To feed or not to feed: lactation during a new pregnancy. Breastfeeding and pregnancy

Situations when a mother who has barely recovered from childbirth again - intentionally or accidentally - becomes pregnant are not so rare. Women who are knowledgeable about pregnancy know that the period of bearing a child is the time of the strongest hormonal and biochemical changes in the body, which can also affect the composition of milk. In this regard, there are concerns about whether it is permissible to breastfeed during pregnancy. We will try to bring with the system all the arguments of the opponents of hepatitis B during pregnancy and explain each of them.

Why are there such concerns at all?

The rejection of breastfeeding with simultaneous pregnancy stems from many factors: from wild folk beliefs to completely scientific theories and observations. However, almost all fears, if you delve into science, turn out to be groundless and based only on the fact that breastfeeding during pregnancy is not accepted in our Western culture.

The situation is completely different in some third world countries, where, despite poverty and undeveloped medicine, women have been practicing hepatitis B during the period of bearing a child since ancient times. This is especially common:

• in Guatemala (50% of pregnancies coincide with breastfeeding);
• on about. Java (40%);
• in Senegal (30%);
• in Bangladesh (12%).

So why is it that doctors in the Western world warn women against continuing to feed an older child while carrying a younger one? Among their arguments, 4 main ones can be distinguished:

1. Elevated levels of the hormone oxytocin due to lactation can cause miscarriage or premature birth.
2. An increase in the hormone progesterone due to pregnancy decreases milk production.
3. A pregnant baby will not have enough nutrients for lactation.
4. Hormonal changes cause soreness in the breasts and nipples.

Argument 1. The negative effects of oxytocin on the uterus

One of the functions of this hormone is to stimulate the contractions of the cells surrounding the mammary glands, so that milk is released from the breast. That is why, during lactation, a woman has an increased level of oxytocin. The second function of the hormone is to increase the contractile activity and tone of the uterus.

It has been proven that frequent use of a breast pump stimulates the production of oxytocin and can lead to labor pains in women whose pregnancy is already behind, and the latching of the baby to the breast helps the uterus return to a normal pre-pregnant state. For doctors who understand the topic superficially, this causes fears of miscarriage.

However, the state of the uterus at the beginning of pregnancy differs significantly from its state after childbirth: it has much fewer receptors capable of absorbing and using oxytocin (by the third semester of pregnancy, the number of these receptors increases 12 times). Therefore, even high doses of oxytocin during this period will not cause premature birth.

Only long-term and regular stimulation of the nipples with a breast pump can cause artificial contractions, and it is this that should be avoided during pregnancy.

However, in rare cases, when there is still a risk of premature birth, breastfeeding during pregnancy does have to be stopped. The reasons for termination are:

• bloody issues;
• uterine pain;
• prolonged maternal weight loss;
• premature birth or past miscarriage.

In most situations, doctors simply forget about the principle "after this, it does not mean because of this." Statistics say that from 16 to 30% of pregnancies end in miscarriages, and if occasionally they coincide with breastfeeding, this makes you see GV as the source of all troubles.

Argument 2. The increased amount of progesterone due to pregnancy will reduce the volume of milk

Most women do notice a deterioration in lactation when carrying a baby. The reason for this is the hormone progesterone, which is necessary to stop the maturation of new eggs, prepare the ligaments and muscles for childbirth, and create a supply of nutrients in subcutaneous fat. Another of its functions is to suppress lactation until the last days before childbirth and to activate it after childbirth.

Since from the first to the third trimester of pregnancy, the amount of progesterone is steadily increasing, therefore, milk production is constantly decreasing. Closer to childbirth, mature milk will be completely replaced by colostrum. However, this does not prevent breastfeeding from continuing as long as possible, which is especially important until the baby is six months old. To the best of your ability, you can maintain lactation with a balanced diet, intake of herbal dietary supplements and vitamins.

It rarely happens that feeding an older child does not allow milk to finally turn into colostrum before giving birth to a younger child. If, by 30-31 weeks of pregnancy, milk has not begun to be replaced by colostrum, it will be reasonable to interrupt GV 2 months before delivery. It is advisable to wean the baby from the breast gradually: try to put him to bed without sucking the breast, shorten the feeding time, and reduce the daily feeding to a minimum.

A similar point of view is shared by the famous pediatrician E.O. Komarovsky. According to him, if the oldest child is at least six months old, breastfeeding can be stopped if necessary.

