Foodie Friday: Breastfeeding Twins

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Categories Breastfeeding, Feeding, Foodie Fridays, Infants

One of our readers posted this question:

“My girls are four months and are exclusively breastfeeding.  I pump for the meals I miss while working.  All is well for now, they’re growing and not too fussy, but I can tell the babies would like more milk than they’re getting.  4 oz. +/- 5 times a day. My mom brings the babies to me at work for lunch, so they are on the breast for all but 2 meals a day, four days a week.  And I squeeze in an extra pumping session in between their breakfast and the 10:30 pump.  But pumping to get milk for those 2 meals a day shows me: 1) that I struggle to get much more than 4 oz each, and 2) that the babies will happily drink 5 oz when they’re lucky to get it.  Now that they’re getting bigger I’d be happier if they were getting 6 oz., but hate to disrupt the routine especially since they sleep so well at night.  I considered waking up to pump, but that seems so wrong! Is there a way to boost supply without getting off our successful schedule?  Will it happen on it’s own?  Will food make up for the lower milk supply?”

I’m going to throw out a couple of ideas and suggestions from the HDYDI moms. However, first I’d like to remind everyone that none of us are lactation consultants, and that lactation consultants are a fabulous resource. If you’re concerned about supply or your baby’s (babies’) needs being met, talk to an LC or your pediatrician.

Supply issues

In general, the HDYDI moms talk about being concerned about supply issues. There’s something about that pump, and seeing how much (or how little) is coming out of it, that makes you just a bit nervous about how much milk your babies are actually getting when they breastfeed. I will share my experience—I pumped about two afternoons a week while I was at school (ugh, in the handicap bathroom stall—wouldn’t you think a school of social work could do better?!). I NEVER got as much milk out with that pump as I know my babies must get while breastfeeding. Just doing the math of how much weight they were gaining, there were times when I know they were getting at least 8 ounces from me (each) and I might have been pumping four. I would often pump twice as school to supplement their one feeding or pump an extra time or two on the weekend. It helped that my guys hated bottles, so they weren’t interested in taking much from the bottle while I was gone. (However, once I got home, they would descend on me like small, starving hyenas. It was disturbing.). At least one HDYDI mom didn’t pump enough milk at work (with three daily pumpings) but did nurse exclusively on the weekends. Other recommendations include nursing on demand when at home, so that the babies have the chance to naturally increase your milk supply during a growth spurt. At least at first, put aside the fantasy of feeding babies every three hours—in order to be able to increase your supply when they need to, they will often require eating more often. (Or, like my babies, will decide that every 1.5 hours is an appropriate feeding schedule). As they get older, they will be able to do a schedule much more easily. If you are concerned about how many ounces a baby is getting at a feeding, you can make an appointment with a lactation consultant. They will weigh the baby before and after a feeding to determine how many ounces the baby is getting.

Increasing the amount you pump

One HDYDI mom suggests pumping not only past the second let-down, but until the third. (I am in awe of her pumping skills!). She suggests not thinking about it as you pump, and definitely don’t sit there and watch the bottles fill (slowly) the entire 20 minutes or so. The hands free bra is definitely a worthy investment–you are free to do other things beside simply just looking at the bottles filling. Remember, babies are much more effective at getting milk out than the pump. Remember, if you pump in the morning, you’ll get more milk than if you pump in the evening.

Several HDYDI moms suggested supplements or foods that increase milk supply. These included Fenugreek, Blessed Thistle, Red Raspberry,  Brewers Yeast (containing B
vitamins) and oatmeal. Other than the oatmeal, I’d recommend checking in with the pediatrician or lactation consultant before taking them—I’m a bit paranoid about making sure whatever I’m eating is also ok for my kids to eat.

Other good HDYDI advice (although I have to admit I didn’t always follow it) was to drink a ton of water every day (about a gallon) and eat plenty of food. That said, I certainly often didn’t do this, but I think it’s a nice goal to aim for. Good self care is important. Oh yeah, and getting enough rest. HAHAHA. Ok, seriously, this is important. But am I the only one who finds it funny too?

Several HDYDI moms suggested renting a hospital grade breastpump. I have to say, I was shocked when I switched from the hospital grade pump to the cute little pump n style. The pump n style is cuter (and better disguised in a little black backpack) but boy, it’s just not as effective. So slow! I still used it, but I can see the value in continuing with the hospital grade pump.

Babies get better at breastfeeding

One important thing to remember is that as the babies get older, they will eat the same amount (or more!) much more quickly than when they were smaller. Several of us remember thinking that there was no way they got enough breastmilk—we’re talking 5 minute feedings here—and yet the feedings were all that quick and the babies continued to grow well. In fact, in the case of my babies, they continued to be quite chunky. My guys don’t do the slender, super-model look. I think increase in feeding speed happened around four months for my guys.

