5/25/17

Breastfeeding Twins: my story



Grace. Let my first word of this post be grace. Breastfeeding twins comes naturally for some mamas while others, like me, will struggle. For me, the desire to feed my babies at the breast was enough fuel to help me endure and overcome three months of struggle and feeding challenges. It was hard but worth it. For other mamas, the emotional and physical challenges will be harder than mine and they will make the decision to pump, use donor milk, or switch to formula. Still others will be forced due to circumstances beyond their control to let go of their desire to feed at the breast. Whatever your story, I respect your choices and hope you find no judgement here. We are all doing our best for our babies and there is lots of room for grace in parenting. 

When I was pregnant one of the first things I googled was, "Is it possible to breastfeed twins?" I had no idea if a woman's body could make enough milk to sustain two lives. My twins are now 13 months old and still nursing! The answer is: yes it is absolutely possible to breastfeed twins! While I've shared bits and pieces of my breastfeeding journey in my monthly postpartum updates, this post will be a more focused and detailed walk through my story. Because I am not a lactation consultant nor a breastfeeding specialist, I don't want to offer any medical advice here; instead I will share my personal journey and offer a few pieces of general advice at the end. While every twin mom's journey will be different, my experiences were not uncommon and I hope you, as an expectant mom or new mom of twins, will find it helpful as you prepare or encouraging as you look for hope in your own journey!

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If you are not familiar with my story, here's a brief summary: my twins are my first children by birth. My husband and I also have an older son who came into our family via international adoption at age 2.5. Our twins were conceived with donor embryos after years of infertility.

When I was pregnant with my twins, I felt very unsure about how breastfeeding would go. I would look at my oldest who was given formula in infancy and feel comforted to know that he was (and is!) an absolutely amazing little boy: smart, healthy, funny, artistically gifted... I could not be more proud of him! So while I knew I absolutely wanted to give my best efforts at breastfeeding, I was not opposed to using formula. I already had a child who was given formula and was thriving.

However the more I began to read about the benefits of breastmilk , the more I wanted to breastfeed. (Among other benefits, breastmilk contains antibodies to protect baby from illnesses, lowers risk for asthma and allergies, and gives babies the perfect nutrition) I also loved the idea that I would not have to wash bottles and I would be able to feed my babies anywhere at anytime. I joined some Facebook support groups to learn how I could prepare myself for breastfeeding and quickly discovered that breastfeeding doesn't always come easily! I told myself I would give it a good solid try for two months before I made any decisions about giving up. It turned out I needed both those months plus a couple more weeks to work out all the issues I faced in my journey! Here is my story:

I encountered two breastfeeding obstacles immediately after the birth of my twins: 1) I had a hemorrhage after their birth and 2) my twins were born prematurely at 35 weeks gestation. The hemorrhage caused my milk to be delayed in coming in and, because they were premature, my twins could not wait to be fed. I was thrilled to learn that the Special Care Nursery at my hospital (which is like a low level NICU) gave parents the choice of donor breastmilk or formula for their preemies. My husband and I chose donor milk which took a huge load of stress off my shoulders as I waited for and worried abut my milk coming in.

As we waited for my milk to come in, the nurses and IBCLCs (International Board Certified Lactation Consultants) encouraged me to come to the Special Care Nursery to hold my babies skin-to-skin and put them to the breast as much as possible. This contact would stimulate my body to produce milk. They also had me pumping every three hours to encourage my milk to come in. On the third day I started producing the tiniest amount of colostrum. Honestly it was so little I probably would have done nothing with it, but the nurses had me put it on my fingers and rub it on the inside of my babies' cheeks. They told me it was "liquid gold" and certainly treated it as such!
Tandem feeding my twins for the first time! 

Seeing my milk come in was exciting! I remember saying to one of the IBCLCs that you know as a woman it is "supposed" to happen but there is a part of you that wonders if it really will... when it finally does it is a huge relief and an amazing thing to think that your body is producing milk to sustain another human life! Or in my case, liveS!

