Wednesday, November 5, 2008

catching up, part 2

The Nursing Update

Where to start? I don't think I've ever really posted fully about our adventures in nursing, but I want to record this for myself, and maybe there's something here that could be helpful to someone else in a similar situation. So, if you're one of my uncles, or you're my dad, and you would rather not read about this part of twin parenting, then just hang in there - I'll have another post up in a few days, I hope!

I'm very committed to nursing the boys. Despite the fact that they're already almost 3 months old and neither is yet nursing completely, I am striving to get there. I'm not really a person for politics or making big social stands, so for me, the decision to try so hard to nurse is mostly because I feel strongly that it's the best course for us, regardless of how hard it might be for me now. I've only got an uncertain amount of time alone with my sons before I'm going to have to start working again, and that makes me even more determined - I want that nursing relationship with each of them, and I hope that intimacy can continue even after I go back to work. Pursuing nursing has become my primary occupation after taking care of their other needs. It takes a lot of time, patience, outside loving support and, believe it or not, money, to succeed at nursing when you have the challenges I've encountered... and yet I persist...


So, here's what I think - if you ever find yourself the first-time parent of a baby in the NICU and you want to nurse, find your gut feeling and go with it. Then, find the best lactation consultant you can outside the hospital system, and get them to come to the hospital and help you and your baby, immediately.

I got pretty bad advice at the NICU. I should have been coached to begin pumping as soon as I got back to my room after being in Recovery. I should have been pumping every 2 hours, in my room at the hospital and at the bedside. I didn't start pumping at bedside until probably 5 days had passed! I did try on Day 1 to get both babies to breast, but I really knew nothing about preemies and nursing, so I focused more on the care I could provide them, like kangaroo care, changing diapers and giving bottles. They call babies sucking a bottle "nippling" in the hospital and actual nursing "practice nursing" - so strange... it's just one of the many ways that the natural process gets screwed up.

The other thing they do in the hospital is feed in 3-hour intervals. Now, if you've had a newborn baby at home and nursed, you will no doubt know that nurslings do not nurse every 3 hours... they nurse much at closer intervals! So, after a month of scheduled feedings, the boys' internal mechanisms for hunger were set on this schedule. Getting them to have smaller, more frequent feedings has been all but a failure.

Along the same lines, I have found it really, really hard to get away from knowing exactly how much they are eating. Whereas moms who exclusively nurse become tuned in to their baby's hunger cues and nursing habits, all i had was a schedule and a number of millileters. Those numbers were so important in the hospital, they impacted when the boys could come home. I never pumped as much as they ate in any feeding, so I was left with fear that they would starve! Still, even after having been home for almost 2 months, it makes me uneasy to not know how much they've gotten from a nursing session, which makes me want to reach for formula supplement if they're acting fussy.

All-in-all, I think my experience was one which led the 3 of us to suppress our instincts about nursing and hunger.


No, I'm not talking about some Sci-Fi creation; galactogogues are substances that help increase breat milk supply.

When the boys were born at 32 weeks, I had many factors against me in the breastmilk supply department:

At 35, I'm in that "advanced maternal age" category;
  • c-section;
  • premature delivery;
  • polycystic ovarian syndrome (also the cause of my infertility);
  • chronic hypertension.

I am taking a ton of herbs (fenugreek, blessed thistle, goat's rue, juice plus, prenatal = 9 capsules 3x a day) and a prescription for domperidone.

Again, because I'm not solely pumping, I haven't got a strong sense of how much I'm producing... right now, it's not enough to feed one exclusively. I'm gratefully receiving some donated breastmilk from a local friend, which always goes to Max, since he's not at the breast much.

So that's where we've been.

Where We Stand

Shoghi is, and has been from the beginning, the stronger nurser. I'm currently nursing him on demand, and six times a day, I also give him supplemental formula with a lact-aid. By now, he's an old pro at latching on. Several weeks ago, I took him to an ENT and had his frenulum (tongue tie) clipped, and this helped to free up his tongue and improve his latch. He can nurse in several positions, and he sleeps next to me so he can side-lie nurse throughout the night. How easy it would be to just nurse one baby! How much sleep mamas of singletons must get!!!

