How to Recognize the Signs of Pregnancy While Breastfeeding
Breastfeeding and Pregnant?
There is a prevailing, old-fashioned belief that one can't get pregnant while breastfeeding.
Although breastfeeding may reduce a woman’s fertility, it does not prevent pregnancy.
Although new mothers usually do not ovulate before three weeks after giving birth, and a mother may not menstruate for months after giving birth, there's no way to ensure or predict exactly when her body will release its first postpartum egg, and she won't know until roughly two weeks after ovulation.
However, if she is breastfeeding her baby exclusively (no formula), day and night, she may not menstruate again for a year or even longer after delivery. In other words, the more often her baby nurses, the longer it may be before she gets her period again. ("May not" does not mean "will not," and she may get her period tomorrow, as well. The only controllable method of pregnancy prevention is contraception.)
Still, breastfeeding has been used by many mothers as a natural and effective contraceptive method. Termed the "Lactational Amenorrhea Method" (LAM), it is effective only under certain conditions. These are:
- The infant is exclusively breastfed.
- The infant is not more than 6 months old.
- The infant breastfeeds more than 6 times a day.
- Each breastfeeding session lasts at least 15 minutes.
- The mother is still amenorrheic (no menstrual flow since giving birth).
If her baby sleeps through the night at an early age, her period will probably return more quickly. The same is true if she's supplementing with formula. If some break or variation in the feeding schedule triggers ovulation, there's no way to know or predict if her body will release its first postpartum egg, and she won't find out until roughly two weeks later.
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How Does Breastfeeding Effect Pregnancy?
The stimulation of nipples that occurs during breastfeeding stimulates the hormone prolactin, which has a negative effect on the reproductive hormones. The higher the prolactin levels in the body, the less fertile one is. Prolactin restricts ovulation and prevents menstrual flow. Its levels are highest during the mother's sleep and shortly after her waking. More nighttime feedings further increase prolactin levels. Some mothers successfully stay infertile for up to 16 months by increasing their prolactin levels. Even if the above conditions have been met, it is still not a 100% effective contraceptive method.
Most women may become pregnant once their menstrual flow resumes. However, it is also possible to ovulate without any menstrual flow. The longer one remains amenorrheic, the more likely it is to ovulate without any menstrual flow. In both cases, one can get pregnant.
It is often held that breastfeeding makes pregnancy unlikely because oxytocin makes the woman's reproductive tract unsuitable for a growing embryo. Oxytocin is also one of the hormones that stimulate lactation. The uterus is thought to be contracted and unable to allow implantation and growth of an embryo. Contrary to this belief, the uterus is only sensitive to the effects of oxytocin in the 24th week of pregnancy.
Typical Baseline Prolactin Levels in Women
Not pregnant or lactating
Pregnant (at term)
7 days postpartum (lactating)
3 months postpartum (lactating)
180 days postpartum (no menstruation, lactating)
180 days postpartum (menstruation started and still lactating)
6 months postpartum (lactating)
Common Pregnancy Signs While Breastfeeding
Signs of pregnancy while breastfeeding are generally the same as those that are seen in regular pregnancy. These are classified based on how well they can predict whether a woman is pregnant or not.
Presumptive Signs (weak indicator of pregnancy)
Presumptive signs of pregnancy are least indicative. They are mostly subjective (only the mom can feel the sign and nobody else can see it), and other things may cause them.
Changes in the breasts are among the earliest signs of pregnancy. A woman may notice these when she is six weeks pregnant. These changes are side effects of the pregnancy hormones estrogen and progesterone. These will affect the breasts and prepare them for breastfeeding after birth – even if she is currently nursing already.
Medications and Tenderness
Medication may cause breast tenderness, so read the drug information leaflet to know if it is one of its potential side effects. Some medicines that cause breasts to feel tender are contraceptives, antidepressants and antipsychotics.
