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

Chipmonkey I assure you I'm not tasking anything out on mars. I think her stance is utterly simplistic and unhelpful, and in this instance doesn't take into account the highly significant factor of the OP's friend's big bleed. You obviously know her in real life and I'm perfectly prepared to believe that she isn't anything like as smug and irritating as the tone of her post - as she says, tone doesn't always come over well in print, but seeing as I don't have anything else to go on apart from what she writes, it's not unfair at all to take exception to such a contentious statement.

But Holly, even in that second study, 63% of women did manage to breastfeed and considering that 85% had hoped to, that still means that Dunoon's friend may have a better chance of succeeding than failing given the right help and support, which seems to be sadly lacking

My own haemoglobin levels when I had ds3 were 5.5 and apparently in theory I should have had a transfusion but my obs didn't want to give me blood. ( Around that time there had been a scandal in Ireland about contaminated blood being given to new Mums and they had been infected with Hep C) I looked like Dracula's daughter but with hindsight, maybe this was better?

I was lucky. I produced a lot of milk despite this and ds3 never, ever had formula, but still feel that the SCBU staff were concerned with schedules and weight gain and were not bothered about getting bf established. There were lots of prem babies there and my feeling was that the staff were happier to throw a bottle of nutriprem at a new Mum rather than help her with bf. As far as I could see, the only ones who were successful were the ones who took it upon themselves to establish bf, usually Mums with prior experience. A friend, who had had her baby in the same SCBU previously had worked very hard to express for her baby, only to have the staff give him formula instead.

And I don't know Mars in RL, only from Mumsnet. I live in Ireland so don't think I have every met any MNer that I know of. It was purely based on her posts here that I asked her to come on.

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.

schmee bf twins isn't always harder than singletons. twins are more likely to be accompanied by complicating factors (be prem, born by section), but I got lucky and had my twins normally at 38 weeks. I have found ebf them easier than feeding ds1 (who also had formula). I have never needed someone to pass me a baby, I have woken less often than with ds1 who was a truly awful sleeper, and I suspect dt1 was better as a twin than she would have been as a single, because when she was small, sleepy and finding it hard to latch, dt2 did all the sucking needed and she was able to just wait for him to start the let down.

Actually the hardest thing I found was maintaining my confidence in the face of HCPs and friends who assumed I would not be able to bf twins or that I should be finding it incredibly difficult, and this is why I wanted to respond to your statement.

OP: I hope your friend gets the support she needs. I have found twins hard, but feeding them doesn't have to be, though it sounds like they're having a tough beginning.

Mars is quite able to stand up for herself, so I won't boost her ego any more by saying how fabulous I think she is

I posted the second article as it gives a very good study of the effect of PPH on BF. The figure of 63% is firstly in relation to ALL women, not just twin mums and is BF for one week and the OPs friend has already done this. The very interesting part about the study relates to drop off rates which are greater than in the general population, who didn't have blood loss.
It also demonstrates that the likelihood of BF ending is even more likely if the woman received a transfusion, had a high blood loss (over 3 litres), her baby went to SCBU and if she had a C Section. As well as delayed lactogenesis, the PPH can be a precursor to Sheehan's syndrome, with chronically poor prolactin levels, so the milk supply NEVER gets the chance to establish, and therefore the theory of supply-demand simply doesn't work.
And that's my point - the OP's friend has LOADS of factors which will make BF difficult and although it's not up to me or anyone else to say what's impossible, it's no good ignoring how the odds are stacked. I really really hope that with good support, and the right drugs she is able to feed the way she wants, but if it doesn't work our, she should know that absolutely she was facing a very difficult battle.
I so so wish I'd read this article when I was desperately trying to keep on BF my twins. I can't believe I put myself through it, but I was utterly determined that attitude and maternal effort were all that was needed and that simply isn't the case. I would have still fed for as long as I did, but wouldn't have beaten myself raw for "failing" when actually, it was a bloody miracle we'd come that far.

BagofHolly - thanks so much for the link about PPH and breastfeeding. I believe I'm probably going to need a blood transfusion for this pregnancy (due to placental complications) so it's these kind of tips which will really help me understand what I need to be considering.

MamaChocoholic - I really don't want to get into a massive discussion about this, but feeding two good feeders may be easier than feeding one baby where there are issues. But feeding two babies who have different feeding issues is obviously going to be more difficult than feeding one.

I fought tooth and nail to bf my twins (although only ever achieved mixed feeding for several months) and I would fight tooth and nail to defend a twin mum's right to breastfeed. But I don't think that denying that things can be difficult helps anyone.

schmee I don't ever deny things can be difficult - for twins or singletons. and I don't underestimate for one second how hard some women work to bf, or partially bf, in circumstances I have been lucky to never have encountered. I have the utmost admiration for people like you and BoH. I know we have been lucky. But just as you say denying things can be difficult helps no one, so I believe assuming things have to be difficult is also unhelpful. I'm sorry I wasn't clear.

Update for those interested and thank you all for your input btw: D is bringing both babies home tomorrow. Smaller twin is BF well and gaining weight, larger one is still v. sleepy and less enthusiastic but has improved, her weight gain is not regular. They are topped up by bottle with formula after each feed now.
Fingers crossed it only gets better from now on.

Lovely to hear that they are coming home- must be such a relief.

Hope things go well for them all.

That's great news. A gentle suggestion that she gets some good advice on how to transition from the top-ups to fully feeding - I can't help on this one as we never made the transition successfully.

I had this problem with my one baby born early at 38 weeks. I think the midwife is talking bollocks actually. When you have a baby early it can take a long time (6 weeks in my case) of expressing, formula top ups and mix feeding before the move to EBF but once I got there I had STACKS of milk, definately enough for two.