Lyla,

I would be concerned about the twins at this age having so few stools and
acting fussy and unsatisfied after evening feedings that last an hour, and
when they are nursing every hour or two during the day.  I would want to
make sure that they are well positioned and attached, and actually
transferring milk from mother to babies. The constipation could be a
reaction to the formula they are getting, but I would want to know about
their wet diaper count and their weight gain.  It's true that babies
frequently seem to want to nurse from 4 pm until 10 pm, but the giving of
formula every evening could also be decreasing the mother's milk supply at
that time.  It sounds as though this mother is not so comfortable with the
formula anyway, and it might be helpful to explore that further with her,
and to help her share her feelings about it with her husband.  He may need
to be given other ways to feel involved and helpful, while letting her do
the feedings. (He could walk, hold, rock, sing to one baby while she nurses
the other.  And of course the 2 older children need lots of his attention,
too.  See the books of William and Martha Sears, such as "The Baby Book,"
for lots of suggestions of ways for fathers to be helpful other than
feedings.)  Knowing that evenings are going to be a high need time for
everyone (the older children, typically, too), perhaps this dad could help
plan how to free up the mom to be able to nurse at length during those
hours.  That would mean finding ways to get supper made, served and cleaned
up by someone else, the older kids' needs for activity, nurturing, feeding
and settling for the night attended to, etc.  And you might want to
acknowledge his feelings of
frustration, helplessness, exhaustion, whatever, and let him know that this
is a very intense period now, but it will get better with time.

The problem I see most often with mothers of new twins plus 2 older
children, is not having enough help with all the household chores.  These
mothers are used to being the coordinator of all the family activites,
running everything, and doing it all themselves.  It is very hard for them
to be on the receiving end of help, but in this situation it is really
important for her to get more rest and take care of herself.  If she can
spend a few days cuddled up in bed with the babies, nursing and sleeping,
that would be very good for her.  It will be hard to convince her that this
is possible.  People generally only can recognize it in hindsight.  They
can sometimes "hear" it from other mothers of twins.

Please also watch this mother and babies to see that they don't develop
thrush on top of everything else.  She should know the signs so it could be
treated right away.  Perhaps it would be helpful for her to be taking
acidophilus now to decrease the risk since she is on antibiotics.

Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI
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