Argument 3: The youngest child lacks nutrients because they are spent on breast milk

Only a nursing mother can suffer in this case, since the body has its own priorities in the distribution of nutrients. First of all, he cares about the preservation of pregnancy, in the second place, he seeks to continue lactation, and the already remaining nutrients go to maintain the health of the mother's body.

That is why simultaneous breastfeeding and a new pregnancy, although completely compatible, cause severe bouts of hunger in mothers: a balanced regular diet and plenty of drink will reduce the risk of deteriorating health to a minimum.

Argument 4: Breast and nipple tenderness

For many mothers, simultaneous hepatitis B and pregnancy cause pain in the breasts and especially in the nipples. According to statistics, this is the main reason for refusing to breastfeed while carrying a youngest child.

Unlike painful cracks in the nipples, this pain is caused by hormones - estrogens and progesterone. If a nursing mother also experienced similar sensations before her period, they will almost certainly appear during pregnancy. Since such pain is not a disease, it is pointless to treat it, but you can reduce the discomfort by moistening the nipples with an infusion of oak bark and cooling them with ice cubes.

Tandem feeding

In the vast majority of cases, a newly pregnant nursing mother can safely continue breastfeeding until the baby is 6-7 months old. At the same time, the mother needs to pay special attention to her diet, take care of the presence of all vitamins, minerals and amino acids in food. Assertions about the high threat of miscarriage are unfounded. Despite the increase in the level of oxytocin caused by lactation, it is not able to seriously affect the uterus, since in the early stages of pregnancy it is not sufficiently susceptible to it. However, if in the past a woman has already had a premature birth or miscarriage, and currently there is spotting, uterine pain and weight loss, hepatitis B should not be continued. Also, during pregnancy, you can not express yourself - the effect of a breast pump stimulates the production of oxytocin much more than a child.

After childbirth, oxytocin, a special hormone, begins to be intensively produced in the mother's body. Normally, it is always present in small quantities in the body of a non-pregnant woman. But it is this hormone that is responsible for the contraction of the uterus after the appearance of the baby, and he is also responsible for the production of breast milk. The more often the mother applies the baby to the breast, the more hormone is produced and, as a result, milk.

Oxytocin in large quantities provokes lactational amenorrhea - the absence of menstruation. No menstruation means there is no ovulation, no ovulation - there is no egg cell ready for fertilization. In some women, amenorrhea lasts for several years, and in some it lasts only a few months (sometimes it is absent altogether). But can a woman predict that amenorrhea is over? After all, the most obvious sign that a nursing mother can become pregnant again is menstruation, but it comes a couple of weeks after ovulation and possible fertilization. And a sexually active nursing mom can get pregnant the very first ovulation without even knowing it.

Signs of pregnancy when breastfeeding

If the mother is feeding, but her cycle has already been established, then the symptoms of pregnancy with hepatitis B will be clearly familiar to her: the absence of menstruation on time and other accompanying possible signs - malaise, nausea, intolerance to certain foods and odors. But how can a nursing mother understand that she is pregnant if she has never had a period after giving birth?

1. The first sign: changes in the quantity and quality of breast milk due to hormonal changes. As a rule, milk becomes less, and the child notices that it has changed in taste, and may be reluctant to suckle or refuse to eat at all. In this case, the chest begins to ache in a completely different way than from the rush of milk; it often increases markedly and swells.

2. The second and most sure sign: a positive pregnancy test. If you suspect that another child is growing in the mother's tummy, you should immediately use the home express method for determining pregnancy, because hCG rises in the urine, regardless of whether the pregnant woman is breastfeeding or not. How to determine pregnancy with hepatitis B with one hundred percent probability? Visit your gynecologist.

Breastfeeding and pregnancy: are they compatible?

Gynecologists recommend maintaining the interval between pregnancies for at least two years. The body has not yet recovered from childbirth, lactation is also a great burden on the body, and a new pregnancy is a huge stress for it. But if another baby is a joy for the whole family, then you should not give it up.

In the end, the weather is great! And many women manage to maintain lactation during pregnancy. However, this pregnancy will require constant monitoring by the attending physician, and the woman should be prepared for possible complications (including premature birth).

Signs of pregnancy while breastfeeding are difficult to detect, especially in the early stages. Most breastfeeding women have an unstable menstrual cycle, and some do not. Sometimes the expectant mother finds out about the new position already when the tummy grows, and the baby begins to move. In order not to get into a mess, you need to carefully monitor your well-being, and use proven protective equipment to prevent an unplanned pregnancy.

