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Breastfeeding: How will I recognize if my babies are drinking enough milk?

The following breastfeeding information is provided for healthy, average term babies.  If you feel that your babies are not eating well, drinking enough milk, or taking in enough nourishment, contact your doctor for feedback on your personal situation.

There are several ways to determine whether or not your babies are eating well and the most obvious is by what comes out the bottom end.

  • In the first two days after birth, on average each baby should have 2 wet diapers and 1-2 soiled diapers.  Right after birth, the first stools will be a thick black consistency.  This is called maconium.
  • On days 3 to 5, each baby needs to have at least 2 wet diapers a day and 2-3 soiled diapers.  Stool colour will be green, yellow or brown in colour.
  • From 6 days to 5 weeks, look for each baby to have 6 heavy, wet diapers per day and 1 or more soilings of a yellow colour per day.

Some signs to let you know that the babies are getting enough milk:

  • are sucking strongly, slowly and steadily
  • has a strong cry and moves actively
  • your breasts feel softer and less full after each feed

When baby is full:

  • will break the latch and let go of the breast of his own accord
  • hand lies gently and open against your body, showing contentment

In the initial days after birth, sleep overtakes a full tummy, especially for preterm or low birth weight babies.  They just don’t have the stamina to keep on feeding.  If your baby falls asleep at the breast after a few sucks, you will need to try and wake him up.  This can be done by stretching him by holding him up under the arms, try to get a good burp out of him, move him around your body, don’t let him snuggle, and some parents will undress the baby to stimulate him to continue eating to fill his tummy.  If babies do not take in enough milk, you will be back to feeding them again in a very short time frame.

Babies’ approximate tummy sizes:

  • Up to 2 days after birth, is about the size of a chickpea
  • 2-10 days about the size of a hazelnut
  • 10 days to 1 month about the size of a walnut.

This is what you are trying to fill at each feed so it is helpful to make sure the tummy is as full as possible each feed.

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A Successful Breastfeeding Experience: PRICELESS!

An interesting breastfeeding issue sporadically presents itself over my desk in a variety of ways: from new breastfeeding parents (those new babies are doing the breastfeeding, not the parents….LOL), friends with multiples, and several participants in the Ottawa Twins Plus Prenatal Classes which I co-faciltate in Ottawa. Dismay and feelings of insecurity abound when family, friends and professionals, including doctors, nurses and pediatricians, offer opinions which, even inadvertently, can sabotage breastfeeding in spite of the babies growing by leaps and bounds and a satisfying breastfeeding experience.

In this day of enlightenment about the benefits of breast milk, one wouldn’t think that such would be the case but I am surprised – no, make that saddened – by how many parents share their frustration and confusion as a result of such feedback. Parents are left questioning their motives and wondering if they should stop breastfeeding. It doesn’t make sense that negativity can be attached to a successful experience, but parents are telling me that that is exactly what is happening.

Here’s an example:  Kathy’s babies were born at 25 weeks and a couple of days. Kathy, with her husband’s full support and encouragement, copious amounts of milk for her sons until they were able to go directly on the breast. At 5 months, they were round, happy, smiling, very content little boys and Mom had an appointment with her sons’ female pediatrician. At this check-up Mom was told, “Breastfeeding is going very well at the moment, but expect to have to supplement at some point.”  Mom left the appointment with many different feelings, including sad, fearful, and upset in spite of how well her babies were doing.

The doctor might as well have said, You are all doing really well, but don’t expect this success to continue.”

One doctor reportedly indicated to a Mom pregnant with twins, “You are not superwoman. Just bottle feed.”

“You can’t breast feed twins,” was my own experience from a nurse in the Neonatal Intensive Care Unit.

Add to the mix comments from family and friends and one’s confidence can barely remain intact: To one family with 3-month old twins where breast feeding was also going very well. “When are you going to stop breastfeeding?”

A variation on this theme goes:  “Surely you are thinking of stopping [breastfeeding] shortly?”  It isn’t unusual to breastfeed a singleton child for up to two years, so why would things be different for twins, at least beyond 3 months?

