Breastfeeding Twins Pt2

On becoming pregnant with twins, women are told of the dangers of the babies coming early. This is one of the fears that is put upon them from the start of their pregnancies. Now, don't get me wrong, I'm not saying it is always untrue, because babies are born early the world over, especially twins. I am, however, saying that it is a fear that is often put into the minds of parents-to-be. My response to this, as usual, is to get informed. If you are expecting twins (or indeed any set of multiples), it is a good idea to get some good information. Another good idea is to talk to your care provider about how they treat women expecting more than one baby. This is also the time to ask the 'what if' questions. Women often find themselves working from a position of ignorance when it comes to birth and breastfeeding and it is easier to sit back and let the 'experts' take over. So, I will assume that you've done the necessary research about your birth and talked to your care providers. Now, let's move on to breastfeeding premature babies.

When we talk about birth, we talk a lot about the immediate postnatal experience. Skin-to-skin contact with babies is promoted more and more by midwives and doctors, which is good news because it benefits both Mum and baby greatly. It helps the baby maintain body temperature – something that is vital in premature babies – it helps to stabilise and maintain the heart rate, respiratory rate and it generally settles the baby. It promotes bonding between mother and babies and encourages breastfeeding as the babies are more likely to root for and attach to the breast. 

Kangaroo Care has been shown to have improved outcomes in premature babies. What better place to have your babies than on your skin, held close against you?

Once the babies are born, it is important to establish your milk supply, and this can be done as soon as your babies are born, no matter what stage of your pregnancy they arrive. The lovely Kellymom has some good information about establishing your milk supply and expressing. She also has a handy guide for expressing and storing milk for premature babies. 

Now, why is it so important that you get your milk supply sorted for twins? After all, there are a fair number of people who will tell you that you “have to” supplement twins anyway and that “only martyrs” exclusively breastfeed. Now, let me quickly set my cards out on the table. I would LOVE for you to breastfeed your twins exclusively and my personal opinion is that the vast majority of twin mums (premature or full term) CAN exclusively breastfeed their babies. However, this is not about my personal opinion and I know that many other factors may come into play.

So, first let's see about reasons for sorting out your milk supply and remember every breastfeed counts. The milk a mother produces for her early born babies is different to the milk produced for term babies. Our milk is very clever stuff. It provides all that our babies need to protect them from infections and these can have very severe consequences in pre-term babies. NEC (necrotising enterocolitis) is one such gut infection that can be life threatening in preemies. Get shown how to hand express colostrum. This is liquid gold. Your babies need as much of it as your body produces. If, for whatever reason, you do not or are unable to produce enough milk for your babies then donor milk is an option. Ask your hospital about this or see if there is a way you can access some donor milk for your babies. 

NICUs commonly have feeding schedules for premature babies. I know I sound like THE biggest fan, but Kellymom really does have great links and resources (and the lazy in me says "why re-invent the wheel"). Here are a couple of articles to read about demand feeding preemies and how it gets them home sooner. (KellyMom articles). The feeding schedules can sometimes lull parents into a false pattern. Yes, I know and recognise the importance of sleep, but did you know that your prolactin levels tend to be higher at night? This will help with expressing and your milk yield. One of the downsides of scheduling feeding is what may happen when you bring your babies home. Suddenly it feels a lot more full on and overwhelming. You no longer have those long, deep sleeps. It is one of the things that most new mums find when they bring their babies home. There are no midwives and doctors to peer around the curtain to check that all is all right. You have sole care of these babies and suddenly you have to deal with the feeding and settling at night. It may feel scary and you may begin to doubt your ability to feed them sufficiently. 

The fear of hospital re-admittance, having just gotten them home, looms large. It is this fear that often leads parents of preemies to reach for formula. Coming home from a regime where everything is timed and measured may cause doubt and mums forget to listen to their instincts about their babies. They do wonderful work in the NICU and they are there to help you get your babies home, so don't be afraid to ask about breastfeeding, kangaroo care and feeding to your babies’ cues. Be informed, it will help you to manage your concerns. 

Let me leave you with some reasons to be proud as you care for your premature babies and some resources for breastfeeding them.

A quick tale about expressing for premature twins.

And on one more note, should you have the privilege of meeting parents of premature babies, here are a few things NOT to say.

