Nursing Preemie Twins

Posted by  | Monday, February 1, 2010  at 12:00 AM  
We're dealing with breastfeeding this week. This will be the third year we have discussed this topic, which is a little unreal for me to believe! Seems like just yesterday I was typing this post on my experiences nursing Lydia and the benefits of breastmilk. Since that time, I've experienced nursing preemie twins as well as begun my coursework and clinical hours to become a certified lactation consultant! If someone had told me five years ago I would oneday work as a lactation consultant I would have laughed. And now. . .well, I absolutely love it.

I've thought long and hard about what direction to write about. I've completed 60 hours of coursework in lactation and everything I've studied has been so fascinating. I wish I could just share all of it with you. But, even with this information, I think that sharing my nursing story with the boys may be the best way to encourage a new mom, or mother of multiples, or mom of a preemie to hang in there and keep going and not give up. Later this week, I will post an article on the "language of breastfeeding" and why our culture has come to believe that while, yes, breast is best, formula is a fine alternative.

My boys were born at 32 weeks, 3 days gestation in a third world country. This was not my plan but, four days before I was flying back to the states to have them, my body spontaneously went into labor and, 2 1/2 hours later, our twins arrived. I new nothing of breastfeeding twins (except that it could be done), nor of the challenges with preemies. Actually, I'm glad no one told me how hard it would be (not that it would have deterred me) but, being the eternal optimist that I am, I just figured tomorrow would be easier :). So, there were actually two big issues going on: the fact that I had twins and the fact that I had preemies. Each of those presents its own challenges, in addition to all the other challenges one can have nursing. I remember talking with the pediatrician the day after they were born and him asking how I was going to feed them. I told him unequivocally that I would exclusively nurse. While he hoped I would, I could tell he'd heard that from other moms who quickly changed their minds. Little did he know who he was dealing with . . . :) So from that conversation he said, "Well, let's get started." (I later learned that I had 6 of 11 factors that make nursing challenging and moms give up. . . greater than that, though, I had determination which will help you beat all the odds!)

After being under an oxygen bubble the first 24 hours the boys were only in the NICU to monitor nursing before discharge, and then to go under phototherapy. All in all, we ended up being in the hospital 6 days. I should also say they were 3 lbs, 15 oz and 3 lbs, 13 oz respectively when they were born, although they lost weight in the hospital because it takes more energy to nurse than they could take in, in calories so we brought them home at 3 1/2 pounds each. During the 24 hours after birth before I started nursing they had an IV with fluids but never received anything orally, including formula. (Okay, I realize it would be different in the states b/c they would give a feeding tube and help get their weight up, which would make nursing easier. . .the five pound mark is a great milestone for efficiency in nursing. . . but, again, I wouldn't trade where they were born or the size we were able to bring them home for anything in this world!).

(Here's a picture to give you an idea of their size.)

Those next few days involved walking up the hallway every couple hours to try to nurse. Being preemies, they ofcourse were always asleep. The nurses were watching everything I did, wanting to make sure they could suck, swallow, and breathe at the same time (I didn't know this then, but this is a developmental skill that babies learn between 32-35 weeks. . . although current research is fascinating. . . with preemies that are in 24 hour kangaroo care - aka skin-to-skin - the skill can develop much earlier!!). Many times they would weigh them before I nursed and immediately after and I'd be "scolded" for them not taking enough milk. I pumped quite a bit in the hospital to help build my supply since they weren't able to eat much in the beginning. Little did I know this was the beginning of a freezer-full of milk! (Months later, after dumping some and sharing a 10-day supply with a friend, I still had 13 gallons!) I then began nursing first and finishing with putting my milk in a bottle to top them off. Once they could eat 20 cc's at each feeding (this isn't much) we prepared to take them home - complete with creating our own little "NICU at home" including coil heater in their room keeping the temp at 79 F, air filter, and digital scale. Oh, there's so many details from this time I could share. . . I'm going to try hard to stay focused on the nursing portion. . .

