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Hi - new here!

post #1 of 25
Thread Starter 
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post #2 of 25
Welcome!
post #3 of 25
Welcome Amanda!
post #4 of 25
Welcome, Amanda. And congratulations and Kudos on pumping
post #5 of 25
Hi Amanda. Welcome.

My twins (now almost 2.5) were born at 32 weeks, 6 days, spent 2 weeks in the NICU and it took them 3 months to learn to nurse. It was the hardest thing I've ever done in my life. They self weaned about 2 months ago, but they still ask to nurse every once in a while, so who knows if we're really finished. Are you getting a lot of nursing support (like from an IBCLC or from LLL)? You found a good board for nursing support! I hope you find everything you're looking for.

It's so hard. I know what you're going through. I wasn't as assertive as I wish I would have been in the NICU and I still have pangs of regret about it. If you are still trying after all this time, you are doing an awesome job, mama. I hope you give yourself a lot of credit!

Good luck to you & your babies.
post #6 of 25
Quote:
Originally Posted by twins10705
Hi,
Just wanted to introduce myself..I have twin boys who were born at 29weeks GA this past October -- spent 41 and 51 days in the NICU. They are getting close to 2 months adjusted age now and are surprisingly healthy after what we all went through.
They never gave me the go ahead to even put either baby to breast even once in the NICU...wish I could go back and assert myself, but I've got to work with what I have now I guess. I still pump and bottle feed them EBM...hoping one day to have a real nursing relationship, but I know that it may take many months or may never happen.
Well, thanks for letting me say, "hi"

--Amanda

Hi, Amanda:

How wonderful that you're providing your babies with your milk. However, don't ever give up re: direct BF if that is what you want. They can get there -- I've worked with lots of MOT who have done it. Babies sometimes do learn to BF several months after birth if mother is patient and persistent. The technique and teat used for bottle-feeding can make a difference in how the babies use their mouths. What kind of bottle teat and bottle-feeding technique are you/helpers using? Do the feed easily from the bottle or do they have any difficulties with bottle-feeding? Are you able to Kangaroo (direct mother-babies, chest-to-chest skin contact) them separately or together between feedings? (Makes a HUGE difference.) Do you have help with bottle-feedings so you are free to practice BF, pump and kangaroo with the babies after feeds? Have you ever tried some type of BF aid/device, e.g. nipple shield, which needs to be fit for babies' mouths and your nipple/areola size?

Are you in contact with IBCLC/lactation consultants or breastfeeding support experts in your area? If not, you can find someone by going to La Leche League International's home page and at the bottom is a "find a leader" spot. Also try, International Lactation Consultant Association's "find a LC" on their home page. The International Board of Lactation Consultant Examiners also has a registry of LCs (by state if in the USA).

Happy to help develop a "progress plan" that you think would work in your situation via this site or personal email or phone. Hang in...

Karen
post #7 of 25
Welcome Amanda! That is so great you have stuck with pumping and they are still getting your milk
post #8 of 25
Thread Starter 
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post #9 of 25
Amanda - you rock! I have no advice, just wanted to say you're doing great. Don't rule out keeping in contact with Karen (above poster), she's probably had more experience with moms in your situation than anyone in the country.