You can also read this and other blogs I've written on the wonderful new resource for Mums: Acorn Pack

Letter to my firstborn

The evening that you were born was strange to me.  They took you from my body and told that it was because of my failure.  My body had failed to progress beyond 4cm and your heart rate was falling.  No one told me that that was a risk I had taken when I accepted the epidural the insistence of the Midwife.  I hadn't prepared myself for your arrival.  I was pretty clueless.  I told myself that I would be a good enough mother.  Not for me the dizzying heights of perfection.  

Looking back, I think I did okay.  That first failure wasn't my last.  I failed to see that my instincts steered me right when it came to you, the baby.  I put you to my breast and pulled you into my bed.  It was a happy relationship that everyone told me was wrong.  They laughed at me when you cried and wouldn't settle in a cot.  They made me question my ability when they saw that you preferred my arms to prams and when I wore you round the house instead of letting you cry on the floor.  I was pushed into weaning you from my breast and filled you with artificial milk so that I could be like everyone else.  It wasn't their fault.  They knew no better than me when it came to babies and how to nurture them.

Some of my failures held you and I in great stead.  I failed to keep you within the pre-school that people said was good enough for you.  I wanted better and best.  I failed to get you into the school I felt was best, but the school you went to was good and I met lifelong friends.  I moved you the next year when a place opened up in the preferred school.  I failed to remain within the low expectations people had of me when I grasped this new school by the horns and took on the PTA by throwing my 'I know nobody' self into the heart of school life.  I failed to accept that boys like you weren't supposed to achieve when you sat the entrance tests a two schools.  The first rejected you by a matter of a few marks, but the second welcomed you in.  I failed to hear the criticisms of the choices I made that took you through that school.  I failed to agree with the statistics that said parenting you alone would cause you to fail and push you into a broken life.

And what did you do in return for those failures?  You grew tall.  You grew kind.  You grew and continue to grow as the best big brother ever.  You surpassed expectations and took hold of your life and began to make choices as a man.  You rejected my dream of an Oxbridge son because it wasn't the path you wanted to take.  In doing so you made me proud because you stood for what you wanted and began carving your OWN dream.

I look back over those almost 19 years of your life and I'm proud of my failures.  I'm so proud of you.  The first in the family to go to University.  The loving son and brother, who cares so deeply for his family.  I'm proud of your loyalty to your friends and your going for your dreams.

A self-indulgent letter no doubt, but when I see you… I see my firstborn baby in my arms and at my breast.  I know that I did something right.  My failure is my success.

Ask Me About Breastfeeding Twins (part 1)

Ask me about breastfeeding twins

That's one of the profile pictures on my Facebook page this week.  It is World Breastfeeding Awareness week (or World Normal Feeding Awareness Week as they say on Mothering Mutiples:Breastfeeding and Caring for Twins or More page )

So, I suppose I ought to respond as though I had been asked.

On a parenting forum I was called smug when a woman asked about breastfeeding twins because she'd heard nothing but horror stories.  I replied that it was much like feeding a singleton except that there were two babies, but fortunately we have two breasts.  A non twin mum jumped quickly up to call me smug and tell me that I had NO concept as to how hard breastfeeding twins was.  Sadly tone doesn't carry through the printed word and no one could 'hear' me smiling as I responded.  I have, of course, helped many women with breastfeeding their twin babies and nursed my own until they were 18 months old.  And I still believe that it is as simple as having two breasts.  Now fret not, I am not some kind of narrow-minded freak who doesn't recognise that there are sometimes difficulties in breastfeeding, be it twin or singleton.  I just believe that we should start with the premise that it is as simple as having two breasts and work from there.

