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Mastitis and Blocked Ducts

The following is general information only. If you have any questions about any aspect of your health, please consult your physician.

Mastitis and/or Blocked Ducts are obstacles many, but not all, nursing women face once, or maybe several times, while nursing. Both are caused by babies or pumping not completely draining the breast(s). Here are some ideas on how to handle them.

Mastitis

Is a bacterial infection of the breast that can occur in breastfeeding mothers. It is different from a blocked duct, which has similar symptoms. A blocked duct feels painful, is swollen, red and a mass can usually be felt within the breast. Mastitis has these same symptoms with the addition of fever and greater pain. It is easy to get the two mixed up. The added sign of a fever is the key that it is mastitis. It is important to see a physician if you have fever, breast pain (in one or both breasts) and redness for more than 24 hours, as antibiotics will need to be prescribed. Once antibiotics are prescribed improvement will be noticed within 2-5 days. Continue your course of antibiotics until they are finished or there is a chance the mastitis will return.

NOTE: If you need antibiotics, it must be effective against Staphylococcus aureus. Amoxicillin, plain penicillin and some other antibiotics are often prescribed for mastitis but are usually not effective. Effective against this bacterium are: cephalexin, cloxacillin, amoxnicillin-clavulanic acid, clindamycin and ciprofloxacin. The last two are effective for mothers allergic to penicillin. You can and should continue to breastfeed while taking these medications. There is no need to pump and dump.

Mastitis does not harm the babies and continuing to breastfeed will speed up the healing process. If you cannot put babies to breast because it is too painful, try pumping as best you can and bottle feed the milk to the babies. This will also help keep your supply up.

Blocked Ducts

These (there may be one or more) can also be very painful, skin becomes “hot” and as lump(s) can be felt when massaging the breast. For treatment of these, hard, deep massage at the point of the clog while baby is breastfeeding can be used. It is painful but the only way to pass the clog is through massage to move it along, and then baby nursing will clear the duct. The released clog will not hurt the baby. There is no need to pump and dump with blocked ducts either.

It isn’t unusual to have one of multiple-birth babies be a stronger, deeper sucker than his/her sibling(s). Another idea for getting rid of a clog in a duct is to place the stronger sucking multiple on the “offending” breast, with his/her chin on the lump. Sometimes the baby can unblock the duct during the nursing session.
Other ways to relieve the swelling for both Mastitis and Blocked Ducts:

  • Heat applied to the affected areas helps healing;
  • Massage in a hot shower;
  • Rest helps with infection;
  • Fever* helps fight off infection;
  • Medication (aspirin, ibuprofen, others) for pain can be helpful; and
  • Two external ways to help with swelling and hotness:
    1) thinly sliced raw potatoes in the bra, and
    2) cold cabbage leaves directly from the fridge in the bra helps sooth. Believe it, they work!!

*Because of so many medications now available, parents get worried around a fever, and so they should. However, a fever has a purpose. The body heats up in order to kill off the infection. But that being said, IF YOU ARE IN ANY DOUBT AT ANY TIME, CONSULT YOUR DOCTOR as he or she is in the best position to properly diagnosis what is going on for you or your child/children.

Adapted from a Guide on Mastitis from The Ottawa General Hospital, and Handout #22 Blocked Ducts and Mastitis written by Jack Newman, MD, FRCPC.

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Simultaneous Breastfeeding

Did you ever think you’d ever be considering nursing two babies at once? Also known as tandem nursing, simultaneous breastfeeding happens all the time, especially with twins and triplets. It can be an effective way to get both babies on the same schedule, and save you time in the long run!

Ask anyone with twins or multiples, simultaneous breastfeeding requires more work and dedication than breastfeeding a singleton. As a mother of multiples, you likely have many questions about how to most effectively feed your babies. Sometimes the responsibility of feeding more than one baby can be overwhelming, and you may worry that you won’t produce enough milk. Despite its many challenges, simultaneous breastfeeding is a great time saver! It will get your two babies on the same schedule, and can therefore be worth the effort. If you plan ahead and receive the support you need, you can certain successfully breastfeed two babies.

To get you started, the following are some photos that demonstrate the simultaneous breastfeeding of two babies/toddlers through combination holds, two cradle holds, and two football holds.

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Keeping Singleton Siblings, Entertained During Multiples’ Feeding Times

It is only natural to wonder and worry about how to cope with or entertain young singletons while nursing or bottlefeeding newborn multiples.  It is difficult to imagine how that scenario might work and, in fact, you might tend to be leaning towards anticipating some chaos and upheaval as you try to figure out how to spread yourself around.  If this resonates with you, your feelings are normal.

Feeding times may run more smoothly depending upon the age(s) of your singleton(s).  The younger they are, the more likely they will require some type of attention from you, especially while you are least able to provide it.  Things may run more smoothly if there are at least two older siblings as they will have each other to connect with and play.  While an older child may take the opportunity to act up when you are tied up feeding the babies, there are some families who will have no issues at all during feeding times.

