New need help BF'ing twins

Hi, I'm new here. I have two older children, Ethan (9) and Amber (4). I have successfully BF them both. I now have twin boys, 3 months old, and am trying to exclusively BF them. They were born at 34 weeks and stayed in the NICU for almost 3 weeks. I pumped from birth and had a good milk supply, pumping as much as 4 ozs from each breast in a session. The problem was the hospital staff had me use extra small medela silicone nipple shields to feed them. I had never used them before and did not know that they drastically reduced milk supply.

So, when we got home and I quit pumping my supply went way down. Now, I am struggling to get it back up. My local lactation consultant told me to supplement them with 2 ozs. expressed breast milk at each feeding from my frozen stash and to pump every two hours. Now, I have been supplementing and their wet and soiled diapers are good again and they are gaining weight, but I'm just not making enough milk now. I managed to wean them off of the nipple shields by stepping them up to the standard size nipple shield to train them to open their mouths more. After using them for a while they transitioned to my bare nipple. I can't pump every two hours, I just don't have the time or ability to work it around their feedings. Not to mention needing to sleep. So, I pump after every feeding. My frozen milk from those early weeks is rapidly disappearing and I just don't know how to get my own milk supply up to par. I don't want to supplement with formula, nor can I afford it.

Anyone have any experience with blessed thistle and fenugreek? I have been told to take them together to increase my supply. I just don't know if it will have a lasting affect or peter out. I'm getting desperate and need advice. I appreciate anything anyone here can offer me. Thanks!

Erin

 

This website has some great suggestions: www.kellymom.com

Good luck!

 

What I would do if you do not have time to pump is try hand expressing after each session for 5 -10 mins, that really helped my supply. Even if you do not see anything coming out it will tell your body to make more.

http://newborns.stanford.edu/Breastfeeding...Expression.html

I haven't tried those herbs, but I have heard from other mothers that they work really well. I think I heard with fenugreek, you have to take a lot of it and you are not talking enough until I believe you smell like maple syrup is the saying. From what I heard they are not meant to be taken for a long time, just until your supply get ups. Also eating oatmeal every day, and for some reason it has to be the real kind not the instant. There is something in oatmeal that can increase your supply. Your proactin level, I believe is the name is, is the highest between 1 -4 am, so try to nurse or pump during that time will really help increase your supply. If you really are struggling and none of this works your doctor can perscribe medications that will help increase your supply. I hope other people can offer you more advice. The only other thing I can think of is a nursing marathon where you just sit one weekend and nurse all weekend long. I did that when I switched from pumping to nursing and that was all it took to make up the 10oz more that they were eating than I was pumping. If your are going to continue to supplement I would make sure you let them stay on the breast a little longer or hand express since every time you supplment you are telling your body that it does not need more milk, since the babies are getting it another way which can hurt your supply. So you want to stimuate your body so that it knows that it needs to make more milk. It works on supply and demand. Hopefully this all makes sense since I am starting to ramble now. Good luck!

 

QUOTE(tarziesgirl @ May 23 2009, 05:43 PM) [snapback]1325857[/snapback]
So, when we got home and I quit pumping my supply went way down. Now, I am struggling to get it back up. My local lactation consultant told me to supplement them with 2 ozs. expressed breast milk at each feeding from my frozen stash and to pump every two hours. Now, I have been supplementing and their wet and soiled diapers are good again and they are gaining weight, but I'm just not making enough milk now. I managed to wean them off of the nipple shields by stepping them up to the standard size nipple shield to train them to open their mouths more. After using them for a while they transitioned to my bare nipple. I can't pump every two hours, I just don't have the time or ability to work it around their feedings. Not to mention needing to sleep. So, I pump after every feeding. My frozen milk from those early weeks is rapidly disappearing and I just don't know how to get my own milk supply up to par. I don't want to supplement with formula, nor can I afford it.

