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#1 of 15 Old 01-15-2013, 06:55 PM - Thread Starter
 
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Hey, so I am breastfeeding my 10 week old twin girls with a decent supply.  However, they are not growing as quickly as the pedi would like.  (My pedi is all about breastfeeding and when they lost 15% of their weight just after birth and needed supplementation, she gave us some of her own breastmilk)

So, it is recommended that they get an extra ounce or two per day, mostly that I've been pumping with a little of the donating milk.  I've been using the SNS tube at the breast and my girls are really fighting me on it more and more.  I'm concerned about creating an aversion to the breast, even though I only use it once or twice a day to get in that ounce or two. 

A girlfriend who is a NICU nurse (in NZ) was talking to me about cup feeding...quicker than a bottle, no nipple issues, etc. (We were talking on Skype and she watched me attempt over and over to introduce the breast with the tube and how much they seemed to not want it.)  My girls have taken bottles and it doesn't seem to be major issue (though sometimes it is).  I've tried cup feeding once or twice with my last babes and it didn't seem to work.  This time I've tried it three times with one of the babes and she gulps a couple of times and then seems to get really angry and of course then there's no getting her to drink from the cup at all. 

Anyone have any success stories or advice for us?

Thanks.


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#2 of 15 Old 01-15-2013, 07:31 PM
 
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I don't have experience with SNS or cup feeding, but just today my lactation consultant gave me an SNS and she mentioned that some moms have to sneak the tube in baby's mouth after she is already latched on. Maybe you've already tried this...I'm sure you will get some good input here.
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#3 of 15 Old 01-15-2013, 07:32 PM
 
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I don't have experience with SNS or cup feeding, but just today my lactation consultant gave me an SNS and she mentioned that some moms have to sneak the tube in baby's mouth after she is already latched on. Maybe you've already tried this...I'm sure you will get some good input here.
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#4 of 15 Old 01-15-2013, 07:32 PM
 
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Triple post grrr!
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#5 of 15 Old 01-16-2013, 09:51 AM - Thread Starter
 
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Yeah, I try sneaking it in...but then they pull all the way off and fiercly try to re-latch, without the tube!! 

Has anyone created an aversion with a tube?


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#6 of 15 Old 01-16-2013, 03:35 PM
 
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Have you tried finger feeding with the SNS? We did that when DD wouldn't latch at birth and it wouldn't be associated with the breast. If they really hate it, I would not push the SNS at the breast for fear of messing with the latch/nursing. We also spoonfed colostrum but I'm not sure if that's practical for 2 oz. I'd probably opt for a bottle over the breast SNS since it's only a little supplementing. Good luck and congratulations!
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#7 of 15 Old 01-16-2013, 04:06 PM
 
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Have you tried feeding with an oral syringe? They are usually used to irrigate after oral surgery and hold maybe 1/2 to 1 oz.
I used them for supplementing both my boys with great success. If you are interested, let me know and I will give you details.
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#8 of 15 Old 01-17-2013, 09:34 AM
 
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Syringe feeding is a great idea. Otherwise, I'd probably supplement with the bottle. My babe was happily using a cup at around 4 months..so the bottle wouldn't have to be long term. Best of luck, let us know how it worked. :)


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#9 of 15 Old 01-17-2013, 12:22 PM
 
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Quote:
Originally Posted by QMtwins View Post

Hey, so I am breastfeeding my 10 week old twin girls with a decent supply.  However, they are not growing as quickly as the pedi would like.  (My pedi is all about breastfeeding and when they lost 15% of their weight just after birth and needed supplementation, she gave us some of her own breastmilk)

So, it is recommended that they get an extra ounce or two per day, mostly that I've been pumping with a little of the donating milk.  I've been using the SNS tube at the breast and my girls are really fighting me on it more and more.  I'm concerned about creating an aversion to the breast, even though I only use it once or twice a day to get in that ounce or two. 

A girlfriend who is a NICU nurse (in NZ) was talking to me about cup feeding...quicker than a bottle, no nipple issues, etc. (We were talking on Skype and she watched me attempt over and over to introduce the breast with the tube and how much they seemed to not want it.)  My girls have taken bottles and it doesn't seem to be major issue (though sometimes it is).  I've tried cup feeding once or twice with my last babes and it didn't seem to work.  This time I've tried it three times with one of the babes and she gulps a couple of times and then seems to get really angry and of course then there's no getting her to drink from the cup at all. 

Anyone have any success stories or advice for us?

Thanks.