So, let's start with healthy, term babies, the ones with no health issues.  Actually, I think we need to start some months prior to this.  I think (and remember these are my opinions) that breastfeeding twins starts with preparing ourselves to nurse them.  Almost from the moment people find out that they are pregnant with twins the naysayers appear.  "You'll never manage to feed twins, it's too much", "You won't have enough milk to breastfeed twins", "I never managed to exclusively breastfeed twins, don't feel bad that you need to use bottles", "No one can breastfeed twins".  This is the time to get yourself informed.  There are many places where you can get good information.   The National Breastfeeding organisations, like The Association of Breastfeeding Mothers, The NCT, The Breastfeeding Network, La Leche League all have helplines, websites and literature.  There are of course the various twin and multiple birth networks as well eg TAMBA and The Multiple Birth Foundation.  There are some wonderful websites full of information about breastfeeding like Dr Jack Newman, How Breastfeeding Works and Kelly Mom.  Of course the growth of social media has simply opened us up to more information (though do be careful about your sources as there are some out there who are simply in it to make a quick buck and their information can be downright dangerous).  I shall quickly name a few favourites, but this could take all day, so I really will just post a few. Dispelling Breastfeeding Myths, Mothering Multiples:Breastfeeding and Caring for Twins or More, Breastfeeding Basics, The Leaky B@@b, Best for Babes Foundation and Lakeshore Medical Breastfeeding Medicine Clinic.

A lack of understanding about breastfeeding and breastmilk tends to be the common denominator for discouraging twin mums when it comes to nursing.  I remember sitting with one of my clients after she had given birth to twins.  The first had fed beautifully and she was feeding the second.  A lady from the MBF (Multiple Births Foundation) came to see her and her opening words were not what either of us were expecting.  "Don't worry if you can't breastfeed twins, not many can.  I, myself, gave bottles.  It's good to get them started".  Fortunately my lady knew that she wanted to breastfeed and she had done her research and knew the key to producing enough milk for her daughters.  Feed, feed, feed according to their cues.

It may well be incredibly tiring, but that doesn't mean that you can't do it.  Get your support put into place.  Some twin mums swear by maternity nurses.  If this is a route you decide to take, make sure your MN knows how breastfeeding works.  I recently had a client who was relaxed and breastfeeding beautifully when I left her.  I went back a few weeks later after she had had a MN in.  She had been told that in order to have things 'work well' she needed to put the babies on a feeding schedule and breastfeeding was only encouraged 6 times a day.  Believe me, when you are a twin mum, some form of order is more than tempting.  Fortunately my lady knew that a lot of what she had been told to do wasn't helping.  Her milk supply didn't seem as good and her daughters were hungrier than they had been.  She recognised that it was the feeding schedule and went back to cue feeding.  

The same things that apply for nursing a singleton apply for nursing multiples, a few tweaks here and there perhaps, but the basic information about breastfeeding remains the same.

So, for now, assuming that your babies are/will be healthy newborns, put them to your skin and inhale the wonder of them.  Let them feed on cue and should there be any difficulties at all, get help immediately.  Often it's a simple issue, with an easy solution.  Use your helplines, call an IBCLC, call a Breastfeeding Counsellor, talk to experienced breastfeeding twin mums. Let your information be good and something that helps and not hinders you.

There is more to come, but for now let's start with two babies, two breasts.  You can do it!

Don't let them tell you birth's not beautiful

I recent read a story about the unassisted birth of undiagnosed twins.  Now this lady wasn't looking for an unassisted birth.  The babies were BBA (born before arrival) of the Midwife.  It was a planned homebirth and the mum simply trusted her body and her baby was born.

This reminded me of the two babies that I 'caught' in their homes.  Both mothers had planned hospital births.  These were first babies and both mothers wanted the 'safety' of hospital.  The first was insistent that her low pain level meant she would require an epidural, the second wanted to do everything to avoid an epidural as she had done her research and believed that she could do it.  The first laboured silently and had a slight change in demeanour and stance, the second roared throughout with an increase in roar and intensity moments before the baby was born.  What they both had in common was a faith and belief in their own bodies.

I find it sad that whenever there is an article, blog or news report of an unassisted birth, the first comments are instant 'doomsayers'.  "Ooh you are so lucky that there were no complications", "My baby would have died if that had happened to us".  There is no denying that there are times when life saving measures NEED to be taken, the clue being in LIFE SAVING.  Why is it wrong to glory in the beauty of birth?  Why can't women, mothers, pat themselves on the back and say "look at me.  I did it!"?  Mothering can be a thankless task at the best of times, so why can't we start our mothering careers with a quick "didn't I do well"?  None of this is about downplaying some one else's birth experience.  This is that moment of congratulation when Mum can look at herself and say "Wow but I was wondrously made, and look at what I was blessed enough to do".