Pregnancy and other conditions that involve hormonal changes may cause the breasts to develop lumps. These lumps may be filled with milk (galactoceles), fluid (cysts), or fibrous tissue (fibroadenoma).
- Galactoceles - Galactoceles are small sacs containing milk within the breast. They are large, soft lumps often found at the lower part of the breasts. These are created when the outlets of the milk ducts get blocked. Breastfeeding mothers and those who have recently weaned their babies may develop them. They usually resolve without the need for any treatment. Galactoceles may or may not be a sign of pregnancy.
- Cysts - Cysts are fluid-filled lumps caused by changes in hormonal levels. They often have no other accompanying symptoms and only a few of them are painful. Women who are menopausal or nearing menopause are more prone to developing cysts than younger women. Menopauseal women receiving HRT (Hormone Replacement Treatment) may develop these. Again, cysts are not sure signs of pregnancy, but they may indicate it.
- Fibroadenomas - Fibroadenomas are solid round lumps that may be moved around the breast. They can disappear on their own after menstruation, but sometimes, they increase in size during pregnancy. If you notice movable lumps that seem to be growing, you may be pregnant.
- Lipomas - Lipomas are not caused by pregnancy or hormonal changes, but by excess fats. They can form on any part of the body containing fat, such as the breasts. It is a condition, which affects 1 in 100 people but a person usually gets only 1 to 2 lipomas on the body. Unlike a cyst or fibroadenoma, a lipoma feels squishy when pressed. Also, a lipoma is deep while a cyst is shallow and near the surface of the skin.
- Breast Cancer - Most lumps such as cysts, fibroadenomas and lipomas are benign, but some may also be cancerous. It is not common during pregnancy, but if you notice lumps on your breasts, have them checked by the doctor just to be safe – especially if the lumps are painful and bigger than 2 inches, and if you have a family history of cancer.
A lump may be cancerous if it has these features:
- If it can't be moved around
- If it's hard
- If it does not go away after the menstrual period
- If it develops after menopause
- The baby's mouth does not attach to the breast properly while breastfeeding.
- The infant has problems sucking the breast.
- The mother does not breastfeed frequently.
- The child misses feedings – especially at night when the mother is asleep.
- The milk is not released regularly, causing the build-up in the ducts.
- The baby tends to get milk from one breast only.
- The breasts are squeezed by tight clothing and/or bras, seat belts, or sleeping on the chest.
- The breasts got struck and acquired damage to the milk glands and ducts.
When this happens, some milk proteins may pile up and prevent the rest of the milk from flowing properly. The stagnant milk may serve as a breeding ground for bacteria. Even if there is no bacterial infection, the immune system may mistake the proteins as foreign bodies and attack them - leading to inflammation.
Breast infections (mastitis) are not signs of pregnancy. These may cause the breasts to feel tender, so to rule out pregnancy, consider whether you have cracked ones, whether there is a painful area on your breast that is hot and red, and whether you have breastfeeding problems. If you have a fever, it is a sign that you have an infection.
An infection is treated by cleaning wounds and by taking antibiotics for about a week. Tell the doctor that you are breastfeeding so he/she can give you medicine that is safe for your baby. After eliminating the bacteria, your breast tenderness may go away as well.
Clogged milk ducts are treated by the following measures:
- If possible, feed the baby with only breastmilk and not formula for at least 6 months.
- Breastfeed when the baby asks for milk, even during odd hours of the night. During the first months, this can be every 2 to 3 hours.
- Encourage the baby to drink milk when your breasts are sore.
- Do not interrupt the baby's feeding – try not to remove the breast; wait for him to release it, instead.
- If you intend to cut down on feedings, do so gradually to allow the milk glands to adjust.
- Ensure that the baby is adequately attached to the breast. When he/she opens his/her mouth wide, the mother should bring the baby to her breast. The baby will tilt his/her head back and take a mouthful of the breast, resting towards the roof of his/her mouth.
- Try different feeding positions.
- Massage the painful breast to remove blockages.
