Have to respond to Bonnie Jones' recent post re: nsg. twins. I breastfed my
twin daughters for about 14 months, and a lot of my suggestions to a new MOT
would be different than hers.

In particular, I don't necessarily recommend starting out by nursing both
babies at once, especially if she's had a CS, a particularly arduous
delivery, etc. I had a CS, complicated by a post-op infection, and I
absolutely hated nsg. both babies at once. For one thing, it was wicked
uncomfortable, no matter what position they were in. For another, my babies
had very different sucking rates and styles, and it just felt yucky to nurse
them at the same time. My babes were big old fat creatures (8#11 and 8#7 at
birth), and even as NB's they kicked and fussed with each other when I tried
to nurse them together - they didn't seem to like it either. The main thing
against it, though, was that it was emotionally very difficult for me to pay
what felt like "proper" attention to them when I tried to do both at once.
It was indescribably uncomfortable to try to divide my "mother" energy - I
had no problem bonding with them individually, but it never felt like I was
attending to them the way my mother instincts urged me to do when I was
nursing them together. Do you know what I mean?

What did work for me well, once I figured it out (DUH!), was to nurse
whoever wanted to eat whenever she "demanded" to nurse, and then wake the
other one and see if she'd do it. Almost always she would. (Although
Bonnie's right, there does tend to be a greedier baby and a less demanding
one - I didn't find that very important, though, because I definitely didn't
tend to spend longer with the second one.) For the first few weeks, that was
fine - they didn't usually "demand" to nurse at exactly the same time, nor
did the "second" baby refuse to nurse when gently awakened. After that,as
they spent more time awake, I found that it worked very well if I propped
the non-nursing baby up in my lap - on bed or sofa, my knees pulled up, nsg.
baby in "cradle" hold or whatever, non-nsg. baby leaning up against my
knees. They seemed to learn quickly, or almost know instinctively, that both
of them would get to eat, and this tended to be a very social experience for
the three of us, but without interfering with that delicious
in-love-with-the-nsg-baby feeling. I think it's also the reason that my
worst nightmare never materialized (well, just once!): both babies screaming
at the same time, in a time/place when I couldn't nurse them (and I also had
a 4-yr. old)conveniently or discreetly or whatever...like in the grocery
store checkout line, in winter coats & snowsuits, no free hands, etc. etc.).
They seemed to understand more about sharing and taking turns than I ever
tried to consciously "teach" them.

Yes, Bonnie - I always advise new moms of twins to keep the babies in the
same bed, for as long as it seems to be working. I'll never forget those
first few nights (so-called) home with them till I figured this out. They
were as happy as clams until I put them in their separate beds, at which
point they would wail as if their hearts would break, till I finally put
them both together in the smallest baby-holder I could find - either a
little wicker bassinet or an old-fashioned singly buggy. At which point they
would scooch and mooch themselves into the tightest corner, with their heads
mashed together exactly the way they were in utero. Their little heads were
like pieces of a puzzle, the way they fit together (eventually we had to
work on correcting the head shape of the smaller one, whose head was all
mashed on one side for several months).

The main thing I try to do when working with other mothers of twins is help
them figure out what will work best for them and their babies. Everyone's
different - and I've worked with moms whose babies were as early as 24 wks.
right up through big honking full-termers like mine were. The mothers need
so much support and reassurance! When you have twins (or more, I'm sure)
everyone you meet makes such a fuss that it begins to seem like some really
huge deal, which it is but so is every baby born...Mostly I think they need
to know that this is not some unheard-of thing, and their bodies are
designed to handle it, and that they have everything they need to do a great
job of it, whatever approach they decide to take. I found BF'ing to be
really easy with my twins (after a miserable experience with my first) -
always a huge milk supply, less time to fuss about the details that can
interfere with the way it's supposed to be, so much easier than the
alternative that I can't even imagine what it would be like. But I think
it's incredibly important to respect & support the mom's ideas of what she
wants to do, whether it makes sense to us with all our special knowledge or
not - if she wants to nurse one baby and bottle the other at one fdg, and
then reverse at the next fdg, or nurse & simultaneously pump, or whatever,
if it's working for her & the babes I just try to support her in what she
wants to do, even though I'm thinking "what on earth is she thinking??This
is 4 times harder than just doing x,y,z.."

Sorry so long - I meant to keep it short, honest!
Cathy Bargar - whose babies are now seniors in high school and beautiful,
strong, healthy young women!

-----Original Message-----
From: The Jones Family [mailto:[log in to unmask]]
Sent: Sunday, December 27, 1998 2:17 AM
Subject: Breastfeeding newborn twins (long)


I have worked with a number of breastfeeding twins in the hospital and
have followed a number of them for at least a while after discharge.
The mother of one set of twins I worked with now works on our postpartum
unit.  It used to be couplet care, but we have gone back to "traditional
care" at that hospital.

None of the mothers I have worked with have mentioned out of the
ordinary change in breast size.  Others are probably better able to
answer this question than I, especially those who sell bras.

A nursing pillow for twins is a great help.  It should be wide all the
way around so there is room for both babies to lie on it at once.
However, this will only work if mom has a comfortable place to nurse the
twins that will accommodate the width of the pillow.

The breasts can be supported by rolled wash cloths, cloth diapers,
receiving blankets, etc.--whatever will support the breast without
interfering with positioning the babies at breast.

The most important thing is for the mother to have help.  In the
hospital she will need help positioning the babies, especially if she
wants to nurse both at once.  I like to have mom do this at least once
in the hospital with my help so she knows how it works.  Double football
usually is easiest for most moms.   She will need help at
home--preferably for at least the first 3 months.  Talk to her, her
husband, her friends and family, and the hospital social worker if she
hasn't yet arranged for this.  Someone will need to fix meals, clean the
house, and assist in caring for older siblings, as well as helping with
the babies.

At the beginning, mom will probably need help latching the babies if she
plans to nurse both at once.  When one baby can self-attach, she can
attach the one who needs help and then latch the other.  Otherwise, the
helper can comfort one baby if necessary while she feeds the other.
Help her develop a routine.  Modified scheduling often becomes essential
to allow the mother to get some rest.  She can try waking the second
baby when the first awakens or as soon as she finishes feeding him.  The
second twin to feed is likely to get more attention, since mom will be
in a hurry to feed the second and may spend less time with the first.
She should therefore develop some sort of plan so one twin isn't always
first.

If the babies require supplementation (due to prematurity, for example)
help mom develop a routine, such as:
Every 3 hours (or sooner if baby is hungry) mom nurses one baby, then a
helper supplements while mom nurses #2.
Mom pumps while #2 is being supplemented.
Mom takes care of personal needs and RESTS!
I worked with one mom who wanted to do everything for her babies and
entertained visitors all day (a big part of the problem, but she
wouldn't listen initially).  Babies were breastfed immediately, but by
24 hours of age were nursing very poorly and had to be supplemented.  We
initially tried a supplementer, but this was too overwhelming, and mom
soon chose to bottlefeed the supplements.  Mom did insurance pumping
beginning after the first feeding and continuing after each feeding.  By
the end of day 3 the amount she pumped had decreased to only a few
milliliters per pumping.  With the above program her milk production
rapidly and steadily improved until she was able to fully breastfeed by
about 10 days postpartum.

Record keeping is essential.  If you have feeding and elimination logs,
give her a number of copies for each baby.  She may find it helpful to
continue record keeping for much longer than a singleton mom.  One
mother of 9-month old triplets reported she was still keeping records.

Would recommend Karen Gromada's book, but understand it is currently out
of print.  The Joy of Twins and Other Multiple Births has a lot of good
suggestions for positioning; unfortunately, some of the basic
breastfeeding info is inaccurate.  LLLI has a nice pamplet on the
subject.

Well, this is much longer than I intended.  Hope it helps.

You probably didn't need half of it.  If you remember the basics, and if
you and the mother use your own experiences and common sense, you'll do
find.  Twins are a lot of fun.

Two more suggestions:  keep the babies in the same crib, beginning in
the hospital, and always call the babies by their names.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA