Re: << My name is Jennifer and I am a junior in the nursing program at the University 
of North Dakota. >>

Jennifer, I thought I replied to your questions soon after you posted but there was a glitch 
in my Lactnet subscription and my response never made it to the board. (Rec'd a 
message that it had arrived but it never was distributed.) So, you may no longer need the 
info, but I'll give it a go again -- just may not be as long and involved!


<< According to a study I read, the mothers of twins consistently produced twice 
as much milk as a mom who had a single baby and mothers of triplets were 
able to produce up to three liters per day (Fliedel, Shinwell 2006). These 
amounts were proven to be accurate because the babies gained the 
recommended amount of weight. >>


Generally, true. However, a recent research report cited multiples as one of the 
significant factors in lower production. This may be perceived at times re: breastfeeding 
or breast-pumping management when caring for so many babies and recovering from a 
more stressful pregnancy/birth that often includes a higher number of maternal 
complications. But mothers of multiples are also more likely to be affected by other 
factors associated with lower production, e.g. PCOS, postpartum thyroid changes, etc.


<< Breastfeeding is especially important for multiples due to their greater 
incidence of prematurity and low birth weight (Leonard 2002). Breastfeeding can help 
avoid any unnecessary complications for these babies. >>

Amen!


<< Nurses need to give additional support during the postpartum period especially due to 
the fact that often, multiples will be discharged at different times. >>


Double amen! And staggered discharge is an issue, but so is hearing that breastfeeding or 
providing mom's own milk is valuable for our multiple babies, that it is worthwhile -- 
even if partial vs. exclusive, etc. Mothers of multiples often tell me that a high number of 
family, friends and healthcare providers ask them if they're nuts to consider 
breastfeeding vs. cheer them on. 


<< Another article stated that moms of multiples reported giving up on breastfeeding 
because it as physically and emotionally exhausting not because they werenÕt producing 
enough milk. >>

This is a huge issue -- but having two, three, four times the usual number of babies is 
physically and emotionally exhausting no matter how they are fed! And there are ways to 
revise care plans re: breastfeeding multiples so mom can get a break or some relief 
when needed. Partial breastfeeding certainly beats no breastfeeding for moms feeling this 
way!

<< One mom reported breastfeeding two babies and bottle feeding 
the third and rotating them with every feeding in order to avoid exhaustion 
(Leonard 2000). Could this rotation feeding be problematic or is it a good 
compromise? >>

The answer to your question is Yes and No! Different strategies -- or variations of them -- 
work or don't work for different mother-infants' combinations. No one thing works best 
for every mother-infants breastfeeding triad, quadrad, etc.

This strategy can be problematic if it doesn't "fit" with the physiology of milk production 
or babies' needs; it can be a great compromise, especially for many mothers of higher 
order multiples. There is a photo of a mother of triplets breastfeeding two while her 
sister bottle-feeds the third at my web site (address below) under Photos. I had a mom in 
my group who breastfed two in the double clutch position while she also bottle-fed the 
third by making a "recliner" chair for the 3rd baby with her legs -- propped her left heel 
on her right knee. She rotated which baby was on which breast every daytime feeding 
and each was bottle-fed every 3rd feed; at night she fully breastfed as she found this to 
be easier. I've also had a mother in my group who did the reverse -- fully breastfed 
during the day and rotated at night so her husband could help with feedings.

Hope this goes through this time. And good luck with your studies and nursing career! 

Karen Gromada (MSN, RN, IBCLC), La Leche League Leader Cincinnati Multiples group
author, Mothering Multiples: Breastfeeding and Caring for Twins or More (revision due out 
any moment!) and coauthor, Keys to Parenting Multiples
www.karengromada.com/

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