Aaron and Sean are 5 weeks old, although my due date is a week away. Thought I would do a little assessment of how breastfeeding is going this far. This post probably won't be of much interest to most but I wanted to write it anyway. Breastfeeding was something that I really wanted to do with all my children. It wasn't a realistic possibility with Marcus and Will (although breastfeeding adopted children can be done). Breastfeeding was the only thing I really feel I was not able to accomplish with my first two kids. I never regretted not being pregnant and never felt that any other aspect of parenting was missed through the adoption, but just always wanted to experience breastfeeding.
From the second I found out we would be expecting twins, I knew my plan needed to be revised. Mainly, I just knew I needed to be flexible in my expectations. I found it to be more important than ever to determine my priorities and work with them. As huge of a priority as it was to breastfeed, the even bigger priority was to maintain my sanity. Preemies, the NICU, and The Early Weeks
From the moment Aaron and Sean came into this world, the ideal breastfeeding situation with them was compromised. I wanted to avoid formula and artificial nipples, but Sean and Aaron were small, born early, and taken to the NICU. I started pumping just a few hours after they were born but they needed to get calories into their little bodies and all I had to offer were a few drops of colostrum (which they got). I was so sick I wasn't even with my babies for their first feeding. The entire time Sean and Aaron were in the NICU, I pumped with a hospital grade pump 8-9 times a day around the clock, a very exhausting task. The convenience that we were hoping would accompany breastfeeding certainly wasn't there. I was finally able to put Aaron to the breast when he was 5 days old. Sean was put to breast at 6 days old. At that point, neither of them were doing very good at eating from a bottle and Aaron in particular had a very weak suck reflex. From that point on, I tried to put them to breast at least once a day until they were released. Sometimes that meant attempting breastfeeding twice a day and sometimes it meant not at all. It always meant topping them off with formula or expressed breast milk after to make sure they were getting the calories they needed. The nurses in the NICU were a wealth of knowledge and helped me daily. I met with a lactation consultant while I was there that gave me some good advice as well.Sean
One piece of advice I got - maybe from a book I read from pregnant - was that every baby will have a unique nursing experience with his or her mother. Having multiples means developing those different relationships at the same time. Sean is the larger twin. In the NICU, he did better at bottle feeds and only required a feeding tube for about 24 hours. He picked up on nursing fairly quickly and easily and by the time he was released, he began to refuse the bottle after breastfeeding. He came home. We tried breastfeeding. He was good to go. During the first 48 hours he was home, he was given 2 oz of formula and hasn't had any formula or a bottle since. Eating is his favorite thing.Aaron
Eating has always been a challenge for Aaron. By day two of his stay in the NICU, he used a feeding tube to take the majority of his feedings. It wasn't until about 3 days before he was released that the tube was removed. Due to his size and his prematurity, he just wasn't a good sucker. He still isn't breastfeeding full time. He has made some strides and is certainly more enthusiastic about trying than he was. He has a shallow latch that doesn't stimulate the release of milk very well. He does better when I'm tandem feeding and Sean helps the milk letdown. In an ideal world, he would be getting nothing but breast milk. However, I am committed to keeping my sanity. I can squeeze in 3-4 pumping sessions a day without losing my mind so that is all I do. Depending on how much I produce, how hungry he is, and how well he does at nursing on a particular day, there are starting to be more and more days when all he gets is breast milk. Other days, he ends up with up to 4 oz of formula. I'm okay with this because I know that we are getting there. Aaron is 5 lbs 3 oz now. He isn't even supposed to be born yet. It takes the average baby 6 weeks to really catch on to breastfeeding so we still have many weeks to go before he can really be considered to be having real issues with breastfeeding. He is growing and developing and it is still a work in process.Tandem Nursing
Most of the time I nurse both babies at the same time. (This was hilarious the first time I did it. So much for keeping my sanity because it just seemed insane!) I feel like I spend most of my day nursing as it is, so doubling that time by nursing them separately is not desirable. I do nurse them apart when we have company because there is no way I can figure out how to do it discretely. For the most part, if one baby is hungry, they both eat. I do feed them apart if one kid or the other decides he wants to eat again shortly after already being fed. Overnight, Greg feeds Aaron bottles of expressed milk (or sometimes formula). While I breastfeed Sean on one side at night, I pump the other side. Once again, having Greg help with night feedings saves my sanity. I'm already tired and don't have to worry if Aaron is eating enough or not. Greg gets a chance to help out with feedings that way too. Until Aaron is much better at nursing, I doubt I'll be switching to tandem nursing at night. Nipple Shield
Both Aaron and Sean use a nipple shield to nurse for most feedings. Both of them will latch without it but usually refuse to continue to nurse until I put it on about halfway through the session. I only work on this slow weaning process from the nipple shield when I am nursing each baby separately. I tried it once while tandem nursing but they kept coming unlatched and it was frustrating to all of us. I don't mind using the nipple shield. The list of pros is far longer than the list of cons. The only real con is always having to make sure I have the shields with me. Not a huge con at this point since I don't really go anywhere.Frequency
All the nursing literature stresses the importance of feeding on demand. While in the NICU, Sean and Aaron were fed on a strict 3 hour schedule. Three hours is a long time for a breastfed newborn to go between feedings. Sean and Aaron were used to the schedule though and rarely ask to be fed more frequently than every 3 hours. Yesterday I thought I would try something different and it worked out great. I still fed them on demand, but if they didn't ask, I woke them up every 2.5 hours to eat anyway. It is more predictable when they are going to eat. Also, they aren't starving by the time they get a chance to eat. The normal feeding process involves changing one baby, laying him down to scream bloody murder because he wants to eat, while I change the second baby. Waking them up to feed them means they aren't as hungry and angry when they have to wait for me to change the diaper of the second kid. Sometimes they do decide they want to eat after an hour and they still get fed then. Feeding them a little more frequently also gives me a little more confidence that they are getting enough to eat to sustain their little bodies. At night time they will go for one 4 hour stretch between feedings and we don't mess with that. Hey, gotta keep our sanity by getting a little sleep too!
In conclusion, breastfeeding is going great. It is still a work in progress. It would be nice if all our challenges were behind us, but that isn't how life works. No matter how you choose to feed your baby, it is a learning process. I'm glad to report that we are all learning slowly but surely and hopefully have a bright breastfeeding relationship ahead of us.