Thursday, June 18, 2009

The Whole Breastfeeding Thing

Long time readers may recall that I breastfed my son. Forever. It was a relatively easy experience and definitely rewarding. I expected that breastfeedingt twins would be different. But breastfeeding twins in the NICU is a whole other experience.

The first thing to note is that I'm pumping almost exclusively. And I know that many people who pump exclusively have a hard time getting and maintaining an adequate milk supply. I have a good idea why: the pumping schedule given to me by the NICU lactation consultants is (sort of) appropriate for singletons and not even close to appropriate for twins. At one point, someone said "This is what you need to pump for twins, but you need to make double what this schedule says."

I'm not economist, but I think I have a better idea of that following a guide to make supply equal demand for singltetons and just "hoping" it doubles for twins is not appropriate.

So the first thing I did was based on my experience nursing Conor: I pretended I was actually feeding the twins and pumped as often as they thought they would want to eat. Lactation Consultant Caustic (LCC) immediately called me irresponsible on day 2 of pumping for not following her directions, saying I would mess up my nipps before I really needed to use them. I, still being a bit hormonal, was pretty annoyed.

I then checked the NICU chapter of my Mothering Multiples Book, one of the best books I've found on this journey. Instead of the 8 pumping times as recommended by LCC, the author recommends pumping 10 times in 24 hours, with 1 to 2 more sessions if you want your body to know you're serious about breastfeeding your twins. I did pump 12 times for a couple of days, but for the most part, I'm pumping 11 times per day. I'm currently right on schedule to have enough milk at the end of two weeks to support to good sized babies.

Let's review that: I am pumping 3 times more per day than recommended and I'm right on schedule. I can tell you right now, those 3 extra pumpings make all the difference. All the nurses in NICU are amazed at my supply....and I keep pointing out that the schedule women are given is not adequate to produce enough milk. It's even more important because the easiest time to increase supply is the first two weeks. After that it gets more difficult. So I'm willing to do this pumping schedule for two weeks and then figure out how I can maintain it until the babies are breastfeeding fulltime.

So, yes. The goal is not for me to pump for the twins. the goal is for me to breastfeed (mostly exclusively) the twins. The good news is that both children "get it". The bad news, or actually the typical preemie news, is that it's going to be a while before they are strong enough to breastfeed for most of their feedings. And you know what? That's absolutely ok. My perspective on what is "normal" and the "right path" for preemies is evolving and is not even close to the same for what happens for term babies.

My children are doing great in learning how to breastfeed and I am so proud of them. (As an aside: how is it possible to fall so hard in love with two people that I have just met? I honestly get overwhelmed with how wonderful and amazing they are. I think knowing how much I love Dave and Conor makes me see how much love I can feel and it's really damn easy to feel it for these two children) So back to being proud of my twins.

Christopher actually got off to a slower start than Bridget did. And I just figured out today that it just may be his style: he likes to take his time and enjoy his fresh from the breast gourmet milk. He does not like to be rushed as he indicated by grabbing my boob with both hands when I tried to remove him thought he had fallen asleep. So he takes a while.

Bridget, on the other hand, well...cue to the 70's music by Heart Barracuda. (I love YouTube) The girl likes to eat. Her first time breastfeeding was like she had never eaten before. Guess what? At 7 days old, that was the truth. And she ate like she meant it. I've been underestimating how much she's been getting because she's on and off so quickly compared to Christopher. But then I realized that she nurses so strongly that she loosens my toenails.

Plus, yesterday I felt so guilty about trying to push her into nursing. She started off really well on Sunday. Monday was good but not great. And then on Tuesday and Wednesday, she just sort of pooped out. This is all part of that two steps forward, one step back issue with preemies. They had to start gavaging her (feeding her through a tube in her nose) because she was too pooped to even bottle feed. This is a problem because she doesn't get her get of jail free card until she can eat for 3 days from either a bottle or from me and still gain weight. And here I was really trying to push her to nurse and she just really needed to get her strength about her.

The whole preemie thing is really humbling. Even more than with term babies, you have to wait and let them set the pace. And the advice one gets for term babies? It's not appropriate for preemies. It just doesn't work.

So, as I have multiple times over the last 12 days, I take another step back and see where they are on this journey. The good news is that we're now approaching 48 hours since Christopher's last brady (a brady occurs when they forget to breathe and their heartrate drops down). He has to go one week with no bradys to get his get out of jail free card. They are thinking he will be ready to leave in one week. I would really prefer that this issue resolves before we go home. And how will it resolve? His brain will mature and breathing will be automatic for him like it is for you.

Bridget needs to figure out how to eat. She will. It is highly unlikely that she is going to enter kindergarten still being fed by a nasal gavage. We just have to wait until she develops enough strength and stamina to eat her food. She has the skills; she just needs the energy. I can wait happily and patiently for that, too. I'm also learning how to bottle feed her. They won't let her go home with us until both Dave and I can demonstrate bottle feeding skills. Dave gets a pass on the breastfeeding.

It will probably take until they are 40 weeks or past until they can fully breastfeed. They just hit 36 weeks yesterday. It may take 4 to 8 more weeks before we have an easy time with the breastfeeding around here. No problem. I can wait. And we will figure it out together.


Bonus track: the Jesus Jones song for Right Here Right Now. Loves it.


Michaela said...

You sound fabulous, Anita, and I am so impressed w/ your ability to both advocate for yourself (frickin' hospital LCs who I found to be Not Helpful in terms of dealing w/ preemies) and know what the babes need. My girl (5 lbs 1 oz) had many gavage feedings as we alternated among that, breast and bottle. Totally not the end of the world for us.

And here's my bit of assvice, which I don't think you need but since I rarely have the opportunity to use this hard-earned knowledge, here it is: I was dead-set on nursing rather than bottle-feeding, but my girl had a tough time getting the hang of it as a 34-week singleton. My fabulous doula recommended that I let go of my breast-only stance and just get her the heck out of the hospital - then work on the bf-ing relationship at home. We did use a nipple shield for a while, which totally helped (although it made weaning off the pump more difficult). But switching to bottle feeding for a few days got her sprung from the hospital much sooner than we'd hoped.

Hang in there!!!

Anita said...


I'm right with you on getting her (and him) sprung and then figuring out the bfing thing on our own at home.

I'm so glad it worked for you! It's a good role model for me!!

Anonymous said...

You are amazing and doing exactly the right thing with the extra pumping. When I had my twins, the advice I was given to establish my supply was to use a hospital grade pump after every feeding so the schedule they gave you makes no sense at all with multiples. Glad you ignored the LC, this is a critical window for success and sounds like you are well on your way.

Kati in CA said...

Thank you for sharing your story and experience with us. You educate, amaze, and inspire with everything you've been through and your strength to do so much, so soon, so well. (Pumping 11 times per day! Constant research! Kangaroo care! Wow!) You rock!