February 28, 2013 · filed under twins
on breastfeeding twins
Today marks the last day of the first month that my babies have eaten nothing but breastmilk. So it seems like a good day to celebrate and to write a bit (or, a lot) about how breastfeeding has gone for me so far. If this isn’t your fave topic, I suggest checking out these cute things.
The Beginning: I really tried to prepare for breastfeeding twins, and I truly thought I was prepared. I read several books, went to a free class at DC’s Breastfeeding Center, and spent lots of time talking to friends who have breastfed to get their advice. Turns out what I was NOT prepared for breastfeeding preemies or NICU babies. I was also not prepared for pumping. Looking back, that was a failure on my part, because many twins are born early and spend time in the NICU. I guess at the time I thought I’d make it to at least 37 weeks and avoid all that drama.
The First Week: Because I developed pre-eclampsia (suddenly and somewhat severely), I had a C-Section at 35w6d and after the babies were born I had to be on an IV of magnesium sulfate for 12 hours. At the same time, the babies were in the NICU. This means that not only did I not get to breastfeed them in the first hours of life, I didn’t even meet them until they were about 18 hours old. Already my plan to put them to the breast early and often was out the door.
Right after my C-section and before the magnesium, I was given a hospital grade pump and I embarked on the first of many pumping sessions. The lactation consultant at the hospital encouraged me to pump 8 times per day, so I did. I didn’t get any milk at all for a few days, and when it finally began to come in, I was getting maybe 1-2 ounces per pump. I never had a lot of milk, or got engorged or anything. It felt like I had to work for every drop from the first day.
When the babies were about one day old, a NICU nurse/nutritionist came into my hospital room to request my permission to give them 5ml of formula. I was still pretty foggy at this point, and I remember asking a lot of questions. I was concerned because I had read about nipple confusion, latching, etc. But, at the same time, I had two five pound babies who were in the NICU and needed to gain weight, so I didn’t feel at the time that I had any other choice but to say yes to this. (In retrospect, I wish I had explored my options and not rushed into anything. But, I was making the best decisions I could at the time I was making them.)
Both boys drank their 5ml bottles in a flash. They were very hungry from the beginning. Soon they were eating 20ml, 30ml, 40ml, and more at each feeding, 8x/day. A few days into their NICU stay, they were eating “ad lib,” which meant as much as they wanted every 3 hours. I was definitely not making enough milk to keep up.
At the same time, I was pumping 8x/day, and practicing breastfeeding with them all day in the NICU. Their feeding times were 8am, 11am, 2pm, 5pm, and 8pm (plus through the night but I never spent the night in the NICU with them). My goal was to be there for as many of those feedings as possible. Each feeding went like this:
- Holden got 5 minutes to practice breastfeeding on one side.
- Holden got a bottle of formula for 25 minutes and was allowed to eat as much as he wanted.
- Teddy got 5 minutes to practice breastfeeding on the other side.
- Teddy got 25 minutes to eat as much formula as he wanted.
- Then I would go pump for 20-30 minutes.
That whole cycle took 1.5 hours, and then it would all start over again 1.5 hours later. Generally, the boys would eat formula all day, and then the NICU nurses would feed them any breastmilk I had pumped in their nighttime bottles. They never lost more than a couple of ounces during their NICU stay (between IV fluids and unlimited formula) and they learned to love the bottle very early on.
Once We Came Home: The boys came home from the NICU when they were 6 days old. For a few days, we kept up the same schedule as the NICU (feeding at 2, 5, 8, and 11 AM and PM). I would attempt to nurse both of them, sometimes together/tandem, and then give them a bottle, and then pump. As you can imagine, this is pretty unsustainable. To only have ~90 minutes of “free time” not feeding or pumping, around the clock, is pretty insane.
Early on I had a lactation consultant come to the house to help. She was wonderful, and gave me a lot of tips on better pumping (bigger flanges, not washing pump parts every time, etc) and on better breastfeeding. She weighed the boys before and after a feed and confirmed they were at least getting some milk. She came back again 3 weeks later and helped us even more. She helped me with tandem nursing, and we tried to latch without a nipple shield (with some success).
Oh yeah, during this whole time I used a nipple shield, because the boys were just so small and it gave them something to really latch on to. Most of the time, we still use it now. I’ve had enough struggles that this is one battle I chose not to fight. Because it helps, I use it.
The early weeks and months I was still not making a ton of milk, and certainly not enough for two VERY hungry boys. We supplemented with formula every day for awhile, and then every few days. I did a lot of things to boost my supply: I watched webinars on how to pump more effectively, I took fenugreek and ate oatmeal and drank water. I pumped like a maniac. I asked twitter for help, and I read everything I could about low supply on the internet.
