Winnie Mading wrote:

<<Are mom's BF benefits increased by nursing multiples?  I think most
of the studies that show a "dose-related" benefit speak of the
benefit increasing with increasing TIME of lactating and do not
mention amount of milk produced.  In that case, the number of babies
one is nourishing at the same time would not be a factor.
However, it does raise the question-Is it really the number of
days/months of lactating or is the amount of milk produced being
interpreted as the time milk over which is produced?>>

Here's my "take" on this topic.

I don't think it's either the length of time until weaning or the amount of
milk the mom produces that makes the difference; I think it's the effect of
lactation on the mom's physiological functioning. There's just one mother
involved. She could be nursing 1, 2, or more babies. She could have a baby
who snacks around the clock or a baby that sleeps 12 hours a night. She could
have a toddler who gets 70% of his nutrition from her, or one who nurses
sporadically.

So this is a case where we shouldn't look at the calendar, but look at the
mother-baby pair. (Same as the rule with a newborn: watch the baby, don't
watch the clock!)

One measurable effect of lactation on the mother's bodily functions is
fertility reduction. My understanding of this process is based on the chapter
by Ellison in Stuart-Macadam & Dettwyler's "Breastfeeding: biocultural
perspectives."  (I apologize for using the word "fertility" incorrectly to
mean "able to get pregnant." The proper term is "fecundability," which is a
rather awkward word in my opinion, although Ellison explains it very
clearly.)

It seems to be the mother's baseline prolactin level that determines the
return of ovulation and luteal sufficiency (which are both needed to enable a
subsequent pregnancy). Higher baseline prolactin means a longer interval
before a mother can begin a new pregnancy. As her baseline prolactin falls,
her risk of getting pregnant rises.

I understand, too, that this is not an absolute measure but a relative one.
Mother A might regain fertility at one baseline prolactin level, and Mother B
at a different level. Thus, we couldn't tell when our own fertility has
returned just by getting a blood test for baseline prolactin. (That would be
too easy!)

And what affects baseline prolactin level? Isn't it the *intensity* of
breastfeeding, in terms of both higher frequency of nursings and shorter
length of the longest inter-nursing period of the day? Oh, and I almost
forgot, we do know from the pumping literature that moms produce more
prolactin with simultaneous stimulation of both breasts!

So, the chances are good that a mom of twins will have higher baseline
prolactin because she is probably 1) giving more nursings per day than the
mom of a singleton and/or 2) nursing two babies at once. In addition, it
seems likely that at least one baby will wake during the night, reducing the
length of the longest inter-feed interval.

If the decrease in cancers for mothers who lactate is tied to the length of
time our bodies get a break from the estrogen- and progesterone-driven
menstrual cycle, then it would make sense that nursing twins long enough to
experience significant lactation amenorrhea would significantly decrease
cancer risk, compared to women who nurse a singleton.

But, as usual, the people who are most interested in knowing more about this
are not the people who have the funds for research. Not to mention the
difficulty of finding a cohort of women who have nursed twins into
toddlerhood and beyond (except for Karen Gromada's lucky moms)!


Chris Mulford, RN, IBCLC
working for WIC in New Jersey
Co-coordinator, WABA Women & Work Task Force





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