Tuesday, 6 August 2013

The True Twin Mummy Diary: Breastfeeding Premature Twins

World Breastfeeding Week

It's World Breastfeeding Week (WBW) so I thought what better time to share my experience of breastfeeding the twins. First though a bit about the WBW theme for this year which is 'Breastfeeding Support: Close to Mothers' and focuses on the fact that there is a sharp decline in breastfeeding rates, and practices, particularly exclusive breastfeeding in the weeks and months after delivery which is why it is so important to have support for the mother.

Breastfeeding is hard, believe me I know, it can be lonely and you can at times feel like you are nothing more than a mere boob which is why it is crucial to have support from those around you. Support can come from many different places and while some people are happiest to find this in partners, family and friends, in today's society this support needs to come from a wider circle by trained health workers, lactation consultants, community leaders and more and more from peer counsellers who can be anyone from the community who is trained to learn to support mothers. The objectives of this years WBW is to highlight this need for support for mothers within her home and community and you can read more about them here.

My Story

With my first son, Ben, I breastfed him until he was nearly three, it all came really easy and to be honest I had a bit of a battle to get him to give up. I enjoyed breastfeeding him and could see that he had benefited from it so I knew I wanted to do the same for the twins. The twins were born by c section five weeks early. It was a bit of a shock and I wasn't really ready for them to arrive that early but they had to be so you just get on and deal with it.

I still remember waiting for the c section and being so worried about the fact that they would potentially be in SCBU until their official due date five weeks later, and thanks to a consultant who had come to talk to me I had the added concern that breastfeeding them may not be a reality due to her quite matter of factly stating that the likelihood was I would not be able to produce enough milk to keep up with the demand of feeding two especially as they were early.

The beginning

When the twins were born they were whisked off quickly to the SCBU. I was gutted. In the recovery room after I managed to hand express 1ml thanks to the help of a lovely midwife. I couldn't make it down to the SCBU to see them on the first day due to the c section but I desperately wanted to do something for my newborn babies so I tried to express using an electric pump, it didn't work. The days that followed I tried and failed many times to use the electric pump. It was a horrible feeling of frustration and failure. The consultants words that I wouldn't be able to breastfeed them exclusively taunted me. I couldn't understand why breastfeeding which had come so easily to me when I had Ben was now seeming like an impossible task.

I did have success early on getting both of the twins to latch on and nurse which was a truly special moment and gave me the boost I needed to persevere but as they were hooked up to tubes and monitors my opportunities to try nursing them were limited.

First time breastfeeding Zoey (L) & Zachary (R)

When they were moved out of their incubators I was able to get them out more often and every time I did I would try nursing. I was also managing to express more, it took about five days after the c section and constant trying and frustration with the pump, thinking it would never work, before I got 10ml, then 30ml and that quickly increased to 70ml and then 100ml and more over the next few days. I found getting my own pump really helped kickstart expressing for me as I hated the "milking parlour" in the SCBU. The noise of the pumps and being surrounded by other anxious mums fretting over milk production along with those supermums filling bottle after bottle of that precious liquid gold just added to the pressure of the task, I found it such a stressful place.

The first time I managed to express over 100ml of liquid gold

Breastfeeding in SCBU

Breastfeeding on demand in SCBU  is hard. A lot of the time it felt to me like the nurses would have preferred if I had just stuck to formula and agreed to giving the babies bottles which would allow them to monitor and control the exact amount the twins were having enabling them to easily stick to their feeding schedules. I am not saying the staff were all like this though, like everything some nurses were more encouraging than others. While I can see the importance of monitoring the intake of feeds for the babies in SCBU, I do think that flexibility is important and sometimes you have to look at the individual case and question the strict routine the majority seem so set on following.

Due to the monitoring I felt a lot of pressure when feeding. I used to hate the way some of the nurses would stand over me, watching the babies latch on and then continue to look to see whether they were sucking correctly and so on. Getting a 3lb baby, whose mouth is tiny in comparison to the nipple they need to latch on to to start nursing takes a little time and the last thing you need is a peering set of eyes watching what you are doing. I'm not sure they even realised what they were doing but I used to find myself politely reminding them I had breastfed my older son until he was nearly three so I knew what I was doing in the hope that they would just leave me alone, unfortunately some were very slow to get the hint. I know they were meant for the good of the babies but I used to hate the constant "how are they feeding?",  "how long are they feeding?", "are you sure you can feel them sucking properly?", "are you keeping one boob for each baby?" etc questions.

The way that I was told feeds work in SCBU is that they start off at hourly intervals with a set volume which builds up to four hourly interval feeds of greater volume. While this works well for bottle fed babies, in my mind it seemed to go completely against breastfeeding on demand and once we roomed in and the twins started waking for feeds, we naturally switched to breastfeeding on demand and the schedules pretty much went out the window. I made sure they never went more than four hours between a feed and fed them whenever they wanted for however long they wanted. I had to keep track of all the feed times and lengths in addition to nappy changes in a chart to be checked by the nurses. There were one or two nurses who questioned the frequency but I just went with my instincts and trusted that the babies were getting as much milk as their bodies needed and could handle and I certainly wasn't going to let them cry just to wait for the magic four hour mark.

