breast feeding, pumping, confused..

[kayra]

So, BF didn't work with DS. In hindsight I think we may have mis-read some signs, panicked the yield seemed so little, he seemed hungry all the time and then we discovered crystalised urine in his nappy. Because I'd had breast reduction surgery 2 years prior to the birth we assumed it must be related and figured it just wasn't going to work out (together with just being overwhelmed by everything, trouble with his umbilical cord drying off, circumcision...it was a chaotic and hard time). So I ended up pumping precious little and topping up with formula, and it was actually fine.

Now..I would like to give BF another shot, obviously with twins that makes it a bit more daunting but I still do really want to try. I've been reading/researching loads and it seems with so much time since the surgery the chances of the ducts, nerves etc. being in better condition are much higher. So here's the bit I'm confused about: On various sites, including a LLL site, it says that pumping after you've BF will increase the demand and so in the first 3 weeks it's vital to empty the breast as much as possible so that you are producing more milk. For this they advise renting a hospital style pump as opposed to the more regular hand or electric pumps. I've looked into that and you can rent such pumps for a reasonable price. So I thought I was all set.
Then today I was talking with some mum friends, and 1 of them mentioned how that is what she did with their first child and BF ended up being disastrous, but that second time round she didn't do that and let the baby just suck all the time and it's been fine (having said that it seems the baby practically was stuck to her for most of the 1st year...). And another mum agreed saying that a babies sucking is much more effective than pumping. Oh and they said that in the book they have it advises not to pump or bottle feed for the first 40 days.
So I'm totally confused. I hated pumping but figured that if it was going to increase my supply I'd be willing to do it the first month till it's mostly established. But now I'm worried that I'd actually complicate things by doing that...? Although I hated pumping like I said, I don't like the idea of 2 babies stuck to my breast the whole time either not to mention I don't want to become a dummy, want them to learn to sleep independently etc..
So, what is the right way? to pump or not to pump to increase supply?

[juliana.s.burgess]

Hi there!

I have a 15 week old and had to go to a lactation consultant for the first 6 weeks this is what I learned. If you NEED to increase your supply for some reason, you can pump after nursing. But if you are nursing, your body will naturally produce exactly what the baby needs, so you shouldn't need to pump extra.  If you pump too much, your body can over-produce.  My sister ran into that problem because she pumped during the first month way too much.  Over-supply is a terrible place to be, so I don't recommend pumping extra unless you are not producing enough naturally on your own. Hope that helps!   

[becj86]

I was pumping a lot in the early days because I'd had a c-section and no contractions prior so they were concerned my milk would be slow to come in. I had massive oversupply issues but I was able to fix those once I found out  why L wasn't gaining. Yes, it's challenging but if you manage it, it with work out in the wash.

It depends a little on what you want to do. Do you want to build a stash of frozen milk so they can be fed by DH/DS while you take a break from time to time?  Extra milk can also help as you go through growth spurts and topping off before bedtime/dream feeds with the bottle can make things easier at night. My friend BF'd twins and said it was tricky and felt a bit prison-like to bit sitting down with one baby on each breast, so it might even be nice to alternately BF one and have someone else bottle feed the other EBM if you can.

[kayra]

thanks!
I think if I hadn't had 'issues' with DS I wouldn't be thinking about pumping, but now i'm thinking that it's likely that i'll need to encourage my supply, so to speak, of course it's impossible to know. With twins if they're small sucking might be an issue in which case I can see how pumping would be useful, but yes I wouldn't want to overproduce, wouldn't that be ironic
Bec I must confess I don't mind the idea of getting some help, when DS was on formula it was so nice for DH to be able to stay up for the midnight feed or for others to take turn at church etc. I can't imagine 2 being stuck at the breast all the time! I suppose my concern is will it work...it would be the perfect scenario if both would take the breast and bottle and I could alternate both!
Has anyone had experience where pumping messed things up somehow? Bec did you have too much supply because you were pumping unnecessarily?
Also I heard that once the breast is empty it takes 4 hrs for it to fill up again so if I was really emptying the breast after a feed that would be bad wouldn't it since they need to feed regularly at the beginning?