I was discharged from the hospital before my babies due to their prematurity. The main thing my twins needed to learn before being discharged was how to eat. The suck/swallow/breathe routine babies need to nurse is quite complex and preemies often struggle with it. My twins had a tube that went down their nose into their belly through which they could be fed. Our general routine was to first put them to the breast and then to give them a bottle to see how well they could take milk by mouth. When/if they tired, they received the rest of their feeding through the tube in their nose.
You can see the nose tube (to feed via "gavage") here. 
When putting my babies to the breast I encountered another problem which was that my babies could not latch. As a result I used a nipple shield which is a thin piece of silicone that makes it easier for my twins to latch. Using the shield was both a blessing and a curse: a blessing because they were able to latch with it but a curse because it was tricky keep on, especially with trying to tandem nurse, and a source of much frustration as I later tried to wean them off it.

As I continued to nurse and pump over the course of my twins' 10 day hospital stay, my milk production ramped up. I would proudly arrive at the Special Care Nursery each morning carrying a bag filled with little bottles of milk for my babies. It made me feel so good to know I was producing for them! However as I produced more milk, my babies began to eat more and I could not quite catch up to them. Near the end of their hospital stay I was producing about 75% of what they needed. I remember thinking that if I only had one baby, I would have more than enough milk. That thought was encouraging and gave me faith in my body, however I wasn't satisfied with that. I wanted to produce 100% of what they needed and was determined to not give up.

While overall the hospital staff were incredibly supportive of breastfeeding, I did receive two comments that stung my emotional postpartum mama heart. They were both the same comment: "You may never make enough milk." 

I'm sure the staff people who made this comment were only trying to make sure I had realistic expectations, but I found those remarks incredibly discouraging. And looking back, I believe it was way too soon for them to make that suggestion. Not only was there no medical reason to suspect that I might not be able to make enough milk, there was medical reason to explain why I was having such a slow start to my milk production. First, I had hemorrhaged which can hinder initial milk production. Second, I was mostly pumping and a mother's body responds differently to a pump than to a baby. Once I was able to put my babies to the breast more frequently my milk production did indeed increase. I wish instead of saying, "You may never make enough" they had said, "Let's continue to keep nursing and pumping and see what happens!"

By the time I left the hospital I was producing about 75% of what my twins needed. While the hospital had provided donor milk during our stay, we were given a special formula for preemies to supplement with at home. I felt okay about supplementing with formula but continued to hope I wouldn't need it for long. Shortly after I got home, a woman from my church contacted me and asked if I would like to receive a donation of her milk to I could stop using formula. I couldn't say yes fast enough! I felt tremendously blessed by her generosity and still to this day feel grateful.
Arriving home with our twins for the first time! 
By the time they were six weeks old, my milk supply had nearly caught up what my twins were eating and we were supplementing with one 3oz bottle of donor milk per day. Having nearly gotten my supply issue under wraps, my next focus was on getting my babies to take their full feeds at the breast.

Getting the twins to take enough milk at the breast proved to be the biggest challenge I would face. Since we had arrived home from the hospital I had been "triple feeding" which means I was nursing and pumping and bottle feeding at nearly every feed... which means every 2-3 hours around the clock. By the time I got done one feeding it was very nearly time for the next! When I say that I was exhausted I mean I was absolutely hollowed out exhausted.
So very, very tired. 
There are not words to tell you how awful it was. Many times I struggled to know if I was making the right decision to keep at it. I thought about giving up on nursing and exclusively pumping instead. But each time I brought my babies to the breast I was overwhelmed with the feeling that this is how it should be. All my motherly instincts were on fire telling me that this was what was best for me and my babies. If only my babies could figure out how to take enough milk from me! I had enough milk! They just needed to get strong enough to take it from me. 

So despite my loathing of the pump and all that time wasted at the sink cleaning and sterilizing bottle and pump parts, I kept on. 

I brought my babies back to the hospital to visit with the IBCLCs for weighted feeds where they would be weighed, then nursed, and then weighed again to see how much they were taking in. By four weeks old they were still not taking enough milk at the breast. 4 weeks may sound young, and it is, but four weeks of triple feeding is a very, very long time. I was feeling desperate.

