Hi Ann - reading your post got me thinking of some reading I've done lately
(can't remember where - blush) about how we define success.  This mom gave
up entirely before in frustration because she couldn't breastfeed
exclusively, so it's already a loaded issue for her - but maybe you should
sit down with her before the babies are born and talk about ways to define
success in terms of breastfeeding for her particular case.  The PCOS is a
risk factor for not making enough milk (you can leave out discussion of her
weight, as I'm sure that's already a loaded issue), twins are difficult to
keep up with for a lot of moms - maybe talk about other ways she can
experience success.  What would using a supplement system like Lact-Aid or
SNS feel like for her?  You can discuss the many benefits of getting some
breastmilk over none at all (much the same way you would address it with an
adoptive mom planning to breastfeed) - the immune benefits, the closeness,
the skin-to-skin benefits for mom and baby, the increased awareness of the
baby's needs, etc etc etc.
It's hard to bring up the possibility of "failure" before you even try, but
maybe if she knows there are other "acceptable" options, she won't feel as
much stress and pressure, and can enjoy the experience she does have - and
can feel some appreciation that her body can produce milk for these babies,
and doing this at all is a wonderful thing!
Side note - Unfortunately, co-sleeping is the way most moms of twins I've
met have managed to keep uo breastfeeding without too much exhaustion, but
her weight contra-indicates this, so she really does have the deck stacked
against her to make exclusive breastfeeding work (not that I would say that
to her, but so you can start to redefine goals from your end before you
approach her).
Anyway - I hope I don't sound condesending towards this mom - but I think
so many of us tend to see breastfeeding as all or none (I'm as guilty of
this as anyone) - but I think in some of these special cases, the ability
to maintain partial breastfeeding for an extended time is a real
achievement and a wonderful gift to give to these babies. You can talk to
her about maintaining any level of supply she can achieve by not
oversupplementing, when to consider starting supplementing (weight loss
percentages, the status of the babies), her feelings about using a
supplementer, etc etc etc...  Maybe share some pictures of babies at the
breast with a supplementer to show her the closeness between mom and babe...

And I also agree to further pursue the domperidone. Remember, it's not
illegal, just inconvenient!

Best of luck with this challenging case - and the maya wrap!

Kirsten Berggren, PhD - working mother's breastfeeding advocate, aspiring
author, and LC-to-be (or wannabe, depending on your views!)

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