Simultaneous feeding of the babies, and depending upon how premature they were, may take anywhere from 20 to 30 minutes at each feeding session.  If you are feeding the multiples back to back (i.e. one after another), it may take closer to the 30 minutes per session. This is an approximation of how long a period an active, older sibling(s) may need some entertaining.

Here are some of those ideas for you to consider regarding entertaining your older child.  Mixing up the activity from time to time can help your singleton avoid getting bored with any set activity.

1.  Use one of the larger twin-nursing pillows which are wide enough to safely accommodate two babies so they can nurse or bottle feed while you have two arms free to engage with your singleton if you need to.

2.  Choose a location to feed the babies that will allow him/her access to you or be near you.  You might choose the couch, or the living room floor, with you leaning back against the couch for back support.  A child-size table and chair can be located near you for his/her special activity.  Some parents like their large bed. Keep in mind that beds tend to be soft and may not have enough back support for you to nurse the babies without your back going into spasm.

Mother nursing twins with older child nearby

3.  Set aside a special toy(s) or activity (colouring, crayons, building blocks, plasticine/play doh, [paints are potentially too messy], etc.) which only appears while you are feeding.  Having items already stored in plastic containers makes for easy accessibility as you get ready to nurse hungry babies.

4. Have an closed drink box or sippy cup handy so there is a drink available.   Consider some small snacks (cheese cubes, apple slices, crackers).

5.  If s/he is not toilet trained, have a pull-up diaper nearby in case you need to do a quick change.

6.  You can read together or put a story on a recorder that s/he could listen to beside you.  You might discuss the story after it is completed should the babies have not finished feeding.

7.  When you are done nursing, give him positive feedback, even if his behaviour is not quite perfect with helping you feed his babies.  Any negative behaviour should disappear as he learns the routine, notes the special attention focused on him even while you are feeding the babies, and the re-enforced positive feedback afterwards.

8.  For an older child with more advanced hand-eye coordination, consider offering them “sewing” cards, paint by numbers sets or working on a puzzle as a creative activity.  Maybe a child-focused iPad or tablet, which only comes out at feeding times.  You know your child best if these more advanced activities would be appropriate or of interest to them.

Does all this sound scary and seem over whelming?  No doubt, but give yourself and all your children a little time to get the routine in place.  Be patient, keep your child in the loop by explaining what is going to happen and make this time fun, upbeat, special and something to look forward to.  Things will generally move forward in no time at all as you all learn what to expect.  Making your older child(ren) part of the solution rather than part of the problem is helpful and letting him/her know that his/her co-operation is a huge help to the family can quickly bring him/her on board.

Reviewed by Bonnie Schultz

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11 Breastfeeding Tips

NOTE: The following suggestions on breastfeeding multiples are provided as information only. If you have any concerns about your particular situation, please check with a Lactation Consultant or your doctor.

Your breasts are going to make milk anyway, so why not give it a try and see where it leads? You may be pleasantly surprised!

  • If you run into any difficulties breastfeeding, get help right away. Don’t wait. Sometimes the answer(s) is very simple and a consultation with a Lactation Consultant may identify the problem and have everyone back on track very quickly.
  • Yes, enough milk can be produced for two or even three babies. Milk production is based on demand and supply. Frequent nursing stimulates breasts to meet nursing demands. Three things postively impact milk supply and production: a) frequent feedings of the babies; b) healthy eating, drinking and snacks; and c) keeping stress levels as low as possible.
  • Simultaneous feedings help get babies on the same schedule and saves an enormous amount of time. Most mothers of multiples feed simultaneously or one after another. Your babies will let you know which method works best for them.
  • Breastfeeding twinsAlternate breasts at each feed. It will be necessary to prepare a schedule so that you can remember who ate at which breast and when. By alternating breasts two important issues are addressed: a) one baby may be a better (stronger) sucker than the another thus stimulating the breast differently. Therefore, alternating breasts encourages both breasts to produce enough milk; b) when a baby only nurses at one breast, the lower eye doesn’t get equal opportunity to focus, look around and strengthen (an older nursing baby [i.e 6 months or so] will always look up, make eye contact and smile at you – it makes one’s heart turn over with love). Alternating breasts gives each of the baby’s eyes a chance to perform properly.
  • It isn’t unusual to have one baby who is a stronger sucker . When settling down for a simultaneous feeding, put the stronger sucker to the breast first then spend time settling and arranging the second baby. Keeps everyone happier.
  • For triplets or more , it may be necessary to introduce some formula before the milk supply is fully established. There are a couple of choices within this situation: a) top up each baby after a breast feed; b) feed two by breast and one by bottle, alternating who gets which at each feed (a schedule will need to be kept for equal opportunities). A helpful idea for increasing breast milk with triplets is to feed two babies, at each breast, followed by the third one on each breast. S uch a routine provides optimum opportunity to increase milk supply to meet the demand.
  • If you can, pump after each feed , collecting and freezing pumped breast milk for bottle feeding. Label and date the bottles. Following is a guide for storing breast milk:
    At room temperature – 10 hours
    In the fridge – 8 days
    In a fridge freezer – 2 weeks
    In a deep freeze – 6 months or longer