 

In order to prevent nipple confusion, my dd used this type of bottle (called a Haberman Feeder) from birth until the day she figured out how to breastfeed at age 3 months:

http://www.medelabreastfeedingus.com/products/83/specialneeds-feeder 

 

(And yes, during that time, we did the SNS.  Some feedings she did the Haberman, and other feedings she did the SNS, until she eventually learned how to nurse at the breast.)

 

But you asked about cup feeding...


Because she never figured out how to drink from a bottle, my dd drank from a cup starting at age 4 or 6 months when she started daycare, until she weaned. At daycare, she was fed with the cup, and at home she nursed at the breast.

 

First, dd refused to drink from the cup when I was in the line of sight.  Only the baby sitter was able to feed from the cup, and only when the baby sitter had her chair turned so that the baby couldn't see me.

 

1.  Put a big burp cloth on baby sitter's shoulder. Hold baby upright on sitter's thigh.

 

2.  Pour just a couple teaspoons of breastmilk into a plastic cough syrup measurement cup.  Thin-walled plastic cup, with straight (not slanted) walls, 1.5 inches tall at most, and rim without a lip. Fill the cup so that the milk is no taller than 1 cm.

 

3. Pull baby's lower lip forward slightly.  Insert the rim of the cup into the baby's mouth so that the lower rim is in contact with gumline of baby's lower mouth.

 

4.  Very slowly tilt the bottom of the cup up, little by little, until the milk just barely reaches the rim of the cup.

 

5.  Baby's tongue should stick into the cup.

 

6.  Baby should lap the milk up like a kitten.

 

7.  If you are doing it correctly, you will hear a loud slurping sound.

 

8.  After about 5 ccs, stop for a couple minutes, burp the baby (lots of gas!), then resume.

 

At day care, my dd would only drink 1 ounce (30 cc) during a single sitting, then she would just refuse to drink any more than that until a couple hours later, where she would drink another ounce.  She drank barely enough from the cup to get by while I was at work, and then she would catch up by drinking what must have been enormous quantities at the breast once I got home from work.  But then, my dd was already six months old at that time. 

 

WAIT A MINUTE!  I just re-read your post.  You say that your supply is fine.  If you have been nursing these ten weeks old since they were born, then nursing should be well established by now, I think.  I mean, my understanding is that by three months of age, it is fine to introduce a bottle without worry of nipple confusion.  Just make sure that you used the "slow flow" nipples, not the "fast flow" nipples.

 

Are you sure that your NICU nurse friend has fed a baby with a cup before?  Because, for a baby that is only 3 months old, I can't imagine how feeding from a cup could possibly be faster than with a bottle.  When my dd was 4months old and when she was 6 months old, cup feeding was super slow going, like 5cc in 45 minutes.  Dd's breastfeeding friend, who drank from a bottle at daycare, was able to bolt down 6 ounces in only a couple minutes at that age.  It wasn't until dd was about ten months old that dd was able to chug down a cup of milk really fast, like 2 ounces in a couple minutes.

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#10 of 15 Old 01-17-2013, 12:32 PM
 
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Hello,

 

Maybe I am confused because I know nothing about twins. 

 

Are your babies strong nursers? 

 

If you just had a singleton, then most people would simply advise you to offer directly from the breast (without SNS) a lot more often.  (No bottles, no cup, nothing but just more breast.)  I was wondering why that is not the same advice you were given for your twins to give them their extra breastmilk?  Is it simply because bottles and cups are easier to measure?

 

From what I read in your post, I'm really not clear about why you need the SNS.

 

Could you explain why you are using the SNS? 

 

The reason that I had to use the SNS was because my dd did not know how to latch on, and by starting the flow of milk quickly, the SNS helped her figure out that she needed to suck quickly and hard in order to create let down.  But your post doesn't seem to indicate the type of problems that I thought SNS is for.  I thought SNS is sometimes for babies that need to be encouraged to suck until the letdown is created, but your children are fighting to latch on without the tube, then that can't be it.  I thought SNS can be helpful for babies who are reluctant to latch on because the milk does not come out of the breast instantly, perhaps due to low supply, but you say your supply is good, so I don't understand what the SNS is for?  Certainly there are several other reasons that SNS is needed, but are you positive that you need the SNS?

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#11 of 15 Old 01-17-2013, 02:30 PM - Thread Starter
 
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Hey Emilysmama,

I am needing to get another ounce or so in them and in order to associate milk/fullness with the breast and give my body stimulation from the suckling at the breast, it was recommended to use the SNS. 