I also kept practicing breastfeeding with both babies. Sometimes Teddy would be better, and sometimes Holden would be better. Neither of them have ever been great. Part of the problem was that I was pumping so much that sometimes there wasn’t enough milk left over for them. But if I stopped pumping and just put them to the breast, they wouldn’t empty the milk supply, and then supply would drop. I was in a really tough spot of HAVING to pump to keep up supply (because the babies were not skilled enough yet) but yet the pumping was hurting my nursing progress. I felt like I could never catch up, let alone get ahead. Plus, the clock felt like my enemy. It was ALWAYS time to pump or feed or pump again. Very relentless.
Two Months In: Around the start of the new year, I started taking a drug called domperidone as a last-ditch effort to boost my supply. It’s not FDA approved and I had to buy it from an overseas pharmacy without a prescription. However, all the research led me to think it was relatively safe. This drug has definitely saved my breastfeeding career. When I started taking it I was probably making about 35-40 ounces per day. I’ve been on the drug for two months now and I think I’m making 55-60 ounces per day. I can’t attribute all of my progress to it, as I still pump like a maniac, nurse as often as I can, and also take other herbs/supplements from time to time. But just having more milk to offer the babies has been amazing.
Right Now: The babies are nearly four months old. The good news is that for the past month, they have only had breastmilk. I’ve also frozen about 40-50 ounces. It feels like such a huge accomplishment, but that’s less than these babies drink in a 24 hour period. Crazy, right?
The bad news is that I don’t think I will ever “just” breastfeed my babies. Right now, Teddy is much better at it, and I generally nurse him throughout the day. Usually, he still needs a bottle afterward. And some days we are out and about and he just gets bottles. Holden’s just not really up for eating on the breast, but I still try about once each day to get him to try. I rarely tandem feed them anymore. Too much frustration for everyone involved. They are too dang long for both of them to nurse in the football hold anymore!
I guess I consider myself a “recreational breastfeeder” who is one step away from being an exclusive pumper. I’ve really, really resisted being an exclusive pumper. I WANT to have a nursing relationship with both of my babies. For one thing, it would be SO MUCH EASIER if they just ate off the breast instead of me pumping, making bottles, feeding bottles, washing pump parts and bottles, etc. Also, I’d love the closeness and comfort that nursing brings. But I also have refused to make myself crazy about it. Plus, it’s nice to be able to leave the house and let another adult feed the babies.
The Future: When Andrew went back to work, I feared that my ability to pump would go away, but that didn’t turn out to be true. Now I’m worried that when the boys become mobile, I won’t be able to pump 6-7 times per day. And when that time comes, I will probably have to start giving them formula again. I’m okay with that. I don’t want to miss out on being a good mom because I’m stuck on the pump. But right now, I can find enough time in the day (usually when they’re sleeping) to pump enough.
I’d like to see if when the boys get a little older if they will be more into nursing for comfort. Right now sometimes it seems like they don’t even know who I am, let alone that I make the milk. But I wonder if that will change in the next few months. I’d like to keep up their skills at least at a minimal level so that if the time comes that they are more interested in the breast, it could be possible to offer it to them. But I also realize that at four months old, that ship may have sailed. They just might be bottle-fed babies. I’d rather have happy, full bottle-fed babies who sleep at night than hungry, angry breastfed babies who don’t sleep well.
I admit to having major envy of twin moms who are able to successfully breastfeed. I so wish that we could have gotten there ourselves. But I also know that I literally did everything I could to make this work. Ultimately, the babies have big appetites, and they got hooked on bottles very early. It’s really hard to overcome that. My supply was always one step behind them, and that’s been really hard.
But I also feel proud of myself and I don’t beat myself up too much. I’ve had a ton of support from twitter, internet friends, and real life friends. I know formula won’t harm my babies and I’m sure that they’ll drink it again in time. I think about giving up often, but at this point I’ve finally got my supply up to meet their demand so it seems silly to quit now. I just keep going one week at a time.
That’s my story for now. I know there are more chapters yet to come. I truly appreciate all the cheering and support that you all have given me. I hope I can offer help to new moms down the road. In the meantime, Teddy is waking from his nap so it’s time to feed him… ; )
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jen
February 28, 2013 5:40 pm
Woman, you are a rock star! Seriously, the dedication you’ve displayed to making this happen is awe-inspiring to me. I think I would have thrown in the towel long ago.
Don’t beat yourself for having to supplement, Teddy and Holden look well-fed and happy. Take care of yourself and be there to talk me off the ledge when I’m going through this in a few months, okay? 
Jennifer
February 28, 2013 6:28 pm
This is the most exhausting thing I’ve ever read
ha! You are an amazing mom for even trying half the things you have tried. And HIGH FIVE on getting through Feb with breast milk! What an accomplishment! (Seriously. You deserve an entire CAKE for that!) And your thinking is healthy, I think- bfing doesn’t HAVE to be all or nothing. Sometimes it can’t be! I got to that point with A when my supply started to tank & she started wanting the bottle over me & I could only pump a 5 or 6oz bottle a day. I had to just accept that she’d get some formula mixed in there once my frozen supply ran out (which didn’t take long, the little piglet!) But we do what we can do.& feed our babies & try to stay sane 
Good job, mama.