- Warm the breast with a warm compress or bathe in warm water. Doing so can help soften the milk and dissolve clogs.
- Express the leftover milk after feedings.
In summary, breast changes may be caused by pregnancy and by several other things, so avoid thinking of them as sure signs of pregnancy.
When a breastfeeding mother is pregnant, she may notice changes in her breast milk:
Milk production decreases. As pregnancy hormones increase, milk production starts to decrease. If you notice that your milk is not as abundant as before, you may have gotten pregnant.
Again, pregnancy is not the only cause of a decreased milk supply. Stress and illness can cause your body to go into survival mode and divert energy used for milk production into crucial bodily activities.
Substances, such as liquor, caffeine and nicotine can dehydrate you and weaken your breasts' ability to release milk. Let go of these vices while you are still feeding your child so your breasts can produce milk, which is safe to drink and in adequate amounts.
Certain kinds of medication can do this as well. If a medication is prescribed to you, let your doctor know that you are breastfeeding so he or she can give you medicine that won't interfere with it.
When taken in large doses, some herbs such as peppermint and parsley can actually decrease your milk output. When breastfeeding, avoid consuming too much herbs and spices. Dehydration and malnutrition will also lower your milk supply so eat and drink properly when nursing.
If you had problems conceiving, you may also have problems with breastfeeding. For the breasts to make milk, they rely on hormonal signals that are sent to them. If you have hormonal imbalances, hyperthyroidism or hypothyroidism, hypertension, diabetes, polycystic ovary syndrome, or another ailment, it's likely that you won't have much milk. You may have to use milk formula or get breast milk from another mom – talk with your pediatrician to know what to do.
Milk quality changes. The breast milk begins to change in quality, usually by the 3rd week of pregnancy. The milk tastes more sour or salty. The breastfeeding child may fuss about the different taste. Breast milk becomes more watery in consistency and less white in color. By the 2nd trimester, the breast milk reverts to colostrum. The mother may observe a decreased desire to feed, or the child may seem unsatisfied with breastfeeding and may need more supplemental feedings. Weaning may naturally occur at this point as the child becomes less filled and satisfied with breastfeeding.
Again, changes of milk quality may not be caused by pregnancy. Illnesses, medications, and some foods can make it taste unusual. You may have eaten food that the baby is allergic to so he/she will refuse to drink the milk. Watch out for dairy products, shellfish, wheat, corn, soy and peanuts because these sometimes cause allergies. If you have eaten something spicy, your breastmilk will become spicy as well.
Eating citrus fruits can make your milk become irritating to the baby's immature digestive tract. If you notice that your baby is refusing to drink milk, recall what you have just eaten. Try to avoid it next time and see whether the baby will start drinking again.
Nausea and Vomiting
Morning sickness is most notable during the first trimester of pregnancy and goes away by the second trimester. Certain food tastes and aromas can trigger nausea and vomiting. Many women report intolerance to fish. If you didn't have your period yet and you start to feel uncomfortable during the mornings, you may have conceived. Smelling citrusy scents can help alleviate the nausea. Make sure to get enough nutrients even with the discomfort of nausea and vomiting. Eat less carbohydrate-rich food and more proteins at this stage.
When you vomit and feel nauseated, avoid thinking that you are pregnant right away. Maybe you have just become sick. Food poisoning, viral infections and other illnesses can cause this, so it's best to visit your doctor first to know whether you're experiencing morning sickness or something else.
Breastfeeding already taxes the body's energy, and adding pregnancy will further decrease the mother's reserves. Pregnant breastfeeding mothers may notice the need for more daytime naps than usual, and there is also an overall decrease in energy throughout the day. Aside from the demands of breastfeeding and pregnancy, other things can cause the body's energy reserves to be depleted. Examples of these drains are stress, illness, problems and major life changes. Whether you are fatigued because of pregnancy or another health condition, you can cope better by taking more frequent naps to recharge and trying to maintain a nutritious, well-balanced diet. Consuming fruits and vegetables can help increase energy levels.