Once we came home we fell into a routine: every 3 hours I'd feed babies. First I'd try to nurse, then I'd give them a bottle, then I'd pump, then we'd sterilize pump and bottles. . . then I'd have one hour (sometimes 1 1/2 hours) and the routine would start all over again. This was 24 hours a day, 7 days a week. It was crazy! The longest stretch of sleep I got for the first 6 weeks was 2 hours! I can remember so many days wondering how I was still functioning and knowing it was only by the grace of God. I called one of my friends in the states who also had preemie twins several times for encouragement as well as a lactation consultant. Because I had nursed Lydia, I knew the goal: I knew it would get easier and I looked forward to the day I had two champion-nursing boys. Yet I still needed to hear they would get there. In the meantime, I was one incredibly sleep-deprived mama who wondered if that day would ever come. With my "one hour" between each feed I would try to eat, sleep, shower, do laundry, be a mom to my then 2 1/2 year old, talk with our families back home who longed to know what was going on, entertain visitors, talk to my husband. . . after a few weeks it was not uncommon for me to fall asleep with my alarm on my pillow and me not even wake up. One time, my alarm woke up Josh from the other end of the house and he had to come and wake me up.

Why did it take so long to feed? Well, they were tiny and couldn't eat efficiently. The bigger they got the quicker they ate, but getting them from 3 1/2 pounds to 4 1/2 pounds took A LOT of hard work, sleep deprivation, prayer, grace, love, and now, amazing memories. I was so worried about nipple confusion I always wanted to start with nursing at the breast. (Knowing what I now know, I would definitely let family have given more bottles of my pumped milk and not tried to nurse at every feeding so I could've gotten more sleep. Also, once my supply was built, I could've dropped a pumping. . . but hindsight is 20/20.) And, every preemie is different. For example, when they were 4 1/2 weeks old (so 37 weeks gestation) I quit pumping and put them exlusively to the breast. Luke thrived but James' weight stagnated and he quit gaining. Because I couldn't nurse one and pump for the other, I had to return to the pump for both until they were 40 weeks gestation. (At this point, I changed the routine and gave them a bottle first - as an "appetizer" - and then put them to the breast for their "dinner." It worked well, and, by this point there were at least one or two feedings a day that I could just nurse them and not pump.)

It was hard because I was sleep deprived and sitting at a pump for 2 1/2 hours a day, staring at a wall, not being able to interact with Lydia was draining. But, there was never, ever a single moment I thought of not persevering. I knew when they were able to nurse at the breast it would be so much easier and wow, is it! And, I must say, nursing twins is amazing! (When you nurse, your body produces oxytocin which, among other things, relaxes you. I never noticed this with Lydia but with the boys, wow, I could fall asleep everytime I nurse them I get so relaxed. It is an amazing feeling! I've learned how to nurse them lying down and that is a common nursing position for us.)

I packed my pump up when the boys were 3 months old and, PTL!!, have not had to get it out since. Nursing now is a dream. Their milk is always fresh, ready, and available. I don't have to worry with sterilizing bottles, measuring formula, paying money for their milk, or packing it when we go places. I'm able to bond with my sweet boys in such a precious, God-given way. Oh, the look in their eyes, how their faces light up, their excitement, when I ask them if they want milk. . . I would do it over a million times even for none of these rewards but oh, just to experience these even once (much less every day!) there is no greater thing than nursing your baby!

In a few weeks we will talk about introducing foods and weaning so I'll save those topics for a later time. But, I'd love to have a great discussion this week so please share your stories, experiences, questions, and comments and let's dialogue together.


Terra Jones said...

What a beautiful story! I love it :)

ChezDeshotels said...