    Previously frozen breast milk can be kept in the fridge for 24 hours. Do not refreeze previously frozen breast milk.*

  • Never microwave breast milk . The high temperature affects its nutritional value. Breast milk defrosts very quickly in a bowl of hot water in the kitchen sink. The milk itself need not be hot, room temperature will do.
  • Using a twin nursing pillow is a real advantage. This larger pillow can comfortably cradle two babies at a time and allows burping/changing one while the other continues to feed.
  • Breast feeding is a learned art , for both mother and babies. Be patient, give it time and, if necessary, get some help.
  • Babies hit a growth spurt at about 6 weeks. As a result, they may feed more often. Many Moms interpret shorter times between feeds as they don’t have enough milk. Consequently, they become discouraged and quit nursing. Continuing to nurse will soon rebuild the milk supply to meet the demand. Don’t give up too soon.

Mothering Multiples: Breastfeeding & Caring for Twins & More, by Karen Kerkhoff Gromada, La Leche League International, 1999

Other Resources

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Breastfeeding Premature Multiples

A singleton gestation is based on 40 weeks, twins on 38, triplets on 36 and quads on 34. Many multiples are born prematurely, from days to weeks early.

For parents of multiples wishing to breast feed their babies, the extent of the babies prematurity can impact breast feeding success. Mother’s milk provides superior nutrition, protects against disease and enhances infant development. In short, it is perfectly made for babies, especially when they are premature. While premature birth complicates the breast feeding of these infants, with knowledge, patience, perseverance, and good support systems in place, breastfeeding can be successful and any amounts of breast milk they can receive is beneficial. Following are some ideas and suggestions to help you, your partner and premature infants successfully breast feed.

  • Whether or not you have decided to breast feed your infants, your breasts will produce milk. This early milk is called colostrum and it contains high levels of antibodies and other substances that protect babies against infection. Therefore, pumping this colostrum and feeding it to the babies makes a lot of sense, and will ensure that they benefit from its important life-supporting properties.
  • One of the last things to develop in the few weeks before birth is the sucking reflex. Thankfully babies can learn how to suck and swallow and that is one of the reasons you will sometimes see some babies in the nursery with a soother. They are practising sucking and swallowing. If the babies are a few days or even weeks premature, you may be able to put them to the breast right away and with a little coaxing, trials and patience, they will learn to latch on and suckle. If the babies are very premature (4 or more weeks), you will have to pump as they will be too tiny and weak to take the breast.
  • At the beginning of each feed a baby gets the foremilk. This stimulates and releases the hindmilk, which is higher in fat (for growth) than the foremilk. It is important that either nursing or pumping lasts long enough to stimulate the let-down of the fat rich hindmilk.
  • When expressing breast milk, expect to pump 8 to 10 times in a 24-hour period. It is helpful to also pump during the nights, as if you were getting up to breast feed term babies. This round the clock pumping will help you establish your milk supply.
  • Once nursing or pumping has been established, supply and demand keeps breast milk forming and flowing. The more the babies feed, or you pump, the more milk your breasts will produce to meet the demands of your growing babies. Remember: make sure you pump frequently, drink lots of fluids and keep your stress levels low. All of these affect the quantity of milk available for your babies.
  • Your doctor, healthcare provider, lactation consultant, doula or midwife can help you decide when to transition from expressed breast milk to putting your babies to the breast. Factors that can help decide when the time is right, will depend on each babies’ ability to suck, breathe and swallow. Each baby will reach this goal at his or her own rate.
  • Premature infants are notorious for falling asleep before their wee tummies are full. While it is wonderful to hold and cuddle each baby, it is important that their tummies be full. You may need to encourage them to continue feeding by undressing them, holding one outstretched in front of you to encourage burping in case that is giving him the feeling of being full or moving them around in your arms to discourage sleep.
  • Initially breast feeding may be a challenge with your premature infants. Don’t give up! Take your time, choose a relaxing place to feed, stop and begin again if need be, and don’t be afraid to ask for help. Talk to the nurses in the NICU unit, check in with a lactation consultant. Babies aren’t born knowing how to breast feed and sometimes with a small adjustment from a knowledgeable source you can all be back on track very quickly.
  • You may wish to begin feeding your babies one at a time until you feel comfortable. If you take this route, the milk stimulation in one breast may also cause a let down in your other breast. Having a sterile container nearby to catch any let-down will make sure that not one drop of your milk is wasted.
  • This double let-down can have a silver lining when feeding two babies simultaneously. It isn’t unusual to have one baby be a stronger sucker than another. Put your best sucker to the breast first then you can spend a little more time adjusting your second baby, plus s/he gets the benefit of the simultaneous let-down without even working hard for it.

Resources

Breastfeeding Your Premature Baby, La Leche League International

Web Sites

Multiple Births Canada, Breastfeeding Support Network
Breastfeeding Online
Dr. Jack Newman, The Newman Breastfeeding Clinic
La Leche League International

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Breastfeeding Multiples: Pumping Tips

There are a variety of reasons why a mother might want or need to pump: for preemie or sick infants; to increase her milk supply; to maintain her supply; for when she goes back to work, to name some.

The purpose of this article is to address some of the situations when Mom may need to pump for her babies, and to offer pumping tips.

  1. Begin regular pumping as soon as is possible after their births. Short, frequent sessions are better than long, infrequent sessions.
  2. Choose a quiet, private spot with comfortable seating.
  3. Moms of multiples will usually double pump for efficiency and because they are typically set for simultaneous letdown. Using a double pump will allow you to take advantage of the simultaneous letdown. In addition, double pumping saves a lot of time rather than pumping one breast at a time.
  4. When nursing one baby, pumping the other side takes advantage of the simultaneous letdown. This may help with better milk production so that one multiple, who may be having difficulty breastfeeding, also has enough milk available. Getting organized for such a scenario may take a little practice.
  5. It may be helpful to establish the proper ‘mood’ for expressing, have photos of your babies around you, perhaps listen to a tape of soft music.
  6. Dad/Partner can massage Mom’s back, shoulders and neck to help with relaxation. Bring her a drink, keep Mom company, wash, sterilize pumping bottles/tubing so they are ready for the next pumping session.
  7. It is important to surround Mom with proper support to ensure a successful pumping session.
  8. Eat nutritiously, rest, minimize stress levels and drink plenty of fluids.
  9. Typically newborns breastfeed 8 times or up to 12 to 14 times in 24 hours. Simulating a newborn’s feeding routine helps produce more milk. While each pumping session may take 10-20 minutes, the length of time will vary with each woman. Continue to pump as long as you have a good flow.*
  10. The opposite will also help with milk supply: pumping when there is low or no flow, helps stimulate the breasts for the next day.*
  11. Keep a record of the date and time of pumping and how much is collected. This will clarify if pumping is occurring often enough to keep the breasts stimulated to produce.
  12. To keep on a newborn’s nursing schedule, set a timer during the night to ensure that you wake up and pump at appropriate intervals.

Storing and Handling Expressed Breast Milk

Most Neonational Intensive Care Unit’s (NICU) have procedures in place for storing and handling expressed breast milk. If your babies are in the NICU, you will need to acquaint yourselves with their regulations. Ask the staff if the hospital provides sterile containers for expressed milk. Your hands will need to be thoroughly clean as will all parts of the pump that come in contact with your milk. Sterile containers will need to be clearly labeled with each baby’s name, date of expression, and perhaps a hospital identifying code prior to being placed in the refrigerator. If you are on any medications at all, you may need to also note what they are on the container label.

Breast Milk can be stored in clean, sterile containers:

  • At room temperature (25C or 77F) for 4 hours
  • In a refrigerator (not the door) for 48 hours [fresh]
  • In a refrigerator (not the door) for 24 hours [frozen]
  • In a refrigerator freezer compartment for 2 weeks
  • In a freezer compartment with a separate door for 3-4 months
  • In a deep freeze for 6 months

Frozen breast milk takes no time at all to thaw in a saucepan filled with warm water. Do not heat breast milk on a stove or in a microwave. Do not refreeze breast milk.

Sore Nipples

If nipples become sore during pumping, make sure that your nipples are properly centered within the suction cup. It is easy to become distracted during pumping and inadvertently shift the equipment. Some mothers report that applying a small amount of modified lanolin cream is helpful. If problems continue, contact a Lactation Consultant or La Leche League member. Don’t wait for the pain to become severe.

Types of Pumps

  1. Electric: efficient, thorough, expensive, can be rented by day, week or month
  2. Battery: good for occasional pumping or not near electrical outlets, not as efficient as electric
  3. Manual: takes a long time to pump, not practical for women who pump often, inexpensive
  4. Hand Expression: difficult for some to master, inefficient, helpful for emergency such as engorgement.

Available Pumps

Medela double pump, lactina, the Avent is is a good manual pump for double pumping.

Some considerations: Find out about the level of suction of the pump. Some can be very strong and some inefficient. Are the instructions for using it clear? Does the company have a 1-800 number if you need to ask questions? Some drugstores and hospitals rent pumps, which can be quite expensive. Some Lactation Consultants offer rentals. Check out the Yellow Pages. Do your homework to find out what works for you.


