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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, March 19, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, March 19, 2010
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- Is it okay to breastfeed while pregnant with a second child?
- Is it possible to continue breastfeeding my toddler while I start to breastfeed my new infant?
- My husband and I are adopting a child of a friend of ours in a few months and we were wondering if breastfeeding this child is an option for me. I breastfed my two natural children.
- Can I breastfeed my premature infant? My premature infant sucks for less than 5 minutes on one breast and then falls asleep. Should I pump my milk, or keep trying to feed her?
Breastfeeding during pregnancy is a decision that needs to be discussed with your nurse midwife or physician and the infant's health care provider. Most well nourished women should have no problems with meeting the nutritional needs of the nursing child and the embryo/fetus. At the same time, many women who nurse during a pregnancy experience a decrease in milk supply, which could affect your infant's growth.
When making this decision you want to consider many things:
There are also medical reasons to wean during pregnancy. Some of these include:
If you breastfeed during a pregnancy, you may experience sore nipples due to hormone changes. Unfortunately, the sore nipples usually last the entire pregnancy. To help with the discomfort, you might try using the breathing techniques from your childbirth classes, varying nursing positions, and hand expressing enough milk to start the flow before the child begins nursing. You will want to make sure you are eating a nourishing diet, so you can maintain a normal pregnancy weight gain pattern AND have plenty of energy for running after a toddler. After all, continued milk production does consume some of your calories each day. You might want to try eating six small meals and have a snack during the night, if you nurse then. It is important to be sure that all of the calories you consume are nutritious, and not "junk food," so that you get the best utilization of the calories you eat. Some snacks to consider are cheese, yogurt, whole-grain products, fresh fruit, fresh vegetables, fruit and vegetable juices and nuts.
Breast milk production often decreases at around the third month of pregnancy, as the fetus' placenta takes over making pregnancy-related hormones and maternal estrogen levels increase. This usually isn't a nutritional problem for a nursling toddler, since most toddlers also eat a lot of solid foods. However, if your toddler's diet still depends on breast milk to a great extent, it will be important to make sure she is getting enough nourishment as your pregnancy progresses.
Child-initiated weaning is fairly common during a mother's pregnancy - in part because of the decreased milk production, but also because breast milk apparently changes in taste. Older toddlers have said it tastes "salty," which makes sense because colostrum and preterm milk are higher in sodium than mature breast milk. Sometimes an expectant mother chooses to slowly wean an older child, especially if continued breastfeeding is associated with extreme nipple or breast tenderness, exaggerated nausea, or higher levels of fatigue. They do this by gradually offering other foods and other kinds of attention in place of one breastfeeding at a time. Other mothers feel very comfortable during the pregnancy, and their babies don't seem to mind the changes in milk quantity or taste.
When a mother breastfeeds two children of different ages (non-twin siblings), it is called "tandem nursing," and many mothers have had successful tandem breastfeeding relationships.
Even if you have been breastfeeding your toddler all along, your breast milk will change to colostrum when the newborn arrives. Since colostrum is so important and since the second baby's growth and development depends on breast milk more than the first, it is important that the newborn takes priority at the breast. This means the toddler may sometimes have to wait to breastfeed, but toddlers can learn this concept of waiting by 15-18 months as their ability to understand language increases.
It isn't unusual for an older nursling to want to breastfeed more often once a new baby comes home. Mother suddenly has a lot more milk, and the older child is in the midst of adjusting to sharing mother with a sibling. Anticipating this possible response, some mothers institute a few flexible "rules" about when, where and/or how long a toddler may breastfeed during their pregnancy, so the child will be used to some restrictions long before the new baby arrives and "competes" for the breast.
Any tandem feeding plan will work as long as the newborn's nutritional needs are given top priority. Many mothers breastfeed both children for some feedings; other mothers prefer to always breastfeed one at a time. Mothers' feelings about breastfeeding both children may range from very positive to ambivalence to resentment. Mothers often report their feelings fluctuate, especially during the first months when they still are recovering from the birth and everyone in the family is adjusting to having a new family member. Most mothers are positive about the overall experience, but they also say tandem nursing is stressful at times.
