What can I do to increase the odds I get the babies breastfeeding?

[annettemarie]

Hey there! On Tuesday, November 23, I had 38-week twins. They were both good sized, fine and healthy. However, I lost 3600 CCs of blood in PPH and went into heart failure after the birth. I was intubated and given some pretty heavy duty meds.  The babies were being cup/syringe fed formula until Saturday, at which point their bilirubin levels were approaching 20, so we gave permission to use bottles. Their transfer of nutrients greatly increased and they got better. They’re still drinking formula from bottles.

The meds I was on are not compatible with breastfeeding. The nipride has a pretty short half-life—several minutes actually—but the problem is that rarely, when used for more than a day, it metabolizes into cyanide, which is obviously bad for babies. I was on it from sometime early Wednesday morning (11/24) through early Friday morning (11/26). The metabolized cyanide has a half-life of three days, and it takes 15 days to be absolutely 100% sure it has cleared the system.

I’ve contacted both Drs. Hale and Newman. One thinks waiting is ridiculous, especially given how rare the chances of side effect are and that I should just start nursing and have the milk tested. There is no place nearby to test the milk. The other agrees that to be 100% sure, I should wait the full 15 days.

The LC and nurses started using the breast pump on my when I was unconscious Wednesday and when I was off the vent Thursday, I was getting some colostrum. I have to dump everything out of course. I have been pumping every two to three hours and trying to do skin-to-skin with the babies. They’ve both tried (successfully) to latch on. I just detatch them and cry and pray they’ll remember next week. I’m also drinking Mother’s Milk tea. I usually get between 2-3 ounces per breast each time, although there is usually one or two sessions where I only get 1 ½ ounces per breast. I am very reluctant to try herbs or off-label drugs because my blood pressure and heart are still in a very precarious position right now and I don’t want to rock the boat,

My plan is to have Naked Baby and Mama Day starting next Wednesday. That will begin the last 3-day cycle and I doubt the babies will latch on right away. I would love tips and hints to help get these babies breastfeeding as soon as possible.

[PatioGardener]

So glad to hear you are doing OK!  You are a very strong Mama!

I'd go with Hale's advice, myself, as he is a pharmacologist and very aware of the mechanisms, solubility etc.

It sounds like you are doing really well with pumping.  Are you able to have the babies close by when you pump?  That may help too - along with lots of skin to skin (for your milk supply.)

Naked day sounds like the perfect way to encourage latching.  Just remember that they may have some anger to express about this whole ordeal before they latch.  It is not uncommon for babies to protest at the breast/on Mama's chest for a while before instinct takes over and they latch.  Looking into baby led latching may help too.

Everyone does what works for her.  I asked my best friend if she would nurse my little guy if I couldn't, when he was born.  Fortunately there was no need, but that is an option too.

Hugs to you, Mama, and good wishes for a happy latch day!  Please come back and let us celebrate with you :)

eta: read your post so fast I didn't realise it was you, annettemarie!  I am in complete awe that you were pumped while still out of it.  I think you are my hero!  you and your little ones will make this work.  If they won't latch right away, you can always try to entice them to the breast with a nipple shield.  Another option may be to finger feed them the day before naked day to get them used to not having the bottle.

I'm sending happy healing vibes your way, and cheering for you all. 

nak

Edited by PatioGardener - 12/4/10 at 5:41pm

[AlDente]

I'm so sorry to hear about your challenges.  You are doing a great job overcoming them!!!

Along with the naked day (which is a great idea!), look into this site.  It really helped me get a good latch at first.  

http://www.biologicalnurturing.com/pages/recipe.html

There is also an article to read and a video to watch in the "For Mothers" menu at the top.

Please let us know how it goes!  We're cheering for you!

[Llyra]

Oh, I'm so sorry for everything you've gone through. What a rough start to this big twin adventure! We were all so worried about you and I'm glad to hear you're home, and well enough to be worrying about this issue.

I don't have a lot of specific advice-- I did choose to continue to nurse my twins, even when on meds that were incompatible with breastfeeding (6mp, which causes bone marrow suppression-- it's an anti-leukemia drug that I take to control an autoimmune disease). I took the chance, knowing full well it WAS a chance, because of DS's allergies, and because I'd fought so hard to get him to nurse in the first place. But that's not a decision anyone can advise you to make...

However, with whether they'll latch-- all of mine had bottles, in the early weeks, largely because of my own health problems. Two of them had terrible nipple confusion. One of those (DS2) went on to nurse successfully, into toddlerhood. The other (DD1)-- well, I gave up. But then at nine months old, after many patient weeks, we taught her to latch again, and I managed to rebuild a supply that provided about half of what she needed. My point? There is always, always, always hope!

You'll probably deal with a certain amount of protest from the babies, when the time does arrive-- when we got DS nursing again, he was miserable for a day and a half, until he figured it out. But the urge to suckle is so strong in the early months-- if you arrive at the point where you're ready to commit to it, and give up all the artificial nipples at that moment, and go skin-to-skin, it should happen fairly quickly. If you're concerned about your supply being equal to their needs-- it may not be, that first few days, but it'll come quickly enough!

I'll be praying for you, and for the LOs.

[smeep]

Just wanted to throw in my first thought... lactation aid!!! If they don't want to latch right away it's really great (and I would suggest doing it for supplementing since your supply probably does need a few days to work up to their needs). You know all about lactation aids and that you don't need to order a special one and can just make it yourself, correct? Just checking.  And Kellymom has a really helpful page on weaning from formula supplements so you can cut it out and increase your supply slowly.
 

Originally Posted by annettemarie 

I’ve contacted both Drs. Hale and Newman. One thinks waiting is ridiculous, especially given how rare the chances of side effect are and that I should just start nursing and have the milk tested. There is no place nearby to test the milk. The other agrees that to be 100% sure, I should wait the full 15 days.

I think I know who it was that thinks waiting is ridiculous.  If it's the one I think it is, I have spoken with him a few times for clients and it's pretty much exactly what he's said to me on at least one occasion. Of course, I can't blame ya for waiting! You make the best choice that you feel is right.