Re: << 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 came out of lurkdom to respond to this post. Almost every breastfeeding
mother I see or talk to anymore is a mother of twins or triplets. I've been
working with MOT/MOM since my own twins (babies 3 & 4 in our family) were a
few months in 1977 and I received permission to start LLLI's first group
exclusively for mothers of multiples.  Here are my suggestions.

One treats/observes each twin or other multiple as one treats/observes each
singleton in the early days. There is NO difference. I'd suggest assessing
each individually for several feedings prior to even mentioning simultaneous
feeding. I wouldn't mention simultaneous feeding, or I'd discourage it if mom
suggests it, until at least one demonstrates outcomes consistent with
effective latch-on and suckling.

Barbara W-C's important caveat re: SGA is very important. Approximately 50%
of twins are born preterm (prior to 37 weeks) and about 50% are SGA. All come
from a more stressed uterine environment; the human uterus was designed to
accommodate one at a time. I've seen twins do sort of great initially and
then sort of run out of steam. Those midlings (35-38 weekers) seem notorious
for appearing to suckle appropriately but not sustaining it. (These issues
only increase with higher-order multiples; MOM, who need the best
breastfeeding start, are the least likely to get it.)

Tracking outcomes should pick that up. I suggest a checklist chart that
includes diaper counts for singletons, but I revise it re: color-coding
(paper, newborn's name, etc.) for each multiple to make it easier to keep trac
k when sleep deprived and confused as to whom one currently has in arms. If
any multiple is NOT breastfeeding effectively, it is really important to
increase milk removal via expression/pumping (hospital-grade pump). (If the
other latches fairly easily, mom can pump on one breast while a baby
breastfeeds on the other.)

PIH/pre-eclampsia has been estimated to affect expectant MOT up to 3x the
rate as mothers of singletons, so it is a common maternal complication. The
biggest problem I've found with mothers postpartum with 24 hour post-delivery
MgSO4 is the mental "spaciness," or feeling of detachment (feeling separate
from their bodies) they complain of. Add that to the fact that probably most
of these MOM/PIH moms had a surgical birth and may also be on a PCA pump, and
it can be hard to breastfeed on cue or pump. Pumping moms don't think of it
without reminders and, if left on their own, many can't manage to keep the
flange in place. Then it can take a few hours beyond the 24 for their heads
to clear, so delayed breastfeeding is an issue. Mom really needs a supportive
partner, friend, etc. to stay with her around the clock if she wants to get a
good breastfeeding or pumping start.

There is no rush to feed two multiples simultaneously. Heck, lots of
first-time mothers these days have never even held one baby, much less two,
so many haven't a clue as to how to comfortably hold/position one to
breastfeeding, much less adding a second. There are many, many of us,
including experienced breastfeeding moms,  who found it took weeks to months
for babies or mothers to find the right "fit" and really get the hang of
simultaneous feeding, yet we made plenty of milk based on babies' weight
gains...

I'm not for assigning a breast, unless one baby consistently cues/demoes
preference for a particular side--assuming that the other baby is OK with it.
Initially, I'd never suggest it, as one often is a more effective feeder and
helps with bilateral milk production. Have had a few too many mothers unhappy
with significant breast lopsideness. Also,  later nursing strikes appear to
be more common in MOT/MOM and a few mothers had a problem when the baby that
wasn't striking wouldn't take the striking baby's breast to help out. Same
has happened when one weaned before another.

Somewhere in here I should say it may help to determine the MOT's/MOM's
short- and long-term breastfeeding goals.  Initially, that may not make a
difference so as to get production going well, but later it might.

Finally, this expectant mom obviously had a complication that called for
birth at 36 weeks. However, there is a notion among many care providers that
birth of twins should ROUTINELY occur at 37 weeks. Some actually tell
expectant MOT that twins reach full term earlier than singletons. Excuse me,
they do not. Cooked is cooked. What some research has found is that the
placenta(s) may begin to deteriorate a bit sooner due to a more stressful
uterine environment. This does not mean babies mature sooner! In fact, based
on suckling ability, my guess is the stress effect is greater. There are ways
to monitor twins to make sure all is still OK in the womb while they mature a
bit more. At any rate, sorry to go on about a pet peeve but did want to draw
attention to a Cochrane Review of this because as LCs you all will have to
deal with the effects of an earlier than necessary birth! Here's the web
address for any who would like the review abstract of "Elective delivery of
women with a twin pregnancy from 37 weeks' gestation":
<A HREF="http://www.cochrane.org/cochrane/revabstr/ab003582.htm">http://www.cochrane.org/cochrane/revabstr/ab003582.htm</A>

And if no one minds (and I guess even if you do), I plan to follow this up
with some references re: breastfeeding twins or other multiples.

Karen
author, Mothering Multiples: Breastfeeding and Caring for Twins or More
(LLLI); coauthor, Keys to Parenting Multiples (Barron's)





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