my supply a little bit beforehand by pumping between feedings? If I do become pregnant, how do I know if he is getting enough milk from me, or if I need to offer another source of dairy products in addition to nursing?

Breastfeeding and Fertility
Kellymom.com is my favorite online breastfeeding information source. I did a quick search of the archives there and found a couple good resources: Breastfeeding and Fertility and another short article, similarly titled.

Taking Charge of Your Fertility is a fantastic book for anyone trying to conceive (or avoid conception, for that matter).

Breastfeeding during Pregnancy
You may find Hilary Flower’s book, Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond, a valuable resource. Here is an excerpt from the chapter entitled “A Pregnant Pause….To Nurse or Not?” to give you a feel for the information it offers.

Hilary Flower has her own sub-section of Kellymom called Nursing2. Here are some key resources, although you may want to tinker around yourself.

- A New Look at the Safety of Breastfeeding During Pregnancy (except in preexisting at-risk situations, it is safe.)

- A quick FAQ on Nursing During Pregnancy.

- Will pregnancy cause my child to wean prematurely? (A qualified maybe.)

La Leche League has a great article called Nursing through Pregnancy that outlines what you can expect. This one from BreastfeedingBasics.com is good, too, and discusses tandem nursing as well.

Statistically speaking?
There is a woeful lack of breastfeeding research out there! Here are a couple nursing/pregnancy-related citations I was able to scrape up:

The La Leche League’s article on Nursing through Pregnancy points to a few

anthropological studies which address the subject have cited “overlap” of breastfeeding and pregnancy in 12 to 50 percent of pregnancies in countries such as Bangladesh (12%), Senegal (30%), Java (40%) and Guatemala (50%) (Lawrence 1994). Many of these mothers continue to breastfeed well into the second trimester of pregnancy or beyond.

In her Nursing2 “Myths vs. Facts”, Hilary Flower asserts the following:
- “70% of mothers notice a significant drop in supply during pregnancy. Still, a minority of mothers continue to produce an abundance of milk throughout pregnancy.”
- “In one study of La Leche League mothers breastfeeding during pregnancy, 26% of children self-weaned, 28% of the mothers led weaning, and the other 46% went on to tandem nurse.”

Here’s another short summary of breastfeeding during pregnancy research.

Increasing Supply with Diet and Herbs
Since the drop in milk supply during pregnancy is dictated by your body’s reaction to the hormonal changes it is undergoing, I’m not entirely sure adding an extra pumping session will work. It can’t hurt to try - you would know if it was effective in a couple days. Your best bet is to try a pregnancy-safe galactagogue. Unfortunately, those that are safe during pregnancy are some of the mildest and least effective!

Kellymom.com suggests eating oatmeal as a way to increase supply.

Dr. Jay Gordon lists the following galactagogues as safe during pregnancy:
Nettle up to 2 capsules 3 times a day
Dill up to 2 ml tincture 3 times a day
Marshmallow up to 4 capsules 3 times a day

You can read more about herbal galactagogues and their dosages here on LowMilkSupply.org

The homeopathic remedy Ignatia 6X can be combined with milder galactagogues such as nettle and marshmallow. The dosage is 2 tablets, three times daily. Homeopathic remedies are considered safe during pregnancy and breastfeeding.

MOBI (Mothers Overcoming Breastfeeding International) Motherhood International has a wonderful article on Lactogenic Foods and Herbs. I also liked the MOBI Herbal - Part 1 here and Part 2 here.

These articles are excerpts from Hilary Jacobsen’s book Mother Food For Breastfeeding Mothers, which you may want to invest in.

Tandem Nursing and Nursing a Toddler
How your milk will change

Check out the resources in my post about weaning (or not) 18 month olds - good stuff on nutrition.

I like Dr. Jack Newman’s article called Breastfeed a Toddler? Why on Earth?!

My anecdote and advice
I got pregnant with #2 when my eldest was a little over 2.5. I was all for nursing during pregnancy and tandem nursing - philosophically. But when the rubber hit the road (or, rather, when the sperm met the egg), my mind changed pretty quickly.

She wasn’t nursing more than at nap time and bed time, and maybe upon the morning wakeup on some days. I was loathe to quit, because nursing a toddler makes things so much easier. I loved being able to guarantee a nap (or at least some restful lie-down time) with her, just by nursing. During the first few weeks of exhaustion, that ability was precious. However, I’m pretty sure my milk dried up quite fast. And let me tell you, “dry nursing” is not comfortable. Combine that with those tender first trimester boobies…..excruciating!

So I formulated a plan to wean at her third birthday. We made a big deal out of it in the weeks leading up to it - mentioning it all the time. And on the day before her birthday, we celebrated “The Last Day!” I told her she could nurse as much as she wanted, any time she wanted, all day long and all night if she wished (Oh, please God, NO, I secretly hoped - haha!). “The Last Day!” went very smoothly; she nursed a few extra times throughout the day, and a bit longer that night. The next morning I only had to remind her once that she was a 3 year old, and “Three year olds don’t nurse!” (at least, not this 3 year old, in this house!). She didn’t even cry.

Honestly? It was I who had a harder time with the weaning! I’m sure pregnancy hormones played a part, but I seriously grieved the end of that era! I had fought so hard to survive nursing her even a year, that to have made three was overwhelming.

I told myself that if she wanted to nurse once the baby was born, I’d let her try. It really was just the pain that made me antsy to wean. Sure enough, she was kind of interested (it had only been 5 months since she’d last nursed), but she didn’t remember how to latch! She said, “Can’t you just squirt it into my mouth, Mommy?” Um….no. :)

As for how much cows milk or other dairy products to supplement for the breast milk your toddler may be missing - it doesn’t have to be dairy. Full fat dairy products are recommended because they are widely accepted by picky toddlers, easy to put in a bottle, and - most likely - because (my own cynical opinion here) the Dairy industry pays big bucks to market their product as The Answer to childhood nutritional gaps. Unless you’re drinking raw milk from a grass-fed cow you know personally, I don’t believe the milk hype. (And actually, that’s the only kind of milk I would go so far as to recommend for a little one!)

I also don’t think soy is a good substitute either.

Your toddler needs a good foundation of fats, calcium, protein, and vitamin D. If he’s not getting it from your breast milk, then he needs to be getting it from his solid food diet. Look at my soy link above and this one for more help on finding creative non-milk dependent ways to achieve those dietary goals. Kellymom also has a good article on toddler nutrition.

Also? Relax. :) He’s very unlikely to starve or be mentally stunted if he weans before he’s two. You’ll figure it out as you go along! Remember how weird it was at first when he started solids? How on earth were you supposed to know if he was getting enough to eat? or nursing enough? or the right balance of both?? You figured that out just fine; you’ll get through this next transition even easier!

I imagine that the hardest transition for both of you is going to be less nutritional and more emotional. When you get pregnant, your energies are going to shift - as subtly as that switch happens, your toddler is going to notice. There may be a big uptick in his comfort nursing or clinginess; there may be changes in his sleep habits (oh yay!). Just go with the flow. New babies upset everything - even when they are in utero!

Ask a Real Expert
While the information I’ve gleaned from the web should be of some use to you, if you want an answer nailed down by someone with real credentials in this area, you can email Dr. Jack Newman. Craft your email very carefully, as his practice is inundated with requests all the time. The question I would ask is what (if anything) you can do to maintain your supply during your pregnancy. I haven’t found any real information in that area - are there measures you can take, or will you just be at the mercy of your hormones?

Hey Laura, I think... Hey Laura, tell me about breastfeeding during pregnancy

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