If you have been having regular menstrual cycles, a missed period may be the first sign that you may be pregnant as will other signs such as fatigue, breast tenderness, morning sickness, etc. But what if your cycles have not returned? One of the first signs for many breastfeeding mothers that they may be pregnant is sudden onset of sore nipples. However, this can also be caused by the hormonal changes that take place with ovulation and menstruation. And teething in the baby, thrush, food particles left in the baby's mouth, etc. can also result in sudden nipple tenderness. Thus, the only sure way to know whether or not you are pregnant while breastfeeding it to have a pregnancy test and be examined by your doctor.

If you are well-nourished you should have no difficulty providing for both your nursing child and your unborn baby, especially if your older child is more than one year old. It will be important for you to gain weight within the normal parameters and eat nutritious foods as well as get adequate rest, just as you would with any other pregnancy. It may be that you will need to consume extra calories if you decide to continue breastfeeding during your pregnancy and taking extra vitamin supplements may also be a good idea.

Although uterine contractions are sometimes experienced with breastfeeding, they are a normal part of every pregnancy and no different than those experienced by many mothers during sexual relations that take place during a pregnancy.

There is no reason to fear that the colostrum that your newborn will need will be "use up" by your older child. No matter how much your child nurses, there will still be plenty of colostrum for your new baby.

The hormones that help maintain your pregnancy do appear in your milk but in very small quantities, far less than the amount your unborn child is exposed to. These same hormones also will cause a decrease in your milk supply about the second half of your pregnancy, or the last four months. If your nursling is less than one year old, you will want to keep track of his weight gain to ensure that he is receiving enough milk for adequate growth.

Your breastfeeding child may wean on his own during the course of your pregnancy due to the drop in supply and change in the taste of your milk as it transitions to colostrum during the last few months. Some toddlers continue to nurse despite these changes in milk quantity and flavor. If your child is still nursing as the birth of your next child approaches, you may consider tandem nursing (nursing your older child along with your newborn).

As has already been mentioned, you may experience nipples soreness once you become pregnant. For many mothers, this passes as the end of the first trimester approaches. For others it continues throughout the pregnancy. Implementing the following measures may help you manage this discomfort with more ease:

• Use the breathing techniques you learned in your childbirth classes.

• Try different nursing positions.

• Ask your older child - if he is old enough to understand - to nurse for shorter periods of time or more gently.

• Pump or hand express until letdown occurs so that your child does not nurse so aggressively.

Feelings of restlessness, antsiness, or irritation at the nursling are also common during feeding times. Trying to distract yourself with a book , the television, a chat on the telephone, etc. may make this more bearable.

As your abdomen grows, you may find it increasingly hard to find a comfortable position in which to nurse your child. The side-lying position may be the most comfortable, and if challenged, your older child will find a way to reach your breast as long as you allow him freedom to explore and try different positions!

Fatigue will be a normal part of your pregnancy whether you are breastfeeding or not.. One advantage of continued breastfeeding is that it may be easier to persuade your older child to lie down with you to nurse when you feel you need some added rest.

While weaning is not necessary in most circumstances, there are a few situations where it may be the wiser choice. These include:

• the presence of uterine pain or bleeding

• a history of premature delivery

• continued weight loss by mother during pregnancy

It is not possible to predict if a child will wean during a pregnancy. Children mature at different rates, and while one child may be ready to wean, another may not. You may wonder if your older child's nursing has become just a habit that needs to be broken, especially now that you are pregnant. Know that it is rare for a child under one year of age to be ready to wean and extended nursing past one year is still beneficial to the child. If your child is older, try substituting a favorite activity for nursing or change your daily routine and note his reaction. If he still wants to nurse despite the distractions and substitutions, it is very likely that breastfeeding still meets a real need in his life. In this case, weaning that is positive may take lots of time, patience, and energy on your part. Taking one day at a time may be the best course for both of you at least for a while.

Last revision: March 8, 1999

Mothering Your Nursing Toddler" by Norma Bumgarner

"The Nursing Mother's Guide to Weaning" by Kathleen Huggins and Linda Ziedrich

"Nursing Two: Is It For You?" - a pamphlet by G. Burke, available through La Leche League