A missed period can be caused by pregnancy or other conditions such as anovulation (no egg is released), low body weight, stress, chronic disease, and endocrine abnormalities. If you have amenorrhea, consult your gynecologist.
This is spotting or slight bleeding caused by the implantation of the embryo into the uterine wall. It usually appears between the 6th and 12th weeks of pregnancy. This is one of the common signs of pregnancy while breastfeeding. However, take note that spotting may occur without implantation. Menstrual cycles also tend to be unusual during breastfeeding. If the bleeding is accompanied by pain, go to the hospital as soon as you can.
When a fetus grows, it presses against the bladder and causes it to shrink. Because her bladder fills up more quickly, she will urinate more frequently than usual. Frequent urination may be caused by pregnancy, but also other conditions like diabetes, kidney and/or urinary tract infections, bladder dysfunctions, uterine enlargement not related to pregnancy, and more. It can also be a result of simply drinking more fluids or taking diuretics (medications or substances that increase urine output).
After giving birth, the uterus will gradually return to its normal, pre-pregnancy size. For the first few days after birth, the top of your uterus can be felt at or slightly below your belly button. After two weeks, it will be entirely in the pelvic area. Breastfeeding helps speed up this process too. This means that if you can feel the uterus above the pubic bone, it means that it may have increased its size again, unless it has not completely shrunk before. If you're pregnant, the examiner will feel the uterus within your abdomen at 12-14 weeks, rising to the belly button at 20 weeks.
Pregnancy is not the only cause of the enlargement of the uterus. Conditions such as adenomyosis (thickening of the walls of the uterus) and fibroids (benign tumors of the uterus' wall) can also cause this. Other symptoms of adenomyosis are bleeding between periods, heavy and painful periods, constipation, pressure in the lower abdomen, frequent urination, and painful sexual intercourse. Adenomyosis causes similar symptoms but the pain during periods tends to worsen over time. Imaging tests and physical exams can determine what causes the uterus to become bigger than normal
Quickening is the fetus' movement felt by the mother. Usually, a pregnant mom may be able to feel her baby move at around 16 weeks. If you feel something moving inside your belly earlier than that, it may be caused by other things such as gas or movements of the intestines. Pseudocyesis or false pregnancy may also cause a sensation of having a baby even if there is none. On the other hand, genuine fetal movements may be hard to detect if you are extremely obese. This is why detecting the actual baby is the only reliable indicator of pregnancy.
Pregnancy can cause certain signs on the skin – but remember: other things can cause them as well.
- Linea nigra: This is a dark line on the abdomen, which appears around the 23rd week of pregnancy. It starts from above the pubic hair and runs straight upwards to the belly button. Sometimes, a linea alba or light line appears and turns into a linea nigra later on. This is believed to be caused by the effect of hormones to the skin, causing it to create a dark pigment called melanin. Dark-skinned women are more prone to having this sign. This usually disappears after birth, so if it reappears, it could indicate that you are pregnant again.
- Melasma: Melasma, or also known as chloasma (mask of pregnancy), is a condition of having dark patches of skin on the face. Like linea nigra, this is an effect of the hormones on the skin's pigmentation. Melasma can also occur on other parts of the body such as the areola. Although pregnancy hormones cause melasma, other things may also cause the skin to develop dark blotches: genetic factors, chronic sun exposure, medication use (ex. phenytoin and other drugs causing skin sensitivity to ultraviolet light), Addison's disease and certain types of skin conditions.
- Striae Gravidarum: More commonly known as stretch marks, striae gravidarum are thin lines on the skin resulting from a growing belly during pregnancy (striae means grooves and gravidarum means pregnancy). Skin develops stretch marks when it grows faster than it can adjust itself. These marks often appear on the baby bump during the third trimester, but they may grow on areas that accumulate fat, such as breasts, hips, thigh, buttocks and lower back. Weight gain or increasing body size not associated with pregnancy can cause these marks.
