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Elena Donovan Mauer

Breastfeeding While Pregnant

You’re nursing and you get pregnant — now what? We’ve got the scoop on what changes with your body, your breastfeeding relationship and your child’s nutrition. And how to handle it all.

Keeping baby-to-be safe

Forget the myths — you can keep nursing, as long as your doctor hasn’t put you on any activity restrictions (such as no sex) and you’re not experiencing  bleeding or premature labor. “While mothers with a history of  miscarriage are sometimes advised not to breastfeed [during pregnancy], there is no evidence to show that breastfeeding increases a mother's risk for premature labor and birth,” says Amy Spangler, MN, RN, IBCLC, author of Breastfeeding: A Parent’s Guide.

The myth that the nipple stimulation of breastfeeding could cause contractions and result in preterm labor is rooted in fact, but those contractions are unlikely to be strong enough to make you go into labor. “Nipple stimulation triggers the release of oxytocin, a hormone that causes milk release. Oxytocin also causes the uterus to contract,” explains Spangler. “Most women experience uterine contractions while breastfeeding, but they are usually mild and often go unnoticed.... And the uterus may be less sensitive to oxytocin during pregnancy, making the risk for uterine contractions even smaller.” So don’t hesitate to continue your breastfeeding relationship if your doctor has okayed it.

"If a mother is experiencing premature labor and/or vaginal bleeding, her health care provider may suggest she wean," says Spangler. "Fortunately, these situations are extremely rare, and each must be considered on an individual basis."

Changes to your body

One of the earliest bumps in the road you might experience is  sore breasts — a common first-trimester symptom. Obviously, that could make breastfeeding more than a little uncomfortable. But Spangler says to stick with it. “Often, the tenderness is mild and short-lived, and perhaps with some minor position changes, a mom can continue to breastfeed throughout pregnancy,” she says. “Only in rare cases is the tenderness so severe that a mother chooses to wean.”

Your milk supply

Some moms don’t find any issues with milk supply after they get pregnant, but others find that theirs decreases — blame it on the hormones. “An older baby may respond by simply breastfeeding more often,” says Spangler, since more frequent nursing can spur your body to produce more milk.

And if baby’s old enough to get started on solid foods, the other things he eats might naturally make up for any less milk he gets — just make sure breast milk is still his main nutrient source if he's under one year old. As long as baby still wants to feed, seems satisfied afterward and is gaining weight healthfully, there’s no need to supplement. If you have any concerns about baby’s weight gain, consult baby’s pediatrician or your lactation consultant for advice.

Staying healthy

Remember, you’re growing a baby and feeding a baby. You should be taking good care of yourself. “The best way to ensure that you stay healthy is to eat a variety of healthy foods each day, making sure that all the basic food groups are represented — fruits, vegetables, proteins, fats — and drink enough liquid to satisfy your thirst: water and unsweetened fruit juice,” says Spangler. “Also, take prenatal vitamins prescribed by your health care provider.”

You’re probably also wondering how much you should be eating. “It depends on the age of the baby and the weight of the mother,” says Spangler, since younger babies feed more often (which burns more of your calories) and different moms have different levels of fat stores. “A mother who is nursing a toddler infrequently may need no additional calories, while a mother who is exclusively breastfeeding a three-month-old and has small fat stores may need an additional 650 calories each day,” says Spangler. She says eating when you're hungry and drinking when you're thirsty are really your best guides to make sure you're getting enough calories and hydration — seems simple, but when you're a busy mom, that can sometimes be neglected. Make it a point to keep healthy snacks and water handy.

The transition to colostrum

Probably around your fourth month of pregnancy, your body will start the gradual transition from making mature milk to colostrum, that thick, yellow milky stuff a newborn consumes. This might taste different to your baby — and prepare yourself for the possibility that he might gradually wean himself as a result. If he doesn’t wean, don’t worry, and feel free to keep it up. “Despite the change [to colostrum], a mother's milk will continue to meet the needs of her breastfeeding baby, so no supplements are needed,” says Spangler.

Getting ready for baby number two

As you near your due date, consider how things will change once the new baby is born. “Enjoy the one-on-one time with your older baby for as long as possible, knowing that feeding three — mom, toddler and baby — presents a new set of challenges,” recommends Spangler.

If you’re considering nursing both children but worried about being able to meet their nutritional needs, think about the moms of twins who breastfeed. “Because toddlers also eat solid foods, meeting the nutritional needs of a baby and a toddler is actually easier than meeting the needs of two babies,” says Spangler.

Mentally prepare yourself for your toddler to react to the change of having a new sibling who’s also nursing. “Mothers often find that their older baby or toddler wants to breastfeed more often after the baby is born — perhaps every time the baby breastfeeds,” explains Spangler. “But once the toddler realizes that a sibling is a permanent addition to the family, the feeding frequency will usually return to ‘normal.’ Many mothers find that tandem nursing actually makes it easier to meet the nutritional and the emotional needs of different-age babies.”