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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 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: 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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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.

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Dad / Partner’s Role

During pregnancy and childbirth, it is not unusual for the other partner to feel somewhat left out and unimportant. In reality, nothing could be farther from the truth!

Dad’s role as supporter, labour coach, listener, evaluator of when Mom may be in (preterm?) labour, baby handler/changer, cook, cleaner and, did we mention listener? – is not to be underestimated. Children thrive under the guidance and nurturing of both of their parents. However, when children are born two or more at a time, it is imperative that Dad become proactive in the care of the babies. Multiple birth babies can cause a lot of stress in the family and being aware of this ahead of time can be important. Taking the initiative in child care, communication and sharing of thoughts and tasks is essential for the well-being of all concerned.

Note: The following has been prepared in order to assist the partner in being supportive of the pregnant woman. It is acknowledged that not all relationships are composed of a mother and father. For ease of writing, the “partner” throughout this article has been referred to as “dad”.

Night Feedings

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It may take several days before you find a routine which works well for the whole family. One family of twins worked out a system whereby when a baby awoke, Dad would get the baby, change him and bring him to Mom to feed in their bed. He would ‘sleep’ until they were finished, take the baby back to his crib, wake the second baby, feed her and bring her to Mom to feed and then return her to her crib when feeding was finished.

A variation of this style of feeding would be to wake both babies and feed them simultaneously, thus shortening the awake time.

Some families agree that since Dad probably works in the daytime, he needs to sleep the night through. Two possible scenarios could help you if this is your decision:

  1. If bottlefeeding, Dad could do the last night feeding, say at 11:00p.m. and the first morning feeding, say 6:00a.m. Both parents can there get some extended sleep time.
  2. If breastfeeding, Mom could get up to do the night feedings and try to catch up on some of her sleep during the next day when the babies are also sleeping.

Some families have hired a night time nanny instead of a daytime nanny. This could be especially helpful for parents of higher order multiples.

Another breastfeeding twin family used this idea, which worked for them. Mom would continue pumping her breasts after each feed during the week, collect and freeze the milk. Friday and Saturday nights, each parent would take a child to a different part of the house and Mom would breastfeed while Dad bottlefed the baby the expressed breastmilk. This guaranteed each parent longer periods of sleep time at least two nights a week.

You will need to communicate often with each other and establish a routine which works not only for you but for your babies too. It may take some time to work out, but don’t give up. Ask other parents of multiples how they worked out the night feedings and be creative with what will work for all of you.

Some Things Dads Need to be Aware of

Father with twinsIt is important that each parent remember that in times of stress and sleep deprivation, things may be said to one another that are unintentionally hurtful. If Dad is the main source of family income, he has the opportunity to leave the home, engage in adult conversation, have uninterrupted bathroom and coffee breaks and he receives positive feedback for achievements. Mom, at home, doesn’t have these small, but important, luxuries. Further, Dad leaves his work and comes home to a new routine. As the stay-at-home Mom, she is on duty 24 hours a day, 7 days a week. It is not unusual for Mom to be waiting at the door for Dad and to thrust a baby into his arms. Getting away to shop for groceries or run errands can provide a much needed change of scenery for Mom.

Sick, cranky or colicky children can cause tears, anger or venting by Mom when Dad returns home at the end of his workday. If you find yourself in such a situation, please remember not to take it personally. An acknowledgement of the situation: “It sounds as if you have had a long and tiring day” or “My how did you manage to do all of that?” is an important validation of what Mom has been dealing with all day. Nothing is going to change, the children aren’t going to “be returned”, but sometimes a validation of our exasperated feelings and a realization that we are together and not facing the situation alone, can make a huge, positive world of difference to all. Listening and acknowledging another’s business in any situation can never be the wrong thing to do.

Remember that each of you are learning how to take care of children from Day One. Women are not born knowing how to look after children and babies don’t arrive knowing how to suckle. Child rearing is an on-going learning situation and Dads are learning too. He needs to learn to diaper, bathe and dress babies. While of course you are assisting your partner in taking care of your children, you are also developing a close rapport with your babies. This is an extremely important and beneficial side effect for all of you.

Little Things Mean a Lot

  • If your partner has had a cesarean section, you may need to do all of the shopping and carrying for the first few weeks;
  • This may be the time to hire someone to cut the grass or shovel the snow. Make your life as simple as possible over those first few weeks;
  • If there is another child(ren), take her grocery shopping with you. This changes the dynamics at home and provides quality time with your other child(ren);
  • You might take one baby grocery shopping. Strap him on into a baby Snuggli and away you go. This is helpful for everyone and allows for important one-on-one time with each child plus encourages each child to become independent and separate from the others;
  • Bring home supper once in a while;
  • Hold/pick up a baby whenever necessary. Don’t wait to be asked to do so;
  • Give Mom a chance to bathe or take a shower, uninterrupted and at her leisure;
  • Learn how to work the washer and dryer and throw in a load of laundry;
  • After the babies are in bed, take some time to be together. You can talk, cuddle, share a glass of wine, offer a back rub to each other or simply sit together. It is important to remember how you got to this place and to take time and space for each other as well;
  • Listen to each other! This cannot be emphasized enough;
  • Provide time for your partner to go out somewhere with friends, alone or to a multiple birth support Chapter meeting;
  • Bring home flowers once in a while;
  • Keep a sense of humour;
  • Join a fathers of multiples support group;
  • Enjoy your children. They will make you feel very special and proud.

Additional Resources

The Art of Parenting Twins by Patricia Maxwell Malstrom and Janet Poland
Twins, Triplets and More: Their Nature, Development and Care, by Elizabeth Bryan, published by the Multiple Birth Foundation, London, England
Twin Care: Prenatal to Six Months, Multiple Births Canada
Finding our Way: Life with Triplets, Quadruplets and Quintuplets, published by Triplets, Quads, Quints Association: http://www.tqq.com
The Joy of Twins and Other Multiple Births by Pamela Patrick Novotny

Written and Developed by Lynda P. Haddon and Sandra Tompkins, 1998