|Breastfeeding and pregnant mothers|
|breastfeeding and pregnant mothers||Arine Valstar||11.09.2000|
|Re: breastfeeding and pregnant mothers||Gulnara Semenova||14.09.2000|
From: Arine Valstar, Arine.Valstaratfao.org
Subject: breastfeeding and pregnant mothers
In several countries we have observed the tendency of mothers to abruptly stop breastfeeding once they suspect to be pregnant again. In WHO/UNICEF recommendations pregnant mothers are encouraged to continue breastfeeding.
In order to correctly advise our project staff in Somalia and Zambia, we would like to know during how many months pregnant mothers should be encouraged to breastfeed.
Your help is appreciated,
Arine Valstar, Associate Professional Officer
Nutrition Programme Service (ESNP)
From : Gulnara Semenova, lrcdiratnmaa.asn.au
Subject: Re: breastfeeding and pregnant mothers
Generally speaking breastfeeding and pregnancy are perfectly compatible. Many women practicing breastfeeding during pregnancy without any problems, not even knowing that they are pregnant again and realising this only when a new baby starts kicking.
Different cultures have a different attitudes to the overlapped pregnancy and lactation.
There are reported beliefs from culture to culture that pregnancy can "spoil" breastmilk causing diarrhoea in breastfed infant, or that nobody can be fed by colostrum twice, therefore upcoming milk belongs only to a new baby, that if women continue breastfeeding throughout new pregnancy she will be punished by God, or sprits can steel the soul of breastfed child, etc, etc.
Many health professionals have concerns that breastfeeding during pregnancy can cause spontaneous abortion due to oxytocin releasing or about depletion of the womens stores, etc.
There was not apparent evidence suggesting that breastfeeding/nipple stimulation can cause spontaneous abortion in a normal pregnancy. I remember a very small study, which showed almost the same number of miscarriages in both groups among those who continued breastfeeding throughout the pregnancy and those who did not breastfed. I read sometimes ago in a textbook on medical physiology, that uterine musculature sensitivity to oxytocin is varies, its enhanced by oestrogen and inhibited by progesterone( what actually is happening during early stages of pregnancy) and that only in a late stages of pregnancy uterus becomes very sensitive to oxytocin, possibly due to an increase in uterine prostaglandins. Uterine contractions also occur during sexual activity, which most couples continue during pregnancy anyway.
Re maternal stores depletion.
In Australia or in the USA where the population is well nourished, or in many cases is overweighted/obese there is no problem with breastfeeding during pregnancy and even with tandem feeding. Speaking about weight loss during breastfeeding some studies reported that about 30% of women from affluent societies do not achieve pre-pregnancy weight even if they breastfeed for 6 months and need another 3 months of breastfeeding to get rid of fat stored during pregnancy. Food intake is usually much high than recommended, so with western women there is no real problems of depletion, unless in a very special circumstances or in submarginal population. Colostrum will appear again right after delivery. We have plenty of literature on breastfeeding management during pregnancy and about tandem feeding
With Somalians and other undernourished population the situation is not as simple, health providers must ensure that the woman will feed herself well, as her stores might become depleted during overlapped pregnancy and lactation. As usually the best approach is prevention- to teach how to use effectively the Lactation Amennhorea Method and after mother resumes menstruation or baby is starting complementary food or when baby is older than 6 months to encourage mother to use other effective contraception methods.
IT was some evidence that infants born from overlapped pregnancies/lactation are about 100 grams less weighted at birth. Therefore a good maternal nutrition should be ensured when breastfeeding and pregnancy overlaps. Also important is to ensure that mothers can decrease physical activity and to have a good sanitation, etc, etc.
Re the length of lactation, usually at least up to 6 months of age of the current child, it means almost throughout the pregnancy, later it depends on the baby's needs, big baby can continue a comfort suckling in a tandem with the new baby. Make sure that the new baby gets breastmilk first.
In Lawrence" When the infant at the breast in only a few months old when pregnancy occurs, there is some rationale to continue breastfeeding for the benefit of the infant until it is time to wean to solids and other liquids at 6 months of age or so. This child will be a year old when the new infant arrives and, if still at the breast, may have demands in excess of the mothers ability to provide"
Some mothers complain about a breast pain as pregnancy is progressing and that the nipples become hypersensitive if they continue to feed during pregnancy. In such cases they tend to wean before a new baby born.
WHO -EURO in its booklet "Breastfeeding how to support success" do not recommend to wean a baby during pregnancy.
If women is from a high risk pregnancy group and has a risk of miscarriage because of a nipple stimulation, then she might be consulted by doctor and they have to decide what is in the best interests of the infant. Early weaning might be more harmful for a current baby, both psychologically and nutritionally and of course by increased risk of infection., especially in a third world sanitary conditions and in an emergency/ refugee situation
In ACC/SCN "...One should consider not only the health of the mother and her foetus but that of the older infant being breastfed. Whether to wean the child or not might depend partly on the age and health of the breastfed child and on the nutritional status of mother. If the child is more than say 18 months of age and in good health, then the mother might be encouraged to wean the child to encourage adequate foetal growth and maternal fat reserves. Alternatively the child might be younger and malnourished. If the mother is able, perhaps she should continue breastfeeding in these cases. If the mother decides to continue breastfeeding,for whatever reason, then she should be encouraged to eat substantially more, particularly energy rich foods. Clearly no satisfactory answer to the problems posed by overlap can be given presently. The safest course is to avoid it through effective family planning programmes"
I strongly suggest to read the references below
1)" Reproductive stress and womens nutrition", by Reynaldo Martorell and Kathleen Merchant in Nutrition and Population Links, 1992, ACC/SCN 18th Session Symposium papers, chapter 3, pp23-32
2) "Breastfeeding- a guide for the medical profession", edited by Ruth Lawrence, 5 edition, Mosby, page 671( nursing while pregnant and tandem nursing)
3) "Breastfeeding through Pregnancy and Beyond", NMAA booklet, 1999reprint.
Nursing Mother Association of Australia is a recognised authority on breatsfeeding and dedicated to the community support for breastfeeding mothers. Besides counselling we produce many books and booklets available in English on any possible breastfeeding problems and situations. Lactation Resource Centre is holding more than 14.000 references on human lactation published worldwide. Please, feel free to contact me, if you like to become our subscriber or to obtain any booklets. We also produce the Breastfeeding Review, a peer reviewed journal on lactation for health professonals and the Topics in Breastfeeding, the LRC own series of papers on breastfeeding( 12 sets on Topics in Breastfeeding and 2 sets of Hot Topics, concise papers on breastfeeding with recommendations for practise).
For more information about any aspects of breastfeeding management and NMAA and LRC activity, please visit our website www.nmaa.asn.au
Booklets/books, topics can be ordered on-line . The prices are really low, just to cover a postage.
I am out of the office until 2 October.
With kind regards
Dr. Gulnara Semenova, IBCLC
Director, Lactation Resource Centre, Nursing Mothers' Association of Australia
PO Box 4000, Glen Iris 3146, Victoria, Australia
Tel 61-3-9885 0855, Fax 61-3-98850866
Email to lrcdiratnmaa.asn.au