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Subject:
From:
Karen Gromada <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 27 Feb 2004 12:02:27 -0500
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In a message dated 2/26/2004 3:33:42 PM Eastern Standard Time, [log in to unmask] writes:

> I am working with a mother with twins born via elective c/s. The babies are
> three weeks old today.
>

How many weeks gestation at birth? (And I won't even comment if surgical delivery was done "just because there are twins"!)What was each baby's birth weight, lowest weight (and date), weight at time of intervention to "lose" the SNS and eliminate supplement (and date), and current/most recent weight (date)? (Were all weights done on same scale and in the nude?) What was initial BF like for each baby; how about feeding routine for each -- waking to feed how often in 24 hours; why was SNS and formula introduced -- per individual infant vs. "the twins"? How has each baby's diaper counts been -- prior to intro of SNS/formula and since eliminating?


> The mom has had one previous birth, a singleton, now age three. When the
> singleton was born, the mom tried to breastfeed for six weeks, by which time
> she felt that the baby's health was in jeopardy because she was not gaining.
> (I don't have any actual numbers on this. The mom couldn't remember how long
> the baby took to regain the birth weight.)
>


Difficult to know if pertinent and milk productin a real or perceived issue, since history of feeding routine, diaper counts, weights, etc. aren't included.


> I first saw this mom last Wednesday. She was feeding with a pattern of Baby
> A gets breast with formula-SNS at a feed while baby B gets bottled formula;
> then at the next feed, Baby B gets breast with formula-SNS and Baby A gets
> formula. After each feed, she would pump to try and increase her supply.
> Needless to say, she was exhausted.
>

This routine is the worst of all world's -- fully BF (one) and fully bottle-feeding (one). Plus using BF aids, etc. while healing from major surgery, dealing with an older toddler, etc.


> Last week, I helped her learn to feed both babies at once. We ditched the
> SNS and the pump. The formula has been shelved. (WOO!)
>


Feeding both at once really helps IF one is certain at least one (and better both) are truly effectively breastfeeding/removing milk and both are on same feeding routine (which is more likely with identical/monozygotic twins than fraternal/dizygotic twins). Encouraging one to adapt to feed with other works better IF certain the adaptee is BF effectively AND gaining adequately.

Ditching the SNS and all formula at once is a BIG elimination, especially with two babies and using 1/2 BF (and with SNS also) and 1/2 formula. Usually  it takes round-the-clock feedings (with VERY effective breastfeeders) to do this and increase production to result in adequate gains in a reasonable time. The "lag" one might expect when doing this for one baby often doubles (or close to it) when for two.


> We did a follow up last night and all looked good. The babies were pink and
> round, they self-latched and nursed until they self-unlatched. The feed I
> watched last night was just over 30 minutes of active sucking and audible
> swallowing. I noted a clicking on one breast, so we worked on a new latch to
> help that. (The mom said she occasionally felt some pinching.)
>

Which baby "clicked" -- the one that lost an oz or the one that gained? I'm with the person who suggested pre-/post-feeding weights to determine intake at breast as more accurate than audible swallows or how it looks. Some babies are foolers. But it does sound as if it is coming together.


> She has not assigned one breast to each baby; instead, she alternates
> breasts, so that a baby gets one breast for the entire feed, and then gets
> the other breast next time.
>

A lot of MOT find it easier to switch breasts only every 24 hours; however, anything works if babies BF effectively and often enough.


> The problem is that she has weighed the babies at the clinic today. (Same
> scale as always.) One baby has lost an ounce; the other
> baby has gained an
> ounce.


Considering the change re: no SNS and elimination of their half-formula diet in this week, that they've each essentially maintained weight sounds pretty good. This week will be telling. But how are each baby's diaper counts? What is each baby's BF routine -- how often does each BF in 24 hours? Is mother willing to feed either more often and individually if that baby cues?

I get the feeling babies are now being lumped together a bit as "twins" vs. two individual newborns who may or may not share BF patterns... BTW, there is info re: BF on my web site for MOT/MOM -- see FAQ, photos, etc.


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

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