Or how about, “You can’t be exclusively breastfeeding. Surely you are supplementing.”  And how about the twin Mom whom had planned all along to breastfeed her babies but was encouraged by the hospital staff to take home 2 cases of formula when they left the hospital.  Talk about frustrating, discouraging and confidence-shaking!

Twins and triplets were born and survived in the many hundreds of years before now. If there was no formula around before the last, say 55 years, just how did these babies grow and thrive if they weren’t breast fed? Many of us have multiple-birth relatives over the age of 55 years. How does anyone think they were fed? Even taking into consideration that royalty and upper classes usually hired Wet Nurses (i.e. lactating servant women hired to breast feed their babies as well as their own – rather like breastfeeding twins……), we can rest assured that many less well-off families could not afford to hire a Wet Nurse and therefore successfully breast fed their own babies, no doubt for months if not years. So why has the current view changed and the opinion prevails that breastfeeding our babies, let alone for weeks or months, cannot be done today?   It’s all quite thought provoking and in fact, this shift in thought doesn’t make a lot of sense at all.

A suggested solution is to use the situation as a teaching experience. Rather than responding angrily, or zapping back with a tricky ‘slice and dice’ phrase, how about changing tactics?

We know we are left feeling upset by such confidence-shattering remarks, and a successful breastfeeding experience doesn’t guarantee we won’t get stung, so let’s take back our power, point out the logistics, and hand back the hurtful and negative opinions. Let’s regroup and get these folks doing some serious thinking before they open their mouths with thoughtless rhetoric. Here are some ideas for consideration:

  • When the decision has been made to breastfeed, reinforce the decision when (if) necessary.  Make eye contact, perhaps hold up a hand, say,“Excuse me, but we have decided to give our babies the best beginning we can and breastfeeding is what we have chosen to do. We really appreciate your support in our decision.” and Smile!  End of story.
  • If a professional makes an unsettling remark, quietly but firmly call him/her on it. ” I’m not understanding what you are saying. You have acknowledged our breastfeeding is going well and the babies are thriving and yet you throw in that our success won’t/can’t continue. I beg to differ. It is possible to breastfeed multiples because breasts adjust to the supply and demand and I’ve got two perfect examples right here! (you can either point to your breasts or to your babies – whichever suits you)” ….and Smile!
  • A remark such as “Surely you will stop breastfeeding soon” might encourage the response, “We will stop when we are ready.” and of course….Smile!
  • And the one about not being Superwoman, how about, “I disagree. I AM Superwoman and my babies are going to have the best start possible with my Super Breast Milk.”   And everyone together now…..Smile!

Offering educational feedback and speaking up is a way to ensure change. It is so upsetting to hear from parents who not only love their children and are doing a great job breastfeeding, but to learn of their uncertainty as they begin to question their motives and ask themselves, “Am I really doing the best thing for my babies?” especially after the powers that be offer failure for the future.  You can set the record straight and perhaps give the next multiple-birth family an easier ride. Speak up, gently express your feedback, set your boundaries and let others know how you feel about their comments. As Martha would say, “That’s a good thing.”

May your breastfeeding go well and your babies grow, develop and flourish. When you are faced with the necessity of teaching others about breastfeeding multiples and how to treat you, may you rise the challenge with humour, confidence and love.

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Breastfeeding and H1N1

With all the news regarding H1N1 and how to stay protected, there is some concern for lactating mothers and their babies. Here are some ideas, which can help both you and your babies continue with a productive breastfeeding experience.

According to Dr. Jack Newman, it is NOT necessary to “pump and dump” breast milk, should Mom have H1N1. As Dr. Newman notes,

” By the time the mother has symptoms she has passed the virus on to the baby [or babies]. So the baby’s best protection is to continue breastfeeding. Even if that weren’t the case, that the baby already has the virus, the baby’s best protection is breastfeeding. What do those people think all those immune factors in the milk are for? To put on medical school exams? No, they protect the baby.”

