I saw a mom today with twins that are 5.5 weeks old.  They haven't nursed
at breast yet (thanks to support in the hospital..sarcasm) but mom has
been trying to pump.  Has gotten a prescription for reglan but is still
only seeing about 1/2oz per breast up from 1/2 total per session.  She
can't manage to pump every 2 hrs so is aiming for every 3 although she
revealed to me that even that is difficult (she also has a 3yo).  She
really wants to nurse but has alot on her plate, she's pretty
overwhelmed.  I had previously given her an SNS and an electric pump,
that she was using to give EBM and ABM at breast. She hadn't brought the
babies in at that point and although I showed her a video on SNS usage
and gave her instructions I had never taken a look at her breasts. (this
is a WIC clinic and not exactly the easiest environment for breastfeeding
evaluations, although I try my best) She did mention that they told her
in the hospital she wouldn't be able to nurse because the babies mouths
were to small for her nipples.  WELL, I did think much of that statement
until I saw her nipples today when she came back in with the babies.
They are about the size of a quarter and quite a stretch for one baby and
the other can't seem to get it in her mouth at all.  Even with the SNS
she just can't seem to get them to accept the breast.  She is almost
ready to throw the towel in.  She can't quite figure out how to
coordinate everything that has to be done for two babies.  The last thing
I wanted to do was throw another piece of equipment at her but she really
wanted to try finger feeding because I mentioned to her the best thing is
to get rid of the bottles and feed the babies with another method so that
they will not get used to only the rubber nipple in their mouths if her
ultimate goal is still to feed them at breast.  I told her each day or
two to go up a finger in size until they are accepting her thumb (which
most closely approximates her nipple).  To always feed as if they were at
breast, lots of skin to skin contact etc.  Recognizing that this has to
be her goal and not mine I verified if this is really what she wants to
do and she really would like to see them at breast.  I told her as the
babies grow they may be able to accept the larger nipple more easily but
it is important that she try to keep up her milk supply in the meantime.
I gave her lots of praise and encouragement and support.  I also let her
know that if it gets to be too much (the pumping, the SNS, the finger
feeding) she can know that she gave it her all.  Having twins just adds a
whole other element here.  She is plain exhausted, I had to give her an
out.

Is there anything else I could have offered her?  One of the twins is
having a more difficult time healthwise (possible reflux according to MD
and is going for an upper GI next week) and she knows BM is the best.  It
is very important to her but I wonder myself if she will be able to bring
in a full supply for two babies at this point.

Warmly, Ilene Fabisch, Brockton, MA
"Each day is a blank canvas waiting for our unique brushstrokes to create
a masterpiece."