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Subject:
From:
Karen Kerkhoff Gromada <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 13 Oct 2003 10:20:30 EDT
Content-Type:
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In a message dated 10/12/03 11:38:24 PM Eastern Daylight Time,
[log in to unmask] writes:

> I was called by SCBU to-day and asked if I could help a mother who was
> wanting to B/f her twins
> they were born 29/40 gestation,
> Now 37/1/40 gestation.
>
> Mother expressing - good supply


Yea! That is a great help already. Keep that milk moving!



> Twin one is on CPAP but improving
> Twin two ok- but will need further investigations for bowel problems
> Both now weigh 2kgs., both are having kangaroo care when mum is in the unit.
> both are having ebm by bottles/ and being tube feed overnight.
> The nurse caring for the babies said that they lick the breast sometimes ,
> they do  attach for a few minutes then fall asleep.
> the nurse identified that this mother has been given sooo much advice that
> she is now confused about what she should be doing .


Both of these babies are still sick. That may affect their BF progress. It is
difficult to expend energy on new skills when not feeling up to snuff. It is
great they are licking the nipple -- signs of progress. Has mom tried BF with
a thin nipple shield? If so, how recent and what happens or happened?



> What would you advise around the breastfeeding
> Should there be a b/f plan put in place?
> I thought that breast should be offered first - say 10 mins, then
> alternative feed.  should the babies continue with bottles, tubes, cups, Any
> suggestions would be gratefully appreciated  I feel out of my depth
> completely and there isnt a lactation consultant availbable  in our
> hospital. and the mother is unable to pay for a private consultant.

I think the current plan of kangarooing, time at breast for licking and
possibly latching is good and seems to be based on individual twin's cues.
Progression based on infant cues is the same whether one has a full-term or preterm
baby, whether baby comes alone or as part of a set. I think your 10 min idea is
realistic for a MOT. If a baby is ineffective BF, she/he is not going to
become more effective with more time at breast and mom loses time for pumping,
kangarooing, etc. Some research indicates the tube feedings may help re: smoother
transition to breast, but if we're talking discharge in the near future for
either baby, then the alternative feeding plan has to accommodate a mother with
two ineffective BF infants (one of whom she may still need to fully pump for,
visit in hospital, etc.). For most MOT/MOM that includes bottles. Using tested
(each time) slow-flow teats and instructing mother and feeding helpers on
reinforcing BF behaviors with this type of teat often helps. It may or may not
slow transition to breast, but maternal sanity re: time and effort have to be
taken into account.

Finally, there are many MOT/MOM who have transitioned sick, preterm twins and
other multiples to breast. She and her babies CAN do this but it can take
time. If this MOT has access to the internet, I'd suggest she join the yahoo
group re: APMultiples per instructions in the archives. I'm always happy to talk
to via phone or work over email with anyone helping a MOM or the mother
herself.

Karen
(author, Mothering Multiples: Breastfeeding and Caring for Twins or More)


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