updated 6/19 first post. Please help me: Nursing twins.....not going well

[veronica]

I thought it was, but it is apparently not. DS's were born at 6lbs7oz and 6lbs4ounces. They each dropped weight in the hospital. One of our sons dropped 14 ounces, but he had breathing issues and was on an IV only for more than 48 hours, so he could not nurse or bottle feed.

when we arrived home last week, we had the obligatory ped. visit the next day, to check weights. the dr. seemed nice about it and wants to see us this thursday. Because one of the boys failed the car seat challenge, we have a nurse service coming out to weight check the boys as well. She was here last week, the day after the Dr. visit, and her weights were on target with the Dr. scale. She was here today and DS's only gained 2 and 4 ounces each.

Needless to day, she was stern and said "that is not good". They should be back to birthweight at two weeks old (tomorrow). They still have to gain 12 and 8 ounces to get there. she immediately questioned my hydration and milk supply (I'm drinking 1.5 gallons of water a day!) and my let down is fierce. I'm not pumping much since I am feeding them on demand but they are very sleepy babies and go close to 3hrs. between feeds , and they said I should nurse every two hours.

I am devastated. Now they want us to supplement with formula. The nurse called my ped. today who had their nurse instruct us to give a bottle of 1-2 ounces of formula after each and every nursing session. We tried that this afternnoon and ......DS threw everything up. So , I feel like we are being forced to overfeed them.

I am devastated. I view supplementing as the first step in me quitting nursing, as if nursing twins was not scary/hard enough for me. Why would the boys nurse well, if they learn that a bottle comes right after it. the nurse said I could just do the formula until they are back to birth weight and then quit but won't they lose weight then? then I will get in trouble for that!!!

I got a speech from the visiting nurse today about how important it is to gain early on, so their organs and bodies get off to a good start and it is most critical now. I feel like a horrible mom. I've been crying ever since she left at noon.

How do I nurse two babies, do two bottles and pump? I feel like the supplementing will just kill all hopes of nursing, which is emotional for me to do as it is....

any advice? Did anyone have other instructions on supplementing formula for early weight gain? is it excessive to do bottle after every feed?

sorry for spelling issues, I'm typing through tears now....

6/19 update:
so, I kept meaning to come back and update. we went to the ped. two days after the nurse service told us to supplement, and our ped. had agreed as well. there are several docs in our practice and the one we saw in person, was adament that we could have been supplementing with BF. She told us, that ounce for ounce, they have the same caloric intake (bm and formula). We were livid at that point , that we had been misdirected earlier, and we let her know. But, the news then was also good, because overall, she was happy with the boys' weight gain for that week. We were relieved.

We went back on 6/14 and guess what?????? One of the boys gained 19 ounces in 12 days and the other gained 15 ounces. They were well passed birthweight. We were told to keep doing what we were doing......which is killing me. I am nursing , pumping out what is left and then, if the boys are cranky, supplementing it right away or saving it. Unfortunately, my supply is just enough for the boys and I can't save a ton, which is dissappointing, since I used to oversupply for one baby. I get so tired, that if I skip a pumping, I do use a bit of formula and wish I didn't have to.

That said, I have good days and very bad days. One of the boys has a terrible latch and I can't correct it myself. Often times, my mom is here and hasn't seen a LC help out , so she can't really help me relatch him. I'm debating on just bottle feeding him, since he gets supplemented the most , after a nursing, due to his poor nursing. Add to that, that his reflux is much worse now that he is eating more and waking more. We already had to adjust zantac for both of them and I think it needs to be done yet again. You can see their entire bodies just "constrict" and a bunch of milk just poors out. Poor babies.....and it's tough to see all that milk come out

I have my nursing pillow almost permanently attached to me. I miss my older kids so much. School is out now and I just don't know if I have it in me to go the long run, especially with all of the issues. If I could just pump 5-6 times a day and get enough to bottle feed both all day, I would . But for some reason, I can only get a total of 6 ounces per pump session at the most (yet I'm still nursing all day so I imagine I could get more if I did not nurse). That's less than I used to get with ODC's.

