Please let us be cautious when providing info that is appropriate for low
risk pregnancies to those associated with more risk for preterm labor and
birth. Fewer than 15% of twin pregnancies reach full term. The average
length of gestation for twins is currently about 35.5 completed weeks. This
average only decreases with an increasing number in a set of multiples.
Although a multiparous woman with a previous full-term pregnancy is more
likely to reach full term with twins, most still give birth prior to term
with multiples.

We're all becoming more aware of the incredible brain development that goes
on during the late preterm period, and we're all aware of the increased
incidence of feeding difficulties associated with late preterm newborns.
(Have you seen http://www.brainmuseum.org/development/index.html?)
Initiating exclusive breastfeeding with two or more newborns -- each having
a different ability and approach to breastfeeding -- is difficult enough for
those of us who gave birth to term twins; it is that much more difficult for
mothers transitioning multiple preterm/late preterm newborns to full
breastfeeding.

I'm all for having colostrum available during the period between birth and
copious production (and I've suggested it at times) but not if it possibly
comes at the expense of additional time in the womb. It is a safe strategy
for most pregnant women, but all women -- and particularly those at higher
risk for preterm labor and birth -- should be fully informed of both
benefits and risks and supporting evidence for any suggested intervention,
including antenatal expression of colostrum. (This is also true re: all
suggested medical interventions.) If stimulation for women at high risk for
preterm labor would trigger even some contractions, it could lead to a
cascade of antenatal and intrapartum medical interventions for these mothers
and babies with potential to definite impact on breastfeeding initiation and
duration.

This is a tough one, because these babies are more likely to need stored
colostrum yet this mother's cervix is more likely to be sensitive and
changing sooner. Before suggesting antenatal expression, please ask those at
known higher risk for preterm labor/birth whether the cervix is being
monitored for changes, has she experienced any preterm labor, is she on any
activity restrictions re: work-related, exercise, sexual activity (orgasm
and exposure to prostaglandins in semen, etc), is she informed of the signs
of preterm labor, etc.

Thanks -- and on to our Thanksgiving dinner...

Karen Gromada
(author, *Mothering Multiples: Breastfeeding and Caring for Twins or More*)
www.karengromada.com/

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