In a message dated 11/13/2003 10:11:22 PM Eastern Standard Time, [log in to unmask] writes:

> It's been a long time since I last posted.  Recently,
> I've been supporting a British expatriate mother with
> 4 week old twins (about 2.5kg. each).  Both have been
> fed breastmilk and breastfed since their birth.  The
> mother called me frantically yesterday to report that
> her twins seem to want to feed non-stop. I suspect
> they might be having a growth spurt.  She was
> enouraged to feed the two of them at the same time (to
> save time & energy) and also continue with the
> domperidone (which was started the night before).
> BTW, how long can one take domperidone?
> 
> I feel that fatigue is also another issue with this
> mother as she also has visiting parents who will be
> leaving Singapore soon.  Her parents have been
> expressing their concerns about the babies' needs. I
> think they are adding to her stressful situation. this
> mother also likes to take her babes out in the morning
> to run errands. I've encouraged to stay home during
> this period to get the much needed rest until her
> supply builds up again.
> 
> Do you have any suggestions for such a situation?


Doris, you don't say at what gestational these little ones were at birth. Also, I didn't note any data to indicate she has any sort of milk production problem re: need for domperidone or building production back up. At this point, nothing really indicates that the babies'individual breastfeeding/other feeding method behavior is unusual or consistent with inadequate production.

Since breastfeeding and taking EBM, does it mean either/both had or still have issues with being able to effectively breastfeed/remove milk at breast? 

Sleep deprivation is the number one issue for most mothers of twins. Add to that traveling with two newborns, hearing negative comments from in-laws, etc. and what mother of even a single-born infant would feel stressed out. And what does mother mean when she says babies are feeding "nonstop"? 

I think breastfeeding is getting confused with the normal extra care needed for twice as many babies as the typical new mother has, which is very common among mothers with multiples. I'd suggest she try to separate breastfeeding issues from twin issues. The mom and those helping her can separate the issues by thinking of the recommendations that would be given to a woman breastfeeding a single-born infant. Would we be surprised by an increase in breastfeeding or cueing to be held/cuddled at this age? I doubt it, as feeding spurts at this age are common. However, this mom needs to know that such feeding spurts can last longer when twins are involved. The increased cueing could also imply that previously ineffective breastfeeders have finally figured it out and they need a few days of round-the-clock breastfeeding to get production where each needs it. Or they may be that slightly preterm babies have hit a normal "awakening." It may be breastfeeding for closeness and some kangaroo-mother-care would do the trick or Dr. Karp's 5 Ss may help (if infants' outputs and weight gains are within normal limits.)

I generally do NOT encourage feeding two young babies at once until at least one demonstrates breastfeeding behaviors and related outcomes consistent with effective breastfeeding. Dealing with the logistics of simultaneous feeding can mean ongoing or new "problems" are overlooked and prolong them. I also can't support the use of galactogogues UNLESS outcomes provide evidence consistent with insufficient milk AND increased milk removal for several days does not make a difference.

Hope this helps a bit. Happy to revise if more data is shared.

Karen Gromada
(author, Mothering Multiples: Breastfeeding and Caring for Twins or More)