Hi Mary-Jane ~

I think this would be an "it depends." How many weeks gestation were babies at birth and how many at (anticipated) discharge - will they be on any supplementary micronutrients? Has there been an in-depth assessment of milk transfer during breastfeeding? It can be particularly difficult to monitor each baby's breastfeeding when feeding both at once, so wondering whether the neither seeming to require complementary EBM after breastfeeding is the only way milk transfer is being assessed? Is this a first-time mother or has she breastfed a prior single infant? Is there a plan in place for monitoring breastfeeding "outcomes" for each baby, e.g. adequate frequency of feeding, outputs, weight gain? (Simple check-list charts are really helpful to ensure both are doing well once home with more breastfeeding.) Will mom have help for household tasks so she is free to breastfeed, breastfeed, breastfeed?!? (Anticipatory guidance needs to include discussion of the increased number of feedings when transitioning to full direct breastfeeding - times 2! The thought and reality of breastfeeding two teeny littles about 10-12x/24 hours can be quite different!)

What are the neonatologists saying - and why? I really do not get when moms are told to breastfeed discharged premies on a very limited basis (1-2x/24 hours) when a premie can consistently latch deeply and suckle actively to transfer adequate milk, but I think premies must be watched closely for awhile. The need for careful monitoring doubles (or triples) for multiples, because it is more difficult to keep track of each baby when home and breastfeeding seems constant, parental sleep deprivation must be integrated with care, etc. 

If this mom is on FB, please let her know there are a couple of terrific (closed) groups for mothers breastfeeding multiple-birth infants:
1. La Leche League for Moms of Twins/Multiples
2. Naturally Parenting Twins 2.0

I hope the transition home goes as smoothly as possible when twice the usual number of babies is involved!

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




On Mar 8, 2015, at 10:14 PM, LACTNET automatic digest system wrote:
> ------------------------------
> 
> Date:    Sun, 8 Mar 2015 17:00:25 -0400
> From:    Mary-Jane Downey <[log in to unmask]>
> Subject: prem bf twins going home
> 
> Have permission to post
> Have a question about prem twins who are bf well and are due to be discharged soon. Mom has only been able to get in to NICU for two feeds per day but tandem breastfeeds and neither babe requires a supp of EBM after the tandem feeds. The rest of the time the babies are fed by staff with bottles of EBM. 
> Here is her question.....does she need to increase her feeds at breast slowly or can she breastfeed them for all feeds once she is at home.  This mom has a lot of common sense and seems very aware of how well each is doing at breast.
> My response was try to bf and see what the twins do - if they seem to be feeding well and settle following great,  however if they seem to be less effective at breast as day progresses then pump and supp with EBM........
> Not sure why I am questioning myself but thought other LCs may have some thoughts to share...
> 
> ****************************************************************************

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