For Mom

Don’t cough on your babies either while nursing or when you are close. Turn your head away should you need to sneeze or sneeze/cough into your elbow. If you are feeling ill, consider wearing a mask while nursing. If you are really feeling badly, try pumping and have someone whom is not sick feed the babies pumped breastmilk. Wash your hands before breastfeeding, or use an alcohol based sanitizer. Wash your breasts and hands carefully after feeding. Keep your fluids up, eat nutritiously and get as much sleep as you can.

For Babies

Babies breathing passages are very small and it can be difficult for a sick baby to nurse and breath. Using a humidifier to keep the air moist may help. If one, both or all babies are too sick to suckle, try using an eye dropper full of your breast milk or sippy cup. Sick babies need lots of fluids and breast milk is a great way to make sure their fluid levels are kept up.

In General

Mother’s milk is full of antibodies which, as we are all aware, are very beneficial to babies and help protect them from viruses and other illnesses. Continue nursing so that the babies can benefit from the antibodies. If Mom is sick, her body continues to fight the virus and nursing babies can benefit from the antibodies Mom passes along to her babies.

For Further Information

Some of these sites also contain information for pregnant women and how the H1N1 virus could/might affect your pregnancy.

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Choosing a good nursing bra

Finding a good fitting bra at the best of times is a challenge and so many women are, in fact, walking around in an ill-fitting bra.  Most of us have two different sized breasts and it is important to fit the larger breast rather than the smaller.  Having a good fitting bra (and some might add attractive too) when you are nursing your babies, is an essential part of the process.  A nursing bra needs to provide good support for enlarged breasts, be comfortable, easy to undo when it is time to nurse and helps us feel good about nursing.

Here are some tips on choosing a good nursing bra

  1. Have someone else do the measuring for you so that you can be sure the measurements are correct.  Looking down and measuring can be a challenge to do correctly.  You need two measurements:  one around the fullest part of the breast (i.e. over the nipples and level around the back), and one just below the breasts on the rib cage.
  2. Inhale deeply each time before measuring.
  3. For your bra size, measure your rib cage and add 10cms. (4ins.) to the measurement you get, e.g. if you are 710.2cms. (28ins.) around the rib cage, add 10cms. (4inches), making you 810.3cms. (32ins.).  If your rib cage measurement is an uneven figure, e.g. 730.5cms. (29ins), then add 12.5cms. (5ins.), making you 860.5cms. (34ins.).
  4. To obtain your cup size, measure around the fullest part of your breast. The difference between the the rib cage measurement and the breast measurement, provides the cup size:

Less than 2.5cms (1in.)   – A cup
2.5-5cms. (1-2 ins.)   – B cup
5-7.5cms. (2-3 ins.)   – C cup
7.5-10cms. (3-4 ins.)  – D cup
10cms. (4ins.) or more  – DD cup

  1. When you are trying on the bra, try to undo the cup flap and do it up again with one hand.  Many a nursing mother has found her other arm engaged in quieting, holding and/or positioning a baby as she prepares to nurse.
  2. There are many new styles of bras out now, some resembling a stretchy tank top (e.g. Bravado) or bathing suit top.  Many women like these as they are comfortable, stretchy, easy to arrange for nursing and come in great colours so if anyone notices, it is no big deal.
  3. Remember that your cup size may change as you continue to nurse your babies and your breasts swell to accommodate the demands of feeding two or more infants.  If your bra is feeling uncomfortable or tight, you probably need a new size (usually larger).
  4. You will no doubt need some nursing pads to catch any leaks so your clothing won’t be soaked.  In case you weren’t aware, ANY crying baby will stimulate your milk letdown so if you are in the mall and another baby begins to cry, with nursing pads you are prepared.  Nursing pads come in disposable and washable/reuseable.  The downside of the former is that you may not feel when they are wet, and therefore run the risk of getting sore nipples as it rubs against you or thrush* which can be transmitted to your babies.
  5. There are conflicting views on underwires.  If these are not bothering you and you would rather that your bra have some, then go for it.  It needs to work for you.
  6. Most Lactation Consultants can help fit you for a proper sized nursing bra.

