Sun and Planets Spiritualities (AYINRIN): HERBS FOR TREATMENT OF BABIES THAT THEIR MOTHER GET PREGNANT DURING BREASTFEEDING BY BABALAWO OBANIFA-Obanifa extreme documentaries

Click on the Vedio above Breastfeeding While Pregnant (What You Need to Know)
milkology - Breastfeeding and Pumping
HERBS FOR TREATMENT OF BABIES THAT THEIR MOTHER GET PREGNANT DURING BREASTFEEDING BY BABALAWO OBANIFA-Obanifa extreme documentaries

In this work Babalawo Obanifa will document in detail some of the herbal remedies available in Yoruba herbal that can be use for treatment of baby who is still breastfeeding but his mother gets pregnant in the process. Sometime a breastfeeding mother can get pregnant be she wean her breastfeeding baby. The thoughts of our forefathers in Yoruba herbal medicine is that such pregnancy may affect the normal activities, growth and welfare of the baby that is been breastfeed. The baby may also begin to cry excessively. In such situation there are varieties of herbal formula available in Yoruba herbal medicine for the treatment of such condition. The nomenclature for the herbal medicine for treatment of baby under such condition is known as is known as Awe liloyun le omo Kekere. Below are documentation of some of the herbal formula for such purpose.

Egungun Inaki (bone of ape)

Awo Ekun(leopard Skin)

Egungun Agburin (bones of Antelope)

Odidi ataare kan (A whole fruits of Aframomum Melegueta)

Egun Osunsun(Drypetes Chevalleri)

Igi senifiran(Unidentfied)

Eyowo kan (one cowry)

Preparation

You will put Egungun Inaki (bone of ape),Awo Ekun(leopard Skin),Egungun Agburin (bones of Antelope),Odidi ataare kan (A whole fruits of Aframomum Melegueta) inside a white clothes. You will put it inside Oru(clay pot) You will fill it up with water. You will add Egun Osunsun(Drypetes Chevalleri).Igi senifiran(Unidentified) ,Eyowo kan (one cowry). You will boil it will be boil together.

Usage

Give the baby to be drink on timely basis . You will use the cowry to make waist or neck pendants for the baby.

Omo ataare mewa (ten seeds of alligator pepper/Aframamoum melegueta)

Owo eyo ti ko luju (unperforated cowry)

Ako Okuta (quartz)

Preparation

You will grind everything together and make it to waist belt for the baby.

Mariwo ope ti a fa tu lekan soso( The fresh palm front of palm tree that is uproot once)

Preparation

You will soak it in water.

Usage

Bath the baby often with the water.

Copyright :Babalawo Pele Obasa Obanifa, phone and whatsapp contact :+2348166343145, location Ile Ife osun state Nigeria.
IMPORTANT NOTICE :As regards the article above no part of this article may be reproduced or duplicated in any form or by any means, electronic or mechanical including photocopying and recording or by any information storage or retrieval system without prior written permission from the copyright holder and the author Babalawo Obanifa, doing so will be deem unlawful and will attract legal consequences.

Clique no Vedio acima de Amamentar durante a gravidez (O que você precisa saber)

milkology - Amamentação e bombeamento

ERVAS PARA O TRATAMENTO DE BEBÊS QUE SUA MÃE FAZ GRAVIDEZ DURANTE A AMAMENTAÇÃO DE BABALAWO OBANIFA-Obanifa documentários extremos

Neste trabalho, Babalawo Obanifa documentará em detalhes alguns dos remédios à base de plantas disponíveis em Yoruba, que podem ser usados no tratamento de bebês que ainda estão amamentando, mas sua mãe fica grávida no processo. Às vezes, uma mãe que amamenta pode engravidar, seja ela que desmama seu bebê que amamenta. O pensamento de nossos antepassados na medicina herbal de Yoruba é que essa gravidez pode afetar as atividades normais, o crescimento e o bem-estar do bebê que está sendo amamentado. O bebê também pode começar a chorar excessivamente. Em tal situação, existem variedades de fórmulas à base de plantas disponíveis na fitoterapia iorubá para o tratamento dessa condição. A nomenclatura do medicamento fitoterápico para o tratamento de bebês nessas condições é conhecida como Awe liloyun le omo Kekere. Abaixo está a documentação de algumas das fórmulas de ervas para esse fim.

1

Egungun Inaki (osso do macaco)

Awo Ekun (Pele de leopardo)

Egungun Agburin (ossos do antílope)

Odidi ataare kan (Frutos inteiros de Aframomum Melegueta)

Egun Osunsun (Drypetes Chevalleri)

Igi senifiran (Não identificado)

Eyowo kan (um cowry)

Preparação

Você colocará Egungun Inaki (osso do macaco), Awo Ekun (pele de leopardo), Egungun Agburin (ossos do antílope), Odidi ataare kan (Um fruto inteiro de Aframomum Melegueta) dentro de uma roupa branca. Você o colocará dentro de Oru (panela de barro). Você o encherá de água. Você adicionará Egun Osunsun (Drypetes Chevalleri) .Igi senifiran (Não identificado), Eyowo kan (um cowry). Você vai ferver, vai ferver juntos.

Uso

Dê ao bebê para beber em tempo hábil. Você usará o cowry para fazer pingentes de cintura ou pescoço para o bebê.

2)

Omo ataare mewa (dez sementes de pimenta jacaré / Aframamoum melegueta)

Owo eyo ti ko luju (cowry não perfurado)

Ako Okuta (quartzo)

Preparação

Você vai triturar tudo junto e fazer o cinto para o bebê.

3)

Mariwo ope ti fa fa lekan soso (A frente da palmeira fresca da palmeira que é arrancada uma vez)

Preparação

Você vai mergulhá-lo na água.

Uso

Banhe o bebê frequentemente com a água.

Direitos autorais: Babalawo Pele Obasa Obanifa, telefone e whatsapp: +2348166343145, local Ile Ife osun state Nigeria.
AVISO IMPORTANTE: No que diz respeito ao artigo acima, nenhuma parte deste artigo pode ser reproduzida ou duplicada de qualquer forma ou por qualquer meio, eletrônico ou mecânico, incluindo fotocópia e gravação ou por qualquer sistema de armazenamento ou recuperação de informações sem a permissão prévia por escrito do detentor dos direitos autorais e o autor Babalawo Obanifa, fazê-lo será considerado ilegal e atrairá consequências legais.

Haga clic en el Vedio arriba de Lactancia Materna durante el embarazo (lo que necesita saber)

milkology - Lactancia y extracción de leche

HIERBAS PARA EL TRATAMIENTO DE BEBÉS QUE SU MADRE SE EMBARAZA DURANTE LA LACTANCIA POR BABALAWO OBANIFA-Obanifa documentales extremos

En este trabajo, Babalawo Obanifa documentará en detalle algunos de los remedios a base de hierbas disponibles en Yoruba herbal que pueden usarse para el tratamiento del bebé que todavía está amamantando pero su madre queda embarazada en el proceso. En algún momento, una madre que está amamantando puede quedar embarazada si deja a su bebé lactante. El pensamiento de nuestros antepasados en la medicina herbal Yoruba es que dicho embarazo puede afectar las actividades normales, el crecimiento y el bienestar del bebé que ha sido amamantado. El bebé también puede comenzar a llorar en exceso. En tal situación, hay variedades de fórmulas herbales disponibles en la medicina herbaria yoruba para el tratamiento de dicha afección. La nomenclatura de la medicina a base de hierbas para el tratamiento del bebé en tales condiciones se conoce como Awe liloyun le omo Kekere. A continuación hay documentación de algunas de las fórmulas herbales para tal fin.

1)

Egungun Inaki (hueso de mono)

Awo Ekun (piel de leopardo)

Egungun Agburin (huesos de antílope)

Odidi ataare kan (Frutos enteros de Aframomum Melegueta)

Egun Osunsun (Drypetes Chevalleri)

Igi senifiran (no identificado)

Eyowo kan (un cowry)

Preparación

Pondrás Egungun Inaki (hueso de mono), Awo Ekun (piel de leopardo), Egungun Agburin (huesos de antílope), Odidi ataare kan (frutas enteras de Aframomum Melegueta) dentro de una ropa blanca. Lo pondrás dentro de Oru (vasija de barro) Lo llenarás con agua. Agregará Egun Osunsun (Drypetes Chevalleri) .Igi senifiran (No identificado), Eyowo kan (un caballito). Hervirás, hervirán juntos.

Uso

Dele al bebé para que lo beba a tiempo. Usarás el cowry para hacer colgantes de cintura o cuello para el bebé.

2)

Omo ataare mewa (diez semillas de pimienta de cocodrilo / Aframamoum melegueta)

Owo eyo ti ko luju (cowry sin perforar)

Ako Okuta (cuarzo)

Preparación

Molerás todo junto y llegarás al cinturón para el bebé.

3)

Mariwo ope ti a fa tu lekan soso (El frente de palma fresca de la palmera que se arranca una vez)

Preparación

Lo empaparás en agua.

Uso

Bañe al bebé a menudo con agua.

Copyright: Babalawo Pele Obasa Obanifa, teléfono y contacto de WhatsApp: +2348166343145, ubicación Ile Ife osun state Nigeria.
AVISO IMPORTANTE: en lo que respecta al artículo anterior, ninguna parte de este artículo puede reproducirse o duplicarse de ninguna forma ni por ningún medio, electrónico o mecánico, incluida la fotocopia y la grabación, o por cualquier sistema de almacenamiento o recuperación de información sin el permiso previo por escrito del titular de los derechos de autor y el autor Babalawo Obanifa, hacerlo será considerado ilegal y traerá consecuencias legales.

Cliquez sur le Vedio ci-dessus Allaitement maternel pendant la grossesse (ce que vous devez savoir)

milkology - Allaitement maternel et pompage

HERBES POUR LE TRAITEMENT DES BÉBÉS QUI LEUR MÈRE EST ENCEINTE PENDANT L'ALLAITEMENT PAR BABALAWO OBANIFA-Obanifa documentaires extrêmes

Dans ce travail, Babalawo Obanifa documentera en détail certains des remèdes à base de plantes disponibles dans les herbes Yoruba qui peuvent être utilisés pour le traitement d'un bébé qui allaite toujours mais sa mère tombe enceinte dans le processus. Parfois, une mère qui allaite peut tomber enceinte si elle sevre son bébé allaité. La pensée de nos ancêtres en phytothérapie Yoruba est qu'une telle grossesse peut affecter les activités normales, la croissance et le bien-être du bébé qui a été allaité. Le bébé peut également commencer à pleurer excessivement. Dans une telle situation, il existe des variétés de formules à base de plantes disponibles en phytothérapie Yoruba pour le traitement d'une telle condition. La nomenclature de la phytothérapie pour le traitement du bébé dans de telles conditions est connue sous le nom de Awe liloyun le omo Kekere. Vous trouverez ci-dessous la documentation de certaines des formules à base de plantes à cette fin.

1.

Egungun Inaki (os de singe)

Awo Ekun (peau de léopard)

Egungun Agburin (os d'antilope)

Odidi ataare kan (fruits entiers d'Aframomum Melegueta)

Egun Osunsun (Drypetes Chevalleri)

Igi senifiran (non identifié)

Eyowo kan (un cauris)

Préparation

Vous mettrez Egungun Inaki (os de singe), Awo Ekun (peau de léopard), Egungun Agburin (os d'antilope), Odidi ataare kan (Un fruit entier d'Aframomum Melegueta) à l'intérieur d'un vêtement blanc. Vous le mettrez à l'intérieur d'Oru (pot en argile) Vous le remplirez d'eau. Vous ajouterez Egun Osunsun (Drypetes Chevalleri) .Igi senifiran (Non identifié), Eyowo kan (un cauris). Vous ferez bouillir ce sera bouillir ensemble.

Usage

Donnez au bébé à boire en temps opportun. Vous utiliserez le cauris pour faire des pendentifs de taille ou de cou pour le bébé.

2.

Omo ataare mewa (dix graines de piment alligator / Aframamoum melegueta)

Owo eyo ti ko luju (cauris non perforé)

Ako Okuta (quartz)

Préparation

Vous allez tout moudre ensemble et le faire à la ceinture pour le bébé.

3.

Mariwo ope ti a fa tu lekan soso (Le front de palmier frais du palmier qui est déraciné une fois)

Préparation

Vous le tremperez dans l'eau.

Usage

Baignez souvent le bébé avec de l'eau.

Copyright: Babalawo Pele Obasa Obanifa, téléphone et contact WhatsApp: +2348166343145, emplacement Ile Ife Osun, Nigeria.
AVIS IMPORTANT: En ce qui concerne l'article ci-dessus, aucune partie de cet article ne peut être reproduite ou dupliquée sous quelque forme ou par quelque moyen que ce soit, électronique ou mécanique, y compris la photocopie et l'enregistrement ou par tout système de stockage ou de récupération d'informations sans l'autorisation écrite préalable du titulaire du droit d'auteur et l'auteur Babalawo Obanifa, ce faisant, sera jugé illégal et entraînera des conséquences juridiques.

Klicken Sie auf das Vedio über Stillen während der Schwangerschaft (Was Sie wissen müssen)

Milchkunde - Stillen und Pumpen

KRÄUTER ZUR BEHANDLUNG VON BABYS, DIE IHRE MUTTER WÄHREND DES FRÜHSTÜCKS MIT BABALAWO OBANIFA-Obanifa-Extremdokumentarfilmen SCHWANGER WERDEN

In dieser Arbeit wird Babalawo Obanifa im Detail einige der in Yoruba Herbal verfügbaren pflanzlichen Heilmittel dokumentieren, die zur Behandlung von Säuglingen verwendet werden können, die noch stillen, während ihre Mutter schwanger wird. Manchmal kann eine stillende Mutter schwanger werden, wenn sie ihr stillendes Baby entwöhnt. Die Gedanken unserer Vorfahren in der Yoruba-Kräutermedizin sind, dass eine solche Schwangerschaft die normalen Aktivitäten, das Wachstum und das Wohlbefinden des gestillten Babys beeinträchtigen kann. Das Baby kann auch anfangen, übermäßig zu weinen. In einer solchen Situation gibt es in der Kräutermedizin von Yoruba Sorten von Kräuterrezepturen zur Behandlung einer solchen Erkrankung. Die Nomenklatur für die Kräutermedizin zur Behandlung von Babys unter solchen Bedingungen ist als Awe liloyun le omo Kekere bekannt. Nachstehend finden Sie eine Dokumentation einiger Kräuterrezepturen für diesen Zweck.

1.

Egungun Inaki (Affenknochen)

Awo Ekun (Leopardenfell)

Egungun Agburin (Knochen der Antilope)

Odidi ataare kan (Eine ganze Frucht von Aframomum Melegueta)

Egun Osunsun (Drypetes Chevalleri)

Igi senifiran (nicht identifiziert)

Eyowo kan (eine Kauri)

Vorbereitung

Sie werden Egungun Inaki (Knochen von Affen), Awo Ekun (Leopardenfell), Egungun Agburin (Knochen von Antilopen), Odidi ataare kan (Eine ganze Frucht von Aframomum Melegueta) in eine weiße Kleidung stecken. Sie werden es in Oru (Tontopf) stellen. Sie werden es mit Wasser auffüllen. Sie werden hinzufügen Egun Osunsun (Drypetes Chevalleri) .Igi Senifiran (nicht identifiziert), Eyowo Kan (eine Kauri). Sie werden kochen, es wird zusammen kochen.

Verwendung

Geben Sie dem Baby rechtzeitig zu trinken. Sie werden die Kaurischnecke verwenden, um Taillen- oder Halsanhänger für das Baby herzustellen.

2.

Omo ataare mewa (zehn Samen Alligatorpfeffer / Aframamoum melegueta)

Owo eyo ti ko luju (ungelochte Kaurischnecke)

Ako Okuta (Quarz)

Vorbereitung

Sie werden alles zusammenschleifen und es zum Hüftgurt für das Baby machen.

3.

Mariwo ope ti a fa tu lekan soso (Die frische Palmenfront einer Palme, die einmal entwurzelt ist)

Vorbereitung

Sie werden es in Wasser einweichen.

Verwendung

Baden Sie das Baby oft mit Wasser.

Copyright: Babalawo Pele Obasa Obanifa, Telefon- und WhatsApp-Kontakt: +2348166343145, Standort Ile Ife Osun, Bundesstaat Nigeria.
WICHTIGER HINWEIS: In Bezug auf den obigen Artikel darf kein Teil dieses Artikels in irgendeiner Form oder auf irgendeine Weise reproduziert oder vervielfältigt werden, elektronisch oder mechanisch, einschließlich Fotokopieren und Aufzeichnen oder durch ein Informationsspeicher- oder -abrufsystem ohne vorherige schriftliche Genehmigung des Inhabers des Urheberrechts und Der Autor Babalawo Obanifa wird als rechtswidrig eingestuft und zieht rechtliche Konsequenzen nach sich.

Нажмите на Vedio над грудью во время беременности (что нужно знать)

молочная медицина - грудное вскармливание и откачка

ТРАВЫ ДЛЯ ЛЕЧЕНИЯ РЕБЕНКА, КОТОРЫЕ ИМЕЮТ МАТЬ, БЕРЕМЕННОСТЬ В ТЕЧЕНИЕ ГОРЯЧЕГО КОРМЛЕНИЯ БАРАЛАВО ОБАНИФА-ОБАНИФА.

В этой работе Бабалаво Обанифа подробно документирует некоторые растительные лекарственные средства, доступные в травах йоруба, которые можно использовать для лечения ребенка, который все еще кормит грудью, но его мать забеременела в процессе. Иногда кормящая мать может забеременеть, если она отлучит своего грудного ребенка. Мысли наших предков в фитотерапии йоруба о том, что такая беременность может повлиять на нормальную деятельность, рост и благополучие ребенка, которого кормят грудью. Ребенок также может начать чрезмерно плакать. В такой ситуации в травяной медицине йоруба имеются различные варианты травяной формулы для лечения такого состояния. Номенклатура фитотерапии для лечения ребенка в таких условиях известна как Awe liloyun le omo Kekere. Ниже приводится документация некоторых травяных формул для этой цели.

1.

Эгунгун Инаки (кость обезьяны)

Аво Экун (Кожа леопарда)

Эгунгун Агбурин (кости антилопы)

Odidi ataare kan (целые плоды афрамомума мелегуэта)

Эгун Осунсун (Drypetes Chevalleri)

Иги Сенифиран (Неопознанный)

Eyowo Кан (один Коури)

подготовка

Вы положите Egungun Inaki (кости обезьяны), Awo Ekun (кожа леопарда), Egungun Agburin (кости антилопы), Odidi ataare kan (целые плоды Aframomum Melegueta) внутри белой одежды. Вы положите его внутрь Ору (глиняный горшок). Вы наполните его водой. Вы добавите Egun Osunsun (Drypetes Chevalleri) .Igi senifiran (Неопознанный), Eyowo kan (один каури). Вы будете варить, это будет вариться вместе.

использование

Дайте ребенку пить вовремя. Вы будете использовать каури, чтобы сделать подвески на талии или шее для ребенка.

2.

Omo ataare mewa (десять семян перца аллигатора / Aframamoum melegueta)

Owo eyo ti ko luju (неперфорированный каури)

Ако Окута (кварц)

подготовка

Вы все перемолотите и сделаете для ребенка поясной ремень.

3.

Mariwo ope ti a fa tu lekan soso (Свежая пальмовая поверхность пальмы, которая выкорчевана однажды)

подготовка

Вы впитаете это в воде.

использование

Купайте малыша часто с водой.

Авторское право: Babalawo Pele Obasa Obanifa, телефон и контакт WhatsApp: +2348166343145, местоположение Ile Ife osun штат Нигерия.
ВАЖНОЕ УВЕДОМЛЕНИЕ. Что касается статьи выше, ни одна часть этой статьи не может быть воспроизведена или воспроизведена в любой форме или любым способом, электронным или механическим, включая фотокопирование и запись, или любой системой хранения или поиска информации без предварительного письменного разрешения от владельца авторских прав и Автор Бабалаво Обанифа, сделав это, будет признан незаконным и повлечет за собой юридические последствия.

单击上面的Vedio怀孕时母乳喂养（您需要知道的）

牛奶学-母乳喂养和抽乳

巴拉比·奥巴尼法（BABALAWO OBANIFA）-Obanifa极限纪录片在母亲遭受孕育的婴儿中得到治疗

在这项工作中，Babalawo Obanifa将详细记录约鲁巴草药中可用的一些草药，这些草药可用于治疗仍在母乳喂养但母亲在此过程中怀孕的婴儿。有时，如果母乳喂养的婴儿断奶，母亲可能会怀孕。我们约鲁巴草药的祖先的想法是，这种怀孕可能会影响被母乳喂养的婴儿的正常活动，生长和福利。婴儿也可能开始过度哭泣。在这种情况下，约鲁巴草药中可以使用多种草药配方来治疗此类疾病。在这种情况下用于治疗婴儿的草药的名称被称为Awe liloyun le omo Kekere。以下是一些用于此目的的草药配方的文档。

1。

Egungun Inaki（猿骨）

Awo Ekun（豹皮）

Egungun Agburin（羚羊骨头）

Odidi ataare kan（Aframomum Melegueta的完整果实）

Egun Osunsun（Drypetes Chevalleri）

Igi senifiran（身份不明）

Eyowo kan（一cow）

制备

您将把Egungun Inaki（猿骨），Awo Ekun（豹皮），Egungun Agburin（羚羊骨头），Odidi ataare kan（Aframomum Melegueta的整个果实）放在一件白衣服里。您将其放入Oru（煲）中，然后加满水。您将添加Egun Osunsun（Drypetes Chevalleri）.Igi senifiran（身份不明），Eyowo kan（一个小岛）。您将煮沸，它将一起煮沸。

用法

及时给婴儿喝水。您将使用编织物为婴儿制作腰部或脖子的吊坠。

2。

Omo ataare mewa（十种扬子鳄胡椒/ Aframamoum melegueta种子）

Owo eyo ti ko luju（无孔的编织物）

Ako Okuta（石英）

制备

您将把所有东西一起磨碎，并放在宝宝的腰带上。

3。

Mariwo ope ti a fa tu lekan soso（被连根拔起的棕榈树的新鲜棕榈正面）

制备

您将其浸入水中。

用法

经常用水冲洗婴儿。

版权：Babalawo Pele Obasa Obanifa，电话和whatsapp联系人：+2348166343145，位于尼日利亚Ile Ife osun省。
重要声明：关于以上文章，未经版权所有者和作者的事先书面许可，不得以任何形式或通过任何方式（包括影印和记录的电子或机械方式）或通过任何信息存储或检索系统来复制或复制本文的任何部分。作者巴巴拉沃·奥巴尼法（Babalawo Obanifa）这样做将被视为非法，并将引起法律后果。

गर्भवती होने पर स्तनपान से ऊपर वेदियो पर क्लिक करें (आपको क्या जानना चाहिए)

दूध विज्ञान - स्तनपान और पम्पिंग

BABALAWO ओबनिफा-ओबनिफा चरम वृत्तचित्रों के माध्यम से बच्चों को जन्म देने से पहले उन बच्चों के उपचार के लिए उनकी योग्यता प्राप्त करें

इस काम में बबालावो ओबनिफा योरूबा हर्बल में उपलब्ध कुछ हर्बल उपचारों के बारे में विस्तार से बताएंगे जिनका उपयोग बच्चे के उपचार के लिए किया जा सकता है जो अभी भी स्तनपान कर रहा है लेकिन उसकी माँ इस प्रक्रिया में गर्भवती हो जाती है। कभी-कभी स्तनपान करने वाली माँ गर्भवती हो सकती है, वह अपने स्तनपान करने वाले बच्चे को वीन कर सकती है। योरूबा हर्बल दवा में हमारे पूर्वजों के विचार यह है कि इस तरह की गर्भावस्था से बच्चे को स्तनपान कराने वाली सामान्य गतिविधियों, वृद्धि और कल्याण प्रभावित हो सकता है। बच्चा अत्यधिक रोना भी शुरू कर सकता है। ऐसी स्थिति में योरूबा हर्बल दवा की ऐसी स्थिति के उपचार के लिए हर्बल फार्मूला उपलब्ध हैं। इस तरह की स्थिति के तहत बच्चे के इलाज के लिए हर्बल दवा के नामकरण को Awe liloyun le omo Kekere के रूप में जाना जाता है। नीचे इस तरह के उद्देश्य के लिए हर्बल फार्मूला के कुछ दस्तावेज दिए गए हैं।

1।

इगुनगुन इंकी (बंदर की हड्डी)

आवो इकुन (तेंदुए की खाल)

एगुनगुन एगबरीन (एंटेलोप की हड्डियां)

ओदिदी अतारे कान (अफ्रामोमम मेलेगेटा का एक पूरा फल)

इगुन ओसुनसून (ड्रायपेट चेवलेरी)

Igi सेनिफिरन (अज्ञात)

आईवू कान (एक कौड़ी)

तैयारी

आप एगुनगुन इनाकी (एपे की हड्डी), आवो एकुन (तेंदुए की खाल), एगुनगुन एगबरीन (एंटीलोप की हड्डियां), ओडिदी अताएर कान (एफ़्रामोमम लेलेगेटा का एक पूरा फल) को एक सफेद कपड़े के अंदर रख देंगे। आप इसे ओरु (मिट्टी के बर्तन) के अंदर डाल देंगे आप इसे पानी से भर देंगे। आप इगुन ओसुनसून (ड्रायपेटेस चेवेलेरी) .गी सेनीफिरन (अज्ञात), आईवोवन केन (एक कौड़ी) जोड़ेंगे। आप उबालेंगे यह एक साथ उबाल होगा।

प्रयोग

बच्चे को समय पर पीने के लिए दें। आप बच्चे के लिए कमर या गर्दन पेंडेंट बनाने के लिए कौड़ी का उपयोग करेंगे।

2।

Omo ataare mewa (मगरमच्छ काली मिर्च / Aframamoum melegueta के दस बीज)

ओउवो आइ तों को लूजू (अनारक्षित कौड़ी)

एको ओकुता (क्वार्ट्ज)

तैयारी

आप सब कुछ एक साथ पीस लेंगे और इसे बच्चे के लिए कमर बेल्ट बना देंगे।

3।

मारीवो ओपे त् ए टू तू लक्कन सोसो (ताड़ के ताजे पेड़ के सामने जो एक बार उखड़ जाता है)

तैयारी

आप इसे पानी में भिगो देंगे।

प्रयोग

बच्चे को अक्सर पानी से नहलाएं।

कॉपीराइट: बबालावो पेले ओबासा ओबनिफा, फोन और व्हाट्सएप संपर्क: 13:48166343145, स्थान इले इफ ओसुन राज्य नाइजीरिया।
महत्वपूर्ण सूचना: जैसा कि इस लेख के किसी भी भाग के ऊपर दिए गए लेख को किसी भी रूप में या किसी भी रूप में इलेक्ट्रॉनिक या मैकेनिकल द्वारा प्रतिलिपि या डुप्लिकेट नहीं किया जा सकता है, फोटोकॉपी और रिकॉर्डिंग सहित या किसी भी जानकारी के भंडारण या पुनर्प्राप्ति प्रणाली द्वारा कॉपीराइट धारक से पूर्व लिखित अनुमति के बिना और लेखक बबालावो ओबनिफा, ऐसा करना गैर-कानूनी होगा और कानूनी परिणामों को आकर्षित करेगा।

انقر على فيديو أعلى الرضاعة الطبيعية أثناء الحمل (ما تحتاج إلى معرفته)

الحليب - الرضاعة الطبيعية والضخ

أعشاب علاج الأطفال الذين يحصلون على رضاهم أثناء الرضاعة الطبيعية بقلم بابلو أبانيفاء-عنيفة

في هذا العمل ، سيوثق Babalawo Obanifa بالتفصيل بعض العلاجات العشبية المتوفرة في Yoruba herbal التي يمكن استخدامها لعلاج الطفل الذي لا يزال يرضع من الثدي ولكن والدته تصاب بالحامل في هذه العملية. في وقت ما يمكن للأم الحامل أن ترضع إذا كانت تطعم طفلها الرضيع. إن أفكار أجدادنا في طب الأعشاب Yoruba هي أن مثل هذا الحمل قد يؤثر على الأنشطة الطبيعية للنمو الذي يرضع من الثدي ورفاهه. قد يبدأ الطفل في البكاء بشكل مفرط. في مثل هذه الحالة ، هناك أنواع مختلفة من التركيبة العشبية المتاحة في الأدوية العشبية اليوروبا لعلاج هذه الحالة. يُعرف التسميات الخاصة بالأدوية العشبية لعلاج الطفل تحت هذه الحالة باسم Awe liloyun le omo Kekere. أدناه هي بعض الوثائق من صيغة العشبية لهذا الغرض.

1.

إيجونجن إناكي (عظم القرد)

Awo Ekun (جلد الفهد)

اجونجون اغبورين (عظام الظباء)

Odidi ataare kan (ثمار أفراموموم ميليجيتا كاملة)

إيجون أوسونسون (Drypetes Chevalleri)

إجي سينيفيران (مجهول الهوية)

ايووو كان (أحد رعاة البقر)

تجهيز

ستضع Egungun Inaki (عظم القرد) ، Awo Ekun (جلد الفهد) ، Egungun Agburin (عظام Antelope) ، Odidi ataare kan (ثمار كاملة من Aframomum Melegueta) داخل ملابس بيضاء. سوف تضعه داخل أورو (وعاء من الطين) سوف تملأ بالماء. سوف تضيف Egun Osunsun (Drypetes Chevalleri) .Igi senifiran (مجهول الهوية) ، Eyowo kan (أحد رعاة البقر). سوف تغلي وسوف تغلي معا.

استعمال

اعط الطفل للشرب في الوقت المناسب. سوف تستخدم حامل الصدفة لصنع المعلقات الخصر أو الرقبة للطفل.

2.

Omo ataare mewa (عشرة بذور من فلفل التمساح / Aframamoum melegueta)

Owo eyo ti ko luju (رعاة البقر غير المثقفين)

أكو أوكوتا (كوارتز)

تجهيز

سوف تطحن كل شيء معًا وستجعله على حزام الخصر للطفل.

3.

Mariwo ope ti a fa tu lekan soso (جبهة النخيل الطازجة لشجرة النخيل التي يتم اقتلاعها مرة واحدة)

تجهيز

سوف تنقع في الماء.

استعمال

اغسل الطفل كثيرًا بالماء.

حقوق الطبع والنشر: Babalawo Pele Obasa Obanifa ، الهاتف واتس اب الاتصال: +2348166343145 ، موقع إيل إيف أوسون ولاية نيجيريا.
إشعار هام: فيما يتعلق بالمادة أعلاه ، لا يجوز إعادة إنتاج أو تكرار أي جزء من هذه المادة بأي شكل أو بأي وسيلة ، سواء كانت إلكترونية أو ميكانيكية ، بما في ذلك التصوير والتسجيل أو بأي نظام لتخزين المعلومات أو استرجاعها دون إذن كتابي مسبق من صاحب حقوق الطبع والنشر و المؤلف Babalawo Obanifa ، القيام بذلك سوف يعتبر غير قانوني وسوف يجلب عواقب قانونية.

Read other people works on Pregnancy during Breastfeeding

Breastfeeding and Fertility
By Kelly Bonyata, BS, IBCLC

How can I use breastfeeding to prevent pregnancy?
The transition to full fertility
Do I need to wean to get pregnant?
References and Additional Resources
Fertility and conceiving while breastfeeding
Exclusive breastfeeding/Lactational Amenorrhea Method of birth control
Print Resources
How can I use breastfeeding to prevent pregnancy?
The Exclusive Breastfeeding method of birth control is also called the Lactational Amenorrhea Method of birth control, or LAM. Lactational amenorrhea refers to the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding. Many mothers receive conflicting information on the subject of breastfeeding and fertility.

Myth #1 – Breastfeeding cannot be relied upon to prevent pregnancy.

Myth #2 – Any amount of breastfeeding will prevent pregnancy, regardless of the frequency of breastfeeding or whether mom’s period has returned.

.

Exclusive breastfeeding has in fact been shown to be an excellent form of birth control, but there are certain criteria that must be met for breastfeeding to be used effectively.

Exclusive breastfeeding (by itself) is 98-99.5% effective in preventing pregnancy as long as all of the following conditions are met:

Your baby is less than six months old
Your menstrual periods have not yet returned
Baby is breastfeeding on cue (both day & night), and gets nothing but breastmilk or only token amounts of other foods.
Effectiveness of Birth Control Methods
Number of Pregnancies per 100 Women
Method Perfect Use Typical Use
LAM 0.5 2.0
Mirena® IUD 0.1 0.1
Depo-Provera® 0.3 3.0
The Pill / POPs 0.3 8.0
Male condom 2.0 15.0
Diaphragm 6.0 16.0
* Adapted from information at plannedparenthood.org.

How can I maximize my natural period of infertility?
Timing for the return to fertility varies greatly from woman to woman and depends upon baby’s nursing pattern and how sensitive mom’s body is to the hormones involved in lactation.

Breastfeeding frequency and total amount of time spent breastfeeding per 24 hours are the strongest factors leading to the return of fertility: a mother is more likely to see the return of fertility if baby’s nursing frequency and/or duration is reduced, particularly if the change is abrupt.
In some populations, research has shown that night nursing slows the return to fertility.

One study showed that mothers who were separated from their infants (but expressed milk to provide 100% breastmilk for baby) had a higher pregnancy risk (5.2%) during the first 6 months (Valdes 2000).
The introduction of solid food can also be a factor in the return of fertility. Once baby starts solids (if mom’s cycles have not returned), the natural period of infertility may be prolonged by breastfeeding before offering solids, starting solids gradually, and not restricting nursing.
You can achieve higher effectiveness by practicing ecological breastfeeding:

keeping baby close
breastfeeding on cue (day and night)
using breastfeeding to comfort your baby
breastfeeding in a lying-down position for naps and at night
using no bottles or pacifiers
If you practice ecological breastfeeding:

Chance of pregnancy is practically zero during the first three months, less than 2% between 3 and 6 months, and about 6% after 6 months (assuming mom’s menstrual periods have not yet returned).
The average time for the return of menstrual periods is 14.6 months.

Moms whose cycles return early tend to be infertile for the first few cycles. Moms whose cycles return later are more likely to ovulate before their first period.
Source: Natural Child Spacing and Breastfeeding by Jen O’Quinn

Source: Natural Child Spacing and Breastfeeding by Jen O’Quinn

While it is possible for a nursing mom to become pregnant while she is breastfeeding and before she has her first menstrual period, it is rare. Most moms do not get pregnant until after their first period (often referred to as the “warning period”). Even after that, while some can become pregnant the first cycle, others will require months of cycles before pregnancy can occur. Still others (this is quite uncommon) may not be able to become pregnant until complete weaning has occurred.

The transition to full fertility
Several studies have indicated that fertility and ovarian activity return step by step (Ellison 1996, p. 326-327):

Follicular activity without ovulation (No chance of pregnancy.)
1a. Menstruation without ovulation (This does not always occur–see below.)
Ovulation without luteal competence (After the egg is released, fertilization may take place. During the luteal phase, the uterine lining is prepared for implantation as the egg travels down the fallopian tube and into the uterus. If the uterine lining is not adequately prepared for implantation, the implantation will probably not be successful.)
Full luteal competence (Full fertility — at this point breastfeeding no longer has any effect on your chance of pregnancy.)
It is possible to have one or (occasionally) more periods before you start ovulating. In this case, menstruation begins during the first stage of the return to fertility –before ovulation returns. Cycles without ovulation are most common during the first six months postpartum. For other mothers, the first menstruation is preceded by ovulation – a longer period of lactational amenorrhea increases the likelihood that you will ovulate before that first period.

A very small percentage of women will become pregnant during their first postpartum ovulation, without having had a postpartum period. Per fertility researcher Alan S. McNeilly, this “is rare and in our experience is related to a rapid reduction in suckling input.”

It is not uncommon for breastfeeding mothers to report cyclical cramping or PMS-type symptoms – symptoms of an oncoming period without the period – for weeks or even months before their period returns. When this happens, the body is probably “gearing up” for the return of menstruation, but breastfeeding is still delaying the return of fertility.

The amount of time that it takes for the transition to full fertility varies from woman to woman. In general, the earlier that your menses return, the more gradual the return to full fertility.

Reference Menstruation without ovulation First ovulation without luteal competence Time between 1st period and ovulation
0-6 mo after 6 mo 0-6 mo after 6 mo
Eslami 1990 67% 22% — 8.4 weeks 0.1 week
Gray 1990 45.1% “the rate fell greatly” 41% — —
�

Reference Frequency of ovulation
Lactation:
1st cycle Lactation:
2nd cycle Post-weaning:
1st cycle Post-weaning:
2nd cycle Formula-feeding only:
2nd cycle
Howie 1982 45% 66% 70% 84% 94%
Do I need to wean to get pregnant?
Probably not. If you are still transitioning to full fertility (as discussed above), breastfeeding may affect the success of implantation. Once implantation is successful, breastfeeding should not affect a healthy pregnancy (see A New Look at the Safety of Breastfeeding During Pregnancy for more information). If your periods have come back and settled into a regular pattern, it is likely that breastfeeding is no longer affecting your fertility.

Many moms can conceive without deliberately changing their toddler’s nursing patterns. There is no “magic” threshold of breastfeeding that will allow you to conceive — every mother is different. Some moms need to stretch out nursing frequency and/or shorten nursing sessions to make it easier to conceive — babies naturally do this themselves as they get older, so one of your options is simply to wait a bit.

Changes that are more abrupt tend to bring fertility back faster (e.g., cutting out one nursing session abruptly, rather than gradually decreasing nursing time at that session) —even if you continue to breastfeed a great deal— this is why many mothers experience the return of fertility when their child sleeps through the night or starts solid foods. If you decide to make changes to your nursing pattern, the time of day that you make the change (e.g., cutting out or shortening a nighttime nursing session as opposed to a daytime nursing session) should not make that much of a difference. Current research indicates that nursing frequency and total amount of time at the breast per 24 hours are the most important factors, rather than the time of day that the suckling occurs.

A few moms do find it impossible to conceive while nursing, but this is not at all common.

Many mothers wonder whether breastfeeding will affect the reliability of pregnancy tests. It does not — pregnancy tests measure the amount of the hormone hCG (human chorionic gonadotropin) in blood or urine, and hCG levels are not affected by breastfeeding. The developing placenta begins releasing hCG upon implantation; a pregnancy can generally be detected with a pregnancy test within 7-14 days after implantation.

For more information, see Getting Pregnant While Breastfeeding by Hilary Flower.

When you do get pregnant while breastfeeding, what next? See Nursing During Pregnancy & Tandem Nursing for more information.

References and Additional Resources
Fertility and conceiving while breastfeeding
Birth Control and Breastfeeding @

Menstruation and Breastfeeding by Becky Flora, IBCLC

Breastfeeding and Menstruation, Birth Control and Vaginal Dryness by Paula Yount

Can I get pregnant while I am breastfeeding? LLL FAQ

The Garden of Fertility by Katie Singer

Breastfeeding and Birth Control by Anne Smith, IBCLC

Breastfeeding and Fertility by Sherri Hedberg, IBCLC

Taking Charge of Your Fertility website – check out the library and the discussion boards.

Campino C, Torres C, Rioseco A, Poblete A, Pugin E, Valdes V, C

Breastfeeding and Natural Child Spacing by S.K. Kippley

A Pocket Guide to Managing Contraception by Robert Anthony Hatcher, M.D., MPH, et. al. includes accurate information on LAM and other methods of contraception

Ellison, Peter T. “Breastfeeding, Fertility and Maternal Condition,”from Breastfeeding: Biocultural Perspectives (Stuart-Macadam, P. and Dettwyler, K., ed.), New York: Walter de Gruyter, Inc., 1995, p. 305-345.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarilla, TX: Hale Publishing; 2010:490-510.

Valdés V, Labbok MH, Pugin E, and Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception, 01 Nov 2000; 62(5): 217-9.

Updated on March 17, 2018
Filed Under: Older Infant, Tandem Breastfeeding, What is Normal?
Tagged With: lactation-physiology

5 Important Tips for Breastfeeding While Pregnant
6/27/2018
As your baby surpasses his or her 9-month milestone and approaches their first birthday, you may already be considering your next pregnancy. Of course, every mom is different! Whatever decision you’ve made – or if you haven’t given much thought to more children yet – is what works best for you and that’s wonderful!

If you’ve recently found out you’re expecting again or if another pregnancy may be right around the corner, you probably have questions about breastfeeding while pregnant. Making sure that doing so is safe for both your little one and your developing fetus is imperative as your pregnancy progresses, particularly because breastfeeding releases hormones like oxytocin, which can cause mild uterine contractions. In fact, that’s why our first tip for breastfeeding during pregnancy is so important:

Check with your healthcare provider first.
You can never be too cautious, especially when it comes to your babies. Generally, breastfeeding while pregnant is safe. Though trace amounts of pregnancy hormones can be present in your milk, these are not harmful to your breast milk feeding child. Additionally, oxytocin is released in small amounts during a nursing session, so it is not enough to induce preterm labor. The contractions caused by this hormone are very minor and rarely increase the chance of having a miscarriage. However, there are certain circumstances when your doctor may advise weaning your child, such as:

If your pregnancy is deemed high risk or you are at risk for miscarriage

If you are carrying twins or multiples

If you have been experiencing uterine pain or bleeding

If you have been advised to avoid sex while pregnant

Talking to your healthcare provider will be a crucial part of determining whether you should continue breastfeeding while pregnant. If it is not recommended for your unique situation, that’s okay – you’ve done a great job and now it is important for your body to prepare for your new baby and the next chapter of your breastfeeding journey!

Sit or lie down while breastfeeding.
It’s no secret that nursing and/or pumping requires energy, something that can be hard to come by with both a baby and a developing pregnancy. Be sure to sit or lie down in a relaxing spot when breastfeeding or pumping to give yourself extra time to rest as your baby is fed. As your pregnancy continues to progress, you may need to get creative with new pumping or nursing positions that are comfortable for you and your little one.

Monitor your milk supply.
Many moms’ milk supplies will start to decrease around months 4 or 5 after birth, so it is important to begin incorporating other nutrition into your baby’s diet. If they are satisfied after breast milk feeding and are meeting their growth and weight markers, then there’s usually no reason to be concerned. The other nutrition your baby is receiving will make up for any temporary or permanent decrease in their breast milk intake. Chatting with your little one’s doctor and/or an experienced lactation consultant can be especially helpful during this time.

Once your new baby arrives, it is important for them to get colostrum, or your early milk. With that in mind, you may decide to nurse him or her first and/or temporarily limit your older child’s breast milk feeding during these important first few days after the new baby’s birth

Consider your diet.
By now, you know all about how eating well is important for the health of your baby – both during your developing pregnancy and after birth, while breast milk feeding. However, consuming additional calories is also crucial for you, mama! Pregnancy and breastfeeding both require a lot of energy, so it’s important to ensure you’re taking in enough calories to maintain your own overall wellness. A general rule of thumb is:

500 extra calories needed if your breast milk feeding child is also eating other foods or 650 extra calories needed if he or she is under 6 mon

regnancy or the 450 extra calories needed if you are in the 3rd trimester of your pregnancy.

Most healthcare providers agree that no additional calories are required if you are in the 1st trimester of your pregnancy, which is often considered a positive for moms who are experiencing morning sickness or nausea.

Invest in breast and nipple care.
You probably already know that sore nipples can be a frequent ailment for breastfeeding moms, but this can be especially noticeable if you are expecting and breastfeeding. This is because breast tenderness is a common symptom of pregnancy, so taking time for self-care is important for both mental and physical wellness. Keeping a supply of products like lanolin and hydrogel pads can provide some much-needed relief, so be sure to stock up!

In many situations, breastfeeding during pregnancy can be done. Remember, even though you might be tired, irritable, busy, cranky, or otherwise exhausted, your body is providing important care to your babies. You got this, Super Mom, and we’re here for you through every step

Chances of Becoming Pregnant While Breastfeeding

Medically Reviewed by
Dr. Nina Mansukhani (Gynaecologist )
VIEW MORE GYNAECOLOGIST
OUR PANEL OF EXPERTS

You might have heard people say that breastfeeding is a great natural contraceptive and wondered if it is true. While many women do not menstruate while they are breastfeeding, this does not mean that they are not fertile during this time. Using some means of contraception is essential if you are keen on avoiding pregnancy during your breastfeeding days.

Can You Get Pregnant While Breastfeeding?
Yes, it is possible to be breastfeeding and get pregnant at the same time. A mother whose infant is under the age of six months and is exclusively breastfed might not menstruate during this period. But there is no way of determining when her body might release an egg, leading to ovulation. So, the chances of becoming pregnant during breastfeeding do exist, though it might be marginally lower

How Does Breastfeeding Affect Pregnancy?
There is increased production of the hormone prolactin in your body as a result of the nipples being stimulated during breastfeeding. Higher levels of prolactin mean a decrease in your fertility. This hormone prevents ovulation and keeps menstruation from happening. Prolactin levels are at their highest during night-time and soon after you wake up. But, it is important to remember that there can be ovulation even if you do not experience any menstrual flow yet.
Baseline Prolactin Levels in Women
The amount of prolactin in a woman’s body will vary depending on whether she is pregnant or not, as well as the postpartum period and whether she’s lactating. Here is a sample table to give you an idea of normal prolactin levels:

Your Condition Prolactin (mg/ml)
Not pregnant and not lactating <25
Pregnant (Full Term) 200
Postpartum (7 days) and lactating 100
Postpartum (3 months) and lactating 100
Postpartum (6 months), lactating, no menstruation 110
Postpartum (6 months), lactating, menstruating 70
Postpartum (9 months) and lactating 50
Common Signs of Pregnancy While You Are Breastfeeding
If you become pregnant while breastfeeding, there are some symptoms that you might experience:

1. Excessive Thirst
You might start to feel quite thirsty frequently, and this is common during breastfeeding as your baby will be consuming a major chunk of the fluids you take in. But if you are pregnant while breastfeeding, it could heighten your thirst as the new baby will also require fluids and will be drawing this from your body.
2. Fatigue
Being fatigued is one of the common symptoms of pregnancy while breastfeeding. Just as you think you are getting your energy levels back to normal, you are likely to feel exhausted at the slightest effort. Simply doing the laundry or washing the dishes might prove to be too much for you. While fatigue usually sets in towards the end of the first trimester, with breastfeeding mothers, this can happen early on.

