Babies very premature. Establishing supply.

[Sevendayitch]

I'm in need of some advice for a good friend who has just given birth to twins at 30 weeks. She really wants to bf. I have successfully bf but don't know much about expressing for weeks on end, which is what she will have to do. We are in Spain so don't have access to the advice lines you have in the UK. How often should she be expressing and for how long? And will she need to wake up several times during the night to express?

Thanks in advance. I really want to give her some sound advice which is why I came here. :)

[FATEdestiny]

I believe that for the first few weeks you have to be diligent in getting up and expressing through the night and very regularly through the day too.

There is an amazing woman who posts on the September Babies post-natal thread who have been exclusively express feeding her child for over 3 months now. So it is definitely doable.

[Waffles80]

My twins (now 6 months) were born at 35 wks. I mix fed both for 16 wks and may have some pointers for your friend.

• agree with PP about expressing through the night. Supply is highest between 2-4am as prolactin levels are highest then.
  

• hospital grade pump - pump each breast. Was advised to only do one initially but subsequently told this was poor advice. I bought a Medela swing double which was good. Was advised to cut slits in an old sports bra to aid hands free pumping
  

• are babies being tube fed? I put mine to the breast when the tube was being used to try to get them to associate full feeling with me / boobs
  

• I used nipple shields to help babies latch. Hand expressed into each (messy!) and the small amount already in the shield helped babies get going.
  

• lots of skin to skin. Found this so hard with my babies as was essential to keep them warm! A sling would've helped enormously. Eventually bought a Moby wrap for use at home.
  

• took ages for my milk to come in as was so stressed! Home comforts and endless support from OH and family helped me a lot.
  

• Other support / advice from La Leche League, Mumsnet (there's a multiples board), Tamba, and a number of FB groups (try Twin Sling - for babywearers but LOTS of bf-ing and v knowledgeable mums), Mothering Multiples. Karen Gromada's site helped me but, if I am honest, I put FAR too much pressure on myself to continue bfing my quite poor feeders and I was often really very miserable in the early days (switching to mix feeding made a huge difference but your friend shouldn't feel obliged to do this!).
  

• Lots and lots of expressing advice on Kellymom website.
  

Hope that helps! Sorry for brevity and kurt bullet points - am in middle of Christmas wrapping.

[TeaandHobnobs]

My DS was born at 31+5. Expressing every three hours and at least once in the night (more than once is better, but supporting a prem baby, let alone two, is hard work and she needs to rest as well). If she can get her hands on a hospital grade pump, all the better, but otherwise she really needs a double electric pump.
Expressing while sitting alongside her babies may help, or otherwise while looking at a picture of them or smelling something they have worn/had next to them. Kellymom is a brilliant source of advice, as a pp said.
It is hard enough establishing breastfeeding with a prem, but twins will be that much harder, especially as they are unlikely to have a suckle reflex for a couple more weeks, and therefore she may not be able to put them to the breast for a while (although, again, as a pp said, kangaroo care is brilliant).
So I really admire her determination to breastfeed, but she mustn't beat herself up if she has to mixed feed, at least at this early stage (my DS was supplemented with formula for the first week or so until my supply could match his needs - I was doubly determined to get to exclusively breastmilk if I could, as formula made him quite sicky). And as they say, every breast feed counts.
Best wishes to your friend and I hope she gets lots of support

[Methe]

I exclusively breastfed my 27wker for almost 2 years after failing to establish bring with a 32wker.

I took domperidone but I'm not sure they prescribe it now. I also tried to mimic how a newborn would feed so I sat attached to my pump all evening every evening and through the night too. Try to pump every 2 hrs to start with with some long pumps too.

It is hard but worth it.

Don't let anyone tell your friend that it can't be down because I can. I know people who have ebf 24wkers.

[RedToothBrush]

Hello, someone on the September thread pointed me this way (DS is just shy of 15 weeks). I've been expressing pretty much exclusively since he was born as DS just didn't seem to be able to latch and it was causing me so much pain. There was some suspicion of very slight tongue tie from one HV and one doctor but 3 midwives and a paediatrician didn't seem to agree. DS was born at 39 weeks so its a different situation all round.

The first thing I would say if she really wants to do this, is she needs to be determined and she'll still need support. It doesn't matter how much advice or how good the pump she has is. I've found it incredibly difficult on some days and its tested my mental strength. It does feel some days like being chained to a pump, and if you have other things going on (like visiting a prem baby in hospital) it will dominate her life. Realistically having someone to do other things around the house is a must.