*Thrush

Thrush is common term used to describe candidiasis of the mouth and throat. The formal term used to describe Thrush is Oropharyngeal Candidiasis (OPC). Oropharyngeal Candidiasis or Thrush is a fungal infection that occurs when there is overgrowth of candida fungus. Candida is normally found in small amounts on skin and/or mucous membranes. However, if the conditions inside the mouth or throat become out of balance, candida will multiply and cause symptoms of Thrush to start to appear.

Source:  www.infoforyourhealth.com/Common%20Diseases/Thrush.htm

Reviewed and input by Erin Shaheen, mother of 4, including twins.

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Best and Worst Advice on Breastfeeding Multiples

Best Pieces of Breastfeeding Multiples Advice …

  • Yes, you can breast feed twins and triplets
  • If you have problems, ask for help from a Lactation Consultation, Doula or midwife
  • If you get into any difficulties with tandem feeding, feed the babies separately so that you can focus on one at a time and identify the difficulty;
  • Relax and just give it a try!
  • Invest in a proper, large,u-shaped nursing pillow
  • Persevere, it is possible!
  • Just because your breasts don’t feel full, doesn’t mean they are empty (Note: breasts don’t actually become empty)
  • Because the babies want to suck more often doesn’t mean that you don’t have enough milk but rather that they have hit a growth spurt and are trying to stimulate more milk to come in
  • It will come (from the Midwife and the Nurse)
  • Use cold cabbage leaves in your bra to help relieve engorgement
  • Breastfeed them together. It saves time and gets them on the same schedule
  • Use breast compression to maximize milk intake and reduce time at the breast, while still getting the advantage of a full feeding
  • Latch on your ‘best’ sucker first so s/he is happy then focus on latching on the other
  • Make sure to switch your babies side to side so that each of their eyes receives an equal workout and stimulation
  • It’s always ready at a moment’s notice and is always the right temperature

Worst Pieces of Breast Feeding Multiples Advice …

Be prepared for lots of negative advice whether you ask for advice or not. Here’s a sampling of what to ignore.

  • You can’t breast feed twins, triplets, quadruplets
  • You look like a cow
  • OB: “Don’t feel guilty about breastfeeding. Plenty of mums of singletons can’t produce enough milk to feed their baby. Just supplement from the start.”
  • I didn’t breast feed my babies and look how well they turned out
  • Or a variation on that theme: I wasn’t breast fed and look how well I turned out
  • Hospital Nurse [when approached for help with breastfeeding]: “Sorry, I’m a floater. I don’t know anything about breastfeeding. You’ll have to wait until shift change.” (Shift change came 6 hours later)
  • Hospital Staff: On the day I was to be released from hospital the nurse told us: “Baby B has lost 2 lbs. (nearly 30% of his body mass). You are not able to breastfeed.” I asked first if she had mixed up the twins. She replied: “No, I’ve checked the chart twice and weighed him again. He’s definitely lost 2 lbs.” I begged to stay in the hospital, fearful that he was not thriving. The nurse replied: “You are safe to go home. But you and your husband must bottle feed this baby every 2 hours over the next 48 hours.” She gave us two full cases of formula! I cried all the way home from the hospital. All night we stayed awake trying to force-feed our baby formula (he repeatedly vomited). In the morning our midwife called. I told her of the weight loss. In 10 minutes she was at our house. She discovered he had lost nowhere near two pounds and that the nursing staff had, indeed, mixed up the babies. Two days later a community nurse visited our home — and also checked the hospital records, confirming on Day 2 following the C-section, nurses had mixed up the babies, switching their weights. I then began the struggle to wean off formula and increase my breastfeeding. I began breastfeeding, as a first time mum, and with multiples, following surgery. (PS. I successfully tandem breastfed my twins for 18-19 months)
  • From a Doctor – You’re not superwoman. Just bottle feed them
  • Shouldn’t you have stopped nursing them already??
  • From an Obstetrician – Many women can’t produce enough breast milk to feed a singleton. Don’t expect you can breast feed twins and don’t feel guilty. Just supplement
  • Wean Keandra [the older child] right away!
  • Wake the other baby when one wakes up first. Mine have very different needs (their weights are more than 2 pounds apart)
  • They need to have a supplement
  • A nurse came into my room one day after our daughters’ births, sat on my bed and said, “We’ve [the nursing staff] been talking about you in the Nurses’ Lounge and I’ve been elected to come and talk to you. You can’t breast feed twins. We think you aren’t being fair to these babies. You need to bottle feed at least one of them .”
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Breastfeeding Resources