3. Tender and Painful Breasts
This is one symptom that you are likely to attribute to breastfeeding your baby. However, if you suddenly experience increased nipple sensitivity or find your nipples extra painful and sore after breastfeeding, then you might want to take a pregnancy test.

. Reduced Milk Production
If you feel that your milk production has significantly decreased and your baby remains hungry even after a normal feed, then it might be due to pregnancy. This usually occurs after about two months of pregnancy but cannot be completely ruled out in the early stages of your pregnancy either. Also, the taste of your breast milk is likely to change if you are pregnant and this might become evident when your baby refuses to feed or seems to feed with some hesitation. Some babies might also start weaning themselves from breast milk as a result of these changes.

5. Cramping
The cramping that occurs if you are pregnant can be quite severe. It might feel as if your period is about to start, but that never happens, and only the cramping persists. This could be a strong indicator of the possibility of pregnancy especially if it is accompanied by spotting while breastfeeding.

6. Nausea or Morning Sickness
If you are pregnant while breastfeeding, it is likely that nausea and morning sickness will be greater this time around. Hence, it is important that you ensure it does not prevent you from eating well as you will need to provide nourishment to two babies simultaneously as well as sustain your own energy and health.

7. Increased Levels of Hunger
As a breastfeeding mother, your hunger is bound to have increased significantly. But if there is a sudden spike in your hunger levels accompanied by some of the other symptoms of pregnancy, then there is a good chance that you have conceived once again.

. Lumps in Your Breasts
Pregnancy, as well as the many hormonal changes that occur postpartum, can lead to the formation of different types of lumps in your breasts. These can range from blocked milk sacs known as galactoceles to fluid-filled cysts and fibrous tissue also known as fibroadenoma.

Health Tips for a Breastfeeding Mother, Unborn Child, and Newborn Baby
If you find out that you are pregnant while you are still breastfeeding your infant, there is nothing to be anxious about. Just following a few simple tips will help ensure that your infant, your unborn baby, and you all stay healthy and well.

1. Eat a Balanced Diet
It is important to eat well and plan your diet properly to ensure that your daily nutrition requirements are fulfilled. You have to nourish not just yourself, but two other growing individuals at the same time. Besides eating a balanced diet, you must take a prenatal vitamin and add at least 500 calories to your daily dietary intake. This is because the foetus will need at least 300 calories to grow adequately. The rest is essential to prevent any interruption in your milk supply for your infant.
2. Rest Well
Your energy levels are likely to be much lower than it would be during a regular pregnancy. This is because your body is involved in nurturing a foetus while it is also nourishing a newborn. This will result in double the effort on your part, and you will be prone to fatigue without doing much. Resting well will help you cope with it all much better.

3. Choose a Comfortable Position
You can choose to either lie down or sit up in a comfortable position when you’re breastfeeding. This will help you catch up on some well-deserved rest, something that you’ll need in abundance while taking care of an infant, that too with a new baby on the way. However, if you do choose to lie down, make sure you don’t fall asleep while breastfeeding your baby.

4. Stay Hydrated
Breastfeeding can rob your body of fluids, and it is important to stay hydrated at all times. When pregnant, this becomes even more important as dehydration can lead to spells of dizziness and prove detrimental to the growth of the foetus. So, make sure you drink lots of water, fruit juices, milkshakes, and other such healthy fluids every day, especially in summer.
3. Choose a Comfortable Position
You can choose to either lie down or sit up in a comfortable position when you’re breastfeeding. This will help you catch up on some well-deserved rest, something that you’ll need in abundance while taking care of an infant, that too with a new baby on the way. However, if you do choose to lie down, make sure you don’t fall asleep while breastfeeding your baby.

4. Stay Hydrated
Breastfeeding can rob your body of fluids, and it is important to stay hydrated at all times. When pregnant, this becomes even more important as dehydration can lead to spells of dizziness and prove detrimental to the growth of the foetus. So, make sure you drink lots of water, fruit juices, milkshakes, and other such healthy fluids every day, especially in summer.
Is It Safe to Breastfeed While You Are Pregnant?
You might wonder about the safety of breastfeeding while pregnant as it is common knowledge that breastfeeding can cause uterine contractions. Uterine contractions can induce preterm labour in some instances. But you don’t have to worry much about this as it is not a problem in a healthy pregnancy. Breastfeeding releases the hormone oxytocin, which is what leads to uterine contractions. However, since the hormone is released in very small amounts, it is highly unlikely to lead to contractions that can induce preterm labour. Such mild contractions are harmless to the unborn baby and also unlikely to cause a miscarriage.

However, there are some cases in which your doctor might advise you to stop breastfeeding. These are as follows:

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In the case there is a risk of suffering a miscarriage
If there is documented cervical incompetence
After the second trimester of pregnancy, when the needs of the unborn baby increase significantly and can easily tire you out
During the last trimester of pregnancy when nipple stimulation can lead to contractions
If you get pregnant while breastfeeding, it’s important to weigh the needs and requirements of your nursing child and your unborn child against each other. The decision of whether it is best to continue with breastfeeding or not is something that you must make after evaluating all aspects. Your individual circumstances will also play a crucial role in the decisions you take and the choices you make. Ultimately, it is important not to have any guilt or regrets about any of these later in life.

How to Recognize the Signs of Pregnancy While Breastfeeding
Updated on June 21, 2019

Sree Lakshmi more
Trained in dentistry, Sree is currently studying lab sciences. She enjoys researching various health topics and writing about her findings.
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There are quite a few signs that could point to pregnancy if you are breastfeeding, but there are only three ways to positively know if you are pregnant.
Can You Get Pregnant While Breastfeeding?

There is a prevailing, old-fashioned belief that one can't get pregnant while breastfeeding. This is not true. Women can get pregnant while breastfeeding, even if their periods have not yet resumed after giving birth.

Although new mothers usually do not ovulate before three weeks after giving birth, and a mother may not menstruate for months after giving birth, there's no way to ensure or predict exactly when her body will release its first postpartum egg, and she won't know until roughly two weeks after ovulation.

However, if she is breastfeeding her baby exclusively (no formula) 24/7, she may not ovulate or menstruate again for six months, or even longer, after delivery. In other words, the more often her baby nurses, the longer it may be before she gets her period again. ("May not" does not mean "will not," and she may get her period tomorrow, as well. The only controllable method of pregnancy prevention is contraception.)

Lactational Amenorrhea Method
Still, breastfeeding has been used by many mothers as a natural and effective contraceptive method. Termed the "Lactational Amenorrhea Method" (LAM), it is effective only under certain conditions. These are:

The infant is exclusively breastfed.
The infant is not more than six months old.
The mother is still amenorrheic (no menstrual flow since giving birth).
If her baby sleeps through the night at an early age, her period will probably return more quickly. The same is true if she's supplementing with formula. If some break or variation in the feeding schedule triggers ovulation, there's no way to know or predict if her body will release its first postpartum egg, and she won't find out until roughly two weeks later.
Is It Safe to Get Pregnant While Breastfeeding?

Many mothers are concerned about the safety of pregnancy while breastfeeding, but there is no real reason to worry.

For most women, breastfeeding while pregnant is fine and will not harm either baby—the one in your arms or the one growing inside. Many mothers not only continue nursing during pregnancy but continue "tandem nursing" after the new baby is born—breastfeeding both children at once.

As part of the let-down reflex related to milk production, the uterus contracts in response to the oxytocin released, so breastfeeding while pregnant may put high-risk mothers in danger of miscarriages, which may be due to elevations in prolactin. If the woman has a history of preterm labor, bleeding, or uterine pain, it might be wise to stop breastfeeding as a precautionary measure.

If the mother is not high-risk, then breastfeeding is generally safe during pregnancy. Of course, should a woman decide to breastfeed while pregnant, she will want to make some adjustments. Nutrition will be extremely important. Three people—the growing fetus, the breastfeeding child, and the mother—will need adequate nutrition, and dietary adjustments should be made to address the needs of all three. The diet should have more fruits and vegetables and an adequate balance of carbohydrates and proteins. Nutritional supplements like prenatal vitamins should be taken regularly.

Ask Your Doctor If Breastfeeding While Pregnant Is Safe for You

While breastfeeding during pregnancy is generally considered safe, you should consult with your doctor in the following scenarios:

If you have a high-risk pregnancy or are at risk for preterm labor;
If you are carrying twins;
If you are having bleeding or uterine pain.
How Does Breastfeeding Affect Pregnancy?

The stimulation of nipples that occurs during breastfeeding stimulates the hormone prolactin, which has a negative effect on the reproductive hormones. The higher the prolactin levels in the body, the less fertile one is. Prolactin can inhibit ovulation and prevents menstrual flow. Following six months of exclusive around the clock lactation, prolactin levels and ovulatory menstrual cycles return to normal. Then, only during breastfeeding, will prolactin levels rise. Even if the above conditions have been met, it is still not a 100% effective contraceptive method.

Most women may become pregnant once their menstrual flow resumes. However, it is also possible to ovulate without any menstrual flow. The longer one remains amenorrheic, the more likely it is to ovulate without any menstrual flow. In both cases, one can get pregnant.

Typical Baseline Prolactin Levels in Women

Woman's Condition
Prolactin Level
Not pregnant or lactating
<25 ng/mL
Pregnant (at term)
200 ng/mL
7 days postpartum (lactating)
100 ng/mL
3 months postpartum (lactating)
100 ng/mL
180 days postpartum (no menstruation, lactating)
110 ng/mL
180 days postpartum (menstruation started and still lactating)
70 ng/mL
6 months postpartum (lactating)
50 ng/mL
According to Riordan J.: Breastfeeding and Human Lactation, 3rd ed., 2005, and Walker M.: Breastfeeding Management for the Clinician: Using the Evidence, 2006.
Common Signs and Symptoms of Pregnancy While Breastfeeding

Early signs of pregnancy after giving birth are generally the same as those that are seen in a regular pregnancy. These are classified based on how well they can predict whether a woman is pregnant or not.

Presumptive Signs (Weak Indicators of Pregnancy)
Presumptive signs of pregnancy are least indicative. They are mostly subjective (only the mom can feel the sign, and nobody else can see it), and other things may cause them. They include:

Changes in the Breast
Changes in Milk Production
Other Physical Symptoms
Probable Signs (Moderate Chance of Being Pregnant)
Probable signs of pregnancy can be observed by someone else other than the mother. These are more reliable than presumptive signs but they are not completely accurate in revealing pregnancy. These include:

Fetal Outline
Braxton Hicks Contractions
Chadwick's Sign
Goodell's Sign
Hegar's Sign
Ballottement
Laboratory Tests
Positive Signs (Confirmed Pregnancy)
Positive signs are those that guarantee that the woman is pregnant. If you have these signs, there is a hundred percent guarantee that you're pregnant. So far, only three positive signs are recognized by medical professionals.

Heartbeat of the Fetus That Is Separate From the Mother's
Seeing the Fetus Through Ultrasound
Movement of the Fetus That Is Felt by an Examiner

If your breastfeeding child is older than an infant, you're more likely to be ovulating, and therefore it is easier to get pregnant. | Source
Presumptive Signs: Changes in the Breast

Changes in the breasts are among the earliest signs of pregnancy. A woman may notice these when she is six weeks pregnant. These changes are side effects of the pregnancy hormones estrogen and progesterone. These will affect the breasts and prepare them for breastfeeding after birth—even if she is currently nursing already.

Note: Breast changes can occur for many reasons, so even though they can sometimes point to pregnancy, avoid thinking of them as signs of pregnancy.

Medications Can Cause Tenderness Whether or Not You're Pregnant
Medication may cause breast tenderness, so read the drug information leaflet to know if it is one of its potential side effects. Some medicines that cause breasts to feel tender are contraceptives, antidepressants, and antipsychotics.

Lumps Can Form For Many Reasons
Pregnancy and other conditions that involve hormonal changes may cause the breasts to develop lumps. These lumps may be filled with milk (galactoceles), fluid (cysts), or fibrous tissue (fibroadenoma).

Galactoceles: Galactoceles are small sacs containing milk within the breast. They are large, soft lumps often found at the lower part of the breasts. These lumps form when the outlets of the milk ducts get blocked. Breastfeeding mothers and those who have recently weaned their babies may develop them. They usually resolve without the need for any treatment. Galactoceles may or may not be a sign of pregnancy.
Cysts: Cysts are fluid-filled lumps caused by changes in hormonal levels. They often have no other accompanying symptoms, and only a few of them are painful. Women who are menopausal or nearing menopause are more prone to developing cysts than younger women. Menopausal women receiving HRT (Hormone Replacement Treatment) may develop these. Again, cysts are not sure signs of pregnancy, but they may indicate it.
Fibroadenomas: Fibroadenomas are solid round lumps that may be moved around the breast. They can disappear on their own after menstruation, but sometimes, they increase in size during pregnancy. If you notice movable lumps that seem to be growing, you may be pregnant.
Lipomas: Lipomas are not caused by pregnancy or hormonal changes, but by excess fats. They can form on any part of the body containing fat, such as the breasts. It is a condition, which affects 1 in 100 people but a person usually gets only 1 to 2 lipomas on the body. Unlike a cyst or fibroadenoma, a lipoma feels squishy when pressed. Also, a lipoma is deep while a cyst is shallow and near the surface of the skin.
Breast Cancer: Most lumps such as cysts, fibroadenomas, and lipomas are benign, but some may also be cancerous. It is not common during pregnancy, but if you notice lumps on your breasts, have them checked by the doctor just to be safe—especially if the lumps are painful and bigger than two inches, and if you have a family history of cancer.
Breast Infections Are Common While Breastfeeding
Breast infections (mastitis) are not signs of pregnancy. These may cause the breasts to feel tender, so to rule out pregnancy, consider whether you have cracked nipples, whether there is a painful area on your breast that is hot and red, and whether you have breastfeeding problems. If you have a fever, it is a sign that you have an infection.

Infection is treated by cleaning wounds and by taking antibiotics for about a week. Tell your doctor that you are breastfeeding so they can give you medicine that is safe for your baby. After eliminating the bacteria, your breast tenderness may go away as well.

Clogged Milk Ducts Are Common While Breastfeeding
Some milk proteins may pile up and prevent the rest of the milk from flowing properly. The stagnant milk may serve as a breeding ground for bacteria. Even if there is no bacterial infection, the immune system may mistake the proteins as for. If milk ducts become clogged, they can be treated by the following measures:

If possible, feed the baby with only breastmilk and not formula for at least six months.
Breastfeed when the baby asks for milk, even during odd hours of the night. During the first months, this can be every two to three hours.
Encourage the baby to drink milk when your breasts are sore.
Do not interrupt the baby's feeding—try not to remove the breast; wait for him to release it, instead.
If you intend to cut down on feedings, do so gradually to allow the milk glands to adjust.
Ensure that the baby is adequately attached to the breast. When they open their mouth wide, the mother should bring the baby to her breast. The baby will tilt their head back and take a mouthful of the breast, resting towards the roof of their mouth.
Try different feeding positions.
Massage the painful breast to remove blockages.
Warm the breast with a warm compress or bathe in warm water. Doing so can help soften the milk and dissolve clogs.
Express the leftover milk after feedings.
Presumptive Signs: Milk Production Decreases

When a breastfeeding mother is pregnant, she may notice her milk production starts to decrease. If you notice that your milk is not as abundant as before, you may have gotten pregnant.

Again, pregnancy is not the only cause of a decreased milk supply. Stress and illness can cause your body to go into survival mode and divert energy used for milk production into crucial bodily activities.

Substances, such as liquor, caffeine, and nicotine can dehydrate you and weaken your breasts' ability to release milk. Let go of these vices while you are still feeding your child so your breasts can produce milk, which is safe to drink and in adequate amounts.

Certain kinds of medication can do this, as well. If a medication is prescribed to you, let your doctor know that you are breastfeeding so he or she can give you medicine that won't interfere with it.

When taken in large doses, some herbs such as peppermint and parsley can actually decrease your milk output. When breastfeeding, avoid consuming too many herbs and spices. Dehydration and malnutrition will also lower your milk supply, so eat and drink properly when nursing.

If you had problems conceiving, you may also have problems with breastfeeding. For the breasts to make milk, they rely on hormonal signals that are sent to them. If you have hormonal imbalances, hyperthyroidism or hypothyroidism, hypertension, diabetes, polycystic ovary syndrome, or another ailment, it's likely that you won't have much milk. You may have to use milk formula or get breast milk from another mom—talk with your pediatrician to know what to do.

Early symptoms of pregnancy after giving birth is much the same as the symptoms you had in your previous pregnancy. | Source
Other Presumptive Physical Symptoms That May Indicate Pregnancy

There are quite a few physical symptoms that may point to pregnancy, but could also be caused by a number of other reasons. These include:

Nausea and Vomiting
Fatigue
Amenorrhea
Implantation Bleeding or Spotting
Frequent Urination
Uterine Enlargement
Quickening
Skin Changes
Nausea and Vomiting
Morning sickness is most notable during the first trimester of pregnancy and goes away by the second trimester. Certain food tastes and aromas can trigger nausea and vomiting. Many women report intolerance to fish. If you didn't have your period yet and you start to feel uncomfortable during the mornings, you may have conceived. Smelling citrusy scents can help alleviate nausea. Make sure to get enough nutrients even with the discomfort of nausea and vomiting. Eat less carbohydrate-rich food and more proteins at this stage.

When you vomit and feel nauseated, avoid thinking that you are pregnant right away. Maybe you have just become sick. Food poisoning, viral infections, and other illnesses can cause this, so it's best to visit your doctor first to know whether you're experiencing morning sickness or something else.

Fatigue
Breastfeeding already taxes the body's energy, and adding pregnancy will further decrease the mother's reserves. Pregnant breastfeeding mothers may notice the need for more daytime naps than usual, and there is also an overall decrease in energy throughout the day. Aside from the demands of breastfeeding and pregnancy, other things can cause the body's energy reserves to be depleted. Examples of these drains are stress, illness, problems, and major life changes. Whether you are fatigued because of pregnancy or another health condition, you can cope better by taking more frequent naps to recharge and trying to maintain a nutritious, well-balanced diet. Consuming fruits and vegetables can help increase energy levels.

Amenorrhea
A missed period can be caused by pregnancy or other conditions such as anovulation (no egg is released), low body weight, stress, chronic disease, and endocrine abnormalities. If you have amenorrhea, consult your gynecologist.

Implantation Bleeding or Spotting
This is spotting or slight bleeding caused by the implantation of the embryo into the uterine wall. It typically occurs one week following ovulation. While the bleeding and/or cramping is light and short-lived, implantation bleeding is not necessary for a healthy pregnancy. If the bleeding is accompanied by pain, go to the hospital as soon as you can.

Frequent Urination
When a fetus grows, it presses against the bladder and causes it to shrink. Because her bladder fills up more quickly, she will urinate more frequently than usual. Frequent urination may be caused by pregnancy, but also other conditions like diabetes, kidney and/or urinary tract infections, bladder dysfunctions, uterine enlargement not related to pregnancy, and more. It can also be a result of simply drinking more fluids or taking diuretics (medications or substances that increase urine output).

Uterine Enlargement
After giving birth, the uterus will gradually return to its normal, pre-pregnancy size. For the first few days after delivery, the top of your uterus can be felt at or slightly below your belly button. After two weeks, it will be entirely in the pelvic area.

Pregnancy is not the only cause of the enlargement of the uterus. Conditions such as adenomyosis (thickening of the walls of the uterus) and fibroids (benign tumors of the uterus' wall) can also cause this. Other symptoms of adenomyosis are bleeding between periods, heavy and painful periods, constipation, pressure in the lower abdomen, frequent urination, and painful sexual intercourse. Adenomyosis causes similar symptoms, but the pain during periods tends to worsen over time. Imaging tests and physical exams can eavy and painful periods, constipation, pressure in the lower abdomen, frequent urination, and painful sexual intercourse. Adenomyosis causes similar symptoms, but the pain during periods tends to worsen over time. Imaging tests and physical exams can determine what causes the uterus to become bigger than normal

Quickening
Quickening is the fetus' movement felt by the mother. Usually, a pregnant mom may be able to feel her baby move at around 16 weeks. If you feel something moving inside your belly earlier than that, it may be caused by other things such as gas or movements of the intestines. Pseudocyesis or false pregnancy may also cause a sensation of having a baby even if there is none. On the other hand, genuine fetal movements may be hard to detect if you are extremely obese. This is why detecting the actual baby is the only reliable indicator of pregnancy.

Skin Changes
Pregnancy can cause certain signs on the skin—but remember: other things can cause them as well.

Linea Nigra: This is a dark line on the abdomen, which appears around the 23rd week of pregnancy. It starts from above the pubic hair and runs straight upwards to the belly button. Sometimes, a linea alba or light line appears and turns into a linea nigra later on. This is believed to be caused by the effect of hormones to the skin, causing it to create a dark pigment called melanin. Dark-skinned women are more prone to having this sign. This usually disappears after birth, so if it reappears, it could indicate that you are pregnant again.
Melasma: Melasma, or also known as chloasma (mask of pregnancy), is a condition of having dark patches of skin on the face. Like linea nigra, this is an effect of the hormones on the skin's pigmentation. Melasma can also occur on other parts of the body such as the areola. Although pregnancy hormones cause melasma, other things may also cause the skin to develop dark blotches: genetic factors, chronic sun exposure, medication use (ex. phenytoin and other drugs causing skin sensitivity to ultraviolet light), Addison's disease and certain types of skin conditions.
Striae Gravidarum: More commonly known as stretch marks, striae gravidarum are thin lines on the skin resulting from a growing belly during pregnancy (striae means grooves and gravidarum means pregnancy). The skin develops stretch marks when it grows faster than it can adjust itself. These marks often appear on the baby bump during the third trimester, but they may also develop on areas that accumulate fat, such as breasts, hips, thigh, buttocks and lower back. Weight gain or increasing body size not associated with pregnancy can cause these marks.
So far, all these are not absolute signs of pregnancy. The next ones are stronger signs of pregnancy. Still, you can't consider them the strongest.

Probable Signs (Moderate Chance of Being Pregnant)

Probable signs of pregnancy can be observed by someone else other than the mother. These are more reliable than presumptive signs but they are not completely accurate in revealing pregnancy. These include:

Fetal Outline
Braxton Hicks Contractions
Chadwick's Sign
Goodell's Sign
Hegar's Sign
Ballottement
Laboratory Tests
Fetal Outline
A ring that may be the gestational sac can be seen within the mother's lower abdomen via ultrasound. This outline may turn out to be something else, so it is best to see the actual fetus before confirming pregnancy.

Braxton Hicks Contractions
Painless contractions (tightening) of the uterus are called Braxton Hicks contractions and they occur during the second trimester. Myomas can also cause these, so unless the fetus is detected, contractions should not be considered as a pregnancy sign.

Chadwick's Sign
When the cervix, vagina, and vulva turn from pink into purple, the woman may be pregnant. This typically appears from six to eight weeks into the pregnancy, when the areas develop more blood vessels to meet the additional needs of mother and child. Related to this is swelling of the legs andand pelvic pain that result from the changes in the blood and lymph circulation. Hormonal imbalances may cause this sign so this should not be your main indicator.

Goodell's Sign
The cervix becomes softer than usual at six to eight weeks. A hormonal imbalance may cause this kind of sign.

Hegar's Sign
The lower segment of the uterus becomes softer. Again, this may be related to hormonal imbalances, not pregnancy.

Ballottement
When the lower uterine segment is tapped by an examiner, the fetus can be felt rising against the abdominal wall. Ballottement is not a 100% certain sign of pregnancy because cervical or uterine polyps (clump of benign cells) can also bounce when tapped.
Signs and symptoms of polyps are heavy periods, bleeding in between periods, and irregular menstrual bleeding. These are diagnosed through transvaginal ultrasound, endometrial biopsy (taking a sample of the area affected via a catheter and examining it in a lab), and/or hysteroscopy (insertion of a telescope into the vagina and cervix). Benign polyps may not need intervention, but they can also turn cancerous. They are removed via medication or surgery if they have turned into cancer.

Laboratory Tests
Although pregnancy tests are accurate for up to 98% of the time, the results are only considered probable rather than positive because there is still a chance of misdiagnosis.

There are many kinds of tests that probably indicate pregnancy. Urine tests are the easiest to use and there are kits that you can use at home, but they are not as sensitive as blood tests.

Note: Most current over the counter urine pregnancy tests (sensitivity of 25 units per liter) are positive results 3–4 days after embryo implantation; by seven days (the time of the expected period) 98% will be positive. A negative result one week after your expected missed period virtually guarantees that you are not pregnant. These tests detect human chorionic gonadotropin (hCG), a hormone produced by the placenta when it becomes implanted into the uterine wall. Traces of hCG begin to appear in the blood 24–48 hours after implantation. They peak between day 60–80 of pregnancy, but after that, the hCG level declines, so it will no longer be detectable in the blood or urine. Thus, pregnancy tests may no longer be reliable after three months.

HCG Blood and Urine Tests: Because pregnancy tests are highly sensitive and accurate, women who get negative results on a pregnancy test are advised to retake the test one week after if they don't still have their period.
Ultrasound: An ultrasound may be given to determine whether the fetus has developed or not. If not, or if it is just partially developed, the positive result of the pregnancy test may just be the result of the hydatidiform mole. Blood tests may also be performed to know what's causing the condition.

Hydatidiform Mole
An overgrowth of bodily tissues that are supposed to become the placenta (hydatidiform mole) causes a positive result on the hCG test even if there is no fetus. This is diagnosed by inspecting the fetus and determining whether it is growing abnormally. There may also be vaginal bleeding, especially during the first three months. It can also accompany preeclampsia symptoms like high blood pressure, and swelling of the legs and feet

Positive Signs (Confirmed Pregnancy)

Positive signs are those that guarantee that the woman is pregnant. If you have these signs, there is a hundred percent guarantee that you're pregnant. So far, only three positive signs are recognized by medical professionals.

Heartbeat of the Fetus That Is Separate From the Mother's
Seeing the Fetus Through Ultrasound
Movement of the Fetus That Is Felt by an Examiner
Heartbeat of the Fetus That Is Separate From the Mother's
Hearing the fetus heartbeat or seeing it in motion is a sure sign that the mother is carrying a child. A vaginal ultrasound can detect a fetal heatbeat at as early as 5 1/2 weeks. The usual heart rate is 120-160 beats per minute. The embryo can sometimes have a slower heart rate, especially before a seven weeks gestational age. A heartbeat above 160 can occur with fetal movement.

Seeing the Fetus Through Ultrasound
An ultrasound will reveal the fetus by the 8th week of pregnancy. Using a real-time technique, the movement of the heart can be seen by the 6th week.

Movement of the Fetus That Is Felt by an Examiner
A woman can sense her baby move inside her womb when she is about 16–20 weeks pregnant, but an examiner can only feel these at about 20–24 weeks. Fetal movement felt by an examiner is considered more reliable than those that are subjective and can only be perceived by the mom.

Eat a balanced diet for both you and your kids. | Source
New Baby, Unborn Baby, and Mother: How to Care for All Three

Calorie Intake: In addition to a balanced diet and prenatal vitamins, the mother should add 500 to 800 calories to her normal recommended dietary allowance. Approximately 300 of those calories goes to the fetus as it grows in the uterus and 200–500 calories will help her maintain adequate milk production.
Calcium: An increased amount of calcium is needed by both the fetus and the breastfeeding child for growth and development and to avoid potential deficiencies in the mother. The fetus and nursing child extract a lot of calcium from the mother's body, which could predispose her to more cramps and even hypocalcemia.
Hydration: Drink lots of water. Keep the body hydrated throughout the day to help combat fatigue and ensure proper body processes and overall health of the fetus, child, and mother.
Rest: Fatigue may be worse than in an ordinary pregnancy or simple breastfeeding. Much energy is required to maintain the pregnancy and to provide adequate breast milk production. Get enough rest and eat more nutritionally-dense foods.
Nipple Care: Due to increased nipple sensitivity occurs in response to the pregnancy hormones, estrogen, and progesterone, the woman's nipples may become sore. If she's still breastfeeding, she'll need to take extra care of the nipples to reduce soreness. Dryness can cause nipples to become more painful and may even lead to cracking or bacterial infections. Apply nipple shields when breastfeeding or use lanolin cream. As the pregnancy progresses, the nipple soreness and breast tenderness may eventually abate.
Weaning: If the discomforts are too much to handle, it may be time to wean the child. Formula may be used to supplement breast milk, and if the child is ready for solid foods, increase these with each feeding. Emotional attachment may become an issue. Deal with fussing, tantrums, or any negative reactions to weaning in a loving manner. Always assure the child of parental love. Engage in other bonding activities to let the child feel less neglected and more loved.
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Regaining Fertility While Breastfeeding

So what happens if you want to become pregnant and you are still breastfeeding? There are both natural ways to boost fertility, along with ways your doctor can help.

For most women, periods resume between 6–18 months after giving birth. Once your periods resume, your body is capable of getting pregnant. Evidence suggests that the increased prolactin levels in women that are breastfeeding prevent them from ovulating and having periods (NCBI). Once an infant starts sleeping through the night, or the mother goes back to work and is separated from the infant during the day, the feeding frequency and duration drops, which in turn makes the prolactin levels drop. This can cause ovulation to resume.

Fertility treatments while breastfeeding is not advisable as the hormones can accumulate in breastmilk and have potentially negative effects on the baby.

Sources

Breastfeeding While Pregnant | What to Expect
Is it okay to breastfeed while pregnant? Learn how to feed your baby while you’re pregnant with another safely, how many calories should be in your diet and more from WhatToExpect.com.
Breastfeeding and special situations | womenshealth.gov
Learn the answers to questions about breastfeeding with twins or triplets, when pregnant, after breast surgery, and in other special situations.
The Effect of Lactation on Ovulation and Fertility - PubMed - NCBI
Clin Perinatol. 1987 Mar;14(1):39-50. Review

Breastfeeding While Pregnant

Breastfeeding During Pregnancy: Safety and Challenges
You may have just started adjusting to breastfeeding only to find out you are pregnant again. This might lead to a rush of questions and concerns. Is it safe to breastfeed while pregnant? How will this affect the fetus? How will this affect my weaning child? Can I breastfeed two children at once?
All of these questions and feelings are understandable. While the decision of whether or not to breastfeed while pregnant is not always clear, an understanding of its benefits, its risks, and how ready you and your nursing child are to wean will help you determine what is best for everyone involved.
Is it Safe?
Many women worry about breastfeeding while pregnant as breastfeeding can cause mild uterine contractions. However, in a healthy pregnancy, these contractions are not a concern, as they generally do not cause preterm labor. This is because oxytocin, the hormone released during breastfeeding that stimulates contractions, is usually released in such a small amount during breastfeeding that is not enough to cause preterm labor. Such contractions are also harmless to the fetus and rarely increase the chances of having a miscarriage. Also, although a small number of pregnancy hormones pass into your milk, these hormones pose no risk to your child.
While breastfeeding during pregnancy is generally considered safe, there are some cases where weaning may be advisable:
If you have a high-risk pregnancy or are at risk for preterm labor
If you are carrying twins
If you have been advised to avoid sex while pregnant
If you are having bleeding or uterine pain
If you experience these symptoms, talk with your doctor to determine whether weaning would be the best option for you, your nursling, and your unborn child.

Is My Child Ready? Am I Ready?
Another important aspect to consider is whether your older child is ready to wean. Factors affecting this include your child’s personality, age, and nursing patterns, as well as your child’s psychological and physical response to your pregnancy.
It is common for a mother’s milk supply to lessen during the fourth and fifth months of pregnancy. This can cause changes to the milk and may make your milk distasteful to your child. For this reason, your infant may be ready to wean earlier than you anticipated. On the other hand, your infant may be attached to breastfeeding and not ready to wean.
Similarly, you may question whether you yourself are ready for your child to wean. You may also wonder how your pregnancy may affect your relationship with your nursing child. Another important consideration is whether your child is breastfeeding mainly for nutrition or for comfort.
It is crucial to monitor the health and development of infants who are less than six months old and are dependent exclusively on breast milk. Additional feedings may be necessary to ensure your infant is properly nourished. Babies who are already eating other foods, on the other hand, may grow to prefer other foods over breast milk as your milk supply decreases.
Potential Challenges
While breastfeeding during pregnancy has its benefits, it may also present some challenges. For instance, some physical challenges may include nausea due to the let-down of milk as well as sore nipples. Nearly 75% of mothers experience sore nipples. Focusing your attention towards something other than the discomfort may provide some alleviation.
Many women also have concerns that breastfeeding while pregnant may contribute to fatigue. Yes, fatigue is a normal part of all pregnancies. Thus, it is certainly understandable that you may be hesitant to breastfeed due to fear that it may require more energy and add to your fatigue. However, breastfeeding is not tiring in and of itself. Sitting or lying down to breastfeed may actually help ensure you get the extra rest you need.

Eating Well
If you decide to breastfeed while pregnant, it is essential that you eat well for the health of your nursing child and your unborn child. Your calorie intake will depend on how old your nursling is. You will need around 500 supplemental calories per day if your child is eating other foods besides breast milk or 650 more calories if he is less than six months old.
This is in addition to the 350 extra calories you need during the second trimester and the 450 extra calories you need during the third trimester. If you are in your first trimester and find it difficult to eat due to nausea, you will be relieved that no additional calories are required during the first trimester.
Ultimately, when breastfeeding and pregnancy coincide, the primary considerations you have to look at, our relationships and feelings. You will want to consider the needs of your unborn child and your nursing child in addition to your own feelings. While you may want to leave your options open depending on the situation and the needs of you and your children, the decision is essentially up to you.
Compiled using information from the following sources:
1. Feldman, S. (2000). Nursing through pregnancy. New Beginnings, 17 (4). Retrieved from
2. Harms, R. W. (2012). Is it safe to continue breastfeeding if I’m pregnant with another child?.
https://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/expert-answers/breast-feeding-while-pregnant/faq-20057803
3. Walters, S. (2008). Breastfeeding during pregnancy.

Could I be pregnant even though I’m breastfeeding?

Expert Answer
Karoline Pahl
GP

Yes, it's possible to get pregnant any time from about three weeks after giving birth. This is true even if you're breastfeeding and haven't had a period yet.

Many women are less fertile while they're breastfeeding, especially in the early weeks and months. This is because breastfeeding reduces your levels of certain hormones (gonadotrophin-releasing hormone and luteinising hormone), which are needed for ovulation and pregnancy.

The more your baby breastfeeds, the lower your hormone levels will be, and the less likely you are to become pregnant. If your baby is under six months and exclusively breastfeeding day and night, your chances of conception are low.

Some women actually use breastfeeding as a form of birth control. This is called the lactational amenorrhoea method (LAM). LAM is most likely to help you avoid pregnancy if:

your baby is under six months and breastfeeds often, including at night
your baby doesn't eat or drink anything except your breastmilk
your baby doesn't use a dummy
your periods haven't started again

However, there are no guarantees with LAM. The longer your baby goes between feeds, the more likely it is that you could become pregnant again.

Many women think that they won't get pregnant until they've had at least one period. However, your ovaries will release an egg before your period arrives. So you'll probably be fertile for at least a few weeks before you notice any signs.

If you know you don't want to get pregnant while breastfeeding, it's best to start using contraception as soon as you start having sex again. Find out which types of contraception are safe to use while you're breastfeeding.

If you are keen to get pregnant again as soon as possible, read what our expert has to say about the best age gap between babies.

More information:
Learn more about breastfeeding and your periods.
Think you may be pregnant? Take our quiz or check out the earliest signs of pregnancy to look out for.

You can carry on breastfeeding while you’re pregnant with your next child, without causing any harm to your toddler or your unborn baby. Here’s what you need to know if you decide to breastfeed while pregnant.

Your body will continue to produce enough milk to nourish your older child through your pregnancy.

Is it safe to breastfeed while pregnant?
You might choose to breastfeed through your next pregnancy for several reasons. For example, you might unexpectedly fall pregnant while your first baby is still young (it is possible to fall pregnant while breastfeeding, even if your periods haven’t come back). Or you might not be ready to wean your toddler yet (weaning usually happens any time between birth and age 3).

Whatever the reason, it is usually perfectly safe to breastfeed while pregnant. Your body will carry on producing enough milk to nourish your older child, while your unborn baby will get all the nutrients they need from your body.

Breastfeeding does trigger mild contractions. These are safe in uncomplicated pregnancies, but if you are at risk of preterm labour — for example, if you are expecting twins or more, or if you have had a miscarriage or preterm birth in the past — then seek advice from your doctor or midwife.

Looking after your first child
Your breastmilk will still provide your first child with the nutrients they need. However, you are likely to produce less milk as your pregnancy progresses. Also, the content of your milk will change as you start to produce colostrum, and it might taste different. These changes might lead your older child to wean themselves at some point during your pregnancy. This often happens around the 5-month mark.

Colostrum is a natural laxative, so your older child’s poo might be more liquid than normal. This is nothing to worry about.

If your older child is less than 1 year of age when you fall pregnant, keep a close watch to make sure they’re putting on enough weight after your milk changes. You may need to introduce extra feeds if they are still relying on breastmilk for their nutrition. Talk to your maternal child health nurse for advice.

How to look after yourself
Breastfeeding while pregnant can make your breasts sore and your nipples tender. You might find you are even more tired or experience worse morning sickness than you normally would during pregnancy.

These side effects are due to your pregnancy hormones. They may clear up after the first trimester, but for some women they last the entire pregnancy. It can help if you make sure your older child is attached well, or change your position while breastfeeding.

You can look after yourself by eating well, making sure you are well hydrated, and getting plenty of rest. You don’t need to take lots of vitamin or mineral supplements — your body will adjust to making breastmilk and nourishing your unborn baby at the same time.

After the baby is born
You can keep feeding your older child after the baby is born. This is called tandem feeding. Your newborn will still get all the colostrum they need — you don’t have to limit your older child to one side.

There are different ways of tandem feeding. You could feed both children at the same time (you might need some cushions to prop you up or you might find it easier lying down). Or you could feed the newborn first and then your older child.

You might find your older child wants to feed all the time because you have a lot of milk. If you like, you can limit their feeds. You might also find that your newborn has trouble coping with your let down reflex because you are producing so much milk. You could try feeding your older child first then attaching the newborn to the other breast after the milk has started to flow.

How to wean your older child
If you decide to wean your older child, it’s a good idea to do this while you’re still pregnant so they don’t have to cope with so many adjustments after the baby is born.

If you would like to encourage your older child to wean while you are pregnant, you could try weaning them slowly by delaying feeds or encouraging shorter feeds. If your child is old enough, explain to them that your breasts feel sore.

For more tips, see weaning.

More information
Call Pregnancy, Birth and Baby on 1800 882 436 to speak to a maternal child health nurse for advice and support.

Sources: American Pregnancy Association (Breastfeeding while pregnant). Opens in a new window.Australian Breastfeeding Association (Breastfeeding through pregnancy and beyond). Opens in a new window.Babycentre (UK) (Can I still breastfeed my baby while I'm pregnant?). Opens in a new window.Mayo Clinic (Is it safe to continue breast-feeding if I'm pregnant with another child?). Opens in a new window.Women's Health (Understanding your menstrual cycle fact sheet)

aby Breastfeeding Breastfeeding Basics
Can I get pregnant while breastfeeding?

By Karisa Ding, editor
October 28, 2018

Yes, you can get pregnant while you're breastfeeding. So if you don't want to have another baby just yet, your best bet is to use a reliable form of birth control as soon as you start having sex again after giving birth.

That said, it's also true that you may not ovulate for several months (or even longer) after giving birth, especially if you're exclusively breastfeeding your baby.

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The fact that breast milk production delays the return of menstruation is actually the basis for a contraceptive technique called the lactational amenorrhea method (LAM).

But in order to use this method properly, you have to meet certain criteria:

Your baby must be younger than 6 months old.
You have to breastfeed at least every four hours during the day and every six hours at night.
When using LAM, you can't supplement breastfeeding with formula. (Pumping instead of nursing and feeding your baby solids also make LAM less effective.)
LAM is reported to be 98 percent effective during the first six months postpartum when you meet these conditions exactly. But the rate of effectiveness drops as your baby gets older and your situation changes – like when your baby starts solids or nurses less as he starts sleeping through the night, for example.

Keep in mind that you could start ovulating again at any time without knowing it. That means it's possible to get pregnant before you have your first period after your baby is born. How? You're fertile around the time you ovulate, and that happens before you get your period – typically about two weeks earlier. So don't wait until you have a period to find a reliable birth control method.

Few women in the United States rely solely on LAM to prevent pregnancy, partly because of easy access to other contraceptive methods. Also, few women in this country nurse their babies around-the-clock for six months.

If you want to use breastfeeding for natural family planning, talk with your healthcare provider or a lactation consultant about LAM – ideally before your baby is born.

s It Possible to Get Pregnant While You're Breastfeeding?

by Jenn Sinrich
Reviewed on June 25, 2019

Wondering if breastfeeding can double as your birth control? Here's the scoop.
If you just recently had a baby, your mind is probably overflowing with a myriad of questions about your new mom life, from how to know whether your baby is getting enough milk to when (or if) you’ll ever score a full night’s sleep again.

One that tends to top the list for most breastfeeding mothers is whether or not you can get pregnant while breastfeeding. You may have heard from a friend that nursing can serve as a form of birth control — and while that’s not entirely untrue, it’s not the whole story either.

Can you get pregnant while you’re breastfeeding?

The simple answer is yes. Although breastfeeding offers some protection from ovulation, the monthly occurrence where you release a mature egg from one of your ovaries, it is possible to ovulate and become pregnant prior to getting your first period.

The key player here is the hormone oxytocin, which is responsible for milk production. It actually suppresses the brain from making the main hormone that stimulates the ovary to grow an egg each month that will eventually ovulate with the goal of meeting a sperm. When a mother is breastfeeding exclusively, or even on a consistent basis, it is less likely that she is going to ovulate at all until she starts to wean.

Can you get pregnant if you’re breastfeeding and haven’t gotten your period yet?

Since ovulation comes before menstruation in your monthly cycle, the absence of Aunt Flo does not eliminate the chance that you could be ovulating at any given point. In fact, it is most common for you to get a period about two weeks after ovulation. In other words, if you wait until you get your period to start using other forms of birth control, it may be too late to prevent pregnancy if that’s what you’re trying to do.

Why do people think of breastfeeding as birth control?

Exclusive breastfeeding, which consists of nursing at least every four hours during the daytime and at least every six hours at night, for the first six months postpartum and before the return of your period is referred to as Lactational Amenorrhea (LAM). It is considered an effective form of birth control so long as all of the criteria are met.

Breastfeeding outside of those criteria, especially when the mother is supplementing with formula or solids and her period has yet to return, does not offer the same contraceptive protection. For this reason, your OB/GYN will likely suggest that you switch to another kind of birth control if you're not actively trying to get pregnant.

Can breastfeeding interfere with your pregnancy if you do get pregnant?

It is generally considered safe to continue to breastfeed once you become pregnant. However, some women may experience cramping due to the release of small amounts of oxytocin (the same hormone that causes contractions) during breastfeeding. The concern is that, in rare cases, this can cause preterm labor.

While this is unlikely, if you are pregnant and breastfeeding you should tell your OB/GYN if you start experiencing regular and/or increasingly painful contractions to rule out any interference with your pregnancy. The most important consideration to make when breastfeeding during pregnancy is to get enough calories to support both your growing fetus and developing child at the same time.

While you certainly can use breastfeeding to your advantage if you’re trying to prevent another pregnancy so quickly, it’s not a fool-proof method, so it's important to be careful. If you follow the rules laid out in the LAM method — exclusive breastfeeding of an infant younger than 6 months old before your period comes back — you have less than a 5 percent chance of getting pregnant. But you shouldn't rely on breastfeeding as a form of birth control, and your safest bet is to use a backup method even if you are nursing.

It's also important to note that doctors advise women to wait a full year and ideally 18 months to get pregnant again because it's the safest and healthiest option for them and their future pregnancies. Getting pregnant earlier than that, especially within the first six months of your previous baby's birth, can increase the risk of complications in the new pregnancy.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect Before You’re Expecting. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.

