Diary of a Tandem Feeder - Part One

Back in 2009 I became pregnant with my third child. My daughter, Laura, was seven at that time and my son, Luca, was eight months old. I was still breastfeeding Luca when I became pregnant and hoped that I could continue to breastfeed him for a long time to come (I'd breastfed Laura until she was three).  I began journalling my experiences of breastfeeding whilst pregnant which, later, transitioned to a diary of my tandem feeding journey. 

Originally these diary entries were published in the Waikato Home Birth Association's magazine, called 'B', and later they were published in Home Birth Aotearoa's magazine, 'Birthplace'. I had a lot of positive feedback from readers about these articles, so thought I'd start posting one per week on my blog in case others might enjoy them, and benefit from reading them, too.  

Breastfeeding Luca at 4 months

Pregnant and Breastfeeding

Gee, I never realised there were so many people out there ignorant of the concept ‘tandem breastfeeding’.  I guess tandem breastfeeding has been such a common occurrence amongst the mothers I associate with that I had not realised what a little-known and poorly understood parenting choice it is amongst the general public.  For those of you reading this who have not, yourselves, heard of tandem breastfeeding before, it is where a mother continues to breastfeed her toddler whilst breastfeeding her newborn (actually, it means breastfeeding more than one child, so it applies to breastfeeding twins or triplets too).

When my son, Luca, was eight months old I became pregnant again.  I am now 17 weeks into my pregnancy.  Although really excited to have become pregnant with my third child, I did feel anxious that it may mean Luca would wean much earlier than I would be comfortable with.  Most pregnant women who are still breastfeeding have a large drop in their milk supply at about mid-pregnancy, and sometimes this leads to the toddler choosing to wean (or the mother choosing to wean her toddler because ‘dry’ feeding can be very painful).  Also, the pregnancy hormones alter the taste of the milk and this too, can cause a toddler to wean even from very early on in the pregnancy.

I have decided to keep a diary of my experiences as a pregnant breastfeeding mother, and hopefully, one day, a tandem breastfeeding mother. 

First 12 weeks of pregnancy

If my milk has changed flavour Luca certainly doesn’t seem to mind the taste.  He is still the eager feeder he has always been.  In fact, I haven’t noticed any changes in our breastfeeding relationship at all so far, the pregnancy hasn’t even caused me any breast or nipple tenderness.  This certainly feels like a positive start.  Furthermore, I haven’t been suffering much morning sickness at all.  Nothing like when I was pregnant during my first trimester with both Laura and Luca.  I’ve started reading the book ‘Adventures in Tandem Nursing’ by Hilary Flower which does say that for some women pregnancy lessens morning sickness and for others it makes it worse.  Guess I’ve got lucky!  

One big change has been my appetite.  When breastfeeding, I eat loads.  When pregnant, I eat loads.  When pregnant and breastfeeding, I eat mountains!  My stomach is a bottomless pit.  I even put Mark (my big hubby) to shame at the dinner table (I think he’s quite shocked at how much food I can put away!).  And if I don’t snack frequently throughout the day my blood sugar seems to drop super fast which is the only time I ever really feel queasy.

It’s strange, but because I’m not experiencing hardly any morning sickness and because I haven’t experienced any breast tenderness, I’m finding it hard to believe I am really pregnant.  In saying that, I can no longer fit most of the clothes that I have only recently started fitting again since birthing Luca, but that might just be because I am eating like a hippopotamus.  Depressing!  When my midwife came to visit at 12 weeks I even asked her to have a listen for the baby’s heart beat with the Doppler (which I typically wouldn’t bother with).  I just felt I wanted some convincing that there really was another baby on the way.  And, of course, there was the reassuring little ba-dum-ba-dum-ba-dum-ba-dum of my baby’s heart.  Okay, so it really is happening.

12 – 15 weeks

A number of my friends have seemed quite shocked that I am still breastfeeding Luca even though I am pregnant.  They hadn’t thought it possible to get pregnant whilst breastfeeding.  Interestingly, when I was breastfeeding Laura, I didn’t start getting my period again until she was 19 months old, but with Luca, he was just 5 months old.  This was probably because Luca had a couple of long stretches of sleep (6 or 7 hours) at night when he was a newborn. Unfortunately, gone are those days – Luca hasn’t tended to sleep more than 2 hours (3 hours max) at a stretch for months.  I think Laura was about 4 years old before she had her first 6 hour stretch of sleep!