It is believed that breastfeeding and new pregnancy are mutually exclusive concepts. Therefore, many couples refuse contraceptives and use the method of lactational amenorrhea. Any gynecologist will say that this method is not reliable, because you can get pregnant even with active breastfeeding.

Women's physiology is designed in such a way that immediately after childbirth, a radical change in hormonal levels occurs. The hormone prolactin promotes the production of breast milk. With increased prolactin, the ovaries stop working, and the endometrium does not grow, which is accompanied by the absence of ovulation and menstruation.

It can be concluded that pregnancy while feeding is impossible, but this is not the case. It is difficult to predict how the hormonal background will react to a new state of the body. Medicine knows many cases when, with HS, the onset of ovulation led to conception. The sex glands can actively start working as early as a month after childbirth or "sleep" before lactation stops.

The likelihood of pregnancy after childbirth increases under conditions:

• feeding by the hour. In order for prolactin to be produced in sufficient quantities to suppress the work of the ovaries, it is necessary to apply the newborn on demand;
• baby sucks on a pacifier. As a result, the baby needs less of the mother's breast;
• the baby is bottle fed. This leads to a gradual decrease in milk production;
• there are no night feedings. During this period, there is a peak in the release of hormones that produce lactation;
• the couple does not use modern methods of contraception. For nursing women, there are several methods of preventing pregnancy (condoms, spiral, mini-drank).

The first signs of pregnancy can be easily noticed if you listen to your well-being.

Signs of pregnancy when breastfeeding without menstruation

It is easy to suspect pregnancy with an established and regular menstrual cycle. With a delay, the woman begins to listen to herself and notices other symptoms of fertilization. However, it is irregular. Therefore, it will not be possible to recognize a new state by a delay in the physiological absence of menstruation.

In the early stages, some women from the first days feel a new position. Others determine changes in their bodies closer to the second trimester. If there is active feeding and pregnancy cannot be determined by delay, it is worth looking for other obvious symptoms.

Sore nipples

As soon as the fertilized cell is implanted into the mucous layer of the uterus, hormonal changes begin. For this reason, the nipples become sensitive and even change their color. During pregnancy with hepatitis B, it is unpleasant for a woman to feed. If earlier sucking the baby did not cause any inconvenience, now every touch of the nipples causes pain.

With hepatitis B, pregnancy manifests itself in the form of growth of the mammary glands. However, the amount of milk does not increase. It is possible to suspect pregnancy during lactation only on this basis: sensitive breasts and painful sensations when sucking.

Hunger

Pregnancy during lactation, like usual, can be accompanied by toxicosis. If in some women it is manifested by nausea and morning vomiting, then in others it is a feeling of hunger. Toxicosis in the expectant mother arises from the formation of toxic substances that are formed during the development of the embryo. In the early stages, this condition does not cause concern among doctors, if it does not lead to depletion of the body.

Toxicosis during lactation in many women is accompanied by the desire to eat something unusual. In the first months of lactation, the newly-made mother should adhere to a special diet and exclude some foods from the diet so that the baby does not develop an allergic reaction or colic. If earlier such restrictions were tolerated calmly, then after conception the craving for salty or sweet becomes irresistible. It should be noted that not only pregnancy with breastfeeding is accompanied by hunger or, on the contrary, nausea. These symptoms may indicate other abnormalities in the body.

Changes in lactation and baby behavior

During breastfeeding, the amount of milk produced is in line with the needs of the baby. As the baby grows up, the amount of natural food increases. If a new pregnancy occurs, then a change in hormonal levels will inevitably occur. The prolactin level will decrease and the amount of progesterone will increase. For this reason, the amount of milk may decrease. The woman notes that the breasts are no longer poured as it was before. The baby has to suckle for a long time to start the hot flush. During pregnancy and breastfeeding, the mother may notice that the baby is anxious. The kid gets angry that he cannot get as much food as he wants, becomes whiny and often kisses on the breast.

It is believed that the taste of breast milk changes after conception. Because of this, some children refuse to eat as usual. But the taste can change due to the mother's diet. Therefore, this feature can also be considered indirect.

Other symptoms

A woman's new conception is not like the previous one. Therefore, you should not look for all the symptoms that were the last time. They can become different.