Congrats on your little ones and on all you're doing for them!
post #10 of 25
Quote:
Originally Posted by twins10705
It took several weeks to wean them down from those super fast flow cross cut NICU nipples, I now use medium flow NUK nipples for my larger son(medium because the nipple portion is so much bigger than the small and he seems to prefer it) and slow flow NUK nipples for my more petite boy(has a smaller mouth). I do not have any help neither during the day nor night, but I do feed them separately about half the time and I do try to directly nurse at least once per day. I don't prop hardly ever and try to make a lot of eye contact with them and caress and cuddle them. Since they have been on the slower flow, larger bottle nipples they actually do latch on for a minute or two sometimes...once in a while, longer. They usually get frustrated quick with the breast because the milk doesn't come out as steadily or as quickly as the bottle.
We cosleep and I am with them all day every day so we have lots of contact...I still have low supply issues, mainly because I do not let down very well. Every time I hand express I feel like I am only getting 1/2 to 3/4 of available milk...which is not doing much to increase my supply I hand express because pumping doesn't work for me -- I used a hospital grade rental for 2+ months, then a PIS and I now cannot hook myself up anymore, I get panicky like I've been traumatized. When I was pumping every 2-3 around the clock I was only getting 12-14 ounces per 24 hours. Now with hand milking every 3 hours I get 20-22 ounces per 24 hours...I need to be making closer to 50oz per 24 to exclusively feed both babies. I have talked to many LCs and have tried everything they have suggested and more, I am not a usual case for them. I have searched for oxytocin nasal spray, but it doesn't even seem to be available by mail order internationally. I have serious adverse reactions to Reglan(the worst) and also Domperidone. The only thing I have not yet done is attend a LLL meeting...this is not possible unless one were within stroller walking distance.
I tried a nipple sheild to no avail...I have very large nipple/areola area and trying to cram myself into the tiny little nipple sheild was pretty ridiculous and could never get the babies to get a good latch on to it. I searched online for a larger nipple sheild, but the only two sizes I saw that even exist are small and extra small
I bought an SNS that I was really hopeful about -- but the babies will not latch onto me and the tube at the same time -- they are very aware of its presence no matter how I position it. They get this curious look on their faces and just accept drops of milk through the tube without latching or actually try to just suck on the tube itself.
If I get my larger ds when he is sleepy, he will latch on and suckle for longer maybe up to 4 minutes or so...he has been doing this for the past week, so I am hopeful we can gradually increase the duration of each session and the number too.
For now, I wince with every formula bottle I have to give them, but I would never dream of quitting. My babies were both very tiny -- littler ds went down to 1lb13oz in the NICU though his birthweight was 2lb2oz...other ds was 2lb12oz. I want to give them breastmilk for as long as I possibly can...hoping the extra nutrition and antibodies help them grow better and recover from the awful start they had at birth
Thanks a lot for your suggestions...I am pretty hopeful to eventually have the nursing relationship I would like

Amanda, the fact that they will sometimes latch on and that one has occasionally BF for up to 4 minutes is tremendous progress! Yea! Good idea to work with him when he's in a drowsy state. You have reason to feel hopeful!

When one's goal still seems far off, a mom can forget to stop and celebrate the signs that progress is being made. STOP. CELEBRATE. A couple of weeks ago they may not even have latched and one had not even BF for 4 minutes. All these little progresses will lead toward where you want to go -- just via a different road.

Where are they now in terms of weight/size? Are you having difficulty believing they are getting better with maturity and are not as vulnerable as before?

Why are you sticking with the bottle teat you mentioned? When we tested that brand we found they had a faster flow rate than desired for better compatibility with infant oral behaviors needed for BF. Also, a speech-language pathologist LC I work with says they are associated with tongue thrusting, which also interferes with BF but may have other oral implications too. If there's a good reason to continue using, that's one thing but other options may be better if they are now of a size to work with something else. When to full-term size, the SLP LC suggests a wide-mouth bottle teat that encourages a wider lip flange as per BF. (Send a personal email if interested in the names of teats our flow rate testing found as more in line with BF.)

Also re: bottle-feeds, it helps if one reinforces BF oral behaviors by:
1. Placing baby in a sitting/semi-sitting position to allows for more control of flow into the mouth. (None of us would feel comfortable if lying on our backs and fluids were coming in; we sit to eat for a reason -- it automatically slows flow, which protects the airway.) Important -- sitting does not mean baby is hunched over, which can trigger reflux.
2. Stroking down from the tip of baby's nose and over the upper lip to elicit rooting and a wider mouth gape -- just as one does for getting baby to open wide to latch for BF. Wait for baby to open wide so baby latches onto bottle teat as per breast.
3. Taking advantage of pauses in the feeding. While feeding shouldn't take too long, it also shouldn't be rushed. Babies pause during BF when the let-down slows; they pause during bottle-feeds too. Stop the feed for a minute without jiggling the bottle teat to get baby to start sucking again. Let baby take that break so he's used to an ebb/flow during feeds.

