Lynne asks:
<but if we are recommending switch nursing as a tool to
*better* empty the breast AND leave some time for milk synthesis, why not
offer to twins as well?
And what about optimizing milk intake?
Would it be helpful to tandem fd. till there is little effective milk tx
THEN take ONE baby off and switch nurse, one at a time w/ vigorous massage?>

Disclaimer - I am only addressing low milk supply with these suggestions -
not a normal supply.

The reason why switch nursing *better* empties the breasts when feeding one
baby is so that both breasts will be as empty as possible in the shortest
amount of time possible, therefore allowing maximum time for milk synthesis
at a faster rate.  Twins will achieve this by emptying one breast each,
without the switching.  When there is <little effective milk tx> there's
not much point putting one baby to the breast.  You may as well leave both
well alone to let milk synthesis get started in both breasts - remember
it's unlikely that much synthesis is occurring  while that baby is still there.

Breast compression (I'm a softie - I prefer it reasonably gentle) and
perhaps switching the twins at the same time will be beneficial if one twin
is not as efficient a feeder as the other.

Lynne also asks:
<How do we weigh the benefit of stimulation (in this case, an even longer
period of sucking) against the risk of not enough time to make the milk?>

The stimulation isn't what is going to make the milk - it's the lack of FIL
in the breast (and it won't be there because there's minimal milk there)
that allows milk synthesis to occur.  Presumably the mother's prolactin
levels are *sufficient* from breastfeeding twins anyway (refer to Cathy
Fetherston's most recent email 2 or 3 digests ago), so now the breasts just
need 1. to be emptied and 2. to be left alone for a little while to get on
with the job.

Someone (sorry, discarded it too quickly) asked about why galactagogues
work - specifically Domperidone which increases prolactin levels (as does
metoclopramide).  We clinicians know it works, and I'm sure you'll get
plenty of responses from others to verify that.  Perhaps re-reading Cathy's
post and getting the paper on prolactin that she mentioned may begin to
answer some of those questions.

Hope this helps
Denise

*************************************************
Denise Fisher MMP, BN, IBCLC
BreastEd Online Lactation Studies
http://www.health-e-learning.com

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