So far, all these are not absolute signs of pregnancy. The next ones are stronger signs of pregnancy. Still, you can't consider them the strongest.
Probable Signs (moderate chance of being pregnant)
Probable signs of pregnancy can be observed by someone else other than the mother. These are more reliable than presumptive signs but they are not completely accurate in revealing pregnancy.
Fetal Outline - A ring that may be the gestational sac can be seen within the mother's lower abdomen via ultrasound. This outline may turn out to be something else, so it is best to see the actual fetus before confirming pregnancy.
Braxton Hicks Contractions - Painless contractions (tightening) of the uterus are called Braxton Hicks contractions and they occur during the second trimester. Myomas can also cause these, so unless the fetus is detected, contractions should not be considered as a pregnancy sign.
Chadwick's Sign - When the cervix, vagina, and vulva turn from pink into purple, the woman may be pregnant. This typically appears from 6 – 8 weeks into the pregnancy, when the areas develop more blood vessels to meet the additional needs of mother and child. Related to this is swelling of the legs and pelvic pain that result from the changes in the blood and lymph circulation. Hormonal imbalances may cause this sign so this should not be your main indicator.
Goodell's Sign - The cervix becomes softer than usual at 6 – 8 weeks. A hormonal imbalance may cause this kind of sign.
Hegar's Sign - The lower segment of the uterus becomes softer. Again, this may be related to hormonal imbalances, not pregnancy.
Ballottement - When the lower uterine segment is tapped by an examiner, the fetus can be felt rising against the abdominal wall. Ballottement is not a 100% certain sign of pregnancy because cervical or uterine polyps (clump of benign cells) can also bounce when tapped.
Signs and symptoms of polyps are heavy periods, bleeding in between periods, and irregular menstrual bleeding. These are diagnosed through transvaginal ultrasound, endometrial biopsy (taking a sample of the area affected via a catheter and examining it in a lab), and/or hysteroscopy (insertion of telescope into the vagina and cervix). Benign polyps may not need intervention, but they can also turn cancerous. They are removed via medication or surgery if they have turned into cancer.
Laboratory Tests - Although pregnancy tests are accurate for up to 98% of the time, the results are only considered probable rather than positive because there is still a chance of misdiagnosis.
There are many kinds of tests that probably indicate pregnancy. Urine tests are the easiest to use and there are kits that you can use at home, but they are not as sensitive as blood tests.
Because pregnancy tests are not that sensitive or accurate, women who get negative results on a pregnancy test are advised to retake the test 1 week after if they don't still have their period. Those who are taking oral contraceptives or psychotropic drugs may get positive results even if they are not pregnant, so it is advisable to discontinue these medications five days before undergoing the test. Those who have proteinuria, hyperthyroidism, or are postmenopausal may also have false positive results so they should seek other ways to determine pregnancy.
Take note: pregnancy tests are only accurate within a certain period of time. These tests detect hCG, a hormone produced by the placenta when it becomes implanted into the uterine wall. Traces of hCG begin to appear in the blood 24 – 48 hours after implantation and reach a measurable level 7 days after conception. They peak between day 60 – 80 of pregnancy, but after that, the hCG level declines, so it will no longer be detectable in the blood or urine. Thus, pregnancy tests may no longer be reliable after 3 months.
An overgrowth of bodily tissues that are supposed to become the placenta (hydatidiform mole) causes a positive result on the hCG test even if there is no fetus. This is diagnosed by inspecting the fetus and determining whether it is growing abnormally. There may also be vaginal bleeding, especially during the first three months. It can also accompany preeclampsia symptoms like high blood pressure, and swelling of the legs and feet.
An ultrasound may be given to determine whether the fetus has developed or not. If not, or if it is just partially developed, the positive result of the pregnancy test may just be the result of the hydatidiform mole. Blood tests may also be performed to know what's causing the condition.
