In a message dated 4/23/2003 11:03:18 PM Eastern Standard Time, [log in to unmask] writes:

> My new set are 34 weeks, born today by c-section for preterm contractions.
> Baby A was 5 lbs 5 oz, Baby B 4 lbs 12 oz.   Unfortunately, I have had to
> send baby B to an outside hospital for NICU care due to RDS.  Baby A remains
> with mom at our little community hospital.  IBCLC has been to see the mom
> already, and helped with first attempt at putting baby to breast, but were
> unable to get him to latch.  Situation is complicated by little preemie
> mouth and large breasts with large, somewhat flat nipples.  This was also
> mom's first delivery, so both she and babies are inexperienced.  She has
> started pumping, and got almost 10 ccs of colostrum on the first attempt,
> which baby A took readily by soft cup feeder.  He does root and sucks a
> little on his hand, so we'll see how he does with time.  He is otherwise
> stable but of course we have a ways to go. 


Re: BF -- with two ineffective breastfeeders, removing milk effectively via adequate expression/pumpuing will continue to be important until both mature and improve at breast. This is essentially what one would do if a singleton, but the adequacy/frequency in 24 hours may play more a role in establishing and then maintaining adequate production when a mother may feel pulled in more directions than usual due to preterm birth, babies in different hospitals, and recuperating from surgery.


> The other one 
> was not stable for
> oral feeds at all, and now is an hour away in the NICU. 

I hope baby can be transferred back to the more convenient hospital soon. When mother is recuperating from a surgical birth (and usually less mobile herself) and also has access to one of her babies, there can be implications for mother-separated-baby attachment. I hope photos are taken daily and shared with the mother. Expressing milk for a sick, separated baby can help her maintain a special cord connecting her with the separated infant. She might also record a message for the separated baby, so that baby can hear her voice. Obviously, getting to the other NICU to spend time with the sicker baby ASAP and as able is paramount. I'd suggest interventions that reinforce her connection to the separated baby, as many MOM find it extremely easy to get all involved in and attached to the accessible multiple in their care and then have attachment issues that can take a long time to resolve with the separated infant. It's tough for humans to form simultaneous, deep attachments to two or more other new humans in their circle; it's even tougher when the human when she cannot see or touch the new human with whom she needs to form an attachment.

Karen