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Saturday, May 23, 2015

Everything You Need to Know about Breastfeeding Twins

Breastfeeding Multiples is one of the things I find people to be curious about when they realize I have twins.  Of course, no one comes right out and ask about it --- unless you are a parent of twins....they sort of get a pass to ask about anything twin related, as there is a weird bond between all parents of multiples --- but I find that most people are curious about it.  If you breastfeed, you know that one baby can be demanding on your time and energy, so I think people are just naturally curious about the body's ability to breastfeed more than one baby.

It's been several months since I've had to breastfeed my babies, but I'll try to remember back to those crazy first few months.  My boys were born at 37 weeks and didn't have to spend any time in NICU.  Breastfeeding premature multiples in the NICU brings a whole other element to breastfeeding multiples, which I will not be covering in this post, as I have no experience with it.  In this post, I plan to cover all the basics of breastfeeding twins, as well as some of the personal things I had to deal with when breastfeeding my twins.  For me, breastfeeding did not go as I had hoped it would, but I learned to adapt and do the best I could with what I had to offer.

My Breastfeeding Plan:  I knew I wanted to breastfeed, rather than use formula.  After all, we're taught that breast is best!  Aside from the health benefits for the babies, breastfeeding was much more cost-effective compared to buying outrageously priced formula for two babies....not to mention, breastfeeding is one of the body's natural ways of losing the baby weight.  I had planned on breastfeeding for at least six months.  My style of parenting is not attachment parenting, so I knew I was not going to breastfeed past one year.  I was also ok with stopping after six months, if I found that it was too exhausting for me to breastfeed two babies all of the time.  I also had planned on pumping in advance when I could, so my husband could help me feed when he was home.  

My Body's Breastfeeding Plan:  My body's plan was to have a very low milk supply, forcing me to supplement with formula from the get-go, and  completely drying up after five months.  This was a complete surprise for me and was hormone related.  Apparently, the same hormonal imbalance that caused our fertility issues, also had an impact on my milk supply.  Prior to this experience, I would have never thought that I wouldn't be able to have enough milk for my babies.

What to expect in the hospital:  
  • No Privacy:  Not that you're too concerned with privacy right after having a baby.  I mean for heaven's sake, you just had your legs spread for who knows how many doctors and nurses to see as you pushed a cantaloupe...or TWO cantaloupes...out of your body! Once the babies are born, instead of showing hospital staff your backside, your showing off what's under your blouse!  You can expect nurses, lactation specialist and even the pediatrician to be checking your breasts ALL THE TIME to make sure baby is latching, sucking properly and getting enough to eat! Ok, so they are really just checking your breastfeeding technique, but still! Seriously, I think the only time I had my robe closed those first 48 hours was when I was sleeping or when we had a visitor!  Speaking of which, other than immediate family, I told people to visit me at home, not in the hospital!  I get that people want to see a new baby....BUT as a new mom, you are tired, hurting, feel gross and have your breasts exposed constantly, so it is possible that you  may not want a bunch a visitors coming to see you just after giving birth.
  • Latching:  One of the most important things that nurses and lactation specialist are looking for is latching.  It's their job to make sure your babies are latching and getting enough to eat.  For me, Baby A was a pretty good latcher, but Baby B took some work those first few weeks.  Once I got him latched, he would eat really well, but I had a hard time getting him to latch on my own for awhile.  He has a high pallet, and just struggled with getting started.   It's easy to get frustrated when a baby won't latch, but try not to get too frustrated and remember that breastfeeding is new to both you and your baby.  At home, my husband would often help with latching, especially during those night time feedings when you are waking up a baby to eat. In the hospital, the nurses were constantly helping me, which kind of goes back to that privacy thing - there's nothing quite like having a bunch of people you don't know grabbing your boob and trying to stick it in your baby's mouth;).  
  • Suckling:  I might have had some latching issues in the beginning, but both of my boys figured out how to suck without any problems!  I wasn't sure how easy it would be for them, since they were born a few weeks early.  To my surprise, they came out of the womb, via an unplanned c-section, and knew exactly what to do the moment they were put on the breast after birth.  It was such a beautiful thing seeing how natural it is for a baby to know exactly how to eat from his Mama with out being told "how" to do it.  Their natural instincts just took over!
  • Colostrum:  It takes a day or so for your milk to come in.  Your body will produce colostrum as nutrients for a newborn until your milk comes in.  My milk took 9 DAYS TO COME IN, which is not normal!!! I tried everything with my lactation specialist, but my milk was just slow to come in.  The colostrum wasn't enough nutrients for my babies, and they were losing too much weight after 48 hrs.  As a result, the doctors had me supplement with formula after two days.  They had the babies take two ounces of formula, every other feeding, but still had me pumping (for breast stimulation) during their formula feedings.
  • Lactation Specialist:  The lactation specialists are your friends....let them help you!  I even called mine several times when I got home and made a few follow-up appointments, as I really struggled with low supply.