1. Change in bowel function. Due to the production of progesterone by the corpus luteum in the ovary, the muscle tissues of the body relax. This leads to poor digestion and decreased motor skills. The woman feels increased flatulence, especially in the evening, and sometimes suffers from constipation.
2. Drawing pain in the abdomen. Sucking on the breast causes the uterus to contract. In a pregnant woman, this is accompanied by pain, and in medicine it is called "hypertonicity". If discomfort occurs periodically, then you should definitely consult a doctor.
3. Vaginal discharge. During the period of active lactation, the amount of cervical mucus decreases markedly. If discharge suddenly appears (mucous, white, milky), then these may be symptoms of pregnancy.
4. Formation of a strip on the abdomen. Pregnancy during feeding, as well as in its absence, is accompanied by the appearance of pigment along the abdomen. This sign is relevant for those women whose streak has already disappeared after the last gestation.
5. High basal temperature. An increase in BT is a reliable sign of HB pregnancy. If a woman kept a schedule, then now she will be able to establish the fact of conception. The basal temperature in the early stages is kept at 37 degrees.

Can I use the test while breastfeeding?

It is believed that it is pointless to use a pregnancy test for HB. According to women, with an increased level of prolactin, which is considered the norm for lactation, the device will not show the correct result. In fact, this is not the case.

The test is designed in such a way that it reacts to a single hormone that is produced from the first days after implantation. Every day, its level rises in the blood, and then in other biological fluids, including urine. If there is a pregnancy and the amount of chorionic gonadotropin is large, then the test will show two strips. For a reliable answer, you should choose reliable devices with high sensitivity.

For women who do not use contraception during lactation, gynecologists recommend having tests every month. This approach will allow you to determine the pregnancy in time. Even if a woman is determined to give birth to weather children, it will be better if she finds out about the conception that took place before it becomes noticeable to others.

Doing a pregnancy test during lactation is not contraindicated, it will not harm. However, for a more reliable result, it is better to take a blood test for hCG.

Is pregnancy dangerous against the background of hepatitis B

Pregnancy after childbirth with breastfeeding is most often not considered a dangerous situation. Many women successfully carry and give birth to weather children. However, such a load is heavy for the body. When breastfeeding, the body spends a lot of energy on its production. Pregnancy is also a stress that requires increased work of organs and systems.

It is also believed that during gestation and simultaneous lactation, the risk of miscarriage increases. Sucking movements stimulate the nipple, and this causes an increase in uterine tone. But not all doctors support this opinion.

Gynecologists recommend planning your next pregnancy no earlier than 1-2 years after the previous one. At the same time, it is advised to wean the baby from the breast in order to minimize the likelihood of problems and allow the body to recuperate.

If pregnancy occurs after cesarean during the first year, then there is a serious threat to the woman's health. Doctors advise planning conception after such an operation no earlier than 2-4 years later. It is important to take into account the condition of the scar. If fertilization occurs earlier, then it can disperse, which will lead to massive internal bleeding and death of the fetus.

If signs of pregnancy appear while breastfeeding, then you need to see a doctor. After the examination, the specialist will allow or advise on the need for weaning. One of the options for successful and long-term breastfeeding is tandem.

Hi guys! I'm with you, Lena Zhabinskaya! There are so many young mothers around us who are raising weather children! When asked if they planned for their sons and daughters to have such a small age difference, the women joke and smile sweetly. More often than not, it just happened.

It is interesting that if for the body of mothers of artificial babies the stress in such a situation is not too great, then for mothers of babies it is palpable. Is breastfeeding allowed during pregnancy in this case? Doctors and breastfeeding specialists know the answers to these questions.

That is why, they advise taking a break between pregnancies at least at 2, or even at 3 years. And that is why they recommend stopping breastfeeding as soon as a new little life is born inside a woman. And for good reason.

Why is it recommended to stop breastfeeding in case of pregnancy.

It is also worth noting that such an early new pregnancy directly affects a woman. Which of the future women in labor did not want to sleep in the first or third trimester? With the first child, this desire was much easier to fulfill. With the second, it is often simply unrealistic. For example, when he constantly requires attention to himself and needs care and attention because he is not yet able to serve himself.

Another point that almost all women who are pregnant with their second child and continue to breastfeed note are pens. The baby is constantly asking for hands, but fear or complications makes the woman refuse him this pleasure. What's the bottom line? Whims and screams from the crumbs. Shaky mental health and nerves at the limit on the part of the mother.

