Anne raises an interesting possibility about going on a nurseathon for twins
currently being supplemented with 14 oz/day in order to build up the mom's
milk supply really quickly, asks if supplements could be ended abruptly and
suggests that urine/stool output could be monitored to know that babies were
obtaining sufficient intake.

In theory Anne, yes, I agree this would be how it should work.  However, I
would be very wary about abruptly eliminating that much supplement and
expecting the mom to make up for it in breastmilk production within a 24
hour period.  That's asking a bit much.  Furthermore, it might be that urine
output wouldn't slow until the day *after*, or the day after that - i e
there would be a carry-over from the previous supplementation which would
lull everyone into thinking that the babies were OK for a while, when they
were not.  My experience with FTT cases is that babies who are not "getting
enough" become extremely vocal about it at first, then eventually become
increasingly lethargic so that they don't drain the breasts well (even when
the milk is there) then get less and less .. and begin a really downward spiral.

Your recommendation of nursing round the clock is a good one, but I would
anticipate that top-ups of supplement would be required for some time to
protect the babies' nutrition and keep their energy levels high.  One of my
references (I think it is one of the LC series on low weight gain) suggests
eliminating supplements no faster than 1 oz per day. I think Coach Smith's
Rule #1 applies here - Feed The Babies - then (my own personal) Rule #2 -
Drain The Breasts, then top-ups sufficient to ensure adequate output, and
lastly - patience, patience, patience! It usually takes as long to "fix" the
problem as it took to create and my observation is that it takes the breasts
about four days to *really* kick in to increasing breastmilk production once
they are being drained really thoroughly really often.  Furthermore, with
two babies you can expect results in at least twice the time.  Gently does it!

This mom sounds really stressed.  She needs lots of practical help with
other tasks so she can sit around plugged in to the babies for most of the
time.  She also needs to keep records of which baby got how much supplement,
and urine/stool output for each baby, so that she can monitor (a) that each
baby is getting enough and (b) that her milk supply is increasing
(supplements are decreasing each 24 hours) as a result of all her hard work,
in order to encourage herself.  Best wishes to all - this sounds like a
really tricky one!

Pamela Morrison IBCLC, Zimbabwe
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