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Nursing twins not going well

post #1 of 35
Thread Starter 
I had my twins Fri 3/28 at 35w6d by c/s. I'd had a c/s scheduled for 4/8 due to breech presentation of both babies but it got moved up because I'd developed severe pre-eclampsia. I was on mag after the c/s. Both babies nursed in recovery. Baby B ended up in NICU a few hours later due to blood sugar issues. I was off the mag 20 hours after surgery (they wanted to run is 24 but I begged them to stop it - I felt like sh*t on it!!!) Baby B was in NICU till Monday night. I was allowed to visit but between having Baby A to care for and being not exactly up to moving around... I think I only saw her maybe 2-3 times a day. DH went more often to give her bottles and little hand expressed tubes of collostrum I was making. Baby A pretty much slept and slept and did not demand to nurse anywhere near as much as my son (a 39 weeker) had. So between the pre-e, the c/s, the mag, A not wanting to nurse much, and B not being around to nurse... my supply is off to a lousy start.

A was losing too much weight in the hospital and they wanted us to start her on formula. We did but requested we be allowed to use a supplemental nursing system. The hospital had BIZARRE anti-breastfeeding policies and the only was we were allowed to do this was to ghetto-rig a feeding tube into a bottle of formula and run it into the baby's mouth while she nursed. Inpatients were not allowed to use the hangie thingie with the two tubes running down. Don't ask why - I don't understand why. Luckily the ghetto-rig worked well enough - but we weren't allowed to use the SNS with Baby B in NICU at ALL. I was allowed to "nurse" her (colostrum only and not much of it!) and then we had to give her a bottle of formula - we could not combine both steps with the SNS. (I was seriously about to rip her IVs out myself and run off with her... this place was total twilight zone!!!) Oddly enough, despite this, B is my better nurser - she has more interest, will suck more/longer... but both babies tend to nurse some and then fall asleep. They sleep ALL THE TIME. Totally different than my son! They're not putting on weight and my supply is wimpy. (Baby A was 5-14 at birth, down to 5-3 now; B was 5-1, is 4-10)

I went to see an LC yesterday and our plan is to feed every 3 hours - wake them and make them feed. (one breast per baby - I alternate babies since B is the better nurser) Then DH is to top them off with a bottle and I am to pump. At night time however it is to be bottle only and I pump only. I am taking fenugreek 5 caps 3 times a day and also mother's milk tea 3 bags a day. The hope is to get my supply up/maintained while the girls get enough nutrition to grow stronger/bigger to be awake and nurse more.

It's soooooooooooooo frustrating!!! I barely get anything when I pump. I pump 15 minutes after a feed and 25 minutes when there is no feed but regardless I get 1 - 1 1/2 ounces. It's like I don't let down well for the pump. All the milk seems to come out in the first 10 minutes or less, then I just sit there dry milking myself. I was using a friend's old Medela DoubleEase but am now renting a Lactina - doesn't seem to make much difference. I was hoping to see milk come flying out with the Lactina but it's not happening. I am thinking of buying my own pump but don't know that i will have much more luck - looking between Purely Yours or the Playtex Embrace.

I just feel like this is never going to work out and all this frustration is going to be for nothing in the end. it was so easy with my son, I was sure I could nurse twins.

Any been there, done that success stories?? Any tips above and beyond what I am doing?? Any stories of when you had to know when to say when? My babies are only 8 days old so I feel it's too early to give up but I don't want to wind up beating a dead horse, either.

Oh, my bp is still astronomically high... in the 160/110 range... I am taking 300mg labetalol 4 times a day... not sure if the bp or the meds could be a factor. LC didn't seem to think so but the BP is so high and the dose of meds is so high... I wonder.
post #2 of 35
I'm sorry you're having problems.

Quote:
Originally Posted by RunnerDuck View Post
At night time however it is to be bottle only and I pump only.
Why?

Quote:
I barely get anything when I pump. I pump 15 minutes after a feed and 25 minutes when there is no feed but regardless I get 1 - 1 1/2 ounces.
It's ok. What you get from teh pump is not indicative of how much milk you're making... just keep at it.

