As I'm sure you will hear from many people on Lactnet: 

1) Do not jump to the conclusion that mom will not have enough milk for all three.  With a good breast feeding and pumping routine she may well have more than enough, assuming there aren't physiologic things you haven't mentioned.   Many moms of singletons have enough BM to feed armies, so there is no outright reason that this mother won't have enough for her platoon.
Mostly mom and HCP's will have to be willing to "wait and see," letting the infants' growth be the guide.  

2)  There are other ways to supplement all babies, besides bottles or gavage feeding.  There is cup feeding, or the use of SNS.

3)  A rotation schedule can be made out, if necessary, as to who is fed with
the supplement, when -- like every third feeding could be  via a 
supplemental system.  But that system could still deliver "the real thing."

And remember mom and her partner will need lots of support to carry out a plan to solely BF all three.

Welcome to Lactnet, and the wonderful world of the perinatal family.
And thanks for thinking and researching.

Chanita, San Francisco


----------
From:   Elizabeth K Miller[SMTP:[log in to unmask]]
Sent:   Sunday, March 23, 1997 4:11 PM
Subject:        Multiple Gestation

Hello Lactnetters!

        I am a Junior nursing student and have a question in regards to
an experience I recently had during my OB clinical rotation.  I was caring
for a mother with her healthy 35-week old triplets and was excited to
hear that she had decided to breastfeed all three!  However she was
supplementing with iron-fortified formula...two would BF and one would
recieve the bottle and they would rotate for the next feeding.  She would
pump between feedings and divided the colostrum amongst all 3.
        I've learned that BF babies should avoid artificial nipples and
supplemenal bottles until BF has been established, as this may
lead to nipple confusion (Olds, et al., 1996; Grams, 1988).  LLLI notes
that supplements are not necessary for twins, but says very little about
triplets or other multiples (1991).  Furthermore, some sources say that
supplemental feedings may be necessary for triplets or quadruplets due to
limited breast access (Mead, et al, 1992).
        I realize that this is a gray area, and that every case is
individualized.  However I am merely looking for suggestions or examples
of similar cases which may help clarify when supplemental feedings are
O.K. (From what I know they did not gavage feed these newborns and were not
planning on doing so.)
Thanks so much for your time!

Elizabeth Miller, Student Nurse
University of North Dakota
[log in to unmask]

References Used:
        Grams, M. (1988). Breastfeeding Source Book. Sheridan, WY:
Achievement Press.
        La Leche League International (1991). The womanly art of
breastfeeding (5th ed.). Ney York: Penguin Books.
        Mead, L. J., Chuffo, R., Lawlor-Klean, P. & Meier, P. P. (1992).
Breastfeeding sucess with preterm quadruplets. Journal of Gynocologic and
Newborn Nursing, 21 (3), p. 221-227.
        Olds, S. B., London, M. L. & Ladewig, P. W. (1996). Maternal
newborn nursing: A family-centered approach (5th ed.).  Menlo Park, CA:
Addison-Wesley.