A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.

com

1 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

Store

Home

Pregnancy

Nutrition

Fun

Breastfeeding

Donate

Ages & Stages

Translations

Parenting

About

Health

Sponsors

Home Pregnancy Breastfeeding during pregnancy A New Look at the Safety of

Breastfeeding During Pregnancy

A New Look at the Safety of Breastfeeding During

Pregnancy
by Hilary Dervin Flower, MA
Read article in German
Introduction
Breastfeeding and contractions
The well-protected uterus
A balanced approach
Extra: A primer on the signs of preterm labor
References cited
Are you ready to try to conceive your second child, but still enjoying a breastfeeding
relationship with your rstborn? Or perhaps you are breastfeeding your child over a

kicking baby belly? If so you are not alonefar from it. In a study of 179 mothers who had
breastfed for at least six months, 61% had also breastfed during a subsequent

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

2 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

pregnancy.1 Of these, 38% went on to nurse both newborn and toddler postpartum, an
arrangement known as tandem nursing.
If you are eager to avoid unnecessary weaning, you have good reason. Human milk
provides important nutritional and immunological boosts for as long as a child nurses.
Indeed, weaning before the age of two has been found to raise a childs risk of illness.2
American Academy of Pediatrics recommends a minimum of one year of breastfeeding,
and the World Health Organization calls for two years or more. Moreover, continued
breastfeeding can be helpful to your toddlers adjustment to a new baby. Besides, what
better way to rest your tired pregnant body while caring for an active baby or toddler?
In contemplating the healthiness of an overlap you will want to
consider how breastfeeding is tting in with your needs for rest,
adequate pregnancy weight gain, and your overall sense of
well-being. You will do well to take into account that
breastfeeding can be painful or agitating for many mothers for

Have you heard

about our sponsor,
Freemie's hands-free
pumping system

some or all of pregnancy, leading some mothers to push for

weaning. The milk tends to dwindle by mid-pregnancy, some children self-wean in
response, while others dont seem to care.
Another concern you may have is the fact that breastfeeding causes contractions. Could
breastfeeding trigger preterm labor or miscarriage? I have dug deep in the scienti c
literature and interviewed over 200 mothers, seeking hard facts to help mothers make
the most informed and balanced assessment they can of this important safety question.
Indeed, this question was my top priority as I researched my new book Adventures in
Tandem Nursing: Breastfeeding during Pregnancy and Beyond, published in July 2003
by La Leche League International. Heres what I learned.

Breastfeeding and contractions

Nipple stimulation releases the hormone oxytocin into the bloodstream. Oxytocin is
important for breastfeeding because it is the chemical messenger that tells breast tissue
to contract and eject milk (the milk ejection re ex). Oxytocin also tells the uterine tissue

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

3 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

to contract. All women experience uterine contractions during breastfeeding, although

they are usually too mild to be noticed. Nipple stimulation can be used to ripen the
cervix when a woman is at term, and can also augment labor after it is underway.
Postpartum breastfeeding e ciently shrinks the uterus back to pre-pregnancy-size.

Given these associations, it seems a short jump to guess that breastfeeding might trigger
labor before its time. This question deserves medical study, and it is important to bear in

mind that at this time we do not have one. At the same time, preliminary data do suggest
that breastfeeding and healthy term births are quite compatible. Sherrill Mosconas 1993
survey of 57 California mothers who breastfed during pregnancy concluded that
breastfeeding resulted in no apparent adverse consequences to the mothers
pregnancies.3 There are also countless anecdotal reports of mothers who have
breastfed throughout pregnancy have given birth to healthy term babies. Of course,
some pregnancies are not destined to proceed as we hope, whether the mother is
breastfeeding or not, and so breastfeeding mothers have su ered their share of preterm
labor and miscarriage as well.
Most mothers notice no contractions during breastfeeding, even during pregnancy (93%
in the Moscona survey).3 Interestingly, even those who experience intense nursing
contractions often nd that the contractions cease soon after ending the breastfeeding
session.3,4 Like Braxton-Hicks contractions, nursing contractions commonly occur
without disrupting the pregnancy. How might that work? The scienti c literature has a lot
to tell us about that.

