Well, after a very enjoyable experience helping my first mom with twins
establish breastfeeding, my second experience has been so far a lesson in
frustration.  This MOT has many more issues to deal with to begin with.  Mom
is young, single, seems to have some power struggle issues with her mother.
 These are her first babies, and they were born at 34 weeks by cesarean
section.  One had to be transferred to an outside hospital NICU, so mom has
been struggling with her recovery, carring for one infant, and worrying over
her other infant.  The frustrating part for me, is that despite her
repeatedly stated goal to breastfeed these babies, she is frequently
reluctant to feed them!  She expresses a high level of annoyance with being
woken at night, and frequently puts the one baby off during the day.  This
has led to a lot of supplementing, because baby needs to be fed and mom
doesn't feel like nursing or pumping.  She has not started producing mature
milk.  The baby still at our hospital acts like a typical 34 weeker.
Sometimes he nurses well, most often he tires quickly and falls asleep
easily.  He takes supplement well from a soft cup.  When he is awake and
active, he does latch well.  The nurses have tried very hard to encourage
skin to skin contact, and feeding on cue.  However, mom sends the baby back
to the nursery a lot.  She is driving even our most patient nurses nuts.
Tomorrow, I am hoping to have a long talk with her and firmly extablish what
her goals are.   Although she has expressed a desire for help and a goal of
exclusive breastfeeding, her actions have been just about the exact
opposite!  Hopefully we can reach some kind of understanding before discharge.
My previous MOT with 36 week babies continues to do great.  Babies have had
nothing but breastmilk direct from the source.  At 13 days of age they had
gained 8 ounces each in the last 7 days and were at or above birth weight.
Mom is getting adept at handling both babies and feeling quite confident, now.
Hopefully, I can find a way to help the younger mom acheive her breastfeeing
goals, too (if we can figure out what they are!)
Jennifer Tieman
Family Physician
Mom to 3 and new baby #4 expected 5/31/03

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