Feel a bit like I could cry

[CalaRei]

My twin boys are now 4 weeks old. Between their two and four week checkups, when we were doing a trial of nursing only, they did not gain nearly enough weight - 7oz and 5oz. So our ped insisted we go back to supplementing or bottle feeding. We replaced every other feeding with a bottle. Our first choice is EBM, if we have it, and then go to formula from there.

Now my larger son is eating 3-4 oz from a bottle!! He's only 6lb9oz and 4 weeks old! That just seems like so much, but he gets so upset and always still seems hungry - he'll just cry and cry and cry after bottle feeds where he doesn't get enough.
The other is 5lb1oz, and eats about 2-2.5 from a bottle. I can't pump enough for them. I know, I know, babies are more efficient than pumps, and they *seem* sated after nursing sessions, but at this rate I don't know how to get back on track. Right now, I can generally have enough EBM for half of the bottle feeds. *sigh*

I've been taking fenugreek for a few days and it doesn't seem to have helped. I pump and pump and pump - after every nursing session and especially when we give bottles. I nurse them for comfort when they cry and the usual suspects aren't their complaint. I tandem nurse to help the smaller son get milk easier. Their latches seem to be improving and their sucking/eating time seems to be getting longer/stronger as they're less sleepy.

Everything seems right.

This was disjointed, I'm sorry, I wanted to wail for a bit. With the smaller boy, NICU time nearly guaranteed him *some* formula, but I wish we'd have had better support with only breastfeeding the other while we were in the hospital. I feel like this should've worked - my babies were nearly term, even.

I might take them to the ped and weigh them on Tuesday after a week of this, and see if they've gained appropriately and then slowly start back on adding nursing sessions back in. I don't know. I'm just so, so sad about this.

[PatioGardener]

s Sorry no time to reply in full. Just want to ask if you have considered supplementing at the breast with a lact-aid, sns or small feeding tube? That way you do all the feeding at the breast and eliminate the worry of bottle preference.

There are some good videos with the feeding tube here: www.drjacknewman.com - just click on videos and scroll down.

[Megan73]

I'm sorry you're struggling with this but it sounds like you're doing all the right things. Hugs. I've BTDT with a singleton, so it must be even more grueling with two.
I agree with the PP - I'd eliminate bottles and supplement only at the breast. I'd strongly recommend the Lact-Aid system.
The other thing I'd add is that I think it's important to supplement only enough to get your babe (or babies in your case!) gaining the average for BF babies, which is 5 to 7 oz a week. They are gaining - albeit slowly - and it may take just a small amount of supplement to make the difference. Babies will often suck back more than they need from a bottle because it's easy which can be bad for your supply.
Have you considered trying domperidone? It might help.
Also, have you cross-posted in the multiiples forum? Other mamas of twins might have useful suggestions and encouragement.

[3girls1boy]

I'm sorry you are going through this, but you should give yourself a lot of credit for doing the best you can for your babies.

I think breast compression (search this term along with "Dr. Jack Newman" for instructions) might help. Also remember that the higher fat milk comes later in the feeding. So it is generally recommended that you let the baby determine when it is time to switch breasts (by coming off or falling asleep). The milk is always flowing a little, even with comfort feeding and sometimes a few minutes of comfort sucking will bring on another let down. The La Leche League site states that 4 to 7 oz. is appropriate after day 4. Make sure your sons are wearing the exact same thing when being weighed and also whether they have peeed or pooped recently which can actually make a difference of and ounce or two. Sometimes scales haven't been recalibrated at appropriate intervals, and that can make a difference too. How is your sons diaper count? This from the LLL site: Counting wet and soiled diapers/nappies in the early days can reassure everyone that baby is getting enough milk for hydration and growth. After day four, healthy, full-term newborns should have at least six wet diapers/nappies and at least three quarter-sized (2.5 cm) or larger bowel movements each 24 hours. A tissue placed inside disposable diapers aids in determining wetness.

Dr. Jay Gordon has a good article online called "Look at the Baby, Not the Scale"

Good Luck.

[Red Pajama]

One of my twins was supplemented for awhile. My lactation consultant suggested using a bottle called a Haberman Feeder. They are made by Medela, and are usually used with babies with feeding problems. She liked them because baby has to work to get the milk out, and she thought it mimiced the natural flow of milk better.

We found that using the habermans made the feeding last longer, which is what the baby wanted-- not actually more milk.

Congratulations on your twins, and good luck!

[Smithie]

1. I think your doctor may have overreacted at 4 weeks and caused you more grief by demanding that you supplement right then and there. I know everybody is nervous with preemies and twins, but honestly, the range of what is "OK" to gain/lose in those first weeks...

2. My (singleton) son drank that much and more from a bottle at that age - EBM only. It's weird, I'll grant you, but it didn't seem to signal any kind of problem with my milk supply. When I was with him 24/7 (which was most of the time), he was content and gained well with what I had "on tap."

3. I third the suggestion to try a Lact-Aid if you continue supplementing, although I acknowledge that it is a hassle and a half.

4. If your babies seem sated after feeding at the breast, well, I am not a doctor and this is not medical advice but... why fix what ain't broke? If you stop the bottles, nurse on demand, and everybody keeps peeing and pooping and gaining, wouldn't that be awesome? And it's not like you would allow them to waste away before your eyes. If it doesn't work, then you can always go back.

[schreiberwriter]

Sounds like you're doing a great job! Breastfeeding them frequently will help your supply and them as well. Right now, your only job needs to be feeding and holding them.

Feel free to get a second opinion before supplementing with formula. Doctors are just humans.

[ewe+lamb]

You sound as if you have been through the mill, do you have a friendly LLL Leader close by who can give you some support? I second the recommendation of using the SNS or Lactaid, you should be able to get this from LLL and ask the leader how to use it. My feeling is that you need to go to bed with your little ones for a couple of days and nurse nurse nurse, get someone over or your dh to tend to your every whim and do what you need to do to get them onto the breast you'd be amazed with how much this helps - are you out of the NICU now? There is a great book which you can get from the library called Kangaroo Care, which would be worthwhile - especially as you are probably working with drs just now. Also you can print out the EBF charts for boys which could also help you http://www.who.int/childgrowth/stand.../en/index.html Breast compression is also a great idea www.drjacknewman.com and click on video clips and scroll down till you find what you are looking for. Do as much research as you can on exclusively nursing twins, there is a multiples forum here so you could search out some other mothers who can give you lots of support and more information. You are doing a great job, please don't imagine for a moment that you are not, being a mother is new, and sometimes not an easy role and there are many pitfalls but having MDC on your side is a wonderful thing!!, post again to let us know how you are getting on.

[hartfelt]

hang tough mama. you rock and you can do it!