Thursday, January 14, 2010

The Post About Breastfeeding

Breastfeeding! I never knew what a struggle it could be to get there with these boys. I nursed my daughter until 15 months when I weaned her to try to get pregnant (insert hysterical laughter here) as I was not ovulating or having periods while nursing. So I consider myself a pretty seasoned breastfeeder and can troubleshoot a lot of latch, supply or other problems. Nursing triplets, on the other hand, was something with which I had no experience. Preemie triplets? Uncharted waters.

The knowledge and experience about nursing I had before having the boys has served me well. I know that breastfeeding is a supply and demand operation. In theory, the more you tell your body to make (through nursing and pumping), the more milk it will produce. This, unfortunately, is not the case for everyone, despite best efforts, pumping and drugs to stimulate production. I am so far, lucky enough to be able to keep up, but that could always change. For now, I drink ridiculous amounts of water to ensure I am hydrated, and take 14 Fenugreek capsules a day. This is an herb that stimulates milk supply and can be found online or at any health food store. I get mine from Amazon or the grocery store.

We are still working to get the boys all nursing from the breast their "full" feeds, which for them is about 90 cc's, or just over 3 ounces per feed, seven times per day. If they are unable to nurse the feed, we supplement with a bottle of EBM (expressed breast milk). How do we know if they got their full feed? I am CRAZY like a fox and have a rental scale. Actually, it provides us with an amazing amount of information about their nursing habits. We simply weigh them before and after nursing, and each gram they gain translates into a cc. So if they gained 60 grams during feeding, they ate about 60 cc's or 2 ounces, which is 2/3 or their feeding. Of course, sometimes they are not as hungry, and sometimes more often, and we always have a bottle ready if they are hungry.

This way of feeding, scheduling a breastfed baby to eat seven times a day, sucks (no pun intended) in so many ways. Newborns should be breastfed on demand, and usually between 10-12 times per day. Our guys are 12 weeks old, almost 6 adjusted, and really should be eating about 10 times a day still. If they did that, they'd only need to eat around 2 ounces or so at each feeding, so that is probably what is developmentally appropriate. Because there are THREE mouths to nurse, and I still have to pump 7 times per day, they cannot be demand fed most of the time. In the evenings I cue feed them whenever they are hungry since we have an extra adult home and I don't have to pump one time then. Ideally, they'd all be put to the breast all the time, all day long, but there are literally not enough hours in the day for me to do that and pump. The other problem with it is I would pump my breasts empty and then be trying to feed a hungry baby who is not the most efficient nurser, as it is.

So a schedule it is. Right now, so they get the most practice, I nurse everyone at each feeding, and anyone who is still hungry will get a bottle of EBM. When we get to where they are all nursing well, I may only nurse two at each feeding while one has a bottle in the interest of time. We've chosen to start doing "AC/PC" or before and after nursing weights with our rental scale to get an idea of how they are doing. We'd like them to nurse 70-90 cc's or 2+ to 3+ ounces at each feeding.

While my little Elephant, our non-twin Baby C is doing an amazing job, usually getting 60-90 at each feeding and often going a whole day without a supplemental bottle, the twins have plateaued. They have made very little gain on the amount they can nurse in the last couple weeks, which is so frustrating! I really hoped they'd be off of supplements by now. So each feeding we weight Baby A, nurse Baby A, weigh Baby A and then possibly give a supplement. Then we repeat that three times. After that, I pump and we begin again shortly after. This process is obviously tedious but keeping logs of AC/PC weights, how much milk we use and how much I pump is really helping us see patterns, or in the case of the twins, a plateau. Part of the frustration is the lack of consistency: sometimes our Lion will take 50 and sometimes 15- it does not seem to have anything to do with time of day, nursing order or position. Their suck is not as strong, they are not as patient to wait for my milk to let down, and they seem to be easily frustrated. To have them push away from me and then latch on easily to a bottle feels hurtful sometimes, though I know it should not.