Then someone suggested to me that my babies might have lip and/or tongue ties. That night I researched the symptoms of lip and tongue ties and I felt like I was reading a description of my babies! They had nearly every symptom. The next morning I went back to the IBCLC's office to have them checked and they did indeed have ties. Why they were not checked earlier, I don't know. I wish I would have known to ask!

My husband and I made an appointment with a specialist in a nearby city to have their ties revised. I researched a lot to find someone who was well-trained and able to complete this procedure with a laser rather than scissors which, after my research, I believed to be a more precise way of revising the ties. The revisions were done at 6 weeks old and took two weeks to heal. It wasn't until 10 days after the revisions that I really noticed a difference but it was a big deal when I did: both twins had latched without the nipple shield! Finally! They had not been able to latch without it until that point, despite my many efforts.

After two weeks, I took them back to the IBCLC's office for another weighted feed and the results were encouraging! The twins were very, very close to taking what they needed at the breast!
Looking down on my babies in a milk coma after nursing! 
What's more, my milk supply had not only caught up to them but exceeded them and I was building a small stash of milk in my freezer! My confidence was growing.

Now, I have to interject a disclaimer here: lip and tongue ties can grow back as they heal. If I look in the twins' mouths now at 13 months of age, to me (not a professional) it looks like their ties have grown back. This does make me question whether the revisions were what turned things around for us or if it was just them getting older and stronger. I guess I will never know but I do know I made the best decision I could at the time with the information I had so I don't regret it. 

Over the next couple weeks my twins continued to nurse more effectively. Until then I had been following up each nursing session by pace feeding a bottle of expressed milk and now they seemed less eager for the bottle. I called the IBCLC's office to talk about taking that bottle supplement away and they gave me the go-ahead. At this point I was still worried about my babies not getting enough to eat so I bought a baby scale to do my own weighted feeds and to make sure they were gaining appropriately. I watched them closely over the course of a month and indeed they gained more than enough by simply eating at the breast! By the time they were 4 months old, I put my pump away and I haven't looked back since.

While my journey to successful breastfeeding was gradual, there was one particular moment that made me feel like I had finally been victorious. It was a sunny morning in early summer. My husband and I had taken our twins and our older son for a short hike at a local nature preserve. While hiking, the twins began to fuss. We stopped at a bench by a small stream. My older son played in the stream and I sat with a baby while my husband held the other... and I nursed. As simply as that. After all those weeks of triple feeding with nipple shields and bottles and pumping etc.... to simply and easily sit down and nurse a baby felt like an enormous victory! I remember looking at my husband and saying, "This is what makes everything worth it."

Breastfeeding only got easier from there and now more than a year later it feels like second nature.

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I want to end this post with some words of advice. I asked the women in a La Leche League support group for moms of multiples what their advice would be for a mom who wanted to breastfeed her twins. I received wonderful words from 40 different women and here I will summarize the 3 most repeated:

3. Get support. Surround yourself with people who will encourage you on your journey and reinforce the truth that it is possible to breastfeed twins! I know I felt vulnerable and emotional in my postpartum period and I needed to hear again and again that I could do this and to not to give up! I could compare it to a long distance run: there will be times when you want to give up because you are so tired but those cheering voices encourage you to keep going. When you cross the finish line you will be so proud of your perseverance! Perseverance is always difficult but it also teaches you how strong you truly are.

"It is going to be tough at first and you may feel at times like they are constantly attached to you or worry that you can't keep your supply up for them. But just know that even though they are little, somehow they let you know they appreciate all you are doing for them.... And remember that you are awesome for being able to provide this amazing nutrition for your baby. Not everyone makes it, determination is key!" - Marlesha Fishnick 

"Don't let anyone tell you that you can't. This is your journey with your babies, don't let someone else ruin it. That being said, surround yourself with supportive people. Doctors, friends, family, LLL, groups on social media are all important to your journey if you utilize them! Find good, supportive ones and let them encourage you when you need it." - Kate Black 

For me the most important people in my journey were 1) my husband who encouraged me and supported whatever decisions I wanted to make about feeding our babies 2) the IBCLCs whose professional advice was invaluable, and 3) fellow breastfeeding twins moms who knew what I was going through and told me again and again, "It gets better!"

