Re: << Subject: A set of twins. 5 weeks old, approx. Mother had initial problems getting pregnant. Took Clomid...
She has about half the milk she needs for her babies... Who are growing
normally. She alternates breastfeeding for each feed, with one baby getting
breastfed and one bottlefed with formula at each feed. They are growing
well. >>

If she's BF 1 baby, it makes sense that she'd have 1/2 production needed for twins. Wondering how she got to this place where she is alternating BF one and bottle-feeding the other? Which is by the way the worst of all worlds, as she is fully BF the equivalent of one young infant and fully bottle-feeding another, so she has all the disadvantages of both methods and few of the advantages. (Most every other feeding "alternaters" that I've met end up weaning early; too hard to keep up. I have seen it work when a mother has a full-time helper who handled the bottle-feedings, and there haven't been many of those.)

The other problem with alternating is that it implies "scheduling" feedings more. Just how often in 24 hours is milk actually being removed via BF or pumping? I'd almost bet that babies aren't cueing to BF enough because of the bottle-feedings and so milk removal is nowhere near what it would need to be to produce for twice as many babies. If both babies are latching well and have been assessed as removing milk well during suckling, has she tried a several-day "baby-moon" of round-the-clock BF with both or one at a time to increase production and move to full (or almost full) BF?


<< She can pump about 1.5-2.5 oz with her PNS at a sitting.>>

The PNS is a good maintenance pump, but it's being asked to do a job it wasn't really designed for. I'd STRONGLY advise trying a rented, hospital-grade pump after assessment for flange/breast shield sizing. (Hopefully, she has a kit from her hospital stay?) MOT/MOM I've worked with strongly suggest the Classic or Symphony (or Hollister facsimile) -- they say PNS takes more time and, in general, they report they don't get nearly as much milk. Kangarooing between feedings is a great attachment tool, and research indicates it plays a role re: increasing production.

BTW, if she's fully BF the equivalent of one baby and pumping this at one sitting, she appears to be producing more than 1/2 of what she needs for two babies. If babies BF well, I'd think a "baby-moon" might do it for her...


<< She has had problems increasing the supply, despite good latches, 80 mg of Domperidone a day, Goat's Rue (which has helped a bit)... Fenugreek, and Blessed Thistle...
She breastfeeds a total of 8 times a day. >>

Can't make enough for two babies on 8 BF, the minimum we'd expect of a singleton infant, plus a few(?) pumpings with a pump that was not designed for the job she's asking it to do. All the galactogogues in the world can't make up for inadequate milk removal.


<< She is not able to do feeding tube at breast, etc, because she has very little help at home, >>

She needs to get more help. Like many MOT/MOM (no matter how they are feeding their babies), this MOT seems to have unrealistic expectations -- trying to apply "singleton" standards to her different situation. It isn't realistic for mothers of multiples to think they can bring home twice (thrice, etc.) the typical number of babies that homo sapiens usually have and do it with no more help/extra arms/hours in the day. Does she truly have no family member, no friends, no church, no jr or sr high school nearby, no senior citizen facility, etc. where she might find some willing extra arms, meals, laundry doers, etc.? Even if she has to pay, she'd be spending more (and still have no more help) if buying formula for 2 babies. She needs to invest her BF savings in herself.


<< and is at the end of her rope in terms of what she can do. She feels that she is doing nothing but feeding them all day, every day. >>

She just brought home two times the usual number of babies and has little help. No matter how she feeds them, she's still going to spend a lot of time feeding because she has two vs. one young babies. (I know that doesn't sound sympathetic. Believe I haven't forgotten the eternity of postpartum with my own twins -- much less the reliving of it with a lot of other MOT/MOM. I just want to jolt her out of unrealistic expectations.)

Alternating feedings as she's doing may be compounding the feeling of that feedings are all she's doing -- but hers are pretty standard feelings during the early months with twins, anyway! 

PLEASE send her to AP Multiples (stands for attachment parenting of multiples) at yahoo groups where she'll find a worldwide community of BF support, commiseration and helpful suggestions. To get there she should go to: //groups.yahoo.com/ She'll have to subscribe (free) with a user name and password. Once in and it says something re: "find a group," she should type as one word APMultiples. I think there's a few-day "check-in" period due to bad spam a few months back, but she'll love it there.


<< Any thoughts? I am wondering what the relationship is between Clomid and
difficulty getting pregnant, in her case, to the present issues. >>

Do you know what her fertility diagnosis was -- why she needed the Clomid in the first place? As you can imagine, our LLL multiples group has numerous members who got there due to Clomiphine citrate -- most with no real production issues. I'm assuming there's no issue re: retained placental fragment (more common with multiples), maternal thyroid, maternal insulin resistance, etc.? 

What were babies' gestational age at birth? Did they or mom experience any complications of pregnancy, labor& delivery or postpartum? How did their BF experience start off? 


<< It's a balance between sleep, enjoying her babies, and trying to build supply. She doesn't have a lot left to do more.... >>

That's always a tough balance for a MOT/MOM. But if she can get household support and take her effectively BF babies to bed, sofa or recliner for a several-day, round-the-clock BF baby-moon, she may very well be able to ditch the bottles within a week. Even if she's BF more, she won't be having to keep up with two different methods and alllllll the disadvantages...

Please tell her to hang in. Again I'd encourage her to join us at AP Multiples and she's welcome to contact me or my multiples group co-LLLL (who's also a LC). 

Karen
(author, Mothering Multiples: Breastfeeding and Caring for Twins or More; web site: www.karengromada.com/ )

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