DD told me she is mad because "I am cheating on her with the babies" and I cried. The boys were one month yesteray, and I want to get to two months. After that, depending on how the reflux is, I may call it a day. I hate to type that but , emotionally, as well as physically, I am not handling this well. It's the guilt of stoppping BF that keeps me doing it. If I could stop, and not feeli guilty, I likely would. In the meantime, I keep trying....

thanks for all the encouragement. I could not have made it this far without all of you!

[Katigre]

Ok, first of all - deep breaths. It doesn't sound like an insurmountable issue at all, especially since you've got a great milk letdown and supply.

1. For newborns, especially little newborns, going 3 hours between feeds is too long and will not help them gain, just maintain. This happened to DD when she was newborn too - she got a terrible cold and basically hibernated for a week to recover, falling into a 'perfect' every-3-hours by day and every-5 hours at night- feeding schedule. Except nursing that way meant she gained only an ounce or so in an entire week and it was not good at all. Once she recovered and started nursing every 2 hours she gained just fine and I never had to supplement.

Wake them to feed if necessary, do many little feeds (it will be basically nursing 24/7 for awhile), but aim for 10-12 feeds per day per baby.

2. Do not supplement yet - no way. Wait another week to see if you can help them gain through nursing. Their latches need to get stronger and better established, and they're not dropping weight! If they were losing weight that would be one thing, but they're slow gainers instead which is another category. I think they're jumping the gun by recommending formula instead of helping your babies get more out of the breast.

3. Strategies for nursing two - do you have contacts in La Leche League or on more natural/crunchy message boards online where moms of twins who have nursed successfully hang out? I know several moms of twins who have exclusively nursed without supplementing - but you need supportive dr.'s to do it too.

[BeachBum]

I don't have a lot of time to respond, but wanted to chime in quickly.
I nursed my twin boys until they were 18 months. We had weight gain issues in the beginning... sleepy boys....and they just weren't getting enough. I got similar advice and went with it. We supplemented for about a week. I also had to pump after each feeding because my supply just wasn't there because they kept falling asleep while nursing. I also wanted to make sure I wasn't letting that supplement interrupt my supply.

I thought my boys were nursing well, but they weren't actually getting anything. My boys started new nursing sessions about every 1.5 hours. I could hardly get up in between nursing, the supplement, and pumping before nursing again. It was a very hard time.

In my experience, my doctor and lactation consultant didn't want me to realize how concerned they actually were about my boys because they thought I would freak out. Instead, I almost didn't take things seriously enough. If your doctor says supplement, I would do it. I just don't think the risk/ benefit is there to do anything else. With me, that little bit of formula really helped them get strong enough to perfect their latch and be awake enough to get a full feed. My boys weren't loosing weight, they just weren't gaining enough.

I just wanted to share my story because I do not think supplementing is "the beginning of the end" of nursing. You can do this. Formula is not the enemy! It really will help you and your kids get over this hump!

[♥ms.pacman♥]

I just wanted to share my story because I do not think supplementing is "the beginning of the end" of nursing. You can do this. Formula is not the enemy! It really will help you and your kids get over this hump!

i too disagree with the whole notion that supplementation with formula somehow indicates the beginning of the end of nursing. IMO supplementing does NOT automatically equal failure at BFing...honestly, i wish that whole idea of that would just go away, us mamas don't need any more guilt as it is!