Supply & demand

A supplementing caveat—if you want to breastfeed exclusively, whenever you supplement with formula, you should pump an extra time to make sure your body continues to make enough milk. No fun, I know. This is the reason that I continued to breastfeed through an evil bout of the stomach flu—it was actually easier and quicker to just breastfeed the baby rather than go get the pump, pump for 20 minutes, put away the milk and have my husband bottle feed the babies. Um, no thank you. However, some moms find that giving onebottle of formula a day provides a much needed break from breastfeeding. My favorite lactation consultant used to answer every breastfeeding question with a two part answer: Do you need to do this from a breastfeeding perspective? And what about from your perspective? Is it too much? Do you need a break? If you decide to use one bottle of formula a day, your body will just produce that much less milk.

In summary, breastfeeding is all about supply and demand. It’s hard. It’s draining. It’s wonderful and rewarding. It’s all those things—and it also makes us worry. There is no way to know exactly how much milk our babies are getting. Everyone deals with this uncertainty differently. My way was to let go—to assume that since my babies were growing well, they were getting enough to eat. This worked for me, because I was mostly at home and my babies got big, quickly. Moms who work have different challenges. Moms with those babies skating the lower end of the growth percentages have different challenges too. How have you made working, breastfeeding and pumping work for you and your twins?

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25 thoughts on “Foodie Friday: Breastfeeding Twins”

  1. Breastfeeding – I haven’t even had my kids yet and I’m already having nightmares. I’ll definitely look into the hospital grade pump and pumping bras – any recommendations where to buy or rent? I’m lucky enough to get 6 momths off work so I want to breastfeed during that time and stop before I go back to work (or slowly pump/wean while starting back). I hear what you are saying about needing to pump if you supplment with formula (so your supply doesn’t diminish) but when does Mom get a break? :)

  2. Thank you, thank you, thank you…I think I am more concerned about BFing than I am labor at this point. I’m trying to let go, and trust nature and my body, but I want to do everything I can to maximize results, too. I’m lucky…I’m going to be a SAHM and hope to BF for one year. I’ll check back to read comments and other advice.

  3. What a great post. Thank you! I have been searching for this kind of info and not found tips on breastfeeding twins after the newborn weeks. I have four month old girls and have been wondering how can they be getting enough, and do they want to nurse every two or less hours b/c there are TWO of them or am I just not making enough milk. After talking with another twin mom and reading this I know the answer is really to stop worrying, and bf when they need it! a bottle really isn’t that much of an easier answer. it can be so taxing and hard but once you make it through the first three months and realize that in the whole scheme of things the breastfeeding year(s) is not that long…my great great grandmother did it way back when, surely i can!
    another helpful tip i have found is to make sure to continue taking your prenatal or multi vitamins as well as Essential Fatty Acids (EFAs) because its so good for babies and mamas brains- we can all use a little help in the brain power dept. i also find taking lactation herbs beneficial.

  4. I breastfeed my twins for a year, and really had no problems what so ever with supply (I could have probably feed triplets…), and feel SOOO lucky about this. To keep up supply (but not waste time sitting to pump), I use to pump IN THE CAR while DRIVING to get in another pumping (in addition to my other pumps at work). I like to multitask. I would do it while commuting to or from work depending on timing and when I needed to feed them by the breast. Of course I could only pump one side at a time. I would NOT recommend doing this while driving babies around. Some how I wasn’t worried about injuring MYSELF while distracted driving, but did worry about injuring my babes. I has the Medela Pump n Style ADVANCE with all every attachment/power source – so it plugged into the car lighter. I did have a problem with my own weight (sort of). No matter what I ate, I kept lossing more weight over the year. Kids are now 15 months and weaned and I am as skinny as college and wearing a size 0 pants. Unfortunately, my cleavage is gone though!

  5. Thanks for getting to my question! There’s no advice quite like another MOM’s. I’ve tried a few of the solutions mentioned; my favorite was the fenugreek, which made me smell eerily like maple syrup. Very funny.

    Guess it’s the classic twin mom decision: choosing what’s important and being flexible about the rest. For me it’s between schedule and breastfeeding. Breastfeeding is more important to me, and I want to make sure the babies get what they need. But it’s so hard to leave the schedule! It gives me routine and predictability. Except when it doesn’t. Last night was a prime example – the girls fed and napped, then woke up ravenous. It was only an hour and a half after they last ate. I tried and tried to calm them, and finally gave up and fed them again. Man, that was what they wanted. Back to their sweet dispositions.

    On-demand weekends it is!

