Congratulations! You are pregnant, again! So you must be wondering first pregnancy vs second pregnancy, is it going to be the same?

We’d have to say no, things are going to be different. The main reason being that you have a toddler so you are surely more physically and emotionally fatigued than you were during your first pregnancy and you have less time to relax and prepare for the baby.

You probably have lots of questions. Like when to tell your toddler about the new baby and if labor is going to be faster this time. We’ve got answers to those common questions and more here; Preparing for baby 2: Three tips for a smooth transition.

Here, we want to focus on two important things that weren’t a concern during your first pregnancy and can impact your health and the health of your baby: the risk of a cytomegalovirus infection and breastfeeding while pregnant. 

Cytomegalovirus (CMV) is a common virus that infects people of all ages. Most people have no symptoms and don’t even know they are infected. But if you are pregnant with a toddler are a very special population because 1 in 3 children under five have CMV, it is easily spread in households and daycares, and infants who are infected with CMV in utero are at high-risk for serious complications. Putting these three facts together, it is clear that mothers of toddlers who are trying to conceive or who are pregnant are at risk.

During your second pregnancy the likelihood of being infected with CMV by your toddler and then passing the infection to your baby in utero is real and it is serious. This was certainly not a concern during your first pregnancy. To make matters worse, two things that you most likely do everyday with your toddler – kissing them and finishing their plates – put your baby at risk.

The advantages of breastfeeding to mothers and children are well known and the rate of and duration of breastfeeding has been on the rise in US women over the past decades. In the US in 2020, 58% of children are breastfed until at least 6 months of age, 37% are breastfed up to 1 year, and 17% are breastfed at 18 months. If you are hoping to have your children close in age this may factor into your considerations.

Being pregnant and breastfeeding are two physiologically demanding tasks. If you have been pregnant or breastfed before, this is no surprise to you. So it makes sense that combining the two, can put extra stress on your body. 

Secondly, there are the hormones. Yes, it is always about the hormones, isn’t it? Breastfeeding and nipple stimulation causes the release of oxytocin. And what does oxytocin do? It causes uterine contractions and postpartum cramping. Remember those afterpains? They were super intense during breastfeeding for this reason. Uterine contractions are incredibly important postpartum. They work to shrink your uterus back down to the size of a lemon after it was the size of a watermelon at birth. 

But if you have that same oxytocin release causing uterine contractions while you are pregnant, there is worry that this could cause miscarriage. The logic behind the idea makes sense. The research is not clear. We know that there are number of oxytocin receptors changes during pregnancy and labor. Hormones needs receptors to function – that is how they share their information, so if there are fewer receptors in pregnancy than less information will be exchanged. But the question is how much is enough, even if it is just a little. That we don’t know.

Studies have shown that the risk of miscarriage is significantly lower if the breastfed child is also eating other food, as in they are not exclusively breastfed. If you are not having Irish Twins, or babies that are very close in age, then this may be the case for you.

We know that short interval pregnancies have an increased and preterm babies. We know that nipple stimulation can induce labor. Could oxytocin and the uterine contractions factor in here?

As you will see, growing your family is going to stretch you. Stretch you to make tough decisions where not everyone will be happy. Stop kissing your toddler to protect your unborn baby? Stop breastfeeding if you have a history of miscarriage? Making these decisions may be the first time you feel this pull. A pull between your toddler and your unborn baby. 

Or maybe you will need to decide between your toddler and yourself. Breastfeeding is exhausting. Even if you are not super “at risk” you may decide to stop and let your body focus on growing and nourishing a baby. 

Do you really have to pick? I think you do. And I know it’s hard. Hopefully with the right information, you can make an informed decision that feels good to you. That’s the goal. To know that you prioritize what is a priority for you.