Don't Listen To Anyone Who Says You Can't Get Pregnant While Breastfeeding

A little pregnancy-prevention preoccupied bird might have told you that if you’re breastfeeding, it’s basically impossible to get pregnant even if you have sex without protection. It makes sense—if you recently had a child, your body should do its due diligence and set up a natural baby-proofing mechanism so you don’t accidentally wind up with way more than you bargained for. But that logic isn’t as simple as it seems.
“It’s true and not true,” Jamil Abdur-Rahman, M.D., board-certified ob/gyn and chairman of obstetrics and gynecology at Vista East Medical Center in Waukegan, Illinois, tells SELF. Yes, the very act of breastfeeding suppresses ovulation, he explains. Namely, prolactin, the hormone that stimulates breast milk production, inhibits the FSH hormone that triggers your ovarian follicles to release eggs, he explains. Without an egg available for fertilization, you can't get pregnant, which is aces when you're still adjusting to new motherhood.

But the general thinking is that this only applies to people who are strictly breastfeeding, not those supplementing with other forms of nutrition for their babies. “When you’re only breastfeeding, your body is getting that constant hormonal feedback,” Sarah Yamaguchi, M.D., ob/gyn at Good Samaritan Hospital in Los Angeles, tells SELF. It’s like with birth control pills, she explains: Protection works best when there’s a consistent stream of ovulation-preventing hormones in action. When you miss birth control pills, you're more liable to get pregnant, and your body interprets on-and-off breastfeeding in a similar way, she says.
There’s no concrete rule about how often you need to breastfeed for this protection to kick in. However, most people who breastfeed frequently, around every four hours during the day and every six hours at night, don’t ovulate and won’t get pregnant, Abdur-Rahman says.
But even if that is true for you, it isn’t even in effect for a full year, the experts caution. “If it’s been more than six months postpartum, most people start ovulating again,” Abdur-Rahman says. You might also start ovulating before that but not realize it, which can lead to an accidental pregnancy, Yamaguchi adds. There's this idea that you'll realize you're ovulating because you'll get your period, but that's not how the menstrual cycle works. Once you start ovulating again, an ovary will release an egg, then if there's nothing to fertilize, you'll get your first real postpartum period. “When you have that first ovulation, you have no clue,” Yamaguchi says. So, when you factor in that you’re supposed to wait six to eight weeks after giving birth to have sex again, you only have about four months to enjoy the sex-with-less-chance-of-pregnancy phenomenon.

There are ways to keep tabs on whether you might be at risk of getting pregnant while breastfeeding, like using ovulation kits, monitoring your temperature, which usually gets higher when you ovulate, or checking your cervical mucus, which tends to get thinner at that time of the month, Abdur-Rahman explains. Still, he says, "it's dicey."
Even if you're pretty sure you're not ovulating yet, neither expert thinks breastfeeding alone, even within the first six months, is adequate birth control if you’re having sex but don’t want to get pregnant. “If you’re exclusively breastfeeding and you really don’t want to be pregnant, definitely use something,” Yamaguchi says.
There are plenty of contraceptive options, although Yamaguchi cautions that ones with estrogen can affect milk supply and also put people at higher risk of blood clots for the first few months postpartum, and that IUDs placed in the months after childbirth have a slightly higher risk of expulsion (although it’s still small overall). A chat with your doctor will help you figure out which birth control method is your best postpartum bet.
You may also like: How Much Do Guys Know About Birth Control?

Early Signs of Pregnancy While Breastfeeding
By: Laura Candelaria
●
13 June, 2017
Many women use breastfeeding as a method of natural contraception until they wean their babies. This method can be successful, but in some cases regular menstruation can begin before you wean your baby, such as if you start breastfeeding less when your baby stops waking up for night feedings, or when she begins to eat solid foods. You can't predict when your menstrual cycle will return, so you could use a barrier method of contraception such as condoms to prevent pregnancy. If you still become pregnant while breastfeeding, there are some symptoms you may experience.

Breast Pain and Tenderness

One of the first symptoms of pregnancy that a breastfeeding woman may experience is breast pain and tenderness. Women may experience an increase in nipple sensitivity at this time. According to EarlyPregnancySigns.com, pregnancy makes the nipple extra sore and irritated while nursing, triggering pain and discomfort for many. There are some natural treatments for sore nipples. These include the use of a nipple shield, applying Lansinoh cream to the breasts after feeding, and allowing the breasts to air dry after breastfeeding. For many women, extreme nipple tenderness leads to weaning their babies from breastfeeding. Those who continue nursing throughout pregnancy may experience relief from breast pain and nipple soreness as the pregnancy progresses.

Decreased Milk Production

Your milk supply with likely slow down when you first become pregnant, according to HealthyChildren.org, which could be a sign of pregnancy. The content and taste of your breast milk will change throughout pregnancy. A woman may experience decreased milk production and changes in the appearance of her breast milk as her pregnancy progresses. A breastfeeding mother may notice that her child seems to be hungry more frequently and tries to initiate additional feedings. Decreased milk production and altered taste during pregnancy causes some babies to independently wean themselves from breast feeding. Supplementing with formula may be a sensible option for mothers who experience decreased milk production during pregnancy. If babies are of the right age, the addition of rice cereal or fruits and vegetables may help to satisfy their hunger.

Fatigue Early in Pregnancy

Fatigue is a common sign of pregnancy in a breastfeeding mother. Breastfeeding puts additional stress on a woman's body causing women who are nursing to feel more tired and sleepy than usual. During pregnancy rising pregnancy hormones can cause an additional increase in fatigue. A nursing mother who is pregnant may find herself sleeping more than usual and requiring naps during the day. A sensible way to combat fatigue naturally is to consume protein-rich meals throughout the day. Mild exercise, drinking plenty of water, and taking a mid-day nap can also help alleviate pregnancy-related fatigue.
Chest Heaviness From Breastfeeding
By: Brenna Davis
●
05 December, 2018
Pregnancy and lactation spark numerous changes in a woman's body, and some of these changes can be uncomfortable or jarring. It's common for breastfeeding women to feel a sensation of heaviness in their breasts and chest. As the breasts fill with milk, they exert pressure on the surrounding tissue and muscles which can cause a feeling of heaviness and even lead to back pain and muscle soreness. In most cases, chest heaviness is not cause for concern, but you should consult your doctor or a lactation specialist about any breastfeeding concerns.

Let-Down Reflex

The let-down reflex typically occurs after a baby has been nursing for a minute or two, but can also be a response to a crying baby, pediatrician William Sears explains in "The Breastfeeding Book." You may notice that your breasts feel heavier, tingly or warm when this occurs, and many women feel an overwhelming urge to breastfeed. Women who do not continue breastfeeding when the let-down response occurs may leak small quantities of milk.

Engorgement

Breast engorgement is the most common cause of painful chest heaviness in breastfeeding women, according to Sears. This occurs when your milk supply and your baby's nursing schedule have not yet lined up, and is especially common in the first few weeks after delivery. Encourage your baby to breastfeed when your breasts are engorged or use a breast pump to pump milk and relieve the painful feeling of fullness.

Larger Breasts

Your breast size can increase by several cup sizes during breastfeeding. This change can be painful and cause strong feelings of chest heaviness, particularly for women with small breasts. A supportive nursing bra can help your body adapt to the change. Stretch frequently and practice good posture with a straight back to prevent your breasts from injuring back and neck muscles.

Other Causes

If your breasts are swollen and red, you may be suffering from mastitis, a painful breast infection. This infection can cause fevers and, in very rare cases, become life-threatening, so consult your physician immediately. Sometimes chest heaviness is merely coincident with breastfeeding. If you feel pressure in your chest, numbness or tingling in your left shoulder or arm, or you feel light-headed, this could indicate heart problems, so call your doctor or go to an emergency room immediately.

Related Articles

How to Abruptly Stop Breastfeeding
By: Jennifer Oster
●
13 June, 2017
Breastfeeding is the recommended form of infant feeding, according to the American Academy of Pediatrics and the World Health Organization, as it has a wide range of health benefits for the baby, as well benefits for the mother. However, you might want or need to stop breastfeeding abruptly due to illness, medication contraindications, supply issues, work demands or personal preferences. Also, some women choose to wean a baby at a certain age due cultural factors or personal readiness, choosing to do so "cold turkey" to avoid prolonging the process. Ideally, you should gradually wean your child as abrupt weaning can be an upsetting to the child and uncomfortable -- or even painful -- for you. If you decide to stop abruptly though, there are ways to make the transition easier for both you and your baby.

Talk to your doctor about pain relief. Since abrupt weaning can be painful, your doctor may prescribe a pain medication to take while going through the process of weaning.

Express milk when your breasts become full. You may hand express or use a pump to relieve pressure, but avoid completely emptying the breast. By only expressing a small amount, your body will be less likely to continue to produce an abundant supply of milk since breastfeeding works on the principle of supply and demand -- the more you express, the more your body will make.

Place cold, fresh cabbage leaves in your bra. While not scientifically proven, the "Journal of Pediatrics and Child Health" recommends the use of cabbage leaves to relieve swelling in the breasts. It is theorized that fresh cabbage has dilation properties, opening the small blood vessels in the breasts, which improves blood flow in and out of the area, allowing the body to reabsorb the trapped fluid, according Marie Davis R.N., an International Board Certified Lactation Consultant.

Use cold compresses or cold gel-packs available at most drug stores for temporary pain relief.

Take a warm shower if engorgement is painful even after expression. Warm water might induce a slight milk letdown that can relieve pressure and pain and help soothe.

Stay hydrated. Staying hydrated is important to remaining healthy -- and decreasing water or fluid intake does not help the weaning process.

Check for signs of breast infection. During weaning, plugged ducts, which can lead to breast infection, may occur. If you develop redness, hard breast lumps, fever or severe pain, contact your doctor.

Tips

To make the transition easier for your baby, provide her with a bottle that is similar to the breast in structure and provides a slow flow much like the human breast.
Warnings

Consult your doctor before abruptly weaning; gradual weaning is the preferred method by most doctors.

Side Effects of Ending Breast-feeding
By: Amber Canaan
●
18 December, 2018
Weaning is the cessation of the breastfeeding relationship. It can be child-led or initiated by the mother. Child-led weaning usually does not occur until the baby is 18 to 24 months old. A mother may decide to wean her baby earlier than this for a variety of reasons, including an emotional need to have her body back, work schedules or going on a medication that may be contraindicated while nursing. Regardless of the reason or whether the mother or child initiates the weaning process, breastfeeding mothers may experience side effects related to the weaning process.

Feelings of Fullness

When breastfeeding comes to an end, it will take a period of time for the milk to subside. During this time, mothers may feel an uncomfortable feeling of fullness, especially if weaning occurs abruptly. Certified lactation consultant Kelly Bonyata recommends expressing just enough milk to relieve the discomfort. Expressing small amounts of milk like this will not stimulate milk production to continue, Bonyata adds. Gradually weaning your baby by reducing nursing sessions slowly over a period of time will allow milk production to adjust and help minimize feelings of fullness.

Plugged Ducts and Mastitis

When weaning occurs, it is possible that very painful side effects such as plugged ducts can occur. When a plugged duct occurs, you will experience a localized point of tenderness on the breast. Massage, heat and milk expression are needed to remedy a plugged duct. If it is left untreated, a serious breast infection known as mastitis can occur. Symptoms of mastitis include severe pain in the breast, redness, fever and warmth to touch. Mastitis is treated using heat, milk expression and, most importantly, antibiotics. Gradual weaning can also decrease the risks of developing these side effects of weaning.

Depression

Discontinuing the breastfeeding relationship can trigger feelings of depression in the mother. As the milk production decreases, hormone levels begin to fluctuate. Prolactin is the hormone responsible largely for lactation. Prolactin can also impart feelings of calmness and happiness to the mother. When this hormone decreases, feelings of sadness may occur. The time of weaning can also elicit feelings of sadness when the mother realizes her baby is growing up and this part of the relationship is over. Mothers with a history of depression may be more likely to experience weaning-induced depression. Talk to your midwife or doctor if depression occurs and does not go away or worsens.

Physical Symptoms

Sometimes the weaning process can cause a mother to experience other physical symptoms unrelated to the breasts. Nausea, mood swings and headaches are all side effects that may occur with the weaning process, most likely due to hormonal fluctuations. These symptoms can mimic early pregnancy symptoms, so some mothers may think that a new pregnancy has occurred when in reality it is the hormonal changes from weaning that are to blame. Discuss the process with your doctor well before your baby reaches the age when he's likely to self-wean or before you need to wean him for other reasons.

Warm Breasts & Tender Nipples While Breastfeeding
By: Candice Hughes
●
18 December, 2018
Nipple pain is common when you begin breastfeeding and is often a natural and normal part of learning how to feed your newborn. Sometimes, however, conditions such as infections, plugged ducts or engorgement could cause sore nipples or breasts that feel warm. If you are concerned about the pain you are feeling in your breasts or nipples while breastfeeding, talk to your physician, a local lactation consultant or your pediatrician.

Tender Nipples

For the first few days after your baby is born and begins breastfeeding, your breasts and nipples may feel sore or get cracked. You may even notice that they bleed. Some women experience intense pain with sore nipples, while others only feel slightly uncomfortable. If the baby latches on well, the pain should subside, though you may feel a pinch for the first few seconds to a minute after your baby latches. A lactation consultant can help you make sure your baby is latching correctly and also help you learn tips and tricks for breastfeeding more comfortably.

Full, Swollen Breasts

You may notice that your breasts feel very full in the first week or two after giving birth. Often, your body will produce excess milk to ensure your baby is getting what he needs. Once you have breastfeeding established and are feeding your baby regularly -- every one to three hours for at least 15 minutes on each breast -- your body will produce just the right amount of milk and the swollen, warm feeling will dissipate.

Engorgement

Engorgement is different than full breasts. It is caused by an increase in your milk supply, extra fluid and blood flow to your breasts, according to the California Pacific Medical Center. Fullness is a normal condition that occurs right after birth as you are adjusting to breastfeeding, whereas engorgement can happen at any point while you breastfeed. If your baby skips a feeding, your breasts may become engorged. To lessen the swelling, use cold or warm compresses or take a hot shower. Massage your breasts to express milk or use a hand pump or electric pump to decrease the amount of milk in your breasts.

Plugged Milk Duct

Sometimes you may feel a hard, painful spot on your breast caused by a plugged milk duct. The California Pacific Medical Center states that plugged ducts often occur due to partial feedings or putting pressure on the duct for an extended period of time. You can try to open the duct by using warm compresses before breastfeeding, massaging the breast in the sore area, nursing frequently and using different breastfeeding positions, wearing loose clothing and avoiding underwire or tight bras.

Mastitis

Mastitis occurs in women with plugged ducts, engorgement or cracked nipples, women who wear tight bras, those who have skipped feedings or women who are anxious and fatigued, according to MedlinePlus. Mastitis is an infection that causes flu-like symptoms, such as muscle aches, fever and hot, red, sore breasts. Antibiotics or other simple treatments can quickly cure the condition, so talk to your doctor if you think you may have mastitis.

Thrush

A yeast infection called thrush can be transmitted between mother and baby while breastfeeding and causes severe, stabbing pain, according to Dr. Larissa Hirsch of FamilyDoctor.org. Thrush is often diagnosed once latching issues have been corrected but pain continues. Symptoms of thrush may include nipples that flake, itch, are red or shiny and a a baby whose mouth has white patches on the tongue or inside of her cheeks or is fussy, gassy and has diaper rash. Sometimes pain may be the only symptom. If your baby latches well but you still have intense pain while breastfeeding, contact your physician for diagnosis and treatment.

Correlation of High Blood Pressure After Delivery and Breast-feeding
By: Natalie Stein
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05 December, 2018
An increase in blood pressure during or after delivery is common and raises a woman's risk for developing chronic diseases later in life. Several factors may influence postpartum blood pressure, and treatment may affect breast-feeding. To keep yourself and your infant healthy, consult your doctor if you have postpartum hypertension or any questions about breast-feeding.

Benefits of Breast-feeding

Breast milk is healthy for your baby because of its essential nutrients, including protein, vitamins and minerals, according to Women’s Health. The antibodies in your breast milk help your infant fight infections, and breast-fed infants are less likely to become obese later in life. Potential benefits for the lactating mother include a lower risk of developing type 2 diabetes, stress reduction and lower costs. You can start breast-feeding immediately after delivery, and postpartum hypertension is not likely to affect the flow of milk.

Postpartum Hypertension

More than one-seventh of pregnant women experience increased blood pressure during pregnancy or soon after giving birth, according to an article in the journal "Heart." Blood pressure often increases within the first few days after birth, and you might need to remain in the hospital after delivery if you develop hypertension. Inform your doctor if you want to breast-feed during this time. Treatment for postpartum blood pressure may include blood pressure medications and further monitoring.

Dietary Components

Caffeine also may increase your risk for high blood pressure, according to MayoClinic.com. Sources include coffee, chocolate, tea and caffeinated soft drinks and energy drinks. According to La Leche League, consumption of caffeine also may lead to caffeine in breast milk, and infants may display symptoms of caffeine ingestion, such as insomnia. New mothers may want to reduce caffeine intake. Note that adequate intake of some minerals, such as magnesium and calcium, is necessary for maintaining healthy blood pressure but not for ensuring healthy breast milk, according to the Linus Pauling Institute Micronutrient Information Center. For example, even if you do not take in enough calcium, your breast milk will be high in calcium from your bones.

Considerations

You can lower your risk of developing perinatal high blood pressure by maintaining a healthy weight before pregnancy and gaining weight according to recommendations during pregnancy, according to the journal "Heart." Women who breast-feed are more likely to reverse pregnancy weight gain with a healthy rate of weight loss. Some medications for high blood pressure may be dangerous for your infant if you are planning to breast-feed. Discuss your situation with your doctor to get the best advice on how to maintain or achieve normal blood pressure readings while providing your child with the best possible nutrition.
Painful Breasts After Discontinued Breastfeeding
By: Jessica Lietz
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18 December, 2018
After discontinuing breastfeeding, it is not uncommon to experience pain in your breasts for several days or longer. Engorgement, plugged ducts and mastitis are painful complications of weaning, especially abrupt weaning. Fortunately, breast pain after weaning is preventable by slowly weaning your baby, and it is treatable with home care and medications.

Symptoms

Pain in your breasts after weaning occurs anywhere in the breast, including the areola or the body of the breast, according to certified lactation consultant Kelly Bonyata. The pain develops in one or both breasts, often peaking a few days after weaning and then slowly decreasing. Your breasts might swell, feel hard or lumpy, and you might run a fever. Leaking of milk from your nipples is not uncommon, especially when you shower, hear your baby or another child cry or when you experience friction from your shirt or bra against your nipples.

Causes

Abrupt weaning causes pain in your breasts due to engorgement, especially if you were breastfeeding or pumping frequently or if you had an oversupply of milk. Your body will continue to make milk for several weeks after weaning, which sometimes pools in the milk ducts, leading to a plugged duct. Mastitis, a painful breast infection, results from plugged ducts left untreated and manifests with symptoms similar to the flu, along with swelling, red streaks and pain in your breasts.

Treatments

If you begin to feel pain from engorgement, hand express or pump to empty your breasts one time, then pump or express just enough milk to reduce the pain as needed, recommends the Baby Center website. Drinking several cups of sage tea daily decreases your milk production, although you should check with your doctor before taking any supplements. Putting cold cabbage leaves into your bra and swapping them out every few hours once the leaves wilt reduces breast pain resulting from engorgement after weaning. Take ibuprofen or acetaminophen to reduce breast pain from engorgement, clogged ducts or mastitis. If your pain results from a plugged duct, massaging the duct and applying heat to the area helps loosen the plug. If you develop a fever or notice red streaks on your breasts, your pain is likely a result of mastitis, which requires antibiotic treatment.

Prevention

When you wean your baby, slowly dropping the number of daily nursing sessions helps prevent pain from engorgement, plugged ducts and mastitis. Dropping one nursing session every three days helps your body adjust to the decrease in demand. Slowly cutting down on the amount of time that you pump, such as decreasing by one to two minutes daily for each pumping session helps prevent painful engorgement for mothers who pump milk to feed their babies.

First Day of Pregnancy Symptoms
By: Evelyn Lewin
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14 August, 2017
Women typically experience a variety of symptoms throughout pregnancy. However, none of these symptoms typically occur on the first day. This is because, technically speaking, the first day of pregnancy is actually the day you conceive your baby. That said, you might experience pregnancy symptoms as early as the first day of your missed period -- or shortly thereafter. Tiredness, breast tenderness, increased need to urinate, nausea and vomiting, change in smell sensitivity and light vaginal bleeding are among the earliest symptoms of pregnancy.

Tiredness

Tiredness is often one of the first symptoms of pregnancy, and it may persist beyond your first trimester. You may be more tired in the morning upon waking, need to go to bed earlier at night or feel you need to nap to make it through the day. Hormonal changes and metabolic needs may account for first trimester fatigue. Anemia or low levels of other key nutrients can lead to exaggerated tiredness in the early weeks of your pregnancy.

Breast Tenderness

Breast tenderness is another common early symptom of pregnancy, which can occur as soon as your first missed period. This symptoms occurs due to enlargement of the milk-producing tissues of the breasts, which often leads to a sensation of heaviness or achiness. Your breasts may also be more sensitive to touch. You may find wearing a bra or sleeping on your stomach uncomfortable.

Increased Urination

Many women feel the need to pass urine more frequently early in pregnancy. This can occur both during the day and at night, leading to frequent trips to the bathroom or waking up during the night to empty your bladder. The need to pass urine more often in early pregnancy seems to be related to hormonal changes rather than pressure on the bladder, which accounts frequent urination later in pregnancy.

Spotting

Implantation bleeding refers to spotting that occurs as the pregnancy burrows in the wall of the uterus. This occurs around the time of your missed period and may be due to direct effects of the process of implantation or hormonal changes taking place at this early stage of pregnancy. Implantation bleeding usually involves only small amount of brown or red discharge, which is unlikely to contain clots.

Morning Sickness

Nausea and vomiting during pregnancy, commonly referred to as morning sickness, can occur at any time of day. Nausea and vomiting affect approximately 70 to 80 percent pregnant women, according to a June 2011 article published in "Gastroenterology Clinics of North America." These symptoms can start as early as 4 weeks into your pregnancy. The nausea of early pregnancy is thought to be due to hormonal changes. While all pregnant women have these hormone changes, not everyone experiences morning sickness.

Increased Sensitivity to Odors

A study published in "Chemical Senses" in June 2004 found that 67 percent of pregnant respondents reported increased sensitivity to odors beginning in early pregnancy. Change in sensitivity to aromas can lead to food cravings when you smell something enticing. It can also lead to food aversion, as the aroma of certain foods may be off-putting during pregnancy. Certain smells can also provoke nausea and contribute to morning sickness.

When to See Your Doctor

Medical care is important throughout pregnancy, so schedule an appointment to see your doctor as soon as possible if you suspect you might be pregnant. Other reasons to contact your doctor in early pregnancy include: -- extreme fatigue and sluggishness -- severe morning sickness -- breast tenderness in one spot -- nipple discharge, tethering of your breast skin or a new breast lump -- burning with urination or blood in your urine -- heavy vaginal bleeding or passing clots

Reviewed and revised by: Tina M. St. John, M.D.

Causes of Swollen Aching Breasts
By: Laura Candelaria
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05 December, 2018
Breast discomfort in women is not all that uncommon, and not necessarily indicative of the presence of a particular disease or disorder, reports Breastdiscomfort.net. Many women experience breast swelling and discomfort at some point in their lives. Women should report any severe breast pain, swelling, or discomfort to their healthcare provider, especially if it is only present in one breast. There are some common causes of swollen aching breasts of which women should be aware.

Premenstrual Hormonal Changes

During the menstrual cycle, estrogen production increases and peaks just prior to mid-cycle, causing enlargement of the breast ducts, while progesterone changes lead to growth of the breast lobules (milk glands), reports Medline. This causes the breasts to swell, ache, and become tender. Some women may experience nipple tenderness during the premenstrual period. Women should consider limiting caffeine, foods high in fat, and excess salt during this time, as these foods may contribute to breast symptoms. According to Medline, the effectiveness of vitamin E, vitamin B6, and herbal preparations such as evening primrose oil are somewhat controversial and should be discussed with a health care provider.

Pregnancy

In early pregnancy, hormonal changes can cause breast swelling, discomfort, and tenderness. Hormonal breast changes may occur as early as 1 to 2 weeks following conception. The discomfort generally occurs during the first trimester, and may occur at, or soon after, childbirth, as the breasts start filling with milk, especially if they become swollen with milk, reports Breastdiscomfort.net. Women can also experience nipple tenderness during early pregnancy. The appearance of the areola (the darkened area around the nipple) may begin to appear larger in size and darker in color. Some women will notice the appearance of blue veins underneath the skin of their breasts. Women of child-bearing age who are experiencing breast tenderness may want to take a home pregnancy test if they have missed their periods.

Medications

Certain medications may cause swollen aching breasts. Oral contraceptives, the contraceptive patch, shot, ring, and the hormone-containing intrauterine device (IUD) may cause breast discomfort. These medications contain hormones that are similar to those in a woman's body. At increased levels, they may cause breast discomfort similar to the discomfort women may experience prior to their menstrual periods. There have also been reports of breast pain associated with prescribed antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), reports the Mayo Clinic.

Breast-feeding & Dry Skin
By: Carolyn Williams
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13 June, 2017
Breast-feeding provides a valuable method of feeding your baby nutrients and the antibodies your body naturally possesses. However, dry skin makes it a difficult process for some women. If you have dry skin, particularly on the nipple, breast-feeding becomes painful. Having dry skin all over your body may indicate a different postpartum medical condition, however.

Cracking

Breast-feeding is initially uncomfortable for many women. If your nipples become too dry, the skin cracks, which invites infection and also makes the process of the baby latching on and feeding painful. Using lanolin-based ointments, letting breast milk dry naturally on your nipples and avoiding synthetic material next to the nipple minimizes the potential for dry skin to develop.

Thyroid Issues

In 5 to 9 percent of women, the process of re-setting the body's functions postpartum causes issues with the thyroid, according to a 1999 study published in the July issue of "Thyroid." Hypothyroidism and hyperthyroidism become permanent for a quarter to a third of this group. Symptoms include systemic dry skin, an intolerance for cold, lethargy and poor memory for those who have hypothyroidism. Hyperthyroidism manifests as irritability combined with lack of energy. If these symptoms occur as you are nursing, consult your doctor for testing.

Hydration

Nursing requires that you stay hydrated. At least eight 8-oz. servings of liquid, such as water, milk or juice, help you maintain your nursing supply. However, the general rule is to drink if you feel thirsty. Especially the first few days after birth, when your body is shedding excess fluids, drink as much as you need, paying attention to the additional demands that nursing places on your hydration levels. If you become dehydrated, you endanger your milk supply and may also suffer from dry skin.

Infant Dry Skin

If you are breast-feeding and your infant has dry skin, speak with your doctors. Moderate dehydration symptoms include dry skin that is spongy and doesn't spring back when gently pressed. If your milk supply is compromised or you live in a very hot climate, pay careful attention to your infant's skin. If she cries without tears, has dry skin and seems lethargic, contact your doctor immediately.

Natural Ways to Stimulate Breastmilk Production
By: Christina Fitzgerald, MS, RD, LD/N
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13 June, 2017
Low breast milk supply is a common concern among many nursing mothers. While most moms produce enough milk to feed their baby, there are natural ways to encourage a larger supply. These include nursing more frequently, staying well-hydrated and consuming foods that encourage milk production. If you continue to have concerns about your baby's growth or your milk supply, speak with your pediatrician and lactation consultant.

Frequent Nursing

Breast milk production is a supply and demand process -- or, more accurately, a demand, then supply process. When your baby completely drains the milk from your breast, this triggers your body to produce more milk. The more often you nurse, the more the demand, and your body will respond with a greater supply. To increase supply, certified lactation consultant Kelly Bonyata recommends nursing every 1 1/2 to two hours during the day and at least every three hours at night.

Consider Pumping

Because breast milk is a demand, then supply process, the more often you deplete the breast, the greater your supply can become. If your baby has difficulty depleting your stores or does not want to nurse more often, pumping can speed up the supply. As the aim is to deplete the breast completely, keep pumping for two to five minutes after you see the last drop of milk. Keep in mind, though, that the amount of milk you pump is not an accurate indicator of your supply. A baby with a good suck can extract your milk much more efficiently than any pump.

Adequate Nutrition and Hydration

Taking care of yourself is an essential part of breast-feeding success but may be a low priority when caring for your baby. Your body needs a minimum of 1,800 calories per day while lactating. Trying to restrict more than this to lose the pregnancy weight could leave your body depleted, making it more difficult to produce milk. While "pushing fluids" does not directly correlate to a greater milk supply, drinking in response to thirst is important. Drink enough to keep your urine clear -- typically six to eight glasses each day.

Herbal Help
Fenugreek is an herbal supplement, and while there is no scientific evidence that it increases supply, moms have used it for this purpose for hundreds of years, according to certified lactation consultant Anne Smith. Fenugreek is rated as GRAS (generally regarded as safe) but may cause lowered blood sugar. According to Smith, the recommended dosage is two to three capsules taken three times per day. You should see a noticeable increase of your milk supply in one to three days if your body responds to the herb. Before starting any new medications or herbal supplements such as fenugreek, consult with your physician and pediatrician first.

How to Tell If You Are Pregnant While Breastfeeding
By: Kathryn Hatter
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23 July, 2013
While breastfeeding a baby, you are likely to experience a disruption to your regular monthly cycles and therefore your fertility. Continuous and regular breastfeeding usually prevents the body from ovulating, which should prevent pregnancy, according to Planned Parenthood. Although unusual, there is a small chance of becoming pregnant even while you're breastfeeding. If pregnancy occurs, discovering your condition may be a bit different this time around.

Note the dates of your menstrual cycles -- if you are having your period -- to determine the possibility of pregnancy. "Lactation amenorrhea" is the term for having no menstrual periods due to breastfeeding. This time without periods could last between 13 and 16 months after the birth of a baby, on average, according to AskDrSears.com. If you miss a period, this could indicate pregnancy. If you are not having menstrual cycles, however, you won't be able to use this as a possible indication of pregnancy.

Check for other possible signs of early pregnancy. You might experience headaches, nausea, a lower backache, fatigue, frequent urination and unusual food cravings or aversions, according to the American Pregnancy Association. It’s also common to experience light spotting, called "implantation bleeding," approximately six to 12 days after conception. Although tender breasts are commonly an early symptom of pregnancy, you may not notice this symptom because you are breastfeeding.

Take a home pregnancy test to determine whether you are pregnant. Follow product information for the timing of the test; some tests promise accurate results as early as the first day of a missed period (if applicable).

Call your physician to take a blood test, which is more accurate than a home pregnancy test. A blood test can give you an accurate result within seven to 12 days after conception, according to the American Pregnancy Association.

Factors Affecting Breastfeeding Mothers
By: Eliza Martinez
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29 July, 2013
You know that breastfeeding offers a myriad of benefits for your baby, but it might not be easy to get started or stick with it. Many mothers face challenges that make or break the decision to breastfeed or use formula. Understanding the possible obstacles you might encounter can help you make the best decision for you and your baby.

Socioeconomic Status

New moms who struggle with their finances might make the decision to skip breastfeeding or wean at an early age, according to Deborah McCarter-Spaulding, associate professor of nursing, on the website for the Center for the Promotion of Health in the New England Workplace. If a mother has to return to work shortly after having her baby, she may choose not to breastfeed because it can be difficult to find time to pump and store breast milk at work. Women with more financial freedom may be able to stay at home with their baby or take an extended maternity leave, which can influence the decision to breastfeed and for how long.

Postpartum Emotions

Most women experience some degree of the baby blues in the days and weeks following delivery. For some moms, this progresses to postpartum depression, which can impact breastfeeding. Breastfeeding can help reduce the risk of postpartum depression, according to the "International Journal of Psychiatry in Medicine." However, for women who suffer from postpartum depression, gathering the energy to breastfeed can be hard. Women with severe symptoms may avoid caring for their infant, which includes making the choice not to breastfeed. Many women experience postpartum depression as a result of weaning, adds a study in "BMC Pregnancy and Childbirth."

Breastfeeding Success

Breastfeeding isn't always easy and can in fact be frustrating and upsetting to some mothers. Preliminary success can influence whether a new mom sticks with it or not. Even women who are highly motivated to breastfeed might throw in the towel if they don't achieve success in the first week, according to an article in the journal "Pediatrics." Women who receive instruction and assistance from a lactation specialist are more likely to achieve success with breastfeeding, which makes hospital consultations important in the hours after birth.

Support

Having a support system in place after delivery improves the success of breastfeeding. Supportive husbands are particularly important, notes the "International Breastfeeding Journal." Having a husband who backs up the decision to breastfeed improves the chances of initiation and a mother sticking with it. If a husband isn't available, a supportive friend or family member offers similar benefits. If all else fails, moms can ask their doctor for a referral to a mom's group or breastfeeding support group that can help them do what's best for their babies and themselves.
Feeding
Physical Effects of Breastfeeding on Mothers
By: Ann Daniels
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13 June, 2017
Breastfeeding is a natural way to feed an infant that also has a variety of benefits. Breast milk provides all the nutrition a baby needs and promotes long-term health in infants. In addition to saving money on formula, mothers can also enjoy the physical effects from breastfeeding, such as health benefits and establishing a bond with their babies.

Weight Loss

Breastfeeding may help mothers lose weight after their baby is born. Weight loss occurs when you burn more calories than you consume. In an NBCNews.com article, University of Oxford researcher, Dr. Kirsty Bobrow, explains that the body burns up to 500 calories per day producing breast milk. The weight-loss benefits might even last decades. In her research, published in the July 2012 issue of the “International Journal of Obesity,” Dr. Bobrow and her team found that women in their 50s and early 60s who breastfed had lower body mass indexes than women who did not breastfeed.

Changes in Uterus

Breastfeeding promotes production of the hormone oxytocin in a woman’s body. This hormone helps your uterus contract so it returns to its pre-pregnancy size more quickly, according to HealthyChildren.org. Not only does this help flatten your tummy after childbirth, but the uterus returning to its normal size also provides additional benefits. The release of oxytocin can also help reduce postpartum bleeding and uterine involution -- when the uterus changes from pregnant to non-pregnant state -- for a quicker recovery.

Mother-Infant Bonding

Hormones released during breastfeeding -- prolactin and oxytocin -- help new mothers connect with their babies. Prolactin helps bring on a peaceful and nurturing sensation, while oxytocin produces a strong sense of love and attachment between a mother and her child, according to HealthyChildren.org. The skin-to-skin and eye contact that takes place during breastfeeding also helps establish a bond. An article published in the April 2011 edition of “Journal of Child Psychology and Psychiatry” reports that breastfeeding promotes a greater maternal sensitivity and improves a mother’s response to her infant's cues.

Other Health Benefits

Breastfeeding promotes long-term health benefits in mothers. WomensHealth.gov reports a link between breastfeeding and lower risk of developing certain diseases and conditions such as Type 2 diabetes, breast cancer, ovarian cancer and postpartum depression. Breastfeeding provides a natural form of contraception as long as the infant is less than 6 months old, the mother’s menstrual cycle has not returned and the baby is breastfeeding throughout the day and night, says HealthyChildren.org.

How to Stop Lactating After Finishing Breast Feeding
By: Lillian Downey
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13 June, 2017
If you and your baby have decided it's time to stop breastfeeding, or if you have to wean due to a medical condition or new medication, there are a few things to consider to make the transition as easy and painless as possible. Letting your milk down gradually is the healthiest way to stop lactating, according to experts at La Leche League International. Quitting cold turkey can lead to painful engorgement and infection.

Don't bind your breasts. According to experts at Breastfeeding Basics, this is an old wives' tale that doesn't hold true. Avoid binding to prevent conditions like blocked milk ducts or mastitis, a painful type of infection common in breastfeeding women.

Use home remedies to help with pain and engorgement. Apply cool cabbage leaves to both of your breasts to soothe and cool your sore breast tissue. Take several cups of sage tea throughout the day. Sage tea is said to slow milk production.

Get enough fluid and reduce sodium intake. Avoid your body's instinct to retain fluids as you become dehydrated. As your body retains water, it also retains fluid in breast milk. Ensure you're properly hydrated to avoid painful, sore breasts as you wean.

Pump or express small amounts of milk. Pump or feed a small amount of milk each day. Express just enough milk so that you don't feel engorged. As your body senses less need for milk, it will produce more. Expressing small amounts of milk will actually help you stop lactating. Never empty the breast, as this will tell your body that you need it to make more milk.

Use over-the-counter pain relievers if expressing some milk doesn't relieve your pain. Be aware that any medications you take will be passed on to your baby if you're still providing her with your milk. Often, when you're not able to express, anti-inflammatory drugs and pain relievers can ease your discomfort.

How Breast-Feeding Women Can Stimulate Milk Production
By: Bibi Estlund
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13 June, 2017
Almost all women can produce milk for their babies with little or no trouble. Breast milk production is controlled by a system of supply and demand. Breast tissue is stimulated when the baby is correctly latched onto the breast and sucking. The brain receives the message from the breast glands that milk production is needed, and breast milk is ejected into your baby's mouth. Breast milk is the perfect food for babies, and having an adequate supply is a concern for many mothers.

Breastfeed as soon as possible after you give birth. Let your hospital staff or midwife know that you plan to breastfeed, and that you would like to nurse your baby frequently to get your milk production going. If your baby is separated from you for a period longer than two hours, make sure to pump your breasts with a quality breast pump to stimulate your milk supply.

Position your baby so he is correctly latched. His mouth should be open wide, taking in a large part of the areola as well as the nipple. His lower gums should be half an inch to an inch from the nipple base. If you experience pain during latching, use your finger to break suction, and relatch the baby until a comfortable latch is achieved.

Nurse frequently, or whenever your baby shows signs of hunger. Newborns will nurse eight to 12 times in a 24-hour period. Babies will demonstrate hunger by rooting, smacking their lips or sucking on their hands. Crying is a later sign of hunger.

Allow unrestricted time at the breast. Do not restrict feedings to a certain number of minutes. Allow your baby to feed until she releases the nipple or when her sucks become shallow or "fluttery." Newborns should nurse for at least 10 minutes on the first breast. If your newborn is falling asleep during feedings, try waking her up to finish.

Offer both breasts at each feeding. The more stimulation your breasts get, the more milk you will make.

Rest as often as you can. It takes a lot of energy to make milk, so be kind to yourself, and don't try to do too much. Rest is essential for milk production.

Eat a nutritious diet. It's not necessary to eat a specific diet, but eating frequently and choosing nutritious foods helps your body do the work of producing milk.

Stay hydrated. Try keeping a glass of water next to you every time you nurse.

Tips

Sore nipples are often a sign of poor latch-on. If you are experiencing sore nipples, please contact your local La Leche League leader or an internationally board-certified lactation consultant.
If you have had breast injury or surgery, please monitor your baby's weight gain carefully. The best way to monitor whether your baby is getting enough milk is to count his wet and dirty diapers. Newborns older than 3 days should have at least six wet diapers and at least three bowel movements larger than a quarter per day. Exclusively breastfed infants older than 6 weeks may have fewer bowel movements, possibly as few as one every two to three days.
Consult with your care provider, lactation consultant or La Leche League leader if your supply has not increased after a few days of following these steps. She may be able to offer suggestions for prescription drugs or herbs to aid in stimulating a more plentiful supply. There are other causes for not producing a full supply of milk, and your consultant can help you to identify if you have any of these factors.

Early Pregnancy Symptoms: Pink and Sore Nipples
By: Sharon Perkins
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26 September, 2017
Pregnancy brings a host of body changes, many of which occur in your breasts. Nipple changes are among the earliest signs noted in pregnancy. Changes in the size and color of your nipples as well as new sensations are perfectly normal, although some can cause temporary discomfort. Knowing what to expect can help you cope with the changes pregnancy brings.

Nipple Symptoms

As soon as you become pregnant, your nipples begin the process of getting ready for breastfeeding. Nipple tingling, soreness, tenderness and itchiness are some of the first symptoms of early pregnancy. Nipples also become larger and generally darker, as will the areola, the pigmented area around the nipple. You might also notice your nipples becoming more erect, which will aid in breastfeeding after your baby is born.

When Symptoms Develop

Nipple symptoms occur very early in pregnancy, often by 4 to 6 weeks. Often, nipple and breast changes are the first symptoms you notice when pregnant. While your breasts will continue to change throughout pregnancy, the worst of the discomfort will often begin to subside by the end of the first to the middle of the second trimester.

Why Nipple Changes Occur

Increased levels of hormones and changing blood flow patterns contribute to nipple changes in pregnancy. Rising levels of the female hormone estrogen and progesterone -- the hormone produced first by the remnant of the follicle that contained the egg and then by the placenta -- can cause your nipples and areola to change color. Your blood volume increases by 40 to 50 percent during pregnancy. The increase contributes to breast and nipple swelling, which can cause itching, tingling and soreness.

Decreasing Nipple Discomfort

Nipple changes can cause an increase in nipple sensitivity that can be painful at times. You can decrease pain and discomfort by wearing a supportive but not overly tight bra, even during the night. Decrease nipple friction by wearing clothing that fits snugly without being so tight that it rubs across the nipples. If you nipples are sore, avoid nipple stimulation during sex, as this can increase throbbing or tingling.

Nine Months Pregnant With Sore Breasts
By: Laura Niedziocha
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13 June, 2017
During pregnancy, your body changes, and that includes your breasts. In preparation for your child, your breasts make changes to supply food for your newborn. Whether you plan to breastfeed or not, you may have some discomfort. Rest assured, this is not uncommon.

Breast Changes

Your breasts go through several changes during pregnancy. They may become sore and sensitive and respond to changes in temperature. You may also notice an increase in size, itchiness, stretch marks, more prominent veins, darker and larger nipples and areolae and some leakage. This is all part of your breasts preparing to lactate and feed your child, but it may also cause soreness.

Causes

Sensitivity and soreness may be caused by the breasts preparing to lactate. During the nine months of your pregnancy, your milk ducts, which hold the milk, are growing to make room for your supply. And they may begin filling with milk. This, in addition to the hormones circulating through your body, can account for soreness.

Mastitis

Extreme tenderness and soreness in your breasts during the ninth month may indicate a problem. Mastitis is an infection of the breast. It can be caused by a clogged duct or a raw, dry and cracked nipple. If one area in particular is hard and sore, this is a good indication that you have mastitis. This condition can be cured with antibiotics. If you suspect mastitis, speak with your doctor.

Relief

You can take some steps to relieve the soreness. Start with a good maternity bra, which can give your breasts the support they need. This may also help to ease some of the strain on your back. Pick a bra with thick straps and plenty of support under the cups, but it shouldn't have underwires, advises the American Pregnancy Association. Take warm showers and baths, but avoid using soap on your breasts. Soap can dry out your skin and nipples and leave them vulnerable to mastitis. For further help, contact your doctor.

11 Weeks Pregnant Symptoms
By: Laura Candelaria
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13 June, 2017
At 11 weeks pregnant, you are almost at the end of the first trimester. Your baby, just over 1 1/2 inches long and about the size of a fig, is now almost fully formed, states the Mayo Clinic. The symptoms you may experience at this point during your pregnancy may differ from another woman's symptoms. Your symptoms may also differ from a subsequent pregnancy. Any changes in pregnancy signs and symptoms should be discussed with your obstetrician.

Breast Swelling and Tenderness

During your 11th week of pregnancy you may experience breast swelling and tenderness. This may be similar to, or worse than the breast discomfort that you may experience prior to your menstrual period. The appearance of your breasts may also change. The areola may seem larger and darker in color and blue veins may be apparent on breast tissue. Wearing a supportive bra is essential at this time and will help minimize discomfort.

Nausea and Vomiting

You may find yourself still suffering from nausea and vomiting (morning sickness) at 11 weeks pregnant. This occurs due to the increase of estrogen in your body, which slows the gastrointestinal system. You may also be more sensitive to odors at this time, which may precipitate nausea. If you are experiencing severe vomiting and are not able to keep foods and liquids down, you may become dehydrated and should contact your health care provider. Most women will begin to experience relief from morning sickness once they enter the second trimester, although rarely it continues throughout the pregnancy.

Fatigue

Increased fatigue is common during your first trimester. You may just feel much more tired than usual. Your body is going through a lot of changes and is expending a lot of energy towards the developing fetus. You may want to take a midday nap and get some additional rest. Walking or light exercise may also help combat fatigue. Make sure you're getting enough iron and protein, recommends the Mayo Clinic. This will help keep your strength up throughout your pregnancy. At 11 weeks you may already be feeling a bit more energetic, and should continue to feel more energy as you head into the next trimester.

Constipation

You may also be suffering from constipation (caused by hormonal changes, which can slow digestion), states Baby Center. Eating a high fiber diet with increased fruits and vegetables, and drinking ample fluids may help combat constipation.

Heartburn

Heartburn is caused by hormones relaxing the valve which separates your esophagus and stomach. This may occur at 11 weeks into your pregnancy. Eating a bland diet and remaining upright after eating may help prevent heartburn. If heartburn occurs, Tums are considered safe for use during pregnancy.

Can You Really Get Pregnant While Breastfeeding?
You're not getting your period—so how would you even tell?!
BY KORIN MILLER
JAN 16, 2018

It's a common myth that you can't get pregnant while breastfeeding a baby—but is there any truth to it?

Well, if you’re breastfeeding your baby, you may experience something known as lactational amenorrhea, which means you don’t get your period because you’re breastfeeding. Your body produces the hormone prolactin to allow you to nurse and that hormone suppresses estrogen, which is why this happens, says women’s health expert Jennifer Wider, M.D.

Still, if you’re having sex, getting pregnant is always a possibility—and that’s something a lot of women don’t realize. “Many women are under the impression that breastfeeding will protect them from getting pregnant again but this isn't always the case,” says women’s health expert Jennifer Wider, M.D. “A woman can ovulate while she is breastfeeding, but sometimes it's difficult to detect, especially if she doesn't have a normal period.”