If I were you, I'd try two things. First, I would change your supplementing strategy, especially given their past difficulties with latching. Many Moms around here have found that supplementing right after a feeding can be a supply killer because the babies get used to getting the bottles after the breast and they start to get a little lazy with their suck. So what most of the twin Moms around here do is the replace a meal strategy. So they nurse on demand, and then they pick a meal here or there that will be all bottle (you can pump when they take the bottle).

For example, maybe their schedule looks like this:
BF @ 6
BF @ 8:30
Supplemental bottle 11AM (I'd say about 3-4 ounces at their age.) Mom pumps.
BF @ 2
BF @ 4
BF @ 6
BF @ 8:30
Supplemental bottle 10:30PM Mom pumps.
Night time BF on demand.

Second, I'd give myself a break and drop most of the pumpings. As long as you think they are nursing well and your breast feel empty, I'd feed at the breast (obviously without the nipple shield). Did you LC weigh the babies before and after a feeding? She should to do that to help you gauge your supply. The only time I would pump is when you replace a meal.

If you need a break for a few hours here or there. You could try to have someone else give them the supplemental feedings and you rest.

I know folks around here have mixed feelings about nipple shields. I never used them in spite of latch problems, but many other women have had their babies latch only with them initially.

You can also take fenugreek, blessed thistle, oat meal, and so on. Another thing, and I sure had trouble with this, drink tons of water. I figured my boys took about 40-50 ounces of milk out of me a day, so I tried to drink that much water.

 

HI there!
Just wanted to let you know we also have a wonderful Breastfeeding forum here on TS. The ladies there are incredibly helpful!
HERE is some good reading on how to increase a low milk supply.
Ive taken fenugreek and had great results with it. I know alot of other moms have also drank mothers milk tea to help with their supply.

Its awesome that you were able to get them off the nipple shields, I had one twin who used one and it took us 5 weeks to ditch the thing. It was not fun.
How often are you feeding? for how long? Do you tandem feed?
Are you gettin enough rest? water? calories? for yourself.
When you pump after a feed what type of pump and how long do you pump for? Do the babies always take that 2oz and what kind of nipples are on the bottles?
Alot of times we discourage moms supplementing every feed ONLY because some babies will get lazy and hold out for the bottle and not do the work at the breast.
If you have to supplement you have to and thats ok, but what would happen if you didnt supplement and you just nursed on demand non-stop for a few days??

 

Mine were also 34 weekers and I pumped for the first 3 months. My suggestions for increasing supply would be to:

* pump as often as possible. I pumped every 3 hours for 15-20 minutes
* massage your breasts while pumping
* use lots of lanolin before pumping
* eat oatmeal (the real stuff) everyday and drink LOTS of water

You could also try cluster pumping and pump every 15 minutes for a few hours several times a day. You would definitely need to do this on a day you have help! Or try a nursing marathon and just camp out and nurse them as often as they will nurse for a day or two. Let your DH bring you food, drinks, change diapers, etc. so that you can focus on nursing.

I hope your supply increases soon!

 

How often are you feeding? Well, on average during the day 3 hours from feeding to feeding. Overnight they will sleep from 5 to 6 hours from feeding to feeding. for how long? I nurse them 20 minutes, then give them their supplement via a rigged supplement nursing system. Do you tandem feed? Yes, most of the time. I only feed one at a time if they are awake and crying and the other is sleeping in between feedings. I'll feed both of them if its between feedings and they won't calm down, but its usually just one of them.
Are you gettin enough rest? Probably not. water? Probably not. calories? Probably. for yourself.
When you pump after a feed what type of pump and how long do you pump for? Medela Lactina electric Plus. Do the babies always take that 2oz and what kind of nipples are on the bottles? This will sound strange, but due to lack of funds and the immediate need to supplement them I purchased the smallest size catheters I could get and use them in the corner of the mouth. It isn't the best situation, but it avoids the bottle (I don't own any nipples) and it still stimulates my breast when they are getting the extra milk.
Alot of times we discourage moms supplementing every feed ONLY because some babies will get lazy and hold out for the bottle and not do the work at the breast.
If you have to supplement you have to and thats ok, but what would happen if you didnt supplement and you just nursed on demand non-stop for a few days?? Will that work?

