Hi Mandy ~

It's difficult to know if current difficulties re: milk production are
somehow inherent for this MOT or whether related to inadequate milk removal
for 2 different babies during their first 2 weeks. As someone who works
with a lot of mothers of multiples, I have many questions!

Were twins conceived spontaneously without any type of reproductive
medicine help or were they conceived with some type of reproductive tech
(from ovulation stim to IVF? If reproductive tech was used, was it due to a
mom-related issue, e.g. PCOS, thyroid condition, etc.? Has she ever dealt
with any type of insulin resistance issue? (Was she on metformin/glucophage
during early pregnancy?) How about thyroid conditions? What do her breasts
look like and what type of breast changes did she experience during
pregnancy and after the birth?

Was it the babies' idea to come out at 38 weeks (went into labor
spontaneously) or was 38 weeks set by her OB care provider(s) with
induction and/or c/sec? Were both babies average weight for week gestation
(AGA) or was either/both small for gestational age (SGA) or born after an
intrauterine growth restriction (IUGR)? Both preterm and early term occur
more with multiples as does SGA/IUGR for one or both. (What was each baby's
birthweight and what is each baby's weight now?)

When did each baby first breastfeed and was each waking to breastfeed at
least 8x/24 hours by their second 24 hours? If not, was one/both "sleepy"
(and are they still) and was milk expression initiated by the second day to
compensate for one/both not breastfeeding effectively?

I wonder how often mom is really pumping? It's generally not realistic to
think one can put twice as many babies to breast for "practice" for >8x/24
hours and also pump 10x/24 hours. (If one can remove 50 ml at breast,
that's more than latching!) When is she resting/getting a few hours of
sleep? Is she putting both to breast at the same time? At this point,
feeding babies simultaneously is often not an effective strategy, as it is
difficult to monitor each baby at breast individually and it can reinforce
poor breastfeeding behaviors.

What is each baby's oral space like? Was each baby's sucking assessed? Have
any breastfeeding aids/devices been tried? If bottle-feeding when not at
breast, is it a feeding-bottle system at least somewhat more compatible
with breastfeeding oral behaviors? (Don't wish to get into a discussion of
actual feeding-bottle system brands/products in this forum.)

What type of breast pump is mom using? Please tell me she is using a rental
pump, e.g. Ameda Platinum or Medela Symphony! If not, please encourage her
to  rent one! Since I don't know this MOT I want to be cautious, but…
Sometimes, when one/more of multiples is ineffectively breastfeeding, it
can help to take a breastfeeding "time out" and focus for several days on
increasing milk production. This is NOT to say "never" breastfeed for those
few days; it is to say focus on effective milk removal at least 8x/day via
a rental pump breast pump in conjunction with hands-on pumping techniques
for at least 5 of the pumping sessions -- include/encourage one 4-5 hour
block of uninterrupted sleep for mom. Encourage kangarooing and
breastfeeding with one/both in between as able. (Or if one can consistently
remove about 50 ml, depending on that baby's weight/caloric needs, it may
be possible to breastfeed that one while pumping/expressing the other
breast.) Then reassess at 3 or so days. She needs to know that production
may still have a way to go before it's where needed, but usually there is a
"hopeful" increase by the end of 3 days if mom's breasts work as they
should.

Should also ask if these are first babies? If not, did she breastfeed a
prior baby? Also, does she have good household help/support? (I'm thinking
she must if truly breastfeeding and pumping as described!)

There are some good "communities" for breastfeeding MOT/Tr on Facebook. Let
me know if this MOT is interested in any of them.

Finally, glad this MOT has you for support!

Sincerely,

Karen Gromada
(author of Mothering Multiples: Breastfeeding and Caring for Twins or More)
www.karengromada.com/


------------------------------
>
> Date:    Mon, 16 Jun 2014 16:35:36 -0400
> From:    Mandy Ball <[log in to unmask]>
> Subject: Twins and milk supply
>
> I recently saw my first mom of multiples-I am in private practice. Twins
> born at 38 weeks and are 2 weeks old now. She is having supply problems.
> One latches occasionally, and the other is not as interested. One removed
> about 50ml when I was there. Mom is pumping about 10 times per day as well
> as putting them to the breast at feedings to give them practice ad keep
> them familiar with the breast. She started fenugreek a couple days ago. I
> feel like she might have enough for one baby, but definitely not enough for
> 2. She is also using hands on pumping which proved to be a little more
> effective at removing milk.
> Any advice for me to give her?
>
> Thanks!
> Mandy
>
>
>



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