    Then there’s the spectre of solid foods looming a few weeks in the future. Good thing the moms have addressed that one already! Thanks!

  6. What a great post! How I obsessed about pumping when I did it. It really was one of the major stressors to me, especially in the early months. I’ve written a lot about it on my own blog. When I hit the 1 year mark:

    http://sarahandjordanll.blogspot.com/2007/09/year-of-breastfeeding-twins.html

    And most recently, this week, at over 21 months:

    http://sarahandjordanll.blogspot.com/2008/06/breastfeeding-twins-at-21-months.html

    I do agree with all of you that it gets easier, the babes get more efficient. But for me, pumping was never as effective as nursing, and I’m glad I didn’t have to rely on it.

  7. Hi all,
    Fellow Mom of 8 month old twin boys. Still BFeeding. (just pumping now ) In the beginning I would nurse one baby, pump when done so I had milk to put in a bottle for the next feeding. My one twin wouldn’t nurse anymore somewhere between 3 and 4 months. So I continued to nurse the one baby. Then I just pumped exclusively. I rented the hospital pump. I leave it on for 30 minutes. You’d be surprised how much more milk You get in those last few minutes. Not to be too graphic but you can feel when more milk is about to come out, so try to leave it on. The hospital pump automatically shuts off @ 30min. I use the time to surf the web, make phone calls, get a break.
    You get more milk in the morning, I know waking up sucks but it’s a great time to stock up. I also take MOre Milk plus and Ovaltine and oatmeal. They all help produce milk. I pump 6 times a day. I’m down to 4 feedings, I now have enough milk where I don’t have to supplement. I’m planning on doing this till they are a year old. It’s working well for me and the boys are thriving. I also appreciate the post on stopping BFeeding. It has given me some useful tips I will try when my year is up.
    I commend all who could BFeed both babies at the same time. I just find that the pumping is working and I haven’t had any problems.

  8. I’d also recommend tandem nursing. I’ve been BF’ing my boys for almost 10 months and I’ve been able to cut down on the length of time it takes me to nurse by feeding them at the same time.

    I recommend the EZ 2 Nurse pillow. (http://www.doubleblessings.com/servlet/Detail?no=271). It ain’t pretty and it’s the size of a Buick but it does the job nicely.

    As for increasing your milk supply, the absolutely best way to increase your milk supply is to nurse your twins more often. Add another feed, keep them on longer, whatever. But if you think you aren’t producing enough milk for them, the best way to do it is to increase the number of nursing sessions. It will take a day or so for your body to respond, but it will. And, of course, drink a lot of water. Your body needs it to produce more milk.

    And finally, I recommend checking out the La Leche League website (www.llli.org). I used their online “ask a question” form and ended up exchanging emails with an experienced BF’ing twins mom in New Zealand!

  9. Breasts need to be emptied at least 8 times a day during the period of exclusive breastfeeding because when longer than three hours elapse between breast emptyings milk production goes down.
    This is caused by hormonal changes in the brain.
    Some mothers find they can let their babies sleep one long stretch of 4-6 hours at night and still make enough milk if they breastfeed or pump frequently enough to get 8-10 breast emptyings a day during the remaining 18-20 hours. Doing the math that means a mother whose babies are sleeping one 4-6 hour stretch needs to empty her breasts about every 2-2.5 hours during the day…if she lets 3 to 4 hours elapse even one time she will fall below the bare minimum of 8 emptyings a day.
    Likewise babies under a year of age need frequent meals. Just 5 feedings a day isn’t appropriate until a baby is the second year of life.
    This frequency of 8-10 nursings a day goes against the expectations that result from bottle feeding. Bottles are made to hold large amounts of liquid…larger amounts than breasts actually ever produce at one time… moreover formula fed babies are put on infrequent feeding schedules that force them to over eat at each feeding to compensate for the fact that they are not being fed often enough. This infrequent feeding of large quantities from bottles is one of the major causes of obesity because it enlarges the stomach capacity of babies and toddlers and they carry this eating habit with them through life.
    But breasts work best being emptied frequently and this matches the needs of infants to be fed small amounts (which match their naturally small stomachs) frequently so that they can meet their caloric needs without stretching their stomachs.
    At this point it sounds like the twins are being underfed because they are being fed too infrequently. More frequent breast emptying should increase your milk supply. If it doesn’t seek the assistance of a board certified lactation consultant. Monitor your girls growth with the growth charts of breastfed babies from the World Health Organization. Breastfed babies double their birth weight earlier than formula fed babies- around four months rather than six months- so your girls should be about double their birth weights at this time but depending on how long they have been feeding only five times a day they could be needing to do some catch up growth.
    Since nothing grows a baby better than breastmilk increasing your milk supply through optimal breastfeeding frequency is the best strategy. Take a nursing vacation where for 2-3 days you nurse your babies 10-12 times a day to bring your milk supply back up. After the nursing vacation empty your breasts at least 8-10 times a day and you should see that you will be able to provide closer to 30 ounces per baby per day rather than the 20 ounces they are now getting.
    Be sure to have your caregiver feed them the same amounts you are able to pump and with the same frequency they would be fed if they took all their nursings at your breast directly so that the caregiver isn’t stretching their stomachs and putting them on a bottlefeeding rather than a breastfeeding eating schedule.
    Herbs and medications can provide a helpful start up when used in conjunction with proper breastfeeding frequency but they cannot compensate for breast emptying under 8 times a day – the two hormones made by the brain when 3 or more hours elapse between nipple stimulations and breast emptyings are just too powerful.

  10. Jen, wow thanks for the direct analysis. I suspected my long night stretches (sometimes as much as 10 hours) might be part of my production problem. 8 times a day, that’s something I can plan on making sure I do.

    Still, even with reduced rations they are growing well and more than doubled their weight at 4 months. Interesting to hear that BF babies do.

    But those are great suggestions. I’ll get to it!

  11. Hi Gena…I’m glad you are so open to altering the nightly routine!

    If a mom puts a higher value on babies sleeping longer than 4-6 hours at night than on exclusive breastfeeding then there is no way to solve the problem of less than optimal milk supply, but since you place a higher value on breastfeeding then on keeping to the same routine then everything is fixable!

    I am glad the girls have already doubled their birth weight that probably means the infrequent feeding hasn’t been going on too terribly long, and if that’s the case then it shouldn’t be too hard to get the girls back on a breastfeeding rhythm which will optimize your milk supply.

    I think nursing multiples often compensates somewhat for infrequent nursing because of the extra nipple stimulation…you have only been nursing/pumping 5 times a day but you are getting twice the nipple stimulation that a mom of singleton would get and that has made all the difference.

    A mom of just one baby nursing just 5 times a day at 4 months postpartum would be experiencing a catastrophic milk supply failure right about now and you are not which more than likely means your body will positively respond to a change in breastfeeding frequency.

    The nursing frequency of the first six months determines how breastfeeding goes in the second six months because it determines the level of your maximal daily milk production.

    Newborns usually consume 2-2.5 ounces of breastmilk per pound of body weight every 24 hours but we can’t really apply this math to to the older baby. As babies get older their growth rates slow down and the efficiency with which they use their calories goes up so they don’t need quite as much milk per pound of body weight everyday. As a result of this mothers’ milk supplies usually level off well before the babies are 6 months of age.

    When nursing frequency is optimized in the early months it means this leveling off will be set at a higher amount than if breastfeeding frequency is sub-optimal.
    So it is great that you are addressing this issue now rather than 2 months from now.

    When solids are introduced babies whose mothers have good milk supplies don’t eat a lot of solid food because there is very little to no shortfall between the babies’ caloric need and mothers’ milk supply. On the other hand mothers who nurse infrequently in the early months have lower milk supplies and their babies eat a lot of solid food.

    How much solid food a baby consumes exactly demonstrates the short fall between the mother’s milk supply and the baby’s caloric needs.

    Of course it is normal for there to be a shortfall sometime after six months but with optimal breastfeeding frequency it won’t be much of a shortfall and babies will continue to be primarily human milk-fed (as they should be) for many months to come.

    Although many mothers report their babies wean themselves under a year of age that’s really not what happened. Most moms are not taught how the breast makes milk and they think that nursings should be spaced further and further apart during the first year of life which is not at all the case. While nursing will be more frequent in the newborn period (10-12 times a day) and then again during certain developmental changes, nursing 8-10 times a day during the first year of life is entirely normal.

    Because most mothers are never told this (in fact they are taught the opposite in most cases) mothers think they should be trying to space the nursings further and further apart ESPECIALLY at night.

    This practice causes mothers to have low milk supplies and it is low milk supply which causes a baby to *appear* to self wean under a year of age. (one caveat- nursing strikes can happen even when mothers have great milk supplies but if the mother recognizes what is happening and protects her milk supply while the baby is recovering they baby will go back to breastfeeding when all is well with him)

    Anyway this probably more information than you wanted but I just wanted to share with you how changing your routine will not only solve problems in the short term but will prevent problems like premature weaning in the future.

    Best of luck to you and your girls, I hope you will experience all the joys a normal course of nursing brings!
    Jen

  12. There’s never too much information. I’ve been thinking and reading about this for a while, and it’s good to have concrete answers.

    Thanks, thanks, and thanks again!

