Breastfeeding and being sick

thermometerAt 3.00 am, C started coughing. The cough turned into a whine, and as my heart sank, a full-blown wail. As I got out of bed to comfort her, I felt a bit odd, but put it down to the early hour and my chronic tiredness.

I sat down to feed C, who was still grumbling, hoping that I’d feel better shortly. I didn’t. After what seemed like an age, C finally had enough milk to send her back into a doze and I put her back into her cot. I then bolted to the bathroom. I only just got there in time.

After I had vomited every last bit of the lovely meal my husband had cooked the night before, I collapsed on to the floor filled with worry. It was one thing for me to be sick, but what if C was too? What if we all were? My thoughts then turned to breastfeeding. To avoid C catching a virus (if that’s what it was) surely the best thing to do would be to steer clear of her? But this would also mean not passing on valuable antibodies, not to mention ruining my milk supply and risking engorgement or mastitis. It was also highly likely that C had already been exposed to any infectious illness before I started exhibiting symptoms, so continuing to nurse as I usually did was really the only sensible option.

I carried on breastfeeding C as normal, washing my hands first and trying to minimize the germs she encountered. Or at least I tried to feed her as normal. After half a day of this, I realised that germs were only a small part of the problem. My energy levels were at rock bottom, I couldn’t keep anything down and I was massively dehydrated. Engorgement was the least of my worries! My let-down reflex took an age to kick in and C ended up bawling in frustration. I’m still trying to work out why exactly my ability to breastfeed was so depleted, but I can only assume it was related to my poor ability to keep food or drink down, and the resulting plunge in fluid levels and blood sugar. Assuming I had norovirus – the winter vomiting bug – this acute phase of sickness shouldn’t last more than 24 hours. I sincerely hoped this would be the case.

Thankfully, 6 hours later, I was sick for the last time. Although it took me several days to recover completely, my milk supply soon picked up and C remained impressively illness-free.  Whether she had developed sufficient immunity through exposure to antibodies in my milk, or simply didn’t come into contact with the virus I don’t know, but she didn’t show a hint of being sick. Unfortunately, the same couldn’t be said for my husband, who started racing to the bathroom the minute I stopped…

Can breastfeeding affect your sex life?

unmade-bedIn the initial period after giving birth, sex tends not to be a top priority. Slowly, as you start to feel less ‘delicate’, and days become distinguishable from nights again, it creeps back up the agenda, and by 6-12 weeks, most women have recommenced intimate relations. The speed with which you get back to sex may be influenced by the way in which you feed your baby, however: there is evidence that if women formula feed, they may be up for it significantly sooner than if they breastfeed1.

Determining how exactly breastfeeding affects a mother’s sex life is a complicated business. The body of scientific literature looking at this issue spans several decades, and whilst it contains some interesting observations, it is also littered with apparently contradictory results. In their 1966 work, ‘Human Sexual Response,’ William Masters and Virginia Johnson reported that all 24 of the breastfeeding women they studied experienced ‘enhanced sexuality’ compared to non-nursing mothers. This result does appear to be something of an anomaly, however; whilst it is certainly not the case that all breastfeeding women experience a pronounced drop in libido, there is a tendency for them to be less interested in sex, and less likely to engage in it than formula feeders.

Of five studies comparing the sexual experiences of breast feeding and formula feeding women, one reported that feeding method did not appear to make any difference2. The remaining four found that breastfeeding mothers were less interested in having sex3,4, less likely to be having it1,3, and more likely to find it painful when they did5.

A study that monitored women during the weaning process also suggests nursing may suppress sexual activity6. Mothers who had been breastfeeding for at least 6 months completed a daily questionnaire about their health and how they were feeling until a month after they had weaned their babies. The responses they gave in the 4 weeks before weaning were then compared with their responses in the 4 weeks after.

Within 3-4 weeks of stopping breastfeeding, the mothers in the study reported a significant increase in sexual activity. They also reported an improvement in mood and a decline in fatigue, and the authors suggest that this may in part explain the women’s increased appetite for sex. Other research has reported that the lower sex drive of breastfeeding women exists irrespective of tiredness or depression, however, so it is likely that there are other factors underlying the issue4.

One potential culprit is the differing hormone levels that occur in women who are nursing. High prolactin and low oestrogen levels are thought to reduce vaginal lubrication, and as these hormone levels are frequently found in breastfeeding mothers, the theory goes that this may in turn reduce their sexual activity1. Although this is a reasonable hypothesis, a direct link between prolactin/oestrogen levels and lower sexual desire in breastfeeding women has yet to be demonstrated: in a study monitoring levels of these hormones directly, no correlation was found between the two7. The study did find a relationship between very low levels of the sex hormones testosterone and androstenedione and ‘a severe reduction in sexual interest’, which affected five women in the breastfeeding group in the study, and none in the formula feeding group. It is important to point out, however, that the formula group was much smaller (14 breastfeeders were compared with only 6 formula feeders), so while the results indicate that breastfeeding may result in lower levels of these hormones, they don’t provide conclusive proof.