[becj86]

This is where starting as you mean to go on is important yes, there are babies who won't take a bottle. DS took both from any early age. His first feed was from a bottle because I was unconscious. He then was EBF for a while there, then he had a little bit of formula to top off between BFs when I had some issues.

I think the OS was partly from pumping and partly genetic. Mum had a massive OS too, never did anything about it though... I pumped in hospital, partly because of the worries about my milk coming in but also because my breasts were bigger than DS' head LOL and he had troubles latching to my flat nipples. As my milk came in, it was worse because I was engorged. After a week or so, I had to express when I lost a piece of my nipple - L had a shallow latch from the overactive letdown and it ripped at every feed. You can down-regulate supply by block feeding or pump off the extra for later. Some even use a stash of milk for adding to solids in the initial stages of introducing solids.

In the early days (months) of BFing, you make milk constantly and as your milk supply regulates, you'll find you make milk on routine with when LO's are feeding. I used to fill up every 4hr for a while there, because L fed every 4hr. About 20min before a feed, I'd know it was nearly feed time because my breasts would get bigger and I'd start to leak.

[shivi]

Hi Kayra

I pumped twice a day, first and second feed of the day, from when O was about 2 weeks old. I wanted to build up a stash for DF and for going back to work at 4 mths. I never seemed to have OS/OAL issues with him and he coped really well with breast to bottle and back again. He did self wean very suddenly and quickly but I think this was due to me not being around all day for little sips at 1 yr plus, as Emma did the same and was never fed by bottle really...

So, worked fine with him.

With Emma, I started with the same plan in mind but she was a very erratic, frantic feeder and what I had pumped I had to use every evening to settle her for bedtime rather than DF as otherwise, she was a little mess! So DF was from the breast, bottle of ebm was 7-7,30 pm after unsuccessful breastfeed. I started to pump at this time, once she was in bed to try and improve things and from around 8-9 weeks, I was able to ditch the pump and the bottle altogether and though I went back to work at 7mths, she never took a bottle.
Also, even without pumping, I was in awful OS/OAL territory with her. I think its easier to get there 2nd time around and when there's some emotional issues - low weight gain or weight loss in Es case as well as a tongue tie they refused to clip - my body went into overdrive very very easily...

With twins, I would be prepared to pump and have that hosp grade pump ready for sure as they are probably going to be smaller, with weaker sucks etc.
My friend had triplets and managed to bottle feed them only EBM for the first 2-3 months (they were so teeny that they were tube fed her colostrum and early milk to begin with) and then she mix fed bm and formula till they were a year old  - all from bottles....but she had her mum living with her, her DH at home also fulltime as friend was the main earner and she got great mat leave as they were born in July (hol time so she didn't start mat leave till Sept) and she was off till May fully paid, then came back to work for 5 hrs a day and pumped for probably an hour of that (2 half hour breaks) as here you get one hr off for breastfeeding per child so she worked three hours less till the summer hols! She was amazing but she says she'd never have been able to do it without the support of her mum and DH. Her kids (two girls, identical twins and one boy) are now 8.5yrs old and doing so well!

S x

as for filling and emptying, your breasts are never truly empty but just resting. Emptying or pumping the breasts until no more comes out is the 2nd most effective way of increasing milk supply after a very good, well latched, human feeder. THe feedback mechanism is  - breast was completely emptied, more milk needed.

[kayra]

bec so sorry to hear about your nipple, that must have been so hard!!! My breasts were so big too with DS and my aerola is huge for some reason so I think that was an issue for DS latching on too, tried a nipple shield but made no difference.
I must say that it's encouraging that for both bec and Shiv your babies took breast and bottle, actually DS was like that too, if it wasn't his feed time yet but he was fussing I'd let him suck at my breast a bit knowing there wasn't much there and he was happy to.
Shiv like you said with twins I am anxious that they won't have a strong suck, so although this friend swears by this book which doesn't advocate pumping initially I think I will have that hospital grade pump standing by.
Triplets-I can't imagine! What a blessing that her circumstances worked out so perfectly!

So say I feed and then pump for 15min whatever, next feed time do I try the breast or just assume there's nothing there yet and give them what I pumped?

[*Ali*]

Offer the breast.  If you give what was pumped it won't signal your body to make the extra.  Pumping will only increase your supply significantly if it is over and above what you feed from the breast.

