by Kasey Stacey

Why would anyone do that to herself? It hurts, right? I heard it hurts. Plus, can a woman’s body really do that? Grow a baby and feed a baby and still have enough left over for her?

The answer to that last one is yes, kind of. But let’s begin at the beginning.

So here you are, nursing your baby or toddler, and you find yourself pregnant. Maybe you intended to become pregnant and maybe you didn’t; regardless, you’ve now got an important decision to make. Do you keep nursing your older child or do you wean?

Obviously, I can’t tell you what the right decision is for your family. Instead, I’ll tell you a little bit about my experience (so far) and why I’ve made the decision to keep nursing my son through my current pregnancy, with the ultimate goal of tandem nursing after my second little one arrives.

Early in my breastfeeding journey with my son Vincent, I set a goal that I had no real confidence that I’d be able to meet. I wanted to continue nursing Vincent through my next pregnancy and then tandem nurse my two babies. Am I crazy? Maybe. I was already thinking about the next baby, after all. I had no concrete concept of what nursing through pregnancy and tandem nursing might be like, but I set this goal anyway. I value the benefits of nursing into the toddler years and I am hoping to have a large family, so I figured that the best way to ensure both of these is to dedicate myself to nursing through pregnancy.

Well-intentioned friends who have multiple children and have nursed through subsequent pregnancies gave me insight into what it’s like. “It hurts. Oh, it hurts,” said one. “But you went through all that nipple pain in the beginning. I’m sure you’ll be able to do it.”

“I’ve never tandem nursed,” another told me. “Nursing through pregnancy hurts, plus you get this really intense nursing aversion. It’s hard. I always end up weaning during pregnancy.”

They weren’t trying to discourage me; they were just fellow mothers sharing their experiences. Still, I couldn’t fathom what “nursing aversion” might be and I couldn’t imagine a more intense breastfeeding saga than what I’ve already experienced. And I love breastfeeding my son. Some people don’t have this experience and they don’t quite understand what I mean, but I have such a deep love for nursing and I am so grateful to have this relationship with Vincent.

If you look closely, you can see a tiny baby bump.

I became pregnant when my son was 11 months old (and not that it’s anyone’s business, but people have asked, and the answer is yes, it was intentional). I just kept nursing him as I always had; early in the pregnancy nothing seemed to change. I feared the return of pain and that the nearly inevitable decrease in supply would lead to early weaning, but I chugged along and decided to just wait and see.

There are so many aspects of nursing during a pregnancy to consider. Some women will have an easier time of it than others, and for some, weaning is ultimately the best choice. For example, a woman who faces an increased risk of pregnancy loss might decide (along with input from her doctor or midwife) that weaning is best. Although no studies have proven a link between breastfeeding while pregnant and miscarrying, there haven’t been many studies done into this matter at all, so some mothers would rather not take the chance.

Any woman experiencing a high-risk pregnancy should carefully weigh the available information and discuss the possibility of continuing to breastfeed with her medical care providers. Aside from physical risks, there may also be emotional challenges for the older child. One friend of mine decided to wean her toddler during her pregnancy because she was diagnosed with placenta previa. In the event that she had to have an emergency delivery earlier than expected, she didn’t want weaning her older child to be a sudden and scarring experience, so she weaned gently after receiving the diagnosis.

High-risk situations aside, there are many challenges that arise when breastfeeding through the course of a perfectly typical pregnancy. This brings back the question from earlier of whether or not a woman’s body can reasonably be expected to provide for the nutritional and other needs of three (or more?!) people: baby, toddler, and mom. It’s possible, sure. But it definitely isn’t easy and it definitely doesn’t work for every family.

