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More on the theme of THANKS, MEDICINE!

The content of this post may be of little interest to an audience of people who have to move heaven and earth to conceive, so are unlikely to be in my baby-hoarding situation. But it involves bitching about the medical profession, and that’s always worth reading, yeah?

I had a checkup with a nurse midwife student, my own OB being overbooked. I asked her whether pregnancy really did result in such a significant reduction in milk supply that I’d have to wean (as my pediatrician had suggested would happen). No no, she assured me, if I ate and drank lots, I’d be fine. Makes sense, I agreed. After all, how could our species have survived if women couldn’t breastfeed while pregnant? But she wanted to check with the actual nurse midwife just to be sure. The nurse midwife came in after about, oh, sixteen years, and said No, no, breastfeeding causes a release of oxcytocin, which results in uterine contractions, which could cause premature labor. I needed to wean by 20 weeks, so I’d better get started now. I felt my lower lip stick out. I felt tears spring to my eyes. Really? I said. Now? Yes, she assured me. I departed. I resolutely thought of my annoying students as I made my way across campus, so that I didn’t bawl. Turns out that while I didn’t know it, I am not ready to wean.

Once in the safety of my office, I let the tears flow while firing up PubMed. Hey! Guess what? There’s no evidence on either side of this question. All I could find was ONE very recent study showing no difference in pregnancy outcome or birthweight between a group of women breastfeeding while pregnant and one not. La Leche League told me that of course I can breastfeed while pregnant. But am I going to put my unborn child’s life in the hands of La Leche League, a biased source?

I stewed a bit. I wondered where the hell this business about uterine contractions came from, whether some jackass decided it was a possibility and since who really cares, it’s just nursing, better safe than sorry? I thought about the fact that Medicine is not always right, that it takes an absurdly long time before relatively conclusive research leads to changes in recommendation. I thought about the fact that I’d decided the introduction of solids at four months via spoon feeding was not for me, and that co-sleeping was, so it wouldn’t be the first time I’d ignored a doctor… But it’s different to make choices for a baby, where you can see the results and change your mind, and to make choices for a fetus, where the wrong decision could leave you hating yourself for the rest of your life.

As we were preparing Bun Bun for bed that night, I talked it over with Mr. Bunny, who was on board with whatever I wanted to do. And then the phone rang. It was the nurse midwife student. She’d talked to my OB, who had corrected her. Since I’m not at risk for premature labor, I can breastfeed unless I am feeling contractions or experiencing any bleeding or cramping. But also, that my supply will most likely vanish, so I’ll probably end up weaning.

SIGH. It’s encouraging that my OB isn’t telling me to do something that doesn’t appear to be backed up by evidence, but it’s discouraging that there’s a lack of consensus on a basic issue like this one. Is it just that we live in a nation of people who don’t breed prolifically anymore, or don’t breastfeed if they do, or don’t have science done on them if they do both? Is it just that lower breastfeeding rates a few decades ago mean there’s a dearth of information on the topic? If it just that it’s such a low priority concern that no one has gotten to it? If so, FINE, but why the hell have a recommendation on it, then?

I’m not overly cowed by medical authority, but it’s not like I’m inclined to trust my own conclusions over those of doctors. Sure, I can use a database and interpret research, but I am also clever enough to know about things like confirmation bias. So I guess the only possible conclusion is TRUST NO ONE. *Looks furtively over shoulder, draws blinds*

11 Comments Post a comment
  1. My doc told me to wean when I went for the first meeting this pregnancy. And here people are very pro-natural approach, vaginal birth, minimal medication, breastfeeding, even though they start solids at 4 months, with babies who can’t even sit up properly and the tongue thrust is still very much present. Anywho…
    Coming back to my doc, she said it was better, considering my age (36) and history. Apparently, the history also meant contractions throughout the pregnancy (but I’ve found this out recently). Which now are stronger, and for which I had to double the initial Mg dose. I have to say it went all very quick, in two weeks tops it was done. And I wept. But George didn’t, which is what matters. He was 14 months though.
    I know two mothers who breastfed while pregnant. Both had the kids self wean at around 16-20 weeks. They seemed to have lost interest, and the milk dried up fast.
    So, as long as there is no reason to wean, don’t. 🙂 You will see how it goes, right?

    February 26, 2012
  2. Oh yes. I am firmly behind the value of bitching about the medical profession. I held onto my OB through this pregnancy because a) she knows my “case” and b) she is fine working with a patient who is inclined to argue with her; she has even gracefully allowed me to make many of the final decisions, conceding the fact that a lot of the time nobody actually knows what they are talking about.

