> Her progesterone level is 12 and the infertility specialist says it  should be above 20.  While he acknowledges he has never worked with a mom who is nursing, he says that there is some theoretical risk of miscarrying.
> This child's primary nutrition is from the breast.  She is not  tolerating any soy, goat or cow's milk derivatives. She has gotten the  nursing down from 8/day to 5-6/day.
> She sees her infertility specialist for the last time on 4-14.  I really think he would be receptive to your input.

He will probably not be receptive to mine!! Was anyone else bothered by
this? Why is she seeing an infertility specialist with a nursing 1-year
old? I hope it is because she spontaneously got pregnant and went back
to him to get through the first trimester.

Regarding the mentioned couple, this is terrible child spacing for all
kinds of reasons! I feel so badly for this couple to be in such a
quandry now with a baby so intolerant of usual foods. Too bad the
healthcare team interacting with them (there must be plenty considering
there is a 1 year old baby, family allergies and infertility care, not
to mention somewhere in the past year there was a 6-week postpartum
checkup where birth control is supposed to be discussed), that
evidentally, nobody helped this couple decide NOT to get pregnant until
present baby weaned or alerted them to the potential problems if they
did. Not only is there a theoretical problem of miscarriage (thank you,
Jack, for your wisdom already posted), but there is now a smaller but
noticeable increased risk of birth defects (the data is there; and yes,
I know tandem nursing happens safely for the majority of moms. The age
of the older infant and quantity of BFing may be the significant
difference.) In fact, March of Dimes research strongly suggests waiting
*at least* 6 months *after* *weaning*  before getting pregnant again in
order for mom to rebuild herself nutritionally for the next baby. I feel
these are issues for which we all (not just the MDs) must take
responsibility to educate our BFing parents when working with them.

Which and whose altar of ignorance was this one sacrificed on? (Clue: It
was not the parents'...)

Katharine West, BSN, MPH
Sherman Oaks, CA