Continuing to nurse an older child while pregnant, often called tandem nursing, is a personal choice requiring careful monitoring. Many mothers notice a reduction in milk volume during pregnancy. While generally safe for low-risk pregnancies, understanding the physiological changes and committing to increased self-care are vital for a successful journey.
Safety and Physiological Changes
Continuing to nurse during pregnancy is considered safe for women experiencing a healthy, low-risk pregnancy. The primary concern involves oxytocin, the hormone that causes the milk let-down reflex and stimulates uterine contractions. However, the amount of oxytocin released during nipple stimulation is typically too low to cause preterm labor or miscarriage.
The uterus is naturally resistant to oxytocin until late in the third trimester because receptor sites are sparse until around 38 weeks. Contractions may be felt as the pregnancy advances, but they are usually mild and harmless. If a mother has a history of preterm labor, a high-risk pregnancy, or is carrying multiples, a healthcare provider may advise against nursing.
The most significant change is the drop in milk volume, which often occurs around the fourth or fifth month of pregnancy. This reduction is caused by the surge of pregnancy hormones, specifically elevated progesterone and estrogen. These hormones inhibit the action of prolactin, which is responsible for milk production.
This hormonal shift also changes the milk’s composition, causing it to revert to colostrum, the nutrient-dense first milk. The taste and consistency change, which can sometimes lead the older child to self-wean. This reduction in supply is a physiological consequence of pregnancy and is not an indication that the mother is failing to meet her nutritional needs.
Nutritional Demands of Nursing While Pregnant
Successfully nursing through pregnancy places a significant combined caloric demand on the mother. During the second and third trimesters, a pregnant woman typically requires about 300 additional calories daily for fetal growth. Maintaining milk production requires an estimated 300 to 500 extra calories per day, depending on the child’s age and nursing frequency.
The total combined need can range from 600 to 800 or more extra calories daily, which must come from nutrient-dense sources. The developing fetus receives its nutritional needs first, so the mother must prioritize eating to satisfy her increased hunger and sustain both the pregnancy and her milk supply.
Micronutrient intake is a heightened concern, as requirements for many vitamins and minerals are higher during both pregnancy and lactation. Iron needs increase to about 27 milligrams per day during pregnancy to prevent anemia. Calcium intake should aim for 1,000 milligrams daily; the body will draw from maternal stores if dietary intake is insufficient. Adequate folic acid (600 micrograms daily) and Vitamin B12 are necessary to support rapid cell growth and development.
Practical Strategies to Maintain Milk Volume
While hormonal changes largely dictate the volume of milk produced, mothers can employ several practical strategies to maximize the remaining supply. The fundamental principle of milk production remains supply and demand, even though the “demand” signal is suppressed by hormones.
Frequent milk removal, through nursing or pumping, helps maintain the stimulus to the breast. Offering the breast more often can help counteract hormonal suppression, even if the output is low. Mothers who pump can use techniques like power pumping, which mimics a baby’s cluster feeding by alternating short periods of pumping and rest over an hour (e.g., 10 minutes on, 10 minutes off, and repeating).
Hands-on pumping, which involves breast massage and compression during pumping, helps empty the breast more effectively and signals the body to produce more milk. Due to increased nipple sensitivity and potential soreness during pregnancy, ensuring a deep and comfortable latch is a practical consideration for comfort.
The use of herbal galactagogues to boost supply during pregnancy must be approached with caution and medical guidance. Common herbs like fenugreek and blessed thistle are generally discouraged, as they may be capable of inducing uterine contractions. Fenugreek, in particular, is considered unsafe in medicinal amounts during pregnancy because of its potential to stimulate the uterus.
When to Consider Weaning or Stopping
The decision to stop nursing is complex, but certain health indicators signal that weaning should be considered immediately. Signs of preterm labor, such as vaginal bleeding, a sudden gush of fluid, or painful, persistent uterine contractions, warrant immediate cessation of nursing and a call to a healthcare provider. If a mother is experiencing severe, unmanageable fatigue, extreme weight loss, or persistent anemia that is not improving with diet and supplementation, continuing to nurse may be unsustainable.
A change in fetal movement pattern or a diagnosis of intrauterine growth restriction may also necessitate stopping nursing to prioritize fetal well-being. If the older child is under one year old and relies on milk as a primary source of nutrition, the significant drop in volume and change in composition may require the introduction of formula or donor milk, even if nursing continues for comfort. If the mother decides to wean, doing so gradually by dropping one feeding session every few days is often recommended to prevent painful breast engorgement and mastitis.