The well-protected uterus

The specter of breastfeeding-induced preterm labor appears to spring in large part from
an incomplete understanding of the interactions between nipple stimulation, oxytocin,
and pregnancy.
The rst little-known fact is that during pregnancy less oxytocin is released in response
to nipple stimulation than when a woman is not pregnant.5

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

4 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

But the key to understanding breastfeeding during pregnancy is the uterus itself.
Contrary to popular belief, the uterus is not at the beck and call of oxytocin during the 38
weeks of the preterm period. Even a high dose of synthetic oxytocin (Pitocin) is unlikely
to trigger labor until a woman is at term.6
Instead, the uterus must actively prepare in order for labor to commence. You could say
that there are two separate states of being for the uterus: the quiescent baby-holder and
the active baby-birther. These states make all the di erence to how the uterus responds
to oxytocin, and so, one can surmise, to breastfeeding. While the baby is growing, the
uterus is geared to have a mu ed response to oxytocin; at term, the bodys preparations
for labor transform the uterus in ways that make it respond intensely to oxytocin.
Many discussions of breastfeeding during pregnancy mention oxytocin receptor sites,
the uterine cells that detect the presence of oxytocin and cause a contraction. These
cells are sparse up until 38 weeks, increasing gradually after that time, and increasing
300-fold after labor has begun.6,7 The relative scarcity of oxytocin receptor sites is one
of the main lines of defense for keeping the uterus quiescent throughout the entire
preterm periodbut it is not the only one.
A closer look at the molecular biology of the pregnant uterus reveals yet more lines of
defense. In order for oxytocin receptor sites to respond strongly to oxytocin they need
the help of special agents called gap junction proteins. The absence of these proteins
renders the uterus down-regulated, relatively insensitive to oxytocin even when the
oxytocin receptor site density is high. And natural oxytocin-blockers, most notably

progesterone, stand between oxytocin and its receptor site throughout pregnancy. 8,9,10
With the oxytocin receptor sites (1) sparse, (2) down-regulated, and (3) blocked by
progesterone and other anti-oxytocin agents, oxytocin alone cannot trigger labor. The
uterus is in baby-holding mode, well protected from untimely labor.4

A balanced approach
Only direct research can de nitively tell us whether breastfeeding can elevate the risk of

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

5 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

preterm labor or miscarriage in any woman. But as you can see, the available research
gives us valid reasons to doubt that breastfeeding could trigger labor before the body
has already begun to prepare for it. With increasing rst-hand experience among health
professionals, many well-respected sources are asserting that breastfeeding is safe in
healthy pregnancies, including Ina May Gaskin, LM,4 the American Academy of Family
Physicians,11 and Ruth Lawrence, MD, in Breastfeeding: A Guide for the Medical
Profession.12
Complicated pregnancies always call for more complicated decisions, but weaning can
still be avoided in many cases. I have corresponded with many mothers who breastfed
through high risk pregnancies, even threatened preterm labor, and have given birth to
healthy term babies.4 Sometimes reduced nursing or weaning seems to be for the best;
no two mothers choices are the same.

You may wish to work with your caregiver to draw up a plan for moving forward with your

eyes open. As in any pregnancy, you should be on the look out for signs of preterm labor.
Any mother who is experiencing contractions that concern her should end the
breastfeeding session and see if the contractions stop as well. Some caregivers judge

that it is helpful to observe the a ects of breastfeeding on uterine contractility, fetal heart
rate, or the state of the cervix.
In closing, I would like to share a bit of my own story. When I became pregnant with my

second child, I worried that breastfeeding might interfere with my healthy pregnancy. My
midwives Anne Hirsch, LM, and CharLynn Daughtry, LM, CPM, were accustomed to
supporting breastfeeding mothers. They provided me with the support I needed to hold
onto my breastfeeding relationship with my two-year-old Nora Jade. What a di erence it
made. After I gave birth to Miles at home, my daughter rushed in to meet her brother,
and she immediately wanted to nurse with him. That na-na is for brother, she said. As
they nursed and gazed at each other wide-eyed across my chest, I wrapped an arm
around each of them, marveling at my bodys powers to provide.
When deciding about the health of breastfeeding during pregnancy, each mother must

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

6 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

sort through her options, her feelings, and what her own body is telling her. Trust yourself
to make the best choice for your family.
A primer on the signs of preterm laborRemember to contact your caregiver
immediately if you experience any of these possible warning signs:
Four or more uterine contractions in an hourentire uterus is tight, hard, balled up
to the touch; may or may not feel painful
Low backache
Pelvic pressure
Cramping (like menstrual cramps)
Increased vaginal discharge, which may include mucus, blood, or water
If these signs occur (or any contractions concern you) during a breastfeeding session,
end the session. It is important to remember that breastfeeding can cause contractions,
and, like Braxton-Hicks, these contractions do not automatically mean you are going into
labor.
If you have stopped nursingor werent nursing at that particular timeand you are still
having or think you are having more than two or three contractions an hour, you should:
1. Begin timing how often one occurs and how long each lasts.
2. Empty your bladder.
3. Drink a large glass of water (dehydration can sometimes lead to contractions).
4. Lie on your left side, or recline with feet elevated, consciously relaxing.
5. And again, if after this you nd you are having four or more contractions in an hour,
you should call your prenatal care provider immediately.