With input from: Erin Shaheen, Child Birth Educator and Mom of 4 breastfed babies, including twins; and Valerie Lavigne, Chiropractor and Mom of 3 breastfed babies, including twins.

Bibliography

*Mothering Multiples: Breastfeeding & Caring for Twins or More!!! by Karen Kerkhoff Gromada, La Leche League International

Resources

Multiple Births Canada, Breastfeeding Support Network

Multiple Births Canada’s Breastfeeding Multiples Fact Sheet Series
Guidelines for Transporting Breast Milk to NICU
-Breastfeeding Multiples: Fathers/Partners
-Breastfeeding Multiples: Nipple Pain & Vasospasm
-Are My Babies Getting Enough Breast Milk?
-Breastfeeding Multiples: Resources
-10 Tips to Successful Breastfeeding

La Leche League International

Additional Reading

Multiple Blessings, Betty Rothbart, Hearst Books, 1994
Your Premature Baby, Nikki Bradford, Firefly, 2003
The Joy of Twins and Other Multiple Births, Pamela Patrick Novotny, Crown Trade Paperbacks, 1991
Feeding Your Baby the Healthiest Foods: from breast milk to table foods, Louise Lambert-Lagacé, Stoddart, 2000

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Guidelines for NICU

It isn’t unusual for twins, triplets or more to be born preterm (i.e. before their due date) and having to spend days, weeks or even months in the Neonatal Intensive Care Unit (NICU) as a result. For those families wishing to breastfeed, it is possible to do so by pumping and bringing in breast milk to the NICU to be fed to their babies.

To ensure the best quality milk for your babies, here are some recommended collecting and storage guidelines of breast milk. Remember that every drop counts and whatever is collected is the best thing for your infants. If you have any questions regarding your milk supply or how to conserve it, be sure to ask the NICU staff.

Storage and Sterilization

  1. Purchase some bottles and labels to store the milk. The bottles need to be boiled and sterilized before each use. Bags are not appropriate for storing milk in the NICU.
  2. Clearly label each bottle, including the babies’ names, date and time that the breast milk was collected.
  3. Ideally prepare bottles of 1 ounce, 2 ounces or 4 ounces, if you can, for storage.
  4. Do not overfill the bottles as breast milk expends when it is frozen.
  5. Make sure all pump material is properly cleaned and sterilized between uses.

Storage Times of Breast Milk for Preterm Infants

Storage time
Freshly expressed milk Room temperature 25C or 77F 4 hours
Refrigerated milk (store in back not on door)4C or 39F a)Refrigerator (fresh milk)

b)Refrigerator (thawed milk)

a) 48 hours

b) 24 hours

Frozen Milk (Store at back, not in door. DO NOT REFREEZE) a) Freezer compartment inside refrigerator door

b) Freezer compartment with separate door

c) Deep freezer not attached to refrigerator

a) NOT RECOMMENDED

b) 3 Months

c) 6 months

Transporting Milk
(freshrefrigerated or frozen)15C or 60F
Packed in insulated cooler with ice or “ blue ice” 24 hours

 Transporting Breast Milk to NICU

Fresh breast milk can be refrigerated and transported to the NICU on ice or “blue ice” packs in a little insulated cooler. Once at the NICU, give your labelled breast milk to the nurse in charge of your babies to be placed in the refrigerator or freezer.

If you have any questions regarding these procedures or about breast feeding in general, be sure and talk to the nurse in charge of your babies. Hospital staff will be most happy to answer your questions and help you at any point.

If you have any questions regarding pumping or storing your breast milk, do not hesitate to discuss them with the nurse or lactation consultant.

Your breast milk is important to your babies. Save ALL the milk that you pump.

References

  1. Lots and lots of great, supportive, every-topic-you-could-think-of information and resources on breastfeeding, www.themilkmeg.com
  2. Hamosh M, Ellis LA, Pollock Dr., Henderson TR and Hamosh P. Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk.Pediatrics Vol. 97, issue 4 pp. 492-498
  3. Lauwers J, Shinskie D., Counseling the Nursing Mother: A Lactation Consultant’s Guide, 3rd edition p.351
  4. Riordan Jan, Breastfeeding and Human Lactation, 3rd edition. p.378-382

From Valerie Lavigne, Mom of three breastfed babies, including twins.
Adapted by Lynda P. Haddon, Multiple Birth Educator,www.jumelle.ca 
Reviewed by Erin Shaheen, Child Birth Educator, Mom of 4 breast fed babies, including twins.

Other Resources:

Multiple Births Canada Fact Sheet: Breastfeeding Multiples: Pumping Tips

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Breastfeeding Twins and Triplets

Breastfeeding twins and triplets? Yes, you can! Many women have successfully breastfed their twin babies, some for over two years.

