I really liked Karen Gromeda's post about moms with twins sometimes having
to use bottles for supply-related issues.  These moms are often twin moms as
the result of IVF.  I saw such a mom this past week.  She is close to 40,
has diagnosed Polycystic Ovarian Syndrome (PCOS) and has  elevated androgens
levels.  She delivered twins at 38 weeks, the boy over 7lb and the little
girl close to 6 lbs.  Babies look great, but when I saw her on Day 8,
neither baby was transferring more than 14 ml at breast and residual vols
had been almost nil.  In the 24 hrs prior to my visit, I told her (based on
reports of no stooling) to supplement the babies and to devote more time to
pumping than to nursing.  She is to still practice bfg at each feed and do
lots of skin-to-skin, but clearly she needs a jolt of stimulation that her
two sleepy, still losing weight babies are unlikely to provide. After 24 hrs
of this plan, when  I saw her, the pumped vols had jumped to a total of 50
ml/pumping session.  That is an improvement, but clearly not enough to
sustain twins.  So we'll keep on with the interventions to get the supply
up.  What her ultimate capacity to make milk, however, may be affected by
the PCOS.  Time will tell.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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