Quote:
I just feel like this is never going to work out and all this frustration is going to be for nothing in the end. it was so easy with my son, I was sure I could nurse twins.
Don't do this, hon, positive thoughts - you CAN do this!!

Quote:
My babies are only 8 days old so I feel it's too early to give up but I don't want to wind up beating a dead horse, either.
You need to give it AT LEAST 6 weeks.
post #3 of 35
Thread Starter 
re: why pump only at night and no nurse - because when we were nursing they would nurse... and sleep... and nurse a little more... and sleep... and nurse... and sleep... and seem to want to go to bed... but wake right back up... and nurse... and sleep... and go down... but wake back up... and then take formula... the result would be we'd ALL be up and down for 2+ hours for "one" waking and the constant innefective nursing is just causing them to burn calories that they can't afford to expend. So the LC thinks it's better for all of us at night to just cut to the chase and give them bottles (we're actually mixing EBM and formula about 1/2 1/2) 2 oz each while I pump to have some supply for the next day. It was heavenly last night to only be up for 45 minutes instead of 2 hours...
post #4 of 35
My sister had a very rough start with nursing her twins who were also in the NICU for a short time (well, one was, anyway) after a C-section.

They are still VERY skinny, though tall, and it was a very slow weight gain at first. They dropped below the LLL recommended weight loss for that first two week period.

Anyway, she just kept at it and is still nursing them without any forumla (they did a couple bottles that first week to make the ped. happy) and they're 4 months old.

I think you CAN do it, and I wish hospitals allowed more nursing time with babies in the NICU or something, but either way you're milk will catch up and they will gain weight. I think that if you did it with your son, then you WILL be fine.

I know for me I didn't switch breasts EVERY feeding because for my other two kids (not twins) I kept them at the same breast for a couple feedings in a row since I have overactive letdown. Now even though the twins nurse at the same time, if one breast produces more hindmilk than the other, then I want the babies to get two feedings worth on the same breast so that the same baby doesn't end up getting just foremilk each time they nurse (if that makes sense.)

My sister also noticed the same thing since she pumps her milk occasionally to make a bottle for grandma when she's out (I haven't bothered to even try a bottle this time around) and one breast had richer, thicker milk than the other, indicating more hindmilk.

So, anyway, just to encourage you, she was able to get it going, though slowly, and I think you can, too.

Deb
post #5 of 35
First of all, congratultions on the arrival of your twins! I hope you post pictures of your beautiful new babes (did I miss the message--I've not been on here frequently lately).

Second, you deserve applause for your efforts to breastfeed so far. With some moms of twins, it's all easy. But for some of us, struggles are very real. My girls were tiny, and I was constantly worried about my supply (they were usually between the 2nd and 25th percentiles for weight--since both my boys had always stayed above 50, it was just scary--and my twins were full term). I did rent a hospital grade pump. It's very important that you have one that's hospital grade if you're using it to increase supply. Some insurances cover it for multiples--check with yours. With my oldest--a singleton, the LCs in the hospital told me that it would cost less to rent a pump and pump the whole time vs. pay for formula for his first year. With twins, you double the savings (one of the few times twins can be two for the price of one).

I have a friend who had one baby who refused to nurse for 3 whole months--her twin nursed just fine; during that time, my friend pumped for the second twin and tried to encourage her to nurse. Amazingly, after 3 months, the second twin learned to nurse, and she continued to nurse until she weaned. So don't give up yet--there's still lots of time! The fact that you have one decent nurser is good. It's good for a baby to stimulate milk production at each breast.

You might also post at the LLL forums. Karen Kerkhoff Gromada, the author of Mothering Multiples, often stops in the multiples forum and answers questions. I'd love to hear what she thinks of your LC's recommendation regarding nights. Also, she has done tests on different types of bottles and found that only a select few types have a similar flow rate to nursing at the breast--using a bottle with a faster flow could make it much more difficult to help the baby adapt to nursing.

Are you trying the SNS with twin A now? It seems to me that would be better than having her bottle fed each time. However, I'll defer to others' opinions on this one as I'm not an LC myself (but I'd consider getting a second opinion at least from knowledgeable people at LLL).