Did you LC weigh the babies before and after a feeding? We did this, and they each weighed 3 ozs. more after the feeding, without the supplement. They were still fussy and I nursed them more and gave them their 2 oz. supplement and they went to sleep. So, it seems that they are taking a rather large quantity of milk. I just don't understand it because they seem to be taking in more than what they would need at this time. They each weight right at 9 pounds and are almost 14 weeks old. From what I found online, 5 ozs. per feeding was too much. Why then would they be discontent after a feeding they got 3 ozs from?

 

I forgot to say that I pump anywhere from 5-20 minutes depending when the milk stops flowing. My LC told me not to pump 2 minutes beyond milk not flowing.

 

You've received a lot of good tips from the PP's. I won't bog you down with more tips...but please report back on how things are going!! We're rooting for you.

 

You did get some great advice from prior posters and your LC... I will say that for us feeding on demand was more like a 2 hour timeline... we did that for over 3 months. though I didn't mind because by 6+ weeks they started sleeping through night feeds, and by 2 months they were sleeping 7-8 hrs a night if I remember. So I figured I needed to feed them more often during the day... I wonder if you'd be able to make the 3 oz. each if you fed them sooner than 3 hours? and if then you'd get in an extra feeding or so during the day if you fed more often? anyway, I hope you get some relief soon and more supply.

 

I would try feeding them every two hours during the day, so they wouldn't be so hungry and need so much to feel full. Mine are 5 month and I nurse them 8-9 times in 12 hours, then the other half of the day they sleep through the night. I try to get in as much feedings during the day. First I would probably try a nursing marathon for a couple of days and just nurse and nurse. If that doesn't work then I would try like other said just picking times to supplement and after that time pump or hand express, so that you can gradually wean them off the times that they are supplementing. I do not know why the LC told you not to pump after two minutes of no milk flowing. I was always told to pump for atleast 5 min after the last drop to tell your body to make more. I belonged to a board of women that just exclusively pumped and they always recommend pumping for 15-20 or 5 min past the last drop, which ever is longer. From what I have heard those extra few minutes can make a big difference in you supply. Go to run

 

I like the sound of the nursing marathon just to get it over with. I can't stand supplementing because they tend to gulp down the milk and swallow a ton of air. Then they are crying until I can manage to get them to burp. Its a mess.

So, for the marathon I don't pump after feeding them right? I would just let my supply build up for the next feeding? I was feeding them pretty much non-stop when we were using the shields until I started supplementing them. I was going nuts then because I couldn't lay them down or they'd cry and cry. Then I'd have to nurse them again until they went to sleep. It was't long before they woke up crying again. That's enough to make you have a meltdown.

I hate to say it, but I don't think my LC has much experience with twins. She has been around the area for many many years. I think most twin moms just formula feed and consequently she hasn't had to advise twin moms or twin moms with the problems I've had. She never even mentioned herbs to me. I've been wanting to decrease the supplement for about 2 weeks, but she said she feels like they really need it, so I've continued on. I just keep thinking that I'll never make more myself if I don't start to decrease the extra they are getting from the SNS.

Thanks for all of the tips. I just feel like I'm doing what I should and my supply isn't responding. I'm going to try feeding them more frequently until I can arrange for help during the marathon. I just need to know how to handle the pumping during the marathon.

 

You said they were getting about 3 ounces per feeding, and I know my guys ate every 2.5-3 hours around the clock at that age. When they got a bottle of BM it was 4 ounces, so from my point of view your only an ounce short of that.

I'd go for the nursing marathon, and try to drop the supplementing and the pumping. I'd only pump if you plan to skip a feeding.