There are many many horror stories about birth out there.  Many!  The oft trumpeted hospital birth having quite a few.  For those that have horror stories there is the birth trauma support group.  A healthy baby isn't the only outcome that we should look for at a birth.  We also need a happy, healthy mother.    What messages do we send to our daughters if we hold back the 'good' birth stories?  And when I say 'good birth stories', I don't just mean the unassisted births or the 'I just breathed and the baby came', I mean ALL the good birth stories.  The 'I laboured for hours and just when I thought I couldn't go on, I was holding my baby', the 'I had my baby in hospital and the MW was so hands off'.  I even mean the 'I knew the pros and cons, I chose to have an epidural and had a lovely birth',  and the 'I was induced and it happened quickly and easily'.  Funny how women are allowed to have THOSE birth stories and no one accuses them of passing judgement on others.  

One of my ladies (remote support) went to 43 weeks with her pregnancy.  It's not as uncommon as you might think, given the levels of inductions at 41+ weeks.  There are the horror stories of the doubling of the still birth rate.  Well who wouldn't run into hospital to be induced if they knew the risk of still birth was doubled!  But what do they mean by doubled? 0.3% to 0.6%.  Statistics. (Here's a quick look at some hospital statistics for birth and maternal health.)  We need to know what they are and what they mean in relation to us and our bodies and babies.  My lovely lady, S, wanted a homebirth.  Her pregnancy was normal.  There were no high risk indicators, both S and baby were doing fine.  As she passed her EDD (Estimated Due Date) the talk turned to induction. The risks began to be talked about.  The homebirth midwives began to say that they would not be able to come out to her if she went over 42 weeks.  Week 40 and her friends were beginning to become impatient.  "Haven't you had that baby yet?", "I can't wait to see that baby.  Why isn't it here yet?".  They began to suggest induction and ask if she was going to be induced.  Week 41 rolled up.  The homebirth midwives were crossing their fingers, but bound by hospital protocol, reminded S that she would have to go to hospital to give birth.  Week 42 appeared.  Mum and Dad were trusting her body and knew that their baby wasn't ready to be born.  The hospital told her that she would no longer be allowed to have a homebirth and that she would have to go in and have a hospital birth.  S asked simply to be monitored and, politely but firmly, told the hospital that her intention was to give birth at home.  With each monitoring appointment, all was clear that mum and baby were healthy and happy.  S, herself, was beginning to get impatient.  "What can I do to hurry this up?" she asked me.  "Wait!" I said.  "Okay, I'll continue with the monitoring and I'll wait".  Week 42 was coming to an end.  The external voices were getting louder "This is taking a really long time.  Are you allowed to be pregnant for so long?".  "Is this baby ever coming?".  S trusted her body.  The baby was moving nicely.  The monitoring still showed a healthy baby and mum.  Good, steady heartbeat.  Dad trusted Mum.  The hospital again told her that hospital protocol didn't allow for her to give birth at home.  When she, again politely and firmly, told that that she was staying home, they told her that they had a duty of care to provide a midwife, but that she had to come in to hospital.

Labour started slowly and moved slowly.  36 hours in and Dad called me for a chat.  What could they do to get things moving?  I replied "Lots of sex and laughter".   More waiting.  He told me that she was having difficulty using the bathroom.  I mentioned that perhaps the head was moving down and getting ready.  He replied "No, the contractions aren't regular enough and she only feels uncomfortable". And then suddenly she was in the birth pool, and then 8-9cm dilated.  Within a couple of hours she was holding her baby and Dad text to tell me that it was a beautiful birth, he remembered his role in encouraging her when it got harder for her at the end. When their daughter was born, the midwives agreed that there was no way this baby was overdue, but had come exactly when she was meant to.  

How different all of that might have been with the interventions.  36 hours of labour and not much seeming to happen?  Surely that's cause for syntocinon?  Surely she needs to have her waters broken?  Surely speed is needed to 'get the baby out'?  

It's time to begin loving women again.  Loving BEING a woman again.  Trusting in women's bodies again.  Celebrating the wonder that is a birthing mother.  

What's a guy to do?

I don't know how she told you.  Perhaps you came home and the table was set with a beautiful meal and wrapped in your napkin were a pair of knitted bootees (yes, clearly my mind is on a very old TV commercial).  Perhaps you were pacing outside a bathroom whilst she peed on a stick.  Perhaps she called you at work.  But now you know.  She's PREGNANT!