An alternative explanation is that breastfeeding women may be less interested in sex as they have an ‘intimate touching need’ satisfied by nursing, and are therefore less likely to seek its fulfilment through sex1. Again, however, this is speculation: it’s possible it may have an impact in some relationships, but it has not been evaluated scientifically.

So far, the research looking at the relationship between breastfeeding and sex hasn’t provided any clear answers. There is evidence that breastfeeding women are more likely to report a lack of interest in sex, or find it less comfortable, but this is not something that affects nursing mothers across the board – many report enjoying sex, and some have even said that their sexual relationship during this period is better than before they gave birth8! Whether this because of, or in spite of breastfeeding is impossible to know, but it indicates that nursing your baby will not necessarily condemn you to a poor sex life. Having said that, the libido of some mothers does appear to be seriously diminished during breastfeeding. The reason for this isn’t clear, but it could be because these women are experiencing particularly low levels of certain sex hormones.

If you do find sex particularly unappealing while you’re breastfeeding, the good news is that it doesn’t appear to last forever. A large study found that although breastfeeding women reported less interest in sex than formula feeders to start with, this difference had disappeared by 12 months4, so however long you intend to breastfeed, it seems your shouldn’t have to wait more than a year for your libido to get back to normal.

  1. J Fam Pract. 1998 Oct;47(4):305-8.
  2. Br J Obstet Gynaecol. 1981 Sep;88(9):882-9.
  3. J Sex Res. 2002 May;39(2):94-103.
  4. Br J Obstet Gynaecol. 1997 Mar;104(3):330-5.
  5. BJOG. 2000 Feb;107(2):186-95
  6. Obstet Gynecol. 1994 Nov;84(5):872-6.
  7. Br J Psychiatry. 1986 Jan;148:74-9.
  8. J Midwifery Womens Health. 2000 May-Jun;45(3):227-37.

Can ‘full term’ babies born before 40 weeks find it harder to breastfeed?

stork-carrying-babyThe fact that premature, or preterm, babies can experience difficulties breastfeeding is well documented. Neurological immaturity, poor muscle tone and underdeveloped reflexes can all affect the ability to perform suckling movements, so babies born early generally don’t find it as easy to feed directly from the breast as babies born at full term1. The length of time that constitutes ‘full term’ is slightly hazy, however. Although the average pregnancy lasts 40 weeks, it is usually from 37 weeks gestation that babies are regarded as being sufficiently mature to qualify as term. There is some evidence, however, that babies born after 37 weeks, but before 40, may not always be as well developed as those born later, and a large study in Australia suggests that this could potentially make it more difficult for them to breastfeed2.

The study looked at the impact that length of gestation had on breastfeeding rates in a sample of 3600 children born over the period of a year. Babies were divided into three groups: those born before 37 weeks (preterm); those born at 37-39 weeks (early full term); and those born at 40 weeks and over (late full term). Preterm babies were the least likely to be breastfed – only 88% of mothers in this group initiated breastfeeding (compared to 92% in the early full term group and 94% in the late full term group), but this could have been due to social factors such as the age and level of education. Although there appeared to be a small difference in the initial breastfeeding rates of the early and late full term babies, it was not statistically significant. 6 months later, however, when breastfeeding status was next documented, the gap had widened to a significant level.

Pre-term babies were still the least likely to be breastfed – only 41% were still being nursed at this point, compared to 61% of the late full term babies. 55% of the early full term babies were still breastfed at 6 months – more than in the preterm group, but significantly fewer than in the older full term group. The fact that there was a difference between the full term groups at 6 months, but not initially, is important as it indicates that early full term babies may be at greater risk of breastfeeding failure: mothers of the younger babies were as likely to start breastfeeding, but they were more likely to stop before their babies reached 6 months. This difference can’t be explained by the other factors recorded in the study, and the underlying reasons for it aren’t clear, but the authors suggest that it may have arisen due to subtle immaturity, such as underdeveloped mouth muscles, that can affect babies born before 40 weeks, even when they have passed the 37 week milestone.

If your baby is born slightly early, the chances are, of course, that she won’t have any major problems breastfeeding. In the study reported above, the majority of babies born after 36 weeks were still breastfeeding 6 months later, so the prognosis is good. It’s still worth noting that a gestation period under 40 weeks might decrease the chance of a mother continuing to breastfeed, however, so any difficulties that do arise can be picked up and addressed before it’s too late. With a little patience and practice even very preterm babies can adjust to breastfeeding as they get older1, so dealing with problems caused by mild immaturity is comparatively straightforward. The key is being aware they may occur: recognizing that for some babies born between 37 and 39 weeks breastfeeding may be difficult for a short time – and providing the right support to mothers through this period – would help ensure that many more babies born slightly early are able to successfully achieve exclusive breastfeeding.

  1. Infant, 2005 July; 1(4):111-115.
  2. Arch Dis Child Fetal Neonatal Ed. 2008 Nov;93(6):F448-50.
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