Recently, I had the pleasure of talking with Midwife and Lactation Consultant, Morgan Michalowski about Breastfeeding during Pregnancy. Morgan is a Certified Nurse Midwife, a Women’s Health Nurse Practitioner, an International Board Certified Lactation Consultant (IBCLC), doula, and mom.
It was a pleasure to talk with her all about breastfeeding while pregnant! We talked about when to stop breastfeeding when you get pregnant, if it’s safe for your baby, and other myths around this topic.
1. Is it safe to breastfeed your baby or your toddler during pregnancy?
It is safe, yes. A lot of moms wonder if it causes miscarriage or preterm labor, and there’s no real evidence around this; it’s theoretical. So while some moms might experience contractions while breastfeeding during pregnancy, it’s a normal part of pregnancy. It’s similar to when you have sex and you have an orgasm during pregnancy. You can experience that same kind of cramping afterwards; it’s just the release of oxytocin, which happens with breastfeeding and intercourse. It can feel a little scary when that happens, but it is normal, and there’s no evidence that it’s linked to any adverse outcomes for the pregnancy.
2. Are there situations like a high-risk pregnancy where it might be safer to wean?
In most cases it is safe to breastfeeding during pregnancy. There’s no medical study that has ruled it out or said it is a contraindication to breastfeeding during pregnancy. But if you are having a complicated pregnancy, like hyperemesis and you’re losing a ton of weight; if you have some bleeding throughout your pregnancy; or you’re experiencing some preterm labor, it’s best to talk to your OB or your midwife about whether you should start to wean or taking the breastfeeding into consideration with the high-risk issue at play.
3. Should you need to up the dosage of supplements like prenatal vitamins or supplement with any additional nutrients so you’re making sure your nourishing both your newborn and your breastfed baby or toddler?
Yes. Keep taking your prenatal vitamin. And because breastfeeding women are at risk for osteoporosis, you want to make sure you’re getting adequate coverage of calcium and vitamin D. This could mean getting enough milk and dairy. Sunlight can help with the vitamin D which helps with the absorption of calcium.
Usually calcium and Vitamin D are in a prenatal vitamin, but you can always supplement with it if you feel like you’re not getting enough in your diet. For example, if you live in Seattle and it’s cloudy all the time and you’re vegan, then you should definitely take a supplement of both vitamin D and calcium. But if you have a pretty wide-range diet, you eat all things, and you really focus on calcium and vitamin D, then you’re okay. But I think most people have a hard time tracking that, so I know for peace of mind, a lot of women do supplement with calcium, vitamin D, and their prenatal.
4. What about calories? Since moms up calories during pregnancy as well as during breastfeeding, should you just add those numbers together to make sure you’re getting enough total calories in your day?
Start by listening to your body. When you’re breastfeeding, you are going to be hungrier. That’s a pretty common experience for women across the board. So usually if you listen to your body and you follow your appetite, you’ll get the number of calories you need.
But just for a point of reference, to maintain a healthy weight while breastfeeding, 1800 to 2200 calories per day is recommended. You can go down a little bit less than that to 1500 to 1800 if you’re trying to lose a little bit of weight. But you really want to treat it like your third trimester pregnancy where you have 300 to 500 extra calories per day to maintain a healthy weight. And some women do find they don’t lose weight while they’re breastfeeding because their appetite is significantly revved up while you’re breastfeeding. So I always say trust your body; it knows what to do.
You can follow the guidelines if you ‘re really trying to focus on healthy eating and losing weight. But I think during that time when you’re a meal source for another human, it’s good to just take care of yourself.
5. What about water? Should you increase how much water you’re drinking?
We recommend two to three liters per day. Staying hydrated during pregnancy is super important. It doesn’t really impact milk production, so you don’t need to think about hydration with keeping your milk volume up. But it is just in general really important for pregnancy. A dehydrated woman in pregnancy is more likely to cramp and have contractions. So I would recommend the two to three liters per day to just help your body out.
6. Can pregnancy affect your milk supply — not only in volume, but the taste or consistency?
Yes, it can. Most moms notice a decrease in supply around mid-pregnancy. But sometimes women experience it within the first month of pregnancy. And then your mature milk transitions back to colostrum. So your baby might not like the colostrum; the taste is different than mature milk. And then if your child or toddler does continue to breastfeed throughout the pregnancy, there might be an increase in volume again as that production really kicks in before your newborn is in the world.
