Can I breastfeed during pregnancy?

In summer 2017, one of our patients came in for an early ultrasound – she was having some vaginal bleeding and thought she was pregnant. She was right – the sonogram showed she was eight weeks pregnant. The ultrasound showed a small area of hemorrhage near the developing placenta, but the small embryo had a normal heart rate.

At the end of the ultrasound, she asked two questions that made me pause. “I’m breastfeeding – did this cause the problem? Can I continue to breastfeed?” While I had some initial thoughts about the advisability of continuing, I asked one of our nurses who is an international board certified lactation consultant to address the patient’s concerns.

Current breastfeeding recommendations from the American College of Obstetrics and Gynecology and the American Academy of Pediatrics are for exclusive breastfeeding for the first six months of a baby’s life, then breastfeeding in combination with solid foods up to 12 months. Some women continue to breastfeed or pump-and-feed breastmilk to their children up to 4 years old.

But the choice to breastfeed during pregnancy is not one to take lightly. Though it’s perfectly safe for many women and their pregnancies, breastfeeding while pregnant can be risky for some.

How often does the decision to breastfeed during pregnancy come up?

While this might seem an unlikely decision to have to make, it’s actually much more common than you might think. Look at the frequency of conception within a year of a delivery in the following three states as a cross-sectional example:

• Pennsylvania 8.5 percent
• Iowa 20.8 percent
• Ohio 20.5 percent

In other words, up to one in five women became pregnant during the time in which at least some breastfeeding is recommended!

There are no hard and fast rules surrounding breastfeeding during pregnancy. However, your Ob/Gyn may advise you to carefully consider breastfeeding if you fall into a higher-risk category.

Certain women should carefully consider breastfeeding during pregnancy

Women who are experiencing problems in the first trimester or have a history of early miscarriages might want to stop breastfeeding. This could include those who have a history of recurrent pregnancy loss or recent bleeding during pregnancy. If you have had a previous preterm delivery or have experienced preterm labor in your current pregnancy you also should consider weaning your infant.

During breastfeeding, the pituitary gland releases the hormone oxytocin, which permits the release of milk in the breasts (milk let down). This same hormone is also known to stimulate uterine contractions. In fact, when we induce labor in the delivery room, we often use a drug called Pitocin, which is a synthetic form of oxytocin. There’s also a test of fetal well-being during late pregnancy that uses nipple stimulation to induce small contractions while we look at the fetal heart rate tracing. In a high-risk pregnancy, the oxytocin release that accompanies nipple stimulation during breastfeeding can increase uterine activity, which could potentially affect the pregnancy.

Every woman’s body reacts a little differently to breastfeeding. I can’t quantify what the risk is of continuing to breastfeed in the setting of these complications. But I do know that women who experience a loss or bad outcome frequently ask, “Did I do something to cause this?” – just like my patient did.

If a woman chooses to breastfeed during pregnancy and then presents with spotting and ultimately a miscarriage, her first inclination might be to blame herself. But in high-risk pregnancies, it’s often difficult to determine what exactly went wrong, and it could very well be that breastfeeding had absolutely nothing to do with the complications.

Still, we understand the desire to make sure your current child receives all the benefits breastfeeding provides. Some moms feel guilty that they’re hurting their babies by not breastfeeding. If you are included in one of the high-risk categories and are passionate about your infant receiving breastmilk during your pregnancy, talk to your Ob/Gyn or maternal fetal medicine specialist (MFM).

Our goal is for you and your pregnancy to be as healthy as possible, and we want to support you in making good decisions. You might be able to get donor breastmilk for your child while you’re pregnant, or we can talk about other options to ensure your child’s nutritional needs are met.

If you choose to breastfeed during pregnancy, we want you to have a smooth experience. I’ve invited nurses Mandi Longoria and Linda Catterton to share their tips for successful breastfeeding during pregnancy. Both Mandi and Linda are International Board Certified Lactation Consultants, which means they adhere to incredibly high standards in lactation and breastfeeding care worldwide.

Tips for breastfeeding during pregnancy

Breastfeeding during pregnancy is a personal decision that requires case-by-case strategies to be successful. The only time we ever recommend that a mom not breastfeed during pregnancy is if she has risk factors such as those outlined by Dr. Horsager above. If you aren’t high-risk and you choose to breastfeed during pregnancy, these tips can make it easier on you and your child.

