I had a consult with multip. yest who delivered 36 wk gest. twins.  Boy A
weighed 6lb7oz and Boy B 5lb9oz at birth, so decent size babies.
Simultaneous positioning was taught at the hospt. and babies went home
without early follow-up, and were managed as if they were term infants.  By
Day 9 when they were finally seen at the pediatrician's, Boy A had dropped
over 11% of birth weight and was dehydrated and jaundiced and in big
trouble.  Baby B, who though smaller was the better feeder, had maintained,
but when I saw them on Day 11, had stayed stalled at the same weight for 2
days and was quite anxious and fussy.  Mom had several days of unrelieved
engorgement during which time these kids slept (rather than ate) with her
nipples in their mouths. Now her supply is down-regulated and the kids are
weak.  Big mop-up action now required and everyone is scared.

The literature is clear that the baby born "just a little early" is at
increased risk for morbidity and mortality, and needs early follow-up.  My
experience tells me that early simultaneous positioning of twins is more a
feel-good trick than a benefit to the babies.  These babies are always
early, always a bit IGUR due to the fact there are two of them, and they
need more early postural control and support to get the best latch.

I do not understand why this type of situation is allowed to cont.  Where is
the early follow-up these babies deserve?  Where is the safety net?

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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