I've had my friend and lactation consultant out, and she thinks they just need to "grow up" a bit more until they can do it. Other multiple moms have said they need to be a bit older to truly have the ability to take full feeds. Other people have suggested that the twins could have tongue tie or another sucking problem and not be able to get more. This could require occupational therapy simply a few tweaks in bottle type to help them learn to suck better. I am getting referrals from our pediatrician today to be seen at Pediatric OT units at two Seattle hospitals. They evaluate baby's abilty to suck/swallow efficiently and their overall muscle tone which plays a part in nursing. I recently discovered I know a Pediatric OT and Speech Language Pathologist (SLP) who works with preemies who are learning to breastfeed. I have a phone call set up with her this weekend and cannot wait to hear her point of view, which may be different from a lactation consultant.

That is where we are at right now- sort of in a holding pattern. I am so grateful that my babies will latch on at all, and enjoy each second of nursing them. I am truly determined to make this work, but I had not expected we'd need to persevere this long. Were it not for my completely amazing mother, who helps me with each feeding, does the dishes and laundry and bottle washing, I would not be able to do this. If it weren't for my husband who encourages me, distracts our three-year-old when I am focused on a nursing baby and doesn't mind the pump and scale rental costs, I would not be able to do this. I am lucky to even have the chance! I have also met an amazing triplet momma who is nursing her trio and she has fielded long emails from me with so much support and kindness. I have an awesome LLL leader friend, one who is on her way and totally unwavering and a great LC to consult with. This is taking a village.

You, bloggy friends, are part of the village! Please let me know if you have any ideas, thoughts or questions about this major undertaking. :)

I think it is important to add our successes over the past couple weeks:

- No one needs a nipple shield to latch on!
- Two of the babies can nurse, laying down in bed with me. Most precious feeling ever.
- They don't cry before they even start as they used to scream and flail while trying to latch them.
- Baby C PREFERS to nurse :)

Part of the problem is a complete lack of info about nursing triplets. It is different from nursing twins or a singleton, and throwing the preemie factor in there makes it even more of a unique situation. I have had limited success in gathering resources about nursing triplets, but a good (and really the only) book about nursing more than twins is Mothering Multiples by Karen Gromada. For those of you expecting babies who are interested,some of my favorite resources about breastfeeding are KellyMom, a great general breastfeeding guide; La Leche League's site which has a good tool to finding local help; and The Nursing Mother's Companion by Kathleen Huggins.


  1. good work...keep it up! i just randomly found you on multiples and more...the title lured me int. i loved nursing my boys! my boys were on just bm until 3 mo (pumped and nursing), then decreased gradually as they ate more and my body just couldnt produce enough (i topped out at about 60 oz/day). hang in there...the pumping is obnoxious and horrible, but the nursing makes it worth it. i nursed until it got to be TOO much work to be worth it (think 3 squirmy 10 month olds plus a 3 year'll be there too!). i just pumped my last time on new years eve. BEST thing i did for my boys...the time, energy, health, cost, glad i did it. so hang in gets better as they eat less often (and you pump less often). sounds like you have a nursing friend of triplets, but if you need more encouragement, i am happy to provide! :) katie

  2. WOW... this is a very informative post - Thank you so much for sharing! I hope I can atleast get to where you are at! Hope the consultation this weekend helps!

  3. Wow -- this is amazing and inspiring. I'm having latch troubles with just my one, and am in awe of what you are doing. Truly a full-time job and then some!!

    Just out of curiosity -- when you you sleep?!?

  4. I'm so worried my twins won't latch on after birth, I'm prepared for pumping and bottles.
    Reading your post I can safely say i feel like a wimp.

  5. Hooray you!!!! I am so impressed, what a commitment! Your schedule sounds grueling but also like it really works (thanks to your support crew). You've made such progress in just a month or so, wow!!!

