Jennifer--
Well how about that for conflicting advice!
-- Pat wrote:

> another thing that can happen is if mom chooses to dedicate a "side" per
> twin the "stonger" twin will do fine and the "weaker" may not suckle well
> enough to maintain a good supply.
>
and I wrote--

> I'd suggest "assigning" each baby to
> their "own" breast--:
> ....     When each has
> their own breast, each baby is able to regulate production precisely to their own appetite and
> thirst.
>
It's not really as contradictory as it sounds, Pat is talking about "weaker" and "stronger," where I was talking primarilly about size differences, and first getting milk supply established.

As I said, at the beginning, before the milk supply is established, the more vigorous baby can help by nursing on both sides precisely to get that milk supply established, and then that good flow can reinforce the suckling by the less vigorous baby. Also, once she is able to nurse them both at the same time,
when she does, the "stronger" baby will stimulate oxytocin and milk release and give better milk flow for the other one, and that flow will keep the other going. (And of course it is not unusual for the more vigorous baby, and "better" feeder to be the littler baby, precisely because littler babies often grow
faster than larger babies.)

But either way, once that milk supply is established, if the babies are different sizes, it usually works best to allow them their own breasts. But as I said, this is something that has to remain flexible, and if for example, one baby isn't feeding well, falls asleep at the breast, then, just to maintain her own
breast comfort, the flexible mom will put the other wide awake baby to that uncomfortable breast, and in so doing, without planning, get the help she needs to push up production for the sleepy baby. Or she may keep the sleepy baby on longer, using breast compression to keep that baby nursing longer, thereby
making her breasts comfortable, and giving the baby cream. Not the best example, because the less nursed breast may not always feel overfull, but the idea is to respond to the situation of the moment. If a baby falls asleep "too soon" on a floppy breast, she might switch the sleepy baby to the the other side,
and then that faster flow may keep him going, but she would be switching because it's not working on this side, a more physiologic switch than a cerebral plan.

The rigid assignment of *always* each baby to their own breast is where problems can arise, just as rigid switching to *always* alternating babies and breasts can also cause problems. It is best to recognize the babies are different sizes, will probably have different feeding patterns, give them each their "own"
breasts, in general, but continue to adapt flexibly to the situation of the moment, so that a rigid pattern doesn't replace comfort and ease.

Breastfeeding, like any physiologic process, works best without too many left-brained rules, but allowing homeostasis to work, which means following mother's breast comfort, her instincts, the babies' behavior, etc.

Also, I really need to say something about "weaker" and "stonger." Often this is real, in which case, whether switching sides or not, we need to attend to that "weaker" infant. Often, it is about rate of weight gain, which is not just the *result* of poor feeding, but more importantly, also the *cause* of poor
feeding-- if a baby is underweight, that baby will not feed well until caught up to whatever that baby's biological expectation might be. (Which our expected numbers can only guess at.) So pushing a pokey sleepy feeder, helping with flow, breast compression etc, pumping and alternative feeding, all may be very
important. But volume alone, if it is skim from a full breast, may keep that baby suckling longer, but it is the cream that really gives those calories. So whether switching sides helps or not will depend on a lot of factors. You can use your left brain to try to figure it all out for mom, and give her a set
plan, which you then may have to adjust over time, or you can give her a framework for understanding this, some tips to help her to follow the situation of the moment, and then have her do whatever she thinks works best to help her baby feed better aat any given moment.

Other times though, the baby who is called the "weaker" may actually not be weaker at all, but rather, just be a baby with a loose latch, because mom has high flow, (or the other baby has a super tight latch using another stategy to cope with higher flow-- could be either way), or a baby who doesn't need to grow
as fast, because he is bigger to begin with, or perhaps is smaller but with a different growth potential, or a baby who just has a different feeding style, temperament, etc., --Any of these could make a baby look "weak" only by comparison--you wouldn't think so if you weren't dealing with twins-- and is a baby
who is actually doing just fine. Listening to mom, examing babies and mom, observation of a few feedings, etc., will sort this all out.

Tina Smillie

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