Also, did the LC know (or look up) whether those particular meds are not a lactation risk? There's a book out there by Hale that lists different medications and their effects on nursing. You could check at kellymom.com to see if any of yours are listed there (though his book is way more extensive than what she can list). I'm sure someone at the LLL forums would have a copy of the book and would look it up for you.

Sorry, I seem to be writing a book tonight Twins aren't easy, but they are a blessing. You will be in a fog for several weeks/months to come. When you emerge from the fog, you'll still be going a little crazy at times (one of my mottos: crazy is good; boring is bad). You are a strong woman, and you will make it, and your kids will be blessed by all the enormous effort you put into this. Please keep posting when you can; we'll be glad to be your cheerleaders whenever necessary.

Michelle
post #6 of 35
Hi RunnerDuck,

I wanted to chime in as a BTDT momma who has nursed a singleton and twins exclusively through multitudes of difficulties.

First of all I applaud your determination and encourage you to seek out local support such as LLL in your area. I know how isolating it can feel to be trying to nurse a singleton in some areas let alone twins. Many healthcare providers are more comfortable with supplementation and do little to help a twin mom suceed. I have met several moms who were simply told "don't bother trying - it's not possible" I am here to tell you that not true. Your body CAN and WILL do this. You are off to a bumpy start - but I hear in your post a lot of determination and strength and THOSE are the things you need to get through this. When i look down at my nursing 14month old twins today I am so thankful I stuck it out. My thoughts:

1. I would wake the babies every two hours to nurse until they regain birthweight AND make gestational age of 37 weeks.

2. Don't expect them to be on the same schedule and don't expect yourself to be able to tandem nurse right now. Many moms find that tandem nursing comes down the road.

3. When you are nursing. Try using the cross cradle hold. It will allow you to most effectively control their head and body for an optimal latch. Also use breast compressions. This will help ensure they are getting hindmilk and help effectively stimulate and drain the breast. It also keeps them more interested in feeding. If you are not familiar with this technique go to www.drjacknewman.com and see his video on breast compressions

4. I would keep them at the breast for ALL feedings. I strongly believe in teaching right from the start and their first lesson is to bond with momma and learn a good effecient latch. If you are needing to supplement at this time - use an SNS. I can't stress how important it is for your babies to learn a good latch AND for your body to get the stimulation it needs. Everyime you introduce a bottle or pacifier you are teaching that baby another type of suck that requires a different mouth position and level of effort. If this is impossible consider having DH use a finger feeder or Haberman vs a bottle.

5. Pumping: When you pump - double pump (both sides at the same time) this will increase your stimulation. I struggle with this. i am a terrible pumper. I have plenty of milk but I can't pump worth a darn. My best strategy is to learn over the kitchen counter and allow my breast to hang into the funnel. While pumping I do breast compressions and these two things helps me a ton. The goal is to not have to pump. If the babies are producing 6 or more wet diapers per day they are getting enough. i would supplement as little as possible. Assuming your babies are healthy i would not follow your LC's reccomendations with you pumping and bottles at night. You will find eventually that everything is easier if you can take pumping out of the mix altogether and the very best solution for your supply to nurse nurse nurse. I worry that this LC is also associated with the screwy hospital you have descrbed.

6. I double checked your medication in Dr. Hale's Medication and Mother's Milk 12 edition. It is an L2 and considred safe. i could not find any indicators of hypertension or hypertension treatment effecting milk supply while taking a beta blocker. Prolactin, secreted while you are nursing may actually help calm you and have possitive bennefits to your hypertension. Your supply concerns are more likely related to a c/s and rocky start with the NICU situation. I think its fine to acknowledge this -but I think the focus needs to be on the here and now and looking ahead and not dwelling and the less than ideal start to your breastfeeding relationship. You can get through this! Be sure you are drinking and eating enough calories. I was eating well over 3500 calories a day and still loosing weight while nursing the twins (up until about 11months). Oatmeal is also a great supply booster and Dr. Newman notes that he sees an even better response to fenugreek when it is taken with Blessed Thistle. Theres also a tincture called More Milk which is great - but I suspect that if you can get the babies nursing exclusively at the breast - that everything will even out.

I know how much of a challenge this is. I know the sleep deprivation. i know the worry and the fear of not feeding your baby enough. But your body CAN do this! Please PM me if you have any questions or need support. I'd be happy to help in any way.