  13. I have 2 month old twins, born at 36 weeks. They are gaining weight has they should be, 8 lbs and 9 lbs. I currently exclusively breastfeed. In the evenings, they eat every 2-4 hours. During the day, they want to eat every hour (I start at 11 am, they want again at Noon). The doctor and nurse said that the feedings should be more like 2-3 hrs so I should distract the babies so they don’t want to nurse every hour. They said babies love the breast and will always want it unless I start to stretch out a bit. What are your thoughts about this? Also, what can I do to distract the for that long in between feedings if they are not napping? They often take short naps, just to wake up for their hourly feedings. Every now and then, they will take a few hour nap if they are really exhausted.

  14. Tammy–

    Congrats on your twins! I wanted to comment quickly on your question. The lactation consultant that ran my breastfeeding support group said that it is normal for young babies to “clusterfeed” for about a four hour period each day—often in the evening. This means that they just want to eat and eat. It’s normal and doesn’t mean that they are using your breasts as a “pacifier” (although I always thought that if it worked as a pacifier and you were ok with it, that’s fine too). It sounds like yours are doing this earlier in the day! Better than from 12am to 3am, I say. I never worked on stretching my guys out duirng the first 6 months and they did it naturally on their own—at 4 months they finally stopped thinking that every 1.5 hours during the day was the way to go. I never found any successful “distraction”. I have to say, for me, as long as the babies were growing well and healthy, I tended to listen to the lactation consultant for BFing advice, not the pediatrician. While I love my pediatrician, her suggestion for weaning at a year was “just stop cold turkey and offer milk”. Um, super. Ouch. That’s just me and what worked for me though. I have to say, by 6 months they were sleeping through 10 hours most nights and all nights by 9 months. It worked out in the end.

  15. Hi Tammy,
    Rebbeca hit the nail on the head with the cluster-feed scenario…I also refer to these cluster-feeds as marathon nursing sessions because sometimes you can’t tell where one feeding ends and another begins!

    When doctors and nurses say a baby is just using a mother as a pacifier they don’t know what they are talking about…a breast is never a stand in for a pacifier…a pacifier is stand in for the real thing except that a pacifier is always non-nutritive and deforms the dental arch and face whereas the breast is always nutritive and promotes a beautiful dental arch and facial structure.

    All sucking at the breast is nutritive…even when the flow seems really slow to the mother the milk that is being transferred to the baby is the fatty hind milk which is calorie packed.

    Pacifiers on the otherhand were designed specifically to combat obesity in the bottlefed baby because bottles deliver large volumes of liquid before a baby’s intense sucking need has been met and overfeeding is absolutely the norm with bottlefeeding.

    Even when the milk is human milk mothers who are pumping will often give the milk from three pumpings in only two bottles because babies on bottles want to overeat to meet their sucking needs….

    The reason babies have such intense sucking needs is to ensure that they spend enough time at the breast. Breasts need frequent stimulation and thorough emptying to work well their best.

    When doctors and nurses convince mothers that they know better what the baby ought to be doing than the baby himself it brings on its heels breastfeeding troubles.

    If you were to stretch the nursings out to every three hours (and it sounds like you are very skeptical about doing so- good for you) you would be doing the bare minimum necessary to be in a permissive state hormonally speaking to fully lactate, but I bet neither your doctor nor your nurse know this. They don’t know they are asking
    you to try to sit on the cusp of lactation at 8 nursings a day.

    Secondly they aren’t considering the long stretch of sleep that many babies take once a day. If the twins ever take long stretch of sleep longer than 3 hours and you combine that with following the doctors advice of nursing every 2-3 hours the rest of the day, you would be nursing 8 times a day or less. Nursing under eight times a day puts a mother in weaning mode. Her milk supply goes down.

    Thirdly the doctor and nurse who recommend schedules of a particular length aren’t allowing for individual differences in mothers milk storage capacities. The way my mentor put it was this: breasts make better factories than warehouses…

    Breasts are not bottles…they don’t have large amounts of empty space to collect a lot of milk hour after hour, so the synthesis of breastmilk is fastest when the breast has just been emptied and the rate of milk-making slows as the breast gets fuller.

    The longer a mother goes between emptyings the less milk she can make in a day’s time- its just that simple. This fact is the very reason most mothers of multiples can succeed at nursing twins and triplets exclusively…they simply empty their breasts more often than mothers of singletons.

    Peter Hartmann discovered that babies nursing patterns often reveal mothers storage capacities. He found that how much milk a mother’s breast could store had a strong predictive value for the nursing pattern.

    Babies of the same weight consuming the same amount of milk in a 24 hour period don’t necessarily nurse the same way. One baby maybe at one extreme of nursing just 8 times a day and another baby is at the other extreme nursing 12+ a day.

