0 comments on “Mastitis and Blocked Ducts”

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.

0 comments on “11 Breastfeeding Tips”

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

0 comments on “Breastfeeding Multiples: Pumping Tips”

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

0 comments on “Best and Worst Advice on Breastfeeding Multiples”

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 .”
0 comments on “Breastfeeding Resources”

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