    I understand you not feeling ready to wean. I think that weaning is very often an emotional process for us. At least it was for me. I performed a quick study on all of the people that I could think of who have been in your situation (n=4) and all of them did end up weaning at sometime during pregnancy. However, none of them did so because they were advised to by medical professionals (none were in our position of being particularly cautious/paranoid in these matters). 75% weaned because it felt like too much stress on their bodies and all 3 did so at a fairly advanced stage of pregnancy (after 20 weeks). The remaining 25% weaned on account of low supply/decreased interest on the part of the baby. I hope that isn’t discouraging to you.

    I believe that your conclusion is well-founded: trust no one and continue to do what instinctively feels right to you for as long as it continues to feel that way!

    February 26, 2012
  3. rinhere #


    I’m 23 weeks pregnant and just ended up weaning my almost 22-month old a week or so ago. It was a very gradual process, but honestly, what happened was that around the middle of the first trimester my milk started to dry up, and by 15-16 weeks or so I don’t think I was making much at all. We kept up for a while just for comfort, but finally I did decide to wean, since I don’t want to tandem nurse.

    I spoke with my midwife and my OBGYN (it’s a joint practice) and they had no problems with me nursing all the way through if I wanted, but they did say it’s pretty common for women to lose their milk around the 3 month mark, and that apparently the milk changes taste and some babies don’t like it.

    Hope this helps!

    February 27, 2012
    • rinhere #

      Oh, also, just wanted to add that another big reason to wean was realizing how uncomfortable it was becoming to have a squirmy toddler pressing down on my growing belly!

      February 27, 2012
  4. I nursed through two pregnancies: one baby was born at 41 w+ (9 lb+) and the other at 40 w+ (7 lb 11 oz). Some nurslings wean when the milk supply changes and diminishes, but IME some don’t mind.

    No early labor at all–however, both times the nipple soreness was pretty intense.

    Also, one positive that no one else seems to mention about tandeming: to have a toddler who really knows how to nurse during those days when you’re establishing supply is awesome. Engorgement? No problem–call the toddler over to take a few sips off the top.

    February 27, 2012
  5. Misfit Mrs. #

    Bitch away my friend. I especially like it when you getva doc who has no factual answer AND a strong opinion. Can’t help with the weaning question, but I suspect that you will be fine if you are able to continue. It will be good for mom and bun when it’s the right time. Hopefully a good long while, yet!

    February 27, 2012
  6. Ooh, I’d never heard of the term ‘confirmation bias’ before. I am definitely going to remember that one next time I have to research something.

    Everything surrounding pregnancy seems to work like this. I remember my daughter was a big baby (macrosomia) which sent up many red flags with my ob/gyn, and even more red flags on the internets which mostly insisted that any medical intervention was for the convenience of my doctor and of detriment to my baby, complete with studies to prove this! In the end, I talked a lot to my doctor, trusted her medical opinion, got the birth I wanted (more or less) and everything was *fine*. But various internet people would probably still disagree with me and my perception of the outcome.

    Do what feels right for you and Bun Bun. I can’t really advise about weaning, since both times, weaning was dictated by my breasts which refuse to lactate past about five and a half months.

    February 28, 2012
  7. Wellllll…. I think in most people supply decreases rather than vanishes entirely. From the perspective of the angry baby, however, there is no milk NOW NOW NOW why not???? With an older child (angry, kicking, verbal Bug) it makes one rather more inclined to offer Cheerios than put up with the wailing. If he’d been younger, I might not have weaned him when about 12 weeks pregnant, but he was almost 2, and I did. I do know several people who have nursed through pregnancy with varying degrees of discomfort- being pregnant is uncomfortable enough. Also one whose child weaned herself partway through, and then started nursing again after the baby was born. So there’s a nonzero number of people who do this successfully.

    It always annoys me when medical professionals know jack about breastfeeding but then I remind myself, only 20% of people are nursing at all at 12 months (see here) so it is kind of a zebra from their perspective. How many pregnant nursing moms do they see? Almost none.

    Maybe it’s a kind of reverse confirmation bias: women who are having kids that close together on purpose are either really fond of children or really religious or something, and aren’t asking their doctors what they think, they’re just doing it.

    As for why have a recommendation, I fear that we both know the answer to that one, and it starts with the letter L.

    February 28, 2012
  8. Thank you all for the concrete info and experience-sharing. It will be interesting to see how things play out…

    February 29, 2012
  9. if oxytocin were so terrible, wouldn’t they say no sex?

    wait, don’t tell them, or they WILL start saying no sex.

    rock on with your earth mother self, my friend.

    February 29, 2012
  10. Bunny…I also find this infuriating. Why do medical professionals get to spout their own versions of “man facts” to patients when clearly the question wouldn’t be put forth in a clinical setting for a response involving bias?

    You must have super nipples by now. I wish I could have made it as far as you. Somedays it truly makes me sad.

    March 5, 2012

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