What to expect when you get home:
  • Breastfeeding is a Full Time Job:  Because my babies weren't getting too much from me....and because I needed breast stimulation from their sucking, in hopes that it would help my lactation specialist wanted each baby on the breast for at least 30 minutes per feeding, even if they were just pacifying....and then in between feedings, I needed to schedule in some pumping.  Newborns feed every two-three hours.  With each baby getting eight feedings a day, I was literally breastfeeding for eight hours a day.  Combine that with all of the other new mom of twins stuff, and I was exhausted those first few days....weeks....and months!
  • Figuring out your breastfeeding twins method:  Do whatever is easiest and comfortable for you, whether that is feeding tandem or feeding separately.  In the hospital the nurses will try to get you to feed tandem.  They will have you feed your babies "football style".  I had no problem with that position, as far as comfort goes.  My issue was that I had one bad latcher, so for me tandem feeding was never something I got used to.  I preferred to feed separately, especially since I was supplementing with formula in a bottle.  For me, I would put one baby on my breast to feed, and prop the other one up in a boppy and give him a bottle simultaneously.  The one breastfeeding would always take longer to eat, but once he was finished, I would burp them both and then switch them, always making sure I let the boys alternate breasts with each feedings.  One of my breast got a little more milk, so if one boy fed from my right breast, he would feed from my left breast at the next feeding. 
  • Pumping in advance:  I exclusively had the boys on my breasts for feedings the first month or two, but I was getting a little "sad" never having a moment to myself, as breastfeeding for eight hours a day was taking a toll on me.  Somewhere around the third month I decided to try pumping in advance. Basically, I would start their 5am feed with all formula and no breast milk, and I would pump and reserve my milk from that feeding session.  At the next feed I would take my reserved milk and put it in a bottle with their formula supplement.  I would do this all day, until we got to the night time feed where they would not get any formula, but rather they would get the reserved breast milk pumped from the previous feed, plus I would put them on the breast for 30 minutes each, as this was part of our nightly Mommy/baby bonding routine.  Middle of the night feedings were also on the breast.  While I breastfed one baby at night, my husband would feed the other baby their formula supplement from the bottle, and then we would switch.  So basically, by pumping in advance, I could bottle feed in the day and breastfeed at night.  Giving the boys a bottle during the day was so much easier on me.  For one, I knew exactly how much they were getting during the day.  Secondly, they took a bottle in less than five minutes, so it was much faster.
  • Feeding Schedule:  I for one will never understand how people do on demand feeding, especially with twins.  For me, a schedule works best.  Which means, yes, we woke our boys up at night to eat, but after several weeks of perfecting night time feedings, we had it down to only being awake for 20-30 minutes with each feed.  In the beginning we even adapted our feeding schedule to work with my husband's work schedule.  We were doing 5am, 8am, 11am, 2pm, 5pm, 8pm, 11pm and 2am feedings all day, so he could be home for half of the feedings with me and so we were only doing one "middle of the night" feed.  In order to get on a schedule that worked for our family, we would just adjust feeding times by 30 minutes here or 30 minutes there.  Of course, as the babies grew, feeding times stretched and new schedules were adapted.