Add to this the imminent problems with lactation against the background of constant fatigue and the need to quickly wean the baby from breast, and the answer to the question about the difficulties of the second pregnancy on HB will be as complete as possible.

By the way, a baby can also experience the negative manifestations of a new pregnancy. How? More on this in the next section.

What difficulties await the first child

Dear, beloved, planned and still very small ... This is your baby. Is he ready to become an elder already at that age? Psychologists say that yes, but they mention the great difficulties that will precede this. What is it about?

Early breast milk deprivation.

First of all, about the same lactation. Any woman, without hesitation, will answer that breast milk is incredibly good for a baby. It saturates it with all the necessary nutrients and ensures normal growth and development.

That is why you should feed as long as possible. Some, however, take this statement too literally and begin to wean from the breast already at the age of 2 years. Meanwhile, the fact remains: HB is useful, and under the condition of a new pregnancy, it is sometimes unrealistic due to contraindications.

Refusal to sleep together.

Another point is a joint dream. In all honesty, most women will say that after giving birth in the first months, or even later, they put the baby to bed next to them. Just because it’s more convenient. When he lies close to his side, feeding is easier to organize, since there is no need to get up and run somewhere.

Needless to say, since the moment my mother found out about her interesting situation, it is better to stop the joint rest. Why so soon? Because this process in practice is delayed and again ends with screams and whims from the side of the baby and stresses from the mother.

Changes in breast milk.

Does pregnancy affect the composition and taste of breast milk? It turns out, yes. Moreover, the visible influence is especially acute in the second trimester, when the baby can suddenly abandon the breast. And you can't explain to him that the sweetish life-giving moisture is incredibly useful.

At one point, he may just stop drinking it. Doctors say it's all about hormones. They affect both the taste and the amount of milk. True, not all children dislike changes. Some do not notice them, others continue to suckle even on empty breasts, just to communicate with their mother.

But what about pregnancy on HB

New pregnancies and breastfeeding are a popular topic of discussion in the medical community and beyond. Several myths have even developed around her, which are often successfully refuted. Judge for yourself.

Myth 1. About the deficiency of nutrients in the maternal body.

There is a myth that breastfeeding the first child at the same time as the second pregnancy is impossible due to the lack of vitamins and minerals that the fetus will experience. Doctors refute it, mentioning the amazing ability of the body to redistribute all useful substances, however, only if they are in reserve.

In other words, anemia in the mother, which is a consequence of a lack of iron, will result in fetal hypoxia and a constant loss of strength in a young woman. In the end, mother nature will, first of all, take care of the offspring, supplying them with useful substances, and only then - about the woman.

Is there a way out of this situation? Yes, and it consists in providing the mother's body with adequate nutrition. So that all vitamins and microelements arrive on time and replenish its reserves.

Myth 2. The risk of miscarriage or premature birth is higher.

During breastfeeding, powerful stimulation of the nipples occurs, which can lead to difficulties in carrying a pregnancy. And all because of the produced oxytocin, a hormone that provokes uterine contractions.

Meanwhile, we must not forget about the role of another hormone - progesterone, which is responsible for milk production and is intensively produced during lactation. It relaxes the muscles of the uterus and smoothes possible problem situations. True, it does this only until 20 weeks, due to which, until this time, the uterus does not react in any way to the presence of oxytocin in the blood.

What happens later? Doctors say that the body adjusts and produces less oxytocin, and its minimum doses are not able to somehow harm a future pregnancy. True, they still do not recommend taking risks.

Doctors do not take into account the miscarriages that occurred exactly at the moment when the first, so to speak, the eldest child was breastfeeding. According to them, up to 30% of all pregnancies, unfortunately, will face such a sad outcome.

Myth 3. The baby is harmed by medications that are prescribed to the mother during pregnancy.

This myth remains a myth simply because the number of drugs is incredibly large. Many of them, which are allowed during pregnancy, are also allowed with hepatitis B.

Doctors know about them, so they always prescribe only proven and safe ones.

Is it possible to continue hepatitis B during pregnancy and when it should be stopped

In general, doctors do not prohibit the expectant mother from feeding the baby during pregnancy, if there is no indication for that. They simply mention that a young woman needs to get tested in a timely manner in order to identify possible changes in her body associated with deficiencies and nutrients, as well as to listen to her body.