Krista, thanks so much for your story and ladies I would like to share one special thing about Krista in the heat of all this I had my 1st biological child and she was a email source of encouragement to me as I tried to nurse. PTL for her during this very difficult time, My story though did not have as sucessful of an outcome. My heart's desire was to breastfeed and I had prayed about it through my pregnancy. I started off with a champion nurser and we were doing fine but when she was 2 weeks old she started loosing weight and wasn't getting enough even though she wanted to nurse all the time. I started pumping, taking fenegreek, eating oatmeal and taking a drug that is used regularly in Europe. I saw some of the best lactation consultants in the country and my supply did come up a little bit. I was able to give her half of what she needed and PTL for my sister who was nursing at the same time VERY successfully and she supplied the rest of Lillian's milk. we did this for three months and despite all my prayers and trying my supply dwindled to 4oz a day I kept that up until 3.5 months and then I totally dried up and my sister's supply dropped as her little boy was self weaning so I started the only alternative I knew and used formula I cried everty time I made a bottle. On top of it all it made my baby very sick. (throwing up blood and blood in stool) We did this for 1 month as I greatly reasearched what I could do...After talking with a lactation consulatant, Krista, a pediatrician, and a natural remedy doctor we begin used raw goats milk. Can I just say it was miracle from God and in a matter of weeks Lillie started gaining weight and thriving as well as not violently vomiting etc....In a matter of 2 months she was off meds and we did find out through all this she is severely allergic to dairy products, rice, soy and eggs. Goat's Milk has been a salvation from us and we go to a local farm 2 times a week (now that she is a year just 1) these women stated thier goat farms because of their inablity to nurse...anyway long story there:) I would like to say some things I learned, keep searching for alternatives, and I still could cry not having more time to nurse my baby but the Lord has helped me grief through that and move on now to a very healthy 20lb 1 year old. I also learned something in hindsight..I feel like my lack of supply was diue to a very bad case of Lyme's Disease and Tick Fever diagnosed almost 6 moths after I begin nursing. So maybe that might have been the problem. I hope that each one of you will have the priledge to nurse your children but if not I hope that you can move past the guilt of thinking you are a bad mom and relish in your precious child and bond in other ways. Thanks Krista for all the encouragement you were to me in meant more than you will ever know


KC said...

I can relate to at least a small fraction of what Krista experienced. After 6 weeks of nursing, I was still in a considerable amount of pain and knew something was wrong. I was also terribly sleep deprived b/c my son wasn't sleeping. My pediatrician told me to just give up because in his opinion, "formula was a fine option." I was determined because I knew breastmilk was best and I wanted that bonding experience everyone described.

I scoured the internet, friends, and books to find answers. Most people were telling me to just give up. Finally were referred to a Dysphasia Clinic by a Lactation Consultant. We found out that my son was biting instead of sucking and he was having trouble getting into a good nursing rhythm.

There were many times I thought about giving up. I was in so much pain and so tired. He was unable to use a bottle, so I couldn't pump and let someone else take a feeding. But, breastfeeding was something I desperately wanted to do, so I stuck with it.

After about 3 months of working with the Dysphasia Clinic, it finally started to get easier. 6 months later and he was finally a nursing pro!

He is 15 months now and is starting to wean himself. It was an uphill battle, but the rewards are totally worth it! I am so glad I stuck with it!

MMS said...

Great job, Krista!!! It's so admirable that you stuck with it in spite of your exhaustion.

Here is my question: I am currently pumping full-time(again)for my second. I think I have an oversupply issue at this point. I basically produce about 2 1/2 oz. an hour. I have a freezer and fridge full of milk and have dumped I don't know how many ounces. I tried to get my husband to drink some to help him get over shingles and pneumonia, but alas, he was not enthusiastic about it. :) Is over-supply a problem? How long can I keep my frozen milk? I've seen different numbers everywhere.

Another question I have: the new recommendation is that breast-fed infants who receive less than 17 oz. of formula a day are supposed to receive supplemental vitamins for iron and vitamin D levels. I was really surprised by this as I thought breastmilk was a complete food. Anyone know anything about this?

Christina said...

Good question about Vitamin D....I thought I'd link Kelly Mom's article on the subject. Basically, the breastmilk is only designed to supply baby with part of the vitamin D that they need. Sunlight provides the rest (and the majority of what we need). Hope this helps!!

Here is the KellyMom link for milk storage guidelines:

I'm so proud of YOU for pumping full time again! About oversupply - you could donate it to the Wake Med milk bank!!!! I never had enough to donate, but SO wish I did. Here is the info about donating:

Yay for extra breastmilk!!! :)

Krista said...

Thank you so much for your kind words! And thanks for sharing your story and encouraging others. . .

Yes, please check out the kellymom links Christina posted. Breastmilk is a complete food in that everything your full-term baby needs is available either from breastmilk or other natural sources God has given us. . . ie the sun for Vitamin D. As for iron, it is true that breastmilk is low in iron. However, it is 100% absorbable in a fully breastfed baby a full-term baby should not need iron supplements before six months (you shouldn't need them after that point depending on what foods you introduce). Interestingly, if you give some formula, even just one bottle a day, along with breastmilk it changes the microflora in the baby's gut and makes him unable to absorb the iron in breastmilk. My advice, don't give a healthy, full-term baby anything other than breastmilk for at least the first six months of life.

