For maximum safety, it's important to have an obstetrician or midwife you can talk with. "Although in the great majority of pregnancies, continued nursing is just fine, difficult nursing or weaning choices do occasionally arise when a pregnancy becomes high risk," notes Bumgarner. "You want an advisor you can trust to know the difference."
Sometimes such an advisor is hard to find. "I am embarrassed to say how many patients I told to wean just because they were pregnant," says Brooke Schumacher, MD, an OB-GYN and La Leche League Leader. "I had no specific training on this, of course, nor did I get more information on it before I gave the advice."
Then she became pregnant with twins while her toddler daughter was still breastfeeding. "I knew my two-year-old wasn't ready to wean," she says. "She really needed nursing, although it was a bit of an endurance test for me." Her husband, who is a high-risk obstetrician, helped her sort out their medical concerns. The pregnancy went smoothly, and after her twin sons were born, Dr. Schumacher tandem nursed three children for over a year.
Occasionally, pregnancy problems do make nursing inadvisable. "I would be concerned about anyone with a history of preterm labor, preterm birth, incompetent cervix, and anyone who has a cerclage or is on medication for preterm labor," says Dr. Schumacher. "I would be very concerned about a mother who is underweight herself, or a baby who is not growing well in utero."
Is it for You?
If you're weighing the decision to continue nursing through pregnancy or tandem nurse, reach out. Support and advice from other moms is invaluable. "It's so helpful to get a sense of the wide range of experiences people can have," says Flower. Local La Leche League groups can be great places to meet other women who have tandem nursed. You can find additional discussion about nursing on BabyZone's Community Breastfeeding Zone.
If your caregiver isn't supportive of breastfeeding during pregnancy, find out what his or her concerns are, what they are based on, and whether the caregiver has ever had a patient who breastfed through pregnancy before. "Often, the physician is just inexperienced or uninformed, and can use some tactful education," says Flower. "The main thing, I think, is to show respect for the physician's experience while gently offering the opportunity to learn more."
Whether you decide to continue nursing or wean, Flower says there's no right or wrong way to proceed. "Trust yourself; the choices can be very complex ... but each mother really is in the best position to make the best choice for her and her family."