5 week prem twins and trying to establish ebf

[Dunoon]

Hi I am posting on behalf of a friend who had her twins at 35 weeks by caesarean section. She had a lot of bleeding and had to be given 4 litres of blood over two transfusions and was very weak and out of it for the first two days.
One baby was 5.10 pounds and the other 3.2. Both were taken to NICU and tube fed. They are now 10 days old and in the less intensive bit in the NICU, off all monitoring and doing well.
My friend is spending all day at the hospital expressing and attempting to feed the babies but has not been able to express more than a tiny amount and although both show interest neither twin is able to feed well from the breast. They get her expressed milk topped up with formula by tube.
She has been told by one midwife that she is holding the twins back by attenpting to establish breastfeeding that the medicine she will be given tomorrow only works in 50% of mothers and that anyway she will never be able to produce enough milk to feed twins. Understandably she is feeling downhearted.
Does anyone have any advice for her and I will send her a link to this thread.
Thanks

TBH, I found some staff in SCBU very negative towards bf when I had ds3. He was born at 32 weeks and was 5lb3oz.

He was tube-fed, then bottlefed EBM and I think in SCBU for a week when I asked a nurse if I could start bfing him directly. She just looked doubtful and said "If you want to" in a tone that suggested that only the slightly weird would want to try!

So I put ds3 to the breast myself and he knew exactly what to do! I am in Ireland, and I'm not sure if it's a cultural thing but the Irish nurses seemed very anti-bf , one said something like "We can't see what he's getting" whereas an Asian nurse and Asian paediatrician seemed much more pro-bf and very keen that I put him to the breast whenever possible. The lovely Asian nurse told me just to feed him when I got home. The Irish nurses said, feed him but then top-up with a bottle of EBM. My instincts told me to listen to the Asian nurse but there was a slight niggle in my mind that said he was so small that maybe topping up was a good idea. So I tried topping up after a couple of feeds but ds3 never took more than 10ml of a top up so I felt that he was getting enough direct from source and gave up the top-ups. He thrived!

You do have to be careful with prem babies but your friend's twins are not as prem as my ds3 was so should be able to suckle? If they do, and I suspect the bigger twin at least may be more able, then a baby at the breast is a great way to improve supply, even if they do need top-ups.

Best of luck to your friend!

Thanks for replying chipmonkey. Did you find any problems with your son getting confused between bottle and breast? This is something which is worrying my friend.
Her bigger twin is very sleepy and less active. It is the smaller baby which latches on and suckles best. However she only latches on sometimes and sucks for a minute or so.

Breastfeeding works on supply and demand so it is possible to make enough milk for twins.

Get your friend to insist that at least some of the tube feeds are done with the babies awake and at the breast so they start to associate food with waking up and boob. Getting the SCBU staff to give dummies for some other feeds can also help them to associatev sucking with getting food. We had real issues with DD not learning that she had to wake up and work for feeds.

She needs to be pumping every 3 hours, maybe 4 hourly at night. Compressions and massage really help. I found having pictures and video of DD by me helpful when she was in SCBU, plus a muslin that smelled of her - I slept on one that she then had that night and we swapped in the morning so she also had something that smelled of me. I found pumping was really affected by being stressed, exhausted, hungry or dehydrated so she needs to look after herself.

Breastfeeding is still best, even if she ends up mix-feeding both twins long term.

Thanks japhrimel. The lack of a link between waking up, being hungry and the feeding is something which had occured to me but I presumed that with smaller babies and in a hospital/SCBU setting the routine was very rigid.
One midwife has already made comments about it not being fair to 'make the babies cry' and when I visited there were comments about the time as I was making one baby [the one who was asleep] late for a feed.
It's all so different from having a full term singleton at home, hard as that can be at times and I don't feel qualified to advise.

Agree with japh re the pumping. Has to be very frequent and through the night too which is sooooo hard because you are so tired but it does pay off.

Sounds like that MW is more concerned for her own convenience than for the babies, tbh

Is there a lactation consultant in the hospital that your friend could talk to?

I would keep putting the smaller baby to the breast, seeing as she will latch because a baby is a much better stimulant than a pump. Also some Mums can never pump much out but manage to supply enough for the babies, so tell her not to assume that because the pumped supply seems low that the baby will be getting nothing if she feeds.

Another thing that can help is kangaroo care, which is wrapping the baby up skin-to-skin in a sling. The baby can smell the milk and the Mum has baby close up so it can help to stimulate supply.

pump.

sorry bump!

Definitely keep a picure of them close. DS1 was 5 weeks early and it really helped.

Remember the amounts are tiny at first - I couldn't believe the small amounts that constituited a feed.

Make sure bm takes priority over formula.

Don't forget night expressing is important.

She could put them to the breast AT THE SAME TIME as them being tube fed.