My massive hunger hasn’t abated in the slightest.  I now do not leave the house without a source of food.  The ‘pick and mix’ section at the supermarket has become my feasting saviour.  I always have a ready supply of dried fruits and nuts.  It feels very reassuring having some of these stored in my car glove box and hand bag!  Certainly beats the nausea and faintness I quickly feel if I let my blood sugar drop.

Luca is still a terrible sleeper and I am starting to feel anxious that this may not resolve itself before the next baby comes.  Since he was four months old he has woken hourly through most of the night, most nights.  We decided to employ a wonderful baby sleep ‘specialist’ to help us sort out his sleep (one who does not advocate leaving a baby to cry on it’s own as a means of learning to sleep).  So far progress has been slow, but I do feel confident that we will get there.  At the very least, Luca has learnt that he does not need a breastfeed to get back off to sleep every time he wakes at night.  He is now down to just two night feeds.  I intend to completely night wean him before the next baby arrives (couldn’t imagine trying to breastfeed two babies through the night), so this is a good start.

Mark’s nana has given me my first wee taste of negativity towards my intention to tandem feed.  She’s a lovely woman and was certainly very sensitive and sweet in how she broached the ‘issue’ with me.  Her concern is that my health will suffer too much if I am feeding two littlies, especially because my babies never seem to allow me much sleep.  I felt quite defensive, but I suppose she may have raised an important point – just how will my body cope?  I am already feeling rather exhausted.

Another ‘downer’ has been the discussions I have been having with women who have tandem fed or were keen to but unable.  The stories have tended to be more negative than positive which I have found quite disheartening.  It seems that for most of the women I have spoken to, the physical pain of breastfeeding during pregnancy has been a massive (sometimes insurmountable) hurdle for them.  I haven’t experienced any such pain yet, but they tell me that it starts about mid pregnancy for most.  Time will tell I guess.

15 – 17 weeks

Beginneth the pain of breastfeeding whilst pregnant!  Over the past couple of weeks it has become increasingly painful when I initially latch Luca at the breast.  Thankfully the pain is only brief and, at this stage, quite bearable.  It feels like it did when Luca was a newborn and my nipples were recovering from a bit of surface grazing.  My milk supply must have decreased a bit as I no longer need to wear breast pads for leaking – perhaps this is why the tender latching has started.  

Luca started to request very frequent feeding a week ago.  I thought he was just going through a particularly clingy phase but it turns out he was keen to kick into the solids in a big way (perhaps due to the decreased milk supply).  He has never been into solids much at all until this point and it is quite an adjustment for me having to prepare and feed him lots of food. Breastfeeding is so much more convenient and easy!

Nights are still rather rough.  The plan is soon to night wean Luca completely in the hope that this will lead to longer stretches of sleep.  I have to psych myself up for it though because I know it is going to involve less sleep and more tears (for both Luca and myself!) before it helps.  Wish us luck!

I have been attending monthly Le Leche League meetings and they are fantastic – such an awesome source of information and support.  I figure such help may well become essential if breastfeeding during my pregnancy becomes a big challenge.

Early in my pregnancy. Luca (10 mths), me, Laura (7yrs) and Mark

Scanning For Trouble

I was working as a midwife when I found out I was pregnant with my first child. I had no idea how far along my pregnancy was and allowed myself the excuse that, as a midwife, I needed to know when I was due so that I didn't book anyone whose due date was too close to mine. So, off I went to my 'dating scan', excited at the prospect of seeing my little baby on a screen.

The scanning process turned out to be a rather invasive one. Being so early on in my pregnancy the ultrasonographer told me I'd need a trans-vaginal scan - immediately my romantic notions of 'seeing' my unborn child were diminished (this, by the way, was the only 'internal examination' of any sort that I had throughout all three of my pregnancies and births). But the worse was yet to come... My tiny unborn child had no heartbeat. "The size of your baby suggests an age of 5 1/2 weeks, by which time we would usually be seeing a beating heart," the ultrasonographer plainly informed me. "Come back for another scan in 7 -10 days and we'll check for a heartbeat again."

The week that followed was torture. I didn't know whether a was carrying a live or a dead child in my womb. Each day, until that next scan, felt like an eternity. Thankfully, the following scan showed a vigorously beating heart within my child's chest. I resolved, there and then, not to have another pregnancy scan unless there was a damn good reason to do so.

Over the 17 years that have passed since the beginning of my midwifery training I have come across many women whose pregnancy ultrasound scans have caused a lot of needless stress. The WHO does not recommend the use of routine ultrasound scans during pregnancy. This is because outcomes for the baby do not improve as a result of such scanning. Yet many pregnant women view their routine 20 week scan as a 'rite of passage' and an accurate means of determining whether or not their unborn baby is healthy. Frequently they are not told of the limitations and possible adverse outcomes of routine scanning (click here for a comprehensive article on the concerns related to ultrasound scanning).