It’s kind of a gradual change both directions. You’re making this mature milk for your baby or toddler, and then throughout the pregnancy, the volume can change and your body gradually transitions back to colostrum. And the volume can increase again, but the colostrum will be there until your newborn comes into the world. And then it’s the standard two to five days again until your mature milk comes back.
7. Are there any other pregnancy symptoms like tender nipples that can affect your breastfeeding journey?
Definitely. That’s a big topic that comes up because it can be really uncomfortable for a lot of moms. Some moms report restlessness or fatigue or irritation while nursing. Having all those hormones fluctuating and another little body needing your body while you’re growing another baby can feel pretty emotional. So it varies from mother to mother.
But yeah, the nipple soreness and fluctuation of mood are largely due to the hormonal changes. And then some moms experience increased nipple soreness in the third trimester, and that can be related to the milk supply changing, latch issues as your toddler/baby is breastfeeding more frequently to get more volume. So there can be a range of both physical and emotional symptoms but they can fluctuate throughout the stages of pregnancy.
8. Can nipple stimulation trigger labor?
When a women is term at 39+ weeks and she’s trying to get labor started because she’s already experiencing contractions and maybe needs a little bit of and extra oxytocin kick, we would say, you can try nipple stimulation with with a pump or on your own, and we have guidelines on how to do it. It’s stimulate for 15 minutes, take a 30-minute break, and repeat for an hour or two.
So that’s different from how breastfeeding functions; it’s different from how you’d pump throughout your pregnancy. And the big caveat is that you’re already in labor. There are no studies that show that nipple stimulation alone without the onset of labor would cause labor, but it can be used to increase the strength of contractions when you’re in labor.
9. How do you tandem nurse after baby is born? Is it feasible to nurse your toddler and newborn at the same time?
It’s definitely feasible. I think it’s an adventure for a lot of moms figuring out how to do it. One of the main questions that comes up with tandem feeding is “Will I make enough food for my newborn?” A lot of moms have concerns that their older child will take away from their newborn. Feeding a newborn in general can feel stressful because you’re wanting to make sure they regain weight.
Recommendations say to feed your newborn first so they get first dibs. You don’t always have to do that, especially if you’re a mom that overproduces or has a fast letdown. Letting your older child feed first can actually help out your newborn because it manages the supply for them.
So it’s really a situation where you might just have to experiment with what works for you. But follow the normal guidelines for making sure your newborn is getting enough to eat, that they’re feeding frequently throughout the day, that they have enough wet diapers and dirty diapers, and that by ten days they are starting to gain weight.
10. Similar to the way moms of twins assign a side to each baby to track supply, can you do that with your newborn and toddler, or would that cause a difference in supply since it’s not the same-aged baby?
My recommendation is to alternate so you have that stimulation on both sides because most likely your newborn is going to be feeding much more frequently than your older child. So just to keep the supply up on both sides, you would want to rotate your newborn back and forth. Unless you have a young baby that’s the older child and they still breastfeed, then you’re probably okay assigning a breast to each of them. But you would want to make sure that if your older child is only feeding two or three times a day and your newborn is feeding 8+ that you’re getting that stimulation on both sides.
11. Are there issue around jealousy when tandem feeding?
Some moms might think “If I tandem feed, do I have to do anything else to help my older child transition into this older sibling role, or will they feel jealous that they have to now share my body with someone else?”
While tandem feeding is a good way to help your older child transition — it keeps the bond going; they still feel close to you — but there are still a lot of other emotions come up and they might still feel jealous or not want your newborn to feed when they’re feeding. So I think planning ahead of time — talking to your child about the change that’s happening, talking about how breastfeeding will change once the newborn is with you — and continuing to do that when the newborn is home with you can help.
It’s a big transition for both mom and the new child. But tandem feeding is a good way to continue that bond and to start forging that sibling relationship.
12. Advice for new moms
Figuring out latch with a newborn can take some time. So making sure mom has a game plan for her own mental health while she’s navigating breastfeeding two children is very important. I would want to alleviate the guilt if she does need to change her plan for tandem feeding. That’s totally understandable and kids are pretty flexible.
Trust your body and be very gentle with yourself because it is quite a transition. There’s lots of support out there. Reach out for help. Even with COVID-19, there are lots of virtual options and you don’t have to feel alone.
Where to Find Morgan:
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