Erika
post #7 of 35
I don't know squat about nursing (you know that!), but
It sounds like you are getting some good advice on this board.

I was about to wish you good luck for the upcoming C-section ... I hope you are recovering well. I'm glad to hear that the babies and you are all at home - wonderful!

Please let me know if you need anything, okay? Groceries, etc. Take advantage of that offer before I pop...
post #8 of 35
Just a and bit of encouragement. I also would recommend the Yahoo APMultiples site -- Karen Gromada is amazing resource for MoMs. Congratulations on the birth of your twins and know there are lots of people rooting for you and your babes.
post #9 of 35
Quote:
Originally Posted by RunnerDuck View Post
I went to see an LC yesterday and our plan is to feed every 3 hours - wake them and make them feed. (one breast per baby - I alternate babies since B is the better nurser) Then DH is to top them off with a bottle and I am to pump. At night time however it is to be bottle only and I pump only. I am taking fenugreek 5 caps 3 times a day and also mother's milk tea 3 bags a day. The hope is to get my supply up/maintained while the girls get enough nutrition to grow stronger/bigger to be awake and nurse more.
Are your babies nursing actively? Can you hear swallowing? How many total ounces of formula (each) are they taking per day in addition to nursing?

Quote:
Originally Posted by RunnerDuck View Post
I barely get anything when I pump. I pump 15 minutes after a feed and 25 minutes when there is no feed but regardless I get 1 - 1 1/2 ounces. It's like I don't let down well for the pump. All the milk seems to come out in the first 10 minutes or less, then I just sit there dry milking myself. I was using a friend's old Medela DoubleEase but am now renting a Lactina - doesn't seem to make much difference. I was hoping to see milk come flying out with the Lactina but it's not happening. I am thinking of buying my own pump but don't know that i will have much more luck - looking between Purely Yours or the Playtex Embrace.
The Lactina is going to work better than the Purely Yours, and certainly FAR better than the Embrace. I urge you to stick with the hospital grade pump, as they are made for increasing production.

You might consider trying this method to help increase your pump yeild (video):
http://newborns.stanford.edu/Breastf...roduction.html

Another suggestion is to use the tips for assisting MER found on this page:
http://www.lactationinstitute.org/MANUALEX.html

You could also consider using hand expression between nursing/pumping sessions:
http://newborns.stanford.edu/Breastf...xpression.html

Quote:
Originally Posted by RunnerDuck View Post
I just feel like this is never going to work out and all this frustration is going to be for nothing in the end. it was so easy with my son, I was sure I could nurse twins.
It WILL work out.

Quote:
Originally Posted by RunnerDuck View Post
Any tips above and beyond what I am doing?? Any stories of when you had to know when to say when? My babies are only 8 days old so I feel it's too early to give up but I don't want to wind up beating a dead horse, either.
Have you tried posting here: http://forums.llli.org ? In addition to many MOM that have BTDT, Karen Gromada, IBCLC, LLLL (Author of Mothering Multiples) can sometimes be found posting there.

Your babies are only 8 days old, and they were a bit early. That in and of itself means that it may take a little longer for them to get the hang of nursing. Remember: Breastfeeding is an art, not a science. Every breastfeeding relationship is different, and you and your babies have to learn together. You can do this. Don't give up!
post #10 of 35
I don't know if this is helpful or not, but my twins turn two months old this week (about 2 weeks adjusted age) and they're still not nursing properly. I'm pumping for them, supplementing one 8 oz. bottle of premie formula each per day. I'm getting about 30 oz. a day by pumping (I think - not keeping exact track).

It's hard to get time to practice nursing with them (because they can't tandem nurse AT ALL - they need too much help latching and keeping their latch, so when they're both hungry at the same time, we just bottle) - but they sound very similar to your two: when they nurse, they don't nurse enough to get really full and they fall asleep. I've heard some other moms say it took them even a month or two past due date to really get exclusively breastfeeding with their twins. So, I'm not giving up yet.

Anyway, on the premise that misery loves company . . .

Pumping's no fun. But I just keep having faith we'll get there. I hope it goes quickly for you.
post #11 of 35
First off, big to you! I'm a bit sleep deprived, so I apologize in advance for this disjointed post.