In discussing the 'to scan or not to scan' debate with others, I have often heard it argued that having a routine 20 week scan is chosen as a means of decreasing stress levels during pregnancy because these women believe they will be reassured that 'everything is okay' with their baby. Interestingly, this has even been said to me by women who have 'had to' have multiple scans because there was a concern about some thing or another... they couldn't see the heart properly; there was too little fluid around the baby; they were worried about the position of the placenta; the baby was too small; the baby was too big... things that ultimately did not turn out to be of any concern, yet for a period of time they caused some degree of anxiety for the mothers.

I, for one, choose not to have routine pregnancy scans in large part because I am scared of the anxiety that having a scan might create for me. In the absence of worrying signals in pregnancy, I prefer to assume that I am growing a healthy baby in my healthy body. Admittedly I have had the misfortune of coming across a disproportionately large number of women who had 'false positive' and 'false negative' scan 'findings' (the numbers of false positive and false negative findings are, according to all the research I have come across, very small) which has also helped to secure my conviction that routine scanning does more harm than good. Some of the more extreme examples have included:

• a routine scan (and many subsequent follow-up scans) 'showing' fluid on the baby's brain that the doctors warned the mother would cause her baby to be brain damaged and very unlikely to live for long (this baby was found to be completely healthy at birth)
• a routine scan 'showing' a major heart abnormality (this baby's heart was completely normal at birth)
• a routine scan failed to detect a diaphragmatic hernia which had resulted in the baby's organs growing into his chest cavity leaving little space for his lungs to develop (this baby died shortly after birth)

And I have also seen the devastating results of discovering difficult truths during a routine mid-pregnancy scan...

A friend of mine was joyously pregnant with her first child. At 20 weeks she and her husband went along for their scan, excited about seeing their baby on a screen and anxious to hear that 'all was well' with their baby. Sadly, the scan detected a major heart abnormality, one that would be incompatible with life outside the womb. My friend was given the choice to either be given an injection of something that would quickly end her baby's life, then being delivered of her dead baby; or to carry on her pregnancy until it's end and give birth to her baby, knowing that her baby would die shortly after birth. She was devastated. She couldn't bear to carry on her pregnancy and chose the first option.

Another friend was given the same tragic news at her routine 20 week scan... your baby's heart has an abnormality which is inoperable and will result in your baby dying shortly after birth. She chose to continue her pregnancy, suffering through the comments of well-meaning people who didn't know her reality: how's your pregnancy going?; when's your baby due?; have you got the nursery ready?; are you looking forward to the birth?; would you like some hand-me-downs for your baby?, and desperately trying not to feel too attached to her unborn baby. Her baby died in her arms within a couple of hours of being born.

I can't help but feel that if it was me, I'd rather have discovered this sort of tragedy after the birth. At least, that way, a positive pregnancy and birth could be experienced beforehand, which is far more preferable, to my way of thinking, than being faced with either of the situations that my friends had to live through. Of course there is never a good time to find out such devastating news. But finding out via a mid-pregnancy routine scan is not going to change the outcome, not in any sort of a positive way anyway.

A routine ultrasound scan in pregnancy is an unnecessary intervention, often the first 'trigger point' for a number of consequential interventions... interventions that research has shown do not improve the pregnancy outcome! Like other unnecessary medical interventions in pregnancy and birth, routine scanning can erode a woman's belief in her body's ability to naturally grow and birth a healthy baby - something which we all know should be the reality for the vast majority of birthing women. Choosing to have a routine scan in pregnancy needs to be an informed and considered decision, not a flippant choice... Just because you can, doesn't mean you should.

Delayed Cord Clamping. Why Wait?

It seems my parents were ahead of their time when, in 1976, they asked that their doctor, who was attending my birth, sign an agreement which, amongst other things, stated that my umbilical cord was not to be clamped until it had stopped pulsating. Thankfully he agreed, and was amazed to witness my cord pulsating for 20 minutes before it was clamped and cut (indeed, it was the first time he had ever left a cord intact for more than a brief moment following birth). My wonderful parents had read that leaving the cord intact allows the baby to experience a much more gentle start to breathing. It was argued that when the cord is cut immediately following birth, the baby has to suddenly suck in air, causing pain in their delicate and sensitive virginal airway. By leaving the cord to continue pulsating after the birth, the baby is supplied with oxygen while it gradually learns how to breathe... a much more gentle start to terrestrial life.

