Hi! My name is Mario Borboa, I am a nursing student at the University of
North Dakota. Our class just finished with the block on multiple gestation
and I personally know two women in the area that were on fertility pills
and who gave birth to quintuplets. The public's reaction was mixed, but
sympathetic for the couples. In these two cases, the mothers did not
breast-feed. I am not really sure why not. The babies were small but
whether premature I do not know. Had the mothers elected to breast-feed,
how should they have managed to meet the recommendation of breast feeding
without feeling exhausted? Whaley & Wong(1995) say that, "the idea of
being committed to feeding multiples every 2 to 3 hours can be
overwhelming."

Would milk supply be a concern? Behrman, Kilegman, and Arvin(1996) say
that milk production for one baby is no problem if lactation is well
established. I would think that meeting the needs of five hungry babies at
one time would be a problem.

According to the new recommendation by the American Academy of
Pediatrics(1997), a mother should be breast feeding her baby for one year
and the baby should be breast fed within the first 30 minutes of life.
They also say not to limit the duration of feeding and that 10 to 12
feedings per day is optimal. I am wondering if the mother in cases of
multiple births could meet the recommendation of AAP, so I did some
research.

It was difficult finding information on breast feeding multiples. I found
one case report on breast feeding quadruplets. In this case report by Auer
and Gromada(1998), they say that, "most of the literature regarding breast
feeding multiples is extrapolated from single full- pre-term births." Auer
and Gromada also note that there is a scarcity of information on the topic
of breast feeding twins and much less on higher multiples. In a study by
Saint et al, as cited by Auer and Gromada, they found that, "the breast
adapted and produced adequate milk in response to increased frequency of
feedings by the exclusively breast fed twins and a set of triplets they
studied."

My question again is, would milk be a concern? I read an article where
mothers can bank their milk to avoid engorgement(Pugmire, 1999). Would you
recommend milk from a milk bank to augment their own milk supply? As the
nurse working with the mother who just gave multiple births, what do we
say to her? How do we help her manage the feeding so the babies get enough
to eat? How do we manage her state of mind so that she does not become
discouraged and discontinues breast-feeding? What are your thoughts? Thank
you.

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