Tandem breastfeeding: Is it safe for mother and baby?

Irene Lekelesoi, a Samburu resident, first became a mother at 24. In an urban setting, she would be among the youngest mothers but in her rural village, it was a way of life.

As expected of her as a married woman, she had one child after another, sometimes barely a year apart. It meant that she had to make some difficult choices; like weaning off early at every cycle of birth. “The older women – who advise us young mothers – ask that we start shunning breastfeeding babies once it is known that another baby is on the way. Failure to abide would attract scorn,” she says.

If it were up to Irene, she would have continued to breastfeed while pregnant and continued to nurse her older child even after the new baby arrived. She had heard that many modern medical practitioners supported the idea (referred to as tandem breastfeeding), but she dared not be the odd one out. 

In a society imbued with culture, it would be safe to surmise that many women in Kenya have faced the same dilemma. Often, the mother’s whims would be too weak to stand. She would yield to demands by friends and family.

In Nairobi, Cecilia Wairimu, a mother of two, had to stop breastfeeding her first born, the result of a steady influx of advice from all quarters - that she prepares the way for the expected baby.

“I hoped to stop breastfeeding him at one year. Having to stop him from nursing was heart-breaking to some extent because he had become so attached to breastfeeding. Every time he latched on, I felt satisfied. It was like a bonding session for us. When I got pregnant with my second born he was nine months. It hurt that he had to stop breastfeeding,” she says.

Cecilia was on her big break. After ten years of struggle with infertility, she had every reason to celebrate the birth of her first born. It is, therefore, not unusual that she ‘let’ herself get pregnant soon after the birth of her first child.

But did she really have to deny her young baby nourishment as she waited for the developing foetus; denying the nine-month old nutrition in the process?

As it turns out, she didn’t. “There is nothing wrong with breastfeeding while pregnant with another baby,” says Dr Supa Tonje, a paediatrician at Adora Children’s clinic in Kitengela, Kajiado County. “The mother may as well continue breastfeeding both the preceding child and the new-born. They don’t have to stop. There are no medical side effects or disadvantages when she breastfeeds both at the same time.”

The World health organisation (WHO) recommends that all infants be breastfed through a duration not less than two years. Breast milk, says Dr Supa, contains antibodies and lymphocytes from the mother that help the baby resist infection, considerably reducing mortality rates.

Susan Wanjuki is proud that she stayed put “despite calls by some people that I stop breastfeeding my baby as I was pregnant.”

Her first-born, a daughter, was a year old when she conceived. “My husband and I had planned for it – the pregnancy was not an accident. I was still breastfeeding and I knew that I wanted to continue,” recalls Susan.

Incidentally, her daughter still wanted to nurse so she decided to let her have her fair share. Even when her second born, a boy, was delivered, the girl continued breastfeeding.

“I allowed both of them to suckle. I had been assured by the doctor that there was nothing wrong with both of them breastfeeding,” Susan says. The only ‘problem’, she says, was dealing with sibling rivalry “when big sister noticed that the small boy was staying longer on the breast.”

But Susan confesses that it’s not just society that frowned upon her decision to breastfeed both her children. She says that she encountered a few in the medical profession who were against it.

“On one antenatal visit in my second pregnancy, a doctor declared that my daughter was old enough to be weaned off the breast. But I sought a second opinion,” she says.

According to Manaan Mumma, a nutritionist at Kenya Aids NGOs Consortium (Kanco), the first 1,000 days of life are crucial for the future of a baby. Life, she says, is programmed and determined at this time. How well a baby was fed – following proper nutrition recommendations – have the ultimate bearing on disease susceptibility of an individual, height, health, and general well-being.

Mothers have practised tandem breastfeeding for centuries but it is not for everyone. A mother might have concerns about the safety of her pregnancy while she breast feeds, especially if she fears that breastfeeding might trigger premature contractions.

But according to the Australian Breastfeeding Association, in a normal, healthy pregnancy, with no previous history of miscarriage in the first 20 weeks or pre-term labour after 20 weeks, there is no evidence to suggest breastfeeding is threatening to a pregnancy. The association’s website quotes a 2009 publication by Obstetrician and Gynaecologist H Ishii, “Does breastfeeding induce spontaneous abortion?” Other experts maintain that the level of oxytocin (hormone that triggers contractions) produced during breastfeeding is not enough to cause a woman to have contractions.

Other concerns about tandem breastfeeding might be that nursing a child while pregnant might deny nutrients to the unborn baby or that the supply of breast milk might not be sufficient when nursing two babies at the same time. She might also wonder whether it is safe for her older baby to drink the colostrum that is produced during the last weeks of pregnancy.

According to an article on www.breastfeedingbasics.com by Anne Smith, an International Board Certified Lactation Consultant, nursing during pregnancy will not deprive the foetus of essential nutrients, and will not create a harmful “drain” on the mother’s body.

“During pregnancy, it is always important to eat nutritiously, gain weight appropriately, and get adequate rest. A well-nourished mother should have no problem providing enough nutrients for both her unborn baby and her nursing child,” Smith writes.

“During the second trimester, the milk will begin to change to colostrum. Both the quantity and the taste of the milk change dramatically during this time, and many babies will wean themselves when the milk changes. If you are nursing a baby younger than 6 months when you become pregnant, you will need to carefully monitor his growth and weight gain, and supplemental feedings may be necessary,” she writes.