    The thing to keep in mind is that both babies are consuming the same amount of milk in a 24 hour period, and are happy and thriving, is just that what works for one mother/baby pair doesn’t necessarily work for another.

    I also need to point out that even when you are dealing with the same mother babies are different. I have six children and its funny my most frequent nursers grew up to be my skinniest kids. My skinniest kids are still my biggest eaters- they simply have much faster metabolisms than their siblings.

    If I had tried to impose a one-size fits all nursing schedule on them I am sure I would have starved my first and my fifth babies. Three of them are teens now and it makes the second one mad that the oldest one can eat anything he wants and still have six pack abs.

    At the time I am sure people told me those babies “just loved to nurse” and were “using me as a pacifier.” Now with hindsight I can confidently say “BALONEY!”

    All my babies loved to nurse (all babies love to nurse) it was just that some had slow metabolisms and could get all they milk they needed nursing briefly 8 times a day, and others needed to nurse every two hours around the clock and once or twice a day have a marathon nursing session to get all the milk they needed. It is no coicidence that those super frequent nursers have fast metabolisms now-they obviously were born that way.

    As an LC I see many late failure to thrive babies caused by bad advice from doctors and nurses.
    In the early months of lactation mothers have extra prolactin to protect their milk supplies while mom and babies are getting the hang of breastfeeding. This extra prolactin can ameliorate the effects of infrequent breastfeeding for as long as 3-4 months so the doctors often don’t realize how bad their advice of stretching out the nursings really is.

    Once the prolactin-safety net disappears completely and the only milk a mother has is the milk she deserves to have based on her breastfeeding frequency slow weight gain issues get so bad the doctor has to reveal this fact to the mother.

    When mothers are sent to me and I take a medical history I often discover that the baby who is now failing to thrive in the 3,4,5 month was a slow gainer from the beginning but the doctor let the mother believe everything was fine.

    Many doctors don’t want to discourage the breastfeeding mother so as long as the weight gain is *acceptable* they won’t say anything negative. Also they usually don’t know how important frequent breast emptying is to a good milk supply so they don’t know how to help a mother correct a sub-optimal supply anyway.

    To them breastfeeding and milk supplies are something mysterious…they simply believe some women can do it and some can’t, and they wrongly believe a lot of women can’t breastfeed and they have no idea why…their hearts are in the right place but their breastfeeding education has caught up with their good intentions.

    Each mother should have her own growth chart from the World Health Organization so she can chart her own babies’ growth. She should know the parameters of good milk making (8 or more times a day and only one 4-6 hour stretch of sleep in a 24 hour period).

    She should know that it’s a good idea especially when a baby is under six months of age to keep her fertility away by waking a baby who sleeps longer than 4-6 hours. Since fertility hormones work against milk production women should know how to keep their fertility at bay with frequent nipple stimulation.

    Once a baby is older mothers can relax about the long stretch of sleep because a loss of milk supply due to pregnancy won’t be so catastrophic to the older baby.

    So Tammy my advice would be to “go with the flow” Do what your babies are asking you to do. As long as they are happy and thriving and not falling off their WHO growth curves than their nursing patterns are exactly what they need to be to keep your supply where it needs to be.

    If the girls were not gaining appropriately even with you nursing them on cue, seek the help of a IBCLC.

    Happy Nursing,
    Jen

  16. Jen and Rebecca,
    Thank you so much for your feedback. It makes me feel better hearing from you. I would hate to hear my babies cry and then force them to wait.

    As for the cluster feeding, my babies seem to want to feed every hour from the time they wake up in the morning until evening as long as they are awake and not napping. In the evenings, it’s usually 1.5-3 hours that they eat. Is this normal for cluster feeding during the day or it should just be a few hours a day? Also, will this continue for a long time? They just started doing this when they were 6 weeks old. Sometimes I think they want to suck and give them a pacificer but they don’t like it so I just nurse them and I think they are hungry since they are eating and my let downs are more frequent now. However, I don’t always hear them swallow, does that mean they are just sucking?

    At first I thought it was just a growth spurt, but now they are going on week 9 still do it. What should I do if this continues because I return to work in 3.5 weeks and my husband will be left to care for them. I’ll be pumping and leaving him milk to feed them. I hope it’s not every hour by then; otherwise, it would be tough for him.

    Thank you!

  17. Tammy,
    You mention the girls want to nurse every hour in the day and every 1.5 -3 hours in the evening…what do they do during the night? Do they take a long stretch of sleep ever? and how long is it?
    Jen

  18. Jen,
    They sleep about 2 – 4 hours at a time in the night and then they want to eat. They only did 4 hours once, usually it’s more like 2 hours on most nights, every now and then they sleep 3 hours straight. During the day, there’s only so much I can do with in between feedings. I try to play with them but that can only last so long, sometimes they just fall asleep while nursing during the day.