As a rule, there are no difficulties before 20 weeks. After, when training contractions appear, breastfeeding will most likely have to be stopped.

Mom will also be advised to refuse GV in other cases, namely:

• if she had a history of premature birth;
• if there was a miscarriage;
• if there was bleeding.

Meanwhile, these factors are not final. The age of the mother and the presence of chronic diseases in her also matter. Moreover, doctors look at the features of the course of pregnancy, the state of health of a woman.

How to ease the situation

In order for the new pregnancy not to become a problem, the mother needs to make a decision to continue lactation together with her doctor. If he advises you to leave everything as it is, it is important to take care of organizing a balanced diet.

The importance of sleep and rest must not be forgotten. Rather, this rule needs to be conveyed to other family members, who now have to help the young woman in everyday life.

And most importantly, you need to take care of yourself, because even a banal cold s, which will entail taking medications, will surely affect not only the baby, but also the unborn child.

The second pregnancy is happiness! Enjoy it. And save the article to your wall in social networks, and also subscribe to blog updates. I, Lena Zhabinskaya, tell you: "Bye-bye!"

More recently, breastfeeding was not very common in Russia. Only 30% of babies were breastfed for up to a year, and after a year it was considered indecent and harmful to feed. Modern WHO recommendations advise mothers to breastfeed exclusively for up to six months, and keep partial breastfeeding (breast + "civilian food") for up to 2 years and longer, if it suits the mother and baby.

When mothers were breastfeeding for only 3-4 months, the situation of pregnancy against the background of breastfeeding was extremely rare. However, now that the mother can feed the baby at both 2 and 3 years old, very often the next pregnancy occurs before the end of lactation.

The topic of breastfeeding is generally quite poorly understood. Even doctors often have no idea about the physiology of hepatitis B. And where there is a gap in knowledge, there are always many myths and fears. A lot of them are associated with pregnancy in a nursing mother.

The first myth: "While a woman is feeding, she cannot get pregnant."

Indeed, in most women, intensive breastfeeding suppresses ovulation and pregnancy is impossible. However, after six months, babies begin to eat not only the breasts, respectively, the frequency of feedings decreases, the mammary glands are stimulated less often, and the level of prolactin falls. Once prolactin drops below a certain level, ovulation and fertility return. Some women are able to conceive as early as 1-2 months after giving birth, although in most nursing mothers, ovarian functions are restored later - approximately when the "civilian" food in the baby's diet begins to prevail over breast milk.

The second and most common myth: "Breastfeeding promotes miscarriage."

Even obstetricians and gynecologists often believe in this myth, so it brings a lot of worries to nursing pregnant mothers. It is based on two facts. First, during breastfeeding, the hormone prolactin is elevated, which suppresses ovarian function in non-pregnant women. This suggests that it can also suppress the work of the corpus luteum, which secretes hormones that preserve pregnancy (primarily progesterone). Secondly, sucking at the breast stimulates the release of oxytocin, a hormone that causes uterine contractions and therefore labor, incl. and premature. To "justify" these hormones, let's look at the action of each of them in more detail.

Prolactin. In terms of the number of target organs, this hormone ranks first in the body, especially in a woman's body. Currently, about 60 different biological effects of prolactin are described. This is not only the effect on the mammary glands, providing preparation for lactation and lactation itself. Not only the effect on the sex glands, which suppresses the production of sex hormones. It is also the regulation of pain sensitivity. This is the provision of orgasm and a sense of satisfaction after sex. It stimulates the immune system during illness, ensures the normal functioning of nerve fibers, and regulates hair growth. During pregnancy, prolactin ensures normal water-salt exchange between mother and baby, regulates the amount and composition of amniotic fluid. It protects the baby from the mother's immune cells, ensures the normal development of his nervous system.

Indeed, prolactin suppresses ovarian function. But from the moment the fertilized egg is introduced into the uterus, the work of the ovaries is not "directed" by the mother's body, but by the child's body: the baby's chorionic gonadotropin (hCG) stimulates the development of the corpus luteum of pregnancy and the release of all the necessary hormones. An increased level of progesterone blocks the binding of prolactin to receptors in many organs (otherwise milk from the breast would flow from the first weeks of pregnancy). Therefore, if the work of the ovaries is suppressed, it is not prolactin (or some other mother's hormone) that is "to blame" for this, but most often the baby himself (with genetic defects and other diseases, HCG is not released enough, the ovaries do not produce enough progesterone - this leads to miscarriage ).

