I am working with a mother, over the phone, I haven't seen her in person.
(I have her permission to post)  I am finding it to be a rather complicated
case that I would love to refer off to an IBCLC, but the only one in private
practice in our area, has moved on.  So I am doing my best to help her with
information and support. This may be a bit long because I want to include
all aspects so that I can get some insight from all the wise ones here on
Lactnet.  She initially called me struggling to nurse twins at 8 weeks old.
Plugged Ducts have been her main complaint, as well as long, drawn out
nursing sessions.  During the course of our first conversation she mentioned
some symptoms that sounded like Reynaud's Phenomenon.  We spoke about
different ways to help her plugged ducts, most of which she had already
tried.  She is very motivated and very educated about breastfeeding and
having twins.  She owns Mothering Multiples and very much wants to
breastfeed for at least a year.  She is very overwhelmed and frustrated.
Plugged Ducts have been an ongoing problem since her milk came in. I talked
to her about Magnesium/Calcium supplements and taking Lecithin.  She decided
to try both and the plugged ducts are resolving with her last one several
days ago.  She is spending at least 1 to 1 1/2 hours per nursing session
with both twins.  She states they are actively nursing and swallowing during
this time.  As I said I have not seen the babies latch on but she describes
a deep latch with flanged lips and deep drawing and swallowing actions.  She
can hear them swallowing milk.  She stated that when the plugged ducts were
at their worst (about two weeks ago, prompting her call) she could barely
pump anything at all and the babies were taking much longer at the breast.
She stated that when the last plug cleared she could press on her breast and
have milk spray. (sounded like the supply is there)   She is concerned
because the babies are "falling off their growth curve".  The lightest twin
was around 4lbs 2oz at her lowest weight after birth. She is now 7lbs 15oz
at nine weeks.  The worry is that the babies gained quite well in the
beginning but slowed their gain to about 3 1/2 oz the last two weeks (7oz
total).  She has tried nursing each twin independently and found that it did
not decrease the active suckling time of either twin.  She couldn't spend
that much time so is nursing them in tandem at all feedings.  They are both
gaining at about the same rate.  Knowing that the plugged ducts were at
their worst two weeks ago, I suspect milk transfer was an issue and that
could be accounting for the slowed gain.  Now that the ducts are not
plugging, I am hoping to see more weight gain in the next weeks.  She has a
scale at home and is weighing twice a week.  She can't get to her pedi that
often without a big hassle so opted to keep the scale longer.  I am looking
for any suggestions or resources, etc. that I can share with her.  She is
absolutely exhausted with the near continuous nursing and is very worried
about them adequately growing.  Thanks so much.  Please let me know if there
is anything that needs clarification.

Wendi Jones
Volunteer Breastfeeding Helper

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