<< From: "Susan E. Burger" <[log in to unmask]>
 
<< I've seen a great case of triplets recently and she's done a better job than many moms of twins I've seen. Moreover, she is not one of those overproducers that just gush milk, she did it through sheer determination, some skin to skin, some nursing at the breast & a lot of pumping. She even managed through some pretty serious health problems right after delivery. >>

It sure would be nice if all MOM (mothers of multiples) were as the one you describe! But all are different as are each one of their infants. Not all MOT/MOM have the same determination, energy, motivation or whatever it is, and we have to meet each where she is. I want to see even the less energized (often for many valid physical and emotional reasons) or motivated hang in, so their babies get as much of their milk and ultimately as much direct BF as is humanly possible for a particular mother in her particular situation. A lot of your suggestions could definitely help achieve that!


<<  I have never seen a single case of side effects when she's screened women carefully and put them on domperidone. I don't know if you have someone similar in your area. >>

Is she still able to do this/use dom post FDA block?


<< I do have a vague memory of the breastfeeding medicine specialist mentioning some things about triplets that I think are worth looking into... First, if I remember correctly, she mentioned a greater tendency towards gestational diabetes and insulin resistence. The other was from an endocrinologist.. his impression is that many more women suffer from hypothyroidism in the postpartum period than is commonly believed (and this can also mimic postpartum depression). Again, I could be misremembering this, but I seem to remember something about postpartum hypothyroidism being more common with multiples...  Now, this could
be one of those coincidences, perhaps it is because more of the mothers who
have multiples now are those who have fertility problems (such as PCOS) and
are therefore more likely to have problems getting to full supply? >>

Per an Oct 2004 ACOG Practice Bulletin re: Multiple gestation -- GDM is higher in multiple gestation -- 3-6% of twin pregnancies and up to 22-39% of triplet gestations. Research indicates much of this higher incidence is related solely to triplet (and higher) pregnancy. As noted, PCOS, hypothyroidism, etc. can contribute to infertility and thus to multiple births. Higher maternal age is also associated with higher incidence of multiples, and I think I read data linking higher BMI with multiple gestation. There are age links with BMI and higher BMI can be related to increasing health issues, including insulin resistance. And hypothyroidism can result in weight gain. Also, I believe a fairly recent study found postpartum thyroiditis was more common than previously believed and MOM had a higher incidence. And all may influence lactation ability. 


<< As for the benefit of baby on the breast versus the pump - this is one of those time management, effectiveness issues. >>

Totally! Effectiveness is the bottom line and can only be played out when care providers are sensitive to the special time management issues of MOM. Gotta remove milk to make milk. An ineffectively sucking (milk removing) baby is not going to get desired results, no matter how much more pleasant.


<< Definitely skin to skin is a big help and often forgotten or not done as frequently with multiples. >>

I find it is thought of more when multiples are co-bedded. Do you find this? And research supports skin-to-skin/kangarooing as related to milk volume produced via pumping…


<< Based on the pre and postfeeding weights, I would come up with a manageable plan for "skin-to-skin" time, "practice feeding time", or if they're doing well at the breast, "effective feeding time", and "pumping time".  >>

Yea!  This is important for any mother “doing it all,” but it is particularly important for a mother trying to work on direct BF with 2, 3 or more unique individuals – each with his/her level of latch & suck ability, number of needed feedings, behavioral style and effects on BF, etc. I’ve sometimes suggested a MOT/MOM decrease or cut out “practice” BF for one or more babies in order to focus for several days on the pumping to increase production. I also suggest letting helpers give alternative feedings so mom can focus on practice BF, pumping and kangarooing. (Helpers should also be instructed re: reinforcing BF oral behaviors as possible.)


<< While I hate "schedules" finding a manageable routine where the most efficient breast drainage technique is given priority, while making sure the other methods are not neglected can be really helpful... Moms of triplets often need some specificity to the advice about getting into a routine. >>

I find this too. Fits in with your earlier "time management" comment. And in general I find the more multiples in the set, the more a mother will seek/need a more “regimented” routine for self-survival.


<< The trick with pumping (and making mom feel more comfortable not exaggerating what she is really doing) is examining all the barriers. More and more, I watch women pumping. 1) I have found one way to eliminate discomfort is determining the most appropriate diameter for the breast pump flanges… Sizing can make a huge difference.>>

I’ve been amazed not only at the difference in comfort but also in improvement re: the volume of milk obtained when flanges suit the mother vs. trying to get the mother’s breasts to suit the available flange size!

A few weeks ago a Lactnetter brought up obtaining better colostrum volumes prior to lactogenesis II/copious production via single-sided, sequential pumping. (Whoever posted she noted that research re: better volumes with double-pumping was conducted after lactogenesis II – not in first days post-delivery.) I was hoping others would jump in and start a discussion. I’ve also seen this. And I think it may make more to sense re: learning to handle the pump and kit initially, easier to monitor if somewhat sedated post-surgical birth or if on MagSulfate -- or for someone (LC, nurse, family member) applying the pump for the mother unable to do on her own due to complications.


<< 4) My cheap trick which I think really makes a big difference is a homemade hands free bra. A stretch sports bra or a yoga top with an internal shelf bra with two holes cut out is great for hands free pumping. Its amazing what a difference it can make for mom to be able to eat, drink, scratch her nose or click on the TV remote while pumping. >> 

Amen!  Do you find this as feasible for larger women or how do you adapt it? Would think the stretchy but supportive sports bra would work better than a more flimsy internal shelf bra that hardly holds up two large breasts, much less keep flanges in place against them… What about the bustiere mentioned?


<< 5) ... I tell them that they should pump when they wake up on their own (and they all do!). I mention that this works better than setting the clock because they are waking on their own natural light, deep cycle…>>
 
Great idea for getting in one longer uninterrupted sleep time with need to pump. 


<< Finally, I also have seen some moms take a while for their milk to increase for no explicable reason. For some moms it just takes time and patience. >>

I’ve also seen this for a number of mothers. Can take 9-15 weeks. Whether related to body, brain or a combo, something definitely changes for the better for many – often quite abruptly. 

I had one question for the original poster re: this triplet mom… The mom is using a Symphony pump. I know it is marketed as hospital-grade and for initiating as well as maintaining production. But has she recently tried several days of the Classic? I just know most MOT/MOM I’ve worked with find they do better with the Classic; however, their option in most cases was a Lactina – not had much feedback re: Symphony vs. Classic. (Yes, I read the report re: Symphony cycles in the recent Medela Messenger.) Just throwing it out as a thought…

Karen (who’s off to her MOT/MOM AP list where she’ll now ask for anecdotes re: S vs. C pumps)
 
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