Hi all.
I'm currently seeing a woman with twins aged 3 weeks, born at almost 36
weeks gestation. Her nipples are quite large (2.5-3 cm diameter). She
managed to BF her 4 yo and 19 mo.The twins are very difficult to latch and
only appear to latch on the nipple and only appear to swallow when the
mother experiences a letdown. Before I saw them last Thursday the twins
were being fed expressed breastmilk by bottle. I did two home visits on
Thursday, the first feed they both latched and appeared to have a few
swallows. Then they were comped with EBM. I returned for the next feed, but
they refused to try. I then suggested fingerfeeding instead of bottles.
On Friday they spent the day at my breastfeeding unit. At each feed (3 over
the course of the day) they latched and had occasional swallows. They would
come off the breast looking for food. We only gave 60ml comps so they would
wake sooner for another attempt. They spent the day with me on Monday and
there appeared to be a slight improvement. They still only swallowed when a
letdown occurred, and then only 4-5 swallows. They alternate between
sleeping at breast or grizzling, squirming, getting impatient for the milk.

The woman can trigger a letdown by using breast compression - 4-5 swallows,
then nothing until the next letdown. Her supply is great, she expresses
most milk by hand expression, using an electric pump to finish off. I saw
them again today (Wed.) with less success than Monday. The mother is very
keen, but is becoming discouraged at the apparent lack of progress. They
are currently taking 100ml comp ebm(fingerfeeding) after 15-20 min attempt
at breast. Today I tried to introduce a feeding tube while at the breast,
but the baby happily sucked milk from the tube with only half the nipple in
his mouth - so we put a stop to that! The mother had tried cupfeeding
before contacting me, but found it difficult, especially with a toddler at
her feet.
My theory is that the nipples are too large for their gums to be able to
reach/compress the sinuses. I've suggested to the mother that patience is
required until their mouths grow larger. Their due date was Sunday 24th
May. The woman has been keen to have frequent contact with me as she feels
they feed
better when I latch them.(Not today they didn't!) I am seeing her again on
Friday at my breastfeeding unit (day stay program).
Any suggestions welcome.
Regards Roslyn Draper RM IBCLC