AUTHOR BIO
Hilary Flower lives in Florida with her 3 children. She is the author of Adventures in
Tandem Nursing: Breastfeeding During Pregnancy and Beyond, published in July 2003
by La Leche League International. She tandem nursed for 18 months while writing the

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

7 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

book. Her essays have appeared in Hip Mama, New Beginnings, Leaven, and Mothering
Magazine.

REFERENCES CITED
1. From an unpublished study by Kathleen Kendall-Tackett, Ph.D., IBCLC, Sugarman,
M., M.D., 2003; discussed in Flower, Hilary. Adventures in Tandem Nursing:
Breastfeeding During Pregnancy and Beyond. La Leche League International,
Schaumburg, Illinois, 2003. p. 16.
2. Bhler, E. Bergstrm, S. Subsequent Pregnancy a ects morbidity of previous child.
Biosoc Sci 1995 27:431-442.
3. Moscone [sic], SR., Moore, M.J, Breastfeeding during pregnancy. J Hum Lact 1993;
9(2):83-88.
4. Flower, Hilary. Adventures in Tandem Nursing: Breastfeeding During Pregnancy and
Beyond. La Leche League International, Schaumburg, Illinois, 2003. p. 225-30, 235.
5. Amico, J., and Finley, B., Breast stimulation in cycling women, pregnant women and
a woman with induced lactation: pattern of release of oxytocin, prolactin and
luteinizing hormone. Clinical Endocrinology, 1986 25:97-106.
6. Kimura T, Takemura,M., Nomura, S., et al. Expression of oxytocin receptor in human
pregnant myometrium. Endocrinology 137:780-785. 1996.
7. Fuchs AR, Fuchs F, Husslein P, Solo MS. Oxytocin receptors in the human uterus
during pregnancy and parturition. Am J Obstet Gynecol 1984 Nov 15;150(6):734-41.
8. Chwalisz, K, Fahrenholz, F, Hackenberg, M., Gar eld, R., Elger, W. The progesterone
antagonist onapristone increases the e ectiveness of oxytocin to produce delivery
without changing the myometrial oxytocin receptor concentrations. Am J Obstet
Gynecol 1991; 165: 1760-70.
9. Grazzini E, Guillon G, Mouillac B, Zingg HH. Inhibition of oxytocin receptor function
by direct binding of progesterone. Nature. 1998 Apr 2;392(6675):509-12.
10. Zingg HH, Grazzini E, Breton C, Larcher A, Rozen F, Russo C, Guillon G, Mouillac B.
Genomic and non-genomic mechanisms of oxytocin receptor regulation. Adv Exp
Med Biol 1998;449:287-95.
11. AAFP Policy Statement on Breastfeeding can found at http://www.aafp.org
/x6633.xml; the selected quote is from the sub-heading Nursing Beyond Infancy.

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

8 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

12. Ruth Lawrence, M.D. in Breastfeeding: A Guide for the Medical Profession, 5th
edition. Mosby. St. Louis. 1999. p. 671.
Copyright 2003 by Hilary Flower. Adapted from Adventures in Tandem Nursing LLLI
2003. No portion of this text may be copied or reproduced in any manner, electronically
or otherwise, without the express written permission of the author.

Adapted from
Adventures in Tandem Nursing:
Breastfeeding During Pregnancy and Beyond
by Hilary Flower

La Leche League International, LLLI 2003

ISBN: 0912500972

Updated on August 1, 2011

Filed Under: Breastfeeding during pregnancy

KellyMom is sponsored this month by Freemie, the hands free pumping system, who ha
graciously helped pay our costs this month.

Our sponsor is not responsible for and has had no in uence over the creation, selection or
presentation of evidence-based or other information or resources provided on this site.

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

9 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

SEARCH
Search this website

CONNECT

FEATURED ARTICLES

Breastfeeding your newborn

what to expect in the early weeks

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

10 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

Frequent nursing

Growth spurts

How do I determine if a
medication is safe for a
breastfeeding mother?

More Featured Posts

TOPICS
TOPICS

Select Category

6/19/2016 12:09 AM

A New Look at the Safety of Breastfeeding During Pregnancy KellyMom.com

11 of 11

http://kellymom.com/pregnancy/bf-preg/bfpregnancy_safety/

RECENT ARTICLES
Can Moms Get More Sleep By Freemie
Feeding? plus Freemie Cups In the
Neonatal Intensive Care Unit (NICU)
When Breastfeeding is Hard
How to become a KellyMom Sponsor
Hand expressing your breastmilk
Zika virus and breastfeeding

Copyright 19962016 KellyMom.com. All Rights Reserved. Log in

6/19/2016 12:09 AM