Nursing

From the Twin-Mommy

Dominic and Alexander are both learning to latch onto Mom for nursing, and we’ve taken our twin nursing pillow to the NICU to start practicing the football hold for tandem nursing. So far, we’re still working with each boy separately. We had an appointment with a lactation consultant on Wednesday who helped give me pointers on how to hold the babies and ways to improve my still slow milk flow. (Unfortunately, Alexander was completely exhausted during the feeding that the lactation consultant was there, and we couldn’t wake him up enough to nurse.) We have another appointment with the same consultant on Monday afternoon.

They currently have Dominic eating 1 hour before Alexander since the same nurse takes care of both, and I’ve been going to the NICU for three feedings a day: 10:30/11:30, 1:30/2:30 and 7:30/8:30. I spend 15 minutes nursing and then 10-30 minutes finishing off a 60 mL bottle with each one. I’ve also been more active while pumping (per the lactation consultant’s advice), using a warm washcloth on the breasts before pumping and gently massaging them to help start and keep that milk flowing. The time with the boys and the more active pumping have already doubled my milk. Yesterday I was up to 20 mL (from 10 mL) at each pumping, and last night I almost made 30 mL at my last pumping before bed.

When you start out scrounging for every .1 mL of colostrum to fill a syringe and your milk takes forever to arrive, it can be an extremely frustrating experience. Many moms of multiples deliver early by C-section, and it is very easy to become discouraged and to give up because we typically take longer and have to work harder to get our milk to come in. I remember one particular morning just crying in my hospital bed after a particularly meager pumping session. I felt so inadequate because there was no way I could feed my babies on my own yet.

I’ve been lucky to have a wonderfully supportive husband who was willing to suck up every drop of colostrum he could get with a syringe that first week and to cheer with me for every tiny increase we achieved. Plus, my mom and the NICU nurses have been supportive. They stress that they will use every drop of colostrum or milk that we give them for our boys and how important it is for them. I also did reading on the Web which reassured me that this is not an atypical experience for mothers of multiples.

If you want to breastfeed your babies (or baby), don’t give up!

• Seek help from lactation consultants.
• Try to spend as much time with your babies as possible, but remember that you’re recovering from surgery or labor and need sleep to keep from becoming ill. Being exhausted can also slow milk production, and if you get sick, they won’t even let you in the NICU to see your little ones.
• Start nursing as soon as it is considered safe for your babies if they are preemies
• Be persistent.

I’ve enjoyed every nursing session with my little tykes. It is an amazing experience to feel them latch on or to see them eager to nurse again, and it’s so much more satisfying than simply pumping.

Also, remember that many people won’t understand why you aren’t producing more milk or why your babies are on formula. Their questions or comments may upset and/or discourage you because you are feeling down about your own milk production. However, everyone just wants what is best for the babies and for mom, and we can educate each other about the trials of NICU and multiples nursing. I’m still hoping to transition my boys completely off formula, and we’re on our way.

P.S. While writing this post during a 2 AM pumping session, I just collected 50 mL of milk! A new record and almost enough to feed one of my boys a complete meal!

From the Twin-Mommy:

Having our boys in the NICU seems like a type of limbo. We are parents, and our little tykes are no longer in my belly. However, at the same time, we are still waiting to be able bring them home to find our own rhythms as a family. Right now, Dominic and Alexander still haven’t been able to touch each other since they were born (and probably won’t until we bring them home), and we have to wash our hands every time we switch from holding one to the other. Their little world is filled with the motion and voices of nurses, other parents visiting their children, and the bells and bings of alarms and notifications from the variety of equipment.

The NICU - for very good reasons - has to be very careful about infections, but this also means that a cough, a fever blister, or any number of symptoms can leave you quarantined from your little ones. I wasn’t able to go in from Sunday morning until yesterday afternoon, and that has made it even tougher and more frustrating to have Dominic and Alexander in the NICU. The last few days I have continued to recover from my C-section and to feel a bit like I’m being converted into a plastic cyborg by my breast pump (whoosh, whoosh, whoosh…is the background sound to my life). Grandma has visited the boys every morning to hold and love on them, and Puck and Grandma returned every evening after he got off work to feed and love on them some more. They were taking lots of little videos for Mom, so I could see my boys.

Alex Wants his Grandma

Grandma holds Alex and Dominic Smiles in his Sleep

(Look for a classic smile around 1:40 into the video.)

Yesterday, I was absolutely elated to be able to go and hold Dominic and Alexander again. We made it there before their 7:30 (Dom) and 8:30 (Alex) feedings, so I was able to nurse them for 15 minutes (good practice for me and for the boys) before giving them their bottles. Both of them did a great job with their nursing workout which is still a lot of work for them with a lot less reward. Still, they were eager to get to business, and Alex drank up his full bottle afterward. Puck and I got to take their temperatures, change their diapers, and something new…. we put them in their first outfits from home - 2 little newborn onesies that were decorated for them at one of our baby showers.