References:
Gromada KK (1992). Breastfeeding more than one: Multiples and tandem breastfeeding. NAACOG's (AWHONN) Clinical Issues in Perinatal and Women's Health Nursing, 3(4), 656-666.
Mohrbacher N & Stock J (1997). The breastfeeding answer book (rev. ed., p. 344-352). Schaumburg, IL: LLLI.
Oftentimes, you are able to breastfeed an adopted infant. However, since your body has not had the nine months of hormonal and breast changes to accompany the pregnancy, you will need to work hard at establishing a milk supply. It is important that you know your reason for breastfeeding. Are you breastfeeding for the emotional benefits or for the nutritional benefits? If you are breastfeeding for the emotional benefits to you and your baby, focus on these and look at the breast milk the baby receives as a bonus. If providing nutrition is the main goal, it may be difficult to fully achieve this goal.
Inducing lactation is a time-consuming effort that requires full commitment. It usually takes 4-6 weeks for the breasts to begin producing milk. During pregnancy, the increasing hormone levels stimulate the growth of milk ducts and alveoli of the breast. Without these increasing levels of hormones, more sucking, pumping or expressing of milk is needed in order to produce breast milk. You will need to stimulate your breast to produce milk. The most effective method (besides a baby) is full-size automatic electric breast pump. These can be rented from a hospital or medical supply company. You can begin pumping for ten minutes a few times per day, and gradually increase until you are pumping every 2 ½ hours. It is important to remember that it will take time before you begin to collect even a few drops of milk, so don't give up after just a few days. The majority of women are able to produce some breast milk, but very few women are able to totally breast feed an adopted child. The amount of milk your body produces after the baby has arrived will depend on many factors. These include:
Also, you should consult a Lactation Consultant who has experience in working with adoptive parents who want to breastfeed.
It sounds as if your daughter is behaving 'typically' for a premature baby - often these infants still need some extra oxygen. In fact, sucking for 5 minutes is quite an accomplishment for her - some infants will just want to nuzzle and lick the breast during these early feedings, so the fact that she is latching on and sucking is very good. The purpose of early breastfeeding is for her (and you) to get used to latching and learning to stay latched on while sucking. Once she can do this, you will get evidence that she is transferring milk - either by the nurses test-weighing her before and after feedings (the most accurate way of knowing) or by you feeling your milk 'let-down' and seeing some milk in her mouth. While it is common that most premature infants don't accomplish full breastfeeding until after they go home and are close to their due date, I would encourage you to keep breastfeeding her whenever you visit. If the nurses can avoid offering bottles until she has mastered breastfeeding, that would be best, but there is no good evidence that getting a bottle will necessarily interfere with long term breastfeeding. The fact that she is learning breastfeeding first will help a great deal.
It is common for people to think that breastfeeding is more work for the premature infant, but studies have shown that premature infants breathe more and maintain their oxygen levels better during breastfeeding when compared to bottle feeding. The main differences between the two feeding methods are that milk is immediately available to the baby during bottle feeding (instant reward!) and that the baby uses different sucking mechanisms to get milk during breastfeeding. Some infants do like the instant reward of bottle feeding and get upset when switched back and forth between the two methods, while other infants don't seem to mind. You will get to know something about your daughter's personality as she progresses in learning to feed orally.
I do have some suggestions for you:
Breastfeeding a premature infant takes a special commitment by the mother. It may be a few weeks before you see progress, but persistence - along with the supports I've mentioned - should have a positive outcome.
Last Reviewed: Jun 17, 2002
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Tina Weitkamp, RNC, MSN Associate Professor of Clinical Nursing College of Nursing University of Cincinnati |
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Karen Kerkhoff Gromada, MSN, RN, IBCLC Adjunct Clinical Instructor Parent Child-Health Nursing Department College of Nursing University of Cincinnati |
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