trying to nurse preemie triplets PLEASE help

[ItsyBitsyBean]

not much time to type pumoing now

born july 31, 2010 -- 4 pounds, 4'11, 4'12
all healthy
33 weeks gestation
7 weeks old now

all babies are now 5+ pounds, boy is 6.5 pounds

NICU for 18 days, nursed all the time, thought they were doing well, bt no test weights in that nicu, so i didn't realize until after we were discharged that they actually are really weak nursers --

Baby M maybe gets 20-30 mL on a good session and normally more like 6-10 mL. She "should" be taking about 60 mL every 2-3 hours. Lact consultant said she has a high palate but no visible/palpable tongue tie.

Baby P gets 20-40 mL straight from the breast several times a day, but it takes a long time. Lact counsultant said she has a mild tongue tie, but didn't think clipping was needed - -though I don't think she factored in how servere ANY obstacle is when you consider how many babies I have and how few hours there are in the day.

Baby H is a pretty good nurser, or was, and can get 30-60 several times a day, in less than 30 minutes, but is big so needs more than that so he has to nurse all day and night in order to poop often and grow well (and in order not to scream all day)

If I had any ONE of these babies, I think I could do it. But all three, there just are not enough hours in the day.

We supplement them with my pumped milk,a dn milk I get from friends, mostly using feeding tubes (#5 french) sometimes at the breast, sometimes with a pacifier (like finger feeding).

I was confused during the first 6 weeks, thinking that I was doing well to have one or more babies at the breast 16+ hours a day, but I did not realize they were such poor nursers, and so now I do not have enough milk (it came it, but they did not remove it from the breast well, so my supply went down). Now, several times a day, I am pumping instead of nursing, or only nursing each for 5-10 minutes (15 for the boy, who actually puts some effort in it). I have had days where I have pumped most of what they take, but then I have days where I can barely pup anything. I think the herbs have stopped working, plus i am profoundly exhausted and I am so unbelievably hungry, but I dpn't have tie to eat much less prepare food. My husband helps the best he can, but he is spacey on a good day (borderline idiot savant -- super smart but very bad at paying attention to mundane things, has done things like I say please change the baby and he put the clean clothes on the baby on TOP of the dirty clothes. He will feed them whenever I ask, but he forgets who got what, who pooped and who didn't, etc., and has to also work and go to school and take care of the middle 2 kids (6 yo, 2 yo). He will bring me food, but all he can think to cook is eggs or chicken. So, I eat that and get protein poisoning (breath smells like ammonia) so I start refusing that food, but he doesn't know what else to offer.

So, I guess my question is this - -are they EVER going to be stronger suckers? Can I recover my milk supply or is it just too late? I am so tired and sad, and the thought of not being able to eventually exclusively nurse them makes me terribly sad.

Is this still possible?

[Camile Rynd]

I just want to tell you that you are my HERO!! You keep doing what you're doing mama!! I am impressed!

I actually do have some advice..get a lot of help from other mama's! Do you have a helper to come do dishes/cook/laundry to ease your other burdens while you get this nursing thing down? I think it's so important! Too many of us try to do it all and it can be overwhelming! I have the same type of husband and he needs a list!! Give him other things to do so that you can concentrate on the babies. He can chop salad and make soups. Seriously, it helped me a lot. My DH was happy to help out once he knew what to do! It was amazing to me that he didn't see that the kitchen needed cleaning, the trash needed taking out, I needed to take a shower, etc! They are oblivious but we love them!

I have read that fennel and fenugreek can help boost milk supply, have you tried it? Drink lots of water! Get some quiet relaxing moments to yourself. Being stressed alone can have an impact on your milk. Do you like your pump? My best friend donated milk and said that the type of pump she used made a difference!

Keep it up! This will get easier with practice and patience! You needn't feel sad or guilty, you are trying your hardest! You amaze me! Deep breaths mama!! You rock!!

[hergrace]

I had the same feeling that you do that I would have been able to deal with the feeding issues of any one of my triplets. I ended up pumping exclusively because I had to deal with an older son and feed my husband and in-laws (because he was working insane hours and i couldn't survive on the food my MIl was able to prepare) and I had no help because I was in a new country and knew no one.

That said, I kept my milk supply up with fenugreek, fennel, and domperidone (use the dosage recommended by Jack Newman - my doctor tried to prescribe me much less and it wasn't helpful until I got it at that dosage).
http://tinyurl.com/nlup8m

What I needed was: somebody to feed my whole family; a lot more food and water than I was consuming - especially water; somebody to do basic cleaning and laundry; somebody to entertain DS1; people to hold hungry babies when I was not available to feed them; and somebody who was willing to physically hold babies on the breast during feedings so I could work on tandem feeding.