Since most women tend to look at their period as a monthly reminder that they’re not pregnant, having no period, an infrequent one, or a really light one due to breastfeeding can really mess with you. But even if your period isn’t regular while you're breastfeeding, you can still get pregnant. You also ovulate before you get a period, which some women don’t realize, says Sherry A. Ross, M.D., a women's health expert and author of She-ology: The Definitive Guide to Women's Intimate Health. Period.

Bottom line: You can get pregnant while you’re breastfeeding, and it’s crucial to be aware of that fact.

So how would you even know if you were expecting? There are a few signs that can tip you off when your period isn’t in play, but it’s a little harder than when you’re not breastfeeding. “It definitely can be challenging to know if you are pregnant before getting your period while breastfeeding,” Ross says.

Here's what you should look out for:

You're wiped out

Pregnancy is tough on your body and it can make you feel tired—but it can be hard to know the difference between pregnancy-related fatigue and new mom tiredness, Ross points out. So just be mindful if you feel overly exhausted on top of other potential pregnancy symptoms.

Related: What to Expect a Day, Week, and Month After Having a C-Section
You're peeing more than usual
Extra blood flow to the developing fetus produces more urine in your kidneys, Wider explains. But don't look at this as your only pregnancy symptom: Breastfeeding often makes women thirsty because you tend to drink (and pee more) to replace the fluids you lose by feeding your baby.

(Torch fat, get fit, and look and feel great with Women's Health's All in 18 DVD!)

You feel nauseous
When you get pregnant, your body has a surge in the hormone human chorionic gonadotropin (HCG)—and that can make you feel super-sick, Wider says.

Find out why your period is late—other than pregnancy:

Your boobs are sore
Hormonal fluctuations of estrogen and progesterone cause breast tenderness, Wider says. But this symptom is tricky given that you can also experience it with breastfeeding.

Luckily, Wider says there are several birth control methods that are considered safe to use while you’re nursing, including condoms, IUDs, the mini-pill, and the shot. Diaphragms and progesterone arm implants like Nexplanon can also be effective, Ross says.

Related: How Your Eggs—and His Sperm—Change in Your 20s, 30s, and 40s
While you can get pregnant while you’re breastfeeding, you shouldn't panic over the risk—just be smart about using a backup. “It’s not incredibly common, but it can happen,” Wider says. “If you are having sex while breastfeeding, it’s important to use contraception.”
MAMA | POSTNATAL | BREASTFEEDING BREASTFEEDING WHILE PREGNANT Rachel G., MS, RD, LDN, CSSD, CBS
What to Know
Yes, you can breastfeed while pregnant
What to take into account when deciding whether to breastfeed while pregnant
Continuing to breastfeed into your next pregnancy is a personal decision. It means taking care of all 3 parties involved – mother, breastfeeding baby and unborn child – nutritionally, physically and emotionally.

Download our prenatal nutrition guide

Know that you have increased nutrient needs when you’re pregnant and also when you’re breastfeeding, so if you’re engaged in both simultaneously then you’ll need to pay plenty of attention to the quality of your diet. Proper hydration, appropriate nutrients and adequate calories are crucial to support yourself, your breastfeeding child and your baby in utero all at the same time.

You may run into some hurdles, but being aware of them in advance can help. For example:

Physically, the changes your body goes through while pregnant and breastfeeding (think nausea, fatigue and other uncomfortable pregnancy symptoms) may pose some challenges.
Hormonal shifts related to pregnancy may change the composition, taste and supply of your breastmilk. Your breastfeeding baby may not prefer this new milk and could go on a “strike” or initiate self-weaning. (Read Navigating nursing strikes for more information on this topic).
Know that it is common to have an aversion to nursing during pregnancy, so if your breastfeeding baby is less than 1 year old have a contingency plan for feeding him or discuss the aversion with a Happy Family Coach.
What to Do
Speak with your healthcare provider

If you want to continue breastfeeding while pregnant, have a discussion with your healthcare provider to discuss any risks that may apply. Specifically, you’ll want to make sure the continuation of breastfeeding won’t interfere with your ability to take care of yourself – think adequate rest, appropriate pregnancy weight gain and stress levels.

Surround yourself with people who support your decision

For many women, the opinions of family and society play a big part in the decision to breastfeed while pregnant.

Take good care of you

Remember that you are not only pregnant and creating a new life (from scratch!), but continuing to nourish another child as well – this is a lot of work! Keeping yourself well fed and hydrated for both your nursing child and fetus are key. This is especially important if your child is exclusively breastfed or under a year old, as her nutrient needs will be coming primarily from your body.

Check in with a Happy Family Coach to make sure you are meeting your needs during this time of high demand.

Stay in tune with the needs of your nursing baby, especially if she relies heavily on breastmilk

If your nursing baby is under the age of 1 or relies heavily on your breastmilk, keep an eye on her overall weight gain, growth patterns and developmental milestones. Be mindful of any changes in your baby’s intake, signs of hunger or fullness and any supply dips that may occur as a result of your pregnancy hormones.

A baby over 1 year of age that is consuming solid foods multiple times throughout the day and has decreased the amount of breast milk as a direct result, will require less milk than a baby under 1 that is still heavily relying on breastmilk as their main source of nutrition.

Do what makes sense for you

Everyone is different. Some women experience supply dips from pregnancy hormones, while others may not. Some women suffer from severe morning sickness and discomfort, while others may have never felt better. Think about whether the continuation of breastfeeding will work for your situation and lifestyle.

And keep in mind that your breastfeeding might make the decision for you! Changes in milk composition can lead to self-weaning in some cases. Take it one day at a time, and listen to your body and your babies.

Pay attention to any nutrient deficiencies

Ke

Getting Pregnant While Breastfeeding
How Breastfeeding Affects Fertility and Fertility Treatments
Medically reviewed by Meredith Shur, MD Written by Donna Murray, RN, BSN Updated on September 26, 2019
You can get pregnant while you're breastfeeding, but moms who breastfeed exclusively tend to experience a delay in the return of their fertility.1 Younger women who want to have more children don't usually find this to be much of an issue. After all, the delay in the return of fertility can help with family planning and child spacing. But, for older women who hear the ticking of that biological clock a little more loudly and fear that they don't have the time to wait, or for women who have struggled with infertility in the past, the waiting may be more of a concern.
Here's what you need to know about getting pregnant again while you're breastfeeding.

How Breastfeeding Affects Fertility
It can take a few weeks, a few months or even longer for your body to become fertile again once you have a baby. After childbirth, it takes approximately six weeks for your body to heal. If you do not breastfeed, you may see the return of your period at about this time.2 When your period returns, you can consider yourself fertile and able to conceive your next child. However, if you choose to breastfeed, you may not see the return of your period and your fertility for much longer.

Breastfeeding can hold off the return of your period and therefore your ability to get pregnant again for a while.
You are not likely to get pregnant if these three things are happening at the same time1 :

You're breastfeeding exclusively around the clock without giving your child any supplementation
Your baby is under six months of age
Your period has not yet returned
For many women, the ability to get pregnant returns once breastfeeding is no longer exclusive. By six months, your child will start eating solid foods and may also be sleeping through the night. Since you will naturally be breastfeeding less often and going for longer stretches of time between nursing sessions, your fertility may begin to return.

All About Breastfeeding and Your Period
Do You Have to Stop Breastfeeding If You Want to Have Another Baby?
If you don't want to give up breastfeeding, but you're anxious to start trying for another baby, you can go ahead and try. If you aren't finding success, you can cut back on nursing and partially wean the child you're breastfeeding. Breastfeeding less often, such as only in the morning and at bedtime, may be enough to bring about the return of your period. It also allows you to continue the special breastfeeding relationship that you have with your child.

When you stop breastfeeding altogether, menstruation may return within four to eight weeks. However, even after fully weaning some women do not get a menstrual period for months or even longer.
When to See the Doctor
If you are older and more anxious to get pregnant again right away, you may want to talk to your doctor. You should also consult your doctor if you've had trouble getting pregnant with the child you're now breastfeeding, or if you think you will need to use fertility treatments to get pregnant again.

Breastfeeding Through Fertility Treatments
You may be able to continue to breastfeed through certain types of procedures. It depends on your treatment plan, the age of the child you're breastfeeding, and how often your child is nursing.

If your period has returned and your child is older or breastfeeding only a few times each day, you may be able to have the following treatments:

A Clomid Cycle: You may be able to take Clomid (clomiphene citrate) and continue to breastfeed. Clomid is believed to be safe to take during breastfeeding, but it can decrease your supply of breast milk.3

An Intrauterine Insemination (IUI) Due to Male Factor Infertility: An insemination does not necessarily require the use of any medication. If your doctor is only monitoring the timing of your ovulation for an IUI due to your partner's low sperm count, there may be no need to stop breastfeeding.

A Frozen Embryo Transfer: If you're going to have a frozen embryo transfer, you only to prepare the lining of y
omeBreastfeeding InfoFertility
Breastfeeding can have an effect on your fertility, particularly in the early months. While for some mothers this is a benefit, it can also be a source of frustration for those hoping to grow their families.

CAN I GET PREGNANT WHILE I’M NURSING?

The simple answer is that you can get pregnant while nursing.

However, many moms experience a time of delayed fertility during breastfeeding. This is very common and is referred to in many places as the Lactation Amenorrhea Method (LAM) of contraception.

As described in The Womanly Art of Breastfeeding, the Lactation Amenorrhea Method of using breastfeeding to delay fertility needs all the following to be true:

Your periods have not returned.
Your baby is exclusively and frequently fed from your breasts- this is especially important to remember when your little one begins sleeping through the night. It means not just that your baby does not have bottles, but also that they do not use a pacifier, in other words that all of your baby’s sucking needs are met at your breast.
Your baby is less than 6 months old. If your little one is older and eating solid foods, your chances of ovulating and risk of pregnancy increases. Some moms will find it takes more than six months for their cycles and fertility to return, while other mothers find that their cycles and fertility return earlier than six months. It is also important to mention that after six months, there is a higher chance that you might ovulate and possibly become pregnant before your first postpartum period. If you suspect you are pregnant, you will want to check with your health care professional.

BUT WHAT IF I WANT MY PERIODS TO RETURN WHILE I AM BREASTFEEDING?

For some mothers, the contraceptive effect of breastfeeding is a very welcome side effect, but it can be worrying and upsetting if over a year has passed since your baby was born and you still have not noticed any signs that your body is returning to being fertile.

You can read more about breastfeeding and menstruation here. The Womanly Art of Breastfeeding states that most breastfeeding mothers will resume their periods between 9 and 18 months after their baby’s birth. Some mothers find that once their baby starts sleeping for longer spells at night, or if they are separated in the day time (for instance through return to work outside the home) this is enough to reduce the effect that breastfeeding has on reducing estrogen levels, so that their bodies can start to menstruate again. Others find that while their baby is still nursing at all, this seems to be enough to suppress menstruation completely.

It can be very hard emotionally if you feel that you are needing to choose between your future hoped for child and meeting the needs of the child currently in your arms. Some mothers like to think of this as an experience of their bodies being in tune with their babies’ needs: when our babies are feeding from us often enough to suppress our fertility, this might be because they are not yet ready to share us with a sibling.

WILL BREASTFEEDING AFFECT MY USE OF FERTILITY TREATMENTS?

If you need fertility treatment such as IVF to grow your family, you may find yourself faced with some difficult choices. This is a complicated and under-researched area. Some drugs used in fertility treatment are safe to use while breastfeeding; others are not harmful to your baby but can affect your milk supply; and still others could be dangerous.1 You will need to talk carefully to your healthcare provider about the proposed plan, and weigh up the length of time you would like to continue nursing your first child for, with the timing of when you would like to begin treatment.

1 https://breastfeedingnetwork.org.uk/wp-content/dibm/IVF%20and%20breastfeeding.p
Pregnancy week by week

SECTIONS
Is it safe to continue breast-feeding if I'm pregnant with another child?

Answer From Shannon K. Laughlin-Tommaso, M.D.
Generally, it's safe to continue breast-feeding while pregnant — as long as you're careful about eating a healthy diet and drinking plenty of fluids. However, breast-feeding can trigger mild uterine contractions. Although these contractions aren't a concern during an uncomplicated pregnancy, your health care provider might discourage breast-feeding while pregnant if you're at risk for preterm labor.

If you're considering breast-feeding while pregnant, be prepared for changes your nursing child might notice. Although breast milk continues to be nutritionally sound throughout pregnancy, the content of your breast milk will change — which might change the way your milk tastes. In addition, your milk production is likely to decrease as your pregnancy progresses. These factors could lead your nursing child to wean on his or her own before the baby is born.

Your comfort might also be a concern. During pregnancy, nipple tenderness and breast soreness are common. The discomfort might intensify while breast-feeding. Pregnancy-related fatigue might pose challenges as well.

With

Shannon K. Laughlin-Tommaso, M.D.

Can I get pregnant while breastfeeding?
Women who breastfeed fully (exclusively or almost exclusively) are less likely to become pregnant as long as the following criteria are met:

Your baby is less than 6 months old.
Your baby is breastfeeding at least every 4–6 hours during the day and at night.
You are breastfeeding fully, offering no breast milk substitutes and using pacifiers only at bedtime.
You have not resumed menstrual periods (monthly bleeding) or spotting.
Using exclusive breastfeeding as a form of birth control is called the Lactational Amenorrhea Method (LAM). In addition to the criteria above, LAM only works if your baby nurses on your breast. The pressure on the nipple sends a message to the mother's body to produce a hormone that prevents egg production (ovulation) in the mother.

Women are more likely to get pregnant if they:

supplement with formula or other foods
follow a rigid feeding schedule, routinely limiting the frequency or length of breastfeeding
breastfeed less than 4–6 hours during the day and at night
have a baby that is 6 months or older
The absence of menstrual periods makes pregnancy unlikely, however, ovulation (egg release) can occur before the start of menstruation. So don’t assume that you are protected (safe) because you haven’t had a menstrual period. You can become pregnant, while breastfeeding, before you resume menstrual periods.

Women considering LAM should consult their health care provider to make sure it's the best choice for their lifestyle, as well as to plan for a new form of birth control as soon as breastfeeding frequency decreases or solid foods are introduced.

If you don’t wish to become pregnant, you may want use another method of contraception in addition to breastfeeding. Birth control options include:

cervical cap
diaphragm
intrauterine device (IUD)
tubal ligation
condoms (female or male)
vasectomy
spermicidal cream, foam, or jelly
birth control pills (containing only progesterone)
In the past, breastfeeding women were told to avoid birth control pills containing estrogen and progesterone (combination pills), and to use birth control pills (minipills), implants (Implanon, Norplant), or injections (Depo-Provera) containing only progesterone instead.

Since 2011, the Centers for Disease Control and Prevention (CDC) has acknowledged birth control, including hormonal methods, may be used by breastfeeding women. The most recent recommendations, released in 2016, are available in the agency’s Morbidity and Mortality Weekly Report. Given reports by some women of a drop in milk supply after starting hormonal contraceptives, some makers of hormonal contraceptives recommend that breastfeeding women wait until their milk supply is well established, at least 4–6 weeks after birth, before starting hormonal birth control.

Last updated October 15, 2018

Updated for 2019!

When we are trying to conceive many women I know like to obsess over possible early signs of pregnancy.

I recently wrote a post about getting pregnant while breastfeeding so I decided to compile a list of possible pregnancy signs while breastfeeding.

Another question I have received a lot lately is how did you know you were pregnant while breastfeeding. I have also heard from women who have not had their period return but still want to get pregnant, or maybe are wondering if they could be pregnant.

While it’s more tricky to know if you are pregnant if your period has not returned, it is not impossible for pregnancy to occur.

I have actually gotten pregnant while breastfeeding twice, so I have personally experienced some of these pregnancy symptoms while nursing.
PREGNANCY SIGNS WHILE BREASTFEEDING ARE USUALLY THE SAME AS TYPICAL EARLY PREGNANCY SYMPTOMS

I know this is kind of boring to hear, but most of the usual symptoms we normally experience when pregnant occur when we are breastfeeding and pregnant too.

One notable difference is the absence or presence of a period as a pregnancy sign.

Since it is possible (but uncommon) to get pregnant before your period returns while breastfeeding; you cannot count on this as a sign. Our cycles can be off or much different than we are used to when nursing as well.

COMMON SIGNS OF PREGNANCY WHILE BREASTFEEDING

Fatigue:

For me personally, one of the very first signs I noticed the second time I was pregnant (and while still breastfeeding) was extreme fatigue when going about normal activities.

I remember going for a walk with my husband and daughter and I started to feel like I could barely make it home, I was very winded and out of breath.

I do not recall feeling that way at all the first time I was pregnant until a little later in the first trimester.

xtreme or just extra thirsty:

I am always more thirsty when breastfeeding and was especially so when pregnant. I have heard from other breastfeeding and pregnant friends that this is common.

Sore breasts or nipples:

While this can be a very early pregnancy symptom whether you are breastfeeding or not; it is definitely more noticeable to me when breastfeeding.

Cramping:

I have gotten some cramps both times I was pregnant. Maybe it is implantation, but it feels like your period could be coming and it is a very common early pregnancy symptom.

Nausea:

Nausea can be an early pregnancy sign although usually it comes a little bit later. I had it both times around but much worse when I was still breastfeeding.

Breastfeeding was probably not related to it, but I thought I would add it here since it’s a pregnancy symptom either way.

A drop in milk supply:

This usually will not occur till somewhat later -closer to the second trimester, but it can be an early pregnancy sign and it will usually occur at some point when pregnant and breastfeeding.

Since a drop in milk supply is specific to nursing mothers this is definitely a sign of pregnancy while breastfeeding. If your milk supply drops unexpectedly and you think there is a chance of pregnancy please take a test.

I have heard anecdotal stories of this being a first sign of pregnancy when a mother’s period has not returned, and there are no other pregnancy symptoms. The drop in milk supply is the first tip off of pregnancy for some breastfeeding women.

A change in milk taste:

This also is typically closer to the second trimester but the taste of your milk will probably change. My daughter let me know when this occurred because sadly she did not like it anymore and abruptly weaned herself.

Hunger:

Once you are pregnant your calorie needs will go up slightly and they should already be up a bit from breastfeeding.

SO, WHAT DOES THIS MEAN?

These signs and symptoms are fun to look for but any of them can occur even if you are not pregnant. When our period is getting ready to return for the first time postpartum there can be some strange related symptoms.

It took me a few months for my period to get regular after each of my babies as well. If you are hoping to get pregnant while breastfeeding I recommend using ovulation tests to try and nail down ovulation better.

And, as far as wondering if you are pregnant or what the signs may be, I know it’s hard when you are in that two week wait and can’t test yet.

It can be even more confusing if your period has not returned but you think there is a chance you could be pregnant while breastfeeding.

Even while breastfeeding and without the return of a period it is possible to get pregnant although not as common.

Some of these earliest symptoms can be noticeable even before it’s time to test so hopefully this list helps you.

Otherwise, if you think you may be pregnant and you are breastfeeding there is really only one way to tell for sure. Get out there and get yourself a test!

If you’ve been pregnant while breastfeeding please let me know, what were the earliest signs for you?

Thanks!

UPDATE!

This post was originally written when I had gotten pregnant while breastfeeding once.

I get a lot of questions and comments on this post from women wondering about possible early pregnancy signs while breastfeeding, so when I got pregnant while breastfeeding again I wrote another post with my experiences.

You can find more on this subject in this post so head on over and check it out if you are inclined!

Your Pregnancy Matters
Can I breastfeed during pregnancy?

In summer 2017, one of our patients came in for an early ultrasound – she was having some vaginal bleeding and thought she was pregnant. She was right – the sonogram showed she was eight weeks pregnant. The ultrasound showed a small area of hemorrhage near the developing placenta, but the small embryo had a normal heart rate.

At the end of the ultrasound, she asked two questions that made me pause. “I’m breastfeeding – did this cause the problem? Can I continue to breastfeed?” While I had some initial thoughts about the advisability of continuing, I asked one of our nurses who is an international board certified lactation consultant to address the patient’s concerns.

Current breastfeeding recommendations from the American College of Obstetrics and Gynecology and the American Academy of Pediatrics are for exclusive breastfeeding for the first six months of a baby’s life, then breastfeeding in combination with solid foods up to 12 months. Some women continue to breastfeed or pump-and-feed breastmilk to their children up to 4 years old.

But the choice to breastfeed during pregnancy is not one to take lightly. Though it’s perfectly safe for many women and their pregnancies, breastfeeding while pregnant can be risky for some.
How often does the decision to breastfeed during pregnancy come up?

While this might seem an unlikely decision to have to make, it’s actually much more common than you might think. Look at the frequency of conception within a year of a delivery in the following three states as a cross-sectional example:
Pennsylvania 8.5 percent
Iowa 20.8 percent
Ohio 20.5 percent
In other words, up to one in five women became pregnant during the time in which at least some breastfeeding is recommended!

There are no hard and fast rules surrounding breastfeeding during pregnancy. However, your Ob/Gyn may advise you to carefully consider breastfeeding if you fall into a higher-risk category.
Certain women should carefully consider breastfeeding during pregnancy

Women who are experiencing problems in the first trimester or have a history of early miscarriages might want to stop breastfeeding. This could include those who have a history of recurrent pregnancy loss or recent bleeding during pregnancy. If you have had a previous preterm delivery or have experienced preterm labor in your current pregnancy you also should consider weaning your infant.

During breastfeeding, the pituitary gland releases the hormone oxytocin, which permits the release of milk in the breasts (milk let down). This same hormone is also known to stimulate uterine contractions. In fact, when we induce labor in the delivery room, we often use a drug called Pitocin, which is a synthetic form of oxytocin. There’s also a test of fetal well-being during late pregnancy that uses nipple stimulation to induce small contractions while we look at the fetal heart rate tracing. In a high-risk pregnancy, the oxytocin release that accompanies nipple stimulation during breastfeeding can increase uterine activity, which could potentially affect the pregnancy.

Every woman’s body reacts a little differently to breastfeeding. I can’t quantify what the risk is of continuing to breastfeed in the setting of these complications. But I do know that women who experience a loss or bad outcome frequently ask, “Did I do something to cause this?” – just like my patient did.

If a woman chooses to breastfeed during pregnancy and then presents with spotting and ultimately a miscarriage, her first inclination might be to blame herself. But in high-risk pregnancies, it’s often difficult to determine what exactly went wrong, and it could very well be that breastfeeding had absolutely nothing to do with the complications.

Still, we understand the desire to make sure your current child receives all the benefits breastfeeding provides. Some moms feel guilty that they’re hurting their babies by not breastfeeding. If you are included in one of the high-risk categories and are passionate about your infant receiving breastmilk during your pregnancy, talk to your Ob/Gyn or maternal fetal medicine specialist (MFM).

Our goal is for you and your pregnancy to be as healthy as possible, and we want to support you in making good decisions. You might be able to get donor breastmilk for your child while you’re pregnant, or we can talk about other options to ensure your child’s nutritional needs are met.

If you choose to breastfeed during pregnancy, we want you to have a smooth experience. I’ve invited nurses Mandi Longoria and Linda Catterton to share their tips for successful breastfeeding during pregnancy. Both Mandi and Linda are International Board Certified Lactation Consultants, which means they adhere to incredibly high standards in lactation and breastfeeding care worldwide.
_________________________________________________________________________________________________
Tips for breastfeeding during pregnancy

Breastfeeding during pregnancy is a personal decision that requires case-by-case strategies to be successful. The only time we ever recommend that a mom not breastfeed during pregnancy is if she has risk factors such as those outlined by Dr. Horsager above. If you aren’t high-risk and you choose to breastfeed during pregnancy, these tips can make it easier on you and your child.

The first trimester can be tricky for breastfeeding. Not every woman experiences first-trimester symptoms, but many women have a range of symptoms, including:
Breast and nipple tenderness
Fatigue
Decreased calorie and fluid intake as a result of morning sickness
To combat breast and nipple tenderness, you can take acetaminophen (Tylenol) and use warm compresses on your breasts to ease the pain and swelling. Tenderness usually is temporary, and most women tolerate this period of discomfort.

If you’re fatigued from pregnancy and caring for your older child, schedule time to rest when you can. Ask your partner or a friend or family member to help a bit more with household duties or childcare when you need additional rest. You might be tempted to drink coffee or energy drinks to keep up with your responsibilities, but try to abstain. These drinks often are laden with added sugar, and the caffeine can dehydrate you further.

Our goal is for you and your pregnancy to be as healthy as possible, and we want to support you in making good decisions. You might be able to get donor breastmilk for your child while you’re pregnant, or we can talk about other options to ensure your child’s nutritional needs are met.

If you choose to breastfeed during pregnancy, we want you to have a smooth experience. I’ve invited nurses Mandi Longoria and Linda Catterton to share their tips for successful breastfeeding during pregnancy. Both Mandi and Linda are International Board Certified Lactation Consultants, which means they adhere to incredibly high standards in lactation and breastfeeding care worldwide.
_________________________________________________________________________________________________
Tips for breastfeeding during pregnancy

Breastfeeding during pregnancy is a personal decision that requires case-by-case strategies to be successful. The only time we ever recommend that a mom not breastfeed during pregnancy is if she has risk factors such as those outlined by Dr. Horsager above. If you aren’t high-risk and you choose to breastfeed during pregnancy, these tips can make it easier on you and your child.

The first trimester can be tricky for breastfeeding. Not every woman experiences first-trimester symptoms, but many women have a range of symptoms, including:
Breast and nipple tenderness
Fatigue
Decreased calorie and fluid intake as a result of morning sickness
To combat breast and nipple tenderness, you can take acetaminophen (Tylenol) and use warm compresses on your breasts to ease the pain and swelling. Tenderness usually is temporary, and most women tolerate this period of discomfort.

If you’re fatigued from pregnancy and caring for your older child, schedule time to rest when you can. Ask your partner or a friend or family member to help a bit more with household duties or childcare when you need additional rest. You might be tempted to drink coffee or energy drinks to keep up with your responsibilities, but try to abstain. These drinks often are laden with added sugar, and the caffeine can dehydrate you further.

You might choose not to breastfeed during pregnancy. Follow your child’s cues to slowly wean the child from nursing, or ask your lactation consultant for tips on how to properly wean your child when you’re both ready.

We don’t usually recommend going “cold turkey” with your child because of the distinct bond that forms between mother and child during breastfeeding. Your child might perceive being cut off from the breast as a sign of rejection. Typically, we’ll recommend dropping a feeding or a pumping session once a day at first, then slowly progressing until you’re down to none. However, if a complication develops suddenly during your pregnancy, you might not have the option of slowly weaning.

Keep in mind, you might continue to produce milk for weeks or months after your child is weaned, whether it was the child’s choice or yours. This leaking is normal, and it’s not a risk for high-risk moms who need to quit breastfeeding. The hormone release that causes milk letdown comes when the child is nursing, not just from the leaking.

For many women, the close spacing of their children makes breastfeeding during pregnancy a possibility, and it is a safe option for most women. To understand the implications for your current child – and for your pregnancy – it’s important to discuss breastfeeding with your doctor in the first trimester. Lactation consultants can provide invaluable advice about breastfeeding during pregnancy.
More in: Your Pregnancy Matters, pregnancy, breastfeeding

Pregnant and Breastfeeding?

If you’re expecting a baby and are continuing to breastfeed your older child, many questions may be going through your mind. Mothers can breastfeed while pregnant; some go on to nurse both their new baby and their older child after the birth. This is known as ‘tandem nursing’.

Breastfeeding during pregnancy is a special, unique relationship and one that may constantly evolve to take into account your changing needs and those of your older child. Breastfeeding can help you meet your child’s needs more easily, especially if he is tired or unwell, and it continues to give him important nutritional and immunological benefits. However, breastfeeding whilst pregnant can often invoke intense feelings. Extra support at this time can be crucial and you may find talking things over at your local LLL meetings really helpful.

Is it safe?
Nutrition
Morning sickness
Milk supply and colostrum
Managing when you are not enjoying it
Coping with questions and comments
Deciding to wean
Tandem feeding
Further Reading

Is it safe?

Research tells us there’s usually no reason why a mother shouldn’t breastfeed while pregnant. Although breastfeeding may help a slow labour to progress, the amount of oxytocin normally released is not usually enough to cause the cervix to open before it is ready to do so. Oxytocin is also released during sex, which is generally considered to be safe during pregnancy. If you are expecting multiples or considered to be at risk for miscarriage/early delivery you may be advised to stop breastfeeding. You could discuss this with a breastfeeding-friendly caregiver.

Nutrition
You won’t be depriving your unborn baby of nutrients by continuing to breastfeed so long as you eat reasonably well. Getting plenty of rest and eating nutrient dense food will help you stay well-nourished and healthy.

The UK Department of Health recommends that all pregnant women take a vitamin D and folic acid supplement (often taken in the form of the Healthy Start vitamins).

Calcium needs during pregnancy and the first six months of breastfeeding it is normal to experience a gradual loss of bone density. Even if breastfeeding continues, recovery of bone mineral content (BMC) starts from around 3–6 months and is generally complete by about 12 months after birth. If a mother has breastfed there may even be a small overall increase. When a mother becomes pregnant again before 12 months BMC actually continues to increase and tandem nursing mothers have no increased risk for osteoporosis. During pregnancy your body absorbs more calcium from the food you eat. If you feel your diet is low in calcium, then eating foods rich in calcium (eg leafy greens, nuts and seeds) may be a good idea but otherwise there’s no need for any extra.

Morning sickness

Pregnant mothers often have nausea, whether breastfeeding or not, though breastfeeding while pregnant may make it worse. Eating frequent healthy snacks can help manage nausea, as can getting more rest. Some mothers find motion sickness wristbands work for them.

Milk supply and colostrum

Around the fourth or fifth month (sometimes before) your milk production is likely to reduce due to pregnancy hormones. The composition of your milk will also change and become more similar to weaning milk. Your child may nurse less or wean completely. Some children resume nursing at a later stage. The drop in milk production is due to hormonal changes and nursing more frequently or pumping won’t increase production in the same way it does when you are not pregnant. Your baby may need age appropriate supplements and a baby under 12 months may need his weight monitored. Continuing to breastfeed during pregnancy has no effect on the milk supply that you will have following the birth of your new baby. Colostrum is produced during pregnancy whether or not it is being removed.
Managing when you are not enjoying it

You may experience nipple soreness, increased nausea and/or feelings of irritability caused by pregnancy hormones. Limiting nursing times, (eg to a few minutes or even a few sucks), ensuring a deep latch, distraction, and offering other snacks/liquids can all help to make nursing through pregnancy more manageable. Support from family and friends can help you get more rest.

Coping with questions and comments

Pregnancy and breastfeeding can be an emotionally challenging time. It can be difficult if you hear negative comments from others. Talking about the importance of breastfeeding to you and your child can sometimes help people appreciate that this is something you have carefully considered and that it is your choice for your family. Sharing information/research and surrounding yourself with supportive people can also help. Your local LLL group will be a good source of support.

Deciding to wean

The decision to stop breastfeeding is a very personal one and one only you or your child will make. It is useful not to have too many expectations when you get pregnant.

Tandem feeding

Continuing to nurse your older child after your new born arrives can help maintain and strengthen your special bond. Mothers often say that tandem feeding helps their older child to be more accepting of their newborn sibling and helps them through the emotional transition of having to now share their mum. Tandem feeding can also foster a special bond between the siblings. Our page Tandem Nursing has more information.

Written by Mhairi Kasapidis, Sue Upstone & mothers of La Leche League GB.

Further Reading

Birth & Breastfeeding
Is My Baby Getting Enough Milk?
Nipple Pain
Safe Sleep & the Breastfed Baby
Still Nursing?

Tandem nursing
Thinking of Weaning?
Toddlers and Food
When Mum Can’t Be There
LLLI page on tandem nursing

References
The Womanly Art of Breastfeeding. LLLI, London: Pinter & Martin, 2010.
*Adventures in Tandem Nursing. Flower, H. Schaumburg, IL: LLLI, 2003.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
How Weaning Happens, Bengson, D.Schaumburg, IL: LLLI, 1999. (link contains book review)
Mothering Your Nursing Toddler. Bumgarner, NJ. Schaumburg, IL: LLLI, 2000. (link contains book review)
Sweet Sleep Nighttime and Naptime Strategies fro the Breastfeeding Family. Wiessinger, D.et al. Pinter & Martin, 2014.
Prentice A. Maternal calcium metabolism and bone mineral status. Am J Clin Nutr 2000 May;71(5 Suppl):1312S-1312s

*Out of print but available on loan from many LLL group libraries.

This information is available to buy in printed form from the LLLGB Shop

Copyright LLLGB 2016

Birth Control & Breastfeeding

Have you heard that breastfeeding is a great form of birth control? If so, you've heard half the story. Here's what every nursing mom needs to know about using breastfeeding as birth control, and other contraception options after Baby.
By Holly Pevzner

Breastfeeding as Birth Control For some women, breastfeeding exclusively can keep pregnancy at bay. The approach is called lactational amenorrhea method (LAM) and it can be used effectively until your baby is 6 months old—or when solids are introduced, says Kelly A. Hightower, R.N., a certified lactation counselor and owner of Bright Birth in Decatur, GA. The kicker is that you absolutely cannot provide any supplementation, so if you're pumping and providing a bottle, you're disqualified. It's the sucking that helps suppress ovulation. "The baby must nurse on demand no less then every three to four hours during the day, and six hours at night," Hightower says.
Return to the Pill If you took the Pill before you got pregnant and don't plan on nursing, it's safe to begin again three weeks postpartum.
RELATED: 8 Facts About Postpartum Birth Control
Start Mini-Pills Opting for oral contraception while continuing breastfeeding? "It's recommended that nursing moms take mini-pills because they contain a low dose of progesterone and no estrogen," says Hightower. That's important because estrogen-containing contraception has been linked to a diminished milk supply. You can begin once your babe is six to eight weeks old.
According to Elizabeth Pryor MD, FACOG, breastfeeding moms frequently use a progesterone-only pill called Micronor, which is marketed specifically at lactating women and doesn't contain estrogen. "The downside with this pill is the cost, as it's more expensive than other pills," says Pryor. "The other very important aspect that a woman considering this pill should understand is that she must take it within three hours the same time every day. We've all forgotten a pill at night and say to ourselves, 'I'll just take it in the morning'--but this is not the pill to do that with. You must take it the same time every day."

Do a Test Run Other long-lasting progesterone-only female birth control options, like the injectable Depo-Provera, a hormonal IUD, and the implant, may be considered as well. However, "nursing moms should be encouraged to try mini-pills for several months first," Hightower says. If you find that your milk supply drops because of the mini-pill, you can simply stop taking it. But if your milk decreases with a longer-term birth control option, you're stuck until it's fully out of your system. (Depo-Provera lasts at least 12 weeks; a progesterone IUD and implant can last up to five years.)
Skip the Patch and Ring "Both are very convenient, but contain estrogen as well as progesterone; this can cause a decrease in milk supply, which can lead to a shorter duration of breastfeeding," Hightower says. These options may be reconsidered after six months of breastfeeding. Consult with your physician and lactation consultant beforehand.
Consider a Copper IUD Unlike its progesterone-only sister, copper IUDs have no impact on breastfeeding. As a bonus, breastfeeding moms actually experience less pain during insertion of the device, according to research in the American Journal of Obstetric Gynecology.
Think about a diaphragm. According to Pryor, those looking for contraception when breastfeeding can also use a diaphragm. "But i's important to be properly fitted for a diaphragm as your body changes with breastfeeding," she says. "A diaphragm may not fit as well or be as effective if you continue to lose weight in the postpartum period. You should be refitted if you lose more than 15 pounds."
RELATED: What It Really Takes to Get Pregnant After Birth Control
Stay Safe with Barrier Methods. Pryor says barrier birth control methods such as a condom used with contraceptive foam have no systemic effects, and they're safe to use while breastfeeding.

Breastfeeding With Implants: What New Moms Should Know

Find out what the experts say about your ability to nurse a newborn with breast implants, plus how breastfeeding can impact your implants.
By Shari Roan

Women who have breast implants may worry about the impact of nursing on their breasts' appearance. But they shouldn't, experts say.
Researchers surveyed 160 new mothers who'd previously had breast augmentation. The study found that neither the size nor the location of the incision influenced nursing success.
RELATED: 10 Things You Didn't Know About Breastfeeding
However, 86 percent of the women who thought breastfeeding would hurt their breasts' appearance were unsuccessful at nursing. While repeated pregnancies can cause breasts to droop over time, nursing doesn't alter the appearance of augmented breasts, says the study's lead author, Norma I. Cruz, M.D., of the University of Puerto Rico.
Studies have shown that any breast surgery, including biopsy, reduction or augmentation, may result in inadequate milk supply. Experts aren't sure why augmentation might have this effect, but there's evidence that surgery could cause damage to the milk ducts or that pressure from the implants could harm the breast tissue.
RELATED: 7 Natural Ways to Produce More Breast Milk
Whether the implants are saline or silicone doesn't seem to affect breastfeeding success. Women whose incision is closer to the crease beneath the breast typically have better success; those with an incision in the nipple area tend to have some difficulty.
Before you undergo augmentation, be sure to let your surgeon know that you want to breastfeed in the future. Also consider postponing the procedure; pregnancy itself may cause changes to the contour and/or size of your breasts.
RELATED: This Influencer Opens Up About the Empowering Decision to Get Her Implants Removed and Breastfeed
7 Breastfeeding Tips for Fussy-at-the-Breast Babies

Is your baby balking at your breast? Try these tips to make breastfeeding easier for you and your baby
By Wendy Wisner
K
As an International Board Certified Lactation Consultant, I get frequent calls from moms whose babies scream and cry during breastfeeding—sometimes rejecting the breast altogether; other times behaving like they simply do not like breastfeeding at all. These mothers are understandably distraught: They worry that they don't have enough milk for their babies, or that there is something wrong with their milk.
The good news is that it's usually a normal, passing phase, and doesn't have anything to do with your milk supply or your breast milk. It's not always possible to pinpoint the exact reason it happens, but fussiness is especially common in the first few months of life, and during evening feedings. Some babies fuss when they are having a growth spurt, or when they are having trouble dealing with a fast milk flow. When babies are really upset, it can be hard for them to calm down enough to breastfeed.
Of course, there are situations when this fussiness is a cause for concern. If your baby is not gaining weight, you should speak to your doctor to discuss milk supply concerns. You may also want to contact a health professional if your baby has signs of an allergy, reflux, illness, or any medical issue that could be causing discomfort.
RELATED: All About Your Breast Milk Supply
But in most cases, all you need to do is find ways to soothe your baby, and then try again. Here are some tried and true methods to get a fussy baby happily breastfeeding again.
1. Try skin-to-skin contact

Leah Segura, a lactation consultant based in Midland, Michigan, recommends spending time skin-to-skin with your baby as a way to soothe the fussiness.
"Skin-to-skin contact before an expected feeding (the more the better) is an excellent way to calm a fussy baby," explains Segura. "It can trigger instinctive feeding behaviors, regulate breathing and heart rate, and it even assists babies with neurological development."
RELATED: Kangaroo Care: The Benefits of Skin-to-Skin Contact
2. Switch sides or try different positions

Sometimes something as simple as switching sides or changing breastfeeding positions can work wonders for your baby. Your baby may be ready for the other breast, but just has no clear way to tell you this (thus the fussing!). Or, your baby might find a different position more comfortable or easy to latch onto, especially during a fussy time of day.
RELATED: The Best Breastfeeding Positions for Mom and Baby
3. Have someone else step in to soothe the baby

Sometimes mom just needs a break—and your baby may even sense this. Handing your baby off to a partner or helper can offer the change of scene that everyone needs. You may find that your baby will welcome breastfeeding after a short break, and you may even find yourself calmer and more able to deal with the fussiness.
RELATED: Secrets For Breastfeeding Success: 37 Breastfeeding Tips
4. Try motion and darkness

Your baby just spent nine months in the cozy environment of the womb, and it's hard to adjust to the loud, bright, bustling world. If you can find ways to mimic the womb environment, and calm a baby's senses, your baby might take to breastfeeding more easily.
Try wearing your baby in a baby carrier, rock your baby in your arms, or try a baby swing. Dimming the lights or adding a little white noise can add to the ambiance. Try breastfeeding again after you've calmed your baby in this way.

5. Burp your baby

Breastfed babies don't always need to be burped, but when they do have a burp in waiting, it often stops them from being able to nurse. "Hold your baby vertically against your chest to see if your baby has to burp," recommends Maria Paciullo, a New York-based lactation consultant. If your baby is having trouble coping with your milk flow, Pacuillo has some tips for that too: "Try laid-back positioning to make sure baby is comfortable and able to deal with different flow rates."
RELATED: This Mom's Baby-Burping Method Is Kinda Going to Change Your Life
6. Breastfeed your baby during sleepy times

A great time to try breastfeeding a fussy baby is just when the baby is waking up from sleep. Try to get to your baby before he or she is fully awake, and offer the breast then. Your baby is much less likely to fuss or protest when just rousing from a sweet slumber.
7. Don't be too quick to try a bottle

Many moms get understandably nervous when their baby cries at the breast, and want to just feed the baby right away. Often, mothers find that their baby will take the bottle more readily than the breast (this is partly because babies don't have to work as hard to bottle feed as they do to breastfeed). But there is almost always a way to entice your baby back to breastfeeding, and if breastfeeding is a relationship you want to preserve, these methods are worth a try before offering a bottle.
If these tricks don't work for you, don't be afraid to reach out for help. Breastfeeding is not something moms are meant to do alone, so if you are struggling with a fussy baby, please seek out breastfeeding help. "If breastfeeding is not easy, work with an IBCLC," recommends lactation consultant Maria Paciullo. "And if one IBCLC is not helpful, do not give up. See another."
Having a baby who fusses while breastfeeding can really shake your confidence, but it's worth the time and effort it takes to find the help to get it right.

No, You Don't Need to Dilute Your Pumped Milk After Drinking Alcohol

The idea that women need to "pump and dump" their breastmilk after drinking alcohol has long been disputed by science. But now, moms are diluting their milk with previously pumped breastmilk from when they didn't have a drink. Here's why "pumping and diluting" is also unnecessary.
By Erica Jackson Curran

Among the many superhuman powers women seem to assume after becoming mothers, the ability to create liquid gold—a.k.a. breastmilk—is among the most revered. That's why the idea of pouring this precious commodity down the drain is unthinkable, even if it is supposedly tainted with alcohol.
The truth is, you don't need to ditch breastmilk if you drank alcohol in moderation. According to the Centers for Disease Control and Prevention, says one standard alcoholic drink per day (12 ounces of 5% beer, 8 ounces of 7% malt liquor; 5 ounces of 12% wine; or 1.5 ounces of 40% (80 proof) liquor) is not known to be harmful to the baby. The CDC advises moms to wait at least two hours after a single drink before nursing, but does not suggest that moms who had an alcoholic beverage should stop breastfeeding.
"In general, if you are sober enough to drive, then you are sober enough to breastfeed," says New York-based lactation consultant Leigh Anne O'Connor. Timing and food consumption aren't the only factors to take into account when deciding if your milk is safe for baby. O'Connor also recommends considering details such as the age of the baby, the mother's metabolism, and exactly how much she's had to drink.
Still, the CDC says that if a mother decides to express or pump milk within two hours of consuming one alcoholic beverage, she may choose to discard the expressed milk. Moms looking for other options are turning to friends and social media for advice. Enter the idea of "pumping and diluting," an alternative to the practice of pumping and dumping that has women diluting their breastmilk with previously pumped, alcohol-free breastmilk—as opposed to dumping it down the drain.
What Does it Mean to 'Pump and Dilute'
It's hard to trace the origin of this practice, but Emily Bernard, a lactation consultant and founder of Before and After Baby breastfeeding support service, says it may have started in online forums. "The thought of blending pumped 'clean' breastmilk with breastmilk that is pumped and contains any substance, including alcohol, is one of those items that has caught wave in a lot of online moms groups," she says. "Sadly, it is not based in any type of science. Many moms also feel that pumping reduces the amount of alcohol within their breastmilk when in reality time is what does."
According to the U.S. National Library of Medicine's Toxicology Data Network, the highest alcohol levels in milk can be found a half hour to an hour after consuming alcohol, although food can delay the peak levels.
Is it Safe to Pump and Dilute?
Gladys Vallespir Ellett, the nurse coordinator for lactation services at NYU Langone, suggests steering clear of diluting altogether. "Because there are no recommendations regarding dilution of breast milk with pumped breast milk, it is not a practice that I would recommend," she says. "Rather than place restrictions and discourage women who are breastfeeding, I believe it is important for a woman to understand the recommendations so she can make decisions that are safe and that meet her desire to enjoy an occasional alcoholic drink."
That may be easier said than done, as recommendations vary between different organizations. Guidelines for how much a mom can safely drink vary between the CDC and the American Academy of Pediatrics. And online forums are a free-for-all that would make any mama's head spin. But Ellett notes that nursing right after one to two drinks can negatively impact an infant's ability to transfer milk, increase agitation, and cause sleep disturbances.
Ultimately, the act of pumping and diluting breastmilk may just be an unnecessarily complicated step for a potentially inebriated mother—especially if she's still attempting to feed her baby with the hybrid milk. "The danger to dilution is there is no way to measure how much alcohol is in the breast milk versus what it is being mixed with," Bernard says.