  • Sore breasts:  To be honest, I never really had this problem.  My breasts never got full enough for me to feel like I had to feed a baby or had to pump to get milk out of me.  I remember being able to feel the milk come in some, but I never felt or looked painfully engorged.
  • Cracked nipples:  Cracked nipples I definitely had!  When you have a baby on boob for eight hours a day, your nipples will be hurting.  Thank goodness for nipple cream.
  • Keep an eye out for mastitis:  I never had it, but I've had friends who have had to deal with it.  It's very painful and can be serious, so make sure that you are aware of the conditions. 
Nursing Supplies:  Below are a few things you'll want to make sure you have if you plan on nursing your babies.
  • Breast Pump:  Check with your insurance before purchasing a pump, as some insurance companies will cover the cost of a pump.  You really are going to want to invest in a hospital grade breast pump if you plan on pumping at all.  My sister-in-law gave us her Madela Pump in Style, and it was a great breast pump!  
  • Storage System:  If you plan on pumping and freezing, you'll want to invest in breast milk bags for the freezer.  I never had enough milk to freeze.  However, I did use the Madela storage system for holding my pumped milk for the next feeding.
  • Twin Nursing Pillow:  I did not use a nursing pillow, although I have had moms of twins tell me that was the only way they could nurse two babies at the same time.  Specifically look for twin nursing pillows like this one from My Breast Friend. I just used regular pillows to prop the boys up around me, and that worked fine for me.
  • Breast Pads:  There's nothing worse than leaking milk through your shirt.  You'll want to put breast pads on your grocery list after the babies are born.  I found that off brands worked just fine.
  • Nipple Cream:  God bless nipple cream!  I used the common Lansinoh brand.  There are all different kinds to choose from.  I've heard coconut oil is a good natural cream to put on sore nipple too, although I have not tried it.
  • Breast Cold Packs:  Because I never had to deal with painful engorgement, I never used my cold packs.  But normal breastfeeding moms tell me these are wonderful;)
  • Nursing Bras:   I got all of my nursing bras from Target.  You really do need to try them on before buying.  I bought mine while I was near the end of my pregnancy and used the "buy one cup size bigger than what fits for when your milk comes in" policy.  My favorite bras were these night time bras. I LOVED these! I wore them all the time!
  • Nursing Shirts:  I didn't worry about what kind of shirt I was wearing at home.  It's when I was out in public I had to think about what kind of shirt I was wearing that would be easy to breastfeed in.
  • Nursing Cover:  I get that breastfeeding is beautiful and natural, but that doesn't mean that I have to pop my boobs out for all to see while breastfeeding in public.  There are times when I had to breastfeed with people around, but there was no reason why I couldn't use a nursing cover.  I put this cover from Target on my registry. 
  • Bottles: If you do pump in advance, you will want to find which bottles work for you.  We had several Avent and Similac bottles before the boys were born, but discovered that the Dr. Brown's Colic bottles were the ones for us.  
  • Bottle Warmer:  I bought two bottle warmers, but I rarely used them.  I had moms tell me to keep them on my night stand and swear they were the best thing for night time feedings.  My boys started taking formula room temperature in the hospital, so that's how they liked their bottles.
  • Lamp Dimmer: This might sound silly, but we invested in one of these for when we brought the babies home, and I LOVED it!  The boys stayed in a twin bassinet by our bed the first few months, and when they woke to be fed, we didn't have to turn on a bright lamp to see.  We were able to barely dim the lamp on my nightstand just enough for us to see. Keeping the lighting in the room low made it easier for everyone to go back to sleep.