Contact La Leche League/ someone similar - maybe someone with knowledge could also visit.

A good friend of mine had twins (born at full term) 7 lbs each, she ebf for 6 months. You make milk supply and demand. Find out whether she needs to express more often to make more milk for twins.

Can they offer donated bm over formula?

Hope they are all ok.

Here is a link to the Bliss site that has a leaflet about breastfeeding premies that you can download.

here it is

Good luck to your friend, she'll need to have a thick skin to ignore the comments from the mws. Instead of supporting and encouraging her, they seem to be hell bent on knocking her confidence.

YY to Kangaroo care.

I didn'y always fight my corner in SCBU (in my defence I was also ill) to this day I regret it. I hope she can.

Support her to fight. I didn't always fight my corner either and later wished I had done. I felt swamped, but looking back, the staff knew DD wouldn't be in SCBU long so really weren't that fussed at working on getting feeding established! And things like tube feeds being done when babies are awake and being held at least can be implemented without much impact on the LOs. Your friend won't be able to be there for every feed because of needing to pump and sleep, but she can insist the staff make an effort to not do tube feeds on sleeping babies in cots all the time. Their dad and any visiting family holding a baby whilst it is fed is better than nothing. When DD left hospital, she had no clue that she had to be awake to get fed! And sometimes, prioritising kangeroo care and bfing attempts over getting a tube feed down them on the hour exactly is the right thing to do.

Thanks everyone.
I just got off the phone with my friend and she is going to read all the posts soon. Hopefully she is off to bed right now!

Does the hospital she's at have donor milk? Can she ask to get some?

How is she expressing? Via a pump and/or by hand. She's welcome to call me (number on my website www.mammydoula.co.uk. My latest twin mum had 12 week premmies and they started mixed feeding and are now exclusively breastfed. Happy to help if I can.

Mars xx

Breastfeeding twins is as easy as breastfeeding a singleton. Supply and demand is the same for one or two (or even three). We were designed to feed twins (two boobs you see).

She needs to do as much kangaroo care as she can, skin to skin etc. I agree with the posters that said the babies should be put to the breast at the same time as the tube feed and one more important thing to remember is that they are HER babies and scheduling shouldn't stop her from holding them if they are not in incubators. Anyhoo... as I said, she's welcome to get in touch.

Hi, I got your message and have replied.
I asked her about donor milk last night as I had noticed posters for it when I visited the NICU
I hope she has had time to read the thead.

Mars "breastfeeding twins is as easy as breastfeeding a singleton". Actually no, it is more than twice as difficult to breastfeed twins as it is to breastfeed a singleton. You will be woken twice as much which will affect supply. And you are trying to make double. You will either have to master tandem feeding (which will necessitate someone passing you the second baby during the first few weeks) or you will have to spend twice as long breastfeeding and will have to let one baby cry while the other feeds. Even skin to skin with both babies at once is complicated to achieve if you are on your on. So it is more difficult.

It's not impossible, but you need an awful lot of support.

That's not intending to put your friend off dunoon, she should definitely persevere. One advantage of being in a hospital setting is that she should be given easy access to the hospital breastfeeding counsellor who should be able to advise her on this. She will also have time, hopefully to increase and establish her supply while there is other support around.

Mars' experience is obviously different to yours then Schmee as she has had twins herself and has supported lots of other mothers with twins through her doula job.

I personally don't believe that being woken twice as much will affect supply although obviously you'll feel better able to function if you have had some sleep.

I'll post properly once my twins are in bed. I'm still breast feeding they are five & a half months now. It is possible, mine were born at 34 & 3 and it was hard work in the beginning but one established it's really been easy for me, echo ing what Mars has said

Pop back later

Why do we tell women to get as much rest as possible to help their supply if lack of sleep doesn't affect it?

Mars may have had a really good experience but frankly I think it's just plain common sense to say that doing twice as much of something is harder work. I also think it's a little bit insulting to the achievements of the women that do exclusively breastfeed twins.

I'm back for my update
I was out of it from my c section and because my 2 were under 6lb, they advised topping up with formula from the word go, as it's not good for them to lose any weight whilst waiting for the mothers milk to come in. I just did what I was told but really wanted to breast feed.

Midwives advised me to put the babies to the breast before each feed but they would do 2/3 suck and fall asleep. They were pretty much asleep for the first 3/4 weeks I miss those days.....

Anyway, I was expressing milk using the hospital pump, 3 hourly even at night. I found it quite easy and produced a lot of milk, but I know it can be difficult. I had the girls next to me as I was lucky enough to be in a private ward due to my company health insurance.

First 2 weeks I would put baby to the breast, then give them expressed milk and then top up with formula, then express for the nex feed. They would be asleep and it was a nightmare literally squeezing it down their throat. Luckily I had my mum with me and DP for help in the evenings, I did nights on my own.