Bottom line: If you're not comfortable breastfeeding your baby after drinking, it's better to feed them either previously pumped milk or formula—or to ask someone else to do it for you. Only "pump and dump" if you're experiencing discomfort.
"The idea is to not get drunk," O'Connor says. "There are risks to caring for a baby while impaired, beyond alcohol in breastmilk—which metabolizes out of milk as it does out of blood. Generally speaking, a breastfeeding parent can enjoy the occasional drink without pumping and dumping."

Which Forms of Birth Control Are Safe to Use While Breastfeeding?

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on April 26, 2017 — Written by Ashley Marcin
IUD
Mini-pill
Barrier methods
Implant
Depo-Provera
Natural family planning
Sterilization
Morning-after pill
Takeaway
How to prevent pregnancy while breastfeeding

You may have heard that breastfeeding alone is a good form of birth control. This is only partially true.

Breastfeeding reduces your chances of becoming pregnant only if you are exclusively breastfeeding. And this method is only reliable for six months after the delivery of your baby. For it to work, you must feed your baby at least every four hours during the day, every six hours at night, and offer no supplement. This means that your baby eats nothing besides your milk.

You will ovulate first, and then if you don’t get pregnant you have your first period about two weeks later. You probably will not know if you ovulate, so there is the danger of getting pregnant when breastfeeding. This method isn’t effective if your period has already returned.

If you’re concerned about preventing pregnancy while breastfeeding, it’s a good idea to speak to your doctor about your options. You may want to avoid birth control that contains the hormone estrogen. Estrogen has been linked to lowered milk supply in breastfeeding mothers.

That said, there are still plenty of options available for both preventing pregnancy and protecting you against sexually transmitted infections (STIs). Keep reading to learn more.

Option #1: IUD

Intrauterine devices (IUDs) are more than 99 percent effective, making them the most effective birth control on the market. IUDs are a form of long-acting reversible contraception (LARC). There are two different types of IUDs available, hormonal and non-hormonal. Both are available by prescription only.

Hormonal IUDs contain progestin, which is a synthetic form of the hormone progesterone. The hormone thickens your cervical mucus to prevent sperm from reaching your uterus.

Options include:

Mirena: provides up to 5 years of protection
Skyla: provides up to 3 years of protection
Liletta: provides up to 3 years of protection
Kyleena: provides up to 5 years of protection
A healthcare provider inserts a plastic T-shaped device into your uterus to prevent fertilization. Because a foreign object is inserted, your risk of infection is greater. An IUD is not a good choice for women who have multiple sexual partners.

Hormonal IUDs may also make your periods lighter. Some women may stop experiencing periods entirely.

Paragard is the onlynon-hormonal IUD available. Paragard uses a small amount of copper to interfere with sperm movement. This can prevent egg fertilization and implantation. Paragard provides up to 10 years of protection. However, this IUD may not be for you if you normally have a heavy period or experience strong cramping. Many women who use the copper IUD report longer, heavier periods.

You can have an IUD placed immediately after delivery, but it’s a good idea to ask your doctor whether this is your best option. Many doctors want to wait until you heal and stop immediate postpartum bleeding in two to six weeks. Otherwise, the IUD may become dislodged if placed too soon and your risk of infection is greater.

Side effects include cramping after insertion, irregular or heavy bleeding, and spotting between periods. These side effects usually ease within the first six months of insertion.

If you decide you would like to get pregnant again, you can have your IUD removed and start trying right away.

Learn more about IUDs »

Option #2: Mini-pill

Traditional birth control pills contain a mixture of the hormones estrogen and progestin. Some women may experience a reduced milk supply, and consequently a shorter duration of breastfeeding, when using combination pills. It’s thought that estrogen may be at the root of this.

If you’d like to use an oral contraceptive, the mini-pill is an option. This pill contains progestin only, so it’s considered to be safer for breastfeeding mothers. The pill is typically only available by prescription, but may be found over the counter (OTC) in some states.

Because each pill in a 28-pill pack contains progestin, you likely won’t have a monthly period. You may experience spotting or irregular bleeding while your body adjusts.

Like with many other progestin-containing contraceptives, you can start taking the mini-pill between six and eight weeks after you deliver your baby. It’s between 87 and 99.7 percent effective at preventing pregnancy.

You may have the best success with this birth control method if you remember to take the pill every day and at the same time each day to keep your hormone levels steady.

While on the mini-pill, you may experience anything from headaches and irregular bleeding to a reduced sex drive and ovarian cysts.

If you decide you want to get pregnant again after taking the pill, speak with your doctor. For some women, fertility may return immediately after stopping the pill or it may take a few months to return.

Many moms notice their milk supply decreases with any hormonal birth control. To overcome that, breastfeed more often and pump after feeding for the first few weeks on the mini-pill. If your breastmilk supply continues to drop, call a lactation consultant for advice on increasing your supply again.

Option #3: Barrier methods

As the name implies, a barrier method blocks sperm from entering the uterus and fertilizing the egg. There are a variety of options available and all are OTC.

The best part? You can start using barrier methods as soon as you’re cleared for sexual intercourse after the birth of your baby. These methods don’t contain any hormones that may disrupt your milk supply.

Condoms

Condoms work by blocking the sperm from getting into the vagina.

They come in a variety of options, including:

male and female
latex and non-latex
non-lubricated and lubricated
spermicidal
Condoms are also the only form of birth control that help protect against STIs.

When used “perfectly,” condoms are about 98 percent effective. This means using a condom every time, from start to finish. In other words, there isn’t any genital contact before a condom is put on. Perfect use also assumes that the condom doesn’t break or slip off during intercourse.

With “typical” use, that number lowers to about 82 percent effective. This accounts for all of the mishaps that may occur during intercourse.

For added protection, use condoms with other birth control methods, like a spermicide, the mini-pill, or natural family planning.
Sponge, cap, or diaphragm

Other barrier methods include:

Sponge: This is a piece of polyurethane foam that you insert into your vagina. The sponge blocks sperm from entering your uterus. It’s about 88 percent effective with typical use, however it may be less effective for women who have given birth.

The contraceptive sponge contains spermicide so it not only blocks sperm with a barrier, but contains chemicals that immobilize and kill sperm. Keep the sponge in place for at least 6 hours after intercourse, and never leave it in more than 24 hours.

Cervical cap: A cap can be placed in the vagina up to six hours before intercourse. The only brand available in the United States is called the FemCap. It’s 71 to 86 percent effective.

A cap is available by prescription only as your healthcare provider will need to fit you for the correct size. If you used one before you got pregnant, you will need to be refitted. This is because your cervix will change with pregnancy and delivery.

The FemCap will need to be used with a spermicide to get that effectiveness. This means that you might have up to a 30 percent chance of getting pregnant. If this risk is too high, then consider another method of birth control.

Diaphragm: This is a small silicone cup that you can insert into your vagina up to two hours before intercourse. It fits over your cervix to prevent sperm from reaching your uterus.

A healthcare provider will need to fit you for a diaphragm, and refit after childbirth as the cervix changes and it may no longer fit. This method is about 60 percent effective for women who have already given birth.

You should always use spermicide with the diaphragm.

Option #4: Implant

The contraceptive implant Nexplanon is the only other LARC available. It’s also over 99 percent effective and is only available by prescription.

This small, rod-shaped device is about the size of a matchstick. Your doctor will insert the implant underneath the skin on your upper arm. Once in place, the implant may help prevent pregnancy for up to four years.

The implant contains the hormone progestin. This hormone helps prevent your ovaries from releasing eggs. It also helps to thicken your cervical mucus, preventing sperm from reaching the egg.

You can have the implant placed immediately after delivery. You may also have it removed if you choose to get pregnant again.

Although complications with Nexplanon are rare, you should tell your doctor if you have:

arm pain that won’t go away
signs of infection, such as fever or chills
unusually heavy vaginal bleeding

Option #5: Depo-Provera shot

The Depo-Provera shot is a long-lasting form of prescription birth control. It uses the hormone progestin to prevent pregnancy. The shot provides three months of protection at a time, so if you don’t keep your quarterly follow-up appointments, you won’t be protected.

The shot is about 97 percent effective. Women who receive their injections on time every 12 weeks have a higher level of efficacy than women who miss a shot or are off schedule.

Side effects include abdominal pain to headaches to weight gain. Some women also experience bone density loss while using this method of birth control.

If you’re looking to have more children in the future, it’s important to note it may take 10 months or longer for your fertility to return after discontinuing use.

Option #6: Natural family planning

The natural family planning (NFP) method is also called the fertility awareness method. It is hormone-free, but it requires some attention to detail.

There are several different ways to approach NFP, but it comes down to paying close attention to your body’s signals.

For example, you’ll want to pay attention to your body’s natural rhythm and how long your cycle is. For many women, this length is between 26 and 32 days. Beyond that, you’ll want to observe the cervical mucus coming out of your vagina.

You may also want to take your basal body temperature each morning using a special thermometer. This can help you look for spikes or dips in temperature, which help indicate ovulation.

However, it can be difficult to predict when your fertility returns after birth. Most women who have given birth don’t experience a period before they begin ovulating again. The first few menstrual cycles you experience may be irregular and different from what you are used to.

If this is your method of choice, you must decide to become educated and diligent about monitoring mucous, the calendar, symptoms, and temperatures. The effectiveness of natural planning methods is around 76 percent or lower if you’re not practicing the method consistently.

This is not a good choice for women who have always had irregular periods. Also, your cycle may be somewhat unpredictable while breastfeeding. For this reason, you may want to consider using a backup method, like condoms, a cervical cap, or a diaphragm.

Option #7: Sterilization

If you don’t want to have another child, sterilization may be a good option for you. Female sterilization is known by many names, including tubal sterilization, tubal ligation, or “getting your tubes tied.” This is a permanent form of birth control where the fallopian tubes are cut or blocked to prevent pregnancy.

Tubal ligation doesn’t affect your menstrual cycle. Some women choose to have this procedure completed after vaginal childbirth or during a cesarean section. The risks with this procedure are the same as for any other major abdominal surgery, including reaction to anesthesia, infection, and pelvic or abdominal pain.

Your doctor or a lactation consultant is your best resource for determining when you can safely return to nursing after surgery and taking medications, like painkillers.

Nonsurgical sterilization is also possible, although it may take up to three months to be effective. Tubal ligation is effective immediately.

Although reversing tubal ligation may be possible, the odds are very low. You should only explore sterilization if you are completely sure that you don’t want to give birth again.
What about the morning-after pill?

If you find yourself in a situation where you think your birth control has failed, it’s safe to use the morning-after pill while breastfeeding. This pill should only be used as a last resort and not as a regular form of birth control. It is available OTC or at a reduced cost by prescription.

There are two types of the morning-after pill: one that contains a combination of estrogen and progestin and another that is progestin-only.

The progestin-only pills are 88 percent effective, but don’t work as well as the combination pills, which are 75 percent effective.

Some options for progestin-only pills include:

Plan B One-Step
Take Action
Next Choice One Dose
My Way
The combination pill is about 75 percent effective.

Although progestin-only pills are preferred, taking a combination pill shouldn’t have a long-term effect on your milk supply. You may experience a temporary dip, but it should return to normal.

The bottom line

Your fertility may return at any time after your deliver your baby, regardless of whether you’re breastfeeding. Breastfeeding alone only slightly reduces the chance of pregnancy for the first six months and only if feeding exclusively at least every four to six hours.

There are many options for birth control that you can discuss with your doctor. Choosing which one is right for you is a personal decision. Generally, breastfeeding mothers should avoid birth control that contains estrogen, as it may impact your milk supply.

If you have more questions about your fertility while breastfeeding and safe birth control methods, consider making an appointment with your doctor or a lactation consultant. Maintaining breastfeeding is important and you want to make a birth control choice that does not interfere.

Advertisement
PUBLISHED SEPTEMBER 19, 2007
WOMEN'S HEALTH
Nonprescription Products for the Pregnant and Breast-Feeding Patient
W. Steven Pray, PhD, DPh
Bernhardt Professor of Nonprescription Drugs and Devices,
College of Pharmacy, Southwestern Oklahoma State University, Weatherford
US Pharm. 2007;32(9):10-14.

It is considered unethical for manufacturers to design prospective human trials to ascertain potential teratogenicity or to determine dangers to a baby when medications pass into breast milk.1 Thus, pregnant and lactating females are often referred to as therapeutic orphans. Many of these patients choose nonprescription products on their own.2 However, even when women do ask, pharmacists are hampered by the general lack of knowledge regarding the potential dangers of these products.

Pregnancy Versus Lactation
While pregnancy and lactation may seem similar with regard to medication toxicities, there are fundamental differences. During pregnancy, the fetus can come into contact with medications in higher amounts than through lactation.3 Despite this, the mother's liver and kidneys aid in detoxification and excretion. However, although less medication reaches the breast-feeding child, the infant must rely on its own detoxification and excretion abilities. Thus, each situation presents a unique set of problems.

Pregnancy
The risk for major malformations in babies is 3%, most of which are unrelated to medication ingestion.1 Nevertheless, pregnant females are usually careful to do everything possible to deliver a healthy infant. This should include abstaining from drugs of abuse and restricting use of medications that are not prescribed. The well-known thalidomide incident is still in the public awareness.3,4 Definitive evidence regarding other medications is usually lacking, as it is unethical to administer any product to pregnant females to determine teratogenicity. The identification of a possible teratogen usually rests on case reports, case-controlled studies, or cohort studies.3 Fortunately, few medications are teratogenic.

Aspirin and other NSAIDs are nonprescription products that are known teratogens, as they affect the fetal cardiovascular system. These products should be avoided during the last trimester. Furthermore, aspirin and other salicylates can cause alterations in maternal and fetal hemostasis mechanisms, decreased birth weight, and increased perinatal mortality.5 If aspirin is given one week before or during labor and delivery, it can result in excessive blood loss at delivery. Its action in inhibiting prostaglandin may also prolong labor and gestation.

The FDA has developed pregnancy risk categories.4,6 Category A (remote risk of harm in controlled studies in women) includes vitamins at RDA doses. Category B (no apparent harm to the fetus in animal and/or human research) includes acetaminophen, cimetidine, aluminum hydroxide, insulin, and ibuprofen in the first and second trimesters. Category C (no well-controlled studies in pregnant women) includes pseudo ephe drine, simethicone, clotrimazole, senna, dextromethorphan, aspirin, and hydrocortisone in the second and third trimesters. Category D (positive evidence of human fetal risk, but benefits may outweigh risk) includes ibuprofen in the third trimester and hydrocortisone in the first. Category X, including vitamin A at doses over the RDA, is contraindicated in pregnant women and in those who may become pregnant.

Breast-Feeding
The majority of prescription and nonprescription medications are not found in breast milk after ingestion.2 However, there are several recommendations that can be given to the concerned mother.2 First, she should be encouraged to avoid medications whenever possible and to explore the option of nonpharmacological therapies. Second, she should be advised to take oral medications immediately after nursing the infant and preferably before the babylongest sleep period. This will help prevent the baby from encountering medications by avoiding peak plasma and breast-milk levels. Third, the mother should take the regular-strength versions of a nonprescription product, rather than extra strength, maximum-strength, or long-acting versions. The mother should rely on single-entity medications instead of combinations, and she should be alert for the first sign of an adverse event in order to notify the pediatrician as early as possible.

Analgesics: Aspirin, magnesium salicylate, and bismuth subsalicylate can enter breast milk; they can cause adverse effects and lead to Reye's syndrome.2 Aspirin in breast milk can also cause rashes, platelet abnormalities, and bleeding.5 Combination analgesic products containing diphenhydramine, phenyltoloxamine, caffeine, salicylamide, and other ingredients should be avoided. Safer alternatives are ibuprofen and acetaminophen.

Antihistamines and Decongestants: Clemastine may produce drowsiness and irritability in the breast-fed infant. 2 Other antihistamines may also cause drowsiness. Experts advise ingesting the antihistamine after the last nighttime feeding, just prior to bedtime.2 Pseudoephedrine passes poorly into breast milk (0.5% of the oral dose), although it may decrease the volume of breast milk.2,7 Oxymetazoline can decrease milk supply.2 Phenylephrine has a shorter duration of action and might be preferable as a topical nasal decongestant, although mothers should carefully monitor the volume of breast milk to ensure that it does not undergo appreciable reduction in volume.2

Cough and Sore Throat Products: Guaifenesin, dextromethorphan, menthol, dyclonine, and benzocaine are reportedly safe for use by breast-feeding mothers.2 Although codeine does reach breast milk in detectable amounts, dextromethorphan is a safer antitussive.

Gastrointestinal Products: For upset stomach or reflux, antacids containing calcium or magnesium are fairly safe, as little passes in breast milk.2 However, sodium-containing antacids (e.g., Alka-Seltzer, Bromo-Seltzer) could cause fetal accumulation and should be avoided. Of the nonprescription H2-antagonists, cimetidine and ranitidine are found in higher concentrations in breast milk than famotidine and nizatidine, making the latter two appear preferable.2 Antidiarrheals containing loperamide are acceptable, but bismuth subsalicylate products should be avoided to prevent Reye's syndrome. For constipation, preferred agents are the bulk-forming products such as psyllium or methylcellulose. Magnesium hydroxide (e.g., Freelax) would also be acceptable, but docusate may cause diarrhea in the infant, and stimulants such as senna and bisacodyl are less optimal choices for all patients because of their nonphysiologic action. Simethicone is safe for flatulence because it is virtually unabsorbed by the mother.

Herbal Medicines and Other Dietary Supplements
Approximately 13% of pregnant women take herbs or dietary supplements (other than vitamins or folic acid).8 Dietary supplements comprise unproven products such as herbals and nonbotanical supplements. (Homeopathic products are also unproven.) The FDA does not have the power to force manufacturers to prove these products are safe or effective for use, and their safety in pregnancy and breast-feeding is virtually unknown.9,10

As an example of possible hazards of dietary supplements, an infant suffered focal seizures 26 hours after birth and was found to have an infarct in the left-middle cerebral artery.11 The mother reported ingestion of blue cohosh tea as a means to induce labor. Manufacturers of blue cohosh (and all other herbs) do not carry out systematic studies of their use in pregnancy or lactation. Cerebral infarcts are exceedingly rare in newborns, but blue cohosh is known to cause uterine contractions and vasoconstriction, making it a possible cause. Furthermore, an older report pointed to blue cohosh tea as the causative factor in a neonate who experienced congestive heart failure, shock, and myocardial infarction.12 While some argue that such case studies should not be used to issue blanket indictments against all unproven products in pregnancy, others point out that the "poor quality control, uncertain efficacy and unknown dangers" of herbal medicines creates an unfavorable risk–benefit ratio with their use.13,14

A series of articles in The Canadian Journal of Clinical Pharmacology explored several herbs' safety and efficacy during pregnancy and lactation. One reported that 45% of midwives use black cohosh to induce labor, but that its use should be discouraged in all pregnant patients due to such concerns as labor induction prior to the appropriate time, hormonal effects, emmen ogogue (promoting menstrual flow) properties, and anovulatory effects.15 Its possible estrogenic/antiestrogenic effects would also cause it to be contraindicated in breast-feeding. Another article examined echinacea, concluding that it may be safe during pregnancy, but insufficient evidence exists to recommend its use while breast-feeding.16 St. John's wort is of unknown safety during pregnancy, and use while breast-feeding may cause colic, drowsiness, and lethargy.17 Ginkgo should be avoided during pregnancy because of its ability to prolong bleeding time; its safety during lactation is unknown and it should not be ingested.18 These reports exploring the safety of herbs in pregnancy and lactation are the exception rather than the rule for dietary supplements.

Taiwanese researchers conducted a prospective study in which over 14,000 live births were examined in relation to maternal ingestion of herbs.19 The herb huanglian was associated with major congenital malformations of the nervous system and An-Tai-Yin with major malformations of the musculoskeletal and connective tissues and the eye.

Each dietary supplement should be subjected to the same type of analysis to determine teratogenicity, but this is seldom done. Thus, pharmacists should advise against use of herbs and dietary supplements in pregnant and nursing patients.

References
1. Kyle PM. Drugs and the fetus. Curr Opin Obstet Gynecol. 2006;18:93-99.
2. Nice FJ, Snyder JL, Kotansky BC. Breastfeeding and over-the-counter medications. J Hum Lact. 2000;16:319-331.
3. Della-Giustina K, Chow G. Medications in pregnancy and lactation. Emerg Med Clin North Am. 2003;21:585-613.
4. Lee E, Maneno MK, Smith L, et al. National patterns of medication use during pregnancy. Pharmacoepidemiol Drug Saf. 2006;15:537-545.
5. Final rule for professional labeling of aspirin, buffered aspirin, and aspirin in combination with antacid drug products. Fed Reg. 1999;64:49652-49655.
6. McCarter-Spaulding DE. Medications in pregnancy and lactation. MCN Am J Matern Child Nurs. 2005;30:10-17.
7. Hale TW. Medications in breastfeeding mothers of preterm infants. Pediatr Ann. 2003;32:337-347.
8. Fast facts about medication use during pregnancy and while breast feeding. Centers for Disease Control and Prevention. Available at: www.cdc.gov/ncbddd/meds/fast.htm. Accessed August 2, 2007.
9. Marcus DM, Snodgrass WR. Do no harm: Avoidance of herbal medicines during pregnancy. Obstet Gynecol. 2005;105:1119-1122.
10. Kuczkowski KM. Labor analgesia for the parturient with herbal medicines use: What does an obstetrician need to know? Arch Gynecol Obstet. 2006;274:233-239.
11. Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med. 2004;351:302-303.
12. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr. 1998;132:550-552.
13. Fugh-Berman A, Lione A, Scialli AR. Do no harm: Avoidance of herbal medicines during pregnancy (Letter). Obstet Gynecol. 2005;106:409-410.
14. Marcus DM, Snodgrass WR. Do no harm: Avoidance of herbal medicines during pregnancy (Letter). Obstet Gynecol. 2005;106:410-411.
15. Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e257-261.
16. Perri D, Dugoua JJ, Mills E, et al. Safety and efficacy of echinacea (Echinacea angustifolia, E. purpurea and E. pallida) during pregnancy and lactation. Can J Clin Pharmacol . 2006;13:e262-267.
17. Dugoua JJ, Mills E, Perri D, et al. Safety and efficacy of St. John's wort (hypericum) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e268-276.
18. Dugoua JJ, Mills E, Perri D, et al. Safety and efficacy of ginkgo (Ginkgo biloba) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e277-284.
19. Chuang CH, Doyle P, Wang JD, et al. Herbal medicines used during the first trimester and major congenital malformations: An analysis of data from a pregnancy cohort study. Drug Saf . 2006;29:537-548.
20. Qu F, Zhou J. Treating threatened abortion with Chinese herbs: A case report. Phytother Res. 2006;20:915-916.

To comment on this article, contact editor@uspharmacist.com.

Breastfeeding Information

Breastfeeding information topics
Breastfeeding through pregnancy and beyond

By Bronwyn Warner, ABA Counsellor

So you're pregnant and still breastfeeding your baby or toddler. You may be wondering if you can continue to breastfeed though your new pregnancy, and even beyond. Perhaps you have been told you must wean. Or maybe you know others who have breastfed through subsequent pregnancies and wondered how it all worked.

Your second and later pregnancies are a special time. You may feel more confident in your role as a mother. Your body has given birth and continued to nourish your baby, completing the natural reproductive role. You could also be apprehensive - how could you love another child as you love your first? Or perhaps you are worried about the physical demands of being pregnant and then having two children to look after. The Australian Breastfeeding Association uses the term 'tandem feeding' to describe concurrent breastfeeding of siblings who are not twins. The children may feed together or at separate times.

As your baby grows into toddlerhood and beyond, your milk is always nutritious and the best food your child could have. If your child's feeds have reduced over time, the immunological benefits are still very valuable. Sometimes a mother, or her child, prefers to wean gradually over the course of the pregnancy, however many are happy to continue, especially if the baby is still quite young or the pregnancy is unexpected. Continuing breastfeeding can also mean an extra rest period or more for you through the day, especially during the first trimester.

All women's bodies are different, but many find they can conceive even while they are breastfeeding. Sometimes introducing solids or other supplements to breastmilk is enough to trigger ovulation. With other women, it takes long breaks between feeds, of four or more hours, or their baby starting to sleep through the night.

What about my unborn child?

You may be concerned about the viability of the pregnancy if you continue to feed. In a normal, healthy pregnancy, with no previous history of miscarriage in the first 20 weeks or preterm labour after 20 weeks, there is no evidence to suggest breastfeeding is threatening to a pregnancy.1,2 If you do miscarry, it is unlikely to be because you are breastfeeding.

Sometimes you may be told that breastfeeding is taking 'the goodness away from the unborn baby'. The reality is your unborn baby has first call on all the nutrients it needs, and may even be healthier than normal, as you may eat better and take better care of yourself during the pregnancy. The other worry people may have is your newborn may be deprived of colostrum. Some mothers do restrict their toddler to one side only during late pregnancy, but it appears the breast reverts to making colostrum automatically without mum having to do anything to help it do so.3

Your body may start to make colostrum during the pregnancy of its own accord, or this may occur if your child stops feeding for a while. The taste of colostrum may encourage weaning, at least temporarily, as it is saltier than mature milk. Other breastfeeding children don't mind at all. Be aware that colostrum is a natural laxative (to help the newborn pass the meconium), so bowel motions may become far more liquid. This won't harm your child at all.

As you are normally advised to adjust your diet to allow for additional nutritional needs during pregnancy or breastfeeding, obviously, it is important to do so while doing both. There is little research on the requirements of a tandem breastfeeding mum, but we understand that our bodies are able to adjust metabolism so we don't need to consume extra large quantities of vitamins and minerals etc.

How will I feel?

There are various possible side effects to breastfeeding while pregnant. Some mums report their morning sickness being worse during a feed, possibly due to hormonal release in the body, hunger, thirst or tiredness, among other things. You may experience nipple tenderness, as a result of pregnancy hormones, which for some mums can be excruciating. This may last a trimester or longer, or not at all. Paying careful attention to positioning and attachment can relieve the discomfort - lying down to feed may be an option for you. Other mums, despite the pain experienced, continue anyway as the benefits of continuing to breastfeed outweigh any negatives they encounter. Most mums note that this nipple tenderness disappears entirely at birth. Some mothers report that the tenderness is worthwhile, as they have found it helps to reduce problems, such as nipple trauma, after the baby is born.

How will my older child feel?

While you may be feeling positive about feeding two children - meeting their nutritional and emotional needs - how could your older child feel? Many older siblings feel a special bond with the baby, as they are both sharing something very special and important. This can help lessen any feelings of jealousy and resentment, as he's not being left out. More importantly, he's still able to have the one thing that may be most important to him - a breastfeed with mummy.

What about my milk supply?

If your baby is under nine months of age, you eat a healthy well balanced diet and offer the breast whenever your baby seems to be interested, you may find your supply is maintained. Breastmilk remains a major part of your baby's diet. If you feel your baby isn't getting enough breastmilk, you may want to speak to your health adviser. Some mothers find their supply diminishes in response to the hormones in pregnancy.3

To wean or not to wean?

If you choose to wean your baby who is under 12 months of age, you will need to speak to your medical adviser about a suitable substitute. An older baby may be able to drink other liquids from a cup, avoiding the need to introduce a bottle. If your child is old enough, you could explain that you are feeling sick or that your nipples are sore. You could delay feeds, or your child could feed for a shorter period. The Australian Breastfeeding Association booklet, Weaning, has information and suggestions on weaning children of all ages.

If your baby or child chooses to wean during pregnancy,2 it is normal to feel guilty - 'Did I hasten the process?' or grief at the end of the relationship. It may help to try and focus on the new baby and the relationship you will have together. Some mothers report that their 'weaned' child returns to the breast after the baby is born.

It may be that your baby isn't ready to wean, no matter what you try. Perhaps reassessing your needs at this time may help. You could try weaning more slowly or try to encourage shorter feeds. You may even decide not to wean.

Why tandem feed?

You may have read or been told that 'mothers only feed older children for their own sake'. Of course, this isn't true. It can be a wonderful experience tandem feeding or feeding an older child. There are few things more satisfying than watching your children holding hands while breastfeeding together.

What about the practicalities?

You could feed both your children at the same time, or one after the other, or at completely different times. You may find that your toddler wants to feed all the time, especially once your milk comes in, and you have a plentiful supply. You may be happy to accommodate this, at least at first, while other mums find it important to limit their toddler's feeds. Only you can decide what works for you. You could try sitting up to feed, perhaps with cushions to help prop you, or maybe laying down to feed will work. There are many ways to tandem feed.

Because you are producing more milk than a mother feeding a singleton, you may find your newborn has difficulty coping with your let down reflex. Changing your feeding routine may help. Perhaps you could offer one side to your toddler, then, after he has stimulated your let down reflex, attach your newborn.

We suggest you speak to your medical adviser about breastfeeding through pregnancy and afterwards. The Australian Breastfeeding Association has trained counsellors who can offer you information and support in your decision.

References

Ishii H 2009, Does breastfeeding induce spontaneous abortion? J. Obstet. Gynaecol 45(5): 864-868.
Moscone SR, Moore MJ 1993, Breastfeeding during pregnancy. J Hum Lact 9(2):83-88.
Marquis GS, Penny ME, Diaz JM, Marin RM 2002, Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy. Pediatrics 109(4):e56-e56.
© Australian Breastfeeding Association Reviewed July 2015

Last reviewed:
Jun 2016

Breastfeeding and fertility
Get breastfeeding support

Ask our breastfeeding expert

Find a breastfeeding support group
You're unlikely to have periods if you are exclusively breastfeeding and your baby is under 6 months.

Exclusively breastfeeding means that you are:

giving your baby no other food or drinks
feeding on demand (including during the night)
not using a pacifier (soother)
Your chances of becoming pregnant in this case are around 3%.

If you're not ready to conceive, use contraception because fertility can return when you are breastfeeding.
Contraception and breastfeeding

Your chances of getting pregnant may increase when your baby is about 6 months old.

This is when your baby starts to take food and drinks other than breast milk.

You may trigger ovulation earlier if:

you leave gaps of 6 hours or longer between breastfeeds
you miss feeds during the night. Prolactin (the milk-making hormone) levels are usually higher at night. Prolactin can suppress (stop) ovulation

Fertility

You will generally know when your fertility returns because you will have your first period after pregnancy. This means that you have already ovulated.

Every woman is unique and your fertility will return in its own time. Some mothers get periods very early on while breastfeeding. Others may only get their periods back after the first year of breastfeeding.

Bringing fertility back sooner

To bring back your fertility sooner, try changing your breastfeeding pattern. There is no general rule around breastfeeding frequency that leads to the return of fertility.

Abrupt changes in breastfeeding generally brings back fertility quicker. Keep in mind that you and your baby would have to be ready for this change. Suddenly stopping breastfeeding can impact the bond your baby is enjoying.

Getting pregnant before your first period

It is possible to get pregnant before your first period after pregnancy. But, it is unlikely that the first egg released will result in conception. Generally, you must have a regular cycle of ovulation and menstruation to sustain a pregnancy.

Increasing your chance of pregnancy

The best way to become pregnant is to have regular sexual intercourse. This should be at times where you both feel ready to be intimate.

If you're feeling an increased desire to have sex, this may be a clue to your fertility returning.

Return of menstrual cycle

If you are having regular menstrual cycles it is likely you have returned to fertility.

Long, short, or irregular cycles can be a sign that your cycles are not yet fertile. Keeping a record of your cycles can help you to identify that your body is ovulating.

How to tell if you're fertile

If you want to know more about your fertility status, you can use simple family planning methods. Learn more about natural fertility on the Natural Family Planning Teachers Association of Ireland's website.

Toni Weschler, MPH (Master of Public Health), includes a section on charting during breastfeeding in her guide Taking Charge of Your Fertility

Fertility treatment and breast milk

Fertility treatments are generally safe for your breast milk.

If you're worried about how a particular drug affects breastfeeding, talk to your GP.

Find a breastfeeding support group near you

Page Last Reviewed: 19/03/2019
Next Review Due: 19/03/2022

Understanding Your Fertility while Breastfeeding

By Evelina Fisher
Introduction
As you journey into motherhood, bonding with and caring for your new baby, the thought of another pregnancy may be distant. Whether or not you want more children in the future, the time to think about your fertility is before or soon after giving birth. Considering options and determining what best meets your personal circumstances can be overwhelming. This article discusses your fertility while breastfeeding and provides links to additional online resources. It is a starting point, which we hope will inspire you to continue this important conversation with your health-care provider and/or your partner.

After birth, when will my fertility return?
Fertility often returns in stages. You may first experience menstruation without ovulation or ovulation without luteal competency (when the uterine lining can support implantation). When you are both ovulating and have luteal competency, your fertility has fully returned. Most women will not start ovulating in the first six weeks after giving birth.1 Breastfeeding typically delays the onset of ovulation.2 Depending on the intensity of breastfeeding, it can be several months or over a year before you regain your fertility. Conversely, absence of breastfeeding may cause you to start ovulating as early as three weeks after giving birth.1

Why is it important to understand your fertility?

The World Health Organization recommends that women wait 24 months after giving birth before becoming pregnant again.3 Your health improves when you have a chance to recover, physically and emotionally, from giving birth and caring for your new baby. When you are healthy, your family benefits, too. Closely spaced pregnancies increase health risks, including preterm labor and low birth weight.4 Women also space childbearing for social and financial reasons. If your first menstruation is preceded by ovulation, you may become pregnant before you are aware that you are fertile again. The possibility of getting pregnant makes it important for women to make and act on decisions about their fertility before or soon after giving birth.

How can fertility be managed?
Contraception refers to methods (and devices and practices) used to reduce the risk of pregnancy. There are many different contraceptive methods, and a little later in this article we’ll look at many of them. First, let’s discuss some of the personal considerations that may influence you as a breastfeeding mother. The following steps can guide your decision-making process:

Establish your fertility goal: For how long do you want to avoid childbearing? How important is it for you to not get pregnant right now? What would you do if you experienced an unintended pregnancy?

Determine what your breastfeeding goal and actual patterns are: How old is your baby? Are you exclusively or partially breastfeeding right now? For how long do you want to breastfeed? How important is it to you that the contraceptive method you use is compatible with breastfeeding?

Consider what fits your personal circumstances and daily routines: How does your relationship status affect your contraceptive choices? How important is ease of use? Do you need a method which is long-acting? Discreet? If you have used certain methods in the past, what did you like and dislike about them?

Respect your own conscientious convictions: What methods are compatible with your personal values and religious beliefs?

Prioritize: Of all these considerations, which ones are more important to you and your family right now?

Consult your health-care provider and/or partner before starting or stopping a contraceptive method. There may be health considerations--such as your age, any illnesses, or smoking--which affect what contraceptive methods you can safely use. Your health-care provider will help you determine your clinical eligibility and identify whether there are methods you should avoid. Your health insurance may restrict what methods are covered under your plan. Talk to your provider about all of your options. Below are some useful questions that you can ask. If you have chosen a method, your provider should also explain or demonstrate how to use it correctly.

Questions to ask your health-care provider:

How does this method prevent pregnancy?
How effective is it in preventing pregnancy?
How long is this method effective?
How do I use it correctly?
What are the side effects and risks of this method?
What evidence exists about its effect on breastfeeding?
Have any breastfeeding mothers in your practice had negative effects on their milk production?
If I experience negative effects on milk production, what do you recommend?
How easily reversible is the method? When do its effects wear off after I stop using it?
If and when I want to have another child, how quickly will my fertility return after I stop using the method?
Is there any medical reason why I should not use this method?
What does it cost? Does my insurance cover it?
What are comparable options?
Contraception
This section looks at how different contraceptive methods prevent pregnancy, their efficacy, and compatibility with breastfeeding. When health professionals talk about efficacy, they usually refer to ‘perfect use’ and ‘typical use.’ Perfect use means that you always use the method correctly. Typical use refers to how most people actually use the method, including incorrect and inconsistent use. Because there are many factors and barriers that influence our use of contraceptives, the average person falls under ‘typical use.’ Failure rates for both perfect and typical use are reported in percentages. The data indicates how many women out of 100, who use the method for one year, will experience an unintended pregnancy.

Lactational Amenorrhea Method (LAM):

Works by suppressing ovulation.2 Without an egg, pregnancy cannot happen.
Depends on exclusive breastfeeding and breastfeeding on cue.5
Is very effective in preventing pregnancy temporarily.6
For LAM to effectively reduce the risk of pregnancy, you need to meet three conditions:

your menses have not returned;
your baby is younger than six months and;
you are exclusively breastfeeding and not allowing long periods of time between feedings.7
The last condition means that your baby does not get supplements of foods or liquids, does not use a pacifier frequently, and does not go longer than approximately four hours during the day and six hours during the night without breastfeeding.

With perfect use, the failure rate of LAM is 0.45% for six months after birth. With typical use, it is 2%.2, 8 LAM may not be as effective for mothers who are separated from their babies and rely heavily on expressing milk, including mothers who are employed outside the home or are full-time students.9 LAM requires that you evaluate and re-evaluate your situation on an ongoing basis to make sure that the three conditions are still met. Whenever one of the conditions is no longer met, the failure rate may be increased, and an alternative contraceptive method would be recommended.5

Other natural methods:

Work by avoiding contact between sperm and the vagina, constantly or periodically, when you are at risk for pregnancy.
Are fully compatible with breastfeeding.
Are very to somewhat effective in preventing pregnancy.6
Abstinence means refraining from shared sexual activity that can result in pregnancy and sexually transmitted infections. To be effective abstinence needs to be practiced constantly. If you decide to have sex, another method is necessary to prevent pregnancy.

There are different fertility awareness-based methods that can help you identify when you are fertile. The symptothermal method requires you to 1) check your cervical mucus daily; 2) take your temperature each morning at the same time and before voiding, and; 3) chart your ovulation symptoms. 10 It can be used once your menstrual cycle has started and become regular again.11 During days when you are at risk for pregnancy, you can practice periodic abstinence, withdrawal, or use a barrier method (discussed below).

Withdrawal (or the ‘pull out’ method) requires your partner to completely remove the penis from the vagina before ejaculation to prevent sperm from entering the vagina. If a man ejaculates on the vulva or near the vaginal opening, sperm can still enter the vagina. After an ejaculation, small amounts of sperm may be left in the man's urethra. There is inconclusive evidence whether the amount of sperm in pre-ejaculatory fluid (precum) can cause pregnancy, and research shows that this is likely to vary greatly between individual men. While withdrawal is more effective in preventing pregnancy than unprotected sex, it is not recommended if avoiding pregnancy is critical for you.

With perfect use, natural methods have very low failure rates (constant abstinence: 0%; symptothermal method: 0.4%; withdrawal: 4%).6 These methods are accessible to all women at no or low cost. Their main disadvantage, however, is that they are often used incorrectly and inconsistently. They require user knowledge, significant self-control, and good communication between partners. Failure rates increase exponentially with typical use: (no method: 85%; fertility awareness-based methods: 24%; withdrawal: 22%).6

Barrier methods:

Work by blocking sperm from passing through the cervix.11 Without sperm, pregnancy cannot happen.
Are fully compatible with breastfeeding.2
Are effective in reducing the risk of pregnancy.6
The most common barrier method is the condom. There are female and male condoms. They are relatively inexpensive and usually easy to acquire. With perfect use, the failure rate for male condoms is 2%, and for female condoms it is 5%.6 Many people use condoms incorrectly and inconsistently. With typical use, the failure rate for male condoms is 18%, and for female condoms it is 21%.6 Condoms also reduce the risk of sexually transmitted infections. They can be used simultaneously with other contraceptive methods, thus offering ‘dual protection.’ Other barrier methods, such as the cervical cap, diaphragms, and the sponge, are less effective than condoms, especially for women who have given birth. Diaphragms need to be refitted after childbirth or with large weight swings. Diaphragms and cervical caps are more effective when used in conjunction with spermicides.

Hormonal methods:

Work both by suppressing ovulation and making cervical mucus thicker, which blocks sperm from passing through the cervix.11, 12, 13, 14 If there is neither an egg nor sperm, fertilization cannot happen. Some of these methods also suppress growth of the uterine lining (details in listing below).11, 13
Are compatible with breastfeeding15 but are not recommended as the first choice for breastfeeding mothers.2, 16
Are very effective in preventing pregnancy.2, 6, 11, 17
Note: Since this article was published the Academy of Breastfeeding Medicine has changed its recommendations regarding hormonal contraceptive use for lactating women.

"A Cochrane review indicated that evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is limited and of poor quality: ‘‘The evidence is inadequate to make evidence-based recommendations regarding hormonal contraceptive use for lactating women.’’
Until better evidence exists, it is prudent to advise women that hormonal contraceptive methods may decrease milk supply especially in the early postpartum period. Hormonal methods should be discouraged in some circumstances (III):

existing low milk supply or history of lactation failure
history of breast surgery
multiple birth (twins, triplets)
preterm birth
compromised health of mother and/or baby
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Hormonal methods can be divided into different sub-categories, including short-acting and long-acting, and combined hormonal and progestin-only contraceptives. Combined hormonal methods, such as the ‘pill,’ the patch, and the vaginal ring, contain both estrogen and progestin. Estrogen may decrease milk production and negatively affect breastfeeding duration.2, 16 The World Health Organization recommends that breastfeeding mothers avoid combined hormonal contraceptives in the first six months after birth unless other methods are not available or acceptable.18 The Academy of Breastfeeding Medicine recommends alternative methods until after the baby has weaned.2

.2

If you are breastfeeding, progestin-only methods are preferred over combined hormonal ones.2, 19 Progestin-only contraceptives include the ‘mini pill,’ the implant, injectables, and the intrauterine system (IUS). The earliest recommended use of progestin-only methods by breastfeeding women, who are clinically eligible to use them, is usually six weeks after birth, if milk production is well-established.2, 16, 19 There are anecdotal clinical reports that progestin-only contraceptives can decrease milk production, too.2, 16

The possible negative effects on milk production can sometimes be difficult or impossible to fully reverse with either combined hormonal or progestin-only methods, especially with methods that cannot be stopped quickly. A nursing mother needs to carefully consider whether to use any of the hormone-based contraceptives while the baby is dependent on breastmilk for the majority of his nutrition. The importance of pregnancy prevention versus maintaining optimal milk supply is something that only the mother can assess.

The following information is based on evidence current as of the date of publication and is not meant as an endorsement of any particular method or as being compatible with breastfeeding.

Select progestin-only contraceptives2, 6, 11, 12, 13, 14, 19

Progestin-only pill (also called the ‘mini pill’)

Perfect use: 0.3%
Typical use: 5%
Requires taking the pill daily and at the same time. Can be stopped at first sign of adverse effects on milk production.
Implant

Perfect use: 0.05%
Typical use: 0.05%
Requires no daily routine and works for three or five years depending on the brand. Like other hormonal methods, the implant suppresses ovulation and makes cervical mucus thicker, which prevents fertilization. It may also suppress growth of the uterine lining.
suppress growth of the uterine lining.
Injection

Perfect use: 0.2%
Typical use: 6%
Should be administered every 12 weeks. It takes longer for the hormone from the injectable to leave your system compared to other hormonal methods. If it has adverse effects on breastfeeding, the method cannot be quickly reversed. It must wear off on its own.
Intra-uterine system

Perfect use: 0.2%
Typical use: 0.2%
Requires no daily routine and works for up to five years. The hormone is released locally in the uterus, and it typically has little to no effect on milk production. Like other hormonal methods, the IUS suppresses ovulation and makes cervical mucus thicker, which prevents fertilization. The IUS also suppresses growth of the uterine lining.
If I choose a hormonal method, will hormones in my breastmilk affect my baby?
Hormonal contraceptives have been used by breastfeeding mothers for decades without any reported adverse outcomes for their babies due to ingestion of hormones in the breastmilk.16 The level of estrogen that transfers to human milk is low. It does not exceed the level that occurs naturally when a woman ovulates.20 Natural progesterone is poorly absorbed by the infant via milk.20 Changes observed in milk composition of breastfeeding mothers who are using hormonal contraceptives are within normal variations.5
Copper-bearing intrauterine device (IUD):

Works by releasing copper ions, which change the chemical environment in the uterus and destroys the function of sperm before they can fertilize the egg.13
Is fully compatible with breastfeeding.2
Is very effective in preventing pregnancy.6
The copper-bearing IUD is available for breastfeeding mothers who want long-acting, reversible contraception without hormones. After the IUD is placed by a trained provider, there is no daily routine, and it can be used for at least 10 years. In the first year, the typical failure rate is 0.8%.6 Over the course of 10 years, the typical failure rate is 2%.11 The copper-bearing IUD can also be used as emergency contraception for up to five days after unprotected sex.21 When placed after unprotected sex, the copper-bearing IUD prevents fertilization and may also prevent implantation.22

Permanent methods:

Tubal ligation works by blocking the egg in the fallopian tube. Vasectomy works by keeping sperm out of semen.11
Are fully compatible with breastfeeding. Medications used during the tubal ligation procedure may temporarily affect breastfeeding.2
Are very effective in preventing pregnancy.6
If you are positively certain that you have completed childbearing, permanent contraceptive methods may be for you (or your partner). With tubal ligation, the fallopian tubes are surgically cut or blocked. If you want to have the procedure done immediately after childbirth, you have the right to give informed consent before giving birth.11, 23 In the first year after the procedure, the typical failure rate is 0.5%.6 Over the course of 10 years, the typical failure rate is 2%, and a small risk of pregnancy remains until you reach menopause.11
Vasectomy is also a surgical procedure. The vas deferens that carry sperm to the penis are blocked. It takes up to three months after the procedure until it is effective in preventing pregnancy. After three months, the man can have his semen analyzed to see whether it contains sperm.11 In the first year, the typical failure rate is 0.15%.6 If the semen is not analyzed, the failure rate in the first year may be as high as 3%.11 Vasectomy is simpler, safer, and less expensive than tubal ligation.2, 11

Emergency contraception:
Even if you take great care to manage your fertility, you may find yourself in a situation where you are at risk of pregnancy. It takes several days after sex before a pregnancy is established.24 Emergency contraception is a safe and effective way of preventing pregnancy for up to five days after unprotected sex. It is not intended to be used as an ongoing contraceptive method. There are two options, including ‘morning after’ pills and the copper-bearing IUD (discussed above). ‘Morning after’ pills work by disrupting ovulation and preventing fertilization. 11, 28 Progestin-only ‘morning after’ pills are generally considered compatible with breastfeeding,26, 27 and breastfeeding can continue uninterrupted.16 Their failure rate is around 10-15% in the first three days after unprotected sex. 28 They become less effective as time passes. Although the ulipristal acetate-containing ‘morning after’ pill has a lower failure rate than the progestin-only ‘morning after’ pill,28 its possible effect on breastfeeding has not been adequately evaluated. Recent research shows that ‘morning after’ pills may also be less effective for obese women.