I wound be fully prepared but bear in mind you may have no time or energy for pumping with twins and another child. 

[Bestbees]

Hi!

I bf my twins with one bottle a of ff a day. It was a seriously hard start, but soooo worth it. I found pumping a practical impossibility with two babies, I had no time, also it made me miserable as I could only ever get a tiny amount and this made me paranoid!
The boys did have slow weight gain but I was always told this was fairly normal for twins and bf ones at that.

I now find that one bottle a day waaaay more effort than the bf. I wish I hadn't introduced it really!

Overall let the babies be on your boobs all the time. If I am honest the whole easy thing was of no use to be until they were five months as before that I mostly fed fed and fed. But that doesn't mean you will be like that! I guess what I am saying is follow their lead, accept that you might have to feed more frequently than with singletons and make sure you have some good local support.feel free to pm me any questions.

Good luck!

Bb x

[Bestbees]

Also the thing about four hours to fill up is NONSENSE a breast is NeVER empty. Sure the flow will ebb and flow but it will continue to produce continually. Check out Kelly mom website.
X

[becj86]

I found when he was still tiny, L latched better if I'd pumped a little off so I wasn't so engorged and the nipple *could* stretch. Also google biological nurturing - the laid back approach worked better for me than worrying about all the mechanics of a good latch that I'd been taught.

If you're going to pump, make sure you get the right size flange and get an LC to check it's working properly. I struggled when I got my pump after I went home because the flange wasn't big enough and it did more damage to an already torn nipple. Ended up having to hand express to let it heal.

You want to be feeding from the breast as much as you can, babies are more effective at getting the milk out than a pump is, so the supply should keep up with demand better than just pumping. Like Ali said, be prepared that pumping could be too much when juggling twins. I know for me, I would feed L,then put him in the bouncer and sing to him while I pumped -  that kept him upright for a while after a feed too, which helped because if his tummy was squashed, he'd lose his feed all over himself. Pumping and feeding was tough with just one baby.

[kayra]

Pumping will only increase your supply significantly if it is over and above what you feed from the breast.

sorry I'm not sure I understand what you mean by this..?
But you're right pumping with twins could be wishful thinking-like I said I HATED pumping with DS, I'm just thinking that if I do have supply issues and if this will help till the milk flow is established it might be worth it rather than resorting to formula iyswim. DS will mostly be at school so that won't be a big problem but I realised that just twins in itself is going to knock me out....
bestbees so you give 1 bottle of formula a day? Is there a reason you're not stopping that if it's so much effort?

Overall let the babies be on your boobs all the time. If I am honest the whole easy thing was of no use to be until they were five months as before that I mostly fed fed and fed.

See I can't imagine that..I'd go crazy. I will have some support but not THAT much, if I felt that that was how it was going to be I'd switch to formula or a mix or something...
Sorry I'm not trying to be difficult, I really appreciate all the input, like I said I'm just confused and can't envision at all what it's going to be like having had a hard time BF with DS and this time being twins...
posted with you Bec, is biological nurturing when you sit kind of upright and let the baby find the nipple? I've seen a video about that, not sure how it would work with twins.??
I've found some info about a LC that can do homevisits after the birth but i'm wondering if she'd do consulting before as well, i need to look into it.
Bec when you say pumped a bit so that you weren't so engorged was that just before the feed or was the pumping you did after the feed sufficient to keep you less engorged for the next feed?

[*Ali*]

Sorry I meant if you pump and then give that milk to the baby it is not telling your body it is extra milk that is required. E.g. You pump 100ml and then give that 100ml to your baby at the next feed your body thinks you need 100ml. If you pump 100ml and then the baby takes another 100ml directly from the breasts at the next feed your body thinks you need 200ml and that is what it will make for future feeds. I hope that makes more sense.

And I agree with bestbees, there is no fixed time for your breast to fill up. They will fill up quicker the more frequently you empty them.

[becj86]

http://www.nursingnurture.com/positions-for-breastfeeding-twins/

At the heart of biological nurturing is letting LO find the nipple and latch on their own rather than holding the breast just so, holding baby like this, hoping LO opens mouth just right and trying to get enough breast into the mouth before it closes...

