Pat, your friend did fantastic carrying her triplets to 35 weeks.  Just
remember that they are still preemies, just 36 weeks now.  I would
definitely recommend that pump for mom to get that  milk going while the
babies are still preemie feeders.  If she's going to breastfeed long term, I
think one of the high grade double electric pumps would be fine for her.  I
would recommend double pumping for 30 minutes every 3 hours or so during the
day until babies are more aggressive feeders.  I imagine she would only need
to pump so frequently for a few days to get her supply in.  Maybe she can
get set up with a feeding tube and syringe to supplement her own breastmilk
at the breast for now.  Teach Dad to help.

There's no need to worry about teaching tandem feedings just yet.  Each
little one needs to learn at their own pace.  Kangarooing is a marvelous
idea.  Babies need to be at the breast and often, helping mom to get the
milk in.  Once babies start feeding more efficiently, she can wean off the
pumping.  As with other preemies, this usually happens near 37 weeks or so.
Many triplet moms quit breastfeeding if they have to pump and then feed the
pumped milk  long term.  It's just too time consuming for three.  Mom is
going to need to be with babies much of the day, so if their are neighbors
or other volunteers who could possibly do some grocery shopping for them,
prepare meals, help with laundry , etc. that could be a real blessing to the
family at this time.  Remind mom to stay in comfortable pajama type clothing
so any visitors remember that she is not yet in hostess mode, but needs to
be helped out as much as possible.

I would treat them just as other preemies.  They need to be taught to feed,
and the fewer bottles the better so they don't get nipple confused or
reverse the confusion that has already developed.  Everyone's going to be
real concerned about that jaundice, so getting mom's supply going is
paramount to avoid ABM supplementation.

Applaud every drop she produces and keep reminding her of the positive
benefits of breastfeeding to get her through the tough parts.

Anne Nans, RN, IBCLC
Fredericksburg, VA
Mom to Caleb, Amy and Riley 12/17/98 and Seth 12/10/00
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