Low Milk Supply:  I was barely getting an ounce of milk from each breast every 2-3 hours, prior to trying herbal supplements.  Herbal supplements increased my supply, but not by much.  I finally used the prescription my doctor gave me, and was able to get my supply close to 2-3 ounces of milk from each breast every 3-4 hours.  That's the most I ever got, and around five months postpartum, I dried up completely.  If you are struggling with low milk supply, here are few things you can do to help.
  • Lactation Specialist:  Talk to your lactation specialist and see what is recommend.
  • Pumping for Breast Stimulation: Pumping in between feeds will provide breast stimulation and is supposed to help increase milk supply.
  • Supplement with Formula:  It's not the end of the world if you have to supplement with formula!!!  As long as your baby is getting appropriate nutrients, that's all that matters!  You are a good mom either way! Whether you feed your baby breast milk or formula doesn't reflect on how good of a mother you are.  I know it's hard, especially if you really wanted to exclusively breastfeed.  You will feel like your body is failing you....and if you struggled with getting pregnant, you know that feeling all too well.  Keep in mind that how you choose to feed your baby doesn't really matter in the long run.
  • Use other moms volunteer breast milk:  I had a few moms volunteer to give me some of their extra milk if I wanted to avoid formula completely, but I was ok with supplementing with formula instead.
  • Water, water, water:  Be sure you are getting enough water to have a healthy milk supply.
  • Foods for Breastfeeding: Here is a list of foods that are supposed to help with lactation.
  • Mother's Milk:  This is a herbal tea commonly used to aid with breast milk supply.  I bought mine from GNC.
  • Fenugreek: This the most commonly used herbal capsule supplement for an increase of milk supply.  I bought mine from GNC .
  • Other Herbal Supplements:  Here is a list of other herbs that are supposed to aid with lactation.
  • Prescription Hormones:  As a last resort, I took a drug called Reglan around one month postpartum to help with my milk supply.  It turns out that it is not completely uncommon for women who struggle with fertility to also struggle with breast milk supply.  My situation was ruled as a hormonal issue, so I went ahead and tried the medication.  One of the side effects is depression, so I really did not want to take this medicine unless it was a last resort to continue my attempts at breastfeeding.  I was told to watch my moods carefully once I started taking it, and if I felt sad or moody, I was to stop taking it immediately.  For me, I did not get depressed, and this medicine was the only thing that gave me enough milk supply to continue nursing.  Without, I would have probably had to stop before my boys were two months old, as I was just not producing enough milk to make it worth all of the time and energy I was putting in to trying to breastfeed twins.
Weaning your babies:
  • My milk supply decreased around five months, once my menstrual cycles returned, and a few weeks later I was dried up completely.  My boys were really easy to wean from the breast, because they were used to taking bottles during the day.  I actually think that I will use both breast and bottles with future children, as it helped with weaning.  It wasn't a huge ordeal to take them off of the breast when I had no milk left for them.  Plus, they weren't getting much from me anyway, so they were preferring the bottle to the breast towards the end. 
  • I think it was harder on me than it was on the boys when I had to stop breastfeeding. I never planned on nursing toddlers, but I wasn't quite ready to give up the bonding time with my boys by five months. If I would have known it was my last time breastfeeding when it was my actual last time to breastfeed, I certainly would have cherished those few moments a little bit longer. 
  • Switching over to formula all of the time was also a big expense financially.  At our peak, we were going through two of the large Up and Up sensitive formulas a week, and that lasted until the boys turned one.  So we were spending $50-60 on formula every week.  Thank goodness my boys were able to use the Target off brand by five months, which was cheaper and gave us more formula than the Similac brand.  Otherwise,  would have been going through three Similac cans a week, so that would have been close to $90 a week.  In the beginning, one of my boys had a sensitive digestive system and could only use the Similac Sensitive for the first few months, but once he started solids, he was able to use the off brand without spitting it up.

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