Hi Karen F ~

If each twin is truly BF well -- and that's a big IF when late preterm and
less than 5 lb -- and "well" is based on individual outcomes, e.g. adequate
outputs and appropriate weight gain for each, then cue-based BF should
result in adequate milk production. As each one's need for more milk
increases, each will cue to BF more often until production picks up. So no
worries IF each is effectively BF and mom understands and goes with
cue-based feeding. (And pumping can complicate a new MOT's already busy life
and can add stress that may interfere with cue-based BF.)

But the IF is huge when babies are preterm and/or SGA. So it's really
important to assess each baby at breast separately and really watch those
output/weight outcomes.

I've worked with a lot of women BF multiples over the years, and one of the
biggest issues re: adequate production when both/all babies effectively BF
is the ability to "let go" and let each baby BF on cue versus some notion of
a schedule. It's too easy to "lump" the individuals into a unit that should
BF for exactly the same number and length of feedings. Not to mention the
tremendous pressure often put on MOT/MOM by self and others to get "them"
(without consideration for the individual baby) on a schedule.

Pumping/milk expression IS needed to increase/maintain milk production IF
either baby is ineffective at breast (based on observation and outcomes) OR
each is effectively BF but not "allowed" to truly BF on cue.


Karen Gromada, 30+ years as LLLL of the Cincinnati Multiples group (and a
MOT)
author, Mothering Multiples: Breastfeeding and Caring for Twins or More
www.karengromada.com/



> Date:    Sat, 19 Mar 2011 16:49:03 -0400
> From:    Karen Foard <[log in to unmask]>
> Subject: Twins/34 weekers/supply
>
> I would be interested in hearing what your experiences and generic
> recommendations would be for initiating and maintaining  supply for twins,
> born at 34 weeks, now are 36.5 weeks adjusted age; both are home from
> hospital as they hit 2 kilograms weight (~4.4 pounds)  Neither baby nursed
> well for first week, mom gradually got milk in by about day 5-6 and is now
> nursing one girl with shield, one baby without shield and they are
> exclusively at the breast- Grandma (my friend- her daughter (babies' mum
> and
> one of my daughter's best friends) shares they are nursing great.
>
> What would your recommendations be re any additional pumping after the
> girls
> eat in order to keep building milk supply to meet needs for the down the
> road? My fear is that they are doing well with the amount of milk now
> because they are still so little but can we at all trust them to keep the
> milk supply growing as they grow so they will have available to them a full
> supply 2+ months from now?  Would love to hear your experiences with milk
> supply and early birds, especially when there are two of them. What advice
> would you be giving?
>
> I am at a disadvantage here as all the happenings are in Nairobi Kenya!
>
> Many thanks!  Karen Foard, IBCLC
>
>             ***********************************************
>
> Date:    Sun, 20 Mar 2011 12:45:14 +1300
> From:    Karen and Lee Palmer <[log in to unmask]>
> Subject: Re: Twins/34 weekers/supply
>
>
> Hi Karen,
>
> I have been a 'lurker' for a while, and this is just my opinion from
> observations with clinical work and understandings I have gleaned from
> conferences, especially from Hartmann reserach.  It can be a bit daunting
> posting here, with so many worldwide experts!
>
>  I often note that many mothers of prems (and twins in partcular), start
> out
> well with a good supply but then  3 months later may be struggling with
> their supply and have introduced more and more formula to maintain
> satisfactory weight gains.  I feel there may be a couple of common reasons
> for this.  Firstly, lack of support transitioning the prem/prems from
> 'managed' feeding to baby led feeding when the baby/babies are mature
> enough
> and secondly, I observe their milk supply may not have reached and
> maintained its full potential in the first 6 weeks.
>
> To this end, I employ a little maths and encourage mothers to try and
> achieve a full term milk supply (for singleton or twin) as soon as possible
> and keep it pitched there until the babies are mature enough and strong
> enough to take care of it themselves.  This may often be around due date
> plus a week or two.  In other words aim for about 700 mls/24 hours for a
> singleton prem and approx 1200 - 1400 for twins.  If the babies go home
> with
> an average volume of around 350 mls/24 hours (160mls/kg for 2kgm baby),
> then
> mum needs to pump about another 300 mls per day over and above her baby's
> feeding, with decreasing amounts each week as the baby is growing.  Same
> for
> twins, only double.  Often this can be achieved with just 4 pumpings a day,
> less in time till eventually, none.
>
> I counsel mothers that this extra work may be challenging for a while, but
> will give less work and stress in the long run. The pumpings need only be
> quick and best done straight after a feed when perhaps the baby/babies are
> being changed by her helper or just propped beside her (filling their nappy
> no doubt!) while she takes  5 - 10 minutes to do a quick double pump. There
> should be flexibility in this too - pumpings may be missed at the end of
> the
> day when the household is especially busy, but picked up more in the early
> morning.  The mum will work it out.
>
> Karen Palmer
> New Zealand
>
>
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome