Many thanks to all of you for your prompt and thoughtful responsed to my
plea for help.  I saw the mom of the twins today, and although of course I
did investigate all of the things which we had collectively thought of
(retained placenta, excessive blood loss, underlying maternal health
problems including hypothyroidism and other hormonal abnormalities, etc.
etc.) in fact the mystery was revealed as soon as I examined the mother's
breasts.  There was indeed a fairly reasonable supply of milk -- not likely
enough to meet all of the babies' needs at this point, but certainly not a
tiny amount.  A bit later in our time together, she had the experience of
nursing both twins together for the first time!  They were both pretty good
little nursers, although they have their difficulties.  They were most
definitely getting milk; however, this was one of those times when I
*really* wish I had a good scale -- I've been severely tempted by the
MilkyWeigh.

Ok, enough suspense, already!  The mom has relatively large, soft, *very*
elastic breasts, and it was immediately evident that her ductile tissue
tends to just slip away from your fingers -- or baby's gums -- or the pump
flange.  We needed to use a firm grasp of the breast tissue to keep the
right stuff in the babies' mouths as they nursed -- mom said that the
difference in their nursing behavior was quite apparent to her.  I showed
her how to hand express, and we talked about some possible ways to make the
pumping work out better.  I'm not a pump person, so please feel free to
give me your suggestions.  I felt that she might do better to try single
pumping, using one hand to hold the breast and the other to hold the
flange.  She also has been so tired and frustrated that she admits to being
lax about positioning and latch, and about pumping technique -- she figured
that she'd worry about the details some other time.  She notes that when
she was pumping and getting nothing, a shift in position might result in a
sudden brief rush of milk.  Mom does acknowledge the difference, and that
she is likely to have more success if she attends more to details.

So.  This mom could really use a doula at home, but seems determined to
force herself to handle it all now because "I can't expect to have help for
the next 18 years".  (We did talk about that...)  Mom is going to do more
offering of the breast, try to make feedings more frequent and cue-based,
and rent a BabyWeigh so that she can base her pumping and supplementing
strategies on some hard data instead of just automatically giving 2-3 oz of
abm after every attempt at nursing.  She's had a rough couple of months now
-- one in the hospital before birth; three weeks at home with no babies and
pumping frustration, and a week of at-home mothering of twins with all of
these same problems.  She isn't sure that she even wants to nurse now, but
was encouraged by the way things went today.  I would love to see her with
an in-home LC on a daily basis for a few days, but I can't provide that and
she is very reluctant to consider letting a 5th LC into her life!

Thanks again for your input.  It's just great to have a peer group so
readily at hand!

Willow       [log in to unmask]

I am very disappointed that 2 or 3 hospital LCs could find no reason for
her apparent inability to pump/produce milk, and that they were first so
quick to have a mom with a history of depression take Reglan (because her
pump didn't fit...), and second so quick to blame the pre-birth hospital
stay, the arrival of twins, and "exhaustion" for her problems.  Cripe, did
anybody examine her breasts??