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.