Re: nipple shield -- there are 3 sizes of the brand we use at the hospital: very small or 16mm; small or 20mm; and "regular" or 24mm. With preterm babies, you may have been given a smaller one due to babies' mouth sizes but that is not the largest size available and you may find a bigger one works now that they are getting larger.

Re: SNS -- many other mothers describe similar frustrations; a number of MOT have told me they prefer a Lact-Aid nursing supplementer. It is the original "at breast" feeding tube system. If you Google it, be sure to include the nursing supplementer part in the subject line or you may end up with links to med for people with lactose intolerance!

Gotta run...

Karen
post #11 of 25
Quote:
Originally Posted by twins10705
...I still have low supply issues, mainly because I do not let down very well. Every time I hand express I feel like I am only getting 1/2 to 3/4 of available milk...which is not doing much to increase my supply I hand express because pumping doesn't work for me -- I used a hospital grade rental for 2+ months, then a PIS and I now cannot hook myself up anymore, I get panicky like I've been traumatized. When I was pumping every 2-3 around the clock I was only getting 12-14 ounces per 24 hours. Now with hand milking every 3 hours I get 20-22 ounces per 24 hours...I need to be making closer to 50oz per 24 to exclusively feed both babies. I have talked to many LCs and have tried everything they have suggested and more, I am not a usual case for them. I have searched for oxytocin nasal spray, but it doesn't even seem to be available by mail order internationally. I have serious adverse reactions to Reglan(the worst) and also Domperidone. The only thing I have not yet done is attend a LLL meeting...this is not possible unless one were within stroller walking distance.

I'm assuming you were provided some larger flanges/breast shields for the pump collection kit? If not, these can make a real difference in amount obtained AND in comfort. Often helps draw breast in better for helping with deeper ducts. I've also heard mothers with similar histories say they had better results with the Isis manual pump; different flange design helped they believe.

Syntocinon nasal spray may be worth considering. Any compound pharmacy (in the USA) should be able to prepare it if your or babies' doc prescribes it.

I have a feeling your production will respond as the babies' BF improves, since you're doing so well with the amount of milk expression you're able to do. I worked with a mother of quads once whose babies were born at a similar age gestation and really couldn't get BF going for the first several months. Her production was lower than yours; however, she'd BF a singleton many years prior, which I believe allowed her body to get by with less pumping initially. At 3 month one took off and her production went sky high. Soon all were BF well.

Finally, you had twice the usual number of babies. They were preterm and have some making up for lost time. Trying to do it all is a good way to burn out. FIND SOME HELPERS!

Hang in...

Karen
post #12 of 25
Thread Starter 
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post #13 of 25
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post #14 of 25
I don't have any good advice, but wanted to say hi.

And it sounds like your babies are huge!! they must be doing quite well. Mine were born Sept. 1 at 4 and 5 lbs respectively and we are about 13 lbs now.
post #15 of 25
Quote:
Originally Posted by Karen Gromada

Finally, you had twice the usual number of babies. They were preterm and have some making up for lost time. Trying to do it all is a good way to burn out. FIND SOME HELPERS!

Hang in...