So, what do you do?  Run screaming for the hills?  Jump up and down in jubilation? Sit down with a stiff drink? Weep with joy?  Well it almost (note almost - the hills thing… not so good) doesn't matter what you think, say or do in that moment, but a top tip… let joy and jubilation be a major part of it! You're going to be a father.

How are you going to support your partner through this pregnancy?  And has your mind wandered towards the birth yet?  And then… oh yes… there's more.  What about when the baby is born?  Parenting!

Okay, one step at a time.  Pregnancy!

There is a temptation to Google and to Google a lot!  Try not to give in to it.  Find some good research based evidence.  And when you talk about birth and labour, try not to listen to the 'horror' stories.  Tell those people that you would love to hear their stories, but not until you have one of your own to share.  The guy at work will have lots to share.  You might not want to hear it all.

She may or may not have 'cravings' or like me.. just go off things.  It might involve the odd midnight dash to that particular bakery/deli/burger bar/bagel shop.  She may eat things that you never want to remember her eating.  Go with the flow my friend.  Make sure she eats, drinks and rests during her pregnancy.  She's not ill, but her body is working hard.

Don't ignore the antenatal classes.  Choose them together.  Go to one that keeps men in the breastfeeding sessions.  You need to know so that you can support her and be her gatekeeper.

Next step.  Birth!

It’s not as easy as it sounds.  Sometimes you'll need to step up and get on with the job at hand and not think about how squeamish you may or may not feel.   Sometimes people say “Well it’s not as if he had to do anything” but let’s think about what you do.  It’s a big job.  It can affect you physically and emotionally.  Whilst Mum is labouring away and not wanting to eat (and Mum should eat) you might feel that you can’t or shouldn’t.  Big mistake.  No one wants a partner who has passed out due to exhaustion and lack of food and water.  Be sure to look after your own needs (remember the oxygen on the aeroplane analogy).  Eat, drink, go to the bathroom.  Oh and when you eat, her sense of smell is heightened, be wise with your food choices.

Then she will want you to massage her, to touch her, to hug her, to kiss her and as you lean in and your hands make contact with her body she may wrench away from you and ask you in no uncertain terms what the hell you think you’re doing!  When she wants a massage you may feel that you’re tired, you just need a rest, but you know she needs you so you press on.  Then she tells you to stop and leave her alone and now you feel rejected.  Take it on a moment by moment basis.  It’s nothing personal.  What she appreciates most is your presence.  Your partner's strength during labour may surprise you, but you may also be confused by some of her reactions, which can include despair, irritability and even hostility. Keep your sense of humour but check your ego in at the door!

So what happens if she gets to place where she feels she can’t go on? 

Look her in the eye. This may help her refocus.  She’ll know that you care and that you are committed to this.  Keep your talking/jokes etc to a minimum.  Let her go into herself and into her “zone”.  Remember the thinking part of the brain closes off during labour and it becomes an instinctual, primeval thing.  A nice firm touch or massage, maybe a hug show her love and can warm her up if she’s cold and shivering.  When she gets to the point where she thinks she can't do any more, tell her you love her and you're proud of her and how amazing she is.  It's hard because all you may want to do is to grab as much pain relief for her as possible.

And the next step?  I'm going to talk about the days after the birth.

This is where you will come into your own. The Midwife will only come to visit a few times. The phone will ring, almost incessantly, as friends and family want to share your joy. But this is your time to allow yourselves to become a new family. Take time to make sure your partner goes back to bed. Make sure she is fed and watered. She will be tired and so food may not be something she thinks about too often.

She has done an amazing thing and your family has increased. Take time to enjoy them, but remember to look after yourself as well.  Send her to bed as often as you can. When the baby sleeps, she should sleep. new parents often worry about what will happen to the baby whilst they sleep. So, after sending Mum to bed, spend time holding your baby, or simply watching your baby sleep. Week six seems to be the peak of tiredness postnatally. If you ensure her to rest in the beginning, she is less likely to fall into total exhaustion. Encourage her to bank her rest. Make no decisions in the middle of the night.  