And, I turned frequently to a paragraph in Karen Gromada's "Mothering Multiples" where she says basically: A mother who has done everything she can and still is not able to exclusively breastfeeding has done an amazing job and should focus on the things she has managed to achieve rather than on the things that still aren't working."

Celebrate the amount you have achieved. I know you feel like you are failing, but I would have given anything for the amount of success you are already having.

ETA: FWIW, some of my friends with twins who had bfing issues found that pushing through until about 6 weeks adjusted got the kids to much stronger places.

[OGirlieMama]

I couldn't read and not reply. My heart goes out to you and your babies, and your whole family, really. I struggled with my preemie twins and ended up exclusively pumping. I had what *seemed* like a good amount of help from my parents, but it was the wrong kind of help, in retrospect. They came over and held the babies and fed them so I could pump and such, but what I needed was for someone to do EVERYTHING ELSE while I nursed them and then pumped. Everything = make food for me, make sure I had water, do the laundry, grocery shopping, etc. (I don't have any older children so that wasn't a factor, but clearly it is for you.)

I wish I had more of a concrete solution for you. I think the paragraph Kate quoted from "Mothering Multiples" is where I found most of my solace. Hang in there and know that you are a rockstar for all the effort you are putting in to breastfeed your babies, regardless of the outcome.

[Devaskyla]

Maybe post in the breastfeeding forum too? Try contacting Dr. Newman?http://www.nbci.ca/index.php?option=...d=62&Itemid=33

[Shuli]

Can anyone in the community/church come round and help? A mother's helper from a nearby high school or youth group? I know that you have older children but from my experience (my twins were my firsts) the babes come first and it sounds like you really want to breastfeed. Is there any way that you could spend one or two days in bed alone with the babes just to get a feel for them and just nurse? Maybe that would help your supply, if you could just rest for a few days and nurse the whole time? Just an idea. My heart goes out to you. I hope everything gets better.

[shoelace]

I haven't had a chance to read all the responses, so I don't know if this has been mentioned, but it sounds like you could really benefit from hiring a post partum doula. I had one when I was first home with my twins and holy did she save my life! Honestly, she is the one who is responsible for my nursing success. We had a bit of a hard time finding the money for her services but it was totally worth it. If money is an obstacle, you could find a doula who is in training and needs to take on clients so that she can get certified, they usually don't charge for their help. If you google DONA you can look for a doula through them. Good luck!

[Barefoot Farmer]

Another mama of triplets here. First of all, congratulations on your three babes. What a blessing! An intense, and very hungry, blessing. This is an incredibly hard time for you and your trips. s s s First you need to take a breath and recognize that you are trying to do a very difficult task, one others might argue you are at quite a disadvantage, what with having one less nipple than there are mouths to feed. It is okay to acknowledge this; you need to. Also, remember that what you do now will not be forever. You will need to do things now which are incredibly time consuming, but when your babes are stronger, you will be free of these tasks and life will be a bit easier (but still difficult, I mean it is triplets!).

I was able to exclusively feed my trips my milk, pumped or otherwise, for the first fourth months, I believe because my pumping established such a strong supply initially. You are going to need to pump A LOT to increase your supply. Look into investing into some More Milk Plus by Motherlove. I did take a lot of this (more than the recommended dose), but it certainly worked. Try to pump every 2-3 hours, maybe with a babe on one breast and the pump on another.

Try breast first, than bottle/feeding tube if needed. As they get stronger, they won't need the bottle as much.

You need to eat and drink a ton! Like 4000 calories a day of food, protein and calicum like crazy. Chocolate milk, protein shakes, ice cream, cheesecake, lasagna, I'm a veggie so you see where my mind wanders. Tell people what to bring over. Do not be shy. They want to know how to be helpful. Be honest. You are producing a ton of milk and need the food to do so.

Give people specific tasks so that you can either: nurse a babe, pump, eat, sleep, or give attention to an older child. Those should be your only tasks. I know that seems idealistic, but try thinking in those terms. Everything else will wait.

Try to find a Le Leche League leader with triplet or twin experience. I had difficulty with this.

Feel free to PM me if you have any specific questions, tandeming, feeding rotations, etc.

Hats of to you Mama. You are a hero to your little ones right now.

Be well.

[ShanaV]

Oh my goodness, Mama, my hats off to you. I see it's been a couple of weeks since your OP, so I really hope things have improved!

I second the advice that you need to enlist help doing "everything else." The only way I'm surviving with my twins is that we moved in with my parents, and they take care of "everything else" while I take care of the babies. And your situation is many orders of magnitude harder than mine because you have three!! Wow! My folks walk the dogs, do groceries, cook, clean, and hold a baby or two when I need my hands free. It's really a life saver. Whenever anyone asks how I'm coping I tell them that I owe it all to my folks, and that it would be a DISASTER if I were on my own.