We are all well aware of the benefits of breastmilk for babies and many wonderful and supportive ‘how to’ books have been written on the subject (some of those books are listed after this article). Even if your babies are premature, you can still breastfeed them. You can pump and take your milk into the hospital for feeding to your babies’. The nutritional content of each mother’s breastmilk is best suited for her babies’ needs. (Source: Side by Side, Breastfeeding Multiples – video, Calgary Foothills Pipeline Hospital).

Check lower down this page for some hints on breastfeeding triplets.

When preparing for breastfeeding, here are some helpful hints:

  • Properly prepare for breastfeeding by reading a general information book on breastfeeding.
  • Discuss your wishes with your partner before birth. It is important that you both have a commitment to breastfeeding and your partner be fully supportive.
  • Get together with other women who have successfully breastfed twins and triplets. Compare notes, pick up hints, ideas and shortcuts. Your local community may offer a breastfeeding class geared towards multiples. Check with your local Health Unit. You may also connect with your local La Leche League Group for support both before and after the babies’ birth.
  • If possible, put your babies to the breast immediately after birth. If you are unable to do so, make sure you have made prior arrangements with your doctor and hospital nurse staff and that they are fully aware of your commitment to breastfeeding. Make your intentions to breastfeed clear and make arrangements to pump and collect milk until such time as you will have the babies with you and can feed them yourself. A double pump is a great investment and can save you a lot of time. Remember: Both you and the babies are learning about breastfeeding. Babies are not born knowing how to suckle. You will need to work together (perhaps with the assistance of a Lactation Consultant while in the hospital) to learn how to breastfeed successfully.
  • It is very common to have one baby who latches on quicker or more easily than the other. Put that baby to the breast first and then you will have ample time to work with settling the other baby who may need a little more coaxing and attention with latching. Another excellent investment is a horse-shoe shaped nursing pillow. Make sure the pillow you purchase is large enough to hold the two babies together. Some of the pillows available in stores are smaller and made for nursing only one baby at a time.
  • Your milk supply will be influenced by several factors: 1) how often you feed the babies (and/or pump); 2) how often you rest; and 3) the stress levels you are experiencing. You will produce an appropriate volume of milk to meet the babies’ demand (the supply meets the demand) and it is equally important to be sure and get enough rest and to limit the stress levels in your day in order to assist you in producing milk (if the beds don’t get made today, so be it!).
  • If you arrive home and have difficulties latching a baby or you or your babies are having difficulties, don’t be shy. Call your local Health Unit and find out where Breastfeeding Support Clinics are held, call your local Twin/Triplet support Chapter, Lactation Consultant or La Leche League Group. Get the help you need to assist you and your babies.
  • It may be that you will experience some nipple soreness when nursing two babies. If you stop nursing, the soreness will only return after the babies begin nursing again. Try nursing for shorter periods of time, but more often. If you are experiencing some pain, it is usually associated with poor positioning. Remove your baby, reposition him and try again. If you continue to experience nipple soreness, seek out some guidance from one of the groups mentioned above.
  • Babies hit a growth spurt any where from 3 to 6 weeks of age (and not necessarily each at the same time) and then at regular intervals of about 6 weeks each after that, depending upon each individual baby. Don’t worry if it appears that you are ‘running out of milk’ as it is more likely the babies are feeding more often due to a growth spurt. Soon the increased demand will meet up with the supply and regular feeding intervals will again develop. Their growth rate slows down at about 3 or 4 months.
  • Do not assign one baby exclusively to a breast because: 1) they may be uneven suckers and very shortly you will have a lopsided shape due to their uneven sucking patterns. Alternating the babies on each breast will even out any different sucking patterns; and very importantly 2) when a baby is assigned to only one breast, the baby’s upper eye gets over worked, while the one below can become lazy and not react properly to stimulous.
  • If you find that one or both of your babies is having difficulties with one feeding position, try a different one. One Mom of twins reported that her son would not breastfeed if he was ‘under’ his sister. The weight of his sister, while using the cradlehold position, was something that he would not tolerate. When she switched to the football hold, which allowed each baby to be free of touching one another, he settled right down and breastfeeding went extremely well.
  • Your babies should eat initially every 2-1/2 to 3 hours and you will need to nurse at least 8 times a day for several weeks. Some babies need to nurse more often.
  • Triplets – For Moms wishing to breastfeed triplets, a suggestion to assist in building up your milk supply is to put two babies each to a breast for 10 minutes and the third baby on each breast for five minutes, at each feed. At the next feed, rotate the turn of the third baby so that each baby has a turn being on the breast within the first 10 minutes. Some Moms have reported a reasonable amount of success in building up their milk supply by using this rotating system. It is agreed that it is difficult to exclusively breastfeed three babies and I know of only one family who successfully did so exclusively for nearly two years. However, I am aware of several triplet families who have very happily partially breast-fed their babies for different durations of time.