The pumping after a feed will increase production and increase the engorgement because there's more milk being made. Once I got myself sorted out, I found I could tuck a container in one side of my bra, hand express the other side, catch both letdowns and then let L feed. Once practiced, I could do that in a couple of minutes. Tough if they want feeding immediately though, I used to do that when I heard him stir and I'd be ready to feed when he cried for me.

[Bestbees]

I can obviously only draw from my experience but I do know women who fed twins on a schedule. Find your local twin group and discuss with them.

I had someone with me for the first five weeks. After that I was on my own. Howvever dh would make me packed lunch!

I would say bf twins was a full time job for first three months! So, if you feel it is too much why not just aim for two weeks? A bit is better than none. I recommend mothering multiples by la leche league.


I do a mix of tandem and individual feeding. At night I recline an they lie across my body.

Good luck
Xx

[kayra]

I understand now Ali, thanks, so what I pumped I'd freeze and use once the milk supply is established?

thanks for the link Bec, i'd only heard of the football clutch for twins so it's nice to see alternatives! Hand expressing a bit to make the nipple more flexible before the feed makes sense, I'll keep that in mind.
Bestbees I definitely appreciate hearing your experience, I hope I didn't sound like I didn't. Unfortunately finding a twin support group kind of a thing here is close to impossible, we don't really have those kind of things and the attitude is mostly Twins, C section for sure, bottle feed for sure, get paid help for sure...I'll definitely look into the book you mentioned, I've been searching for a good book on twins but haven't been able to decide by looking at reviews.

[Bestbees]

Just looked at where you are, I loved Istanbul when I visited a few years a go. So beautiful. Good luck with your babies and follow what is best for you.
Xx

[kayra]

thanks, let me know if you visit again

[*Ali*]

Or if you. Give the milk at BT or DF that night for example just make sure you pump as well/while they are feeding so your body is not missing a feed.

[louis-mummy]

Hi kayra 

I think if you hated pumping last time then I wouldn't plan at this stage to do it again, but I understand your worries about supply considering the reduction op....Ideally i would start bf and let your supply establish and see how it goes, you might be pleasantly surprised, do you definitely want that option for someone else to be able to bottle feed them? (twins are bound to be demanding on a whole new level!) or is it your supply you're worried about?

I have a friend who mixed fed her twins past the first year and it worked for her as she knew when her DH would be around to help with bottles but tended to bf when she was on her own with them both. She didn't seem to worry about supply/demand too much (prob too tired to keep track anyway) so if she'd bf them both 'a lot' that day (fed on demand) then she would give them extra bottle if they still seemed hungry. This is not textbook bf advice though, just a case of finding what worked, they had been prem and had reflux so the rules go out of the window 

[kayra]

I don't know
Initially I wasn't planning to pump, then when I read that it would help with the supply I thought maybe I should. Someone else feeding with the bottle wasn't my initial motivation but a sort of side-bonus.
However pumping during the day is one thing, having to pump at night is another, I just couldn't do that.
I read loads of the nursing nurture site last night and there it says that actually during the night esp. it's so much easier to BF because you can doze while feeding too and that that way you don't really have to wake the other to feed too when one wakes (which is what everyone else says you should do), you just kind of alternate babies in the night. (of course this is assuming they don't need a nappy change etc).
Ideally my milk would just come in nicely and I'd only pump if there seemed too much rather than with the stress of trying to make more milk.
Taking it as it comes is probably what I should do, it just goes against my grain of wanting to have a plan in place and being ready. So maybe I just need A, B, C plans. Like have a pump on the ready but don't use it initially work on BF, hand express before the feed if nipples are too flat. Try different positions, see what works. B plan, if supply does seem to be an issue start pumping. or C plan if BF 2 at the same time is just too overwhelming pump so 1 can be bottlefed and try to alternate... does that make sense?
I asked about the lactation consultant and it's roughly 80£ for 1 visit you can choose whether it's pre or post birth. To me it would make so much more sense if it was a 1 pre 1 post sort of package, don't know if it's worth going down that route, not sure i'm going to get any great revelations that haven't been mentioned here or on other nursing websites..

[*Ali*]

I would actually get the LC to come in the first week after birth. There is nothing better than having her observe an actual feed IMO.