    Tammy

  19. Jen,
    I’d like to add that they seem to sleep a lot. I don’t know if it’s because they are still small (8 & 9 lbs) and 2mos old. So maybe that’s why they are eating so frequently? We try to put them in bed around 8 pm, they like to sleep until 9 or 10 sometimes. They just eat and doze right off.

    Tammy

  20. Tammy,
    Falling asleep at the breast isn’t necessarily a problem…

    Breastfeeding is meant both to feed a baby and put a baby to sleep and I laugh every time I come across a book that tells mothers not to let their babies fall asleep while breastfeeding. There is a dipeptide in human milk that is a sleep inducer and prolactin the milk-making is also a sleep and gastric hormone.

    Moreover the act of sucking helps babies tune out stimuli and fall asleep. I now everyone says just make all the noise you want around babies and they’ll learn to sleep through anything but its just not true…babies are like us…some adults can fall alseep through anything, others need quiet and a still others find a white noise helpful…sucking and swallowing fills a babies head with this white noise..

    Often once a baby is in the “limp limb” stage of sleep you can make all the noise you want without waking them up, but some babies need more help getting to the limp limb stage of sleep than others, and others need more quiet to stay there.

    Additionally when a baby nurses for at least twenty minutes digestion of the foremilk has already started and digestion triggers satiety and sleep.

    So all in all its a minor miracle if anybody- babies or moms- can stay awake throughout a nursing…

    Sometimes falling asleep at the breast too soon can be a problem. In the newborn period babies are basically moving in and out of sleep with very short quiet alert periods at all, and so it is important that the milk be transferring fast enough at the breast that babies get enough milk before they fall asleep.

    In the newborn period when I see a baby who falls asleep almost immediately at the breast it is a sign of poor milk transfer because good flow can keep a newborn awake.

    Now I don’t consider your girls newborns so it is a little trickier to figure out if their falling asleep at the breast is just the normal “I’m full and I’m done” kind of falling alseep or a sign of slow flow, but it would be helpful to know their birth weights to figure out if their nursing pattern is absolutely fine and working for them or if it is a sign that something is up.
    Jen

  21. Hi Jen,
    I really do appreciate all your feedback. I”m glad to know it’s ok to let them fall asleep while nursing in the evenings. I always read that I shouldn’t because they will come to expect it every time to sleep. My girls are 2 months old, weighing about 8.5 lbs and 9.5 lbs. 3 weeks ago, they were 7.5 and 8.5 so I’m assuming, they have at least gained a pound since they have been gaining half pound a week.

    I, too, thought maybe I didn’t have enough milk for them so I put expressed milk into a bottle (about 2.5 oz) and see if they will want to nurse in 1 hr, sometimes, they still do. Sometimes, i feel like if they know I’m around, they want to nurse. When we have company over and distract the babies, then they don’t always want to nurse at 1 hr, they can go longer. If they are really exhausted and is napping then they don’t expect it every hour either. I’m home alone with them during the weekday, that’s when this 1 hr frenzy usually occurs. When my husband is home in the evenings and on weekends, it doesn’t not happen consistently.

    Since they nurse every 1 hr, sometimes, it may come in slower since I don’t have time to replenish. When that happens, they sure do let me know. They will usually nurse for 10-20 min before they fall asleep during the day. Sometimes, they don’t fall asleep though.

    tammy

  22. Tammy,
    Maybe it would be good to get the girls weighed, then you will know whether it is ok to try to keep them happy for a little while longer without breastfeeding.

    Babies need a lot of holding- they need the vestibular stimulation and the pasive exercise that comes from being carried around (babies who aren’t carried enough develop skull problems and sometimes even need physical therapy.)

    This being carried around is so important to babies’ development that if babies aren’t held unless they are nursing they will learn to asked to be nursed just get their holding needs met.

    Putting a baby into a Bjorn or sling immediately after breastfeeding, or in between breastfeeding, will let the baby know that she does not have to ask to nurse to be picked up and held and carried around.

    With multiples this baby-wearing is more difficult obviously- they might have to take turns for now- but once the babies have good head control you can put one baby in the Bjorn and one in a baby back pack.

    I am sure there are baby wearing devices for twins but you will have to ask other MOMs for advice about this.

    My favorite baby wearing device with my super frequent nursers was the sling because the baby can nurse in it…but my favorite baby wearing device for just wearing not nursing the baby was the Baby Bjorn because I could actually load the dishwasher and do laundry and such with the baby on board…also it was easy to get a sleeping baby out of it, which I did not find easy to do with a sling even though I wore a sling for some many years it became like an appendage to my own body.