    I also felt like having nursed my eldest (and having significant challenges with her) helped "prep" me wonderfully for nursing twins. I have problems with low milk supply, so I've learned a lot about that and how to work around it successfully. I supplemented all three of my girls, and had worries about bottle preference of and on, but we persevered and are still going strong at 19 months. I also LOVE nursing my two lying down (me flat on my back, babies propped in my arms with pillows under) and it got me many more hours of sleep early on, as well as precious cuddles.

    Thats great that you have LC and LLL leader friends to help out and cheer you on! I have this vision of creating a LLL in Seattle for multiples but probably will never find the time to help it become a reality...

  6. You are doing an amazing, amazing job Carrie! Just think of the incredible gift you have already given these little men. I am beyond amazed. Learning to breastfeed with Zeph being just a preemie was hard. I seem to remember breastfeeding still being hard until he was 4-5 months (2-3 adjusted). But nearly a year later, we're still at it! Speaking of that, time to feed the baby...

  7. Bravo to you for getting a village involved. I wish I had insisted on getting more outside help! We didn't realize until one of our trio was about 2 months that her bf issues were because she was tongue-tied. She would tear me up as well. (we had her tongue clipped which was a minor procedure) Her brother was tongue-tied but had more movement. He nursed great. It takes our preemies quite a while to "get it" and once you can start tandem nursings it will go smoother. I know you've done your research but my advice is to definetly keep them on the SAME eating schedule or you will have one on the breast 24/7. The flow to our schedule has really worked for all of us. You need to trust your'll know what to do.

  8. Wow. Kudos to you for your success with feeding three. I have 10-week-old twin boys who were born full term (38 weeks) and we've had lots of struggles. I've tried fenugreek, pumping, water, hoping and wishing but still have difficulty. Both boys lost a ton of weight in the first week, then spent 4 weeks struggling to get back to their birthweight and have had to be supplemented with formula. One baby is very hit-or-miss with his latch and only gets an ounce or sometimes two in 30+ minutes of nursing. The other baby is allergic to cow's milk and soy so I've had to completely eliminate both from my diet. I've had thrush and a bladder infection. I even rented a hospital-grade pump but even so the most I've ever pumped is 2 oz per side which means I need to pump at least twice to feed them once. And the biggest frustration: 10 weeks in my nipples still hurt. Bad.

    It's heartbreaking to put so much into it and still have so little success. I hate that I can't meet their needs. I take the boys each week to a lactation consultant and have them weighed. We're sticking with it best we can, I've just had to accept that my boys are only partially breastfed and it's not the wonderful experience I'd hoped for.

    Congratulations. My hat's off to you. Your schedule does sound super-human, and I applaud your accomplishment. What a great thing to do for your little ones.

  9. I'm so happy for you. It still breaks my heart that the mastitis destroyed my long term breast feeding dreams. I am just soooo glad that you are finding success!!!

  10. The girls and I haven't had nearly as much success as you, so your perseverance is certainly paying off. Hooray for not needing the breast shield anymore. I'm incredibly impressed and don't know how you have been able to keep up this grueling schedule. You are one determined, amazing woman. Hats off to you! I'm so exhausted that I'm barely able to pump exclusively and here you are breastfeeding all three AND pumping. You are a freaking rock star and should feel incredibly proud of what you've accomplished already.

  11. There are no words for your awesomeness. As soon as you were pumping enough for all 3 in the NICU I was wowed, and it just got more amazing once they started feeding by mouth.

    OT for nursing never occurred to me.

    Funny that you like Mothering Multiples so much, as I found it quite useless for the troubles that I've had, and the tone infuriating.

    Re: their impatience about let down, the book Making More Milk, which you thankfully don't really need but which has been a lifesaver, has several suggestions about training them when they're on the bottle to be more patient. Preemie nipples, taking breaks, keeping the bottle horizontal so that gravity doesn't encourage flow and they have to work harder, others that I'm forgetting. I will say that I've given up on those particular efforts myself because all of the suggestions add to the time it takes to bottle feed, which is often 40 minutes per baby at the best of times.

