I am wondering if any of you can give me any pointers on what specifically
to watch for with twins breastfeeding in the early days.  I don't have a lot
of experience with breastfed twins, as I don't provide obstetric care for
multiple pregnancies, and I haven't had a lot of twins in my practice.  I
have a patient who gave birth to twins this am, at 36 weeks, after induction
for pre-eclampsia.  Mom breastfed her two older children for most of the
first year.  The twins were discordant, weight 6 lbs 5 oz, and 4 lbs 10 oz.
 They appear healthy and vigorous so far.  The littler one, in fact is very
alert and a nice aggressive eater right from the start.  The bigger one had
several very good feedings today, and a couple of very sleepy ones.  I was
present for delivery, and both babies went ot breast in the first hour.  Mom
has put each baby to breast at least every 2 hours today, and is feeling
pretty confident so far.  For now, mom is nursing each one on one side per
feeding, and alternating breasts each feeding.  Due to being pretty tired
and feeling like she doesn't quite have enough hands, she has not tried to
nurse them together yet.  They are just about 18 hours old.
Aside from the obvious concerns about prematurity, small for gestational age
issues, what things do I need to watch for in the early days?  Mom is also
receiving magnesium sulfate for 24 hours after delivery due to
pre-eclampsia, but is not receiving any other meds except for ibuprofen for
uterine cramping.  She plans to room-in and Dad is available around the
clock also.  Mom is very dedicated and very excited about these twins.  Our
IBCLC will see her tomorrow also, but I was just wondering if there are any
other things I should be watching for.
Jennifer Tieman
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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