[koe2moe]

Hi Kayra

I also think that LC after births and be prepared to have her there for a few days in a row after birth would help more than pre. 

I did exclusively expressing for 5.5 months.  It was awful for me and my body but I was grateful that I could do that.  I think the plans you have in place are great.  No panic at the spot when things don't work one way or another.  Remember that as little or as much as the babies could get at the first days is already GREAT for their little growing bodies.  Put your own health first so that you can care for them.  Try with positive outlook and accept the outcome as it comes. 

Write these plans down so that others can just look at them and remind you or help you when you are exhausted/stressed.  xx

[kayra]

yes i'll need to keep an open mind about the LC coming in the first week after birth, I didn't get the impression I'd need to book in advance so shouldn't be a problem.
Writing the plans down is a good idea too, I should do that.
I'm feeling a bit more relaxed now, I think I was worrying myself into a frenzy and obviously getting ahead of myself b/c there's only so much you can plan ahead... I don't want anything to take away from the joy of these 2 lives we've so longed for.

[Erin M]

I'd look for a good nursing pillow for twins too -- the twin mommies I know who nursed swore by them .

[nona]

your plan sounds good to me:)

you def want to have a pump, just in case.  if the babies need to be in NICU for some reason, then you will have it. with DS, who I BF for 13 months, i did need to use the pump a few times on a boob that i had a nursing blister early on (in week 2 or 3?(. BUT, you don't need to worry about using after BFing unless you have a supply issues…but you won't know that until after the babies come.

also, you will BFing a lot so my hunch is that you won't need to worry about supply!

also, my DS was a c/s baby and my milk came in no problem.

even with the age difference, nursing DD was much easier and only took about a week to get the kinks worked out.

don't stress too much about this…take it day by day….let your instincts help you….def hire a respectable LC to have in that first week. is there a BFIng class you take before you deliver? we have those as well as L&D class.

btw, my DH's sister had twins and she BF them both and gave bottles as needed when she started working.

[kayra]

a friend has a pillow she's going to give me, called breastfriend or something? I don't think it's twin specific though..I'll need to look into that, I never had a pillow with DS.
I just heard about some LCs in training so I'm thinking of contacting them, I'm assuming they'd charge less since they aren't certified yet so I could afford to have someone come more than once, I don't think that just 1 time would be enough. A specialised sort of BF class would most likely be quite expensive, before DS I participated in a general 'getting ready for a baby' kind of class the hospital sponsored but it was very general and didn't really give any more info about BF than I'd already read about.

[koe2moe]

I would just skip the class. They would only give you very generalised information.  I think you can get that from a book.  Keep some reserve funds for a good experienced LC.  (Ask around if someone can refer you from their experience.)  Some people in training are very good, some people with many years experience can be crap.  Try not to go by the price only. 

I understand now why BF was a no go for me.  It was my body.  When I had to look down, my body stiffened.  Doing that so many times to get a latch, etc, drained me and got me extremely frustrated and with lots of muscle ache.  I wish I had known this.  Perhaps try practice those positions.  Everyone is unique.  You are generally healthy, so perhaps those don't apply to you at all.  Just throwing it out there to help you prepare.  xx 

[Sezzle]

I expressed for my twins for 3 months while they were in nicu (premature, born at 25 weeks) then managed to establish breastfeeding and ended up continuing until they self weaned at 2.5 years  .

I did have oversupply related to my expressing while they were tube fed, as I was so concerned that I wouldn't have enough milk for them when they needed it that I pumped and pumped and pumped massive volumes, way too much for 2 babies lol!  It took about another 3 months after breastfeeding was established for my supply to settle down enough to get rid of the pump.

I think being prepared and having some plans of action is a great idea, but for me the decisions were taken out of my hands and expressing was my option.  My twins fed 4 hourly around the clock upon discharge, and took about 1:45-2hrs to breastfeed them both (I fed individually rather than twin feed due to reflux and them constantly needing reattaching), and would often express before and/or after due to my oversupply and also to add to the stash in the freezer.  Hard work!!  But totally worth it.  Once they were older I used the "my breast friend" twin feeding pillow and it cut down the time spent feeding dramatically!

I was lucky to have support in Australia from the Australian Breastfeeding Association and Australian Multiple Birth Association. 