Unintended pregnancy
If you experience an unintended pregnancy while breastfeeding, you are not alone! About half of all pregnancies in the United States are unintended. As with any pregnancy, you have options, including continuing the pregnancy or having an abortion.

Continuing the pregnancy:
When you breastfeed, the hormone oxytocin is released, and it can cause uterine contractions. These contractions are usually very mild and undetectable. With a healthy pregnancy, continued breastfeeding is considered safe and unlikely to increase the risk for preterm labor.36 Pregnancy, itself, can have a negative effect on milk production. This will have a greater impact on a younger infant who is more dependent on your breastmilk as the primary source of nutrition.

Abortion:
Breastfeeding USA does not take a position on abortion; rather, we are committed to providing evidence-based information.

Three in 10 American women will have an induced abortion in their lifetime. 29 The majority (61%) already have children29 and may still be breastfeeding. In the first trimester, abortion can be done using vacuum aspiration or medicines. If you have decided to terminate a pregnancy and are considering an aspiration abortion, you can discuss pain management options with your health-care provider. Together you can agree on a pain management plan that has no or low adverse effects on breastfeeding.

Medical abortion can be done with a combined regimen of mifepristone and misoprostol.30Mifepristone passes into breastmilk, and there are no known adverse effects on the breastfed infant.30, 31 One small study found that levels of mifepristone in milk samples taken 6-12 hours after maternal intake ranged from undetectable to low, depending on the dose. The study concluded that with the low dose of mifepristone, “breastfeeding can be safely continued in an uninterrupted manner during medical abortion.”32 Alternatively, you can opt to express and discard milk for two days after taking mifepristone.31Misoprostol is used for a range of reproductive health indications, including management of postpartum bleeding.33 It passes into breastmilk, and drug levels rise and fall quickly. Misoprostol may temporarily cause infant diarrhea.20, 31 Within five hours, there are no detectable traces left in breastmilk.34

About one in five confirmed pregnancies end in spontaneous abortion (miscarriage). If you experience an incomplete miscarriage (when some pregnancy tissue remains in the uterus) or a missed miscarriage (when fetal death has occurred but the body does not expel the pregnancy), vacuum aspiration or a misoprostol-only regimen may be used as part of your treatment.

Conclusion
Understanding your fertility is an important aspect of life as a new mother. There are many options available for breastfeeding mothers who want or need to manage their fertility. This article is an introduction to this important subject, and we encourage you to continue the conversation with your health-care provider and/or your partner. Remember, you have the right to decide how to manage your fertility. Only you can decide which option is right for you. Being an active, informed health-care consumer can help you achieve your goal.

Online resources
Information about contraceptive methods:
http://bedsider.org/methods
http://www.choiceproject.wustl.edu/en/METHODS
http://www.plannedparenthood.org/health-topics/birth-control-4211.htm
http://www.arhp.org/MethodMatch/
http://www.acog.org/For_Patients
http://ec.princeton.edu/
http://www.cecinfo.org/what-is-ec/iuds-for-ec/

Information about contraception and breastfeeding:
http://kellymom.com/bf/can-i-breastfeed/meds/birthcontrol/
http://kellymom.com/bf/normal/fertility/
http://www.lalecheleague.org/ba/nov01.html
http://www.breastfeedingbasics.com/articles/breastfeeding-and-birth-control
http://www.mother-2-mother.com/menstruation.htm#BirthControl
http://www.who.int/reproductivehealth/publications/family_planning/WHO_RHR_09_13/en/
http://ec.princeton.edu/questions/ecfeeding.html

Citations
[1] Jackson, E. & Glasier, A. (2011). Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstetrics and Gynecology, 117(3), 657-62.
[2] The Academy of Breastfeeding Medicine. (2005). Clinical Protocol Number 13: Contraception during breastfeeding. (Author’s note: This document cannot be retrived online because it is out of date. As of May 12, 2014, the Academy had not released its revised version.)
[3] World Health Organization, Department of Reproductive Health and Research. (2007). Report of a WHO technical consultation on birth spacing. Geneva, Switzerland: World Health Organization.
[4] Zhu, B. P. (2005). The effect of interpregnancy interval on birth outcomes: f[4] Zhu, B. P. (2005). The effect of interpregnancy interval on birth outcomes: findings from three recent US studies. International Journal of Gynecology and Obstetrics, 89 (Supplement 1), 25–33.
[5] Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. Hale & Hartmann’s textbook of human lactation. Eds. Hale, T. W. & Hartmann, P. F. Amarillo, Texas: Hale Publishing
[6] Trussell, J. (2011). Contraceptive Efficacy. Contraceptive Technology, Twentieth Revised Edition. Eds. Hatcher, R. A. et al. New York, NY: Ardent Media.
[7] The Breastfeeding Answer Book. (2012). Retrived on April 23, 2014, from http://www.llli.org/docs/0_babupdate/04babupdatecontraception.pdf
[8] Labbok, M. H. et al. (1997). Multicenter study of the Lactation Amenorrhea Method (LAM): Efficacy, duration and implications for clinical applications. Contraception, 55, 327-36.
[9] Valdéz, V. et al. (2000). The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception, 62, 217-9.
[10] Weschler, T. (2006). Taking Charge of Your Fertility, the Definitive Guide to Natural Birth Control, Pregnancy Achievement and Reproductive Health, Tenth edition. New York, NY: HarperCollins Publishers.
[11] Johns Hopkins Bloomberg School of Public Health/ Center for Communication Programs & World Health Organization. (2011). Family planning: a global handbook for providers, 2011 Update. Geneva, Switzerland: World Health Organization.
[12] Jonsson, B., Landgren, B-M. & Eneroth, P. (1991). Effects of various IUDs on the composition of cervical mucus. Contraception, 43, 447-58.
[13] Ortiz, M. E. & Croxatto, H. B. (2007). Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception, 75 (Supplement 6), S16-30.
[14] Health Matters Fact Sheets, Implant. (2010). Retrived on April 23, 2014 from http://www.arhp.org/Publications-and-Resources/Patient-Resources/fact-sh...
[15] American Academy of Pediatrics. (2001). Transfer of drugs and other chemicals into human milk. Pediatrics, 108(3), 776-789.
[16] Mohrbacher, N. (2010). Breastfeeding Answers Made Simple, a Guide for Helping Mothers. Amarillo, Texas: Hale Publishing.
[17] Interventions Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy: RHL commentary. (2008). Retrived on May 12, 2014 from http://apps.who.int/rhl/fertility/contraception/CD001326_bahamondesl_com...
[18] World Health Organization. (2010). Combined hormonal contraceptive use during the post-partum period. Geneva, Switzerland: World Health Organization.
[19] World Health Organization. (2008). Progestogen-only contraceptive use during lactation and its effects on the neonate. Geneva, Switzerland: World Health Organization.
[20] Hale, T. W. (2008). Medications and Mothers’ Milk, Thirteenth edition. Amarillo, Texas: Pharmasoft Medical Publishing.
[21] International Consortium for Emergency Contraception. (2012). The Intrauterine Device (IUD) for Emergency Contraception. New York, NY: Family Care International.
[22] Schwarz, E. B. & Trussell, J. (2011). Emergency Contraception. Contraceptive Technology, Twentieth Revised Edition. Eds. Hatcher, R. A. et al. New York, NY: Ardent Media.
[23] The American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. (2012). Committee Opinion Number 530: Access to Postpartum Sterilization. Obstetrics and Gynecology, 120, 212-215.
[24] International Planned Parenthood Federation. (2004). Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services, Third Edition. London, United Kingdom, International Planned Parenthood Federation.
[25] The difference between medical abortion and emergency contraceptive pills. (2010). Retrived on April 23, 2014 from http://www.arhp.org/publications-andresources/clinical-fact-sheets/mifep...
[26] Gainer, E. et al. (2007). Levonorgestrel pharmac

[26] Gainer, E. et al. (2007). Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception. Human Reproduction, 22(6), 1578–1584.
[27] Polakow-Farkash, S. et al. (2013). Levonorgestrel used for emergency contraception during lactation, a prospective observational cohort study on maternal and infant safety. Journal of Maternal, Fetal and Neonatal Medicine, 26(3), 219-221.
[28] International Consortium for Emergency Contraception. (2013). Clinical Summary: Emergency contraceptive pills. New York, NY: Family Care International.
[29] Guttmacher Institute. (2014). Induced Abortion in the United States. New York, NY: Guttmacher Institute.
[30] Ipas. (2009). Medical Abortion Study Guide. Chapel Hill, North Carolina: Ipas.
[31] My bpas Guide. (2012). Retrived on April 23, 2014 from http://www.bpas.org/js/filemanager/files/my_bpas_guide_jul_12.pdf
[32] Saav, I. et al. 2010. Medical abortion in lactating women: low levels of mifepristone in breast milk. Acta Obstetricia et Gynecologica Scandinavica, 89(5), 618-622.
[33] Allen, R. & O’Brien, B. M. (2009). Uses of Misoprostol in Obstetrics and Gynecology. Reviews in Obstetrics and Gynecology, 2(3), 159-168.
[34] Vogel, D. et al. (2004). Misoprostol versus methylergometrine: Pharmacokinetics in human milk. American Journal of Obstetrics and Gynecology, 191(6), 2168-73.
[35] Abdel-Aleem, H., et al. (2003). The pharmacokinetics of the prostaglandin E1 analogue misoprostol in plasma and colostrum after postpartum oral administration. European Journal of Obstetrics and Gynecology and Reproductive Biology, 108, 25-8.
[36] Ayrim, A., Gunduz S., Akcal B., Kafali, H. (2014). Breastfeeding Throughout Pregnancy in Turkish Women. Breastfeed Med, 9(3), 157-160.
Top 13 tips for breastfeeding during pregnancy and beyond
Pregnant, but want to keep nursing? Our lactation expert’s advice will help you do this.
BY TERESA PITMAN | SEP 1, 2011

Congratulations! The pregnancy test confirms what you suspected — a new baby is on the way. You’re excited but can’t help wondering about your toddler, who is breastfeeding. Yes, he’s eating solid foods and enjoys his sippy cup, but you know breastfeeding is still a big deal to him. What now? Can you keep breastfeeding even though you are pregnant, and what happens once the new baby is born?

In most cases, you can continue to breastfeed while pregnant, and many women go on to nurse both their toddler and new baby after the birth. It’s not always easy, though. Here are some tips to help you through.

Check with your doctor or midwife first, but breastfeeding during pregnancy is generally not an issue. Though, in some situations, such as when you have a history of premature births caused by your cervix dilating too early, or signs of premature labour during this pregnancy, or unusual bleeding, your doctor may recommend weaning. It’s the contractions of the uterus that breastfeeding causes that may be a problem in these instances. Most often when this is the case you are also advised to abstain from sex.

2.
For some mothers, morning sickness seems to be aggravated by nursing. If you’re one of those, try keeping light snacks handy; when your toddler comes over to nurse, eat a few crackers or a piece of toast to ease any nausea. In severe cases, you may need to work towards complete weaning.

3. Make sure you are eating well. Your body is helping to sustain a toddler AND grow a baby, so good nutrition is crucial.

4. Be prepared — sore nipples (due to hormonal changes) are very common during pregnancy! Most mothers find this easiest to deal with by keeping feedings short. Depending on the age of your toddler, you may be able to negotiate this (by saying something like “We’ll nurse while I count to 10, when I get to 10 we’ll go to the kitchen and have a snack, or go outside and play catch.”) Remind your toddler to open wide and help her latch well. Yes, the underlying problem may be hormonal, but toddlers are notoriously careless about latching, and that can make it worse.

. As your milk supply decreases (a normal part of pregnancy), your toddler will need to have more foods and drinks added to his diet to compensate.
If your toddler always nurses to sleep, you may want to begin introducing some other approaches to sleep to that it will be easier when you have the new baby. For example, you could begin patting your toddler’s back or singing a song while nursing her to sleep. Once she’s accustomed to that, you could try singing or patting for a while before you offer the breast. As you extend the time that you are doing these things, she may start falling asleep before you even get to the nursing part. Then your partner may be able to take over the patting or singing, at least some of the time. Or your partner may want to develop his or her own going-to-sleep routine. There’s nothing wrong with continuing to nurse your toddler to sleep, if you want, but it is sometimes useful to add other ways of helping the baby relax and doze off.

7. As your belly grows, you may find you need to experiment with new positions. No, I’m not talking about sex here — although you’ll need some new positions for that, too — but the traditional baby-across-your-lap position obviously won’t work when you’re nine months pregnant. Side-lying is often good. Your toddler may also be willing to sit or kneel or even stand beside you and nurse.

8. Talk to your toddler about sharing his “num-nums” with the new baby when it comes. Many are very resistant to this idea — one toddler told his mom “when the baby comes, Grandma can give it her num-nums,” but most come around once there is an actual baby. Don’t push it too hard — you’re just trying to plant the seed.

9. It’s important for the new baby to get a good “dose” of colostrum, so in the first few days after the birth you may want to limit the toddler’s feedings and try to always nurse the baby first. Plan to have someone who can distract your toddler with games and activities, if you can. Once your milk “comes in” — and nursing two will certainly speed up that process — you won’t need to worry too much about who nurses when. Some mothers, especially those with younger toddlers who are still breastfeeding quite frequently, will assign one breast to each child. Others just nurse both on each side, on demand.

Don’t be surprised if your toddler — who just days ago was your little baby — suddenly seems huge once the new baby arrives. You may even feel a bit annoyed when he nurses, in contrast to the cuddly, loving feelings you feel when nursing your newborn. This is common; it will get easier.

Some toddlers are delighted when your milk supply increases dramatically a few days after birth, others have gotten used to the lower supply and may even wean because they don’t like getting lots and lots of milk every time they nurse. You may also notice that your toddler has very loose bowel movements in the first few weeks after the new baby is born, because your colostrum and newly-abundant milk is quite laxative.

12. If you can, get to know some other moms who are also “tandem-nursing” (the name given to the situation where a mother is nursing siblings who are not twins or triplets). They’ll be able to give you some perspective as well as practical tips for coping with some of the more challenging moments. Remember most toddlers feel some jealousy towards the new baby and may regress in behaviour (acting like babies themselves) or show anger by acting up, complaining or being aggressive to the new baby. So if your toddler is doing this (or worse!), it’s not because he’s still nursing — it’s because having a new sibling is stressful.

Keep in mind all the good things about tandem nursing. If you run into any breastfeeding difficulties, toddlers are great for helping out. Got an overactive letdown or too much milk? Your toddler can get that first, fast flow so that it’s easier for the new baby to manage. Having problems with plugged ducts? A toddler’s stronger suck can often get the milk flowing again. Most importantly, it gives you an extra tool to calm a cranky toddler and another way to reassure him that he’s still loved and close to your heart. (And there will be days when you are grateful for all the tools you can get!)

Breastfeeding during pregnancy: A systematic review.
Review article
López-Fernández G, et al. Women Birth. 2017.
Show full citation
Abstract
BACKGROUND: The consequences of breastfeeding during pregnancy (BDP) have not been clearly established. Available studies have addressed isolated aspects of this issue using different methodologies, often resulting in contradictory results. To our knowledge, no systematic review has assessed and compared these studies, making it difficult to obtain a clear picture of the consequences of BDP.

AIM: To review and summarise all the scientific evidence relating to BDP, and determine whether this evidence is sufficient to establish clear implications for the mother, breastmilk, breastfed child, current pregnancy, and ultimately, the newborn.

METHODS: We conducted a systematic review of the English and Spanish literature published between 1990 and 2015 using Cinahl, PubMed, IME, CUIDEN, Cochrane Library, Web of Science and PyscINFO.

FINDINGS: 3278 publications were identified from databases, their titles and abstracts were checked to ensure the studies were related to the subject and met the selection criteria. Only 19 studies met all requirements and were included in the review.

CONCLUSIONS AND IMPLICATIONS: Data suggest that BDP does not affect the way pregnancies end or even birth weights. However, several questions remain unanswered. Specifically, it is unclear how BDP affects maternal nutritional status in developed countries, the growth and health of breastfed siblings, the composition of breastmilk, or the growth of the newborn after delivery. Further studies of BDP are needed with larger samples, adequate methodology and proper control of the main confounders.

Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
PMID 28642112 [Indexed for MEDLINE]

How to Get Pregnant Whilst Breastfeeding

Mother Nature is a hypocritical sod. Check this out: The raison d’etre of your existence is reproduction. So why then, does good ol’ Mother Nature muzzle our fertility while we’re lactating? And is there anything we can do to get pregnant without pulling the plug on breastfeeding? In this post I will answer both questions in turn. What gives me the confidence to speak about this issue? Firstly, I’ve been there (conceived under 6 month postpartum whilst exclusively breastfeeding), secondly, I’ve conducted a shed-load of academic research into breastfeeding fertility.

A word of warning before we begin: As a result of reading this, you may find yourself up the duff, toot sweet. Want closely-spaced siblings? Dream of tandem-feeding? Read on!

Aunt Flo takes a vacation

While breastfeeding a lot of mothers notice that ‘shark week’ no longer occurs every month. Yet, as with many physiological happenings that appear idiotic, Mother Nature has a plan. You see, every time you bring your baby to your breast, you are sending your body an important message: “I have my hands full here, this baby needs me!” Because breastfeeding is such an intensive energy-draining practice, your body halts the baby production line so that you can focus your energies on the little cherub you’ve just popped out. Aunt Flo (your menstrual cycle) goes AWOL.

Whilst this is frustrating for the broody mom wishing to get knocked up, it is legit in evolutionary terms, it makes sense. Our bodies evolved in circumstances where moms were carrying their babies 24/7 (we lived in herds and never settled in one spot for too long), where foraging for food and catching prey required significant physical exertion, where babies would suckle every 15 minutes, and where we relied on our own body heat to keep us warm. We modern moms like to whinge that we’ve got it tough, that we’re soooooo busy with multitasking overload, but we don’t know SHIT compared to our prehistoric sisters.

Mother Nature knew that if babies were ever going to survive longer than their shrivelled cord stump, Mom couldn’t be getting pregnant anytime soon. If she did, she would be too knackered to do all that maternal stuff. And so, by the wonders of natural selection, we inherited an epidemiological quirk: our fertility pauses during lactation, a phenomena known as, yup: ‘lactational amerrhoea’ (took me several days to learn to pronounce that shit, and I still say it like ‘men’s diarrhoea’).
Interesting, but can I successfully breastfeed *and* get pregnant?

Yes, you can!
Okay, how?

Practically every lay article ever written on breastfeeding fertility has offered the following solutions to the ‘get pregnant whilst breastfeeding’ conundrum: 1. Give your baby a pacifier. 2. Space feedings. 3. Stop night-nursing. 4. Introduce solid foods. 5. Failing all that, wean baby from the breast.
Each of these suggestions is a simplistic anti-breastfeeding knee-jerk scraping of the barrel. They all involve reducing breastfeeds in an attempt to kick-start ovulation. Recall that breastfeeding sends your body the message: “I’ve got my hands full looking after this baby”. The above solutions aim to send the contrary message: “My baby doesn’t need me that much”, or even: “my baby is dead”.
Each solution has varying degrees of success – good for your fertility, not so good for your baby. Folks who offer the above solutions have clearly not read all of the fertility research. We can’t blame them. Most of the research into breastfeeding and fertility focuses on developing countries because fertility is a huge issue to those folks. In countries where survival means strenuous daily physical activity and poor nutrition, postpartum fertility can mean the difference between life (mom doesn’t get pregnant and so can sustain her infant), or death (mom gets pregnant and infant #1 perishes).
However, if you dig around the vaults of epidemiological fertility research (and here’s where being a PhD student has slapped me on the back and bought me a pint), you can discover the dichotomy between lactational amerrhoea in developing countries and lactational amerrhoea in prosperous Western countries.
In essence:
The key to getting pregnant is sending your body a new message: “I’ve got my hands full…BUT it’s still safe to get pregnant right now”. How can you do this? Forget Fertility Friend, your new BFF may just be your local grocery store…
Introducing the ‘Relative Metabolic Load Hypothesis’

Despite its fancy label, this theory is straight forward. Ever since scientists learnt how to precisely measure reproductive hormone levels in saliva and urine, a new body of evidence opened up: the relationship between maternal nutrition and fecundity; or in other words: what you eat while breastfeeding affects your fertility status. Woah, goosebumps! Exciting, no?

This hypothesis suggests that ‘shocking’ your body through nutrition can kick-start fertility. In one study (Lunn et al 1984), a substantial increase in food consumption during lactation had negligible effects on milk production and milk quality but – and here’s the magic – it hastened the return of menstrual cycling, and shortened the interval to next conception! Yup, turns out the female reproductive system is highly sensitive to metabolic energy availability. It’s the same kind of process as seen in anorexia, only in breastfeeding, the mechanism is way more sensitive (Rosetta and Taylor 2009).
What you eat during lactation has an important effect on fertility – an effect independent of nursing frequency (Frisch, 1978; John et al., 1987). Consider this curious fact: Moms that nurse with high frequency get pregnant just as fast as moms who nurse much less frequently… providing they meet the threshold of ‘well-nourished’ (Worthman et al 1993; Valeggia and Ellison 2004; Ellison 2001; Lipson and Ellison 1996). Let’s just soak that up for a moment: Stuffing your face while breastfeeding can increase your fertility. I’ll say it again: Eating more food can increase your chances of conception.
OMG! So how does it work?

The studies show that resumption of menstrual cycling is closely coordinated with changing insulin levels, and whaddya know: insulin is a pretty badass stimulator of ovarian estrogen production (Willis et al 2001). Insulin reflects changes in metabolic energy balance (Valeggia and Ellison 2009), it’s a signal to your body that food is available.

So, if you want to increase your chances of getting pregnant while breastfeeding do what scientists refer to as ‘creating favourable energetic conditions’. A sudden burst of energy-dense food consumption can trigger the following cascade: Firstly, mom experiences a brief period of insulin resistance above her average levels, and then, usually a few weeks later, her ovarian cycling resumes. Within this time period, she may notice that her body begins to produce fertile quality cervical fluid (gunky eggwhite vaginal discharge) as her hormone levels pass over that all-important estrogen-threshold. To illustrate, take a gander at the diagram below (taken from the wonderful Weschler 2003). It shows your hormone levels as your body repeatedly attempts to ovulate, and then succeeds:

In other words: Sudden gorging can increase your chances of getting pregnant because it raises your insulin levels higher than your body is used to. Elevated insulin then stimulates ovarian steroid production, causing estrogen levels to rise. (Science, I could hump your leg right now!) Rising estrogen stimulates your fat cells to bring the insulin levels back into the normal range. This whole process serves to jump-start ovarian function as maternal energy availability rises above the demands of milk production. It’s all about reassuring your body that it’s safe to breed. No need to reduce breastfeeds.

This amazing process – your body’s intuition – is a pattern that we humans share with both chimpanzees and orang-utans (Ellison 2001; Emery Thompson 2005). Energy dense foods are cues we can use to satisfy our body’s drive to synchronise reproductive success with energy availability. But before you get all health-police on my butt, I’m not suggesting you should start auditioning for ‘Fat: The Fight Of My Life’ or anything like that. Rather, I’m suggesting that increasing your energy intake is a temporary strategy with the purpose of reassuring your body that food reserves are plentiful. You can always opt for those energy dense foods that come in healthier guises (nuts and honey are stellar examples), but dayuuuum, just look at that cake!
In a nutshell…

You CAN (quite literally) have your cake and eat it. It is possible to nurse all hours under the sun and still conceive. The duration of lactational amenorrhea is inter-related with the relative metabolic load of lactation: fertility will stall if the body experiences lactation as a heavy burden. So, whilst infant feeding behaviour determines absolute metabolic load, maternal nutrition impacts upon relative load. Tonight, we feast!
Good luck, and enjoy the BFP!

Can You Get Pregnant While Breastfeeding?
By Philippa Pearson-Glaze IBCLC
Last Revised 13 Nov, 2019

Exclusive breastfeeding can work as a contraceptive preventing pregnancy for many women in the early months after birth. But when breastfeeding continues beyond months and into years—and a mother wants to expand her family—she may wonder whether she can get pregnant while still breastfeeding. This article looks at:

how reliable breastfeeding is as a contraceptive
whether you can get pregnant while breastfeeding an older baby
how to increase fertility while still breastfeeding
How reliable is breastfeeding as a contraceptive?
Breastfeeding can be a 98% reliable form of contraception in the first six months after birth—if a mother’s periods haven’t returned yet and her baby has nothing other than breast milk to eat or drink. The specific guidelines are described in the lactational amenorrhea method (LAM) of contraception (see below) . When the guidelines are followed, LAM is said to be more effective than the progestin only pill. However, once one or more of the statements are no longer true, breastfeeding stops being a reliable contraceptive. Depending on how frequently and how often a baby or toddler nurses, breastfeeding may still have a contraceptive effect beyond six months for some mothers.

Guidelines for the LAM method of contraception
LAM is a method of contraception that breastfeeding mothers can use when the following three statements hold true:

A mother’s periods haven’t returned yet since the birth.
A menstrual bleed is defined as two consecutive days of bleeding after the baby is eight weeks old.
Baby is breastfeeding exclusively day or night without any long breaks between feeds. Note: LAM hasn’t been shown effective for mothers who pump frequently instead of breastfeeding .
Occasional supplemental feedings of once or twice a week are acceptable.
Baby is under six months old.
After six months of age most babies will begin to take solid foods and this increases the chances of getting pregnant.
If any of the three statements don’t hold true then the mother can’t rely on LAM alone for her contraceptive needs.

Alternative contraception for the breastfeeding mother
For further information about your options for contraceptives see:

Academy of Breastfeeding Medicine (ABM) Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015
Taking Charge of Your Fertility, Toni Weschler, 2015
A note on hormonal methods of birth control
Hormonal methods such as the pill, contraceptive implants, hormone impregnated intrauterine devices (IUD or coil) have the potential to affect milk supply especially during the first six months after birth . They may also have potential to expose a baby to synthetic hormones (ABM, 2015). Jack Newman, Canadian paediatrician explains why normal methods of birth control can affect milk supply:

Dr. Jack Newman’s Guide to Breastfeeding, Jack Newman and Teresa Pitman, 2014

When breastfeeding mothers become pregnant, their milk production decreases dramatically, because the hormones of pregnancy (including the estrogens and progesterones that are in most birth control pills) inhibit the action of prolactin, the hormone that stimulates the breasts to make milk. The effect of the birth control pill on milk supply may occur with progesterone-only pills as well. The IUD, which releases progesterone, also seems to decrease milk production in some mothers.

See the ABM Protocol for a look at the contradictory research on the impact of hormonal contraceptives on milk supply and for the pros and cons of all options.

Can you get pregnant while breastfeeding?
It is unlikely that a mother who is exclusively breastfeeding her baby in the first six months according to LAM guidelines will conceive. After about six months, once solids are introduced in her baby’s diet the contraceptive effect can no longer be guaranteed and a mother could get pregnant while she is still breastfeeding. For some mothers, the contraceptive effect of breastfeeding may carry on for longer, especially if breastfeeding happens at least every four hours in the day and six hours at night and is offered before complementary foods are given (ABM, 2015). Exactly how soon a mother’s fertility returns is unique to each individual mother:

EXCERPT FROM
The Womanly Art of Breastfeeding, LLLI, 2010

frequent nursing is a powerful fertility suppressor, as part of a well designed system: when a baby grows older and starts nursing less often, that’s a signal that he’s finally able to share his mother with a younger sibling.

When will my periods return?
Many mothers enjoy a long break from their monthly period while breastfeeding, but periods can return anytime from six months (or earlier) to the second year after childbirth. Exactly when will depend on the intensity of breastfeeding, frequency of feeds and a mother’s body chemistry. One study found that when mothers practiced “ecological breastfeeding” namely; exclusive breastfeeding for the first five to eight months, and with breastfeeding continuing on demand and for comfort day and night, their periods returned at 14.6 months after birth on average

Ovulation can happen before the first period and the longer a mother’s periods have been delayed the more likely she will ovulate before that first period . If you are aware of what to look for, your body will show signs of impending ovulation such as sensitive breasts or nipples and changes in cervical fluid and waking temperature, see Taking Charge of Your Fertility for further information.

If a baby begins breastfeeding intensely again, for example due to an illness, a mother whose periods had returned may find they stop again temporarily (Mohrbacher, 2010).

How does breastfeeding affect fertility?
Breastfeeding influences the hormones involved in fertility. Even after a mother begins menstruating again, full fertility may not return straight away. Author Nancy Mohrbacher explains:

EXCERPT FROM
Breastfeeding Answers Made Simple, 2010, p 492

the hormones of breastfeeding cause a deficient egg and follicle and a deficient luteal phase, and the hormonal levels in the second half of the menstrual cycle are too low to maintain a pregnancy.

Lower levels of luteinising hormone (LH) can prevent normal follicular development which affects ovulation while higher levels of prolactin can shorten the time from the day after ovulation until a period starts (known as the luteal phase of the cycle). If the luteal phase is too short, it may prevent pregnancy from developing however some breastfeeding women ovulate normally in spite of higher prolactin (Wambach and Riordan, 2015). There can be other causes of a short luteal phase and it may be helpful to discuss with your doctor whether progesterone supplements might be appropriate in your situation (Womanly Art, 2010, p 322).

Will the return of my periods affect my milk supply?
Most mothers won’t notice any changes in their milk supply once their periods return. However some mothers notice their nipples are more sensitive around ovulation or feel their supply drops a little at the time of their period—making their baby fuss. The Womanly Art says:

EXCERPT FROM
The Womanly Art of Breastfeeding, LLLI, 2010, p 193

these changes are short lived each month, and solids are there to make up the difference. A daily dose of 500 to 1,000 mg of calcium and magnesium supplement from the middle of your cycle through the first three days of your period can help minimise any drop in supply.

How to increase fertility while breastfeeding
When a nursling isn’t ready to stop breastfeeding yet but his mother is ready to plan for her next baby, a mother may feel she has a difficult choice to make. Fertility will automatically return once breastfeeding falls to a low enough level, but exactly how low is unique to a mother’s own body chemistry. If waiting for this natural return is not an option, ideas to kick start fertility include; increasing the time interval between breastfeeds, giving a baby who is ready for solids his food before a breastfeed and introducing solid food quite quickly. A six hour gap between breastfeeds on one or several nights may be enough to trigger the return of a mother’s periods (Mohrbacher, 2010).

My periods are back but I’m still not pregnant
Once breastfeeding has dropped to a level that triggers the return of your periods, charting your cycles will help gather as much information as possible about your fertility and ovulation. For a comprehensive list of next steps including tests and treatments see Taking Charge of Your Fertility.

There are various reasons why a mother may not get pregnant and this is not necessarily to do with breastfeeding. However, some mothers might not be able to get pregnant with any amount of breastfeeding, even though they are having regular periods. Once they do completely wean, their fertility returns in about a month (Mohrbacher, 2010). For more information on weaning see How to Stop Breastfeeding.

My consultant says I have to stop breastfeeding in order to start IVF treatment
Before being accepted for IVF (in vitro fertilisation) or ICSI (intracytoplasmic sperm injection) you may be asked to stop breastfeeding. For many mothers and toddlers this is not an easy step to take. Researching your options and finding others who have been through this will be helpful. Medications can be checked for safety during lactation (see Medications and Breastfeeding) and the following articles and websites may be helpful:

Breastfeeding and IVF Australian Breastfeeding Association, 2017
Breastfeeding Through Fertility Treatments Baby Dust Diaries, 2010
Breastfeeding and Fertility Treatment (website) and Breastfeeding During IVF and Fertility Treatment (Facebook)
Breastfeeding and pregnancy
Some mothers worry whether continuing to breastfeed during pregnancy could increase the chances of miscarriage or premature birth. Current research suggests that if a pregnancy is healthy and low risk then breastfeeding during pregnancy needn’t be discouraged. There is not very much information however about the safety of breastfeeding during pregnancy when risk factors for premature birth are present. An Italian position paper summarises:

EXCERPT FROM
Breastfeeding during pregnancy: position paper of the Italian Society of Perinatal Medicine and the Task Force on Breastfeeding, Ministry of Health, Italy, Cetin et al, 2014

Based on the hypothetical risk, caution may be warranted for women at risk of premature delivery, although no evidence exists that breastfeeding could trigger labor inducing uterine contractions. In conclusion, currently available data do not support routine discouragement of breastfeeding during pregnancy.

Additional resources with further discussion include:

Adventures in Tandem Nursing, 2003 (book) by Hilary Flowers discusses the general safety of breastfeeding during pregnancy and A New Look at the Safety of Breastfeeding During Pregnancy (2003) by the same author discusses how the pregnant uterus is protected from breastfeeding hormones.
Breastfeeding during Pregnancy and Tandem Nursing: Is it Safe? 2016, by Hilary Flowers summarises current research that concludes breastfeeding during a normal pregnancy is not harmful and not associated with premature birth.
Despite information to hand, some women (or doctors) may feel their bodies can’t manage to breastfeed and sustain a pregnancy at the same time. The decision whether or not to wean is a very personal one.

Other factors affecting pregnancy
Other factors that could affect a breastfeeding mother during pregnancy include nipple soreness and discomfort and 70% of mothers notice a decrease in milk supply causing many children to wean naturally during this time. There is also a reported change in taste of the milk (Wambach & Riordan, 2015).

Mother to mother support
For mother to mother support for trying to conceive while breastfeeding or breastfeeding through pregnancy try contacting a local La Leche League group.

SUMMARY
Breastfeeding is quite a reliable contraceptive during the first six months of exclusive breastfeeding as long as a mother’s periods haven’t returned and baby breastfeeds regularly day and night. Although some mothers can become fertile quite quickly after this time, others find that the hormones involved with breastfeeding affect their fertility for much longer. Increasing the time interval between breastfeeds can speed the return of a mother’s fertility.

SUMMARY
Breastfeeding is quite a reliable contraceptive during the first six months of exclusive breastfeeding as long as a mother’s periods haven’t returned and baby breastfeeds regularly day and night. Although some mothers can become fertile quite quickly after this time, others find that the hormones involved with breastfeeding affect their fertility for much longer. Increasing the time interval between breastfeeds can speed the return of a mother’s fertility.

In the weeks following birth when you’re tired and breastfeeding around the clock, something like birth control is probably the last thing on your mind, right? It might surprise you that 70% of pregnancies in the first year postpartum were unintended.

Postpartum birth control isn’t only about spacing your children with your ideal timing apart. It’s also about safety for mom and baby. That’s why healthcare professionals recommend you develop a birth control plan a.s.a.p following delivery. While breastfeeding may decrease your fertility, it is still possible to get pregnant while breastfeeding.

But it’s important to note that when you’re breastfeeding, there are additional considerations for choosing a safe birth control method. Below, we’ll help you sort through what’s what to help support you with your breastfeeding goals.

WHY POSTPARTUM BIRTH CONTROL MATTERS
The World Health Organization recommends that women space their pregnancies about 24 months apart. Pregnancies spaced more closely together increase the likelihood of several serious infant and maternal outcomes.

Babies face an increased risk for:

Birth defects
Low birth weight
Stillbirth
For moms, there is a higher chance of:

Miscarriage
Pregnancy anemia
Maternal death
Scary stuff? Yes. But knowledge is power. There are simple steps you can put in place to minimize these risks.

SAFE BIRTH CONTROL FOR BREASTFEEDING MOMS
As a breastfeeding mom, you’re advised to consult your doctor before taking any kind of medication, and birth control is no different.

The good news is that all birth-control methods are safe for your baby while nursing, according to The American College of Obstetricians and Gynecologists (ACOG). However, using a birth-control method containing estrogen may reduce your milk supply, especially in the early weeks of nursing. To help inform your discussion with your doctor, we’ve compiled a list of popular methods that won’t negatively impact your milk production.

1. Progestin-Only Birth Control Pills
There are two types of birth control pills: the combined pill (containing estrogen and progestin) and progestin-only pills, a.k.a. “the mini pill.” Research has found that progestin-only hormonal methods do not decrease milk supply and are safe for infants. Still, ACOG recommends that you wait until your milk supply is established, even before taking a progestin-only pill. It’s important to note that progestin-only pills must be taken at the same time each day for maximum effectiveness.

2. IUDs
There are also two types of IUDs: the copper IUD, which doesn’t contain hormones, and the hormonal IUD, which releases a small amount of progestin (that’s the one to ask for if you’re nursing!). Many moms like IUDs because after they are inserted, there is nothing to remember to take—a big plus for an exhausted new moms!

3. Barrier Methods
Condoms, diaphragms, and cervical caps don’t contain hormones and are safe; however, they are not as effective as other methods.

4. Lactational Amenorrhea Method (LAM)
Breastfeeding can suppress fertility, but only after three guidelines are met: exclusive feeding at the breast every four hours; your periods have not returned, and your baby is under six months of age. Important: While pumping and feeding with a bottle counts as “exclusively feeding breastmilk,” introducing the bottle can make LAM ineffective in preventing pregnancies. (For more information read: Myths and Facts About Breastfeeding as Birth Control. )

DID YOU KNOW?
Forty to 57% of couples begin having sex before the 4-6 week postpartum appointment when birth control options are routinely discussed. With this article, The Baby Box Co. seeks to raise awareness about the risks of closely spaced pregnancies to mom and baby, and that you can get pregnant while breastfeeding without a good plan in place. Got a friend who may not know? Please share this article!

EXCLUSIVE FOR OUR MEMBERS: Take our Breastfeeding Basics class, and we’ll reward you with a sweepstakes entry to win a year of FREE birth control thanks to our proud sponsor Nurx, who shares our goal of supporting breastfeeding moms. (Got insurance? Great news! You already qualify for free birth control + free delivery via Nurx. We’ll direct you there when you complete the class!)