i don't have twins, but i had a preemie DD who was very very weak in the beginning (too sleepy, didn't have coordination to nurse properly and for long enough periods of time) and had to be in the NICU for three and half weeks due to her feeding issues and other problems (apnea). In the beginning before my milk came in, i was asked to supplement with formula (15ml after every feeding) because she was a preemie and so little. I had to pump after every feeding as well. Even once my milk came in, my breastmilk that i pumped (that was r tube-fed and later bottle-fed to her) had to be fortified with Neosure (preemie formula) so she could get the extra calories to gain enough weight. At her 1month appt the ped said she was okay with her weight but that if we were still giving her bottles to add the Neosure. eventually at about 5-6 weeks as she got better and better at nursing and was gaining weight she was off bottles completely, and i finally stopped pumping and she was exclusively breastfeeding. she is almost 3 mos now and is still exclusively breastfed (and at her 2mo appt was in 75%ile for weight, even tho she was barely 1mo adjusted age). so, another story of someone who supplemented in the beginning (for the first month) and was able to eventually breastfeed exclusively without any major issues. so, based on my experience, i don't really think that supplementing in the beginning is such a horrible thing or that it automatically means you won't be able to EBF eventually (if that is what you want).

[Dr C]

First of all--don't give up!
Second of all, if your ped says you need to supplement, you probably do need to. Sometimes babies need to gain a bit of weight in order to become strong enough to be able to nurse effectively at the breast. If you can boost your supply (ideally by pumping at least after the daytime feeds), that would be good--that way when they are strong enough they will be able to get full feeds at the breast.
Third, please contact a lactation consultant. They can help you by doing pre-post weights and figuring out how much the babies are transferring, and by making sure they are latching well and transferring milk as efficiently as possible. They can also counsel you on alternate ways to suppliment if you're resistant to a bottle--nipple syringe, SNS, etc.
Fourth--let's say, worst case scenario--that you need some supplement long term: remember that any breast milk (even 2 oz per day) is beneficial for the babies. But I have seen many moms of twins get through this phase of needing to supplement and get back to exclusive breastfeeding.
Good luck. You will get through this. Breastfeeding twins is REALLY tough--much tougher than breastfeeding a singleton, and you should congratulate yourself on how far you've come already. You can do this!

[Hawkeyewife]

Everybody has such great advice.

I just learned something interesting about newborn weights that may be interesting and help you through this. Remember all the water they pumped you with at the hospital to keep your blood pressure before the epidural. Well, your babies may have been born with a few more ounces on board than without the water and of course they "lost" all that extra weight in their diapers over the first day or so. Maybe their birth weight is a bit skewed to begin with and you are doing fine. Think about how you have persevered so far, you are a wonderful Momma, keep it up! Many Mommas would have given up by now. Good JOB!

[TwinFoxes]

I was going to suggest waking them up, and I see a PP did. I'm actually surprised your ped didn't suggest it. We had to wake our babies, it's not something that anyone wants to do. But honestly, it worked fine.

As for supplementing, I supplemented my (very) low birth weight babies. I nursed until 15 months, and only stopped because I had to start medication that was counter indicated. It's not the beginning of the end if you don't want it to be, especially if you're making enough milk.

I also think you're giving your babies (geniuses I'm sure!) a little too much credit. I don't think they'll figure out this early on that a bottle is coming, and thus not try to nurse. I think most babies just hink "FOOD!" and not "hmm, I think I'll wait for the next course". Also, my LC, who I loved, said she's never seen an actual case of nipple confusion in her years of experience. so I don't think it's as common as people assume. Obviously it happens, but like she said, my girls didn't get confused. They also have those supplemental systems, where you attach a tiny hose connected to a bottle to your nipple, so the baby is "nursing" but getting formula. I don't know if that will work in your situation though. Good luck! You can do it! And if you don't, you're still a good mama.

[twowhat?]

I nursed my twins for 18 months as well, and during the day I woke them up every 2 hours to eat. It was hard to wake up sleeping babies - DH helped me and sometimes we'd strip them naked and tickle their feet until they woke. It could take a good 10 minutes just to wake them. That was honestly one of the most frustrating things. I also had to stimulate them to keep them awake while nursing. Ticking the backs of their necks helped. Breast compressions helped because it helped the milk flow more quickly at the beginning when they were still awake. I did have to supplement in the beginning with formula for a few days not because of supply, but because I didn't have a pump yet and the babies were jaundiced.

As soon as I got my pump, I pumped after EVERY feeding and then supplemented with 1-2 oz of pumped breastmilk.