Both are stong nursers.  Right now they are at the breast 8+ times a day.  As of 2pm they have breastfed at least 5 times since midnight.  I am not limiting their time at the breast at all.  If they cry, that is generally where they go as soon as can be managed with 2 other 2.5 year olds around!  I'm pumping a couple times a day to encourage my milk supply and then giving it back to them by the SNS, occasionally bottle by my DH. 

My doc thinks they need that extra milk that I pump or use donated milk...she estimated the amount/day.  So, now I'm just working on the best way for us to get it in them without damaging our breastfeeding at all. 

My NICU friend and I've seen video of it too, has used cup feeding with brand new babies who have need for milk and can't get it directly from the mother's breast...we just were not having any success with the cup and the point of my original post was to see what expereinces others might have had with it.  I don't know anyone in my area, even the lactation consultants, who have used cup feeding. 

Maybe using the bottle is the easiest way to go.

Thanks for reading!


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#12 of 15 Old 01-17-2013, 08:56 PM
 
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Originally Posted by QMtwins View Post

Hey Emilysmama,

I am needing to get another ounce or so in them and in order to associate milk/fullness with the breast and give my body stimulation from the suckling at the breast, it was recommended to use the SNS. 

Both are stong nursers.  Right now they are at the breast 8+ times a day.  As of 2pm they have breastfed at least 5 times since midnight.  I am not limiting their time at the breast at all.  If they cry, that is generally where they go as soon as can be managed with 2 other 2.5 year olds around!  I'm pumping a couple times a day to encourage my milk supply and then giving it back to them by the SNS, occasionally bottle by my DH. 

My doc thinks they need that extra milk that I pump or use donated milk...she estimated the amount/day.  So, now I'm just working on the best way for us to get it in them without damaging our breastfeeding at all. 

My NICU friend and I've seen video of it too, has used cup feeding with brand new babies who have need for milk and can't get it directly from the mother's breast...we just were not having any success with the cup and the point of my original post was to see what expereinces others might have had with it.  I don't know anyone in my area, even the lactation consultants, who have used cup feeding. 

Maybe using the bottle is the easiest way to go.

Thanks for reading!

 

Hi again,

 

I apologize for still being a little confused.

 

I understand the part about how the ped wants you to get another ounce per day in the babies. Whether your ped is correct about the amount, I can't tell, based on what you've written. I guess I'd have to look at her calculations in order to understand that. I was just wondering, however, whether your ped is taking into consideration the following factors listed in:

http://kellymom.com/bf/got-milk/supply-worries/enoughmilk-older/

The reason that I ask is because when my dd was that age, I found that counting the number of wet diapers was a much more reliable indicator than counting ounces. Don't get me wrong, because I kept track of both, but the number of wet diapers was a more direct and accurate measurement than counting ounces.

 

I also understand that it is generally good to get a baby to associate milk with the breast. However, I am confused because you say that the babies pull away the tube and fiercely try to latch on without the tube. (Do they succeed in latching on? It sounds like they do.) So, unless I am missing something, it sounds like the babies already have already established a definite understanding that latching onto the breast leads to milk.

 

I can't figure out what you mean about associating fullness with the breast. Do you mean that you want the babies to associate their stomach's fullness with something about your breast? Or do you mean that you want your the feeling of fullness of milk felt by your breasts to, well I don't really understand what you meant. Could you please clarify? Because my understanding is that when you offer the breast, the milk will come out of the breasts, whether or not the breasts feel full. (And at about ten weeks, the breasts will feel less full than before, but the milk nevertheless gets created to meet the demand.)

 

I definitely understand why you want to give your body stimulation by suckling at the breast. What I am really confused about is why nursing with the SNS will do that more effectively than nursing more often without the SNS. What really confuses me is that it takes a lot of time to prepare the SNS, and that is extra time that I would think could instead be used to offer the breast more often. From my experience from when I used an SNS, offering the breast without SNS more often, is no work at all, compared to all the work required with the SNS.

 

Also, my understanding from how the SNS works is that the SNS gives the baby a little taste of milk before the breast lets down in order to encourage the baby to suck more vigorously to get the breast to let down its own milk. But, unless I am misunderstanding you, when you say that your babies are strong nursers, it sounds like your babies are already able to get the milk to let down from your breast, correct? So that's why I can't figure out what the purpose of the SNS is for in your case.

 

Okay, the babies are at the breast at least 8x per 24 hours and between midnight and 2 pm, were on the breast 5 times since midnight. So 8x per 24 hours is an average of once every 3 hours. From midnight to 2pm is 14 hours, and at the breast five times during that 14 hour interval, means that the babies are averaging 2.8 hours (~3 hours) between feedings.

