Patricia

An update on my client with very large nipples. The twins are seven weeks
old tomorrow. They are growing nicely. Until 2 days ago the mother was
offering the breast at most feeds - individually (impossible to latch two
difficult-to-latch babies at the same time), then each baby would be
finger/tube fed 90-100ml EBM. Then mum would express for the next feed.
These babies have only had breastmilk from birth.
A week ago we started using breast compression with moderate success in
stimulating letdown, therefore more suck/swallows (these babies prefer to
suckle only when a letdown occurs). The mum stimulates several letdowns
during the course of the feed. The babies would still insist on their tube
feed of 90-100ml. after breastfeed.
2 days ago the mum called with the news of a MAJOR BREAKTHROUGH. She was
having problems with one particular baby not being prepared to stay on long
enough for a letdown, at my suggestion she had tried rocking until letdown
- THIS WORKED! Over the last two days the babies have been more content
after a breastfeed, so haven't been comped. They stay awake, but go back to
the breast every 2 hours during the day. After 10pm and 2am feeds they get
a 60ml ebm comp.
Yesterday she called me because she found it distressing to listen to one
baby crying whilst she fed the other. We discussed ways to support both
babies at the breast at once - she usually finds it too painful as she
can't get them well latched when she is dealing with both at once.
BTW I showed my client a nipple shield, but we both felt her nipples would
not fit. We tried SNS but couldn't get the milk to flow successfully.
I think they're mouths have finally grown sufficiently for them reach the
milk sinuses. Their mother is one very determined woman!! Neither of us
have ever doubted she would succeed (she BF two older children), but the
path has been extremely frustrating and laborious!

Regards Roslyn Draper, midwife, IBCLC, Melbourne, Australia
[log in to unmask]
----------