It should be noted that in women with hyperproactinemia not associated with lactation, various pregnancy disorders are indeed more common. However, a pathological increase in prolactin rarely occurs in isolation, it is usually associated with many other disorders: thyroid insufficiency, metabolic syndrome, obesity, etc. Often, prolactin increases in people exposed to chronic stress, with insufficient rest and sleep, alcohol abuse and treatment some drugs. In these cases, problems during pregnancy are caused not so much by the prolactin itself as by the diseases that caused its increase. Accordingly, it is necessary to treat first of all not hyperprolactinemia, but the disease that led to it.

In nursing babies, if their babies are older than 3 months, prolactin levels are not necessarily elevated. In half of the cases, it will be normal, since prolactin does not rise around the clock, but "jumps", mainly at night.

From the eighth week of pregnancy, prolactin increases in both lactating and non-lactating. By the end of pregnancy, the level of prolactin exceeds the "non-pregnant" level by 5-10 times. Therefore, there is no point in being afraid of prolactin in itself: hyperprolactinemia is dangerous only when it is a symptom of some disease.

Oxytocin... This hormone is also called the love hormone because of its extensive influence on the human nervous system. During feeding, oxytocin helps milk flow. During labor, it enhances the contractions of the uterus, helping the birth of the fetus and stopping postpartum hemorrhage. Oxytocin increases during sexual arousal (and not only during intercourse, but also when viewing erotic pictures and plots), it participates in the formation of orgasm and causes contraction of the fallopian tubes and the "absorption" of sperm into the uterus. Thus, oxytocin promotes conception. In addition, this hormone causes a feeling of affection, trust, openness in communication, calmness in the presence of a loved one.

Most often, mums worry about the effect of oxytocin on the uterus. However, look at how often oxytocin is released in the body. If you prohibit pregnant women from feeding, then logically you need to prohibit them from making love, watching movies with kisses, hugging your husband and just being with him. And also drink warm drinks, eat chocolate and listen to pleasant music, because with all these actions, oxytocin is also released, and sometimes even in large quantities.

Why does not everyone have miscarriages, since oxytocin rises so often in the body? The fact is that to expel a baby from the uterus, contractions of the uterus are not enough, you also need the cervix to be open and "release" the ovum. Oxytocin does not affect the cervix. Accordingly, if no other reasons (genetic defects, infections, or the coming date) open the cervix, oxytocin will be safe. However, it can speed up miscarriage due to other causes.

In addition, the sensitivity of the uterine muscles to oxytocin is not the same at different times. The uterus becomes truly sensitive only in the active stage of labor. Therefore, it makes no sense for a healthy woman to be afraid of the bad influence of oxytocin.

The third myth: "If a mother is breastfeeding, the baby inside will not have enough nutrients for normal development."

This myth grows from the time when mothers were fed for no longer than a year, and, therefore, a woman could be pregnant and, at the same time, lactating only if she became pregnant soon after giving birth. Pregnancy greatly depletes a woman's body, because she needs to take 3-4 kilograms of living matter from somewhere, several liters of water, not to mention hormonal changes. Usually, a woman, even if she is well nourished, needs several months to recover. Therefore, even if the mother does not breastfeed, an early second pregnancy will be difficult for her: the risk of anemia, problems with bones and joints, low birth weight, etc., will increase. If the mother is breastfeeding, then this is intensive feeding: the baby can eat more than a liter of milk per day. Milk production consumes about 800 kcal, many macro- and microelements.

Pregnancy is completely different if at least 9 months have passed from childbirth to the next conception. In this case, the body has more or less recovered, and the HS itself is not as intense as in the first months. After a year, the child eats 1-2 glasses of breast milk per day, which is not so stressful for the mother.

Therefore, it is not HB, but an early new pregnancy that can lead to nutritional deficiencies. The better the postpartum period goes, the more chances you have to carry out the next baby normally and easily.

For 7 years of work (both as a consultant on hepatitis B and as an obstetrician-gynecologist), I have repeatedly observed pregnancy in nursing mothers (including my own). Of the approximately two dozen pregnancies, there was not a single case of premature birth and fetal growth retardation. The number of other problems did not differ from the average (or rather, it was even less than the average, since these mothers usually monitor their health especially carefully, try to eat well and lead a healthy lifestyle). The weight of babies was usually even slightly more than that of their older brothers and sisters (which, in general, is normal, even for non-nursing re-pregnant women).