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http://jhl.sagepub.com/Journal of Human Lactation http://jhl.sagepub.com/content/early/2013/11/26/0890334413514294The online version of this article can be found at: DOI: 10.1177/0890334413514294 published online 4 December 2013J Hum LactPerinatal Medicine and Task Force on Breastfeeding, Ministry of Health, ItalyKnowles, Lorenzo Monasta, Riccardo Davanzo and on behalf of the Working Group on Breastfeeding, Italian Society of Irene Cetin, Paola Assandro, Maddalena Massari, Antonella Sagone, Raffaella Gennaretti, Gianpaolo Donzelli, AlessandraForce on Breastfeeding, Ministry of Health, ItalyBreastfeeding during Pregnancy: Position Paper of the Italian Society of Perinatal Medicine and the Task Published by: http://www.sagepublications.com can be found at:Journal of Human LactationAdditional services and information for http://jhl.sagepub.com/cgi/alertsEmail Alerts: http://jhl.sagepub.com/subscriptionsSubscriptions: http://www.sagepub.com/journalsReprints.navReprints: http://www.sagepub.com/journalsPermissions.navPermissions: What is This? - Dec 4, 2013OnlineFirst Version of Record >> at Ospedale Burlo Garofolo on December 5, 2013jhl.sagepub.comDownloaded from at Ospedale Burlo Garofolo on December 5, 2013jhl.sagepub.comDownloaded from

Journal of Human LactationXX(X) 1 –8© The Author(s) 2013Reprints and permissions: sagepub.com/journalsPermissions.navDOI: 10.1177/0890334413514294jhl.sagepub.comInsights in PolicyBackgroundBreastfeeding has been widely recognized as a healthy behavior with short- and long-term benefits for both mother and infant.1,2 As a consequence, the promotion of breastfeed-ing has been pursued by governmental3 and health authori-ties4 and by scientific societies.5,6At the same time, a stronger and more widespread culture of breastfeeding in the general population has demonstrated an epidemiological resurgence of breastfeeding in many industri-alized countries.7 In this context, health care providers (mainly obstetricians, midwives, pediatricians, pediatric nurses, and lactation consultants) are often called upon for advice on whether or not to continue breastfeeding during pregnancy.The objective of the Italian Society of Perinatal Medicine Working Group on Breastfeeding (SIMP-GLAM) is to 514294JHLXXX10.1177/0890334413514294Journal of Human LactationCetin et alresearch-article20131Obstetrics and Gynecology Unit, Department of Biomedical and Clinical Sciences, Hospital L. Sacco, University of Milan, Milan, Italy2Division of Neonatology and NICU, Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy3RIFAM, Italian Network of Trainers in Breastfeeding, Rome, Italy4RIFAM, Italian Network of Trainers in Breastfeeding, Milan, Italy5Neonatal Medicine, A. Meyer Children’s Hospital, University of Florence, Florence, Italy6Health Services Research and International Health Unit, Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, Italy7Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Trieste, ItalyDate Submitted: March 4, 2013; Date Accepted: October 31, 2013.Corresponding Author:Lorenzo Monasta, MSc, DSc, Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health – IRCCS Burlo Garofolo, Via dell’Istria 65/1, IT-34137 (TS), Italy. Email: lorenzo.monasta@burlo.trieste.it Breastfeeding during Pregnancy: Position Paper of the Italian Society of Perinatal Medicine and the Task Force on Breastfeeding, Ministry of Health, ItalyIrene Cetin, MD1, Paola Assandro, MD2, Maddalena Massari, MD1, Antonella Sagone, PsyD, IBCLC3, Raffaella Gennaretti, CNM, IBCLC4, Gianpaolo Donzelli, MD5, Alessandra Knowles, MSc6, Lorenzo Monasta, MSc, DSc7, and Riccardo Davanzo, MD, PhD2, on behalf of the Working Group on Breastfeeding, Italian Society of Perinatal Medicine and Task Force on Breastfeeding, Ministry of Health, ItalyAbstractAs more women breastfeed for longer, it is increasingly likely that women may be still breastfeeding when they become pregnant again. The Italian Society of Perinatal Medicine (SIMP) Working Group on Breastfeeding has reviewed the literature to determine the medical compatibility of pregnancy and breastfeeding. We found no evidence indicating that healthy women are at higher risk of miscarriage or preterm delivery if they breastfeed while pregnant. No evidence indicates that the pregnancy–breastfeeding overlap might cause intrauterine growth restriction, particularly in women from developed countries. Little information is available on the composition of human milk of pregnant women, and we found no data on the growth of infants nursed by a pregnant woman. However, both the composition of postpartum breast milk and the growth of the subsequent newborn appear to be partly affected, at least in developing countries. SIMP supports breastfeeding during pregnancy in the first 2 trimesters, and we believe it to be sustainable in the third trimester. Based on the hypothetical risk, caution may be warranted for women at risk of premature delivery, although no evidence exists that breastfeeding could trigger labor inducing uterine contractions. In conclusion, currently available data do not support routine discouragement of breastfeeding

2 Journal of Human Lactation XX(X)promote breastfeeding in the period around childbirth. In this context, SIMP-GLAM has also considered the topic of medical compatibility of breastfeeding during pregnancy.Following a dedicated workshop on the topic held in Florence on April 1, 2011, at the society’s national confer-ence, we performed this review on breastfeeding during pregnancy, with the objective of producing a policy statement.MethodsTo review all aspects concerning the overlap between preg-nancy and lactation, we carried out a systematic Medline search of the literature with the strings (“pregnancy”[MeSH] AND “breast feeding”[MeSH] OR “lactation”[MeSH]) with the specific addition of other keywords related to the main areas of interest where the impact of breastfeeding during pregnancy was evaluated: maternal nutrition (includ-ing weight changes) (“maternal nutritional physiological phenomena”[MeSH] OR “maternal nutrition”[All Fields]), miscarriage (“abortion, spontaneous”[MeSH]), fetal growth (“embryonic and fetal development”[MeSH]), preterm delivery (“premature birth”[MeSH] OR “preterm delivery” [All Fields] OR “obstetric labor, premature”[MeSH]), breast milk quantity and quality (“milk, human/chemistry” [MeSH] OR “lactation/physiology”[MeSH] OR “breast/physiology”[MeSH]), growth of the infant breastfed during pregnancy (“breastfed”[All Fields] AND “infant”[MeSH] AND “growth”[MeSH]), and growth of the breastfed new-born (“breastfed”[All Fields] AND “infant, newborn”[MeSH] AND “growth”[MeSH]). The search was restricted to stud-ies on humans, published in the English language, and indexed up to February 27, 2013 (“0001/01/01”[PDAT] : “2013/02/27”[PDAT] AND “humans”[MeSH] AND “English” [lang]).Due to the scantiness of relevant high-quality research, we considered all pertinent papers, including case reports and commentaries.The Physiological Basis of the Pregnancy–Lactation OverlapDuring pregnancy, increasing amounts of progesterone, estrogen, and prolactin activate the production of colostrum (lactogenesis I).8 The onset of copious milk secretion (lacto-genesis II) is triggered only by an effective expulsion of the placenta and the consequent sharp reduction of progesterone levels.9The immediate effect of sucking is the release of pro-lactin and oxytocin from the pituitary gland. Prolactin stimulates breast milk production, and oxytocin stimu-lates milk ejection. Prolactin is a prerequisite for galacto-poiesis and is maintained through milk removal, either by a nursing baby or by hand or mechanical expression.10 Both baseline and peak (after sucking) levels of prolactin progressively decline, even if there seems to be no rela-tion between the concentration of prolactin in plasma and the rate of milk synthesis, which remains constant.11-14 This phenomenon suggests a permissive rather than a reg-ulatory role of prolactin for lactation.12 In fact, once lacta-tion is established (stage III lactogenesis), milk production is regulated either by the suckling offspring who stimu-lates the release of prolactin or by continuous breast milk removal.10The persistent physiological hyperprolactinemia associ-ated with exclusive breastfeeding suppresses ovulation, possibly resulting in lactational amenorrhea.15 Lactation-associated infertility prolongs interbirth intervals, which could be considered a desirable condition for the wellbeing of both the mother and her child.Epidemiological DataBreastfeeding during pregnancy is a worldwide phenome-non, although cultural pressure to wean in this period is equally common.16-18 Breastfeeding during pregnancy is more prevalent in developing countries, where the duration of breastfeeding is longer and the use of contraceptive meth-ods less prevalent.As an example, in Bangladesh in the late 1970s, more than 50% of the breastfeeding women who became pregnant continued to breastfeed beyond the sixth month of preg-nancy.18 More recent data from Egypt indicate that 25% of women attending antenatal

Cetin et al 362% of these were still breastfeeding at the third month of pregnancy, 19% at the sixth month, and 4% were still nurs-ing at around the ninth month.23Mother and Child OutcomesIn theory, the overlap of breastfeeding and pregnancy could affect maternal nutrition and health, fetal growth, and/or the growth of the nursed infant.Maternal NutritionThe Medline search identified 298 articles. After title and abstract screening, only 3 articles were considered rele-vant.24-26 Two further articles were added from the authors’ personal records.27,28The coexistence of both lactation and pregnancy is believed to be an energetically taxing process, which may be most onerous during the third trimester.29-31 We are not aware of any guideline on caloric and nutrient intake requirements for women who breastfeed during pregnancy, although it would be important to define such requirements in order to safeguard the health of the mother, the fetus, and the nursed infant.Using a factorial approach, Butte and King24 tried to esti-mate the energy requirements of pregnant and lactating women, based on indicators such as optimal pregnancy out-come and adequate milk production. The estimated total cost of pregnancy for women with a mean gestational weight gain of 12 kg was 90, 288, and 468 kcal/day for the first, second, and third trimesters, respectively. Energy requirements dur-ing lactation were derived from rates of milk production, energy density of human milk, and energy mobilization from tissues. The energy cost of lactation for exclusive breastfeed-ing was 628 kcal/day, although recommended intakes are lower, due to the calories available from fat stored during pregnancy.24Quantifying the energy needs of a breastfeeding pregnant woman is a controversial issue. In principle, women who have not started menstruating and are exclusively breastfeed-ing their baby with feeding intervals that never exceed 4 hours during the day and 6 hours at night are unlikely to become pregnant during the first 6 months postpartum.32-34 Subsequently, reduced breastfeeding of the previous child would permit a new pregnancy at a time when the nursed infant is usually older than 6 months and at least partially weaned, with the mother producing much less milk than at peak lactation.Even though we were not able to identify any study that specifically evaluated the energy cost of lactation overlapped with pregnancy, the additional energy requirements seem to be relevant at least during the third trimester. Again, how-ever, we can expect that, although the energy requirements of pregnancy increase, breastfeeding requirements decrease because during the third trimester, the nursed infant will be more than 6 months old and at least partially weaned.Good nutrition is essential to support breastfeeding dur-ing pregnancy.29 In a sample of non-pregnant mothers, English and Hitchcock27 found that nursing women con-sumed 2460 kcal daily and non-nursing women 1880 kcal, with a net difference of 580 kcal. The Committee on Nutritional Status during Pregnancy and Lactation of the US Institute of Medicine stated that “lactating women who con-sume a well-balanced diet with adequate calories (2700 kcal/day) also meet the RDAs for all nutrients with the exception of calcium and zinc.”30 A 2200-kcal diet would be deficient in calcium, magnesium, zinc, thiamin, vitamin B6, and vita-min E, whereas an 1800-kcal diet would be deficient in all previously mentioned nutrient levels plus riboflavin, folate, phosphorus, and iron.30 In other words, the nutritional risk for the nursing woman increases as her energy intake decreases.According to the maternal nutritional depletion hypothe-sis, a close succession of pregnancies and periods of lacta-tion may negatively affect the mother’s nutritional status, which in turn has adverse effects on subsequent maternal health outcomes.35 The risk of a maternal depletion syn-drome seems higher in low-income countries where women are pregnant or lac

4 Journal of Human Lactation XX(X)Weight Changes during LactationToday, many women try to lose weight soon after childbirth, which raises the issue of possible consequences for the nursed infant.41 An intentional weight loss plan from the sec-ond month postpartum at a rate of no more than 2 kg/month, with a 544 kcal/day reduction in mean energy intake, does not appear to influence breast milk composition or volume or to impair the growth of the nursed infant.28 These data sug-gest that, in normal-weight and overweight women, lactation is not adversely affected by moderate rates of weight loss caused by either caloric restriction or exercise. The same might not be true for undernourished mothers with limited body fat stores.This said, however, more research is definitely needed to understand the nutritional outcome for both the mother and the nursed infant of the overlapping of pregnancy and lacta-tion, in particular in women with low fat reserves and popu-lations with limited resources.26Breastfeeding and Spontaneous AbortionFrom the Medline literature search on the relationship in humans between lactation and spontaneous abortion, we obtained 106 references. Among these, only 2 articles were relevant to the hypothesis of a causal relationship between spontaneous abortion and breastfeeding.42,43In a randomized controlled trial, Hirahara et al44 consid-ered hyperprolactinemia as a cause of recurrent spontaneous abortion. The rate of successful pregnancy among hyperpro-lactinemic women treated with bromocriptine was found to be higher than in those not treated with bromocriptine (sam-ple size of 24 treated and 22 untreated women). In fact, bro-mocriptine has the therapeutic effect of inhibiting the production of prolactin, positively influencing ovulation and fertility. Hirahara et al also reported that prolactin levels dur-ing early pregnancy were significantly greater in women who miscarried. This association led the authors to hypothe-size that the elevated circulating levels of prolactin associ-ated with breastfeeding might increase the risk of spontaneous abortion in early pregnancy. Obviously, the study by Hirahara et al is relevant only for the generation of a pathogenetic hypothesis, rather than confirming a causative relationship between increased prolactin levels and miscarriage.We should also consider that prolactin levels decrease after stage II lactogenesis, thus its role is less crucial during the calibration phase (first 4-8 weeks postpartum).8,10 Breast milk extraction becomes the main determinant of milk pro-duction, based on an autocrine mechanism.10,12,45The low levels of prolactin that are typical of the auto-crine regulation of milk production are unlikely to represent a risk factor for miscarriage.Further support for the argument that breastfeeding may induce miscarriage comes from the knowledge that nipple stimulation by the suckling infant leads to the release of oxytocin by the hypothalamus. Oxytocin, in turn, induces myoepithelial cell contraction for milk ejection, also trig-gering uterine contractions.46 Similarly, rapid uterine reduc-tion after childbirth in response to suckling from the very first hours postpartum is believed to reduce maternal blood loss.The physiological capability of the uterus to contract under the action of oxytocin has also been evoked to sustain the hypothesis of an abortive effect of suckling at the breast. However, oxytocin secretion in response to breast stimula-tion seems to decrease over time. Leake and colleagues mea-sured plasma levels of oxytocin before and during breast pump stimulation in lactating, amenorrheic women from 10 days to 1 year postpartum.47 Although baseline mean plasma oxytocin levels were similar during the study period, levels measured after stimulation significantly decreased after 90 days. In addition, uterine sensitivity to oxytocin peaks around labor and is associated with both an up-regulation of the oxy-tocin receptor and a strong increase in

HIV in Pregnancy and During Breastfeeding
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By Sally Robertson, B.Sc.
Reviewed by Susha Cheriyedath, M.Sc.
A pregnant woman who is HIV-positive can pass the virus onto her baby during pregnancy, during childbirth or through breastfeeding. This mother-to-child transmission, also referred to as perinatal transmission, is the most common route of HIV infection among children.

When a woman is diagnosed with HIV during pregnancy, treatment with a combination of antiretroviral medications can reduce the risk of this transmission to less than 1%.

Treatment is most effective if started as early on as possible during the pregnancy, although beginning treatment at a later stage or even during delivery can be greatly beneficial.

Medication
HIV medications are used at the following times:

During pregnancy HIV-positive women receive antiretroviral therapy (ART) which includes a combination of at least three drugs
During labor and delivery, oral medications are continued and she is also administered intravenous zidovudine (also called AZT)
After birth, babies are administered AZT for six weeks. In addition to AZT, babies born to mothers who did not receive HIV drugs during pregnancy may also be given other HIV drugs.
HIV medications work by reducing the amount of HIV (viral load) present in the mother’s body, ideally to an undetectable level.

This reduces the chance of the mother passing the virus on to her baby during pregnancy or birth. Some of these drugs can also cross the placenta and reach the body of the unborn baby, which can help to protect it from infection.

This is very important during delivery when the baby is at risk of exposure to any virus present in the mother’s blood or other bodily fluids.

Medication Risks
When advising on HIV drug regimens for use during pregnancy, healthcare providers consider the benefits and risks of the various medications available including the short- and long-term effects on babies born to HIV-positive mothers.

Although research has not shown any clear association between the use of these medicines and birth defects, some drugs have raised concerns.

In the US, women taking these drugs during their pregnancy are advised to enrol in the Antiretroviral Pregnancy Registry, which monitors prenatal exposure to these medications in order to identify any potential increased risk of birth defects related to their use.

Breastfeeding
HIV is present in breast milk. However, advances in the use of ART have meant that HIV-positive women no longer need to avoid breastfeeding.

In 2011, the British HIV Association updated their Position Paper to state that if an HIV-positive mother has already been receiving triple ART and was repeatedly shown to have an undetectable viral load during delivery, then she may, after thorough consideration, proceed with breastfeeding during the first six month’s of the child’s life.

However, if she does choose this option, she should breastfeed exclusively because mixing the milk with other foods raises the risk of HIV being passed onto the baby.

The guidelines for HIV-positive mothers who choose to breastfeed recommend the following:

Mothers should receive:

Support in their decision to breastfeed exclusively
Triple ART for more than 13 weeks prior to delivery and also until one week after weaning

Monitoring to ensure an undetectable viral load (of less than 50 copies per mm3)

Follow-up checks on a regular basis to check medication adherence

Rapid treatment of any problems that arise with breasts or breastfeeding

Infants should receive:

Preventative treatment with ART for 4 to 6 weeks after birth

Regular checking of HIV status

Reconsideration of these measures in the light of any new findings
Sources
www.avert.org/.../pregnancy-childbirth-breastfeeding
www.aids.gov/.../
aidsinfo.nih.gov/.../the-use-of-hiv-medicines-during-pregnancy
http://www.cdc.gov/hiv/group/gender/pregnantwomen/
www.womenshealth.gov/.../pregnancy-and-hiv.html
https://aidsinfo.nih.gov/ContentFiles/Perinatal_FS_en.pdf
http://www.lcgb.org/resources/hiv-breastfeeding/
Further Reading
All HIV/AIDS Content
What is HIV/AIDS?
HIV-1 versus HIV-2: What’s the Difference?
What Causes AIDS?
AIDS Symptoms

Ruling on fasting for pregnant women and breastfeeding mothers
06-11-2003

Question 50005
Is it permissible for my wife who is breastfeeding my ten-month-old son not to fast during Ramadaan?.
Answer
Praise be to Allaah.
With regard to breastfeeding mothers – and also pregnant women – two scenarios may apply:

-1-

If the woman is not affected by fasting, and fasting is not too difficult for her, and she does not fear for her child, then she is obliged to fast, and it is not permissible for her not to fast.

-2-

If the woman fears for herself or her child because of fasting, and fasting is difficult for her, then she is allowed not to fast, but she has to make up the days that she does not fast.

In this situation it is better for her not to fast, and it is makrooh for her to fast. Some of the scholars stated that if she fears for her child, it is obligatory for her not to fast and it is haraam for her to fast.

Al-Mirdaawi said in al-Insaaf (7/382):

It is makrooh for her to fast in this case… Ibn ‘Aqeel said: If a pregnant woman or a breastfeeding mother fears for her pregnancy or her child, then it is not permissible for her to fast in this case, but if she does not fear for her child then it is not permissible for her not to fast.

Shaykh Ibn ‘Uthaymeen (may Allaah have mercy on him) was asked in Fataawa al-Siyaam (p. 161):

If a pregnant woman or breastfeeding mother does not fast with no excuse, and she is strong and in good health, and is not affected by fasting, what is the ruling on that?

and she is strong and in good health, and is not affected by fasting, what is the ruling on that?

He replied:

It is not permissible for a pregnant woman or breastfeeding woman not to fast during the day in Ramadaan unless they have an excuse. If they do not fast because they have an excuse, then they have to make up the missed fasts, because Allaah says concerning one who is sick (interpretation of the meaning):

“and whoever is ill or on a journey, the same number [of days which one did not observe Sawm (fasts) must be made up] from other days”

[al-Baqarah 2:185]

Pregnant women and breastfeeding mothers come under the same heading as those who are sick. If their excuse is that they fear for the child, then as well as making up the missed fasts, according to some scholars they also have to feed one poor person for each day missed, giving wheat, rice, dates or any other staple food. Some of the scholars said that all they have to do is make up the missed fasts, no matter what the situation, because there is no evidence in the Qur’aan or Sunnah for giving food in this case, and the basic principle is that there is no obligation unless proof of that is established. This is the view of Abu Haneefah (may Allaah have mercy on him) and it is a strong view.

Shaykh Ibn ‘Uthaymeen (may Allaah have mercy on him) was also asked in Fataawa al-Siyaam (p. 162) about a pregnant women who fears for herself or her child, and does not fast – what is the ruling?

He replied by saying:

Our answer to this is that one of two scenarios must apply in the case of a pregnant woman.

The first is if she is healthy and strong, and does not find fasting difficult, and it does not affect her foetus. In this case the woman is obliged to fast, because she has no excuse not to do so.

The second is where the pregnant woman is not able to fast, either because the pregnancy is advanced or because she is physically weak, or for some other reason. In this case she should not fast, especially if her foetus is likely to be harmed, in which case it may be obligatory for her not to fast. If she does not fast, then like others who do not fast for a valid reason, she has to make up the days when that excuse no longer applies. When she gives birth, she has to make up those fasts after she becomes pure from nifaas. But sometimes the excuse of pregnancy may be lifted but then immediately followed by another excuse, namely breastfeeding. The breastfeeding mother may need food and drink, especially during the long summer days when it is very hot. So she may need not to fast so that she can nourish her child with her milk. In this case we also say to her: Do not fast, and when this excuse no longer applies, then you should make up the fasts that you have missed.

Shaykh Ibn Baaz said in Majmoo’ al-Fataawa (15/224):

With regard to pregnant women and breastfeeding mothers, it is proven in the hadeeth of Anas ibn Maalik al-Ka’bi, narrated by Ahmad and the authors of al-Sunan with a saheeh isnaad, that the Prophet (peace and blessings of Allaah be upon him) granted them a dispensation allowing them not to fast, and he regarded them as being like travelers. From this it is known that they may not fast but they have to make up the fasts later, just like travelers. The scholars stated that they are only allowed not to fast if fasting is too difficult for them, as in the case of one who is sick, or if they fear for their children. And Allaah knows best.

It says in Fataawa al-Lajnah al-Daa’imah (10/226):

The pregnant woman is obliged to fast during her pregnancy, unless she fears that fasting may affect her or her foetus, in which case she is allowed not to fast, and she should make up the fasts after she gives birth and becomes pure from nifaas.

Can You Get Pregnant While Breastfeeding? The Truth May Surprise You!
Nearly 30% of mamas in the U.S. conceive within 18 months of giving birth. But can you get pregnant while breastfeeding? In a word, yes. Here’s how.

Written by Genevieve Howland
Updated on December 09, 2019
I just had a baby, but… I’m looking at a positive pregnancy test. How can that be? Can you get pregnant while breastfeeding!?

In a word, yes.

Here’s everything you need to understand your fertility while breastfeeding, including:

On this page…
Can You Get Pregnant While Breastfeeding?
When Do You Get Your Period After Giving Birth?
Signs You’re Ovulating Even If You Don’t Have Your Period Back
Can You Get Pregnant While Breastfeeding?
Even though it’s not as likely, you most certainly can get pregnant while breastfeeding.

In most cases, breastfeeding women are not fertile (not ovulating) for approximately six weeks immediately following birth.
In some cases, breastfeeding further delays fertility because it often suppresses ovulation.
How? When you’re breastfeeding, your body produces prolactin to help make milk. This hormone suppresses hormones, like estrogen and progesterone, that facilitate ovulation. The more you breastfeed, the more prolactin you produce and the less likely you are to become pregnant.

Can You Get Pregnant While Breastfeeding When Using LAM?
LAM stands for ‘Lactational Amenorrhea Method,’ a temporary amount of time after birth when the body does not menstruate.

ost breastfeeding moms experience lactational amenorrhea for at least the first few months of exclusive breastfeeding. Though not as common, some moms experience LAM for well over a year. It’s different for everyone, based on how their bodies function.

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How Effective is LAM?
LAM can be a highly effective form of birth control if understood and used correctly, though even with perfect understanding and use, it is not a 100 percent method.
Studies show LAM is 98 to 99.5 percent effective when used properly. There are three conditions that must be met for this method to work:

You must be exclusively breastfeeding your baby. This means no formula and you must put baby to breast at least every 4 hours during the day and at least every six hours at night.
Your baby must be under 6 months of age.
You must not have resumed your menstrual cycle yet.
If any of these conditions change (return of period, formula feeding) or your baby is older than 6 months, you can assume that LAM is no longer a reasonable or effective method of birth control for you.

But there’s a catch…

The problem with LAM is, other studies suggest many women don’t know enough, if anything, about LAM to rely on it as an effective form of contraception.
When Do You Get Your Period After Giving Birth?
Some women get their period as soon as eight weeks after birth, while others may not get their period for a year or longer.
It’s difficult to know when the body is gearing up for the return of its menstrual cycle, and a woman may ovulate before the obvious return of her period. Because of this, you can get pregnant while breastfeeding even if you haven’t had your period yet.

To learn more about your period after pregnancy, check out this post.

Signs You’re Ovulating Even If You Don’t Have Your Period Back
For most women, menstrual blood will be the first indicator their fertility is creeping back, followed by ovulation.
For others, ovulation will occur before the the tell-tale sign of bleeding.
When the latter happens, women who aren’t using any other method of birth control may conceive before they even know they’re fertile.
Here are a few clues to help you tune into signs of ovulation:

Spikes in body temperature, also called basal body temperature
Increase in cervical mucus
Cramping in lower pelvic area
Increase in libido
Bloating
Sensitive breasts
Click here for more signs of ovulation

Note: When your period does come back while you are breastfeeding, it might not look or feel the same way it did before you were pregnant.

It may be:

lighter or heavier
more brown, pink or yellow-hued
longer or shorter
different in regularity (it may come every 28 days or randomly)
Over time your menstrual cycle should return to your normal pattern, but in the meantime, you may still be fertile.

If You’re Not Ready for Another Baby…
If you’re asking can you get pregnant while breastfeeding because you or your partner aren’t ready for another baby, think about what form of birth control is right for you. Here’s an article about natural birth control options for you to consider.

If You Want to Try for No. 2
On the other hand, if you’re asking can you get pregnant while breastfeeding because you want to conceive again, be sure to give your body time to fully recover from childbirth.

Experts suggest waiting at least 1 year, preferably 2 before trying again.
If you’re ready for number two, you can take the following steps:

Increase baby’s solid intake. Try increasing baby’s solids intake if he or she is enjoying food and older than 6 to 8 months. This will decrease the demand for milk, which affects hormone output and puts you one step closer to fertility.
Encourage baby to sleep through the night. It also helps to have a child who is sleeping all night, as you will need to rest when pregnant.
Optimize your diet and lifestyle for fertility. You can also follow some of the lifestyle and diet recommendations in this post to balance hormones and boost your fertility.
Start taking prenatal vitamins (if you aren’t already). Your body has spent a long time nourishing another life. Start taking prenatal vitamins as soon as possible to ensure you have enough folate and other nutrients to support a healthy pregnancy.
Prepare for a higher likelihood of having twins. Women who become pregnant while breastfeeding another child are far more likely to have twins.

How soon can you get pregnant after giving birth?
Medically reviewed by Holly Ernst, P.A. on October 9, 2018 — Written by Zawn Villines
Ovulation and postpartum periods
Can you get pregnant while breastfeeding?
How long to wait
Takeaway
Myths about postpartum fertility are widespread. From rumors that it is impossible to get pregnant while breastfeeding to beliefs that the body will not get pregnant until it is "ready," it can be hard to get the facts.

While unlikely, it is possible to get pregnant less than 6 weeks after having a baby. However, it is impossible until a woman ovulates again. The point at which ovulation happens varies from person to person, which means some women could get pregnant earlier than others.

Sometimes, ovulation happens before a period, so it is also possible for a woman to get pregnant before having the first postpartum period.

In this article, learn more about how soon a woman can get pregnant after having a baby, as well as how long to wait, and the possible risks of pregnancies that are too close together.
Ovulation occurs when an ovary releases an egg for fertilization. If the egg is unfertilized, the body expels the egg, the uterine lining, and blood in a menstrual period. Ovulation must occur for a woman to get pregnant, and regular periods are a sign that a woman has ovulated.

A 2011 review of previous studies found that women ovulate for the first time between 45 to 94 days after giving birth. Most women did not begin ovulating until at least 6 weeks after childbirth, but a few ovulated sooner.

Usually, women who are not breastfeeding ovulate sooner after giving birth than women who do breastfeed.

However, a woman's first ovulation cycle might occur before she gets her first postpartum period. This means that it is possible for a woman to get pregnant before menstruation begins again.

Pregnancy causes many hormonal shifts, and it takes the body time to get back to normal. For many women, their first few postpartum periods are irregular.

Can you get pregnant while breastfeeding?

Breastfeeding often prevents ovulation, but this is not always the case. However, women who breastfeed their infants exclusively for 6 months are less likely to ovulate during this time than women who do not breastfeed.

Some women use breastfeeding as a birth control method. Doctors call this the lactational amenorrhea method (LAM). Amenorrhea means a lack of menstruation.

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, the following three factors must be present for LAM to have the best chance at preventing pregnancy:

The baby must be younger than 6 months old. After 6 months, breastfeeding often becomes less frequent, increasing the risk that ovulation will return.
The mother must be exclusively or almost exclusively breastfeeding. Giving formula or other foods to the baby increases the time between breastfeeding sessions. Breastfeeding on demand with intervals of no more than 4–6 hours between feedings is the most effective strategy.
The woman's period must not have returned. While not all menstruating women are fertile, the return of a woman's period suggests the body is preparing to ovulate.
Research on the effectiveness of the LAM is mixed. One major challenge of this method is that it is difficult to use correctly. Traveling away from the baby overnight or spending long days at work can create gaps in breastfeeding that make this method less effective.

According to Planned Parenthood, LAM is about 98 percent effective when people use this method in the first 6 months after the baby is born.

After 6 months postpartum, LAM is less effective. Women who are not considering another pregnancy might think about starting to use another contraceptive method.

How long to wait to try for another pregnancy

Getting pregnant again too soon after giving birth increases the risk of adverse outcomes for both the woman and baby. Recovering from birth takes time, especially if there were complications.

According to the World Health Organization (WHO), the safest option is to wait 24 months before trying for another baby. The charity March of Dimes suggests waiting at least 18 months.

Women who have had a pregnancy loss, stillbirth, hemorrhage, or surgical birth may need to wait longer. Talk to a midwife or doctor for help timing the next pregnancy.

Takeaway

Some women cannot imagine having another baby after giving birth, while others cannot wait to start planning for another.

There is no right or wrong way to feel about getting pregnant after childbirth. But practical considerations — including whether pregnancy might disrupt breastfeeding, and the safety of a pregnancy soon after birth — should play a role in the decision.

Also, recommendations for when it is safe to have sex after giving birth vary. In general, it is best to wait until postpartum bleeding has stopped, pain has disappeared, and a woman wants to have sex.

Consider using the final postpartum doctor's visit as a chance to discuss birth control options and ask questions about fertility, as well as any concerns about having sex.

Women have many options for preventing pregnancy, including condoms and hormonal contraceptives that are safe to use while breastfeeding. In many cases, the LAM method will be effective for the first 6 months postpartum.

Pregnancy / ObstetricsFertility

Journal
Journal of Obstetrics and Gynaecology
Volume 20, 2000 - Issue 2

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Research Article
Is breastfeeding during pregnancy harmful?
U. Onwudiegwu
Page 157 | Published online: 02 Jul 2009
Download citation
https://doi.org/10.1080/0144361006293

Abstract
Prolactin and oxytocin are among hormones associated with lactation. Oxytocin released from the posterior pituitary during breastfeeding is known to cause myoepithelial contraction of the breast tissues thereby promoting milk let-down and ejection. Additionally, oxytocin stimulates uterine contraction during breastfeeding causing 'afterbirth pains' and facilitating postpartum uterine involution. It is possible therefore that breastfeeding continued into a new pregnancy could, by oxytocin effect on the uterus, lead to abnormal uterine contractions, unintended abortion, impaired uteroplacental blood flow in latter pregnancy, intrauterine growth retardation, premature contractions/premature labour, low birth weight or in extreme cases intrauterine death. Eckford and Westgate (1997) recently reported placental abruption associated with breastfeeding in pregnancy progressing to fetal distress, emergency delivery and early neonatal death. We have had occasion to counsel women who discover and unplanned pregnancy while breastfeeding. In this report, two cases of continued breastfeeding into the second half of pregnancy without adverse sequelae are documented.

Breast-Feeding During Pregnancy: A Painful, Controversial Choice

By Erica Kain
March 22, 2013
I had a positive pregnancy test when my first daughter was just 9 months old, and I immediately called my ob-gyn to share the news.
"Stop breast-feeding," she told me, and dutifully, I weaned my daughter that night.
A week later, when I miscarried what turned out to have been a chemical pregnancy, I had two things to mourn: the baby I'd expected, and the nursing relationship I'd ended with my daughter.
I wondered, even if the pregnancy had continued, was it necessary to wean her? Why would my doctor have said that?
What I've learned since that day has changed my mind entirely about nursing during pregnancy. In fact, if I am lucky enough to get pregnant while breast-feeding, I'd want to continue the nursing relationship, even extending into a "tandem nursing" situation after the baby is born.
Why don't pregnant women breast-feed more often?
In all my years of playing with my young children in parks, I have never once seen an obviously pregnant woman breast-feeding. Why not?
Many times, apparently, it's very painful.
According to Wendy Haldeman, one of the founders of the Los Angeles–based The Pump Station, it can hurt to breast-feed during the first trimester. "The nipple soreness is just something the mother has to endure," she tells me. "Some can; others find it is just too painful to continue."
Local mothers who attempted nursing while pregnant agreed with Haldeman. "By the time I was about 2 months pregnant, nursing became excruciatingly painful," Amanda, a local mom, tells me. "I almost cried every time I went to nurse, it hurt so bad. I ended up weaning my son at that point."
Milk supply can also diminish. "My experience is that if the first baby is over a year, the milk supply is not as much of a concern," Haldeman says. "Infants under 9 months of age frequently need to be supplemented with formula because the mother simply cant produce enough milk."
Basically, your body begins producing a different quantity and quality of milk sometime in the second trimester. This is spelled out in Breastfeeding for Dummies by Sharon Perkins, RN, and Carol Vannais, RN:
"Somewhere between four and eight months of pregnancy, your milk does start changing from mature milk back to colostrum, the first type of milk that you gave your baby. The colostrum usually tastes a little different than mature milk, so you may find your baby not as interested in this new menu item and starting the process of weaning."
But if I could bear the pain and my baby could bear the "new menu item," is it a good idea from a medical perspective?
Next Page: Will nursing hurt my unborn baby? [ pagebreak ]
Will nursing hurt my unborn baby?
"In most circumstances, breast-feeding can be continued during an uncomplicated pregnancy," says Pamela Berens, MD, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of Texas Health Science Center, at Houston, who researches lactation and breast milk.
However, she explains that if your health-care provider has instructed you not to have intercourse, then you may not want to reconsider breast-feeding.
Apparently, both orgasm and breast-feeding trigger a release of oxytocin, which some women may want to avoid, as it can cause uterine contractions. "The increased oxytocin could be problematic in the patient that is experiencing preterm labor," Dr. Berens says.
Dr. Berens advises that women with a history of preterm labor, placenta previa, or a "classical" C-section uterine incision consider weaning. However, these reasons occur later in pregnancy, so the mother wouldn't need to wean abruptly in her first trimester.
Also, Dr. Berens recommends weaning for women with severe hypertension (high blood pressure), severe vascular or renal disease, or a prior "growth restricted" infant (a cautionary recommendation based on what Dr. Berens describes as a "small body of research that suggests that the weight of the infant born to the mother that breast-fed during her pregnancy may be very slightly reduced").
Could nursing cause a miscarriage?
Though no research has found any increased risk of miscarriage in women who continue breast-feeding during pregnancy, women might want to consider weaning if they are experiencing bleeding during early pregnancy, says Dr. Berens.
But be sure to confirm the pregnancy is viable. "If the pregnancy has already miscarried or is 'non-viable' (meaning no fetus has formed or the fetus has no heartbeat), then there is no benefit to weaning," Dr. Berens says.
If only I'd heard that sound advice four years ago! Armed with this knowledge, I know that for any future pregnancies, I'll hold on to my nursing relationship with much more confidence.

When Sierra Strangfeld was pregnant with her second child, she looked forward to the hours they would soon spend together breastfeeding. Her 18-month-old daughter had a tongue tie that kept her from nursing, and Strangfeld was excited to try again.
But, tragically, it wouldn’t be possible — she learned at 20 weeks that her son, whom she would name Samuel, would not survive due to an extremely rare condition called Trisomy 18, or Edwards’ Syndrome. Fetuses with the condition have an extra chromosome that causes severe developmental delays like an abnormally shaped head, clubbed feet and birth defects in their organs. Most pass in utero from an early miscarriage or die shortly after their birth.

“It was earth shattering, not knowing what our future held. Not knowing if we’d get to meet our baby or not,” Strangfeld, 25, tells PEOPLE of the moment in early July when she and her husband Lee learned the news. “I felt in a daze most days. But cherishing every second of every day that I got to carry him.”
The salon owner from Neillsville, Wisconsin, spent the next two months going to checkups, and on Sept. 5, her doctor said he would likely pass in utero in the next week. Strangfeld wanted a chance to hold Samuel, so she pushed for a C-section delivery, even though her doctor could not promise that he would arrive alive.
“The unknown of what was about to happen was scary. And I believe the whole thing was traumatizing,” she says.
Samuel lived for three hours out of the womb, and Strangfeld was able to hold her son. She then decided to pump the breast milk that had come in for Samuel and donate it to babies in need, in his honor.
Sometimes it seems as if all we see on social media is the bad and the ugly—so the good really deserves to be shared far and wide.
The perfect example of what can be described as “good” on social media right now is a Facebook post from William Trice Battle. On November 18, Battle posted a raw and honest tribute to his wife, Lauren, inspired by his experience watching her go through labor and childbirth.

“I honestly don’t know how she did it,” he began. “The pain was so intense, so overwhelming, that even I felt it. Everyone in the room felt it. Yet she pulled through.”
I honestly don’t know how she did it. The pain was so intense, so overwhelming, that even I felt it. Everyone in the...
Posted by William Trice Battle on Sunday, November 17, 2019
Battle went on to describe how Lauren’s labor triggered a physical response from him: “I found myself gritting my teeth when she did, tensing my entire body when her contractions hit, and shedding tears along with her.”
If you’re reading this thinking, Yeah, but he doesn’t really know what she’s going through, you’re absolutely right––and the new dad knows that, too.
“I was merely a passenger, never to truly experience the excruciating pain she was experiencing,” he wrote.
RELATED: Epidural Side Effects and Risks, According to an Ob-Gyn
His heartfelt tribute continued: “She gave her labor every ounce of life and energy she had in her. And then gave a little bit more. And through it all, at the end of it she selflessly gave all of us a glimpse into what she has been enjoying exclusively to herself for the past 9 months. We all finally get to love and hold the boy that she sacrificed her body, comfort, energy, and self for.”
Battle ended his emotional post by acknowledging that while babies are incredible, what’s even more incredible––and not said often enough––is the effort it takes to bring them safely into the world.
“My son is an absolute miracle,” he said. “Babies are absolute miracles. But to me, the greater miracle is his mother, who has shown me what selfless sacrifice really is. What love really is. My wife is the real miracle.”
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

“I honestly don’t know how she did it,” he began. “The pain was so intense, so overwhelming, that even I felt it. Everyone in the room felt it. Yet she pulled through.”
I honestly don’t know how she did it. The pain was so intense, so overwhelming, that even I felt it. Everyone in the...
Posted by William Trice Battle on Sunday, November 17, 2019
Battle went on to describe how Lauren’s labor triggered a physical response from him: “I found myself gritting my teeth when she did, tensing my entire body when her contractions hit, and shedding tears along with her.”
If you’re reading this thinking, Yeah, but he doesn’t really know what she’s going through, you’re absolutely right––and the new dad knows that, too.
“I was merely a passenger, never to truly experience the excruciating pain she was experiencing,” he wrote.
RELATED: Epidural Side Effects and Risks, According to an Ob-Gyn
His heartfelt tribute continued: “She gave her labor every ounce of life and energy she had in her. And then gave a little bit more. And through it all, at the end of it she selflessly gave all of us a glimpse into what she has been enjoying exclusively to herself for the past 9 months. We all finally get to love and hold the boy that she sacrificed her body, comfort, energy, and self for.”
Battle ended his emotional post by acknowledging that while babies are incredible, what’s even more incredible––and not said often enough––is the effort it takes to bring them safely into the world.
“My son is an absolute miracle,” he said. “Babies are absolute miracles. But to me, the greater miracle is his mother, who has shown me what selfless sacrifice really is. What love really is. My wife is the real miracle.”
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

“I honestly don’t know how she did it,” he began. “The pain was so intense, so overwhelming, that even I felt it. Everyone in the room felt it. Yet she pulled through.”
I honestly don’t know how she did it. The pain was so intense, so overwhelming, that even I felt it. Everyone in the...
Posted by William Trice Battle on Sunday, November 17, 2019
Battle went on to describe how Lauren’s labor triggered a physical response from him: “I found myself gritting my teeth when she did, tensing my entire body when her contractions hit, and shedding tears along with her.”
If you’re reading this thinking, Yeah, but he doesn’t really know what she’s going through, you’re absolutely right––and the new dad knows that, too.
“I was merely a passenger, never to truly experience the excruciating pain she was experiencing,” he wrote.
RELATED: Epidural Side Effects and Risks, According to an Ob-Gyn
His heartfelt tribute continued: “She gave her labor every ounce of life and energy she had in her. And then gave a little bit more. And through it all, at the end of it she selflessly gave all of us a glimpse into what she has been enjoying exclusively to herself for the past 9 months. We all finally get to love and hold the boy that she sacrificed her body, comfort, energy, and self for.”
Battle ended his emotional post by acknowledging that while babies are incredible, what’s even more incredible––and not said often enough––is the effort it takes to bring them safely into the world.
“My son is an absolute miracle,” he said. “Babies are absolute miracles. But to me, the greater miracle is his mother, who has shown me what selfless sacrifice really is. What love really is. My wife is the real miracle.”
To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

Wait, what exactly is a cryptic pregnancy?

So, a cryptic pregnancy (aka, a stealth pregnancy), is when a woman doesn’t realize she’s pregnant, Felice Gersh, MD, an ob-gyn and founder/director of the Integrative Medical Group of Irvine, in Irvine, California, tells Health. This can be for a variety of reasons: She may be asymptomatic, she may receive a false negative pregnancy test, or she may simply assume it isn’t an option due to fertility issues or age, says Dr. Gersh.
However, Dr. Gersh specifies that most cryptic pregnancies occur in overweight women who have very irregular cycles, “so they assume when they miss periods that it’s just who they are.” Also, they simply don’t recognize the growing baby within them, says Dr. Gersh.
RELATED: 5 Surprising Things You Didn't Know About Pregnancy
In the case of the Australian model, Dr. Gersh points out that she claims she was using contraceptive shots—which stop menstrual cycles—so not getting a period was what she expected. “She just didn’t conceive of the possibility that she was pregnant,” she explains.
Another uncommon characteristic of Langmaid's pregnancy: She apparently didn't gain much (if any) pregnancy weight. "Although she was thin, she apparently didn’t notice nearly a 7.5 pound baby within her,” says Dr. Gersh. She notes that this is “uncommon” but “not impossible,” due to the fact that with women who are young and have strong abdominal muscles, “the baby is held tightly to their body, as if in a binder.”
“It is unusual for a full-term baby to be unsuspected in a thin woman, but when the persons with her and she herself have no idea that pregnancy is a possibility, the signs are simply missed,” she explains.
Dr. Gersh does point out, however, that any woman who is pregnant can easily be recognized as being pregnant by a medical doctor, assuming one does an examination. “The pregnancy is cryptic to the woman as she is not suspecting she is pregnant, not because it can’t be detected.”
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Importance of Prospective Studies in Pregnant and Breastfeeding Women Living With Human Immunodeficiency Virus
Angela Colbers, Mark Mirochnick, Stein Schalkwijk, Martina Penazzato, Claire Townsend, David Burger
Clinical Infectious Diseases, Volume 69, Issue 7, 1 October 2019, Pages 1254–1258, https://doi.org/10.1093/cid/ciz121
Published: 13 February 2019 Article history
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Abstract
Recently, the US Food and Drug Administration and European Medicines Agency issued warnings on the use of dolutegravir and darunavir/cobicistat for treatment of pregnant women living with human immunodeficiency virus (HIV). It took 3–5 years to identify the risks associated with the use of these antiretroviral drugs, during which time pregnant women were exposed to these drugs in clinical care, outside of controlled clinical trial settings. Across all antiretroviral drugs, the interval between registration of new drugs and first data on pharmacokinetics and safety in pregnancy becoming available is around 6 years. In this viewpoint, we provide considerations for clinical pharmacology research to provide safe and effective treatment of pregnant and breastfeeding women living with HIV and their children. These recommendations will lead to timelier availability of safety and pharmacokinetic information needed to develop safe treatment strategies for pregnant and breastfeeding women living with HIV, and are applicable to other chronic disease areas requiring medication during pregnancy.
In May and June 2018, the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) issued warnings on the use of the antiretroviral agents dolutegravir and darunavir/cobicistat for treatment of pregnant women living with human immunodeficiency virus (HIV). A large observational study detected a 0.9% risk of neural tube defects (NTDs) in infants delivered by women receiving dolutegravir around conception or early in the first trimester of pregnancy. This was considered a substantial risk relative to 0.1% NTDs observed with other antiretrovirals [1–3]. This observation led to a recommendation that dolutegravir should only be used in adolescent girls and women of childbearing potential together with consistent and reliable contraception [4]. The use of the darunavir/cobicistat combination in pregnancy was associated with an average reduction in plasma darunavir concentrations of approximately 50% in pregnancy compared to postpartum, with concentrations in some individual pregnant women reduced by as much as 90% [5]. Low darunavir exposure has been associated with an increased risk of treatment failure and may therefore increase the risk of HIV transmission to the infant [5–7]. Cobicistat and ritonavir levels decrease by approximately 50%–60% during pregnancy, possibly leading to a reduced boosting effect. In the case of boosting with cobicistat, this led to 50% reduction of darunavir exposure (area under the curve [AUC]) and 89% reduction of darunavir minimum concentration (Cmin), whereas the reductions in darunavir exposure and Cmin when boosted with ritonavir were less remarkable (35% lower AUC and 50% lower Cmin) [7, 8]. In October 2018, this led to FDA label changes for all cobicistat-boosted antiretrovirals, indicating that these should not be used in pregnancy due to substantially lower exposure to the antiretrovirals during the second and third trimesters of pregnancy [9–11].These recent warnings highlight, first, that regulatory authorities take a serious view of the risks for infants of maternal pharmacotherapy during pregnancy. Second, they highlight the importance of collecting safety and pharmacokinetic data on antiretrovirals in pregnant women in a prospective, systematic, and controlled way [3, 12]. Dolutegravir was registered by the FDA in 2013, darunavir/cobicistat in 2015, and elvitegravir/cobicistat in 2012 [13]. Despite the treatment of pregnant women with these agents over the past years, the risks associated with their use during pregnancy were only identified in 2018.

In the past decade, the FDA and EMA have continued to emphasize the need for inclusion of women (pregnant and nonpregnant) in clinical development programs, issuing guidance for industry on how to conduct pharmacokinetic and pharmacodynamic studies in pregnant and lactating women, as well as on establishing pregnancy registries [14–16]. There is still, however, a general lack of legislation or regulations that formally incentivize or mandate drug studies in pregnant women [17].

Despite efforts to promote postmarketing surveillance and investigate the pharmacokinetics and safety of antiretroviral agents during pregnancy [18–20], data from these studies usually become available years after approval by stringent regulatory authorities (Figure 1). As a result, a substantial number of pregnant and breastfeeding women will inevitably use antiretroviral agents in the absence of any pregnancy-specific safety or pharmacokinetic data, putting both mother and infant at potential risk. Healthcare professionals are faced with the difficult balancing act of either accepting the potential risks of using newer antiretrovirals despite the absence of safety and pharmacokinetic data or denying pregnant and lactating women access to antiretrovirals that may offer significant benefits over older agents [21]. Consequently, there is a need for information, gathered under rigorous scientific conditions, on antiretroviral pharmacokinetics, efficacy,

rs between US Food and Drug Administration approval and publication of pregnancy data for different antiretroviral drugs. Abbreviations: 3TC, lamivudine; ABC, abacavir; ATV, atazanavir; AZT, zidovudine; DRV, darunavir; DTG, dolutegravir; EFV, efavirenz; ETV, etravirine; EVG, elvitegravir; FTC, emtricitabine; LPV, lopinavir; MVC, maraviroc; NVP, nevirapine; PK, pharmacokinetic; RAL, raltegravir; RPV, rilpivirine; TDF, tenofovir disoproxil fumarate.
In July 2018, the World Health Organization (WHO) Paediatric Antiretroviral Working Group launched a toolkit for research and development of paediatric antiretroviral drugs and formulations, which aims to guide industry on approaches for accelerating the development of antiretrovirals for children and pregnant and lactating women [23]. In this toolkit, the working group provides considerations for effectively evaluating all aspects of clinical pharmacology that are required for safe and effective treatment of women living with HIV and their children and to optimize pharmacotherapy during pregnancy (Table 1). This article touches on the issues raised in the specific pregnancy module of the toolkit and expands on these issues.

Table 1.
Considerations for Clinical Pharmacology Research in Pregnancy
1. Placental transfer should be studied during the preclinical phases of drug development using techniques such as in vitro–in vivo extrapolations or ex vivo human cotyledon perfusion models.
2. Regulatory authorities and ethics committees should incentivize and support inclusion of pregnant women in premarketing clinical trials for compounds potentially being used in pregnancy. As a first step, women enrolled in phase 2 or phase 3 clinical trials should not be removed from the study drug if they become pregnant during the trial.
3. Antiretroviral clinical pharmacology studies in pregnant and lactating women should be executed according to the highest standards and requirements.
4. Modeling and simulation should be used to facilitate understanding of pregnancy-related clinical pharmacology and inform clinical studies in pregnant women.
5. Cord blood samples and maternal samples should be taken at delivery to assess fetal exposure, and blood samples in the neonate should be taken to assess neonatal elimination.
6. Postpartum lactating women should be included in clinical trials and breast milk transfer from mother to infant should be assessed.
7. Safety of antiretroviral therapy and pregnancy outcomes should be closely monitored during pharmacokinetic studies that include pregnant women and in (obligatory reporting in) postmarketing surveillance studies, preferably in a global database.
Ethical Concerns Regarding Exposure of Pregnant Women and Their Fetuses to Antiretroviral Drugs Under Development

Although there are clearly ethical considerations when including pregnant and breastfeeding women in clinical trials, it can also be considered unethical not to test new drugs in pregnant women in a controlled setting. In practice, once new drugs are approved in adults, their use rapidly expands to include pregnant and breastfeeding women, exposing more mothers and infants to these potential risks than would have occurred in the context of a clinical trial.

