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Subject:
From:
"Karen Kerkhoff Gromada, MSN, RN, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 17 May 2003 11:11:02 EDT
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In a message dated 5/17/03 4:54:40 AM Eastern Daylight Time,
[log in to unmask] writes:

> I have been a lurker for several years; and I know that this is where I
> can get help for my concern. I am a NICU RN and IBCLC. My daughter gave
> birth 16 days ago to twins, which is nowhere that I have been. The babies
> are exclusevely breastfeeding and as of their first peds visit are gaining
> approx one ounce a day each. The concern is that these babies won't leave
> the breast. My daughter and her husband are exausted.Does anyone have any
> help or tips? They like to nurse and then stay there on the breast which
> is causing very full and painful breasts and nipples. I am so very proud
> of my daughter and don't want to make it any harder. Please, any tips or
> encouragement. She can read this e-mail and any encouragement from you all
> will be so greatlyappreciated. Thanks so much, Laura and Cindy



Congratulations on becoming the grandmother of twins!

1. When dealing with problems or concerns it is easy to focus only on that,
and it can help to remind oneself to celebrate all that is going right! How
wonderful that your daughter is BF and the babies are gaining so well. That
is terrific!

2. No matter how one slices it, two babies are twice as many as the usual new
parents get; it is likely everyone would be feeding a bit overwhelmed and
exhausted no matter how they were being fed. In addition, your daughter is
recuperating from a more physically stressful pregnancy and birth, which can
affect one's resistance level and ability to cope at times -- one naturally
gets more tired more easily. It also can become very confusing re: is it that
they really "won't leave the breast" or does it just seem like it because
there are twice as many?

3. If babies truly "won't leave the breast," it sounds as if there may be a
minor latch-on problem. It is important to assess how true "won't leave the
breast" is. It is normal for each newborn to cue to breastfeed approximately
8 - 12+ times in 24 hours; however, the average breastfeeding lasts about
10-30 minutes. At some point in 10-40 minutes a baby will demonstrate signs
of satiety, get a drunk/sleepy "food coma" look and self-detach. This doesn't
mean a baby still won't want to be held and if put down may act as if hungry.
Don't want to confuse the need for food with the need for contact.

When a baby consistently indicates a lack of satiety by about 40 minutes of
feeding and when there is nipple pain or actual tissue breakdown, we now know
that it means a baby is not quite latched correctly. The full, painful
breasts may be another sign that the latch is not quite "right." Often a
minor adjustment in positioning will make a huge difference on both length of
feedings and nipple comfort. (Nipples should appear and feel "normal" before,
during and after breastfeeding.) Obviously, babies are suckling effectively
enough to result in weight gain, which is great, but they may be compensating
for a less than terrific latch by hardly ever leaving the breast.

Is your daughter feeding her babies simultaneously? If so, she may be
reinforcing less than ideal latch on because it is often more difficult to
coordinate positioning babies at breasts...

I'd highly recommend your daughter see an IBCLC for an assessment of a
breastfeeding. A minor adjustment re: latch may solve her problems.

If she's at her wit's end re: needing a bit of uninterrupted sleep, I've
known many MOT that pumped and then let Daddy or someone else offer the EBM
so Mom could catch a few hours of sleep. This can make a tremendous
difference in mood! She won't want to overdo and I'd suggest a
breastfeeding-friendly feeding method for the EBM, but sometimes one does
what one has to do to keep it going!

If you can't be there, could they hire a postpartum doula to help out? Your
daughter is saving hundreds of dollard a month by breastfeeding her babies.
Perhaps some of those savings could be invested in some extra hands in the
household for the first weeks!

Hope this helps.

Karen Gromada

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