Hello Lactnetters!

        I am a Junior nursing student and have a question in regards to
an experience I recently had during my OB clinical rotation.  I was caring
for a mother with her healthy 35-week old triplets and was excited to
hear that she had decided to breastfeed all three!  However she was
supplementing with iron-fortified formula...two would BF and one would
recieve the bottle and they would rotate for the next feeding.  She would
pump between feedings and divided the colostrum amongst all 3.
        I've learned that BF babies should avoid artificial nipples and
supplemenal bottles until BF has been established, as this may
lead to nipple confusion (Olds, et al., 1996; Grams, 1988).  LLLI notes
that supplements are not necessary for twins, but says very little about
triplets or other multiples (1991).  Furthermore, some sources say that
supplemental feedings may be necessary for triplets or quadruplets due to
limited breast access (Mead, et al, 1992).
        I realize that this is a gray area, and that every case is
individualized.  However I am merely looking for suggestions or examples
of similar cases which may help clarify when supplemental feedings are
O.K. (From what I know they did not gavage feed these newborns and were not
planning on doing so.)
Thanks so much for your time!

Elizabeth Miller, Student Nurse
University of North Dakota
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References Used:
        Grams, M. (1988). Breastfeeding Source Book. Sheridan, WY:
Achievement Press.
        La Leche League International (1991). The womanly art of
breastfeeding (5th ed.). Ney York: Penguin Books.
        Mead, L. J., Chuffo, R., Lawlor-Klean, P. & Meier, P. P. (1992).
Breastfeeding sucess with preterm quadruplets. Journal of Gynocologic and
Newborn Nursing, 21 (3), p. 221-227.
        Olds, S. B., London, M. L. & Ladewig, P. W. (1996). Maternal
newborn nursing: A family-centered approach (5th ed.).  Menlo Park, CA:
Addison-Wesley.