In a message dated 5.8.02 7:32:41 AM, Denise writes:

>about managing twins when the mother has low supply.  I would
>still encourage the mother to breastfeed the babies together if that is
>what she prefers - presumably they will both drain her 'low supply' breasts
>to their maximum anyway, which is what we are trying to achieve ie. both
>breasts with as little breastmilk in them as possible, so that milk
>synthesis will be at maximum in both of them.

Yes, I guess..... but if we are recommending switch nursing as a tool to
*better* empty the breast AND leave some time for milk synthesis, why not
offer to twins as well?
And what about optimizing milk intake?
  Would it be helpful to tandem fd. till there is little effective milk tx
THEN take ONE baby off and switch nurse, one at a time w/ vigorous massage?
In terms of optimizing production, would it be preferable to then switch
nurse both babies, in sequence with presumably shorter intervals bet fds (ie.
tandem, switch nurse one, switch nurse 2- feed again in an hour) or switch
nurse one only, (feed both again in a hour), figuring that the milk is
*largely* gone after the first switcher?
 How do we weigh the benefit of stimulation (in this case, an even longer
period of sucking) against the risk of not enough time to make the milk?
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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