The plan with Shoghi is to drop his supplement amount slowly over the coming weeks until my supply catches up with his needs.

Maxwell is pretty much starting at the beginning of learning to nurse. It has taken having his posterior tongue tie clipped twice, the last time being last Friday, to free up his tongue mobility and allow him to latch well. He gets all his calories from formula, given to him by bottle. Now he is finally able to "pratice" nurse, so whenever I can. I start his feeding with 1oz of formula, offer him the breast for as long as he wants, then finish up with the rest of the bottle.

A note about frenulum clips - everyone told me it wouldn't hurt the baby. In my experience, that proved to be false. Seems a little like the old supposition that circumcision didn't hurt. I'd recommend giving babies homeopathic aconite for both the pain and fear, and have some baby pain reliever or arnica on hand for afterward.

I'll be meeting with the lactation consultant again next week, and I'll let you know our progress then. It'll definitely be easier to post about this next time, since I won't have to start at the beginning.


  1. Hi! I'm a lurker on your blog, but also have preemie twins that I'm desperately trying to nurse. They were only 6 weeks early, but I didn't pump for over 12 hours after they were born via c-section (even though I requested a pump several times). I had seemingly plenty of milk while they were in NICU, but my supply tanked as soon as I brought them home, probably because I wasn't emptying my breasts fully after trying to nurse them. I then got into a pumping frenzy trying to up my supply and never really recovered. They also had/still have weak sucks, so are not able to fully remove milk.

    I've spent lots of time, money, patience, sanity(!!) trying to get them to the breast. We always "practiced", but not every feeding or even every day. But at 3 months, I put them to the breast tandem (the only way I can envision nursing working for me) and they just latched right on and sucked for a good long while. Afterward, I layed them down and they actually seemed satisfied. So I did it again in a few hours and got the same result. I was soooo excited that it looked like they were really getting the hang of it. I was supplementing about once or twice per day. However, as the days went by, I was finding myself supplementing more and more. I was feeding them on demand HOPING my supply would catch up to their demand. But I knew they weren't wetting enough diapers and weren't gaining enough weight. They weren't losing, but weren't gaining much either. So when they would cry (feelings hurt cry) when I'd take an empty bottle out of their mouth, then I knew I didn't feel right about them being so hungry.

    I decided that I would nurse them every time and let them get as much good Mama Milk as they could. Then, while they were still laying on the boppy in the "football" hold, I would give them their bottles. After the bottles, if I'm able, I pump what's left.

    That's where we currently are. Next, my plan is to try slowly decreasing their formula intake to see if that does anything for my supply. As tiring as this ordeal has been, I'm not ready to give up yet. I know it's sometimes hard for others to understand the intense desire to feed your children from the breast when it seems like odds are stacked against you. But I think it's worth it. Even when they only suckle for 5 minutes before getting impatient for the bottle. I think it's worth it.

    If you haven't already discovered these groups on yahoo, you might check out the MOBI group and the pumpmoms group. There are several emails a day, but there is lots of good information you can gather from moms also very committed to breastfeeding. Also, feel free to email me anytime (I don't have a blog...) even just to vent about how hard breastfeeding preemie twins is!! :)

    I really enjoy reading your blog. Thanks for sharing your nursing experiences with us!

  2. A big cheer for the nursing, Celeste! I'm so happy that you are making a go of it and succeeding! I can easily "second" all of the things you said about bf'ing a NICU baby. I wish I had had someone who told me that way back when. The only other recommendation I would make is to have your friends and family be on the lookout for signs of PPD and have an intervention ready. Dealing with the NICU just makes it easier to get depressed and that not only ruins the nursing relationship, but mars the first few months.

  3. Its wonderful that you are so dedicated to nursing. The wonderful thing is that any amount of nursing is so good for them.

  4. Oh Celeste!!! I am tearing up reading this! You are SUCH an amazing mama!!!

    Much love to you and your beautiful boys!!!!


  5. "it's just one of the many ways that the natural process gets screwed up"

    yes, so many of your words are comforting in a been there done that knowing what it's like way.

    you are AMAZING to hang in there.
    we all are ,)
    but you have a degree above mama .D