Breastfed formula supplmented twins refusing formula?

[deni bronson]

I have 2 month old twins and breastfeeding them both although disappointing, I had to supplement with formula. I have tried all kinds of formulas and finally went to soy where at least the spitting up and gas is reduced. But some days when I really need the break because the pump I received as a gift hurts like heck, I need to formula feed them and they will cry and cry until I breastfeed. I noticed it doesn't seem like my breasts fill up with milk anymore like they did in the first month. Any tips on how to get more milk flowing? I've tried the hot beverages trick, doesn't seem to make a difference because they are still hungry after 20 minutes on each breast. Also not financially sound to purchase a $100-200 pump of my own.

[cameragirl]

Is this a new thing? If it is just recent, there is a chance that they're going through a growth spurt. It's normal for them to hit a spurt somewhere between 6-8 weeks. In that case, they'll want to eat a LOT. I know it can seem overwhelming, but is there any chance you can settle in for a couple days of nursing as much as possible? That will increase your supply and help keep their tummies full. It's also normal for your breasts to not feel as full as the first few weeks, since your supply is better regulated after that time.

[deni bronson]

Originally Posted by cameragirl 

Is this a new thing? If it is just recent, there is a chance that they're going through a growth spurt. It's normal for them to hit a spurt somewhere between 6-8 weeks. In that case, they'll want to eat a LOT. I know it can seem overwhelming, but is there any chance you can settle in for a couple days of nursing as much as possible? That will increase your supply and help keep their tummies full. It's also normal for your breasts to not feel as full as the first few weeks, since your supply is better regulated after that time.

Well, they did it a little at 2 weeks. But then they accepted the formula and 4 oz of breast milk a day. Now, it seems like they ONLY want breast milk and ONLY straight from the breast. Nipple Shields just don't stay put and they are so frantic when they feed, it's hard to help them latch on without accidentally scratching them (I've trimmed my nails and filed them down but still when it catches them, I scratch them). I'm also scared I'll hurt them trying to calm their head to latch on. It's even harder when they both get hungry around the same time. They take so long each to feed to fullness, the other is waking up too so formula was the best way to go at night. My pediatrician ok'ed us to use a little rice cereal to coat the milk for the spitting up but the soy seems to have helped some. Just imagine trying to hold and feed two babies at once on each breast that are frantically turning their heads side to side and crying at 2am! Just too overwhelming... I wonder if stress affects the supply too?

[cameragirl]

I can only imagine - it is tough with one.

[Mama2ChicknLil]

Hey mama! My ds is around the same age and you are my hero for handling 2!!! Your breasts should begin to soften between 6-12, basically your breasts have figured out this milk production thing and no longer become inflammed in response to the milk. Unless your supply has been compromised by something(s) else, I would go ahead and celebrate the end of engorgement! Remember, this doesn't mean you have a lack of milk, though I know that psychologically it's hard to comprehend...heck, I could easily feed two or three babies due to oversupply and I still worry when my breasts remain soft!!

I don't know your specifics, but if you can get to a WIC office and qualify for services they might be able to loan you a pump, I know they offer that here in CA. Just make sure you tell them you are EBF twins. I would also see of you can find one used on craigslist or something, I know they say single user, yadda yadda...while there are no guarantees, my pump is 4 years old and was used twice by the mon who lent it to me for two different kids 3 years apart and it works like a dream for me, Medela pump in style...

Good luck

[Mama2ChicknLil]

Oh, also as far as the pump you have goes, I don't know what kind it is, but when a mom says it hurts to pump I immediately think 1) wrong size cones - a pretty cheap fix, our 2) mom is pumping on too high a setting...I know for example Medela recommend pumping at the highest setting you can stand, but I have found that for some moms (myself included) the lowest effective setting is the best bet. So for example, when I pump I wait for the let down using the lowest simulation setting, and when the milk starts flowing turn it up just high enough to get a good stream and keep it there. It might also help you to go back and forth between the simulation and expression settings, unless your pump does that already (mine doesn't).

Also, don't worry about hurting them, babies skin is still pretty low on nerve endings comparatively speaking, so while they will feel scratches and bumps, it's mostly the quick scare that gets them crying.

I knower your pediatrician oked you to use cereal, presumably to help them feel fuller longer and maybe increase sleep? Pedis are notoriously breastfeeding stupid (no offense), and research studies have shown it does not actually work, and introducing ANY solids to the virgin gut too young can cause problems. Don't know if you are familiar with www.kellymom.com, but I would check it out...especially the why delay solids article.

K sorry, I'm done

[CheriK]

Oh, goodness, I remember those early days.  My twins are turning 10 at the end of the month - you do survive!  We also had to supplement at first and it was so incredibly hard.  But we were able to wean off the supplement and exclusively breastfeed.  Even if you do need to supplement on-going, remember that you have twice as many babies and likely had more interventions for pregnancy and delivery, which make breastfeeding challenging when you have only ONE baby, let alone two.  Your babies will benefit from however much of your milk they receive.