I know EXACTLY how you feel about feeling like you're forcing down the formula because they throw it all back up so quickly. I HATED supplementing because of this exact feeling but knew that I had to. Switching to a very low-flow nipple helped (those hospital bottles sucked! Once I got home and we used our BornFree bottles, it was much better). Also, as they grow it gets much easier for them to handle being "topped off" with 1-2 oz. DH and I referred to supplementing as "topping them off" LOL because that's exactly how it felt...that we were filling them up to spilling over the brim...

Mine barely gained back their birthweight in 2 weeks. I pumped after every feeding for a couple of months, supplementing 1-2 oz after each feeding and storing the rest in the freezer. We woke them every 2 hours at night until they gained back their birthweight, then my ped said to quit setting an alarm at night but continue with every 2 hours during the day. I always fed them tandem. Having both babies nurse at the same time (I think) helped with keeping production high, and ensuring that both babies get to that fatty hindmilk. I'd switch sides each time I nursed in case there were differences in supply between the two sides.

You can do this. BUT, I TOTALLY agree with PPs that if it would make your life easier to supplement with formula, DO IT. If you want to make breastfeeding a long-term goal, then pump after every feeding. I found that having 2 sets of pump parts helped. That way I didn't have to wash after every pumping session. DH also helped to make sure my stuff was washed. The easiest way to do it was to keep a big bowl of warm soapy water on the counter - after pumping I threw all the parts in there. Then all it took was a quick rinse in hot water and they were ready to use again.

Good luck. Breastfeeding twins is not easy. There is nothing wrong with supplementing with formula and it does not mean you've failed by any means. If formula would help to reduce the stress of having infant twins AND older children in your house, then it is totally and completely worth it.

eta: totally and completely agree with PPs that formula can help get you over that hump. Just protect your supply by pumping whenever you supplement with formula.

eta again - we had the same experience with the nurses. Ours lost more than 10% of their birthweight during our 5 day hospital stay and they did a great job of making me feel like crap about it. I soooo feel for you. You will get through this just fine!! Hang in there!

[ahrimie]

Just like everyone else said, supplementing does NOT mean failure! I know nursing and struggling through that is such an emotional time but in the end, whether you nurse or you bottle feed or do a combination of the two, you ARE providing for your child. In the end, it should just matter that they are growing and thriving--not so much in HOW you did it.

DD had great birth weight but because my milk came in super duper late due to other medical reasons for me, we had to supplement with formula. She was too sleepy to nurse and would always fall asleep. Nipple confusion doesn't happen in all newborns but it did for her; so while it took a lot of work to fix, we did it and nursed until 8 months! The only reason I stopped was because I couldn't keep up with her demand and I started look ghastly

I would do what the doctors tell you to do and do what you can to keep nursing once they are at their birth weight. For us, supplementing and pumping was ESSENTIAL to nursing exclusively.

Don't lose hope and rock on!!

[essnce629]

My only advice is to get a certified lactation consultant who has experience with twins to come out to your house and watch you breastfeed, weigh the babies before and after the feeds, etc. It usually costs $60-$100 for the first visit for them to come to you, but it's definately worth it. Some insurances even cover it. Here's how to find one in your area: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

I've heard many stories of doctors and nurses telling moms they HAD to supplement, only to find out that the babies were doing just fine and getting enough milk after meeting with a lactation consultant. Lactation consultants are the experts in breastfeeding, not doctors and nurses. When I was in nursing school I pretty much got zero education regarding breastfeeding.

Now if the lactation consultant says you have to supplement then I would. But there are plently of ways to supplement and that doesn't have to always involve formula and bottles. You can supplement with your pumped milk using an SNS, syringe, etc. if nipple confusion is a worry. I also had a client with a baby with very low weight gain who had to add a human milk fortifier to her pumped milk. This is different than formula and just adds additional calories to your milk to help speed up weight gain. Here's some more info: http://preemies.about.com/od/glossary/g/HMF.htm

Keep us updated and you are doing great already!