You may have put a huge amount of effort into your breastfeeding experience with your first baby and are now really enjoying it. Then you become pregnant again and wonder what to do. Will breastfeeding during pregnancy harm your unborn baby? Will the child you are already feeding want to wean? Will breastfeeding result in premature labour? Will you breastfeed both children after your new baby arrives? This concept is known as tandem feeding.              

Unfortunately, there are not huge amounts of evidence in regard to tandem feeding, although it is something many mums wish to consider. First of all, it is important to note that you can conceive whilst breastfeeding. Lactational amenorrhoea, which is the concept of contraceptive effect of breastfeeding is only effective when baby is less than 6 months, feeding regularly and Mum’s period hasn’t returned yet. After this, some Mums may even ovulate and conceive before their first period postnatally.

In a normal pregnancy, we do believe that there is no risk to the unborn baby, neither nutritionally or due to premature labour, if a Mum elects to breastfeed during her pregnancy. Some Mums however note an increase in nausea with let down, nipple tenderness or even an aversion to breastfeeding whilst pregnant. During pregnancy, breasts may switch from making mature milk to colostrum, which can taste salty, so the older child may not be interested in breastfeeding as much either. It is estimated that 70% mothers notice a reduction in supply during pregnancy.

Once a newborn arrives, it is important to breastfeed the newborn first. After that, some Mums choose to feed both children simultaneously, or one after the other. It can be a challenge meeting the requests of both breastfeeding children. Tandem feeding may lead to a generous supply, so it is important to ensure optimal fit and hold to achieve good milk transfer to avoid blocked ducts and mastitis.

If the older child has a cold sore (Herpes simplex virus) it is important not to breastfeed them during this time due to the risk of the newborn baby contracting the virus. Otherwise, in regards to other childhood illnesses, Mum’s breastmilk will adapt to supply antibodies to the virus to the newborn (how clever is that!).

Many thanks to Dr Katie Fourie for generously sharing the photos of her tandem feeding her beautiful children.

Tandem Feeding in Practice

A colleague of ours, Dr Melody Jackson, a GP/LC and NDC accredited practitioner based in Sydney has kindly agreed to share her tandem feeding experience:

I have been tandem feeding for a grand total of four weeks now! I have a 21 month old son who was still breastfeeding when I fell pregnant. My supply greatly reduced within weeks of falling pregnant but he persisted with feeding throughout the pregnancy, largely for comfort, as the milk volumes were negligible. Breastfeeding was a great way of bonding for us both, especially given that I had returned to full time work. When my second baby came along, my toddler continued to want to feed and as I was home 24 hours after the delivery, he had plenty of opportunities. My milk came in quite quickly, within 36 hours, which I think was due to the tandem feeding. The engorgement that came with it was greatly reduced thanks to the toddler! The whole process was much easier this time. I had huge breastfeeding issues with my toddler for months after he was born with pain, nipple damage and fit and hold problems. This time around was so much easier. The baby latched quickly and easily and has been a champion feeder since. I have had no problems with pain, even whilst feeding two children who latch quite differently. I haven’t mastered feeding both at once yet, as I’m still being careful with fit and hold for the newborn and would prefer to feed her alone, but I hope to be able to feed both together at bedtime in the future. I have been very lucky to have a very generous milk supply, but I still try to always feed the newborn first to make sure her nutritional needs are met, even if it means the toddler sits next to me whinging. I try to limit his feeding to before sleep only, but sometimes it is the quickest and easiest way to reconnect with him if he is upset. He will often only feed for a minute or two before going back to playing, so I haven’t been overly strict in saying no to his requests for “mook”! Sometimes I feel a bit exhausted and ‘touched out’ from feeding both, but overall I’m glad that I have continued to feed the toddler as I think it has helped him to stay connected to me during a period of huge change for him. If I did not have a good milk supply I don’t think this would have been possible. It has been a little challenging as my husband and family are not overly keen on me tandem feeding (and I’m sure there are plenty more judgmental thoughts that go unsaid), but at the moment it feels like the right thing for my two children, and for as long as it is working for us, I’m happy to keep on doing it.

References

Lawrence & Lawrence, Breastfeeding for the Medical Profession 8^{th Ed., Elsevier, 2016}

Wambach & Riordan, Breastfeeding and Human Lactation, 5th Ed., Jones and Bartlett, 2016

Breastfeeding during Pregnancy and Tandem Nursing: The Official FAQ, ^{https://kellymom.com/ages/tandem/officil-tandem-bf-faq/}

Breastfeeding through pregnancy and beyond, Australian Breastfeeding Association, ^{https://www.breastfeeding.asn.au/bf-info/breastfeeding-through-pregnancy-and-beyond}