Jennifer, I wouldn't worry too much about adjusting a routine for mothers
expressing for multiple-birth infants IF she's expressing often enough
(combining mechanical pump and hands-on techniques) AND thoroughly enough
every 24 hours. A hospital in central Ohio recently implemented a new
protocol for initiation of lactation when one/more babies heads for the
NICU after delivery - initiation at 1 hour is considered "optimal";
initiation by 3 hours is considered "acceptable"; by 6 hours is considered
"imperative." I believe they said they were first implementing via manual
expression and then adding the mechanical pump as per evidence. (This also
means an inability for milk expression "self-care" needs to be carried out
on the mom by staff, husband/partner, etc until the mother is able to
assume milk expression self-care herself!)

If mothers of twins/higher multiples (MOT/MOM) could just get off to a good
start re: initiation of lactation, we'd probably find (and the literature
supports) they'd obtain better volumes and they start obtaining them
sooner. The biggest problem is waaaay too many MOT/MOM get off to the worst
possible starts due to preterm delivery, maternal
pregnancy/birth complications, surgical deliver, etc. The delays that often
occur in initiating milk removal are inexcusable, especially now that there
is more research evidence that "early and often" also applies to initiating
milk expression when one/more babies is unable to "move the milk."

Physiology indicates effectively breastfeeding newborns feed at least 8x/24
hours so that seems a good place to start re: how often in 24 hours, so
effectively expressing milk at least 8x/24 hours seems a good place to
start. (How a MOT/MOM gets in 8 milk expression sessions/24 hours may vary
- no reason to "schedule" specific time intervals for pumping any more than
for an effectively breastfeeding baby. Can fit the pumping routine to the
MOT/MOM rather than the MOT/MOM to one's pumping routine.) One research
report indicates mechanical pumping yields the bulk of the milk for most
moms within the first 10 mins (give or take a few minutes for maternal
differences). Rather than adding time with a mechanical pump alone, the
evidence indicates it's often is more productive to lengthen pumping
sessions via hands-on expression techniques.

A revision of *Mothering Multiples:Breastfeeding and Caring for Twins or
More* will be de-emphasize the "old" number (10-12/24 hours) of sessions
suggested - that number is completely unrealistic for women recovering from
multiple pregnancy/birth, spending time with babies, etc. and will
emphasize at least 8/24 hours, including hands-on techniques for at least 5
of those 8(+) sessions. It will also emphasize maintaining a milk
expression log to ensure adequate milk removal occurred.

Finally, I am BEGGING/PLEADING with all who work with MOT/MOM pumping for
one or more of their multiples to URGE them to use a RENTAL breast pump
until ALL of their multiples breastfeed/transfer milk at breast
effectively! (If I had a dime for every MOT/MOM - and even mothers of
singletons - who is trying to establish/maintain production for an
ineffectively breastfeeding baby via a personal pump and is dealing with
inadequate or decreasing volume... A good pump used for the wrong job
becomes a bad pump.)

I'll ask the NICU MOT/MOM on a few lists I'm on about their milk expression
routines and get back...

Apologies and stepping off soap box!

Karen Gromada
(author *Mothering Multiples: Breastfeeding and Caring for Twins or More*)



>
> Date:    Sat, 19 Oct 2013 09:37:42 -0400
> From:    Jennifer Fultz <[log in to unmask]>
> Subject: Re: Pumping schedule/times
>
> My specific question is how do you adjust it for multiples? It is my
> understanding that pumping session shouldn't exceed 30 minutes....so for
> twins/triplets not at breast what is the recommendation? My thought is
> initially pump after delivery for 10-15 minutes 8x first 24 hours then
> increase to either 15 minutes for singleton, or 10 minutes per baby? Is
> this accurate and is there research to back the case of multiples? Of
> course with hand expression and pumping 2 minutes past milk stops
> dripping...
>
> I have heard 100/day is enough for milk supply regardless of number of
> babies. I've heard 45 minutes every 3 hours. I've heard 20 minutes every
> 1.5 hours.
>
> I'm just curious if there is an answer that is evidence based.
>
> Thanks!
> Jennifer Fultz, IBCLC
> North Carolina
>
>

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