So far, nursing through pregnancy is working for my family, though, despite a few common challenges:

Decreased Milk Supply

Probably the most pressing concern of mothers who become pregnant while breastfeeding revolves around milk supply. Pregnancy and lactation are, in some ways, incompatible. On a hormonal level, the pregnancy hormone (progesterone) and the lactation hormone (prolactin) don’t cooperate well together. When a woman is breastfeeding, her body produces prolactin, which tells her breasts to make milk. Prolactin suppresses progesterone, which is why lactational amenorrhea (not having your period while breastfeeding) occurs (um, for some women—not for me—I’m not bitter about it at all…). It’s as if a woman’s body is sending the message, “Hang on. No new babies yet. I’m still trying to feed this one!” As baby starts solids and nurses less and less frequently, prolactin levels drop, and mom sees the return of ovulation and menstruation. With lower levels of prolactin, the body makes more progesterone, which allows for the return of the menstrual cycle. Since progesterone and prolactin don’t work well together, when progesterone is high, prolactin is low, which is why some women notice a decrease in supply in the phase between ovulation and menstruation. Progesterone is high during this phase of the cycle so that a fertilized egg can attach to the uterine wall and pregnancy can occur. If a woman has conceived, progesterone levels continue to increase as the pregnancy progresses, which further decreases prolactin and stifles milk production. The decrease in milk supply isn’t instantaneous, but it does happen relatively quickly, whether a woman’s intention is to wean or not.

Okay, maybe you don’t care about all that. I find it fascinating. The short version, though, is that for most women, milk supply decreases over the course of pregnancy, ultimately drying up altogether sometime in the second trimester. So can a pregnant woman’s body still feed an older baby? Yes, for a little while. Pregnancy milk has a different composition (and different taste) than ordinary milk, so baby might not like it as much, and as supply decreases, he might lose interest in nursing altogether. Sometimes, weaning occurs whether or not the mother wishes for it to happen. And, if baby is less than a year old when milk production slows, decisions need to be made about the necessity of supplementing with formula or donor milk.

At this point in my pregnancy (just shy of 20 weeks), my supply is barely hanging on. During my early breastfeeding days, I had a lot of irrational fear about my milk suddenly drying up. I knew that this was an actual risk if I were to become pregnant (though I know now that it’s a fairly gradual process), so when I did become pregnant, I knew I had to be okay with my son potentially weaning before my milk came back upon the birth of my second baby. Katie has assured me that Vinny loves my boobs way too much to wean even if he has to dry nurse for a while. (As she was in the beginning of my journey, Katie has been a wonderful cheerleader and confidant, helping me to navigate this bizarre situation I’ve put myself in.) One of my midwives at The Birth Center, who has experience tandem nursing her sons, also said that since we’ve made it through the first trimester without weaning, he’s more than likely to continue nursing. I’m reassured, but I’m also more comfortable with total weaning if the decision is Vinny’s.

It’s a girl!

He is 15 months old now and has slowed down significantly, especially in the past couple weeks. Although my efforts to lead our path through night weaning have failed miserably, on his own he’s even started nursing less often overnight (though as I type this, he’s woken up at least five times, at one point even getting out of bed and waltzing himself into the living room to look for me—some nights are just like that, I guess). The other night, the unthinkable occurred. My son, who hasn’t slept through the night since he was maybe two months old, didn’t wake up to nurse overnight. A miracle if I ever saw one. Of course, I was up every half hour to pee. (Thanks, new little baby. I feel like my children are already conspiring against me.) Still, if this is a sign of things to come, I’m pleased. I want to continue nursing him, but night weaning is a must.

Nipple Pain

With increased levels of progesterone and decreased levels of prolactin comes nipple pain, another common fear of mothers contemplating nursing through a pregnancy. Again, as pregnancy progresses, progesterone takes over and blocks the body’s ability to produce prolactin. This is all quite typical during pregnancy, but these lower levels of prolactin also contribute to nipple pain. Katie always says that nipple pain during breastfeeding might be common, but it isn’t normal—it’s a sign that something isn’t going right. During pregnancy, however, a primary cause of nipple pain is hormonal, not physical, and there isn’t a whole lot to be done to ease the discomfort. This is another reason many women wean during pregnancy. The pain can be intense, and women who experience particular difficulty with nipple pain find it better to wean. Who could fault them?

