Dear Doc | Pregnant again at my six week postnatal visit
Q: I am writing my question while still in shock and crying. I just don’t know how this could happen and what I must do now. I am the mother of a four-month-old baby. I went to my six weeks’ postnatal visit at eight weeks. I wanted to start planning my family, so the doctor ordered a pregnancy test before starting me on it and it was positive!
How?! How can this happen?! I had barely just finished bleeding from after the delivery and I was breastfeeding! Isn’t that a form of birth control? And also, no periods had come back as yet. Now I don’t know how this going to work, because I planned to breastfeed my baby for a year. Can I still breastfeed while I’m pregnant? Will it affect my pregnancy or the growth of the unborn baby? Will my other child be worse off for having to stop breastfeeding so early?
A: All of these questions and concerns are expected. The decision as to whether or not to breastfeed while pregnant is not always a simple one, and is dependent on numerous factors. Understanding the benefits, and risks, and how ready you and your nursing child are to wean, will help you decide what is best for you, your baby and your new pregnancy.
First of all, I think you already know how it happened, but to answer you, yes! It is possible to get pregnant while breastfeeding, even if your periods have not come back as yet. You are not alone in this situation, as women commonly believe once they are breastfeeding and not seeing periods, they cannot get pregnant; so, hopefully, you writing to me will prove this belief as false.
Is breastfeeding while pregnant safe?
Breastfeeding can cause mild uterine contractions. This is because oxytocin, the hormone that is released during labour, is also released during breastfeeding. As a result, it stimulates contractions. It is believed that the oxytocin released during breastfeeding is too small an amount to cause preterm labour. However, this is in reference to a healthy pregnancy, where these contractions would not be of concern, as they rarely increase the chances of having a miscarriage and generally will not cause preterm labour, and will also be harmless to the foetus.
Given the lack of data on the effects of breastfeeding during complicated pregnancies, it is advised that pregnant women who are at high risk for preterm delivery or uteroplacental insufficiency (such as preeclampsia, or foetal growth restriction), should stop breastfeeding by about 24 weeks of gestation.
Other cases where weaning is advisable include:
If you are carrying twins.
If you have been advised to avoid sex while pregnant.
If you are having bleeding or uterine pain.
It is important to talk with your doctor to determine whether weaning would be the best option-based on your current pregnancy.
Another question commonly asked is, ‘Is my baby ready to be weaned?’
The answer will depend on your child’s age, personality, breastfeeding patterns, as well as your child’s response to your pregnancy. Another important consideration at this time will be if your child is breastfeeding mainly for nutrition or for comfort.
During pregnancy, your breast milk will still provide your first child with the nutrients they need; however, breast milk supply commonly lessens during the fourth and fifth months of pregnancy. Also, the content of your milk will change as you start to produce colostrum, and as such, it will taste different to your child, who may find it distasteful. Colostrum is also a natural laxative, so your child’s stool might be more liquid than normal.
For this reason, your infant may wean earlier than you anticipated, OR, your infant may be very attached to breastfeeding and still not wean, despite the changes.
If you decide to continue breastfeeding during your pregnancy, it is crucial to keep a close watch on the health and development of your older child who is less than one year old, and is dependent exclusively on breast milk, to make sure they are putting on enough weight after your milk changes. Additional feedings may be necessary to ensure the proper nutrition of your older child.
If you decide to breastfeed during your pregnancy, it is important that you also pay attention to your own nutrition. You will need to eat well for the health of your breastfeeding child and your unborn child. Your increased calorie intake will depend on how old your breastfeeding child is and will increase with each trimester. If you are in your first trimester and finding it difficult to eat because of nausea or morning sickness, no need to worry, no additional calories are required during the first trimester.
After the baby is born
You can breastfeed your older child and baby, after the baby is born. This is called tandem feeding. Your newborn will still get the colostrum they need. You also will not have to limit your older child to one breast.
There are various ways of tandem feeding. You could feed both children at the same time, or you could feed the newborn first and your older child after.
You might find that your older child wants to feed more because you are producing a lot of milk. You might also notice that your newborn has trouble coping with your let – down reflex for the same reason – you are producing an increased amount of milk. To overcome this, you could try feeding your older child first, then placing the newborn on the other breast after the milk has started to flow.
If you decide to wean your older child, it may be better to do this during your pregnanc,y in order to reduce the number of adjustment they have to cope with after the baby is born.
You could do this by slowly delaying feeds and encouraging shorter feeds.
Have a discussion with your Ob-Gyn, and have them help you decide which is best for you and your pregnancy.