To Any and All who've had experience with helping mothers of twins:
A mother who I saw a couple of weeks ago is having difficulty maintaining
adequate milk suply for her twin sons. She contacted me when the boys were 4
1/2 weeks old and she had been supplementing with ABM via bottles for both of
them since they were about 4 days old; milk supply was greatly diminished at
this time. She had been offering the breast first then giving ABM after
every feed, per PNP's Pediatric Nurse Practioner) instructions. She at first
was giving 1 oz, but they were up to 2-3 oz at time of home visit. She
wanted to breastfeed exclusively and eliminate supplement; was giving both
babies approximately 10-12 oz ABM/24 hrs. Latch on and breastfeeding needed
improvement and she was quite discouraged when I informed her that neither
baby was latching onto the breast correctly; they both failed to open well
and latched shallowly, though without discomfort to mom. Attempts to correct
latch at time of visit were marginally successful and ways to continue
improvement instructed. SNS used successfully at breast so bottles could be
eliminated. Infants weights were good and they were thriving. Pumping
instructed with H**, double electric, for 10-15 min. after every feed or as
much as she could manage. Herbal galactagogues suggested which she took
routinely.
Now 2 weeks later, her supply has come way up, for the past week she's been
breastfeeding exclusively, until few days ago when babies were fussy and
supplement by bottle given, approx 3 oz/24 hrs. She feels she doesn't have
enough milk because babies, especially one of them is on the breast all the
time during the day but feeds well during the night when her breasts are
fuller and he sleeps longer.
She wants to take Domperidone (I had mentioned it as a possibility, initially
if use of SNS, improving latch and pumping not adequate to increase her
supply.) and states she's doing all she can to improve latch and knows at
times it's just right but other times it isn't as good.
My sense is that the latch and quality of breastfeeding is the culprit but
she declines another home visit; I informed her of this today when we spoke.
MY questions are:
1. Is it possible that her supply will not come up and stay up because of
her missed opportunity to establish good supply in those first 4 1/2 weeks?
Could it be lack of prolactin receptors established early on? Will
Domperidone be less effective if prolactin receptors are not abundant?
2. Any tips for positioning when she's simultaneously breastfeeding? She's
used clutch with twin nursing pillow, side sitting (which I suggested so they
could come from under the breast) and these help at times but she still seems
frustrated when they're both wanting to eat and she's fumbling with trying to
obtain a good latch and in her words she just gives in and puts them on.
Sorry for the length of this, but thought it would clarify her situation and
the advice I get will be more specific. By the way, the reason for initial
supplementation was that one baby could not latch on due to engorgement and
hadn't fed in over 6 hrs. "Phone help" was given by PNP and no instruction
given to relieve engorgement, actual PNP visit was when supplement suggested
for both infants--difinitely not good and mom is aware of this without my
saying a thing.
Your help is appreciated greatly!
Barbara Latterner, BSN,RN,IBCLC
Brewster, NY
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