hello-  i am new to lactnet and this is my first post.  thanks to all who
read further.  sorry it is so long.  3 months of info.  i am a birth and
postpartum doula working towards IBCLC certif.

i have been working with a 29 yr old twins mom since before birth. 
(permission to post)  her girls were born 5 weeks early but went to breast
fairly well after birth and in the first weeks combined it with lots of
pumping, syringe feeding then bottlefeeding, and continuous support.  her
milk came in plentifully but the girls mostly got bottles after a week or
so and went to breast before each feeding for a good 15 min.  they had a
scale and they weren't getting but perhaps 30 cc for the first few weeks
from breast.  as they grew we expected them to start to transfer more but
the levels stayed about the same.  the avent bottles were used at first,
but a doctor said their mouths were too small for them.  they started
using gerber bottles with shorter nipples and started gaining more and
because of this they had more time to stay at the breast without having to
work so hard at the bottle.

so around the time they were officially due (5 weeks old) we expected them
to be gaining well and be developed enough to start breastfeeding more.  
they got the okay that the girls were gaining well and i suggested along
with another LC that she go to bed with them for the weekend while her
husband was at home and just nurse to try and make the shift over.  for
one reason or another this never worked so well for them.  seemd like mom
was also nervous about it actually working.  then they started to develop
reflux or one of them was not getting enough and doc was worried about
weight gain.  i suggested trying the avent bottle again because it seemed
to me that they each did not suck very well and still took a while to eat
at the gerber bottle.  i was able to get them each to work at the bottle
and maintain a suction on it so that it did not leak out their mouth but
it seemed to be somewhat frustrating for them especially in the latter
part of the day.  and for the parents, they could not get the hang of
feeding them with these bottles again, it was too messy.

then mom started complaining that her girls were starting to hurt her
nipples when they nursed.  they definately blanched them and she developed
chronically sore nipples, thrush and then mastitis. (none of these were
actually confirmed by her caregivers, she was just treated for them all- a
case of mysterious nipple pain)  i have never seen actual trauma to her
nipples (ie scabs, blood...) but the nipple is surely flat when it comes
out.  she started to get very discouraged and wondered if they would ever
solely breastfeed.  i then referred her to another lactation consultant. 
she was treated for nipple damage and the babies were examined again. 
tongues long but humped and they don't like having things far back in
their mouths.  a strong gag reflex.  her nipples are long and supple. 
they had an examination with another OT/IBCLC and the head of lactation at
the local hospital.  both visits were inconclusive and they said that they
may grow out of it.  they were given suck training exercises.  she also
tried the shield but still with pain.  and there is normal development of
their jaw/head (no torticullus).

they continue to pump and feed with dr brown's nipples and she puts each
to breast once a day usually in the morning when they are more patient and
stronger.  i see how they go on big but pull back quickly.  they do not
suck well on my finger, kind of gum it with the top of their tongue, and i
suspect that they can suck well but have preferences now on what and when
they will suck.  sometimes they nurse and transfer a good 2-3 oz each but
i think that it is simply because mom has a great let down and can pump
that much from one breast quickly.  but more than once a day hurts too
much.  they have never gulped down their bottles though.  i find it
interesting that both girls have nearly the same issues (they are
identical) but that one is slightly ahead of the other in ability usually.

this mom is also dealing with cow's milk protein allergies and a suspected
soy allergy so most of the ABMs are out for them and she hates the
hypoallergenic stuff.  so she feels like she is stuck pumping with no
certain future for breastfeeding.  i have told her stories of women whose
babies have learned to latch months down the road.  these stories are not
enough anymore, and though she is so strong and committed she is nearly
done.  she says if it will take a lot of work and training then she can't
do it.  but if it is possible for them to grow into it without much fuss
then she will stick it out.  any thoughts on what might be around the
corner for them or ideas for why things aren't working better?

thanks so much for any input you all might have.

alissa wehrman
www.sunbirth.org
seattle wa

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