Positive Signs (confirmed pregnancy)
Positive signs are those that guarantee that the woman is pregnant. If you have these signs, there is a hundred percent guarantee that you're pregnant. So far, only three positive signs are recognized by medical professionals:
Heartbeat of the fetus that is separate from the mother's - Hearing the fetus heartbeat or seeing it in motion is a sure sign that the mother is carrying a child. The fetus' heart starts to beat at the 24th day after conceiving, but it can only be detected by a common stethoscope when it is 18 weeks old already. A Doppler technique can detect heart sounds in as early as 10 weeks, while an echocardiograph can pick up a heartbeat at 5 weeks.
Movement of the fetus that is felt by an examiner - A woman can sense her baby move insider her womb when she is about 16 – 20 weeks pregnant, but an examiner can only feel these at about 20 – 24 weeks. Fetal felt by an examiner are considered as more reliable than those that are subjective and can only be perceived by the mom.
Seeing the fetus through ultrasound - An ultrasound will reveal the fetus by the 8th week of pregnancy. Using a real-time technique, the movement of the heart can be seen by the 6th week.
Is It Safe to Get Pregnant While Breastfeeding?
Many mothers are concerned about the safety of pregnancy while breastfeeding, but there is no real reason to worry.
For most women, breastfeeding while pregnant is a fine choice and will not harm either baby-- the one in your arms or the one growing inside. Many mothers not only continue nursing during pregnancy but continue "tandem nursing" after the new baby is born –breastfeeding both children at once.
As part of the let-down reflex related to milk production, the uterus contracts in response to the oxytocin released, so breastfeeding while pregnant may put high-risk mothers in danger of miscarriages. If the woman has a history of preterm labor, bleeding, or uterine pain, it might be wise to stop breastfeeding as a precautionary measure.
If the mother is not high-risk, then breastfeeding is generally safe during pregnancy. Of course, should a woman decide to breastfeed while pregnant, she will want to make some adjustments. Nutrition will be extremely important. Three people–the growing fetus, the breastfeeding child, and the mother–will need adequate nutrition, and dietary adjustments should be made to address the needs of all three. The diet should have more fruits and vegetables and an adequate balance of carbohydrates and proteins. Nutritional supplements like prenatal vitamins should be taken regularly.
New Baby, Unborn Baby, and Mother: How to Take Care of All Three
Nutrition. In addition to a balance diet and prenatal vitamins, the mother should add 500 to 800 calories to her normal recommended dietary allowance. Approximately 300 of those calories goes to the fetus as it grows in the uterus and from 200 to 500 calories will help her maintain adequate milk production. Increase calcium as it is needed by both the fetus and the breastfeeding child for growth and development and to avoid potential deficiencies in the mother. The fetus and nursing child extract a lot of calcium from the mother's body, which could predispose her to more cramps and even hypocalcemia.
Hydration. Drink lots of water. Keep the body hydrated throughout the day to help combat fatigue and ensure proper body processes and overall health of the fetus, child, and mother.
Rest. Fatigue may be worse than in ordinary pregnancy or in simple breastfeeding. Much energy is required to maintain the pregnancy and to provide adequate breast milk production. Get enough rest and eat more nutritionally dense foods.
Care of nipples. Due to increased nipple sensitivity occurs in response to the pregnancy hormones, estrogen and progesterone, the woman's nipples may become sore. If she's still breastfeeding, she'll need to take extra care of the nipples to reduce nipple soreness. Dryness can cause nipples to become more painful and may even lead to cracking or lead to bacterial infections. Apply nipple shields when breastfeeding, use lanolin cream. As the pregnancy progresses, the nipple soreness and breast tenderness may eventually abate.
Weaning. If the discomforts are too much to handle, it may be time to wean the child. Formula may be used to supplement breast milk and if the child is ready for solid foods, increase these with each feeding. Emotional attachment may become an issue. Deal with fussing, tantrums, or any negative reactions to weaning in a loving manner. Always assure the child of parental love. Engage in other bonding activities to let the child feel less neglected and more loved.
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