The first trimester can be tricky for breastfeeding. Not every woman experiences first-trimester symptoms, but many women have a range of symptoms, including:

• Breast and nipple tenderness
• Fatigue
• Decreased calorie and fluid intake as a result of morning sickness

To combat breast and nipple tenderness, you can take acetaminophen (Tylenol) and use warm compresses on your breasts to ease the pain and swelling. Tenderness usually is temporary, and most women tolerate this period of discomfort.

If you’re fatigued from pregnancy and caring for your older child, schedule time to rest when you can. Ask your partner or a friend or family member to help a bit more with household duties or childcare when you need additional rest. You might be tempted to drink coffee or energy drinks to keep up with your responsibilities, but try to abstain. These drinks often are laden with added sugar, and the caffeine can dehydrate you further.

For morning sickness, you’ll want to schedule times to eat and drink throughout the day. This helps with feeling less nauseous as well as keeping up your calorie and water intake for your milk supply and your personal health. If you get burned out on water, try sugar-free drink mixes or pediatric electrolyte or sports drinks (in moderation due to the sodium levels these drinks often have). You also can freeze these drinks in popsicle molds to change things up a bit. Even if your milk supply decreases during this time, it can come back to normal once you start to feel better.

Before you commit to breastfeeding while pregnant, make sure you can get enough healthy calories to meet this need every day. During pregnancy, women generally need to consume 300 – 400 extra calories per day to accommodate the developing baby. A woman needs to consume 500 extra calories a day to successfully breastfeed. Together, that’s nearly 1,000 extra calories you’d have to eat every day to keep up with your current and developing baby’s nutritional needs if your older child is younger than a year old!

If your older child is a toddler or older, you don’t need to eat as many extra calories for nursing. A child’s diet is mostly solid foods at that age, and the breastmilk is a supplement. Talk to a lactation consultant if you are concerned about your calorie intake.

As your belly grows larger in the second and third trimesters, you might need to reposition your child during nursing. The child likely won’t mind the position change, so find one that is comfortable for you. You can lay your child on top of or next to you while lying down, or your child can stand next to or in front of you to breastfeed.

Tandem feeding when the new baby arrives

Some women choose to continue breastfeeding their older child when the new baby arrives. Often, women who do so will feed both children in one sitting to save time and encourage bonding. It’s important to let your new baby nurse before your older child. The older child will have mastered nursing at that point and can drain a breast quickly. The new baby will still be learning and will need a little longer on the breast.

When you have a new baby, your breastmilk will return to colostrum for a short time. This is the “liquid gold,” the thick, yellowish milk that is rich in calories newborns need. It’s perfectly safe for your older child to have colostrum, but we warn moms that it can cause diarrhea in the older child for a short time. Make sure your older child has some extra fluids throughout the day, but this symptom will pass.

Weaning your older child when you’re both ready

During pregnancy, the consistency and taste of your breastmilk supply might change to become saltier. This is due to hormone changes in your body as part of pregnancy. Your child might not like the taste and choose to voluntarily wean himself or herself.

You might choose not to breastfeed during pregnancy. Follow your child’s cues to slowly wean the child from nursing, or ask your lactation consultant for tips on how to properly wean your child when you’re both ready.

We don’t usually recommend going “cold turkey” with your child because of the distinct bond that forms between mother and child during breastfeeding. Your child might perceive being cut off from the breast as a sign of rejection. Typically, we’ll recommend dropping a feeding or a pumping session once a day at first, then slowly progressing until you’re down to none. However, if a complication develops suddenly during your pregnancy, you might not have the option of slowly weaning.

Keep in mind, you might continue to produce milk for weeks or months after your child is weaned, whether it was the child’s choice or yours. This leaking is normal, and it’s not a risk for high-risk moms who need to quit breastfeeding. The hormone release that causes milk letdown comes when the child is nursing, not just from the leaking.

For many women, the close spacing of their children makes breastfeeding during pregnancy a possibility, and it is a safe option for most women. To understand the implications for your current child – and for your pregnancy – it’s important to discuss breastfeeding with your doctor in the first trimester. Lactation consultants can provide invaluable advice about breastfeeding during pregnancy.