Despite the fact that breastfeeding does not harm pregnancy, pregnancy against the background of HB has its own characteristics.

Sore nipples.

This is the main "problem" of a pregnant breastfeeding woman.

Many mothers report nipple tenderness or even soreness when feeding. This can cause discomfort and even lead to refusal to breastfeed. Indeed, the nervous system of a pregnant woman undergoes significant restructuring: both the excitability of the nerve receptors and the emotional perception of their own sensations change. It is especially difficult to endure discomfort in the chest when they are combined with toxicosis or other uncomfortable conditions of pregnancy.

It is worth noting that many babies (especially if they are over 1.5-2 years old) refuse to breast themselves if their mother is pregnant. This is due to the fact that the child feels the state of the mother and is trying with all his might to adapt to it. If the mother is subconsciously afraid of every feeding, the baby can go to meet her and separate himself from the breast.

No one has the right to blame a mother if she stopped breastfeeding due to sore nipples. However, if Mom wants to continue with GW, it is very important to support her in this.

First, it is important for mom to remember that the period of hypersensitivity is over. Usually it is limited to the first trimester, although here everything can be very individual for different women.

Secondly, special attention should be paid to the correct attachment of the baby. Normally, when feeding, the baby does not touch the nipple, since it captures the areola far enough from it. But adult babies are often distracted, turn their heads while sucking and "slide" to the nipple. It is important to forbid them to do this: to pick up the breast and give it correctly. It would also be a good idea to feed in a quiet, familiar environment so that there are fewer distractions.

It is very important to pay attention to nipple hygiene and crack prevention. It can be useful to arrange air baths on the breasts, wear soft natural underwear. Some women lubricate their nipples with emollient oils: cedar, olive (but not sea buckthorn - it can increase sensitivity).

Itching of the nipples.

Some women experience peeling and itching of the nipple during pregnancy. This is due to a more intensive renewal of the epithelium and a change in the work of the areola glands. To alleviate the condition, you can use all the same emollient oils. But it is better not to use special ointments for itching, since most of them contain steroid hormones, which are not very useful for both babies.

Nutrition of a nursing pregnant woman.

A nursing pregnant woman should eat well, but not "for three" in terms of quantity. You should avoid unhealthy foods, eat both fruits, vegetables, cereals, and animal products. Vitamins and supplements are recommended to be used only under strict indications: if there are signs of a lack of one or another element in the body. It is advisable to eat more often, but in small portions: this way the nutrients are better absorbed.

The amount eaten does not increase much. Usually, it is better for a woman to focus on the feeling of hunger, and not "gorge" forcefully extra pounds.

And if you need to take medicine?

Most drugs that can be prescribed to a pregnant woman are compatible with breastfeeding. However, here it is better to once again warn the doctor who prescribed the drug that you are feeding. In addition, it is worth discussing how HB affects the course of a particular disease. If the doctor has doubts or cannot answer your questions, you can also consult with a breastfeeding consultant (in this case, it is better to contact a consultant with a medical degree - their coordinates can be found on the AKEV website). However, remember that the hepatitis B counselor does not have enough information about you, so you should not ask him to diagnose you and prescribe treatment - he will only assess the compatibility of the medications, and you decide the need to take them only with the doctor who sees you.

To excommunicate or not?

The decision to wean or tandem feed should be made exclusively by the mother. Quite a lot has been written about tandem feeding, I want to note only one nuance. After giving birth, milk changes its composition and adapts to the needs of the youngest child. The first 3 days, colostrum is excreted from the breast. The more intense the suckling, the faster the colostrum will be replaced by transitional milk. It is very important for a newborn to get as much colostrum as possible, so during these three days it is advisable not to breastfeed the elder or give it as little as possible.

Different specialists (gynecologists, pediatricians, psychologists) disagree about the optimal interval between pregnancies. Numbers from 9 months to 4 years are usually cited. But in any case, the last word remains with the mother. The main thing is to remember that breastfeeding cannot become a reason for terminating a pregnancy, and pregnancy is not an absolute indication for terminating hepatitis B. Feeding during pregnancy has its own characteristics (sometimes difficulties). But in itself, it does not harm pregnancy. And - most importantly - all problems can be solved, if only there is a desire to solve them.

obstetrician-gynecologist, HB consultant

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