As for over supply, you could certainly donate to a milk bank. However, if you are exhausted from pumping you could also probably drop a pumping during the day. Each person is different, but your baby is over a month old and your supply is obviously adequately built. If, for example, you are pumping 8x a day for 20 minutes I would cut back to 7x (and later on 6x) and cut the duration from 20 to 15 (and later to 10 minutes or less). Just keep a log and it will help you adjust pumping to your baby's needs. (Feel free to email me if you have more questions about pumping.)

elawhorn said...

Krista, I am Amy Bowman's aunt and was reading her blog today and glanced at her other blogging friends and noticed your post on nursing preemies and had to "lurk!"
I have twin boys that are now 14 years old, however, they were born at 33 weeks and spent almost a full month in NICU until they were 4 1/2 lbs. before leaving there. I also was determined I could nurse as I had nursed my two other boys, and my neonatalogist told me point blank they would be healthier and be able to leave the hospital sooner with breastmilk in their tummies! I pumped from the beginning, sometimes only reaping a couple of drops of colostrum until one nursed at 2 weeks old and then the other at around 2 months. I nursed one while pumping for the other, a sight to behold I am sure! Finally, both were nursing (often at the same time) and this continued until they were around 13 months of age.
I well remember never getting more than 2 hours of sleep at a time also. In fact, it wasn't until my twins were 8 months old that BOTH slept 5 hours straight at night. That is some very serious sleep deprivation and probably explains why I cried ALL the time!! I am convince it would have been more difficult with formula just because of all the hassle of bottles, sterilization, etc. The whole experience was bittersweet, however, I will always be grateful I was able to nurse them and encourage all new moms to learn about breastfeeding before the baby comes and persevere if at all possible!


Melissa Pearce said...

Way to go! I think your story of perseverance speaks wonders of your love for your babies. When I have had to go out of town and had to pump every few hours I thought, man, I don't know how mamas can pump round the clock!! For me, I know it would have to be a matter of serious dedication.
I think if we thought of breast milk not as an option among many, but the way to go unless there is another medical issue at stake, more mamas would get over the hump like you did!
I, too, have a freezer full of milk, because since my girl (7.5 months) sleeps 12-13 hours at night, I have to pump off once before I go to bed in order to not ache by the morning... (I used to get clogged ducts a lot with my son.) I give the milk to a local mama with a special needs baby who needs the extra milk. It works out for both of us. I totally recommend passing it on to a friend or a milk bank rather than dumping-- it's so beneficial!

Keri said...

Breastfeeding week came just at the right time for me! I was told today that my six month old baby has failure to thrive (She is below 0 on the weight percentages and has gained no weight since her 4 month appointment) and that I need to give up breastfeeding and switch to formula.... I hate that.... I am thinking that I am still going to breastfeed and then pump like crazy and supplement her with formula. Anyways... Thanks for making it breastfeeding week again!

Amy said...

excellent post! I too am working on my IBCLC license. I am a pediatric/OB nurse and have all my hours- just working on my CEU's now. Plan to take boards in July.

Would love to hear your favorite books on breastfeeding.


Courtney said...

Hey Krista, how long are you planning to nurse the boys?

Krista said...

You've made the six month mark - way to go! I would encourage you to continue to breastfeed anytime your baby wants and, in addition to this, add food (rather than supplement with formula). Plain, whole milk yogurt, sweet potatoes with a big pat of real butter, avocadoes, and bananas would all be great foods. My boys, too, were very small (still are on the charts. . . actually they're probably not on the charts but they are following their growth curve which is really the only important thing) and I mixed extra virgin olive oil and tahina (sesame seed paste) in their kefir/yogurt around 8 1/2 months.

How exciting! Good luck on the boards. Two books I've enjoyed lately are The Politics of Breastfeeding and Mother Food. What about you? I'd love some book recommendations on this subject.

I nursed Lydia 19 months and only weaned b/c we wanted to get pregnant again. I'm considering weaning them while we're in the states b/c I can get good raw milk to use and then transition them off milk before we return (which would mean weaning around 19 months again). But, if they are still really enjoying nursing, then I'll just wait until they are ready. So, all that to say. . . I'm not sure!

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