Karen
Nice sentiment Karen. Its something that I wish more people would say . . .
post #16 of 25
Quote:
Originally Posted by twins10705
I would love some help, but I don't see how it will happen...its actually getting a bit easier now that they aren't so colicky and sleeping more at night. I take them out on long walks each day -- it tires them out so they sleep better and it saves my sanity
--Amanda
Hi Amanda -

Here is one idea on "how" to find helpers that I've seen others suggest on MDC -- tell your best friend that now that the babies are home from NICU, you could really use some help. Ask her to start a help calendar -- and when anybody asks how you are, or if they can do anything for you -- tell them "yes" and give them your friends number. She can set up a "help-calendar" for you with well-wishers. I am sure they are out there - they usually just don't know "what" to do. Some ideas are: drop off evening meal, come for 2 hours to help rock babies, do an errand for you, come in the morning and do laundry, . . . .the possibilities are endless . . . . and each little contribution can really make a difference in your life. Your Best Friend can even "let it be known" that Amanda would like some help -- and I think you'll be amazed at how eager people are to pitch in for you in times like this.
post #17 of 25
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post #18 of 25
Thread Starter 
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post #19 of 25
Quote:
Originally Posted by twins10705
Well, actually, I don't know anyone in this city, state or area of the country. We moved here last February never intending on having kids so soon...all I did was work work work in the beginning until I was put on bedrest around week 18 of my pregnancy. It was a long, lonely time on bedrest knowing absolutely on one. There was no one to even run to the store for me, so I had no choice but to "violate" bedrest when I ran out of food -- I can't help but wonder if that contributed to my PTL. Then the NICU time...I was also very alone. Now, here with my babies in this 400 sq ft apartment, we are still alone and...I don't think that's going to change. I'm not asking for pity or anything....I've done it alone this whole time now that the babies are sleeping a lot more at night and letting me sleep too it is so much better. Several weeks ago, I didn't know if I was going to make it...no sleep at all I thought I was literally losing my mind. There were times I had to put the babies down and just curl up in a corner for a little while. My parents bought me a twin stroller and had it shipped to me -- it has been a life saver...I walk 8 to 10 miles per day now with that thing...starting to lose a little of the pregnancy weight finally I believe, so things are looking up for me. I hope to be moving out of this studio and into a larger apartment soon. I am married -- but he is never here...he is constantly out or working..whenever he does come home, he immediately puts in earplugs and sleeps until he has to leave again. That's another issue that it's probably best I don't get into..I've actually done plenty of venting about that on the PPD forum so I'll save it for there. At least he puts money into the account to pay the bills -- single women don't always have that luxury.
I do appreciate the advice though -- I know my situation is not one that one would generally assume.

--Amanda
Amanda - yikes - what a year it has been for you. Oh! I sure do wish you lived in San Diego as I would marshall the local moms here to lend a hand! Well - apologies for being dense about your situation -- and here is me, back in problem solver mode - other potentials might be church groups? and local twins moms group? Maybe moms in the local LLL chapter? I know when our triplet moms hear about a new triplet pregnancy or mom - regardless of whether she is participating in the group -- the emails start flying - clothes get delivered, food, diapers -- you name it. Not presuming to understand the limits you are living under -- just another possibility.
post #20 of 25
Hi Amanda,

I'm not too sure what my babies weighright now.. I'm guessing that they are about the same size - the last time they were in together they were 7 oz apart and then Gedalya had to go back in and dh took him and he had totally acught up to her ( and this was less than aweek later). She always seems bigger; it's her build.

As for the dh sleeping and ear plugs; I know howw you feel. My dh spends minimal time w/ the babies and doesn't care for them when they cry. He used to be AP with me and now he says they cry because they are spoiled and always want to be held . He tells me that he's afraid that the twins are just too much for him because he works so hard, is older (47), and has a heart condition. I try to be understanding, but I feel that I'm running a one-man show at home. To his credit, he usually makes dinner and doe the shopping, and takes my kids to school; but I do everything else.

In any case, I just noticed this smiley and I think that you need it... so
here you go. I hope that you have a good day, and if you want, I'm almost always at home and love to talk on the phone (and yes, I can tandem nurse, talk on the phone ANd do my Sudoku puzzle or crossword).
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