2. Be flexible, be patient, be determined. If your milk comes in late or you need to supplement or use a nipple shield or your twins are preemies or you deal with lip and tongue ties... go with the flow while keeping your eyes on your ultimate goal.

"I have found that breastfeeding is truly a journey that ebbs and flows. What works one day, may not work the next. There will be days that the babies are satisfied and happy, and there will be days when you are all crying together. Never give up on your hardest day. One day you may be able to exclusively nurse, one day you may have to pump, bottle feed and nurse, and one day you may need to supplement with formula, nurse, and pump! It's exhausting, but you are not alone and you are doing the very best thing you can to give your babies a good start in life." - Ashley Stultz Kempton 

"If one feeding doesn't go well, try not to think that is how it will be, and remember how sleep deprived you are before you start saying the world is going to end! As the weeks go by they will get better at nursing, remember you are learning with your little ones" - Sarah Jackson Clark 

"Grace. Give yourself grace. I had times that I was overwhelmed. And exhausted. And so convinced that I had to do all direct from the breast all the time, because as a stay at home mom, I had no excuse not to. Except I don't need an excuse. You have to do what you can do. And you have to let go of other people's ideas of perfect." - Rachel Brooks 

1) Get a twin nursing pillow! This was BY FAR the most repeated piece of advice and I 100% agree. I used my nursing pillow in the hospital, at home in bed and on the couch, in the minivan, on vacation.... every time I tandem nursed for the first 6 months. There are two popular options: I had the My Brest Friend Twin Plus pillow which I would recommend and anther option is the Twin Z pillow. Most women followed up the pillow advice by saying you should store water and snacks in the pillow's pocket or nearby. Breastfeeding twins burns something like 1,200-2,000 extra calories per day so you are going to need to eat lots and stay hydrated!

"It will be a year breastfeeding my twins and I have 3 older kids I nursed as well. With twins it is completely different and wonderful. Go into it with an open mind knowing there will be tough days. When those tough days come, lean on your loved ones, ask for help, accept that lactation consult, pump and trust yourself. I was surprised when they wanted to eat every hour round the clock so I spent weeks on the couch with my twin Z nursing pillow, huge water container and a smorgasbord of snacks. When days turned into weeks and weeks into months I realized that without my noticing, it had gotten better and became more of a snuggle session. My personal saving grace is that I learned to nurse them at the same time." - Deanne Rivera Sellars  

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Last week a woman in my community had a baby and nursing got off to a rough start. She needed donor breastmilk to supplement for a while and I was able to give her 75oz that I had pumped and frozen months ago and never needed to use. As I made my donation I thought back to myself last year: emotional, struggling, wondering if I would really ever have enough milk or be able to feed my babies at the breast... 

If I could see me now! ;-)

xo

3 comments:

  1. I only had one baby. I had over supply and it still was super difficult at first. It took almost 9 months before it felt natural. At one year my son became ill and was hospitalized. I kept nursing. We made it 2 years. Moral is, it is tough. Parenting is tough. Thanks for sharing your journey. You are double the Awesome.

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  2. Thank you for this post. I am expecting twins this Winter and have been nervous about breastfeeding two. Great thoughts and tips.

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  3. You are such a wonderful and strong mother! I have to confess, that I am a little bit (more) jealous. My breastmilk got less instead of getting more. I had noch choice but to support with formula. I am glad, you don´t judge mothers, who support with forumla. It is really not easy to admit ones self as a mother, that your body cannot feed your child. To all mommies out there I want to say: you are wonderful moms, as long as you love your child and try your best to feed your little one healthy! I found a healthy formula without added sugar, GMO, gluten and all that stuff. For mothers in the same situation I recommend Holle organic formula. You can read the ingredients here: https://myorganicformula.com/collections/holle-organic-formula. Thanks for your wonderful blog!

    Sandra

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