    The Bjorn was the best investment of any baby gear I have ever owned over the two decades I had babies, in fact it is the only baby device I would bother to buy if I had to do it all over again…everything else I could have lived without. Other carriers are poor imitators because they lack the slides which make putting the baby in and out so easy.

    Baby Bjorn also makes a nice bouncer seat that moves with the babies movements. I have lent mine to many moms and invariably even if they have other baby seat type devices already they get the Baby Bjorn bouncer seat because their babies so much prefer it to the other seats out there.

    (Just a note I have no relation to Baby Bjorn…)

    As far as babies growing accustomed to nursing to sleep I won’t lie and say this doesn’t happen..of course babies come to associate nursing with falling asleep…what I am saying is there is hardly a way around it…breastfeeding is a sleep inducer.

    Moreover even most bottlefed babies need parenting to sleep…that is why there are so many books about “how to get you baby to sleep”…most which are just rationalizations of the cry-it out method.

    You may have noticed there are also a lot of products like lavendar baby bathes, nightlights, music boxes etc etc that are marketed to parents to help get their babies to fall asleep.

    This is because most babies are wired to need the presence of another human being to feel secure enough to fall alseep. It is a good survival strategy to demand the presence of your mother when you are entering that most vulnerable of states- sleep.

    Breastfeeding is the most streamlined sleep routine there is. You can of course replace breastfeeding with some other sleep routine but be forewarned other sleep routines are more labor intensive.

    Babies and toddlers do outgrow the need to be parented to sleep just as they outgrow the need to breastfeed. As long as your timetable for the natural growing out of these needs are years not months you won’t be frustrated.

    One of the nice fringe benefits of investing your time in parenting your child to sleep as a baby rather than sleep training is that they never make any negative associations with going to sleep and thus they don’t fight it and don’t fear the dark etc.

  23. Hi Jen,
    Thank you so much for your feedback. I really appreciate it. Babies are scheduled to get weighed next week.

    My husband and I both have the Baby Bjorn and we always put the babies into them when he gets home from work and on weekends. When I’m home alone during the weekday, they just have to take turn. Baby Bjorn is the best, we do love putting the babies into them and they love it too. Our relatives keep telling us not to hold the babies so much because we will spoil them. We do not agree with them so we just ignore them.

    I will continue to breastfeed them, I think it is a wonderful time for me to bond with my babies. I’m totally ok with them falling asleep while breastfeeding. I just love watching them.

    Again, thank you so much for your feedback.

    Tammy

  24. Jen (or anyone else who might help),

    I am in my 10th week of trying to exclusively breastfeed my preemie twin boys, and I am starting to wonder if I will ever be able to make enough milk for them. But I don’t want to give up something so important to me without seeing if there is anything else I could be doing differently. Your posts about keeping lactation hormones up by feeding a bare minimum of 8 times a day and not going for more than 4-6 hours once a night caught my eye.

    My babies were born at 5 lbs each at 34.5 weeks and spent 7 days in the NICU getting tube fed and bottles (with some breastmilk that I pumped in the hospital.) After working with a local LC, one baby has been bare breastfeeding (without nipple shields) for about 6 weeks and one for 3 weeks, but they are just getting the hang of nursing now.

    I have been breastfeeding (initially with nipple shields for only a few minutes at a time), supplementing with bottles, and pumping after almost every feeding since we all got home from the hospital. But with bottle supplements (a mix of formula and breastmilk) and help from family visitors, it has been a challenge to even get 8 feedings in a day. Even now with 8 feedings a day, we go longer than 3 hours more than once at night and sometimes during the day.

    Over the past two weeks, I tried to reduce the bottle supplements during the day, and the babies fussed more, but I thought it was just a matter of time before their nursing demand would bring in more milk. But when I went to the pediatrician last week, she said they were “falling off the growth chart,” and I needed to supplement them more not less. They were close to 8 lbs at 10 weeks.

    I am now breastfeeding them 8 times a day and supplementing with 60 ml bottles afterwards 6 times a day. But I am afraid that this much supplementation (still a mix of breast milk and formula) will make it even harder for me to exclusively or even mostly breastfeed them.

    I haven’t been able to make enough breastmilk without two strongly nursing babies until now. The pumping has not been enough to make milk for two babies, but I also have pumped 6-8 times a day. I am taking domperidone and herbal teas, which haven’t made a dramatic difference in supply.

    I want to have realistic expectations about breastfeeding my babies, but I also don’t want to give up too soon. Does anyone know if you can still develop a full supply this late in the game? If so, what could I do differently while still feeding my babies enough?

    Thanks for any shared advice or experience,

    Alice

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