Birth Defects and Other Adverse Birth Outcomes

Essential elements of pregnancy-related clinical pharmacology are the direct and indirect drug effects on the fetus. Indirect drug effects, such as increased risk of preterm labor or impaired glucose homeostasis, may have profound effects on fetal well-being. Also, many drugs cross the placenta, resulting in exposure of the fetus, with potential toxicity. Exposure during the first trimester may impact fetal organogenesis and result in teratogenicity. Exposure later in pregnancy may put the fetus at risk for impairments of growth and development or harm to specific organ systems. Fetal exposure to antiretroviral drugs may also provide beneficial effects such as preexposure prophylaxis that may aid in preventing perinatal HIV transmission [24]. Short- and longer-term monitoring of infants exposed to antiretrovirals in utero is essential, but many pregnancy registries are based on voluntary reporting, which results in bias and often leads to reporting delays.

Physiological Changes in Pregnancy May Affect Exposure to Antiretroviral Drugs

Pregnancy is associated with a wide range of physiological, anatomical, and biochemical changes that substantially impact the pharmacokinetics of therapeutic agents [25, 26]. Prolonged gastric transit time, nausea and vomiting, and dietary alterations may alter drug absorption. Drug distribution in pregnant women may change because of changes in body composition, blood volume, protein binding, and expression of transporters. Activity of drug-metabolizing enzymes may increase (eg, CYP3A, UGT1A4) or decrease (eg, CYP2C19), affecting the intrinsic clearance of antiretroviral agents. Increases in cardiac output, renal blood flow, and glomerular filtration rate may increase elimination of renally cleared drugs. In combination, these changes may result in alterations of the unbound pharmacologically active concentration of drug at the target site, leading to changes in drug response. For some antiretrovirals, such as lopinavir/ritonavir, darunavir/ritonavir, elvitegravir/cobicistat, and darunavir/cobicistat, these changes have such an impact on drug exposure during pregnancy that pregnancy-specific dosing recommendations have been developed; in some cases, the drugs are not recommended for use in pregnancy. Furthermore, drugs and vitamins typically used during pregnancy may interact with antiretrovirals on an enzyme level, but also on transporter levels (ie, iron tablets and dolutegravir). Studying the pharmacokinetics of antiretroviral drugs in pregnant women and understanding their interactions with other commonly used drugs or supplements is necessary to ensure adequate drug exposure in this vulnerable population and also to be able to assess the possible transfer of drugs over the placenta and into breast milk.

Placental Transfer, Fetal Exposure, and Disposition Into Breast Milk Are Unknown

Physiologically, placental transfer is the main determinant of fetal exposure during pregnancy [27]. However, quantifying fetal exposure in humans is not straightforward, as the fetus itself is not accessible for sampling during pregnancy. Assessment of fetal drug exposure is usually limited to cord blood sampling at the time of delivery.

After delivery, infants can also be exposed to antiretrovirals through breast milk. Transmission of HIV from mother to child in the postnatal period via breas
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Importance of Prospective Studies in Pregnant and Breastfeeding Women Living With Human Immunodeficiency Virus
Angela Colbers, Mark Mirochnick, Stein Schalkwijk, Martina Penazzato, Claire Townsend, David Burger
Clinical Infectious Diseases, Volume 69, Issue 7, 1 October 2019, Pages 1254–1258, https://doi.org/10.1093/cid/ciz121
Published: 13 February 2019 Article history
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Abstract
Recently, the US Food and Drug Administration and European Medicines Agency issued warnings on the use of dolutegravir and darunavir/cobicistat for treatment of pregnant women living with human immunodeficiency virus (HIV). It took 3–5 years to identify the risks associated with the use of these antiretroviral drugs, during which time pregnant women were exposed to these drugs in clinical care, outside of controlled clinical trial settings. Across all antiretroviral drugs, the interval between registration of new drugs and first data on pharmacokinetics and safety in pregnancy becoming available is around 6 years. In this viewpoint, we provide considerations for clinical pharmacology research to provide safe and effective treatment of pregnant and breastfeeding women living with HIV and their children. These recommendations will lead to timelier availability of safety and pharmacokinetic information needed to develop safe treatment strategies for pregnant and breastfeeding women living with HIV, and are applicable to other chronic disease areas requiring medication during pregnancy.
pregnancy, clinical trials, antiretrovirals, safety, pharmacokinetics
Topic: pregnancy hiv breast feeding clinical pharmacology safety pharmacokinetics anti-retroviral agents
Issue Section: Viewpoints
In May and June 2018, the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) issued warnings on the use of the antiretroviral agents dolutegravir and darunavir/cobicistat for treatment of pregnant women living with human immunodeficiency virus (HIV). A large observational study detected a 0.9% risk of neural tube defects (NTDs) in infants delivered by women receiving dolutegravir around conception or early in the first trimester of pregnancy. This was considered a substantial risk relative to 0.1% NTDs observed with other antiretrovirals [1–3]. This observation led to a recommendation that dolutegravir should only be used in adolescent girls and women of childbearing potential together with consistent and reliable contraception [4]. The use of the darunavir/cobicistat combination in pregnancy was associated with an average reduction in plasma darunavir concentrations of approximately 50% in pregnancy compared to postpartum, with concentrations in some individual pregnant women reduced by as much as 90% [5]. Low darunavir exposure has been associated with an increased risk of treatment failure and may therefore increase the risk of HIV transmission to the infant [5–7]. Cobicistat and ritonavir levels decrease by approximately 50%–60% during pregnancy, possibly leading to a reduced boosting effect. In the case of boosting with cobicistat, this led to 50% reduction of darunavir exposure (area under the curve [AUC]) and 89% reduction of darunavir minimum concentration (Cmin), whereas the reductions in darunavir exposure and Cmin when boosted with ritonavir were less remarkable (35% lower AUC and 50% lower Cmin) [7, 8]. In October 2018, this led to FDA label changes for all cobicistat-boosted antiretrovirals, indicating that these should not be used in pregnancy due to substantially lower exposure to the antiretrovirals during the second and third trimesters of pregnancy [9–11].These recent warnings highlight, first, that regulatory authorities take a serious view of the risks for infants of maternal pharmacotherapy during pregnancy. Second, they highlight the importance of collecting safety and pharmacokinetic data on antiretrovirals in pregnant women in a

WInadequate drug exposure with the use of cobicistat-boosted drugs in pregnancy could have been recognized earlier if pregnancy pharmacokinetic studies had been performed at an earlier stage of drug development or if outcomes of initial pregnancies exposed after licensure had been registered. Regulatory requirements for obligatory studies in pregnancy should not delay the registration process or the availability of new drugs for women of childbearing potential, if these studies are routinely incorporated into the drug development process. Regulatory incentives may help successfully ease the transition to performance of initial pregnancy pharmacology studies as part of drug development and obligatory registration of pregnancy outcomes after licensure.

An approach based on the considerations outlined here and in the WHO toolkit for research and development of pediatric antiretroviral drugs and formulations will facilitate the timelier availability of safety and pharmacokinetic information needed to develop safe treatment strategies for pregnant and breastfeeding women living with HIV. This approach is also applicable to other chronic disease areas where medication during pregnancy is required, such as diabetes mellitus, epilepsy, and autoimmune diseases. Cross-sector efforts are needed to accelerate research and ensure that protecting women and their babies does not delay their access to universal health coverage.

Notes
Notes

Acknowledgments.The authors thank Gerhard Theron, Alice Stek, and Lynne Mofenson for review of the module on pregnant and breastfeeding women of the toolkit for research and development of pediatric antiretroviral drugs and formulations, and the members of the World Health Organization Paediatric Antiretroviral Working Group (PAWG) for their input.

Disclaimer. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the WHO.

Potential conflicts of interest. A. C. and M. M. received a grant for their contribution to the PAWG toolkit for research and development of pediatric antiretroviral drugs and formulations. M. M. has received personal fees from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, grants from Gilead, and grants and personal fees from ViiV. A. C. has received grants to her institution from PENTA, ViiV, Janssen Research, Gilead, and Merck. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Can you conceive while breastfeeding?
10 Answers

Martha Artyomenko, Mother for about 19 years, taking care of infants for over 30 years.
Answered Feb 14, 2017 · Author has 1.6k answers and 2m answer views
Originally Answered: What is the chance of getting pregnant while breastfeeding?
The question is subjective to many things.

If you are ovulating while breastfeeding, you can get pregnant.

For some women, breastfeeding suppresses ovulation, if you are following ecological breastfeeding. This generally means, breastfeeding at night, every two-three hours during the day and every three to four at night, no bottles, artificial nipples (pacifiers), instead of a feed, and exclusive breastfeeding.

Since many people begin solids at six months, that is most often, women begin to ovulate. Six-nine months is one of the most common time periods. There are some as early as four-six wee...Read More
PREGNANCY, CHILDBIRTH & BREASTFEEDING AND HIV

FAST FACTS

A pregnant woman living with HIV can pass on the virus to her baby during pregnancy, childbirth and through breastfeeding.
If you are a woman living with HIV, taking antiretroviral treatment correctly during pregnancy and breastfeeding can virtually eliminate the risk of passing on the virus to your baby.
Attending antenatal appointments means you can get tested for HIV and if needed receive treatment and medical advice to help keep you and your baby healthy.

How is HIV transmitted from mother to child during pregnancy?

If you are a pregnant woman living with HIV there are a number of ways that HIV might be passed on to your baby. HIV in your blood could pass into your baby’s body. This is most likely to happen in the last few weeks of pregnancy, during labour, or delivery. Breastfeeding your baby can also transmit HIV, because HIV is in your breastmilk.

There is a 15 to 45% chance of passing HIV on to your baby if neither of you take HIV treatment.

However, taking the correct treatment during your pregnancy and while you breastfeed can virtually eliminate this risk.

How do I know if I have HIV?

If you are pregnant, it is important to attend your antenatal appointments, as these are the times when you can get an HIV test.

Your healthcare professional will offer you a test at your first appointment. If the result is positive you will be encouraged to start antiretroviral treatment as soon as possible. You will also be offered a test in your third trimester (from 28 weeks).
Remember that, whether you are pregnant or not, if you do have HIV you may not show any symptoms. The only way to know whether you are HIV-positive is to get tested.

If at any point during your pregnancy or breastfeeding stage you think you have been exposed to HIV, you may be able to take post-exposure prophylaxis (PEP). You need to take PEP within 72 hours of possible exposure to prevent HIV from establishing in your body and being passed on to your baby. If you’re breastfeeding, you should discuss whether or not to continue breastfeeding with your healthcare professional.

If you are pregnant, it is important to attend your antenatal appointments, as this is where you can get an HIV test.

How can I prevent passing HIV on to my baby?

If your HIV test result is positive, there are a number of things you can do to reduce the risk of passing on HIV to your baby.

Taking antiretroviral treatment to protect your baby

Taking treatment properly can reduce the risk of your baby being born with HIV to less than 1%.

If you knew that you were HIV-positive before you got pregnant, you may be taking treatment already. If you are not, talk to a healthcare professional about starting treatment as soon as possible.

If you found out that you living with HIV during your pregnancy, it is recommended that you start treatment as soon as possible and continue taking it every day for life.

Your baby will also be given treatment for four to six weeks after they are born to help prevent an HIV infection developing.

Protecting your baby during childbirth

If you take your treatment correctly, it will lower the amount of HIV in your body. In some people, the amount of HIV in their body can be reduced to such low levels that it is said to be ‘undetectable’ (undetectable viral load).

This means that you can plan to have a vaginal delivery because the risk of passing on HIV to your baby during childbirth will be extremely small.

If you don’t have an undetectable viral load, you may be offered a caesarean section, as this carries a smaller risk of passing HIV to your baby than a vaginal delivery.

If your HIV test result comes back positive, there are a number of things you can do to reduce the risk of passing HIV to your baby.

I was diagnosed with HIV. After a few years I entered a relationship and we decided to have children. My HIV consultant assured me that it was fine since my viral load was undetectable. I had my twins through C-section, which was planned.

HIV and breastfeeding

Breastmilk contains HIV. However, guidelines on whether or not to breastfeed vary depending on what resources are available to you.

If you always have access to formula and clean, boiled water, you should not breastfeed and give formula instead.

If you do not have access to formula and clean, boiled water all of the time, you may be advised to breastfeed while both you and your baby are taking antiretroviral treatment.

If you do breastfeed, you must always take your treatment and exclusively breastfeed (give breastmilk only) for at least six months. Mixing breastmilk and other foods before this time increases your baby’s risk of HIV. You can mix-feed your baby after six months.

As every person’s situation is different, it is best to talk to a healthcare professional to get specific advice.

Does my baby have HIV?

Your baby should be tested for HIV at birth, and again four to six weeks later.

If the result comes back negative, your baby should be tested again at 18 months and/or when you have finished breastfeeding to find out your baby’s final HIV status. It is very important to take your baby for this final HIV test to ensure they are HIV-negative or to get them on treatment if they are positive.

If any of these tests come back positive, your baby will need to start treatment straight away. Talk to your healthcare professional, and attend follow-up appointments to ensure your baby receives treatment.
What You Need to Know About Breastfeeding While Pregnant

STILL NURSING YOUR CHILD BUT HAVE A NEW BABY ON THE WAY? BREASTFEEDING WHILE PREGNANT IS TOTALLY POSSIBLE. HERE, SOME CHALLENGES YOU MAY FACE AND HOW TO SURMOUNT THEM.

For many nursing women, breastfeeding is something that comes after pregnancy—but if you’re ready for baby no. 2 when your firstborn is still young, you might find yourself breastfeeding while pregnant. Nursing can come with its fair share of surprises and challenges, so you can bet the prospect of breastfeeding during pregnancy raises a bunch of questions for moms, starting with whether it’s even safe. Here’s what you need to know about breastfeeding while pregnant, the hurdles you might face along the way and tips to help make the whole process a little easier on you and your body.

In this article:
Can you breastfeed while pregnant?
The challenges of breastfeeding while pregnant
Tips for breastfeeding while pregnant

CAN YOU BREASTFEED WHILE PREGNANT?
Yes, you can absolutely breastfeed while pregnant—it just might be harder to actually become pregnant while breastfeeding if you’re actively trying, says Maura Quinlan, MD, MPH, an assistant professor in the department of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine in Chicago. That’s because prolactin, the hormone that powers breast milk production, also clamps down on estrogen, which is needed for ovulation. Still, there have been plenty of women who become pregnant while nursing a child.

Logistics aside, is it safe to breastfeed while pregnant? Generally, yes, it’s perfectly safe, Quinlan says. But every woman and every pregnancy is different, so it’s a good idea to at least let your doctor know you’re planning to continue nursing through your pregnancy. That’s because there are a few potential risks to keep in mind. “There can be some issues of making sure you get enough calories to make breast milk and support the current pregnancy,” Quinlan says. If your doctor has concerns about your weight gain or baby’s growth, they may ask you to increase your calorie intake to compensate.

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The act of nursing can also stimulate your uterus, Quinlan says, adding that there’s a chance of preterm labor when breastfeeding while pregnant. “Nipple stimulation triggers the release of oxytocin, a hormone that causes milk release. Oxytocin also causes the uterus to contract,” explains Amy Spangler, MN, RN, IBCLC, author of Breastfeeding: A Parent’s Guide. “Most women experience uterine contractions while breastfeeding, but they are usually mild and often go unnoticed… Also, the uterus may be less sensitive to oxytocin during pregnancy, making the risk for uterine contractions even smaller.” However, if you have a history of going into labor early or have certain risk factors for a preterm birth, like placenta previa, your doctor may recommend weaning at a certain point during your pregnancy.

THE CHALLENGES OF BREASTFEEDING WHILE PREGNANT
Breastfeeding can be hard under the best of circumstances, so it can be particularly trying during pregnancy. There are a few things to keep in mind.

First, your breasts might not feel great, especially in the first trimester. “One of the first signs of pregnancy is breast tenderness, so breastfeeding may be more uncomfortable due to the hormones of pregnancy,” says Diane L. Spatz, PhD, N-BC, FAAN, a professor of perinatal nursing at the University of Pennsylvania and nurse researcher and director of the lactation program at Children’s Hospital of Philadelphia. If you’re having breast pain and your nursing child is verbal, Spatz recommends talking to them about it. Tell them what’s most comfortable for you and do what you can to prevent them from biting.

You also may feel more exhausted than you normally would during pregnancy, since breastfeeding and pregnancy can each tire you out in their own right. That’s why it’s a good idea to work naps into your regular routine, go to bed early and try to outsource tasks like house cleaning and meal prep as much as you can to give yourself a break, says Leigh Anne O’Connor, a New York City-based board-certified lactation consultant and La Leche League leader.
Contraception During Breastfeeding
It is possible to get pregnant after giving birth while you are breastfeeding. Options of contraception and the timing on when to use them are discussed.
I've heard that you can't get pregnant while you breastfeed. Is that true?
Not necessarily. During breastfeeding, the chance of getting pregnant is lower. However, women can still get pregnant.

When should I start using contraception?
It's a good idea to discuss contraception with your clinician before you give birth. Breastfeeding women have many birth control options. Many contraceptives can be started immediately after birth, including intrauterine devices (IUDs), arm implants, Depo-Provera® shots, and progestin-only pills. The most effective contraceptives are intrauterine devices (IUDs such as Mirena® and ParaGard®), and the arm implant called Nexplanon®. This means there is a much lower chance of getting pregnant when using an IUD or an arm implant, as compared to a birth control pill, Depo-Provera shot, condoms, or any other contraceptive.

Non-hormonal methods of contraception
Condoms with or without spermicides: These can be used with no impact on breastfeeding. The vagina of the nursing mother might be dryer than normal, which can make condoms irritating. If this is a problem, use additional lubrication. It is important to know that this method has a much higher chance of pregnancy as compared to the hormonal methods.

Barrier methods: These methods, such as the diaphragm and cervical cap with spermicides, have no effect on breastfeeding. Check with your clinician to refit the device because you might need a larger device after having a child. It is important to know that this method has a much higher chance of pregnancy as compared to the hormonal methods.

PARAGARD is an intrauterine device (IUD), which is non-hormonal. This type of IUD is made of copper. The IUD does not affect the quality and quantity of breast milk. PARAGARD IUD is safe and effective for 10 years.

Tubal sterilization: This is a surgical, permanent form of birth control, known as “having your tubes tied,” that only affects breastfeeding if general anesthesia is required. (That means you are put to sleep for the operation.) Anesthetic medicine can pass through the breast milk.
Hormonal methods of contraception
Progestin-only oral contraceptives, or “The Mini-Pill,” contain only a progestin (a female hormone). The method, when used daily, is highly effective for breastfeeding women. This method of contraception has a slightly higher failure rate than oral contraceptives (OCs) containing both estrogen and progestin. During breastfeeding, however, women are not as fertile. A small amount of hormone passes into the breast milk but has no known bad effects on the infant. In fact, some studies have suggested a good effect on the quantity and quality of breast milk. When the woman stops breastfeeding the baby, or when menses returns, some clinicians suggest switching to combination OCs, which have a slightly higher effectiveness.

Combination oral contraceptives, or "The Pill," contain both estrogen and progestin. The American Academy of Pediatrics has approved the use of low-dose OCs in breastfeeding women once milk production is well established.

(NuvaRing®) and a skin patch (Ortho Evra®) contain estrogen and progestin, similar to combination oral contraceptives, or "The Pill." You should discuss with your doctor if this is an appropriate option for you during breastfeeding. Most often, products which don’t contain estrogen are preferred during breastfeeding (preferred products are Mini-Pill, IUDs, progestin only arm implants, etc.).

The Mirena IUD releases a very small amount of hormone into the uterus, where it works locally. This IUD does not affect the quality and quantity of breast milk. The Mirena IUD is safe and effective for five years.

Medroxyprogesterone (Depo Provera): This is an injection or shot that can be safely used during breastfeeding and does not suppress milk production. At least one study suggests that this method of contraception might have a beneficial effect on the quality of breast milk in terms of its fat concentration, calories, minerals, and protein composition.

Nexplanon, a progestin-only implant is inserted into the upper arm. This is done via a simple office procedure. This is one of the most effective birth control options, and is effective for three years. This can be inserted immediately after delivery of the baby.

Remember: If you are at risk for a sexually transmitted disease (STD), use condoms to protect yourself. Sexually transmitted diseases can happen to anyone who is sexually active, even during breastfeeding. Don't stop taking or using your birth control method on your own. Always call your clinician to talk things over.

If you are thinking about getting pregnant while breastfeeding, you may have some important nutrition questions. On the one hand, you need to feed your growing baby. On the other, you want to optimize your fertility and improve your chances. Read on for our nutrition guide to getting pregnant while breastfeeding.

Critical Nutrients For Getting Pregnant While Breastfeeding
The Centers for Disease Control and Prevention issued Healthy People 2020 Objectives which set goals to increase the proportion of breastfeeding newborns. The good news is that breastfeeding is on the rise! Breast milk is optimal nutrition for your baby. It is not necessary to stop nursing while trying to conceive. Once you conceive, you may experience some changes in your breast milk, but this should not affect its healthfulness.

It is important to maintain optimal nutrition for both fertility and nursing. How can you be sure you get the nutrients you need to support nursing and to prepare you for pregnancy?

Vitamin D For Fertility
Your vitamin D level is critical when thinking about conceiving. For women trying to conceive naturally, those with higher vitamin D levels have better odds of conception.

There are a number of studies looking at the effects of vitamin D among women going through fertility treatment. Many studies link normal vitamin D levels with higher pregnancy rates and maintaining a healthy pregnancy.

Vitamin D supplements are beneficial for fertility and are also considered safe to continue during pregnancy and nursing.
Vitamin D While Breastfeeding
During nursing, vitamin D is important for your baby’s overall growth and development. For most women, breast milk doesn’t contain the amount of vitamin D recommended for their baby. The American Academy of Pediatrics recommends giving babies who are exclusively nursing 10 mcg (400 IU) of infant vitamin D drops each day. But for many moms, giving vitamin D drops is difficult since some babies don’t like the taste. In fact, research has shown that less than 20% of nursing moms give their baby vitamin D drops each day. Because of this low compliance rate, many nursing babies run the risk of vitamin D deficiency.

A more recent study asked breastfeeding moms about vitamin D supplementation. Surprisingly, over 85% reported that, rather than give the baby drops, they would prefer to take a vitamin D supplement themselves.

A study by Dr. Bruce Hollis helps us answer the question of how much vitamin D is needed while nursing.  In this study, mothers took 160 mcg (6,400 IU) of vitamin D daily. Their infants achieved the same vitamin D blood level as those given 10 mcg (400 IU) daily by dropper. So, these babies received enough vitamin D through breast milk alone.

As your baby is introduced to solid foods, you can begin to take less vitamin D. At this stage, your breast milk is not the sole source of food for your baby. Your nursing child should be able to get enough vitamin D from your breast milk and solid foods rich in vitamin D such as eggs and fortified cereals.

Vitamin D During Pregnancy
If you get pregnant while breastfeeding, you can take up to 100 mcg (4,000 IU) of vitamin D each day. This dose will meet both your nursing baby and your needs while pregnant.  Research shows that 4,000 IU of vitamin D is safe and effective for achieving a normal vitamin D level during pregnancy.

Folate (folic acid)
Folate (folic acid) helps with many of the body’s normal processes. However, the most well-known benefit is that folic acid prevents birth defects of the baby’s brain and spine. These birth defects are known as neural tube defects (NTDs).

The neural tube starts out as a tube-like grouping of cells inside the embryo. It finishes forming 4 to 6 weeks after the first day of a woman’s last menstrual period.  Studies have shown that taking at least 667 mcg DFE (400 mcg of folic acid) for at least one month before conception, and continuing through pregnancy, can significantly reduce the risk of NTDs.

Since your nursing baby relies on the nutrients your milk supplies, health experts often recommend a supplement to supply enough folate (folic acid) every day to support lactation.

Choline
Choline is important while trying to conceive and during pregnancy and lactation. This nutrient is a vitamin-like compound that supplies building blocks for other compounds in the body. It has many roles including cell membrane signaling and lipid transport.

It is important to get enough choline while trying to conceive. Choline works along with folate in neural tube formation. 

Although your body can make small amounts of choline, it can’t make enough to meet your needs. During pregnancy, these needs increase to 450 mg and go up to 550 mg during lactation.

Your requirement for choline is higher during lactation than at any other time during your life. Despite choline’s importance, few women get enough in their diet. National survey results show that only 6% of women in the U.S. meet the recommended amount of choline each day.

To get enough, eat foods rich in choline. In most cases, you will also need to take a supplement to get the amount your body requires. It is worthwhile to also structure your meals by choosing choline-rich foods. Here is a list to help you plan meals to get adequate choline through your diet in addition to a choline supplement.

DHA (docosahexaenoic acid)
DHA is an omega-3 fatty acid connected to brain, vision and nervous system development, and it’s important for your nursing baby. It accumulates rapidly in the baby’s brain starting during the second trimester of pregnancy and continuing until age 2. The amount of DHA in your breast milk depends on the amount of DHA you get in your diet or through supplements. Most health experts recommend a supplement containing at least 200 mg DHA during lactation. Studies show that DHA supplied through breastmilk may increase your baby’s DHA level better than giving DHA directly to your baby.

If you become pregnant while breastfeeding, you may experience changes in breast milk.
Between the fourth and eighth month of pregnancy, breast milk will usually change over to colostrum in anticipation of birth. It’s fine for an older child who is nursing to consume colostrum. However, be aware that colostrum has a natural laxative effect. Your older child may experience more frequent, looser stools. The colostrum will be present until the baby is born and the colostrum usually changes over to mature milk three to four days after birth.

If you are considering getting pregnant while breastfeeding, you can meet your unique nutrient needs by choosing a prenatal vitamin that supplies folic acid (folate), vitamin D, choline, and DHA.

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CBD Oil and Breastfeeding
By Clarence Swader / CBD for Pregnancy / Leave a Comment
While there is still a lack of enough evidence at this stage, enough studies have shown that the use of cannabis while pregnant or breastfeeding can lead to increased risk of low birth weight, preterm labor, and brain and behavior problems.

But how does CBD oil alone affect breast milk? And is it safe to take while breastfeeding? This article explores how CBD can affect breast milk, as well as the risks and safety of CBD on nursing mothers and their newborn babies.

CBD and Postpartum Issues

The many changes that happen to a woman’s body after giving birth may bring about several pains, mental health issues, postpartum anxiety, stress, and nausea-related problems. Unfortunately, the verified safe options available are limited, as many prescription medications can bring about adverse side effects that may harm both the nursing mother and her new baby.

Having heard that CBD has many potential benefits, some mothers may be looking to it for alleviating some of these issues, including postpartum depression (PPD), which affects 15% of all mothers.

But as new moms look to CBD as a natural alternative to pharmaceuticals, they must also know whether or not CBD is safe for them and their babies.

CBD and Breastmilk: What Research Says

The critical issue surrounding CBD oil and breastfeeding is the necessity for more deductive and conclusive research on nursing mothers and their infants. Limited research and clinical trials only focus on the use of CBD oil and breastfeeding mothers.
CBD has to be measurable to determine how much CBD ends up in breast milk. However, CBD is entirely fat-soluble. It is nearly impossible to accurately measure the CBD component in breast milk, which is full of fats.

In 2006, some CBD products were tested by the U. S. Food and Drug Administration (FDA), and they were found to contain trace amounts of other cannabinoids, like THC (tetrahydrocannabinol). THC is the main psychoactive component of marijuana. While there are methods used to detect concentrations of THC in breast milk, nothing is conclusive as of yet for CBD.

Researchers at the Centers for Disease Control and Prevention developed a novel technique that begins with saponification to separate cannabinoids from fat in milk. Saponification, a process often used in soap-making, is a chemical reaction that occurs when fatty acids come into contact with lye. With this novel approach involving saponification, the team can detect trace levels of active marijuana compounds, including cannabinol (CBN) and cannabidiol (CBD).

Researchers are hopeful that, in the future, saponification could help in detecting and measuring the exact amount of CBD in breast milk. When and if this takes effect, any doubts about CBD oil and breastfeeding can be cleared.

However, given the current lack of regulations on CBD products available in the market, there is a wide range of disparities in potency, quality, and general effectiveness. Regardless of what the labels say, consumers, especially new mothers and breastfeeding women, should be wary of the brand of CBD that they consume.

In 2018, a group of researchers from the University of California San Diego conducted a study on marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. However, as CBD was not the focus of the study, the research is still limited in scope. Thus, the results of the study are still inconclusive with regards to the safety of CBD oil when used during breastfeeding.

The test also recognized psychomotor deficits in more than half of the 12-month old infant participants involved in the study. However, the results of CBD on these breastfed children are not yet available. Considering the dearth of evidence on the effects of CBD oil and breastfeeding, complete abstinence is the safest course of action.
The limited clinical studies that exist on only CBD were either done in vitro or on non-human subjects. One study on non-human subjects showed that CBD use during pregnancy might change the physiological characteristics of the placenta, which is a potentially frightening idea. However, the study only looked at the subjects’ prolonged exposure to marijuana.

Meanwhile, studies on THC and its effects on infants has been alarming. Research demonstrated that exposure to cannabis use in utero has an adverse influence on birth weight and increases the risk of an infant baby going into intensive care. While the results are defeating to most people, it is essential to note that the study only outlines the fact that women should not smoke marijuana while pregnant. Also, the study does not mention anything about CBD use during pregnancy.

Still, one must be informed of the potential dangers of THC in breastmilk.

THC can remain in breast milk for up to 6 days, according to the study.
THC can affect the baby. The same study found that infants exposed to THC in breastmilk had a lower motor function by the time they were one year old.
THC poses an enormous risk. Breastfed babies of those who smoke heavy amounts of marijuana would test positive for THC for up to three weeks.
Breast Milk and the Endocannabinoid System

It is only recently that scientists discovered the full potential of these cannabinoid receptors that exist within the endocannabinoid system (ECS). The primary function of the ECS is the regulation and homeostasis (balance) within the body.

A developing fetus, even when it only has two cells, has a growing endocannabinoid system, the system that CBD benefits.
Endocannabinoids in breast milk are crucial for a newborn baby’s development. They stimulate hunger and teach the infant how to suckle.
Breast milk contains endocannabinoids that are very similar in structure to CBD.
The lack of these endocannabinoids may result in a disorder called ‘non-organic ability to thrive’ wherein the infant has no desire to feed.
Endocannabinoids help teach a newborn baby how to feed by stimulating the process of suckling. In the absence of these endocannabinoids, babies would be unaware of how to feed, nor would they have the appetite to eat. The result could be fatal, as it could lead to malnourishment or death.

Cannabinoids naturally exist in breast milk. Still, evidence remains inconclusive about the potential interactions between CBD and nursing mothers and their babies.

There are dozens of cannabinoids, and there is no evidence that explicitly confirms the presence of CBD or THC in human breast milk. Given that it is nearly impossible to find an accurate estimate of the amount of CBD that breast milk contains, it is potentially unsafe for babies to consume CBD.

CBD Oil and the Endocannabinoid System

CBD oil works by binding to cannabinoid receptors in the body. Through this method, CBD can influence the modulation of activities in the ESC. ESC impacts several bodily functions, such as mood and anxiety. Hence, ESC is involved in particular disorders as well, such as movement disorders such as Parkinson’s disease, mood and anxiety disorders, neuropathic pain, multiple sclerosis and spinal cord injury, obesity, metabolic syndrome, and osteoporosis.

What Women Should Know
Women who are contemplating to take CBD while pregnant or nursing should consider the following imperatives:

Consult with a medical professional about the risks and benefits of CBD, as well as interactions that CBD may have with any prescription medications that are being taken in conjunction with CBD.
Ensure that the CBD product that would be purchased contains no THC. Read product labels and only purchase from reliable manufacturers.
Choose cannabis products that contain pure CBD, no heavy metals, solvents, or harmful pathogens. Third-party lab tests are essential under any circumstances, but for a breastfeeding mother, the availability of those tests should be non-negotiable.
One should commence her CBD regimen with a low dose, which is typically 5 mg CBD.
Monitor any changes in the baby’s behavior and feeding schedule. Any changes must be reported to the baby’s doctor.
Before considering CBD, it is important to remember that there is still a lack of enough evidence, at this stage enough studies have shown that the use of cannabis while pregnant or breastfeeding can lead to increased risk of low birth weight, preterm labor, and brain and behavior problems.
CBD Benefits for Nursing Mothers

Nursing mothers may be tempted to turn to CBD because it can provide a number general benefits that is safe to men and women who are not pregnant or breastfeeding, such as:

New moms typically suffer from a lack of sleep. CBD can help promote healthy sleep habits that allow its users to wake up feeling invigorated and ready for the next day. A study shows that CBD can reduce anxiety levels, which could result in improved sleep.
CBD may boost the body’s immunity. Research demonstrates CBD as a potent immune suppressor, which makes it beneficial in maintaining good health. Because the immune system is linked to the endocannabinoid system (ECS), CBD also promotes a stable immune system.
CBD supports a positive mood and increased energy levels. A study shows how ECS may impact mood by regulating the body’s response to stress.
CBD restores the body to a state of calm. By balancing the neurotransmitter anandamide, CBD supports a healthy stress response and can alleviate feelings of unease.
CBD stimulates the brain and improves cognitive performance. CBD is believed to respond to numerous receptors throughout the brain and the central nervous system. As an antioxidant and neuroprotectant, CBD offers numerous benefits for general brain health.
CBD soothes muscle stiffness. Cannabinoids are potent anti-inflammatory agents ideal for joint mobility.
While these benefits are ok when not nursing a baby, at this stage enough studies have shown that the use of cannabis while pregnant or breastfeeding can lead to increased risk of low birth weight, preterm labor, and brain and behavior problems.

Conclusion

There has been limited research and not enough information on cannabis, breastfeeding mothers, and their infants. These studies primarily focus on the effects of THC on breast milk and children. However, THC and CBD are two vastly different cannabinoids. To date, there have not been any conclusive studies about the safety of CBD oil use during breastfeeding so it is not recommended until further studies are completed.

Breastfeeding

In This Section
Is breastfeeding a form of birth control?

Breastfeeding isn’t just a healthy way to feed your baby. It can also be a form of birth control — but only done in a certain way.

How does breastfeeding prevent pregnancy?

When you exclusively breastfeed — meaning you nurse at least every 4 hours during the day and every 6 hours at night, and feed your baby only breast milk — your body naturally stops ovulating. You can’t get pregnant if you don’t ovulate.

No ovulation means you won’t have your period, either. That’s why breastfeeding-as-birth control is also called the lactational amenorrhea method (LAM). “Lactational” refers to breastfeeding, and “amenorrhea” means not having your period.

How effective is breastfeeding as birth control?

When you do it perfectly, the LAM birth control method can be about as effective as hormonal contraceptives (like the pill). About 2 out of 100 people who use breastfeeding as birth control get pregnant in the 6 months it can be used after a baby is born.

Breastfeeding won’t prevent pregnancy if you feed your baby anything other than breastmilk. So if you breastfeed but also use formula, LAM isn’t a great birth control method for you. It also doesn’t work if you use a breast pump — you need to nurse your baby if you want your breastfeeding to prevent pregnancy.

It’s important to remember that breastfeeding can only be used as birth control for the first 6 months of a baby’s life, or until your period returns. After that, breastfeeding is way less effective — especially as the baby begins to eat solid foods and sleeps longer at night. Be ready to use another birth control method at 6 months, when your period returns, or if you start feeding your baby food or formula.

How do I start using breastfeeding as birth control?

You can start using LAM as soon as your baby is born. It may take a little while for you to get used to breastfeeding. Lots of people need help in the beginning, especially if it’s your first baby. Most hospitals have people who can help. And you can check out La Leche League for information, resources and support.

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Guest post: Breastfeeding through pregnancy and beyond

Emma Pickett is the chair of the Association of Breastfeeding Mothers, and also works as a lactation consultant. Here we share her article on breastfeeding through pregnancy, and potentially continuing to breastfeed two (or more!) children, known as tandem nursing.

Let’s imagine you are breastfeeding your toddler and you discover you’re pregnant. It’s a much wanted pregnancy but perhaps you weren’t expecting that positive test quite so quickly. And now here you are, pregnancy test still drying, teeny tiny new person inside you and less teeny person on the outside, very much still in love with breastfeeding.

By still feeding your toddler, you’ve already been up against it in terms of what most modern cultures find comfortable and acceptable. Now you’re ticking the box for another misunderstood area of breastfeeding: one full of myths and nonsense and one lots of uneducated people claim to be experts about.

A useful starting point is finding a group online of mothers who have breastfed through pregnancy and beyond. That can be reassuring and immensely helpful but it’s worth remembering that every woman’s experience is different and it’s very hard to make predictions about how things will go for you.

I’m going to guess that when many people are looking at the drying pregnancy test, their thoughts shift to the consequences for their current nursling. Then soon, you wonder about the baby-to-be. Is breastfeeding during pregnancy ‘safe’?

What does the research say?

What does the research say?

Let’s look at this study from 2012: A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes. Madarshahian F, Hassanabadi M. The study looked at 320 women in Iran, some breastfed during pregnancy and some did not. It showed that, “Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group.”

So, breastfeeding during pregnancy didn’t ‘take nutrition away from the baby’ and it did not cause prematurity.

Another study of 57 Californian women from 1993: Breastfeeding during pregnancy. Moscone SR, Moore MJ. Just under half continued to breastfeed through pregnancy and after the new baby arrived. The new babies were healthy and appropriately sized.

However, it’s not all clearly positive. Another research study on 133 women in Peru found a link between breastfeeding through pregnancy and 125g on average less weight gain for the new baby in the first month. (Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy. Marquis GS, Penny ME, Diaz JM, Marín RM. 2002)

Another study looked at 540 women in Egypt with sub-standard nutrition. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study. Shaaban OM, Abbas AM, Abdel Hafiz HA, Abdelrahman AS, Rashwan M, Othman ER (2015). This was not all positive news with increased risk of maternal anaemia and issues with infant growth. BUT there was NOT an increase in miscarriage risk when women breastfed through pregnancy.

How’s your nutrition and how are your iron levels? If you are a mother with access to good nutrition, it appears you have less reason to be concerned.

Does breastfeeding trigger early labour? Even for those women who were struggling with other issues, it doesn’t appear so.

Hilary Flower is the go-to person on the subject of breastfeeding during pregnancy. Her book, “Adventures in Tandem Nursing” is considered the bible on this subject. It was first written in 2003 and is now out-of-print but a second edition is currently being worked on. Her focus was on bringing the facts to pregnant mothers and she looked at this idea of triggering contractions or early labour in detail. She reminds us that we need oxytocin to trigger a milk ejection reflex (the letdown reflex) and this is also the hormone that can trigger uterine contractions. However, this doesn’t mean that breastfeeding in pregnancy triggers risky contractions and there are several safeguards in place. We need hormone receptor sites to exist before hormones get acted on by the uterus and they remain small in number until around 38 weeks of pregnancy. And even the hormone receptors that are in place can’t really do their job of causing contractions as there are oxytocin blockers in place like progesterone (made by the placenta) and proteins missing which would act as special agents to help the oxytocin do their job. Triple protection! So, oxytocin can carry on doing its breastfeeding jobs while baby remains protected in the uterus.
I think we can say science is on our side. Which makes sense when you think that throughout history women have been breastfeeding older babies and having sex and getting pregnant.

Do you know anything about the history of pregnancy testing? Today, we might know we are pregnant days after conception. For generations, it was based on guess work, someone examining your urine’s appearance and something about rabbits (early 20th century pregnancy tests involved injecting urine into a rabbit and observing a change in their ovaries). A lot of breastfeeding women couldn’t rely on whether they had missed a period as periods may only just be settling in or may not have even appeared yet. Some breastfeeding mums get pregnant without yet having a period. They ‘catch the first egg’. Then they go and see their doctor and the doctor brings out the chart that predicts due date based on last menstrual period, “errr…2015?”

Nature isn’t daft. If breastfeeding during pregnancy was hazardous, I doubt you nor I would be here. Hilary Flower mentions that if you have a high-risk pregnancy, you should talk to your health care providers about your specific situation but if you are safe to continue sexual intercourse, breastfeeding is very very likely to be fine too.

Science might say that breastfeeding during pregnancy is safe but that doesn’t mean you have to do it, or that it’s super easy for everyone. There is a wide range of experience and you need to reflect on what feels right for you.

The age of your current nursling might be a factor in your decision. If they are 7 months, you might feel differently than if they were 4 years old and you were getting a bit tired of breastfeeding a plastic truck several times a day.

If your baby is 7 months, or at any age where milk is still a significant proportion of their nutrition, you’ll need to do some thinking. It’s likely they will need an alternative source of milk (still doesn’t mean breastfeeding needs to end). Most women who are breastfeeding when they are pregnant do notice a decrease in milk supply – often a very significant one. This can start as early as the first few weeks after that positive pregnancy test. Whatever you do, your body will be resetting in its lactation story and you will go back to making colostrum during your pregnancy. It happens at different times and some mums might go through a period of feeling like they have virtually nothing and their child is ‘dry nursing’ before colostrum then appears and quantities seem to increase again.
Nurslings behave differently during the changes of pregnancy. Some self-wean as the quantities drop. Some self-wean when things seem to taste a bit different. Some care not a jot that changes are happening and would carry on breastfeeding whatever was coming out or if nothing was. Word of warning: colostrum has a laxative effect. That’s one of the reasons it’s so great for newborns as it helps them to pass meconium. Potty training a toddler? Brace yourself.

What else can you expect? For some women, not much else. Pregnant and breastfeeding felt a lot like not pregnant and breastfeeding. You’ve just got to worry about the bump being in the way towards the end. (This was my experience).

Other women struggle with sore nipples from increased sensitivity that probably has something to do with hormonal changes and sometimes aversion to breastfeeding can be a problem.

The reduction in milk supply can also be upsetting for some. It can come at a time when we might already have mixed feelings about giving birth to another child. We know what positives a new sibling can bring for your toddler but there’s sometimes a feeling of loss or even guilt as we’re concerned how their life is going to change – especially in the first few months. And when milk seems to be going too – that can feel doubly hard. Unfortunately, there isn’t much you can do to increase milk supply in pregnancy when changes are starting. All the usual stuff doesn’t work: pumping, herbs,

It’s important to remember though (and this is engraved on the heart of many of us in breastfeeding support) that BREASTFEEDING IS NOT JUST ABOUT MILK. Your little bloke with the plastic truck might not care a jot if supply diminished and milk tastes different because this is only partially about milk. It’s also about connecting to you, relaxation, safety and contentment. That big world out there is only getting bigger and breastfeeding is home.

If you are happy to continue with that, breastfeeding is still working.

You might also be wondering what life is going to be like when the new baby arrives. How does breastfeeding work when there is a newborn and a toddler? Pretty much like it did the last time there was a newborn – nature gets on with it. While breastfeeding during pregnancy doesn’t ‘use up’ colostrum, during in the first few days after the birth, it’s sensible to let the newborn do their thing first before the older nursling gets a turn. And once your mature milk transitions, you can make decisions based on how your newborn’s nappies and weight gain are getting on. Sometimes there is talk of restricting a baby to one breast and a toddler to another. Most lactation consultants agree that’s not sensible. Ideally you want the newborn to have the option of both and continue to have the option of both fully lactating as their breastfeeding experience continues. Toddlers feeding after newborns are very effective at helping a milk supply to develop and tipping into oversupply is more of a worry than running out of milk. A toddler is also fabulous at relieving engorgement in the early days post-partum. Flashback to my 3-year-old son announcing proudly to his grandmother (not entirely on board with natural term breastfeeding) that he ‘helped mummy because her milkies were really full’!

Does the toddler feel jealous of the baby having ‘their milk’? I have yet to meet a mother who feels that’s been a problem. In fact, many feel that it can help in the arrival of a new member of the family. Toddlers are likely to need some extra support, but breastfeeding is still there for them. The thing that has always provided comfort and reassurance. And good news! It’s changing back to regular milk and there’s lots more of it! What might not be sensible is weaning a toddler in the last few weeks of pregnancy so if you are thinking tandem breastfeeding really isn’t for you, it might be wiser to wean sooner rather than just prior to baby arriving. If that’s you, I wrote an article on weaning an older child which you might find helpful:
http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/weaning-toddler-bob-and-pre-schooler-billie-how-do-you-stop-breastfeeding-an-older-child

It sometimes happens that an older child who hasn’t breastfed for a while asks to do so again when a new baby is on the scene. That might be because they weren’t a fan of the colostrum. Or there might be some other things going on in their head. Are they ‘testing’ whether they still get to be your baby? Are they just curious? Some resume breastfeeding at this point. Some are happy to have a taste of expressed milk in a cup. Some ask and run away giggling and don’t mention it again. There’s no right or wrong answer on how to deal with this but ideally, we’re looking for ways to minimise rejection and any refusal is done so as gently as possible.

Still think it’s a bit hippy and ‘risky’? This is the American Academy of Family Physicians (folks on the opposite end of the spectrum from hippy and risky):
“Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned.
Breastfeeding the nursing child during pregnancy and after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.”

We can’t gu

How to Get Pregnant While Breastfeeding with No Period
Co-authored by wikiHow Staff
Updated: November 15, 2019 | References
When you’re breastfeeding exclusively, your period likely won’t return for at least the first 6 months after you have your baby. During this time, you might use breastfeeding as a natural form of birth control, which is called lactational amenorrhea method (LAM) . If you want to get pregnant right away, however, you might be worried about your missing period. Fortunately, you can get pregnant while you’re breastfeeding even if you haven’t gotten your period back.[1]

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HERBS FOR TREATMENT OF BABIES THAT THEIR MOTHER GET PREGNANT DURING BREASTFEEDING BY BABALAWO OBANIFA-Obanifa extreme documentaries

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