Hang in there. Preemies are so sleepy for the first month or so. I'm guessing that once they wake up a little, things will really settle down for you.

My issues were different than yours. My supply was never great, even with my singleton. The fact that you nursed your singleton easily makes it even more likely that it will happen with your twins.

I also question the advice about nursing at night. My supply was always best in those early morning (like 3 am) feedings, and my twins actually nursed better when they were half-asleep.

Have you posted on the AP Multiples Yahoo group? They are so helpful, and Karen Gomada posts there all the time. I'm sure she could give you some great advice. I found fenugreek to be quite helpful, though eventually I needed Domperidone.

So, here's my success story: In spite of persistent supply issues, I was able to exclusively breastfeed until my twins were 3 months. Then I had to supplement. I supplemented nearly every feeding until they were a year old (in spite of heroic efforts to increase my supply). Then we said bye-bye to the bottles, and they kept right on nursing until they weaned at 27 months. Supplementing was a pita, but it was better than giving up outright. I am not saying this will happen to you. In fact, from what you've said, I think you guys are going to do great. But I wanted to share my experience because I think it's so easy to fall into an all or nothing mindset. I think that as long as your mental health is not in jeopardy from the struggle of trying to nurse, that you should stick with it. The other question is, do you have lots of help? You need amazing support right now. One of the keys to our ultimate success is that when my nursing troubles hit full force at three months, my in-laws gave us the money to hire someone to help me for 4 hours a day. She did laundry, fed me, washed dishes, and kept me company. It was a godsend.

Just try to remember that it's so early! Even with my singleton, it took 6 weeks to establish a good nursing relationship. You are not beating a dead horse. You are doing something really hard, and you deserve lots of credit.

And take advantage of kjoy2's offer and any others you get!!
post #12 of 35
I'm verbose tonight, forgive me. I just thought of something else to add.

Even though my twins were 6 lbs. 10 oz. and 6 lbs. 12 oz., they did not like to wake to nurse at first. It was very hard to wake them for the first couple of weeks. Remember that your twins aren't really 8 days old. When you adjust their ages for gestational age, they're really much younger. It's going to take them awhile to get into the swing of things.

Once my twins put on about a pound (close to my singletons' birth weights), they woke to nurse much better. Tiny babies are sleepy babies--you have to really work to wake them to nurse. You're doing great; hang in there!
post #13 of 35
Do you have help? I found it invaluable to have help so that the only thing I had to do was nurse the babies. I remember feeling like all I did was nurse them. In the beginning I found it easier to nurse them one at a time so that I could focus on latch plus I needed help positioning them and the sensation of tandem felt creepy.

I had issues with DS falling asleep at the breast so we used to strip him down to his diaper and I'd tickle under his chin to encourage him to nurse.

hugs to you mama! I remember it feeling like it wouldnt get better but I decided to stick it out until six weeks and then I aimed for three months. they just had their first birthday and are still nursing. Be gentle with yourself mama, you can do this!
post #14 of 35
Congrats on your sweet babies!!!!! Although I have not had my twins yet, I had nursing challenges with my singleton. I felt like we were in lockdown in the NICU, and finally got out of there, but had to stay in the hospital as my baby was having a hard time eating.
But..... they wanted a 3 hour schedule, and ultimately she wanted to eat every 2 hours.
I had LOUSY supply. I really didn't understand all the pumping stuff, and although I felt like I always pumped, I don't think it was enough times, though you may be doing that.
It is soooooo hard!!!!! I think so many mamas here understand that. We are all thinking of you, and like others have said, 8 days old is not much! I basically had to wait for my DD to reach 40 weeks gestation before she would nurse exclusively.
Not sure if you'd be into it, and I don't know much about it, as I haven't tried it, but I think there is a medication for increasing milk supply. Again, I really don't know much here, and it might be way too early to even consider that.
You are out of the hospital--- yea!!! and now your nursing relationship will begin to grow and develop.
By the way, we rented a scale for about a month to make sure that my DD was getting enough each time she nursed. Made us a little obsessed, but also brought some peace of mind. You can do it!
post #15 of 35
Another one here who had a really rough start nursing twins. I am so glad I stuck it out, even though we had so many ups and downs. Mine were four months old before we had all their issues resolved and got them off the supplements entirely. It can be done.