While having our little ones in the NICU is not ideal in many ways, we are so happy that they are being well taken care of by a large staff of very capable and friendly nurses and doctors. It’s important to also recognize and appreciate the other benefits. I’ve probably been able to recover faster after my surgery and to get a bit more sleep, and we’ve gotten lots of on-hand, expert advice about holding our babes, changing diapers, bottlefeeding, breastfeeding, etc.

How the Boys Are Doing:

Like most every baby, our boys initially lost weight after birth, but they are both almost back to their birth weights. For a time, they were only 2 ounces apart, but Alexander has pulled back ahead. Yesterday, Dominic weighed 5 pounds 11 ounces (2794 grams), and Alexander weighed 6 pounds 2 ounces (2583 grams). Plus, they changed them to bottlefeeding for every meal, and the nurse removed the tape and let them pull out their own hated feeding tubes under her supervision.

They are no longer monitoring Alex’s oxygen levels, and if Dom continues to do well, they will stop monitoring his soon too. Alex’s heart rate dipped sharply on Monday (though it came back up on its own), so we know that he has no chance to come home before next Monday as they monitor a preemie’s heartrate for a week after that. Alexander and Dominic are each eating 60+ mL at each feeding (and Mom is currently barely producing 60+ mL each day, though it’s milk now and not colostrum). In fact, I must go get ready to head to the hospital to see my little piggies right now.

From the Twin-Daddy:

Wendy, Trish, and Becca visited today, and Trish came out to the NICU to visit the boys.  Dominic was busy playing with his pacifier (binky), and Alex seems to be sleeping through his first growth spurt.

From the Twin-Daddy:

Dominic and Alexander are two little boys made from the same life-stuff.  One egg magically divided to bring two matching lives into being where previously only one had existed.  For 34 weeks and 3 days, they were always together and held close by their mother.

August 1st changed that, and Dominic’s wail at being born represented not only his struggle to live in a new world but also the pain of separation from his twin and mother.  Alone, in the bright lights and the cold,  his cry expressed a fear that everything was not okay.  Our careful plans to lay him on his mother’s chest and then his brother shortly thereafter were all dashed away by the necessity of the moment.

Taken to the NICU, each boy lay alone and separate from his brother unable to feel him or hear his cries.  That changed when both boys were upgraded to Room D, and they lay in adjacent cribs.  Yesterday, before Mary came home, she slowly made the painful walk to the NICU so that she could sit with the boys, and our entire family was reunited again for the first time since August 1st.

Mom and Dad with Alexander (left) and Dominic (right):

Mary is home and recovering, and while they are in the NICU, the boys will not share a crib, but when Alexander cries, Dominic reacts.  When Dominic cries, Alex hears him as well.   Every day takes them a little closer to being home with us.

From the Twin-Daddy:

Today I arrived to find a sad Mary who was frustrated because her pumping was only producing a pittance of colostrum (0.005 mL - 0.3 mL).  It isn’t uncommon for a C-section mom to have this trouble, and preemie moms are also playing catch up.  Medela’s site has a useful explanation of some of this:

LINK TO MEDELA SITE

After holding the boys skin-to-skin for a bit over an hour, Mary’s… um… output jumped up to 1.5 mL.

That’s an increase of 5 times what she was producing without the skin-to-skin contact!

I sometimes speculate that men are simplified tinker-toys compared to the strange and wondrous machines that are women’s bodies.  Skin-to-Skin is great for the mom and the babies, and as soon as one of my baby-chimps settles onto my chimp chest, he magically quits squawking and settles into chimp-style sleeping, muttering occasionally and making little faces as he dreams.

Both guys are doing well, and I asked the NICU nurse about the low oxygen levels and how normal this was.  She was happy to tell us that it wasn’t unusual even for healthy adults to drop like that, and the difference is that we are not continuously monitored.  When babies need to burp, poop, or toot, they may hold their breath for a bit while they work on it.  It’s hard for them to get everything figured out at once, and that’s what typically causes most of the episodes.  Whap them a few times gently on the back or bottom, and they will be right as rain.  When this happens a lot, that is a cause for more concern which is why they kept a close eye on Mr. Dom.  His oxygen level has been lowered back to room air, and he seems to be doing fine.

Mr. Dom also showed he can be a good eater as well, and he sucked down 45 mL in a single feeding.  Both boys are now off the IV, and while having lost weight after delivery (as expected), they are slowly putting it back on.  They still take some food through bottles and some food through feeding tubes so they can rest.

Mom will be going home today, and we hope the boys will follow sometime in the next couple of weeks.