Thursday, December 10, 2009

Breastfeeding twins and triplets (or more! )

A first time mother finds out she's expecting twins! One of the first thoughts that race through her mind is " how on earth will I be able to breastfeed one baby, let alone two?!"

A seasoned mother is expecting her second child after having succesfully breastfed her first for over 3 years. Her feeding choice is a 'no brainer'... that is...until she's told that there's not just one baby in there...there's three. She feels shattered and overwhelmed at even the prospect of trying to nurse three babies. "After successfully breastfeeding a first child, you don't even flinch about the decision to nurse the second baby, so when I found out I was having three, I felt a sadness about possibly not breastfeeding one or more of my triplets"

What these two women have in common is a wide-spread reluctance and fear of breastfeeding more than one baby. Does this mean that it's impossible? Absolutely not! If you're a mom the second time around, but the first time around with multiples, you may be wondering less about if you're able to make milk and more about how you're gonna get the milk to all two or three babies!

Below is an article taken from entitled:

Breastfeeding Triplets: Advice from Successful Moms

By Ellen Zagorsky-Goldberg
Web Exclusive

Sheri Ingalls of Port St. Lucie, Florida, nursed her first child for almost two years. Three years later, when she discovered she was pregnant again, she had no doubts about what her feeding choice would be. Then she found out that she was carrying triplets.

Some of Ingalls's healthcare providers were very negative about even the possibility of nursing triplets. Ingalls, however, was determined to breastfeed, and her perinatologist put her in touch with The Triplet Connection Despite a rocky start--the babies spent two nights on formula in the hospital nursery and then had terrible nipple confusion when they arrived home--Sheri's triplets breastfed happily until weaning themselves between the ages of one and three.

Ingalls and other mothers of triplets report that the most essential factors in breastfeeding success are becoming educated before giving birth about the intricacies of nursing triplets, and receiving information and support from other mothers who have successfully nursed triplets. It is crucial to remember that nursing three children at once, although more difficult than nursing one child, is possible.

Breastmilk works on the theory of supply and demand: The more you nurse or pump, the more milk you produce. Therefore, if you are nursing all three babies at each session, you will make milk for all three. If you nurse two babies and give the third a bottle of formula, you will only produce enough milk for two babies. Pumping after nursing is a great way to increase milk supply, as well as provide reserves for bottle-feeding. Some mothers of triplets have found that this method enables them to pump up to 20 ounces of milk in only 15 minutes!

Good positioning is crucial for nursing triplets. Some mothers prefer to nurse each baby individually, so that each gets "special time" at least once a day. In the interest of time, many mothers nurse two at once; the third then either gets expressed breastmilk in a bottle or nurses after the first two have finished. Since the composition and amount of breastmilk subtly change over the course of a feeding, always make sure to rotate which baby is first at the breast at each session.

If your third baby will be bottle-feeding while the others are nursing, a hands-free baby feeding system can be useful. Propping a bottle with a towel or one of the specially designed bottle holders that seem to be gaining popularity is greatly discouraged because of the very real possibility of your baby choking on the steady stream of fluid.

Many mothers recommend using nursing pillows like the "Boppy" or the "EZ-2-Nurse" pillow made by the Double Blessings company. Finding positions that work for you and your babies often requires some experimentation. You can try using the "double football" hold, where a baby is tucked under each arm, with only the babies' heads at your breasts. Or one baby can be in the football hold and the other in the cradle hold, with her body across your chest (make sure her tummy is on your chest, not facing the ceiling). You can also try the "double cradle," with the children's legs on each others'.

Sleeping with your babies can be a real sanity-saver. Shari Lynn-Henry Rife, of Kalamazoo, Michigan, found that putting a bedroll in the babies' room was the only thing that allowed her to get some sleep when her triplets were newborns. "When someone woke up to nurse, I would lay down, put them to breast and go back to sleep. When the next one woke up I would put the first one back in bed, put the next one on the other breast, and go back to sleep until baby number three woke up." Other families work to put the babies on the same schedule by waking all three when the first wakes.

 Although it may not seem like a specific help for breastfeeding, finding people to assist around the house allows you to use your energy to make breastmilk, not dinner. Shari Rife's mother-in-law helped keep her house clean. Other mothers of triplets have received help from friends and family on everything from taking older children to soccer lessons to dropping off a casserole for dinner. As Sheri Ingalls says, "It will take all of your precious energy to feed and care for your babies. Sleep is so important and laundry isn't! Let somebody else do it!"

Relaxation and good humor will help during the early days of nursing triplets, since, as Rife says, "no one is going to starve if they have to wait a few minutes to eat." Education, perseverance, and mental flexibility are key to adjusting to life with triplets. Looking back, Sheri Ingalls notes, "I have to say it was very tough, but worth it."

Ellen Zagorsky-Goldberg, RN, MSN, is a pediatric nurse, freelance writer, and homeschooling mother of Batsheva (6) and Chana (4). She lives in Boston.

Another article by La Leche League International regarding frequently asked questions about mothering twins

There is a good deal you can do while you are pregnant to make things easier for you later. Before your babies arrive is a good time to learn as much as you can about breastfeeding. There are some very helpful books in the LLLI catalogue for mothers of multiples. Having Twins, by Elizabeth Nobles and Mothering Multiples: Breastfeeding and Caring for Twins or More! by Karen Kerkhoff Gromada are two books that address the special joys and challenges of having (an breastfeeding) more than one baby. You will also find a great deal of information and helpful suggestions in THE WOMANLY ART OF BREASTFEEDING available from the LLLI Online Store.

Mothers of multiples are in special need of support, and one of the best places to find that support is at a La Leche League Group meeting.

