Yesterday I saw a mom with 11 day old triplets at the breastfeeding
boutique where I do "mini-consults" one afternoon a week. (I have her
permission to post.)  Babies were born 4/29 at 36 weeks (considered
"full-term"), went to breast early and went home with mom exclusively
breastfeeding. Milk came in the night of 5/2. Seen by a pediatrician on
5/3, some weight loss at that point (I don't have the numbers) and
formula was recommended, but mom who nursed her now 5, 4, and 2 year old
children, elected to continue breastfeeding since milk had just come in.
Birth weights had ranged from 5lbs 4 oz. to 5 lbs 14 oz. A weight check
on 5/6 at the birth center indicated some continued weight loss, so mom
came back to the birth center to see me yesterday. This weight check
showed that the smallest baby had lost a full pound and the others had
lost almost as much. When I entered the room mom was nursing two babies
in cradle position, babies bodies in a "V" away from her. Latch appeared
shallow.  One baby released a nipple at that point. Nipple was long and
wide with a shallow areola; baby had been feeding on nipple only (and as
it turned out, the others were doing the same.)  I taught mom to relatch
with a deeper, asymmetric latch in football position, and this baby
seemed to nurse much better at this point.  The second baby released
nipple but refused to relatch in any position, so baby #3 was latched in
football with asymmetric latch; baby kept returning to nipple only for
several minutes until breast compression (done by me) helped get a fresh
MER, then baby accepted the deeper latch and nursed for a little while
with better appearing suckling.

We made a plan together to have mom pump (she had done so once that
morning with a yield of 3-4 ounces) after every feed, at least from
morning to night) and give at least one ounce to each baby using paced
bottlefeeding (mom's choice), using formula if needed to give them
enough for weight gain. Mom will also try using some More Milk Plus to
maximize supply, as well as working with the deeper latching.  They were
to see a new pediatrician later that afternoon, and I asked her to tell
him our plan and see if he agreed (he did).

My reason for telling all of you all this is that I cannot figure out
how mom can do breast compression while nursing to increase the amount
and fat content of the milk transferred.  Dad went back to work
yesterday, and her help is mostly taking care of the other children.
Those of you with more experience in working with multiples (I hope you
are reading this, Karen Gromada!), please give me your suggestions!  All
though I've been an LC for a long time, this is the first set of
full-term triplets I have seen in a very long time, and I don't even see
all that many twins. TIA.

Flossie Rollhauser, IBCLC, RLC



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