Breastfeeding Multiples – Positions

You can be assured that your babies are feeding well if:

  • there are 6 to 8 soaking wet cloth diapers or 5 to 6 wet disposable diapers per baby in 24 hours during the first six weeks;
  • each baby is having 2 to 5 bowel movements in 24 hours during the first six weeks;
  • they are feeding at least 8 to 12 times a day for a duration of 10 to 40 minutes. Duration and number of feeding times per day will vary with each baby.

Breastmilk can be stored at room temperature for about 10 hours; in a refrigerator for about 8 days; freezer compartment with a separate door for 3-4 months and in a separate deep freeze for 6 months.*

Other Resources for Breastfeeding Your Multiples

I love the drawings in some of these books. It is very helpful to actually ‘see’ the positions so they can be interpretted correctly and find the ones that will work best for you and your babies.

*Source: Mothering Multiples: Breastfeeding & Caring for Twins or More!! by Karen Kerkhoff Gromada, La Leche League International (a great book, easily understood and takes you through the steps of breastfeeding, what ‘problems’ to look for and how to correct them, the important role of partner and lots more!)

The Joy of Twins and other multiple births by Pamela Patrick Novotny, Crown Trade Paperback Inc. (includes excellent diagrams of possible positions for simultaneous feeding)

Double Duty by Christina Baglivi Tinglof, Contemporary Books (also has some great illustrations for feeding positions. Walks you clearly through the steps of breastfeeding and has a list of ‘5 Top Breastfeeding Boo Boos’.)

Multiple Blessings by Betty Rothbart, M.S.W., Hearst Books (Has a Chapter devoted to breastfeeding, including feeding the babies simultaneously or back to back, creating a peaceful environment for breastfeeding and more! Also has excellent drawings showing different breastfeeding positions.)

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Guidelines for Storage and Sterilization at Home

Storage and Sterilization

  1. Purchase some bottles and labels to store the milk. The bottles need to be boiled and sterilized before each use
  2. Clearly label each bottle, including date and time that the breast milk was collected so that you know the age of the bottle of milk.
  3. Do not overfill the bottles as breast milk expands when it is frozen.
  4. Make sure all pump material is properly cleaned and sterilized between uses.

Storage Times of Breast Milk for Preterm Infants

Storage time

Freshly expressed milk Room temperature 25C or 77F 4 hours
Refrigerated milk (Store at back of fridge, not in door)4C or 39F a) Refrigerator (fresh milk)b) Refrigerator (thawed milk) a) 48 hoursb) 24 hours
Frozen Milk (Store at back of freezer, not in door. DO NOT REFREEZE) a) Freezer compartment inside refrigeratorb) Freezer compartment with separate doorc) Deep freezer, not attached to refrigerator a) NOT RECOMMENDED
b) 3 Monthsc) 6 months
Transporting Milk (Fresh, refrigerated or frozen)15C or 60F Packed in insulated cooler with ice or “blue ice” 24 hours

Do not microwave breast milk. Microwaving changes the nutrient content of breast milk. To defrost frozen breast milk, run it for a few minutes under hot water, or stand the bottle in a pot of hot water where it will quickly defrost. If you have any questions regarding pumping or storing breast milk, do not hesitate to discuss them with a lactation consultant, doula or midwife.

Your breast milk is important to your babies.

*Reference

  1. www.kellymom.com/bf/pumping/milkstorage-preemie.shtml
  2. www.preemie-l.org/bfaq.shtml
  3. Hamosh M, Ellis LA, Pollock Dr., Henderson TR and Hamosh P. Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk. Pediatrics Vol. 97, issue 4 pp. 492-498
  4. www.cpqcc.org/
  5. Lauwers J, Shinskie D., Counseling the Nursing Mother: A Lactation Consultant’s Guide, 3rd edition p.351
  6. Riordan Jan, Breastfeeding and Human Lactation, 3rd edition. p.378-382

Multiple Births Canada Resources

  • Breastfeeding Multiples Fact Sheet Series (includes Pumping Tips Fact Sheet)
  • Breastfeeding Twins Pamphlet
  • Breastfeeding Triplets & Quadruplets Pamphlet
  • Nursing Your Infant Twins Booklet
  • Special Delivery: The Handbook for Parents of Triplets, Quadruplets & Quintuplets Booklet
  • Twin Care: Prenatal to Six Months Booklet
  • Expectant & New Parent Support Kit