Yes, it IS possible to successfully breastfeed your twins, triplets or more!

This list is a great place to start learning and researching about breastfeeding your babies. Learning about breastfeeding twins or more and practice, practice, practice once they arrive ensures a satisfying experiences for the whole family.

The following in no way constitutes a complete list as there are many wonderful breastfeeding resources available other than these listed. Don’t limit yourself to just books on breastfeeding multiples. Please feel free to let me know if there is something special you feel that needs to be included.

Booklets

  • Nursing your Infant Twins, booklet, Multiple Births Canada
  • Special Delivery: The Handbook for Parents of Triplets, Quadruplets & Quintuplets, booklet, Multiple Births Canada
  • Twin Care: Prenatal to Six Months, booklet, Multiple Births Canada
  • Expectant & New Parent Support Kit, Multiple Births Canada

Books

  • Finding Our Way: Life with Triplets, Quadruplets and Quintuplets ,
  • Triplet, Quads & Quints Assoc., 2001, ISBN 0-780968716007
  • Mothering Multiples: Breastfeeding & Caring for Twins or More, Karen Kerkhoff Gromada, La Leche League International, 1999, ISBN 0912500514
  • Double Duty, Christina Baglivi Tinglof, Contemporary Books, 1998, ISBN 0809230194
  • The Joy of Twins and Other Multiple Births, Pamela Patrick Novotny, Crown Trade Paperbacks, Inc., 1994, ISBN 0517880717 (has great diagrams for positioning the babies for simultaneous feeding)
  • Expecting twins, triplets and more, Rachel Franklin, 2005, St. Martin ’s Griffin , N.Y. , ISBN 0-312-32823-0
  • When You’re Expecting Twins, Triplets or Quads, Dr. Barbara Luke and Tamara Eberlein, 1999, Harper Perennial, ISBN 0-06-095723-9

Video

  • Side by Side: Breastfeeding Multiples, a 16-minute video by Calgary POMBA and the Calgary Foothills Hospital . Available through the Hospital, Public Affairs Office AGW5, 1403-29 th St. N.W. , Calgary , Alberta , Canada T2N 2T9

Websites

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Weaning Multiples

Weaning, in some instances, can be a challenge. When is the right time to wean? What if one baby is ready and the other(s) isn’t? What if two or three are and one isn’t? How can I make this as painless as possible and not feel guilty? What if nursing them settles them down and it’s the only way they will fall asleep? What if they are ready and I am not? Or what if I am ready and they are not?

Decide when you think it is time to consider weaning. You know your own situation best. The children could be 2 months, 10 months, 1 year, 2 years or anywhere in between. Reaching the decision may be because you need to go back to work, or it has been a year and you are exhausted with nursing combined with everything else needed doing. There may be pressure from others and having a plan to handle that pressure may be necessary. Nevertheless, think about introducing weaning slowly so that not only do the kids have a chance to learn the new routine, but your body can also make the necessary physical adjustment. Just as demand and supply increases milk supply, a reduced demand will result in less milk production. Slow reduction also allows for the physical relationship of Mom to babies and vice versa to change.

