Tag: milk

Breastfeeding Premature Multiples

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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

Guidelines for Storage and Sterilization at Home

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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

 

Best and Worst Advice on Breastfeeding Multiples

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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 .”