You are your family's gatekeeper. You may want to consider leaving a message on the answer phone letting people know that all is well and that you will call them back in a few days. Perhaps you might ask relatives to put off their visits until you have found your feet as a family. You can ask that family and friends bring food and tidy or take away the dishes. It's also worth considering having an" open afternoon/evening" where you invite everyone around for a couple of hours and lock the door behind them afterwards (don't forget to have someone on tidy up duty). Then when they are all gone, turn the phones off and go to bed.  Remember what you learned in the Breastfeeding class.  Encourage your partner, especially in the middle of the night when she's at her most vulnerable. Know when to call for help. Keep that list of breastfeeding support lines and Lactation Consultants in your phone and on the fridge. Whenever she sits down to nurse the baby(ies) make sure she has water. Put a plate of snacks beside her Massage her shoulders, tell her what a wonderful job she is doing. Protect her from anyone who tells her she can't do it, including your mothers.

As to the parenting... well only you two know how you want to raise your children. Everyone will have theories but only you two will know what works for you too. Look to your instincts.

Keeping abreast of the matter

I want to talk about a view boys have of breasts and how I feel it affects breastfeeding!  

This example that I'm about to share contains language I wouldn't ordinarily use, but in order for the story to sound 'right', I've had to keep the original phrase.

I read a story on a parenting forum about a woman breastfeeding in the local coffee shop.  There were many breastfeeding mums in that day.  Two young lads walked in and the first said, "Blimey mate, look at all them tits", to which the second lad said "Don't be silly mate, them's feeding tits, not w***ing tits'.

Now I've been thinking about this a lot just recently.  I have an 18 year old son (Number One Son) and a 7 year old son (Wee Weapon 2/Boy Child).  Getting Number One Son to 18 has been no easy task.  We have had talks about sex, pornography and all the relevant in between conversations.  So as you can imagine boys and breasts are something that I'm relatively familiar with and it seems to me that for some, the whole breast issue is a minefield.

I was out to dinner with some friends when one of them told me that she was concerned about the images that her son was seeing on my Facebook page.  Now as far as I remember, I had no nude shots on it and I'm reasonably sure that there are no "ooh drunken Doula not on call" shots.  Her concern was the amount of breasts that her 15 year old son was seeing on my page.  Now I've looked through my page/my wall/my links etc etc and I don't see anything perverted there.  And so of course the initial story flew back into my  head.  

There are a lot of sexual images out there for young boys (yes, I'm aware of the imagery for girls, but at the moment I'm talking boys… oh man, I'm going to have to write again on the subject of girls.  I have three girls!).  Young boys, old boys, men, all of us, have breasts thrust at us from every angle.  Want to advertise a car?  A nice buxom woman reclining on the bonnet should do the trick.  Want to advertise perfume?  Let's have a beautiful  young woman strip as she walks towards the camera.  Want to advertise aftershave?  A couple of squirts and women will throw their clothes off.  At least the Wonderbra ad was advertising bras and so one might reasonably expect to see bosoms.  Perhaps the "Hello boys" was little more than an invitation to 'dive right in' but hey, if we're going to advertise women's products to women, we must make sure that they will become more attractive to men.  And so, our little boys grow up knowing that 'tits and arse' are what they should expect and the idea that a woman's breasts might not primarily be there for a man's pleasure comes as a bit of a shock.  

Facebook, of course, does not help here.  Pretty much every day another account and/or page is deleted for 'obscene imagery'.  Pole dancing is fine.  Breast enlargement is fine.  In fact pretty much every image of breasts is fine until there is a baby nursing from them.  Comments from Joe Public aren't always good/kind/helpful.  Shock horror reverberates through people when they realise that a baby is about to be or is being fed.  Summer will be interesting.  All the spaghetti tops will be out, the low hips, low necklines and highly visible breasts.  There will be many photos on Facebook that will cause excitement and pleasure.  But a feeding baby, well that's really rather disgusting.  Imagine using the breasts as they were intended.  Feeding tits!

One of my very lovely twin mums

When Doula-lly went Dou-la-la!

There's a blog that I've been enjoying and she asked if I wanted to do a guest blog for her.  Well of course you know how much I have to say.  So I wasn't going to say no now was I? 


The blog is Dou-la-la and here is my guest post.  Once you've finished with that, why not browse through her blog and see what she has to say.  It's well worth it.


Happy Saturday people!