Wishing you all the best, it's great that you are doing lots of research and preparing yourself!  Being a twin mummy is awesome!

[kayra]

oh my gosh Sezzle, 25 weeks! they must have been barely over half a kilo each, bless you! Thrilled to hear that they made it and thrived, amazing
Yes, so much is out of our hands, so its good to have a plan but be flexible, thanks so much for your input, it's nice to see more twin mummies here

[nona]

Kayra do you know the sex of the babies yet?

[kayra]

nope, next wednesday hopefully!

[koe2moe]

How exciting!! 

[louis-mummy]

Kayra do you know the sex of the babies yet?

I was also wondering this! very excited for you!
Hope to see a happy update from you next week then!

[louis-mummy]

I plan on using my Brest friend again, especially in the early weeks when baby is learning and needs a lot of holding in position and reattaching. I think it became redundant after 10 weeks or so. But it is brilliant. I answered the front door to my MW with O still attached, when he was a few days old, which would have been impossible otherwise as I needed 2 hands on him at that stage

Success stories are invaluable, prem reflux twin success stories are even more inspiring! 

[nona]

i used a breast friend pillow too - good to know they make one for twins!

[kayra]

not sure that i'm getting the twin version, a friend said she had one for me so i wasn't sure if it's the one she used or she's found it from someone else or bought one....we'll see.
I corresponded with the LC in training and she was very nice and said she could offer peer to peer support, no charge. So I could probably email with her, possibly meet up and chat, but don't think I could ask her to come over after the birth or something, feels like taking advantage of her though she was very sweet overall. we'll see. in the meanwhile i'll research what services the hospital i'm likely to give birth in offers. It's the reduction thing which I feel throws a spanner in everything, it may be unrelated (when i talked to the dr who did it, when DS was born, he didn't seem to think it was related to that and kept going on about my stress levels-which of course really helped my stress levels ) but it's always a niggling thought. And I think I feel slightly embarrassed about it when I have to mention it to a LC.

I am excited about wednesday DS then wants to have meetings about name choosing but he does have some rather strange suggestions so not sure how we're going to navigate that!

[nona]

And I think I feel slightly embarrassed about it when I have to mention it to a LC.

about having a breast reduction? LC are the experts in all things breasts related. i'm sure you are not the only one who wants to BF who has a breast reduction?

i hope you are not getting too stressed about this….yea it will be great if you can BF the twins but it is fine if you don't!

[kayra]

Quote from: kayra on January 24, 2014, 07:08:35 AM
And I think I feel slightly embarrassed about it when I have to mention it to a LC.

about having a breast reduction?

I guess, I don't know it's just another thing to have to explain I suppose, but it's silly I know and noone I've spoken to (about BF) has ever made me feel embarrassed about it.
I'm not too stressed at present, I was, mainly because I was just confused about whether pumping was good or not, but I'm doing better now, there's a rough plan and like you said if it does come to formula it's not the end of the world, DS was FF and was absolutely fine, not having the expense would be nice but we'll figure it out if it comes to it

[nona]

yea the expense would be nice as it would be double eek! however,  BFing 2 sounds a bit daunting but time goes by fast! esp that first year!  my DD will be 2 in a few weeks! I can't believe it!  i think i'd be more worried about the toddler stage than the BFing one LOL  my DD is a handful compared to DS!

[koe2moe]

You know what?  It doesn't have to be all or none.  Sometimes BF and sometimes bottles also good.  Any breast milk is a surplus!  Stay happy is most important.  Prayers for you all xx

[nona]

very true Koe! my Sil did a mix for her twins who she birthed both vaginally. crazy!!!!

[nona]

It is wednesday here!!!! can not wait to find out the sex of these babies! praying everything went well during your visit/ultrasound.

[kayra]

All is well thankfully, I've updated on my 'some news' thread couldn't figure out how to alter the title of the thread tho..

I'm fine with the idea of doing both BF and FF, DS was like that so I know that it's by no means the end of the world.

[nona]

yes everyone hope on over to the other thread! congrats!

[Erin M]

I've updated on my 'some news' thread couldn't figure out how to alter the title of the thread tho..

Changed it for you, let me know if it's not ok. 

[kayra]

it's perfect Erin, thanks so much!

[Erin M]

Such good news deserves attention!