How often is each baby nursing every 24 hours?  How much supplement have they been getting?  Are they getting supplement w/ breastmilk or just with formula?  If they've been getting formula ongoing and are now refusing bottles of formula, it could be that they're getting more supplement than they truly need.  Babies have a need to suck beyond their need for food.  Breastfeeding is ideal for that because if baby is "comfort sucking" they are less likely to trigger a letdown and get a lot of milk.  Bottles are flowing constantly, so baby can't just suck for comfort.  Are you feeding at the first sign of hunger cues (whenever possible - I know if you've got one baby at the breast and the other starts crying there may not be much you can do) or waiting for babies to start crying?   Crying is a late sign of hunger and a frantic hungry baby is going to have difficulty latching on.  Offering to nurse earlier might help with the frantic behavior at the breast.  It might also help to use a syringe or eyedropper to run a little milk or formula onto your nipple as you're latching baby; that instant gratification of milk might help them calm down and latch.  And it's okay to remove a partially full baby from the breast so the other baby can nurse before getting totally frantic.  Do you have a bouncy chair?  Putting one baby in the chair and using your foot to rock baby while you nurse the other can help.  Sitting on the floor so you can care for one baby while the other nurses.  You get creative really fast out of necessity!

Do you have a good supportive nursing pillow designed for twins?  I had an EZ-2-nurse pillow which is bigger and more supportive than a standard nursing pillow, so I could actually get one baby latched on well, then be hands-free to help the other baby.  Otherwise, it was impossible to feed both.  They were such inefficient nursers at first.  Having that good pillow really made a huge difference.

Do you have help at home?   We decided when our twins were young that it took one more adult than the # of babies to keep everything and everyone from falling apart.  Can someone help you with nursing?  I would nurse one baby for about 20 minutes, while my DH or my mom rocked and held the other baby, changed diaper, whatever, then we'd trade.  After another 20 minutes, we'd trade again.  We'd usually do that twice, so each baby nursed for 40 minutes.  That way I could focus on one baby, getting that baby latched really well, making sure s/he was nursing well.  I'd keep one baby on one side for that whole time.  Then DH would finger-feed if either baby needed supplement.  It was crazy how long it took, and then we'd get them to sleep just in time to start it all over again.  We didn't do that every time, it was just impossible.  Sometimes I'd nurse one baby and someone would give the other a bottle, and once I could get them both latched simultaneously it made a huge difference time-wise.

Is there a Parents of Twins club near you?  You can google NOMOTC (National Organization of MOthers of Twins clubs) to find a local group.  Having in-person support from folks who have been there can be so important.  My local club, although not incredibly breastfeeding supportive, brought us tons of clothes and food even though we didn't join until our babies were already born.  And someone loaned me the nursing pillow, so I didn't even had to buy that.  There's a multiples forum here at Mothering, also at the LLLI forums, and several Yahoo groups for mothers of twins.  All good places to get support.  What you're going through is so incredibly hard, but it's so common for moms of twins.

I agree w/ the PP.  Pumping shouldn't hurt.  Some pumps are poorly designed.  Pumping equipment is not one size fits all.  What kind of pump is it?  If it's a cheap pump, it's probably not doing you much good.  If you're in pain, it's causing trauma to your nipples and it may not be providing adequate stimulation to help your milk supply.  I know it's expensive, but getting a good quality pump pays off in the long run, especially if it means you can wean off formula or at least reduce the formula.  You might consider renting a hospital-grade pump for a couple of months to see if you can boost your supply.  A rental pump is the gold standard as far as stimulation.  And most (not all!) rental pump facilities are run by IBCLCs, which means you get some in-person help with pumping and being sure you're using the pump correctly, and that everything fits you correctly.  Remember you're not using the pump for what it's designed for, which is for a mom w/ an established supply to pump when separated from her baby.  You're using it to build supply and for that you might need something different.  Also, flange fit is important.  Are your nipples filling the flange tube completely?  If they are, you need a larger size flange.  Is a large amount of breast tissue being pulled into the tube along with your nipples?  Then you need a smaller flange. 

You might want to try breast compression to increase milk flow while your babies are nursing.  It will probably be easier to do this if you nurse them one at a time, at least until they are latching better on their own.  Jack Newman has wonderful videos and descriptions of breast compression: http://www.breastfeedingonline.com/newman.shtml.  Time at the breast isn't a good indicator of how much milk they're transferring.  Some babies are really efficient nursers and are done quickly, some are quite slow "snackers" and will hang out for a long time.  And if your babies aren't transferring milk well due to poor latch or immaturity or sleepiness, then they might not get enough milk no matter how long they spend at the breast, especially if your supply is low. 

How about an IBCLC or LLL Leader to help?  It would make such a big difference to have someone in person to watch your babies nurse, help you with latch and breast compression, help you watch for signs of adequate milk transfer, develop a plan for pumping and feeding both babies.  Your insurance may pay for an IBCLC, or the hospital where you gave birth might have a breastfeeding clinic where you can get help.  If you're WIC elegible, there might be a peer counseling program or IBCLCs on staff.  And LLL is always free; Leaders have different levels of experience, but some are incredibly knowledgeable and helpful.  Again, the cost for good breastfeeding help is likely worth it in the long run.  We had no money when our twins were born; I'd been on disability & my husband's job had been cut while I was pregnant, so our savings were gone.  If I had it to do over again, I would have spent more money on the tools that would have helped us because it made things so much easier when we finally did.

Karen Gromada's book "Mothering Multiples" is a wonderful resource for nursing twins.  Her website http://www.karengromada.com/ has lots of photos of positioning for twins, which might give you ideas for getting both latched on simultaneously.  Also, the website www.lowmilk.org and the book by the same authors, "The Nursing Mother's Guide to Making More Milk" has detailed info about increasing supply, pumping, supplementing, etc.  If you have a local LLL group, you might be able to borrow both books.

Ed: feel free to PM me if you'd like to chat more.  I know how it helps to communicate with someone who's been there!

Edited by CheriK - 11/17/11 at 5:36pm