How to recognize when your multiples may be ready to wean

  • the kids themselves may be ready to give it up, but not completely and you would like to speed up the completion date;
  • maybe the kids are becoming disinterested in nursing and are self-weaning (it does happen from time to time);
  • weaning can be challenging when one is ready and the other isn’t. To add to the mix, the one whom is ready may continue only because his sibling hasn’t stopped yet. Multiples can become quite competitive if they feel their sibling(s) is getting something they are not; or
  • it could be that the opposite happens and one stops nursing and isn’t bothered that his/her sibling(s) continues to nurse.

Knowing one is ready to wean, may be the impetus needed to begin thinking along the lines of weaning all of them.

Suggestions for implementing weaning

  • changing the routine is a good place to begin. Drop the easiest daytime sessions first, or stretch out the time between daytime nursing with a distraction (story, trip to the park). You may still need to nurse at nap times;
  • try a sippy cup or straw if someone is thirsty;
  • a good rule of thumb, “don’t offer, don’t refuse;”
  • have a nursing song, perhaps ABC’s or slowly count to 20, to indicate the length of a nursing session. Be consistent so they know what to expect;
  • avoid areas of the house where they were nursed, e.g. sitting/lying on the sofa, their room, la-z-boy chair;
  • some children respond well to verbal interactions/preparations, e.g. big girls and boys use a cup;
  • you may only nurse them at nap/bedtime for a time;
  • when working on giving up the nighttime nursing, some Moms leave the house so that Dad, partner or grandparent can be the one to put the kiddies to bed. If Mom is anywhere in the house, expect to be found and there be a request to nurse. Staying out of the house ensures that someone else is the soother and comforter for the time being;
  • weaning, for whatever reason, may need to occur while the babies are still very young, e.g. 4 or 6 weeks. In such case, try not to switch to formula in one or two days. Dropping a few feeds each day will allow Mom’s body to respond to the decrease in demand and make weaning a more comfortable experience;
  • babies/toddlers nurse also for comfort so as weaning occurs, they are also looking to increase their other sources of comfort. This can take a little time to become the norm. Lots of hugs and physical touch is helpful.

Things to think about

  • never compare the children to one another, e.g. Look at Harry, he’s a big boy and doesn’t need to nurse;
  • be flexible, especially at the beginning. If one (two or three) is having difficulty letting go, be aware of each child’s individual needs and concerns. Being in tune to those needs will, in the long run, pay dividends;
  • stick with what works for a period of time until each child is comfortable with the change in routine, e.g. stretching time between day time nursing, no nursing during the day;
  • be prepared for setbacks. Tomorrow is another day and you can all try again;
  • don’t rush the process. Let the children tell you as much as possible what they need and when;
  • do not plan any huge changes in nursing patterns at emotionally stressful times: holidays, travel, having family guests, starting daycare, illness;
  • if you need to wean your babies because you are on medication, don’t stop cold turkey. Pumping from time to time will comfortably help reduce your supply;
  • for older toddlers/children, consider having a Weaning or Milestone Party to celebrate their growing up;
  • consider rite of passage changes to their bedrooms, changing cribs to Big Kid beds, moving out the rocking chair, and so on;
  • one inventive Mom put band aids on her nipples signifying that she had a “bobo”;
  • if you are receiving pressure from others indicating “it’s time,” gently stand your ground as to what you and your multiples need; and
  • speak to parents with older multiples and find out what worked for them.

Sources

Mothering Multiples: Breastfeeding & Caring for Twins or More, Karen Kerkhoff Gromada, La Leche League International, 2007

La Leche Leaque of Canada
www.lalecheleague.org

Additional Resources

Searching “breastfeeding multiples weaning” offers many helpful blogs.

These 2 books are not multiple-birth focused but they do contain helpful information about weaning. They are available on line through La Leche League:

  • How Weaning Happens , Diane Bengson
  • Nursing Mother’s Guide to Weaning , Kathleen Huggins and Linda Ziedrich

Lynda P. Haddon, Multiple Birth Educator, with helpful in put from Erin Shaheen, mother of multiples + more, and Kathy Litalien, Mom of twins.