They slowly started being awake more and suckling on the breast more, when they were 2 and a half weeks old I stopped the top up and only breast fed. Midwife weighed them and they were putting on weight and thriving.

Since then I've found it a doddle and as I said before we're coming up to 6 months. I still prefer feeding seperately but sometimes you do have to do both, I was always fine tandem feeding on my own. I'd put the babies on the middle of the bed, surround myself with pillows and then latch both on. Later I bought the EZ2 nurse cushion. I'm usually on my own too, DP works long hours and you just get on with it. Hard work yes, but fun and a joy all the same

Once your friend is feeling better, tell her to come and find some twin mums on the multiples boards, very friendly and lots of help

Good luck

Goodness me there are some similarities here! I had my twins at 36 weeks by c section and then had a 7 pint pph, big transfusion and was deteined to BF as I'd exclusively BF my son for 13 months. The factor which was BY FAR the most difficult was the PPH as presumably whoever donated the blood I had, wasn't pregnant with twins, so my hormone levels were all over the place, as well as severe anaemia - both major factors in milk supply. (I'll reference that if anyone is interested.)
I got hold of domperidone when I got put of hospital, to increase my supply - it worked but only for as long as I took it and it gave me awful side effects. One of my boys absolutely couldn't latch- I had a series of lactation consultants and representatives from La Leche League try their best but to no avail - he'd just stretch backwards and scream. It turned out he has reflux, as does his twin, and I managed to get him to take expressed milk fairly well, only for him to throw it all back up again, and again.
I was So ill, so exhausted, and so overwhelmed all I could do was cry and think about sleep. I had to continue with formula top ups which got steadily bigger as my boys grew, and at 7 weeks very reluctantly called time, in the knowledge I'd done everything I could.
Your friend could try domperidone, and also speak to proper lactation consultants but she has to understand that she isn't on a level playing field with the rest of new mums. Babies born early often do have confounding difficulties which although not insurmountable in the long run, make BF very very hard in the first instance, and she's dealing with that twice, on the back of a blood loss.
Breast is best when everything else is equal but sometimes life isn't "equal."
And Mars, you sound off your nut, trotting out nonsense like BF twins is as easy as BF a singleton. Great for you that it worked out. And once it's established, yeah I'm sure it's easier than FF, but getting BF established in two babies is TWICE as hard as doing it in a singleton. I'm so glad you weren't my doula, you sound terribly smug. "Two breasts you see." Get over yourself.

schmee... I exclusively breastfed my twins and also my singletons. I was a little more tired but actually I didn't wake twice as much. When one woke I woke the other.

When I work with my twin mums we talk about how breastfeeding works and how to make it as simple as possible. I don't believe that I insult anyone when I say that it is as easy as feeding a singleton. I have worked with mums with preemies and term twins.

Sleeping, or lack thereof, affects MUM in the main, but not the milk. If both babies are latched on then she will produce enough milk for both. By putting the babies to the breast and allowing the oxytocin and prolactin to work the milk is produced and delivered.

We also work through how to deal with picking up twins, it is not necessary for someone else to pass you the second baby. But it does take a moment to realise that you are capable of doing it. (and you get used to picking them up like puppies - by the scruff of the babygro)

I do appreciate what you are saying and if you feel insulted (I don't know whether or not you are a twin mum) then I apologise for that was not my intent. But I stand by my words that it is as easy as feeding a singleton.

When it came to staying in hospital... often it is the staying in hospital that lessens your supply because you meet many HCP and others who tell you how hard it is to feed twins, how you'll never produce enough to feed twins etc and how it will be essential that you have to supplement with formula (mix feed). Not that all HCPs etc will say that.. but in my experience, and it is vast, that is the majority view.

I picked up your message Dunoon. Hope I can be of help.

I wasn't trying to be smug Holly. Honestly I wasn't. It was the "not enough milk for two" that I was addressing. It is entirely possible to feed one baby with one breast, therefore it is no great leap to think that two breasts can feed two babies.

Tone doesn't carry well in print and online. In life, I come over better than I clearly have here.

Shouldn't they be getting donated BM rather than formula ?
TBH the HCP shove formula down everyones throat my friend has just had a 4 week early baby and he's got a bit of jaundice, guess what the answer to that is apparently - cow and gate

Holly, I contacted Mars to ask her to come on this thread because I have "known" her on Mumsnet for years. She has always come across as being lovely, kind practical and supportive and was the first person I thought of when I saw this thread because I have seen her help numerous other struggling Mums of twins. I am sorry you had such a hard time with your twins but pleast don't take it out on her. She is anything but smug and your comments are very unfair.

jhl.sagepub.com/content/11/2/123.abstract

And more about PPH and breastfeeding:
www.biomedcentral.com/content/pdf/1746-4358-5-5.pdf