  12. GO CARRIE.

    Keep up the great exhaustive work. I Exclusively pumped for 11 months so I have a special hatered/love relationship with pumps. What bottles are you using or have tried. I like the above posters idea of baby having to work to get milk out of the bottle. In theory that may help.
    Hoping you get to the place you want to be with BF.

  13. YOU ARE CLIMBING MOUNTAINS!!! Good for you. Keep it up. Your perserverance will pay off.

  14. What a labor of love for your beautiful boys! When this is all said and done YOU need to write the book about triplet nursing!!

  15. Best of luck to you! I continue to nurse my 10 month old twins but I remember it was very hard in the beginning even though my babies were full-term and full-size. I really commend you and I know you'll do a great job!

  16. Wow! That is amazing, good for you!! Breastfeeding is the HARDEST thing I ever had to learn how to do, and I just have the one. :) We used a nipple shield for 8 weeks. I learned (and I'm sure you remember) that it gets much easier for around the three month mark-it's like they "get" it-finally.
    I'm impressed with your commitment, keep it up. :D

  17. Wow, just wow. When do you sleep?! I'm still pumping for my trio but can only fit in five times/day and need to supplement about 20 oz/day with either formula or frozen EBM.

    You're absolutely right about the utter lack of info about triplets - nursing, milestones, everything. We're always told, 'it depends on the baby' or just plain, 'I don't know.' I've started to ask when we should be worried rather than when we should expect things to happen.

    Since you're taking fenugreek, you may want to check out Making More Milk, as mentioned by Baby Smiling. It lists foods that can negatively affect supply.

    As for the scale and pump rental costs, DH figured out that every ounce I pumped saved $0.20 in formula. For our monthly pump rental fee of $55, we break even at 12oz/day.

  18. Carrie, I'm in awe. I was just telling DH the other night that breastfeeding ONE newborn has cured me from ever wanting multiples again. I can't imagine breastfeeding THREE.PREEMIES.AT.ONCE. Oh my... You're simply amazing--and your boys are, too!!!

  19. I just came across this post and I wanted to say you are doing an awsome job and to hang in there. It gets sooooo much easier and more enjoyable once you don't have to pump so much and they are able to BF well. It does take time and I agree that if you can get them to tandem BF that helps alot. I found that when I tandem fed them, the stronger nursers helped with letdown and supply for the weaker one. I didn't fret so much about the amount with each feeding. As long as they were gaining weight ok I figured they were getting enough milk and if they take less with one feeding they probably make up for it by taking more at the next. My 31 wk premie triplets were on exclusive BM until 5mo when I went back to work and then wasn't able to pump enough at work so had to supplement with some formula but I continued to BF them until they were 16.5mo and then they self-weaned because I was 8wks pregnant w/ #4 and my milk completely dried up. So, I just wanted to offer you my encouragement and let you know that it is possible. :)

  20. Just wanted to let you know I'm thinking about you and hoping you, your dh, A & the boys are hanging in there. Last night my girls slept 5, 6 and 7 hours respectively for the very first time! Hope more sleep is in your near future too. Lots of hugs from all of us.

  21. My friend just sent me a link to your blog, specifically this post, since I am having some challenges breastfeeding my 8 week old twins. It's really great to read the experiences of someone in a similar situation, because you are right; resources on nursing multiples is limited.
    I have a few questions for you if you don't mind...

    1) How did you know how much fenugreek to take? I've been taking the same one you show in this post, but only the 6 per day as recommended on the bottle.
    2) I see that all of your babies have finally figured out the breastfeeding thing. Yay! So encouraging! Did you end up having to get the twins' tongues clipped? My twins have the short tongue ties also.
    3) At what age did they finally get it, so that you could stop supplementing and pumping?
    4) Also, in this post you made a comment about pumping yourself empty and then trying to feed one of the babies. I'm concerned about that also. How did you avoid that?

    Thanks so much for sharing your experiences with this blog! Great job to you - I only hope that I can do so well.