Dear Lactnetters,
       I wanted to let you all know the results of my post regarding the
premature twins from 1-13-04. When I search the archives I read posts with a great
deal helpful information, but often times the final outcome telling if/how
the problem was resolved is not available. I wanted to share this so others who
might encounter similar circumstances would know what worked. I received a
number of helpful emails from Lactnetters. Thanks to all. Both babies at the
outset were not feeding effectively at the breast. Up until that time they had
been fed in numerous ways over the previous months. Mom's milk supply was low,
but we weren't sure how low. The goal was to achieve exclusive breastfeeding.
Initial recommendations included:
1 all feeds at breast
2 SNS supplementing only - - These proved helpful. The babies had been fed in
so many different ways I think they didn't have a chance to learn to
breastfeed. Effectiveness of feedings was up and down at first. I think this was due
to varying milk supply and fatigue in the babies. After about 10 days they were
consistently feeding better at the breast and are now good at it. Baby A who
is a better feeder and bigger only goes to breast to get fed and then he's
done. Baby B, who has to work harder given the missing chin muscle likes to nurse
a lot and stays there for long periods of time. Mom calls him "slow and
steady wins the race". Last communication with Mom revealed their intakes were
basically the same per pre- and post feed weights even with the different nursing
patterns.
3 Each baby gets supplement at a different time so we know who is getting
what amount-- Mom did this by putting all 3 oz in the supplementer for the
feeding at once. Then she only let one baby take 1.5 oz and closed off the tube.
Then the other baby got his 1.5 oz. She gave supplement first to which ever one
was most hungry. Once in a while they were both too hungry to make one wait so
she let them have it at the same time and we just couldn't measure at those
feeds. Overall, it worked to know how much supplement they were getting vs from
the breast.
4 supplement to remain at prior day's amount of 6 oz total per baby to see if
it was enough
5 weight check each day-- These two didn't work out and had to be revised.
Mom initially judged need for supplement by their fussiness. She gave more
supplement when they seemed fussier and the number of ounces went up and down. We
switched to doing test weights pre- and post-feed for 3 feeds. At the 4th
feeding Mom gave supplement via SNS to make up what they required and didn't get at
the breast alone in the measured feedings. It turned out to be too long to
wait for additional supplement, babies got too fussy so she dropped it to
supplement at the 3rd feeding after 2 measured intakes. Based on their weights we
knew each needed about 2 oz per feeding, 10x/day. Once the babies were
consistently fed enough - I don't think they had been getting enough calories in the
previous number of weeks- things really improved. They were less fussy and
output increased.  Mom discovered they were sometimes fussy after a really good
feeding so fussiness wasn't related to amount of milk consumed. We also knew Mom
had about a 2/3 milk supply.
6 no pacifiers Since Mom had full-time help with the twins for two straight
weeks she decided to not give any pacifiers until after that time. She wanted
to give the most effort to putting them to breast while she could knowing when
she is on her own she probably will have to use them sometimes. Since we knew
their intake was adequate for certain they used two baby slings, one for Mom
and one for grandma for soothing aside from the breast. As much as possible she
also put them to breast for comfort.
       All throughout this Mom slept between babies at night and nursed them
one at a time all night long. she kept rolling side to side and would doze
intermittently. She did take about a 2 hour nap with them every day in the late
afternoon.
       I suggested per advice from LNers that Mom limit feeding time to 15
minutes at breast and then pump after for efficient emptying to increase milk
supply. She was only pumping 1 or 2 times per day initially. She did increase
pumping to 5 or 6 times per day, not at night, for about 15 minutes, but really
didn't limit feedings as much. I think they were getting better at feeding and
emptying the breast on their own about this time also.
       After agonizing about the decision to supplement or take fenugreek to
make up the difference in milk supply, Mom decided to take fenugreek. She was
concerned about this since she has asthma and fenugreek has reportedly
aggravated asthma in other mothers. It's been 5 days and there is no reaction so far.
She was also concerned about taking fenugreek because of the citation in Hale
about the premature baby with a GI bleed. One of the infants had a prior GI
bleed and NEC. Last call, she reported they found 7 more 3 oz bottles of frozen
EBM in a second freezer and were ecstatic. She is hoping she will avoid all
supplements since this gives her a few more days to bring up the supply.
       I think I covered everything. I have learned from this case and hope
it will help others too.
Judy Gutowski, BA, IBCLC
In frozen Western PA.

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