It is very important that you pay attention to your nutrition during your pregnancy. Owing to the risk of premature labor in a twin pregnancy, a healthy diet is especially important for a good start. Eating foods with high nutritional value will help you and your babies as they grow in utero, and later as you breastfeed.
Choosing the health care providers you will use during your pregnancy and childbirth will be a very important decision. Pre-natal care is crucial for your babies, and for you. You will want to learn as much as you can about your options during labor and delivery so that you can actively participate in the planning. Many parents prefer to talk with several providers before making a decision. There are several books in the LLLI catalogue that would be helpful in this. You can view our selections on childbirth at the LLLI Online Store
Once you find a doctor for you, the next task is to find a doctor for your babies who is knowledgeable about lactation. Some questions you may want to ask your baby's prospective health care provider are:
  • How do you feel about breastfeeding in general and about breastfeeding twins?
  • Do you think it is possible to exclusively breastfeed twins, without using supplements?
  • If one or both of my babies require special care, can I pump my milk to feed my babies?
  • Do you encourage mothers and babies to spend time together even while in special care?
A negative response to any of these questions may alert you to a health care provider who may be less than supportive of your decision to breastfeed. Sometimes there will be a neonatologist present for the birth. It may be a good idea to know their procedures and routines ahead of time, as well as meeting him/her.
Take advantage of childbirth classes (if available) as soon as possible just in case you have to be on bed rest toward the end of your pregnancy.

It is crucial for you to line up help at home. Find a person who will support your decisions and not someone who will be critical. Make it clear that you will need help with the housework, not the babies, so that you will be able to devote all your attention to them.

Learn about pumping your milk because you are at higher risk of having to spend a few days separated from your babies than if you were having a singleton birth. A good option is to have a hospital grade double pump available.

When your babies arrive:

It would be ideal for you to begin breastfeeding as soon as possible after the birth. When a mother is expecting more than one baby, sometimes a surgical birth becomes necessary. In this case, some hours may go by before you can start to breastfeed. However, it is important that you nurse your babies as soon as you are able. Some multiple births also take place prematurely. If this happens and you are unable to initiate breastfeeding soon after the birth, you can still pump your breasts to initiate lactation. From the moment of birth, your body will begin the process of producing milk for both your babies and its important to express the milk that is beginning to be produced to establish a good milk supply. For this you can use a high quality breast pump or manual expression.

Milk from mothers of premature babies is quite different from that of mothers of term babies. If your babies are early, they will especially need your milk.

If both babies are born healthy, talk to the pediatrician about breastfeeding them on demand. The ideal setup is rooming in with your babies.

If it should become necessary that the babies receive a supplement, you may want to look into other methods of feeding such as cup feeding, finger feeding, or using a spoon, medicine dropper or syringe. Bottle feeding sometimes can interfere with lactation due to the fact that some babies develop a preference for the artificial nipple, making it harder to reestablish breastfeeding.

Once you and your babies are home, you will need to take care of yourself as well as the babies. Eat healthy food, and enjoy frequent snacks (such as low-fat cheese and crackers, vegetables, yogurt and fruit). This is your chance to be able to eat a lot without gaining weight. Be sure to drink water, juices, or milk to thirst. Try to sleep when the babies are asleep.

Develop a plan for getting the housework and other home management tasks done. Enlist any and all available help, and carefully consider what tasks are most important to you and your family. Assign priorities along with your mate. People's needs come first, especially babies' needs, then comes food and clothing.
Limit your visitors during the first weeks. Family members and friends who come to see the babies can help you in many ways-- they can bring you meals, change diapers, give you a massage, watch the babies while you take a 15 minute walk or a shower, listen to you, etc. Don't be shy about asking for the help you need.
Be aware that many mothers of twins receive criticism from those around them who do not share their enthusiasm for breastfeeding. They may pressure you to use formula or other foods before they are needed or to wean before you feel ready. Sometimes, questions such as "Are you sure you have enough milk?" or "Isn't this too hard for you?" are enough to lower a mother's confidence. Your belief in your ability to produce enough milk for your babies is one of the most important factors in maintaining a great milk supply. Remember always that milk is produced on the principle of supply and demand. The more your babies breastfeed, the more milk your body will produce for them.

Tips for life with breastfeeding twins:

Breastfeed them together to save precious time. This works well during the first weeks. After this you may have to breastfeed them one at a time depending on their particular hunger patterns.
There are several different ways that you can position the babies in order to nurse them at the same time. One way is to place the babies in front of you with their legs overlapping, making an X across your lap. The other position is to place both babies in the clutch hold. You will need pillows at your side (and maybe one on your lap) and you will place the babies on the pillows with their legs going toward the back of the chair. Remember that if you are placing the babies in front of you, you must try to keep their whole bodies turned toward you, their chests against your chest. Their bodies must not be facing up. This is very important to avoid soreness and also to make sure that the babies are receiving enough milk.

Use lots of pillows. There are special pillows available that help in positioning twins, or you can make a nursing pillow yourself.

Alternate feeding each baby from both breasts. This evens out their particular needs and also gives them extra visual exercise.

Learn different positions to breastfeed. Learning to nurse while lying down may be a little tricky to learn the first few weeks, but is worth it for the added rest you will get.
Prepare "changing areas" in several different places in your home.
Don't give babies a daily bath. Just make sure the diaper area and their faces are cleaned every day.

Books on multiples

Mothering Multiples  by Karen Kerhoff Gromada  

Having twins and more  by Elizabeth Noble

Websites providing information and support in the care of multiples

The triplet connection .com
La Leche League International

All Images Courtesy : Google Images

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