Additional Resources

Finding Our Way: Life with Triplets, Quadruplets and Quintuplets , Triplets, Quads & Quints Assoc., 2001
Mothering Multiples: Breastfeeding & Caring for Twins or More , Karen Kerkhoff Gromada, La Leche League Int’l, 1999, ISBN 0912500514
When You’re Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Multiple Pregnancy , Barbara Luke and Tamara Eberlein, Harper Collins, June 2004, ISBN 0060542683
The Joy of Twins and Other Multiple Births , Pamela Patrick Novotny, Crown Trade Paperbacks, Inc., 1994, ISBN 0517880717
Double Duty , Christina Baglivi Tinglof, Contemporary Books, 1998, ISBN 0809230194

Video: Side By Side: Breast Feeding Multiples – a 16 minute video by Calgary POMBA and the Foothills Hospital; available from Foothills Hospital, Public Affairs Office AGW5, 1403-29 th Street, NW, Calgary, AB T2N 2T9 Telephone: (403) 670-4853

Web Sites

La Leche League of Canada
Tel: 1-800-665-4324 www.lalecheleague.org

From Valerie Lavigne – Mom of three breastfed babies, including twins. Adapted by Lynda P. Haddon – Multiple Birth Educator – www.jumelle.ca

 

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Breastfeeding Fathers/Partners

On the surface, it doesn’t appear that Dad’s or Partner’s role could be very important in the breastfeeding department. But the truth is a Father/Partner’s role is essential to successfully breastfeeding multiples. Detailed communication between the parents before the babies’ arrival and a commitment to give them the best start in life, sets the stage for a successful breastfeeding experience for the whole family.

Here are some hints and tips to guide you in your breastfeeding support role:

  1. You and your partner have discussed in detail that you want to give your babies this important start to their lives. Reinforce this decision whenever it is necessary, to other family members, friends, to each other.
  2. Consider asking for extended parental leave from your job so that you can be available in the first few weeks after your babies are home. Even if your workplace doesn’t offer extended leave, ask anyway. Explain why this extended would be an asset. Each time an employee asks for this type of extended leave, a seed is planted. Companies are often rethinking employee benefits and extended leave for the parents with multiples might become automatic.
  3. Bring your partner a nutritious snack and a glass of water each time she breastfeeds. Help to get her comfortable by putting pillows under her elbows, behind her back and a stool under her feet.
  4. Actively involve yourself in the care of the babies. Don’t wait to be asked. You may change diapers before breastfeeding and burp, cuddle and talk the baby who finishes first so that Mom can focus on the other (next) baby.
  5. Take breastfeeding classes, ask questions and check out the vast array of books on breastfeeding. Learn how to put babies to the breast, and about proper latching on so that you can assist your partner at those important first feedings. You will be a big support during those initial attempts at simultaneous breastfeeding.
  6. With the birth of multiples, it isn’t unusual for there to be a shift in the family roles, especially if the babies were delivered by c-section. A c-section is major surgery and it takes at least six weeks for recovery. Dad/Partner needs to be prepared for a variety of duties: grocery shopping, laundry, childcare for other children and food preparation, for some examples.
  7. As breastfeeding progresses and the milk supply established, Mom can express breast milk so that you can feed one of your babies with a bottle, if this works for the both of you.
  8. Breastfeeding is a learned art for both a mother and baby. Don’t stay on the sidelines. Get involved, offer encouragement and problem solving techniques to your partner as they are needed.
  9. It is important to remember to look after your relationship with your partner. Try and do something together at least once a week: Go for a walk or for a coffee and conversation. Arranging time together as a loving couple will help reinforce your togetherness and decision to breastfeed.
  10. You may need to reevaluate your feelings about your partner’s breasts. While initially you may have thought of them sexually, after a birth, things turn can around as those same breasts become a source of nutrition for your babies. Be aware of your feelings and keep the lines of communication open with your spouse. These conflicatual feelings are normal.
  11. It isn’t unusual for a father/partner to feel jealous of the mother and babies’ physical connection. Try not to feel rejected or displaced. You continue to be an important person and a leading role player both with your babies and with your partner.
  12. If you feel that Mom is having difficulty with breastfeeding, encourage her to attend a La Leche League meeting or arrange for a consultation with a Lactation Consultant. Some of the latter make house calls and with a quick consultation, matters can quickly be rectified.
  13. It isn’t unusual for multiples to arrive early, i.e. before their due date. One of the amazing miracles of breastmilk is that each mother’s milk is specifically suited for her child’s gestational needs. During the early days after your babies’ births, you may need to provide encouragement and support as Mom pumps for your babies, if they are unable to breast feed independently.
  14. Have faith in yourself and your capabilities. These are your children too and looking after yourself as well as your partner and babies, will help you all have a satisfying breastfeeding experience.

For more information about fathering, parenting, breastfeeding:

www.dadscan.ca
www.fathers.com
www.fathersforum.com
www.lalecheleague.org

Reviewed and with very helpful input provided by Erin Shaheen, Child Birth Educator and Social Service Worker, Ottawa, Ontario.