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“I loved having twins even though there were already three kids under the age of five running around the house. We lived in a huge old house on a two-hectare farm. My favorite time of day was in the morning, when I lay in bed to breastfeed the twins, one on each side; Then her brothers would come in and get under the blanket, and the dogs too. And I there, buried in flesh and noise, thoughts scattered everywhere. This scene that Jane Smiley narrates in A love anyone (Sixth floor) describes what it would be like to breastfeed with multiples,which is the one that occurs with babies of the same age and that in this case Joe and Michael shared, according to Rachel, the protagonist of the novel. In the case that breastfeeding is with creatures of different ages, then we talk about breastfeeding in tandem and, in general, it usually happens when breastfeeding her son or daughter, the mother becomes pregnant again and decides not to stop breastfeeding. Then, once the next baby is born, keep breastfeeding with both.
Although for some women breastfeeding in tandem can be a happy experience that fits perfectly into their family routines, making them even easier, for others it can be an exhausting and stressful experience, with moments of agitation due to breastfeeding. . Or you can live both experiences at the same time. Maternal ambivalence always present.
Knowing other experiences, analyzing our circumstances and having information can be aspects that help us make a decision. Then life, which puts us on the road with circumstances that we may not have counted on: that the breast is so sensitive during pregnancy that the mother wean the eldest before the brother arrives, that the eldest ends up weaning for own initiative during pregnancy, that although the initial idea is to keep the tandem for a while, you will end up enjoying years of experience… Some of the most frequent doubts regarding lactation in tandem are analyzed below.
What are the biggest difficulties mothers find in being able to practice tandem breastfeeding?
From the experience of Inma Mellado, IBCLC and president of the Spanish Association of Certified Breastfeeding Consultants (ILCA), the greatest difficulty encountered by mothers who wish to breastfeed in tandem is social pressure . "Even mothers who are enjoying this experience see that enjoyment overshadowed by the criticism they receive," she says.
Adds Myriam Triana Junco, pediatrician-neonatologist, IBCLC and author of the blog On demand, that in lactation we still have a lot to learn: “Unfortunately, the so-called“ prolonged lactation ”is still not absolutely normalized, much less tandem lactation. I do believe that in the last decade we are gradually becoming more aware of the importance of breastfeeding and its benefits; I see more and more interested families and more mothers who are breastfeeding beyond what is “socially” accepted ”. It happens that in Spain there is no official lactation monitoring and follow-up system that allows professionals to accurately analyze the practice of breastfeeding, but according to Myriam Triana, “cases of tandem lactation are probably very few, not only due to to the lack of support and little training by professionals, insufficient sick leave or little family support, but also to the fact that of the children who continue to breastfeed when their mother becomes pregnant, more than half are weaned during pregnancy, since production breast milk decreases a lot. "
Regarding technical issues, the practice of breastfeeding in tandem, according to Mellado, “the greatest difficulties arise in finding a comfortable way to breastfeed both children at the same time, from the desire to satisfy the needs of both or doubts about the well-being of the child. smallest baby. And in all of them, flying over, the doubts of the environment, which often end up also doubting the breastfeeding mother ”.
Are there any precautions or measures to take when pregnant and breastfeeding another child?
A comparative study of breastfeeding during pregnancy conducted in 2012 analyzed the impact on maternal and neonatal outcomes. The results suggest that breastfeeding during normal pregnancy does not increase the chances of adverse maternal and neonatal outcomes.
As Inma Mellado explains, if it is not a risky pregnancy there is no problem to continue breastfeeding during pregnancy. “Even in pregnancies with certain complications, breastfeeding and pregnancy can be compatible taking into account each specific circumstance. There are few cases where it would really be incompatible ”, he points out. The appearance of vaginal bleeding or painful and active uterine contractions during the suckling of the baby or that the cervix is shortened and begins to dilate before the pregnancy reaches term, may be some of these rare cases.
Then, when the baby arrives, in which cases is tandem breastfeeding not recommended?
Alba Padró Arocas responds, that only in case the mother does not want it, or does not see it as an option. "If you are afraid, do not feel like it or believe, a priori, that the situation is going to overcome you, perhaps it is better not to try." She also adds particular circumstances such as cases in which the mother only breastfeeds, "something that can make tandem difficult".
In the case of breastfeeding in tandem with an older baby and child, is breast milk suitable for the baby or the older child?
“ From the moment a new pregnancy occurs, the mother's body focuses on the new creature. So much so that from the first weeks the mother can experience unexpected sensations as a certain rejection of her older baby suckling. The amount of milk produced by the mother also suffers a decrease especially from the second trimester of pregnancy and when the time of delivery approaches, the mother produces colostrum, although there is some evidence that it may be more and somewhat different from what it would secrete if I was not breastfeeding another baby ”, explains Inma Mellado. After birth, according to the IBCLC, the same thing happens, the milk that is available is aimed at the survival of the weakest, which is the newborn, and therefore the mother will start secreting colostrum, transition milk and then mature milk.