As my supply decreases and my body shuts down milk production in order to prepare to make colostrum again, my nipple pain has increased. Women who contemplate nursing through a pregnancy hear different descriptions from different people. Some say that nursing through pregnancy brings on minor nipple irritation, perhaps similar to what women experience while breastfeeding during ovulation or menstruation. Others claim that it hurts in a really serious way. Every woman’s experience and toleration of pain is different, so your mileage may vary, but I will say that I’ve experienced both.

Especially as the weather gets colder, I’ve seen the return of vasospasms, which I’d classify in the “minor irritation” category (not to upset anyone who has found vasospasms to be intensely painful—again, we’re all different). When Vinny isn’t nursing, I find my nipples tender, especially if I’m not wearing a bra and they rub against a loose-fitting shirt. It’s a minor annoyance, not something I really pay much attention to.

When Vinny latches, though, it hurts. This is when breastfeeding during a pregnancy can get really painful, in my experience. It doesn’t hurt at every nursing, and some days are worse than others, but it definitely doesn’t tickle. It’s more than uncomfortable. Toddlers can be really lazy latchers as it is (and Vinny has always had a shallow latch), and as my milk diminishes, Vinny doesn’t need to work to effectively milk my breast. He’s nursing for comfort, and he’s lackadaisical about it.

I had a great deal of pain and nipple trauma at the beginning of this breastfeeding journey, so perhaps my tolerance is a touch higher than other people’s might be, or perhaps I’m just stubborn, but I don’t find the pain unbearable, so we are continuing on.

Nursing Aversion (a.k.a. Am I Going Insane?)

By far, nursing aversion has been the absolute worst part of breastfeeding during pregnancy. I can’t provide a huge wall of text about why this occurs. I don’t know why (I’m not sure that anyone has pinpointed the exact cause). All I know is that it is the greatest challenge I’ve encountered in my entire breastfeeding experience.

Who needs mama’s milk when you can eat your food from a bowl?

By the time he was 13 months old and I was nearing the end of my first trimester, Vinny was really starting to house some food, a sure sign that my body was not making as much milk as it had been. He was still nursing constantly, particularly overnight, much to my chagrin. I was exhausted and feeling especially ill, and I began seriously thinking about that dreaded W-word. I wasn’t really ready to wean, but I was no longer in love with breastfeeding, and I knew that we needed to make a change.

I couldn’t believe myself. I had set this goal, but I was starting to doubt how realistic it would be to continue nursing through pregnancy. And how could I not love nursing? It’s so difficult to put it into words. Motherhood has changed me in such a fundamental way, and nursing has been, from the beginning, a huge part of my concept of myself as a mother. Plus, my son loves nursing, too. I couldn’t imagine taking that from him before he’s truly ready, so I knew that total weaning wasn’t something I was prepared to do. Still, something had definitely changed, and I was beginning to resent breastfeeding.

I tried to consider why I was feeling resentful and what exactly had caused this change in my attitude. First, the lack of sleep overnight was a primary concern. Vinny had always been in a sort of reverse cycle, nursing more at night than during the day, but this had never been a problem for me. Co-sleeping allowed me to sleep through his night nursing, and I liked the pattern we were in. It worked for our family.

Enter nursing aversion. Honestly, I could never imagine what nursing aversion would be like, even after reading about it, but I think it’s one of those things that you have to experience first-hand to truly understand. For me, it occurred during the overnight hours, and it was the most intensely negative feeling I have ever had the displeasure of experiencing. It’s both physical and mental, a skin-crawling sensation that made me feel trapped and crazy, sort of like the narrator in Charlotte Perkins Gilman’s “The Yellow Wallpaper.” It turned me into a mean, mean lady—someone I don’t particularly care for. I said terrible things to my son. I would bark at him, “Don’t touch me! Get off! I am DONE with this!” I wanted to rip off my breast so that I could get up and run away from him. I never wanted him to be that close to me again. I could no longer relax and drift back to sleep during those overnight nursings.

