Wednesday, April 23, 2014

Breastfeeding Preemies

Not everyone gets the "normal birth experience" that often occurs with a singleton pregnancy.  Multiple births and NICU stays go hand in hand more often than not, and the struggle with the desire to breastfeed your twin littles can be overwhelming, especially to a new mom.  It is for this very reason we are so excited to include Christina's experience breastfeeding her boy/girl twins during and after their 25 day NICU stay. 
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Before I was pregnant, how a mother fed her child never really crossed my mind. I thought breastfeeding was just a bit odd and somewhat unnatural, even though it is the most natural act possible. It was never a topic I thought too much about until I became pregnant with twins, and it seemed everyone else was curious if I was going to breastfeed them. Everyone assumed I wouldn’t or that I couldn’t. It was always just kind of strange to me that nearly complete strangers would ask me about this topic. But, I get the curiosity, the surprise, of it all. Logistically it is a little interesting.

During my pregnancy
I read a couple different books regarding twin pregnancy and birth, one specifically on breastfeeding (http://www.karengromada.com/mothering-multiples/). My husband committed to supporting this decision; he read the books, too! We chose a pediatrician that had a full-time lactation consultant on staff and I also identified a local lactation consultant I could call should I need the assistance. Others questioned, and doubted, my decision to breastfeed the twins, but for every person that doubted me, I took it as a challenge to prove them wrong.
When they arrived
Henry and Caroline arrived on May 11, 2013, at 34 weeks, 4 days, by cesarean section. Due to their breathing complications, I was not able to hold them until 7 hours after birth, so I missed out on the immediate “skin-to-skin” time that helps a mother’s milk come in. I started pumping immediately, every 3 hours. Once we were able to hold them, my husband and I continued skin-to-skin as much as possible during their NICU stay.  This was not only beneficial for my 'new mother' soul, but for my babies as well. Preemies can get over stimulated easily and require quiet, warm touch that doesn’t involve excessive stroking. They can have difficulty keeping up their body temperatures and skin-to-skin also helps with that. When Henry and Caroline arrived they couldn’t suck, swallow and breathe at the same time; this suck-swallow-breathe neurological function doesn’t even kick in until 36 weeks gestation. It was for this reason that they immediately were fed by a tube that went through their nose and into their stomach. 

At 36 weeks gestation equivalent, this ability kicked in for Henry, but not Caroline. She took a few more days, and even still it didn’t go well. I utilized the help of the NICU’s lactation consultants every single day for the 25 days my babies spent in the NICU. It took a while for my body to produce the milk, and even though it still wasn't quiet enough, I didn't feel guilty or sorry for having to supplementing with formula.  As a mother I was doing the best I could do for those two.  I continued to try to nurse them every three hours, and pump afterwards with a rented hospital-grade pump that I used for the first 3 months. This helped me build my supply and also helped me feel like I was contributing to their well-being when it felt like nurses were doing everything for them. For the first 10 days of their NICU stay, before I started staying full time at the hospital, I would wake in the middle of the night to pump and give the NICU a call to check in on them. I spent lots of my time in the NICU reading www.kellymom.com, an excellent breastfeeding resource.
Caroline was the first to be weaned off her feeding tube, but she’d never nurse enough to be satisfied.  She would scream and arche her back every single time I tried to feed her. She and I cried it out together a couple times. A lactation consultant suggested trying a nipple shield, which aids in latching and after a few rough nights of “cluster feeding” (every 45 minutes or so, if needed) she finally improved. 
When we got home

One week after their NICU discharge their pediatrician made note that Caroline wasn’t gaining weight well. For the next month I nursed her, and then gave her a little bit of breast milk in a bottle to “top her off.”  Since she wasn't working hard (and burning calories) while nursing for long periods of time, her weight gain improved. I used the nipple shield for the first three months of her life because she continued to have trouble with finding a great latch. It was cumbersome and difficult, and there were many tears shed, but we figured each other out in time. At three months I weaned her off the nipple shield and we fell into our rhythm.
Preemies tend to sleep even more than the average baby, and can take longer to eat due to lack of nursing stamina. I finally gained enough confidence at two months to tandem feed them with the help of the My Brest Friend twins nursing pillow (it looks and feels like some sort of flotation device). I took Fenugreek supplements, brewer’s yeast, ate lots of oatmeal and drank lots of water to help increase my supply.
They received 2 bottles/ day of formula until they were six months old, and thereafter it has been 1 formula bottle/day. In the early days, it helped give me a break when each nursing session was fraught with anxiety if Caroline would eat. My husband also enjoyed being able to do this for them. I work full time, and supplementing with formula also takes some stress off me about being able to pump enough while I’m at work. I think a lot of women approach nursing with an “all or nothing” mentality and it doesn’t have to be that way.

In return for the support people gave me, I try to be a cheerleader to friends who breastfeed. Not just because of the benefits to the baby, but because my own struggle resulted in a changed relationship with both of my children. I continue to provide feedback on the “Breastfeeding Multiples” site on Babycenter.com for other moms. I thank God that He gave me Henry, an easy eater, to power through my struggles with Caroline. Without my bevy of resources, support, and Henry for encouragement, I’m not sure how long we would have lasted. This is something we did together as a team. There is also something intrinsically fulfilling about being about to feed your child anywhere, anytime. No one else can do that. This is the one thing I can do for them that no one else can. As a working mom, I especially appreciate this time with them. We are approaching one year old, and I’m beginning to get questions about weaning. We will continue so long as it works for the three of us (although I am really looking forward to not toting my bag of pump parts to/from work each day). 
Even though this chapter of breastfeeding will eventually be closed, I will continue to be other mom’s cheerleader in this area well beyond that.

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Thank you, Christina!  What an awesome resource you are to other moms who might fear this struggle or have experienced this in some shape or form. 

Christina has offered her email address if you have any questions!  CLICK HERE to send her an email!

What tips to you have in addition to what Christina shared?  

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April is Multiple Birth Awareness Month!  This Friday (April 25), Twin Talk is hosting a blog and Instagram link-up.  We'd love for you to participate!

If you're a blogger, dedicate this Friday's post to your twins!  Afterward, come to our page and link up so our followers can "meet" your sweet twins! (We'll have "how-to" instructions on Friday!)

If you're on Instagram, post a picture of your twins on Friday and include the essentials: Names, date of birth, area (city and/or state) where you live, etc.  Use hashtag #twintalkcelebratesmultiples and get to know twins all over the country!  


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3 comments:

  1. Well done, Christina! My twins were 64 days in the NICU (born at 29 weeks), and I started pumping immediately because we were so afraid of Necrotizing Enterocolitis (preemies' intestines are fragile like their lungs). Because our girls were only being tube fed very small amounts, we invested in a deep freezer and stored as much milk as possible to last in the future when they would catch up to my supply. I didn't get to hold my sweeties for several days, and skin to skin took even longer, but I still managed to get a good supply (oatmeal, holla!). I never did feed on the breast (just pumped and taught them to bottle feed at 34 weeks), because my husband was going to be home with them for 3 months after I returned to work. I didn't keep pumping when I went back to work, but I'm grateful we got them past the scary months with breast milk. In fact, breast milk is so important for preemies, the NICU our girls were in is going to a new protocol where they order human milk from a bank for those moms that can't produce. Moms- do not feel the least bit guilty about supplementing with formula for twins. We had to, despite adequate supply because the girls, as preemies, needed more calories than breast milk provides. The formula was mixed IN the milk. Do what you can and feel good about even a few drops of colostrum. If you can't produce and are worried, ask about milk from a milk bank.

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