 

I understand what you mean when you said that you are not limiting time at the breast. I guess my question is whether you are encouraging the babies to feed more often by offering the breast before the babies cry. You said that if the baby cries, then the baby goes onto the breast as soon as you can manage. It would seem to me that if you want the babies to get more breastmilk, you would want to offer the babies the breast before they start crying. In other words, instead of feeding 8x per day or every three hours, offer the breast 10x per day or every two hours. (How you would accomplish the logistics with two babies and 2 toddlers running around, I have no idea. Perhaps cross-posting in the Multiples SubForum would give you practical suggestions.)

 

I understand the part about how you are pumping, to encourage your milk supply, and then giving it in the SNS and/or Daddy delivered bottle. Speaking as a person who pumped around the clock for two weeks to successfully build up her supply from a total zero, and then maintained the supply for three months doing round the clock pumping and no nursing, I have to tell you that pumping is much less effective at encouraging milk supply than offering the breast more often.

 

Furthermore, and I know this first hand, the extra time messing with the pump and the SNS and/or the bottles takes a lot of time, and that's time that would be more effectively used at offering the breast more often. In the time that it takes to pump and deal with the SNS, you could feed twice from the breast and put a lot more milk into your babies.

 

Now, forgive me if I'm asking the obvious, but are you feeding the babies one at a time, or both at the same time? Because I have read that mothers with twins, even those mothers without the two extra 2.5 year olds running around, feed both babies at the same time so that they can get fed often enough. (I apologize for guessing because I don't have any experience about twins, but I thought some of my friends with twins mentioned that unless you feed the babies simultaneously, then there just aren't enough hours of the day to feed the twins.)

 

Okay, so again keep in mind that I know nothing about twins. But here are my thoughts. My first choice would be to offer the breast (no SNS) a couple more times a day instead of, or in addition to, pumping. Second choice would be either bottle or cup. Second choice would be cup if you had legitimate concerns about nipple confusion, but I don't understand why there should be worry about nipple confusion because breastfeeding babies often get introduced to bottles at age 3 months without any problem with nipple confusion. If the baby were just a few weeks old and nursing relationship has not yet been strongly established, then I could understand the fear of nipple confusion. The problem is that, in my experience, the cup is very time consuming and messy, or at least it was when my dd was 4 months old. When my dd was 4 months old, one measly ounce took 45 minutes, and the sitter ended up wearing a lot of that ounce. By comparison, at three months old, my dd was able to put a way a lot more than one ounce in a single nursing session, and she was able to do this even though was a super slow nurser. So I can't really think why you would choose a cup over adding extra nursing sessions (no SNS). Bottle would be fine for a strong nurser, as long as you pump at least once (perhaps twice) for each bottle feeding session in order to prevent your supply from dropping. If you worry about nipple confusion, then you should use the slow flow nipple, and not the fast flow nipple. The only advantage that bottle or cup has over more nursing sessions is that the bottle or cup can be done by Daddy or someone else, but it seems to me that the time saved by having someone else doing the bottle or cup feeding would be offset by time that you would lose by adding the extra pumping session to keep your supply from going down. So it just seems that given the choice between bottle and extra nursing sessions, the extra nursing sessions would be more effective and less work.

 

BUT, and this is a big but, I don't have four children (two of which are nursing), so what seems to be less work for me might not be true for you.

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#13 of 15 Old 01-18-2013, 09:32 PM
 
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What were their birth weights?

Their weights at two weeks?

Their most recent weight?

 

Have you tried spoon feeding? This isn't in English, but it's a good demonstration:

 


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#14 of 15 Old 01-23-2013, 10:48 AM - Thread Starter
 
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Phathui5, Their birth weights were 7#1oz & 6#13oz.  At 2 weeks they were still under their birth weights (they had lost 15% each). At 2 months they were 8#13 & 8#11oz.

 

It was causing much stress and anxiety trying to cup feed, so we are now just giving their supplemental ounce or two, which is expressed brest milk, by bottles.  I am pumping about 3 times a day, after a feed, for about ten min each time.


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#15 of 15 Old 01-24-2013, 04:34 PM
 
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Sounds like you've got it figured out (using the bottle) but I was also going to mention spoon feeding. My son had a feeding aversion and would nurse nor take a bottle. I fed him expressed breast milk from a spoon!! He'd just slurp it up, one little spoonful at a time. I propped him up in a bouncy seat and I used a plastic picnic type of spoon which I just touched it to his lower lip and he'd slurp it right up.

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