In a message dated 10/6/2003 11:56:20 AM Eastern Daylight Time, [log in to unmask] writes:
> This woman has struggled with breastfeeding, pumping and formula for 3months
> before she contacted me. Plus mastitis, thrush and initially sore nipples.
> She has tried hard to breastfeed exclusively but when I first spoke to her,
> her routine was breastfeed singly (she can not manage her breasts to twin
> feed or double pump), bottle top up with expressed milk and formula, pump,
> then practically start again.
> She lives a long way (1300kms) away, no local LC, told her babies attach
> well but from comments on the ph they have never fed
> vigorously.
> I feel that the odds are well and truly stacked against her.
I've known several MOT with similar histories. The end results varied but most continued to partially BF, pump as possible, and use formula as necessary. Here's my suggestions:
-- Redo the thyroid testing. Childbearing year thyroid changes are not unusual and may be more common with her history and a twin pregnancy.
-- Get some physical household help for chores and alternative feedings. When others help with alternative feedings, mother can focus more on BF and pumping p.r.n. (Don't let her tell you she has no possible resources for help. There are different kinds of options. It isn't reasonable for her, her husband, our culture to think it reasonable to care for twice the normal number of newborns without physical help. Heck, women with one shouldn't have to.)
-- It wasn't clear whether babies are effectively removing milk when BF. If not, I'd limit either or both's time at breast during a feeding to make more time for removing milk via pumping. Also, some mothers find production improves if they take a few days break from BF (ineffective assumed here and concentrate on milk removal
-- Increase Kangaroo mother care time. Skin contact can enhance attachment, provide some of the close feeling of BF, and provide access to the breast.
-- Reinforce BF behaviors with the alternative feeding method and instruct helpers to do the same re: elicit root, wide gape, deep lathch, etc. (Teat type if bottle-feeding makes a difference re: baby's ability to suck-swallow-breathe as per BF.)
There's probably more. If you are working with this MOT via email and she has web access, I'd highly encourage her to join us on the yahoo group of APMultiples. She'll meet other mothers with similar histories. Gotta tell you that some stories may encourage and some may discourage, but all kept plugging away. (Perhaps "plugging" is not the word I should use...) If she's interested, tell her to go to ://groups.yahoo.com/ Once there she'll need to subscribe with a user name and password. Once in she should search for APMultiples (no spaces). I'd also be happy to "talk" to her. Feel free to share my email address.
Karen
(author, Mothering Multiples: Breastfeeding and Caring for Twins or More)
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