I wish I had time to tell my whole story, but I don't. So I'll just say that I agree about doing all feedings at the breast. The SNS is what saved my supply and saved my sanity. What I did was the opposite of what your LC is advising-- I nursed with the supplementer all day, and then just nursed all night. It meant that we were nursing literally all night, but it also meant that my supply was getting stimulated in the best way possible, at the time of day when the hormone levels were peaking. If you honestly can't nurse all night (and yes, I totally understanding the monumental exhaustion after caring for twins all day AND recovering from pre-e and a section! It is overwhelming!), then maybe you can do one or two night nursings with each baby, maybe with the SNS.

I also agree that you should go for every two hours, not three, at least in day light hours. It will make a big difference in stimulating their supply. And the more they eat, the more alert they'll start being. And keep on pumping!

And hang in there. My LC kept telling me that if we could just get them to their original due date, it would all get easier. She was right. It will all come together, with persistence and lots of help from whoever's willing to help!
post #16 of 35
I totally understand where you're coming from!
In fact, I posted something similar not too long ago.
This is not what we expected to happen with our babies, but don't worry - with time and support we can achieve our goals.
My little 34w premies came home from the NICU on bottles of expressed BM and formula- and it took each one 45 minutes to drink 2oz, 8 times daily. Without any nursing attempts. We felt that they were burning so many calories just to drink a bottle that we waited for the nursing. Meanwhile, I was pumping 8-11 tmes daily with a Lactina.

After a week or two they got faster on the bottles. But I still wasn't pumping a sufficient amnt for them both - bugged me! I practiced nursing with them a few times daily, but it was awkward and difficult and none of us were any good at it. A week before their due date we met with an LC to improve the nursing (these are my first) and she recommended to nurse daytime, bottles and pumping nighttime until we get better. Good b/c the feeds would run into each other sometimes during the day, and I couldn't imagine doing that all night, too! So I agree with your plan to continue with bottles at night until their nursing gets stronger. To keep your supply, don't wear yourself ragged.

They hit their EDD this past week and their latch got better...it no longer takes 15+min to get one on. It still sometimes takes 90min to 2 hours to do a feed, but sometimes just an hour. Sometimes we'll do simultaneous now, but I do also work with each individually. My son is now exclusively BF, and my daughter needs a few bottles of expressed BM still. Just this weekend I'm nursing at night now, too. It's been a process.

Having the LC come over was terrific - the pre- and post weighs reassured me that they were nursing more than I was pumping.

The transition was tough - gotta run, more later.
post #17 of 35
I've never had to nurse a preemie (or two), so I can't offer BTDT advice, but . I'm sure it is difficult, but it sounds like you've gotten a bunch of good suggestions already.
post #18 of 35
I just wanted to offer more encouragement and some . You've gotten some great advice here. You might consider meeting with another LC, too, if that's a possibility. Not that the first gave bad advice, but just like any professionals, they will each have their own ideas and the more ideas, the better. Best of luck.
post #19 of 35
Big hugs to you -- I am another BTDT mom, DD was OK but DS was such a struggle (6 week NICU stay despite relatively late birth -- for a preemie -- at 34w5d and good birth weight of 5#4oz). I think it wasn't until he was a full 3 months (12-13 weeks old) before I really felt he was getting it. Hang in there, you have gotten great advice and are doing all the right things. Give it time to take effect.

My only suggestion is to see if you can rent a Medela Symphony instead of the Lactina. I heard anecdotally that some people get poor results with the Lactina but do just fine with the Symphony. I loved the Symphony, almost cried when I had to return it! (But then didn't because I stopped pumping altogether -- ahh freedom!)
post #20 of 35
Just want to add that you're in the tough stage right now - the nursing and pumping and experiencing the frustration of trying to teach tired premies to nurse. Don't be too hard on yourself, and know that it WILL get easier.

When my LC told me the transition would take 2w, I was so grateful....I could keep it up for 2w, but not 2 mos. So hang in there! It WILL happen for you and your babes.
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