After four days of rooming in and just when I felt things were going well and that there was a chance we would be going home we had a visit from the consultant, the one that was negative about breastfeeding from the start. She checked Zachary first and said she was happy with him but when it came to Zoey she made a point of saying how tiny and fragile she was, again mentioning that while I had the best intentions to breastfeed exclusively she felt that Zoey was lighter than last time she held her and had probably lost weight. She went on to say that if this was proved correct at the next day's weigh in we would potentially have to look at formula and bottle feeding and would be in SCBU longer. Next day the twins were weighed, for the first time since birth Zoey was back to and maintaining her birth weight and Zachary had put on weight. We were discharged, I was immensely relieved.

Home at last

In the weeks that followed I continued with breastfeeding on demand and we had regular visits from our lovely community nurse who it turns out was the one who pushed for us to be discharged as she could see the babies were doing well breastfeeding in SCBU. She weighed and measured the twins first twice weekly, then weekly and finally fortnightly until she was happy to discharge them. On the second or maybe it was the third visit the question of potentially topping up with formula was discussed, I'm not quite sure why as both babies were putting on weight, ok Zoey was putting on less that Zachary but she was just over 3lbs in comparision to his 5lbs so surely it was all relative to their body mass. I said I would rather not top up and we left it there until the next visit at which both twins had again put on weight and were charting perfectly against their respective percentile graphs. Top ups and formula have not been mentioned since and I feel so relieved I pushed back against any suggestions. I do wonder if it is just routine to suggest combination feeding with low birth weight babies.

I feel fortunate that I had experience breastfeeding Ben for so long before the twins as I knew what I was doing and I was confident that breastfeeding on demand could and would work. I am sure if I had been a first time mummy faced with twins in SCBU I would have been swayed by the nurses and doctors and would have probably given up on breastfeeding or opted for combination feeding with formula. It does make me wonder how many mothers do give up on breastfeeding in similar situations.

A new understanding of how hard breastfeeding is

One thing that has definitely come from my experience of breastfeeding the twins and the rocky start I had, is that breastfeeding is difficult and does not always come easy like it did with my first child. I can totally understand and respect mothers who chose to go down the formula root and after experiencing the measuring out and sterilising process involved in formula feeding and the hassle of pumping and expressing milk I know just how hard these are as well. I still remember that horrible, crushed feeling I had worrying that I wouldn't be able to breastfeed in those early days, it gave me a completely different insight into breastfeeding and what it is like when you can't.

Three months into breastfeeding the twins

I am now breastfeeding the twins over three months and in comparison to breastfeeding a singleton it is more than doubly hard. I tandem feed the twins together a lot but relish the times when I have a chance to just feed just one on their own and can enjoy that special bonding moment just a little bit more.

One milk drunk, one feeding
The reality is you are a lot more tied down breastfeeding twins as unlike nursing a singleton where you can get up, walk around and do things while still nursing you simply can't when tandem feeding. Mealtimes are often amusing in our house as I sit at the table, balancing the twins on their breastfeeding pillow attempting to eat, I have even been know to resort to using a scissors to cut up my meat. It makes me think back and wonder why I ever thought breastfeeding one while eating my tea at the same time was difficult. It is trickier when you go out in public too if both babies decide they need to feed at the same time, tandem feeding both discreetly is not easy but it can be done with the aid of scarves and the right nursing top, I love empire style nursing ones like this Milker top. Nights are more tiring too, with Ben I used to co-sleep and nurse him throughout the night still managing to get a decent amount of sleep but with the twins this isn't possible and I end up awake nursing them a lot of the night. One word of advice to breastfeeding twin mums be sure to get yourself a good twin nursing pillow like the Harmony Duo twin breastfeeding pillow, it is definitely an essential.
Despite all the challenges there are breastfeeding twins I wouldn't have it any other way. My babies are thriving and putting on weight consistently, I love breastfeeding them and seeing their progress as they gain weight and grow each and every day as a result. I am so glad we overcame the difficult start to get to where we are. 
My happy healthy twins


LauraCYMFT said...

Wow, go you! I found it hard to breastfeed one so I'm super impressed that you persevered and are managing to feed two babies. They are gorgeous!

Mummy's Space said...

Thank you. I had a rocky start but glad it's working now and they are gaining weight well.

Lynn Hogg said...

Well done you. It sounds as if feeding in the SCBU was difficult and would be really hard for a first time mum. Luckily you had lots of experience and the confidence to do what you felt was best.

Mummy's Space said...

Thank you. SCBU was difficult, just glad it all worked out in the end. You're right when you saying being a first time mum would be harder, everyone is so busy it makes it difficult when a mum wants to do something like bf on demand which goes against the scheduled feeds. I hope maybe some first time mums might read this and know it is possible if they find themselves in a similar situation.

TwinMummyL said...

Thank you for your article, and very well done. I wanted to b.f my twins but they were my first babies, 8 weeks early and the support was not there in NNU - it was for my milk, but not for it to come directly from me. I therefore expressed for 8 months and at times have wondered if I made a mistake; if I'd've stuck up for what I wanted more etc how it would've been but you remind me not to feel guilty because you've accurately captured how the nurses & consultants are (because they want the little ones to do well I'm sure). Enjoy your lovely twins, mine have just turned 3 and the interaction between them is magical, x

Mummy's Space said...

Thank you for your comment. You definitely have no reason to feel guilty, it's so hard in NICU/SCBU and like you say it seems the nurses preferred the milk to come in pumped form as it makes it easier for them to stick to the feeding plans. Pumping is so hard, you did amazing expressing for 8 months. I really grew to hate that noise in the short time I had to express not to mention all the sterilising and so on!

I'm loving watching the twins begin to interact, still can't believe they are not far off being 4 months now! 3 years is such a lovely age - I bet your two are super cute these days. x

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