I needed to get a grip. I couldn’t let these horrible feelings destroy my peace of mind in this way and hurt my son, who was confused about his angry, scary mama. I felt awful about the person I became in those moments. I would work on night weaning, but until we could accomplish that, I needed to check myself. I tried to gain control again, and when the feelings of nursing aversion would wash over me, I would breathe deeply and remind myself that I control my emotions; they don’t control me. I still feel this aversion to nursing at times, but now that I am well-entrenched in my second trimester, my supply has decreased further and Vinny nurses less both day and night. It’s common for nursing aversion to lessen as the pregnancy advances, and for that, I couldn’t be more grateful. I feel much saner these days.

Some women wean because of nursing aversion, and I completely understand why. Oh, my goodness, do I understand why. If I experienced this aversion at every nursing, or if I couldn’t overcome the intensity of it, I would wean, too. I wouldn’t want my memories of nursing my son to be colored by such incredible negativity. I considered weaning and really had to remind myself why total weaning was not right for Vincent and me.

Recently, Katie asked me how I felt about the fact that everything in my body seems to want me to wean. I mean, isn’t that the signal that my body seems to be giving me? I’m barely producing anything, my nipples hurt, my emotions are frazzled, and I’ve experienced a physical and emotional repulsion from breastfeeding. I should listen to that, right?

Except that I don’t know if everything in my body is screaming for me to wean. At times it definitely feels that way, but at other times nursing feels as right and as wonderful as it has for most of this journey. I’m a big believer in not letting my emotions dictate my actions and I try not to make long term decisions based on what I feel right now. Feelings are fleeting, but weaning is forever. Since I’m sure that Vinny and I both are not ready for that, I have to check my temporary discomfort and remember my motivating factors, like Katie encourages new moms to do when breastfeeding gets tough.

There are so many things to consider when it comes to nursing through a pregnancy and tandem nursing. It might not be wise to nurse through a high-risk situation. The pain and nursing aversion can be difficult to overcome. It’s taxing on mom’s body and contributes to greater exhaustion. It can impact mom’s weight gain during pregnancy. Do the benefits outweigh the difficulties? Each family must decide for themselves. For me, I really think I can do it. My hope is that tandem nursing will afford my children a greater opportunity to bond and that it will diminish any feelings of jealousy or confusion for Vincent. He won’t quite be two years old when the baby is born, and I don’t want him to have the sense that he’s being replaced, especially since he is a hardcore mama’s boy. My desire is to ease him into the transition of having siblings with tandem nursing as my aid.

I’m about half way through this pregnancy, and my goal of tandem nursing feels much more in reach. I won’t say that nursing through pregnancy has been a greater challenge than my early breastfeeding difficulties, but it has been a more prolonged challenge, and no matter the eventual outcome, I’m grateful to be undergoing it. Though my own breastfeeding experiences and through getting to know other nursing mamas, I’m continually amazed by the way that motherhood causes us to grow as human beings, challenging us to overcome any number of adversities as we evaluate and make decisions about what is best for our children. Yes, nursing through pregnancy is physically and emotionally taxing, but it is also rewarding. That’s how motherhood goes, though, isn’t it?

P.S. I’ve been reading Hilary Flower’s Adventures in Tandem Nursing, and it’s a great resource. It covers in great detail the topics I’ve described above and many others and it recounts the experiences of real mothers who have made the decision to continue nursing through a pregnancy. I recommend it to anyone who finds herself pregnant while nursing, as it has helped me gain perspective on what the best decisions for my family are. (Sorry to anyone else who wants to borrow it from The Birth Center, as I’ve been monopolizing it for a while. If you want it, shoot me an e-mail and I’ll bring it back next time I’m there.)

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