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Monday, August 13, 2012

Guest Post: Exclusively Breastfeeding Twins

For breastfeeding month, I want to share this inspiring story of my college batchmate, A.  A and her husband had long been praying for children and finally conceived twins through IVF.  During her early breastfeeding days, we were texting and I asked her to share her story.  What I was amazed with A's story was that she exclusively breastfed her twins! No glucose water, no formula milk, no donor's milk!  Thus, I wanted to share her story to encourage moms with singletons or multiples that it is possible to exclusively breastfeed your baby from Day 1 without supplementing.

When I sent the questions to A, her twins were less than a month old.  She didn't feel confident to respond and held off.  A finally emailed her replies when her twins were 4 months.  I have decided not to edit her answers and just copy and paste them as it is.  It is quite lengthy but there are a lot of insights to be picked up and these learnings will be most helpful to pregnant moms - to help them understand how to successfully and exclusively breastfeed your baby.

1. What made you decide to breastfeed your twins?  Who inspired you or influenced you to breastfeed?
My mom died of breast cancer.  She gave birth to 6 children and due to several factors (work, most of all), she did not breastfeed any of us and actually took medication to stop breastmilk production.  Of course this was during a time when breastfeeding was NOT the norm and was seen as 'backwards' or what people in the province did.  One of the risk factors for cancer is not breastfeeding.  This made me decide to try my best to be able to breastfeed, as I didn't want to have my children see me go through cancer or have to leave them without me to take care of them.  And of course, the fact that it's best for them as well, reducing their risks for diseases, among them cancer as well.
Another factor which helped was that I thought my friends who already had twins had breastfed them exclusively from the start.  It was only after I gave birth and I got in touch with them to ask for some tips that I found out that all of them had started with either formula / donor's milk first before settling into exclusive breastfeeding after the first 2 months or so.  In this case, ignorance on my part helped as I thought since they were able to do it, I should be able to as well! :-p
2 of my sisters, living in the USA & Canada, also fully breastfeed their children, without ever once using a bottle!  They always did direct feeding and I've never heard them complain about any difficulties with breastfeeding, which was why I was shocked when I encountered lumps, soreness, engorgement, and discovered that many Filipinas encounter problems too! I am inclined to believe (though I of course may be wrong!) that this is due to an increased use of pumps, which is why I try as much as possible to do direct feeding and as little pumping as possible.  I try not to pump to have freezer stock.

2. What preparation did you make for breastfeeding?
I read up a little bit but to be honest, none of that prepared me for the actual experience!  I did try to 'prepare' my nipples by placing nipple cream on them during my last trimester to reduce eventual nipple soreness.  However, it needs to be done gently, otherwise it may stimulate premature contractions.
(note: no preparation is actually necessary during pregnancy for breastfeeding)

3. You mentioned that your pedia doubted your ability to produce enough milk at the start, how did you deal with this? How do you deal with the doubters and naysayers?
My neonatologist told me right before our hospital discharge, 'mea culpa' (which I didn't know the meaning of then!). She then told me that the reasons she thought I needed to look for donor milk was that (1) I was a first time mom (2) I underwent fertility treatments which usually adversely affect milk production (3) babies were born prematurely (4) the fact that there's 2 of them to feed versus 1!  Both my babies had to undergo phototherapy and she mentioned that they may become dehydrated if I'm not able to give them enough milk, so she suggested either sugar water or donor's milk.  I declined and said I'll try my best and it would be the last resort to give them sugar water, as (1) I didn't want my babies to get a sweet tooth from the sugar water and (2) I was afraid donor's milk might have some diseases like Hepa B that might pass to my babies, who hadn't gotten the Hepa B shot due to their low birthweight.  
I didn't really have any doubters or naysayers, though my dad did say once to give them formula once in a while so that I could get some rest, as I was feeding every 2 hours and only getting 30minute-1hour breaks in between feedings.  I didn't do that though as I knew if I skipped a feeding, my milk production would go down.

4. Who were your supporters?  And how did they help you succeed?
The nurses at Makati Medical are very well trained in helping the babies latch properly.  My family and friend gave lots of breastfeeding tips, and suggested products and techniques that would help.  I received a LOT of breast pads, milk bags, nipple cream :-)  I also called them up to ask about their experiences, milk storage, etc and they really, really helped a lot! Having friends who gave birth at roughly the same time I did also helped as it made me understand that everyone is going through the same thing I am :-)

5. Describe your day.
I don't feed my babies on a schedule as recommended by some twin sites; I feed on demand as I've read that babies fed on demand have IQs higher by 5 points than those that are on a schedule.  This however means that one baby feeds every 3 hours from me while the other goes every 4-5 hours - I don't wake them up too for feedings (beginning the 3rd month) as sleep is the time when growth hormones are released.  Which is why it's important for me to switch breasts the next day :-)

But, roughly this is what happens:

  • 9am - direct BF
  • 10am - if they're awake, i give them a bath
  • 12nn - direct BF
  • 3pm - direct BF
  • 6pm - direct BF
  • 9pm - direct BF
  • 12mn - direct BF, then I sleep
  • 3am - Babies drink ref milk; I pump for the next 6am feed - this I just leave at room temp & don't ref to maximise vitamins
  • 6am - Babies drink the 3am milk; I pump and ref it for the evening 3am feed.
  • 9am - direct BF
Right now I have a little excess from my pumping sessions so these I freeze and store.  I've never had to use my frozen milk for my twins.