Plus, congrats on getting to 33 weeks!! You have me beat by three weeks and a good pound and a half each! You WIN! Your babies will grow up strong, for sure!

Is your pump a hospital grade one? They are most helpful at increasing supply.

Try Mother's Milk tea, if you haven't already. It has fennel and fenugreek, as a pp mentioned. Boosted my supply in a day or two.

Sending T's & P's your way!!

[smeep]

I'm in the middle of things so this will be a quick reply, but I have a few suggestions.

For the high palate, look into a palatal obturator. Unfortunately I don't know too much about them, but I would definitely look into it.

For the tongue tie, I would go ahead and get it clipped ASAP. As you said, you have so much that you're dealing with and even the smallest thing can become a big deal. Even if it was just that one baby and it's just a mild tongue tie some women/babies cannot handle even a mild tongue tie (it really does affect milk transfer and therefore supply as well).

I would recommend using the tubing at your breast (as a lactation aid) every single time that you can (unless, say, you're nursing two and the third is desperately hungry, then I could see an exception being made). The more your babies get anything that isn't directly at your breast, the more your supply goes down.

I would definitely consider domperidone. I would like to say that you should work on other things first (namely, the latch issues and making sure all feedings are at the breast whether or not they're supplemented) and then consider domperidone, but it may be worth it to get the extra boost since you're a special situation and this seems to be a much more time specific matter.

HTH! And I also suggest posting in the Breastfeeding Challenges forum. I'm sure a lot of the mamas here have good suggestions but you may get some other good ones if you cross post in there.

[turnquia]

This is a link to a friend of mine with triplets. She is still exclusively breastfeeding at 10 months old. She will be more than happy to discuss what she did, what worked, what didn't and offer additional advice.

Her triplets were born at 34 weeks.

http://onedayatatimenicole.blogspot....stfeeding.html

[Spring Lily]

First, I just have to say how awesome you are. I had trouble nursing twins with one older child, and you have triplets and 3 older kids to take care of?? Amazing.

I second the suggestion of a postpartum doula, you more than deserve that. Your husband may want to be supportive, but you just need more than he's able to do right now.

OK, the nursing.
Your babies are just now hitting 40 wks gestational age. Mine were born at 34 weeks and couldn't nurse until 41 weeks gestation. No one told me that it might take until 40 weeks or more for them to be able to suck and nurse efficiently enough to get all their milk that way. So I am telling you now: just because at this stage they are having trouble DOES NOT mean it's not going to work out.

With mine, it wasn't until they were 2 months old that they were able to really get a full meal at the breast, and that was only with a nipple shield. They just weren't strong enough to hold the latch AND keep the nipple in place AND coordinate sucking & breathing AND do it long enough to get enough food. Totally within the range of normal. I just kept at it, kept pumping, kept supplementing. By 3 months I had them exclusively nursing with no nipple shield. It was amazing how quickly and smoothly their progress went when they were old and strong enough to really get their meals by nursing. And when they go going better, my supply easily tripled. Tandem nursing will stimulate a powerful letdown and it really will get your milk supply where it needs to be. When they're ready.

I hope that helps you feel more optimistic! It was one of the hardest things I've ever been through, and you have one more baby than I did. Try to stay positive and not focus on what they "should" be doing right now or worrying about the future. It CAN work, you are doing great, take it one day at a time!

[cdahlgrd]

s mamma! You have a lot on your plate.

You need to sit down with your dh and come up with a plan that will work for your family.

1. Can you pay for some help? If not, you both need to make sure there is some help for you everyday. Especially if you are pumping and nursing. That is a HUGE HUGE time suck. I did it for 2 moths with twins. I didn't get much else done.

Places to find free or cheaper help: LLL and ICAN leaders, midwives and doulas, local churches even if you aren't a member, neighbors, community colleges with early education or nursing departments, high school couselors can often list a few kids who are responsible.

2. If you are going to breastfeed/pump for these babies, it has to be top priority right now. FOOD and WATER, REST, FOOD AND WATER, naked time with the babies, did I mention food and water? Seriously, I was pumping 1/2 gallon of milk a day for my twins. But if I wasn't drinking a gallon of water. . . I couldn't get it and they were hungry.

Put a list of food on the fridge for your dh to make or have him watch the littles for a few hours while you make a big pot of soup, quiche, lasagne, wraps, etc. to last you the week. HAVE YOUR FOOD DELIVERED, if you can.

