Tuesday, 13 August 2013

Triumphant Tuesday - Breastfeeding Twins

In a society where most women fail to breastfeed their newborn, having two newborns to feed simultaneously must surely spell curtains, right? Indeed, many health professionals, upon discovering their client is carrying twins, promptly and without tact suggest that she should expect the worst – and head to the nearest bottle store.

Thankfully, Mother Nature doesn’t take orders from health professionals. Her production line is connected to her line manager – the baby (or babies, in this instance). From womb service to boob service, Mother Nature will satisfy her offspring’s remit – if left to her own devices, as the following story illustrates:

“When I was pregnant my doctor told me to line up donor milk from a milk bank.  I don't think she was confident that I could produce enough milk fast enough or maybe she just wanted to be thorough. Either way, it made me doubt my breastfeeding abilities before my babies were even born.  

Preemie Twins

My twins were born via medically indicated cesarean at 34 weeks due to many factors including IUGR and TTTS.  They weighed 4 lb 15oz and 6 lb 5 oz. They went to the NICU and I was sent to my room to recover from the cesarean. We had made birth plans that we passed out to the doctors and nurses and a copy stayed with each baby at all times. I wanted to breastfeed as soon as possible but was not able to see and hold them until that night. I was adamant that they not be given any formula. They had IVs so that held them over until I could nurse or pump.

Pumping Stations at the Ready

The next day I was given my pump and I started right away. I was excited to get a good sized quantity of colostrum.  Later that day I was able to put them to the breast and see if they could latch. Preemies born before 35 weeks have problems with their suck/swallow coordination and are unable to concentrate on multiple stimuli. We were not sure if they could physically nurse. The first time we tried they were both too sleepy and just wanted to cuddly skin to skin. We could only keep them out of their boxes for 30 minutes at a time to allow them to sleep as much as they could and stay warm. Preemies can easily tire themselves out and expend more calories than they take in just by trying to nurse for too long.

So began our new routine of 30 minutes of nursing/cuddling per twin and then back to the room to pump. Every 2-3 hours my husband and I returned to the NICU to nurse the boys.  The second time we tried nursing, the bigger twin latched on and nursed for 30 minutes! The smaller twin took more time but he began nursing shortly afterwards. My milk came in on day three and we brought 3-4 oz of pumped milk with us every time we saw the boys. 

Introducing Bottles

The doctors recommended topping off each nursing session with pumped milk.  Little warning bells went off in my head at this idea! I didn't want to use bottles. The NICU nurse could see my alarm and explained the recommendation to us. The boys were expending so much energy nursing and trying to stay warm that they needed some milk they wouldn't have to work for in order to gain weight. This made sense to me so we started topping them off with tiny amounts (5-10 ml) of pumped milk.  My husband was awesome at bottle feeding while I was utterly incompetent. When I bottle fed the babies they would spit it out, choke, or just hold the bottle in their mouths and not drink. I suspect the babies thought I was holding out on them.  So instead, I would go back to our room and pump while he finished up with the boys.

One day we were held up (talking to doctor) and got to the babies 15 minutes after they were supposed to be fed and discovered that the NICU nurse had already given the babies bottles of pumped milk.  It was our fault for arriving late but it was nonetheless upsetting to me.  We were never late getting to the babies after that!  


Each day brought a new challenge. The boys got jaundiced and needed to be under the billi lights for two days, they were taken out of the warmer to see if they would maintain their temperatures (they didn't) and most of all they needed to gain weight.

I nursed and pumped every 2-3 hours day and night for a week and the boys passed every test. They gained weight, they maintained their temperatures overnight, and they passed the carseat test. On the eighth day we finally got to take them home! I brought a couple of gallons of pumped milk home with me as well.

Nursing and Pumping 24/7

At home we continued to nurse and supplement with pumped milk. I planned to nurse on demand but they were happy to stay on the same 2-3 hr schedule.  It got exhausting to wake up at 2 in the morning to nurse and pump but we did it for an additional 5 weeks until their due date.

They seemed like they were nursing as strong as a normal newborn so we phased out the supplemental bottles over the next two weeks (42 weeks GA) and they breastfed exclusively at the breast from that point onward. They began to nurse on cue more often as well and I nursed them tandem during the day and individually at night. We co-slept with me in the middle and I would nurse whoever woke.

In the meantime I carried on pumping and was able to donate around 500 oz of breast milk to three babies, one of whom was terminally ill and one which had bone disorders.

Nursing in Public

I nursed by babies all the time whether or not people were around. My family seemed to be a little uncomfortable at first and avoided eye contact (lol) but they soon got used to seeing my boobs out!  With my first two kids, nursing in public made me very self conscience, but I feel like a proper lactivist now. I fed them anytime, anywhere - restaurants, parks, stores, cars, visiting friends. I've even tandem nursed at church!  There hasn’t been a single negative reaction.

I hope my story can encourage mothers to have faith in their breastfeeding abilities.  If I can feed two preemie babies, surely you can meet your breastfeeding goals!  I want you to face booby traps armed with confidence and knowledge. Determine that breastfeeding is your #1 priority and I believe you will succeed!”

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Mdegraeve said...

Love it!!! your story and you/babies are beautiful!

On Green Carpet said...

This story has been truly inspiring, thank you for that! I wish you all the best of love and happiness in your family!

Lucy said...

This is a lovely story of breastfeeding commitment. I can't help but wonder though how much easier things would have been if this mom had been shown some better strategies for bf preemie twins rather than the standard bf for 30 minutes and then pump and top up. Small or premature babies really do benefit from strategic positioning, a deep asymmetrical latch and the use of breast compression and very few babies would even need topping up if mothers were taught these things. Breast compression alone can double the amount of milk transferred in a fraction of the amount of time and is a fabulous tool that is so underused. Instead, women pump and top up by bottle which has a negative impact on the way the baby suckles at the breast. Also it is tiring for mom and very overrated as a tool for "emptying" the breast. Although bf mothers and perinatal nurses understand how important the latch is, they don't realize that a good latch is about twice as deep as they think. I rarely come across a photo of a baby with a really good latch. For example, the baby on the right (in the photo of the mom bf her twins) is very poorly latched and would not be able to transfer any milk except perhaps during letdown. So many babies spend long periods of time dry sucking with a poor latch or fall asleep at the breast because the flow of milk is slow. Not to mention the "ouch" factor! Correcting the latch comes first but learning how to control the flow of milk at the breast is just as important.

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