6. Any tips or advice for new moms - especially for pregnant or new moms of multiples?
Latching correctly is very very important!  -  I'm blessed never to have experienced cracked or bleeding nipples as I always tried to make sure their latch was correct.  If it was wrong, I'd remove the baby and try again and again till it was correct.  This is because I've read on so many websites that the reason breastfeeding usually stops is due to pain from incorrect latching and I really wanted to last, so this was my primary concern.
Twins are usually born prematurely so you need to feed them every 3 hours at the very most.  You can't feed 'on demand' as premature babies tend to keep sleeping, so you need to wake them up and 'force' (gently) them to feed.  I fed them every 2 hours at the start for about 2 months.  
Nipple creams are very important!!  I kept putting them on my nipples to prevent cracking and soreness and yes, they did help!  Earth Mama Angel Baby's Nipple Butter worked best for me. (note: you can also use breast milk to moisturize nipples and prevent cracking and soreness)
Most suggest to feed twins together but in my experience, I preferred feeding them one after the other as I can position them correctly and check their latch, plus one-on-one bonding time.  I tried feeding them together and they tended to fall into wrong latch positions on my nipples and pull on them, causing pain.  Since you're holding both babies, you can't re-adjust their latch!  So, short term inconvenience (longer feeding time since one after another) for long-term benefit (painless feeding!)
I don't offer both breasts to one baby at each feeding.  I usually designate one breast for one baby for the day, then switch the next day. The reason for this is that if you don't, you might accidentally feed the next baby on a previously emptied breast, causing the other breast to be engorged since it's missed a feeding. I switch the next day to ensure my breastmilk production is balanced as your babies will definitely not have the same appetite level.   Also feeding styles vary (one is very aggressive, and the other a slow feeder) so switching everyday keeps nipple 'trauma' even, hehe.  
If babies cry when they feed, don't automatically think it's due to no milk from your breasts.  I've found that it's usually one of the following reasons: (1) nose is clogged, so they need to be suctioned (2) breastmilk flow is too fast, so adjust your position (3) diaper is wet or dirty, so change it (4) they are sleepy and are using you as a pacifier, so put them to sleep first (5) they are too excited, so have a helper calm them down first before returning to you for feeding (6) they are gassy, so they need to be burped (7) they don't like their position, so change their feeding position.  
Always remember that babies go through growth spurts at 6 weeks, 3 months, etc so around these times they'll start to feed constantly, almost every hour.  Don't think that they're doing that because they aren't getting enough milk from you; they're doing it to help your body increase production during their growth spurt. :-)  
When pumping & bottle feeding:  Store your milk in 1 oz servings, especially at the start.  Don't overfeed your babies, which is easy to do when bottle feeding.  I try to make the bottle feeding session last almost as long as the breastfeeding session, ie if they breastfeed for 15 minutes, the bottle feeding should last that long as well.  Keep baby upright, don't tilt the bottle too high, pause frequently to burp baby (especially premature babies with underdeveloped digestive systems - they can choke easily from too fast milkflow) and make sure the nipple you use is specially for breastmilk as nipple holes for breastmilk are finer than for formula since breastmilk is more watery than formula.  if you use nipples for formula, the milk will flow too fast and babies can choke.

When to pump:  Avoid pumping for the first 6 weeks as it can decrease your milk production (in my opinion -  as the few times I did it gave me lumps & engrogement!)  I started my regular 2x day pumping when they were 3 months old.  

Anyways, I did semi-heed Abbie Yabot's advice on not overfeeding the babies when bottlefeeding them (1 oz per month!) I started with 0.75 oz and increased by 0.25 oz at the babies' own pace.  So now my baby girl takes 3.5oz during bottle feeds while baby boy takes 4.5oz.  I let them set their own pace.  And funnily enough it's my baby girl who is the heavier one!  At birth, my baby boy was 4.5lbs only (5th percentile!), and now he is 14lbs, while my baby girl was 5lbs at birth and now 14.5 lbs :-)  My family and friends are amazed at how chubby they both are, considering they are twins and are purely breastfed :-)  FYI I have extremely small breasts to start with so size is definitely not an indicator of milk supply!

My last advice is not to over-pump; ie pump to build a freezer full of supply!  I always try to pump just enough for their feedings.  Why I decided to do this  is due to my observations of many Filipinas who experience lumps, engorgement, mastitis, etc and one common factor I found was that they all pumped more than they direct breast-fed.  (For me, I think it's because the overpumping causes your body to overproduce and then since you aren't getting the milk out fast enough, problems occur - then I think it backfires since you aren't able to continue breastfeeding properly due to these problems.)  I've already heard of 2 recent cases where women had to have surgeries on their breasts due to clogged ducts from too much milk.  Then they ended up not being able to breast feed at all as the milk ducts had to be surgically removed.  I think there seems to be a certain 'pride' in being able to produce lots of milk but if your body cannot handle it then your breastfeeding journey might be cut short instead.

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