Second thing, is to have a good pump. Don't skimp on it or try and cut corners. Get the best she can afford as you get what you pay for. Listen to advice - the medula swing is very good. I've not tried a hospital grade one, so can't comment on them.

When I was establishing supply I was pumping AT LEAST every 4 hours 24/7 pretty much religiously until I couldn't get any more out. This includes compressing and massaging the boobs to get every single drop out that is humanly possible. Basically, the more you express the more you produce is the rule of thumb. So whether you get it in a tub to use to feed or it ends up being expressed down the sink (for whatever reason from you've no where to store or because its to get the last few drops off that you can't get into a tub) its still just as important. Really it was about as much as I could humanly manage whilst also juggling a newborn - my advice is really to simply do it every waking minute you humanly can. With a good session in the early hours of the night being the most important of the day. I found this one really exhausting and really lonely (as I was also feeding DS at the same time so it took forever). However the worst session of the day was mid afternoon when I was in the house on my own and nothing seemed to be come off easily. It was the sole destroying one. I had a couple of occasions where I hit a brick wall and really did feel like giving up. I think the fortnight and 6 week marks were the hardest points to get through. I could not have done it without DH's support practically and emotionally. Its enormously stressful worrying about whether you have produced enough or not. If I'm honest, if its prem twins, I really would say that supplementing with formula is probably a realistic, wise move for sanity's sake however good her intentions are or how determined she might be.

Once I got going, I found I didn't need to do it quite as often. I wouldn't really give time scales - its really about draining the boob which can take varying amounts of time depending on the time of day and how many weeks you've been doing it for.

Compressing and massaging boobs are really important not just to get every drop out, but also to try and prevent blocked ducts which are the bane of my life. At the first sign of hard lumps its beast them with expressing by machine but more importantly with your hands. If they get really bad, use a wide tooth comb and comb together the nipple (I've given myself bruises doing this as I've done it so hard. But its the only way to stop the pain of the blocked ducts).

Fenugreek supplements are helpful, if supply slows down, but I personally use them sparely. It tends to over stimulate my supply and cause blocked ducts. You don't need it every day, as the point is to increase supply and once you've down that your body naturally maintains or increases that supply if you continue to express enough. Using it too much gives me more problems than is helpful.

Hot compresses are good for helping with let down. And relieving pain if engorged. Hot baths are good for relieving block ducts in (you can express without getting it everywhere). I can't remember when I last had a relaxing bath now sadly.

Its not easy. It sounds it in principle. Just use and machine and away you go. But its time consuming, pumps have their limitations and it needs stamina and persistence in maintaining your boobs. Machines are simply not as good as babies at pumping. Hand expressing before and after you start with the pump helps to get things going/clear the last few drops.

DS has never really got to grips with breast feeding, and neither did I in the end. I can now get him to latch on occasionally without pain - he got a lot better as he got older and it resolved a lot of the issues we had. However in our case, it just never was for us. DS never had issues with nipple confusion (used tommy tippee bottles) but he got used to the flow of the bottles and easily gets frustrated and impatient if he tries to feed from the breast and if I'm honest I just haven't got the determination to try and persuade him otherwise. Seeking support for that just wasn't for me. However I do think its very possible to breast feed a few weeks down the line, from my experience. I have got DS to do it periodically if he's in a good mood and not too tired.

I think that's everything I can think of straight off the top of my head right now. It can be done, though I have come across a lot of raised eyebrows and HCPs who don't seem to have much of a clue. Google has been my best only friend (bar the September Crew of course who have been amazing).

I found these two resources helpful too:
kellymom.com/bf/pumpingmoms/pumping/milkcalc/
www.fourfriends.com/cgi-bin/milk.pl

[andadietcoke]

I express fed twins for 10 weeks. There were days when I had to top up with formula, so they'd have half and half each - my supply never really increased enough to feed two but I struggled to express at night when they were on 3 hour feeds and it took 90 minutes to feed them both which gave me an hour to sleep if I was expressing as well. The midwives recommended looking at a photos of the girls to help with let down. I hired a Medela industrial pumper from the hospital which was great until it broke and I was still unable to drive after my section so I was a bit stuck - worth having a low tech back up.

[Sevendayitch]

Thank you so much everyone who took the time to reply. Such excellent advice. I will pass it on. :)