Although many women consider breastfeeding in tandem, the truth is that once the time comes, they finally decide that the situation is beyond them: can the oldest be weaned while continuing to breastfeed the youngest?
According to Alba Padró Arocas, the weaning guidelines are the same in all cases: “In case of weaning the eldest in tandem weaning, what we need is a lot of help from the family. Older siblings are usually very excited after the birth of their little brother and having so much milk for them is a feast, so they may be more motivated to breastfeed, and they suck a lot! Sometimes more than the little one. This is why it is so important that the family can take care of the older brother, creating a calendar of activities and guaranteed fun. ”
In this process, Padró explains that when the older child asks for the breast, he can be allowed to suckle for a few minutes and then a member of the family (who may be the couple) suggests that he do some type of activity: play something who likes it, going out to the park, cooking something fun ... "The objective is to try to make the time spent in the chest less and less, gradually reducing time and thus facilitating the weaning process." Also consider that all this can be reinforced with specific stories for weaning and, of course, always with great patience. "Patience is key at the moment, as is empathy towards what our son is experiencing: the arrival of a brother or sister, having to share mom, leaving the tit ...", he declares.
In the case that the little one is not gaining weight: Can it happen in any case that is a consequence of the tandem or are there really other problems for this to happen?
"The most common is that in a tandem there is overproduction, that women produce milk for their two children in significant quantities," says Alba Padró. If it happens that there is a real problem of weight gain, Padró explains that it can happen that the little one has a weak or ineffective suction, that he is too sleepy or not very active and that this causes him to gain little weight. “If we detect the problem, it is important to solve the difficulties as soon as possible, and this does not always mean weaning the older one, since sucking helps us to keep milk production up. We will be able to express milk and offer it to the little one while everything is being solved ”, he points out.
What are the benefits of tandem breastfeeding for the mother and her babies?
For Myriam Triana Junco, tandem breastfeeding has an important advantage for the mother in the postpartum period and is that engorgement is softened by the older child, which empties the breast very well. In addition, she considers that the beginning of lactation can be easier.
As for children, the expert points out that newborns tend to lose less weight after birth in cases of breastfeeding in tandem and growth crises also seem to be less noticeable in them because “milk is always available and production increases more Quick". As for the older boy or girl, Triana states that it is common for them to want to breastfeed almost always when the baby does it as a way of "feeling close to their mother and feeling integrated". Even many mothers breastfeeding in tandem serves as a way to avoid or appease jealousy between siblings. Side B? That this increase in frequency, which Padró has also pointed out, supposes a certain burden or rejection for the breastfeeding mother.
Can the oldest boy or girl take the colostrum that comes after delivery?
Colostrum is neither "bad" for the older child nor will it leave the little one without it, as there will be enough for both. As Myriam Triana Junco explains, when breastfeeding continues during pregnancy, a significant drop in milk production is observed around the third or fourth month (which is why many children are weaned), and it does not seem to be until a few days before delivery when colostrum appears. "Studies have been conducted analyzing the composition of colostrum in women who did not breastfeed during pregnancy compared to others who did and there are no differences in composition. And of course the older brother can take colostrum, it will bring him many benefits (remember that colostrum has a lot of immunoglobulins and we often refer to it as the first vaccine). "
How should feedings be organized in case there is an older baby and child?
One of the most common fears of mothers who breastfeed in tandem is that they will not produce enough milk for the newborn, but this does not happen. “The oldest will not leave the youngest without colostrum by sucking during pregnancy or after delivery; nor will it leave you without milk later; rather the other way around, it will allow the amount of milk to increase rapidly and the newborn to have milk to spare. The greater the stimulus, in this case the suction, the greater the production ”, insists Myriam Triana Junco; However, some mothers decide to “organize” the feedings, either leaving a breast for each sibling –without this being a problem–, or they offer the baby first and then the older one to individualize the care.
And the feeding of the mother who breastfeeds in tandem? Should it be special or different for this circumstance?
The diet of the mother who breastfeeds in tandem does not differ from that of a single baby, in fact, it hardly differs from that of any other woman: a healthy diet, without breastfeeding implying eating larger portions or avoiding some foods. According to Julio Basulto, dietitian-nutritionist, in Mom eats healthy, it is advisable to follow a healthy diet to protect our health and set an example for our children but the mother's diet does not interfere with the composition of her milk. There is another question: should you drink more fluids? Neither. According to a document published by the WHO in 2001 entitled Healthy Eating During Pregnancy and Breastfeeding , women who breastfeed should drink the amount they need to satisfy their thirst, just like anyone else who doesn't
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