3. Try to relax about getting the babes onto the breast exclusivly. My twins were full term and STILL didn't nurse until they were 7 weeks old. I bottled them because I just didn't have time or energy to use tubes and finger feeding and and and and . . . Then one day, I decided to try to latch them on. . . and we never went back! So if you can't get the babies onto the breast, it is OK. You can try later. But if breastfeeding is stressful for them and you, they will resist it. So let it be a nice bonding experience without any stress.

4. You don't have to feed them just your breastmilk. Many many moms do BOTH and it is OK. You only have so many hands and so much time. You can even go to formula it is OK. You all have to come out on the other side. Leave the guilt for someone else.

[babydanielsmom]

I just popped in here from the main forum and I wanted to say


I think you are super-woman and congrats on your Little Blessings.

[ItsyBitsyBean]

It's nine weeks later and I have a moment to catch you all up. Your suggestions were awesome. I posted on Facebook that I was exhausted and needed help and more than 40 people over that 9 week period came, cooked, cleaned, rocked babies, read to the mediums, etc. All THREE babies had posterior tongue ties and all three got clipped 8 weeks ago. It took 2 weeks for them to relearn how to use their tongues and about that long for my milk supply to build I also used domperidone. As of 3 weeks ago we were still using bottles (my pumped milk) far more often than I wanted, so I used butterfly tubing and a 30 mL syringe (purchased 30 of each, online) to make a breastfeeding teaching kit for my littlest -- when she sucked correctly, I pushed milk through the tube, when she rested too long or just sat waiting for milk (nipple confusion/flow preference), I would do the "nipple tug" to get her to suck again. I think that, plus telling myself and my husband a hundred times that babies cry for reasons other than hunger -- that's how we finally got off the bottles (and the frenotomies, and the volunteers, and the domperidone, etc.). I am so thrilled to be able to nurse them. We have such severe food allergies and Celiac disease, most of my nieces and nephews have to have or had to have Nutramagen and even still were sick, and we have a lot of IBD, so being able to nurse them was not just a crunchy thing for me, but I felt actually afraid for their health -- I have an autoimmune disease caused by bacteria entering my vascular system through my leaking gut. So, again, I am so grateful for all of your suggestions and for all the help my community gave me. They nurse 12 combined hours a day, sometimes 2 at a time, sometimes not, and have cubby cheeks and full diapers and we are so blessed and so grateful.

Edited by ItsyBitsyBean - 11/23/10 at 9:50pm

[ItsyBitsyBean]

And I eat like crazy -- that helps a lot. After nursing my first 4 kids for a total of 16 kid years, I thought I could make milk without having to eat a lot. Sure, a little bit of milk, no problem. But these babies take in a total of about a gallon a day -- I can't make that without eating at least 3000 calories a day and drinking 2 gallons of water a day. GF Cheesecake, snickers, chocolate milk, etc. If I feel hungry, I eat as much as I can (and yet am losing 2 pounds a week) because I learned while I was pumping that hungry will dramatically decrease my output. Previously, I was so busy trying to nurse them, I was actually in starvation mode and would have hypoglycemic spells (vomiting and loss of bladder control and uncontrollable shaking and low body temperature and had to get in a warm bath and drink a gallon of OJ to get my blood sugar back up). Oh, and the fenugreek helped to make that way worse. They say that fenugreek can cause hypoglycemia, add to that making milk for 3 babies and being too busy to eat and you'll get yourself a nice hypoglycemic speel. Yuck.

Edited by ItsyBitsyBean - 11/22/10 at 12:06am

[hergrace]

I'm so glad to hear things are getting better!

[GoodUserNamesTaken]

Yay!!! I'm so glad things are better and that you got so much help! :)

[charis4]

I realize I'm hitting this thread way late, but I just wanted to say wow, you're my hero!!! I'm so glad to hear that things are going better!! I'm definitely going to take from your experience for when my triplets are born in the next couple of months.

I know this is too late for your situation, but for anyone else out there dealing with milk issues, there is some research coming out of Stanford about maximizing milk production while pumping. Here is a link to the video http://newborns.stanford.edu/Breastfeeding/MaxProduction.html As a doula and childbirth educator, this is very intriguing info, even more so because I need to make milk for 3 this time around!

Again, I'm so impressed in how you've handled everything, thanks for sharing!

Morgan

[purpleheather79]

You've gotten some great advice already, but I wanted to chime in about the tongue tie.  Get it clipped!  It can really cause a lot of problems, even if it appears minor.  My second set of twins had posterior tongue ties and nursing was awful.  They had them clipped but it wasn't enough.  After surgery at 3 months, things started to get better.  Now they are two and still nursing, but we never would have made it without getting the tongue tie fixed.  I'm not sure where you live, but if you are anywhere near me I'd offer to come help!  Hang in there, mama!  You are doing an AWESOME job!