Just to clarify, for those of you who may not be aware, for many years now Western medicine has preferred an 'actively managed' approach to the third stage of labour, part of which involves the immediate clamping of the umbilical cord at birth. Delayed cord clamping is the term given to the approach whereby the cord is left intact until it ceases to pulsate (in other words, until the baby has received its full quota of blood). 

What my parents didn't know was that they were actually benefitting me in other very important ways as well. When a baby's umbilical cord is clamped straight away, it is estimated that up to half of the newborn baby's total blood volume is left in the cord!  (See photos below comparing Jonah's cord full of blood straight after his birth with the limp, bloodless cord that remained when his placenta was born). This blood not only contains helpful oxygen, but other important nutrients and minerals as well. Red blood cells, stem cells and immune cells are all in there too. Iron-deficiency anaemia in infancy is linked to early cord clamping, and for babies whose breathing is compromised at birth, the additional source of oxygen with delayed cord clamping can be life-saving. Doesn't it seem illogical that the babies most in need of resuscitation almost invariably have their umbilical cord severed immediately?! Surely it makes more sense to leave the cord intact, allowing the baby to passively receive oxygen whilst any further resuscitation that is required is done with the baby in the mother's arms (or between her legs or at her side)?

There are many easily accessed articles that delve into the physiology behind the benefits of delayed cord clamping if you wish to research it further, but I think for the purposes of this blog post that that's enough technical jargon to swallow for now. (Here is an 18 minute TED talk youtube clip that is well worth a listen).

When my second child, Luca, was born he was slower than most to begin breathing on his own. He'd had a very lovely water birth and when I initially held him in my arms he was incredibly peaceful. His colour was good but he wasn't attempting to breathe spontaneously and his heart rate was dropping. I tried giving him a few mouth-to-mouth breaths, but felt a bit clumsy so the back-up midwife gave him some oxygen via the bag and mask. About a minute later my midwife vigorously turned him onto his front and that startled him into breathing on his own. I think he was just so relaxed following his gentle birth and he was receiving oxygen via his cord that there was simply no urgency on his part to start breathing. Although his dad and others in the room felt anxious during his first few minutes of life, I can honestly say that I didn't feel in the least bit worried that he might be compromised (of course, it may have been all those delicious endorphins that were skewing my view of the situation!). To me, he was just taking his sweet time to become fully present in the world. Undoubtedly I would not have felt nearly so trusting and confident had his cord been immediately severed following his birth.

The transitional time of babies gradually switching between intrauterine and extrauterine life (the time following birth until the cord stops pulsating) is also natures way of encouraging and protecting the important initial bonding that takes place between the mother and her baby. While the cord is intact the baby and mother are unable to be separated.  The baby remains intimately close to its only source of comfort - its mother; breathing in her smells, feeling the warmth of her skin and hearing her familiar sweet voice. And the mother instinctively cuddles her baby; keeping him warm and safe, marvelling at his beauty and quickly falling in love with him. The early initiation of breastfeeding is also encouraged with this close, undisturbed baby-mother contact, the benefits of which are many.

With all three of my children's water births, I left cutting the umbilical cord until after the placentas had been birthed. This whole process took place in the birth pool, allowing plenty of time and opportunity for me to cuddle, admire and bond with my new babies (the baby in the photos below are of my third-born, Jonah). Having experienced this precious and most important phase of the birth process, I find it incredibly distressing when I hear about, or see footage of, babies being separated from their mums immediately following their birth, taken to a resuscitation table and vigorously rubbed, suctioned, injected... all manner of unnecessary undertakings, when where they should be and where they need to be, is in their mother's arms. Baby checks, weighing, injections, bathing and dressing can all wait. What's most important in those first minutes following birth is that the mother and baby are given undisturbed time to bond. Fullstop.

Not all midwives and obstetricians have altered their recommendations and practices to be congruent with current research findings regarding the benefits of delayed cord clamping. If you are having a baby it is important that you discuss cord clamping with your caregivers prior to birth and make it clear that you do not want the cord clamped before it's ceased pulsating. Some maternity care providers might argue that if the baby is compromised at birth, or if it is born by caesarean section, that immediate clamping will be necessary in order to carry out resuscitation measures. If you speak up and present the evidence then maternity care providers should be hard pressed to deny you the right to maximise safety and wellbeing for your baby at birth! Here is an example of an emergency caesarean birth where the woman's birth plan request for delayed cord clamping was respected. And here's a midwives' explanation for how resuscitation of a newborn can take place in the mother's arms.

Full cord immediately after birth.

Limp lifeless cord. Placenta birthed.