MrsViolet
February 28, 2013 7:34 pm
Lord have mercy! We would LOVE twins, but I think about trying to BF them and go…wow JANET IS A SUPERHERO!
Good job, lady!
Alana
February 28, 2013 7:51 pm
Ah! This post was so comforting to read. I gave birth to my (now 2-month-old) twins at 25 weeks gestation, so even though your boys were much closer to term and spent MUCH less time in the NICU (my babes are still there), there is a lot of overlap. Lots of pumping, trying to breastfeed before their ‘real’ feeds, fenugreek to try and up my pitiful supply, etc. I think it’s totally amazing that you’re able to breastfeed as much as you are, even if it’s not what you were hoping for. In fact, if we end up with a situation like yours I will be quite pleased!!!
(Just a note as well that domperidone is prescribed for mums here in Canada if that makes you feel any more reassured about its safety)
Suzanne
February 28, 2013 8:20 pm
Good lord, lady. You could have a career as a lactation consultant. No matter how much your babies eat at the breast or how often, your commitment to it is way above and beyond many mamas I’ve known who have tried to nurse only one baby. Good job, mama. Clearly, they’re both amazing and growing every day <3
Tara
February 28, 2013 9:27 pm
You should be very proud! I only lasted 2.5 months with my twins and have no more frozen milk left. The current society puts a lot of pressure on breastfeeding, I was formula feed only and would like to think I turned out OK and am happy that my babies at least got something. I also feel emotionally better post pumping, less hormones, etc.
Brooke
February 28, 2013 10:05 pm
I think it sounds like you’re doing an amazing job, especially after early challenges. Sounds like you have exactly the right attitude, too. I look forward to hearing about how it goes as they get older!
Jane
February 28, 2013 11:17 pm
whoa! I am sooo impressed! Amazing!!
Janssen
February 28, 2013 11:42 pm
This is seriously the most impressive thing I’ve ever read. I mean, Hillary Clinton has nothing on you!
I am just blown away that you’ve made it happen. Also, I used a nipple shield exclusively with Ella and then, suddenly at nine months, she decided she didn’t need it anymore.
J.A. from Amsterdam
March 1, 2013 4:29 am
Dang, Janet, what a journey! You are doing amazing. I wish it could have been easier for you!
doahleigh
March 1, 2013 10:33 am
I wrote my breastfeeding story the day before you did! And even though I don’t have twins and our situations are different, there were a lot of similarities. Low milk supply, nipple shield, pumping like a maniac. It was so emotional and difficult for me in the beginning, and my relationship with my daughter was strained as a result. I can’t imagine doing this with two babies.
I’m curious about the larger flanges and how you know if you need them. And what’s this about not washing pump parts every time? I kind of hate that part of the process, so if it’s not always necessary… I’m intrigued.
Janet
March 1, 2013 6:29 pm
Shannon –
I had an LC fit me with bigger flanges. HUGE difference. But I forget the “rule” about how you know if you need bigger ones or not. I think it has to do with the nipple moving freely in the plastic.
As for the pump parts, you can store them in the fridge between pumps! I wash mine 2x/day and store in the fridge in between. I do the same with their bottles. Obviously it’s a little bit riskier in terms of things like thrush, but it’s a risk I’m willing to take to save a TON of time.
See more info on both topics here: http://www.isisparenting.com/page/webinarsbreastfeeding
Specifically: Secrets of Milk Storage: Debunking 6 Myths, Five Tricks for Better Pumping, and Pumping, Storing and Feeding Breastmilk
alison
March 1, 2013 12:38 pm
I hated breastfeeding and told myself “one more week” or “one more month” every week that went by (and somehow made it to a year, twice!) I think you are a true super-hero to have kept up all that you have for this long and I think the boys are thriving so their is ABSOLUTELY no reason to question yourself in any way!
Kyley Leger
March 1, 2013 7:49 pm
Like I said on Twitter, you’re doing such an awesome job! TWO BABIES! That’s so amazing! It’s not something that everyone can do. Sometimes I have to take it a day or even feeding at a time! Parenthood is hard, but it’s also the greatest joy! Thanks for sharing your journey!
Danielle
March 2, 2013 2:53 am
You should be incredibly proud of yourself. I have 1 six month old baby and only managed 5 days breast feeding (in which I beat myself up for brutally). What I realized along the way (on a very different journey of course) is that my bundle of joy would not remember how he was feed, only the incredible love I feel for him. Bottle fed Mammas get a horrible wrap but are just as loving and caring with the children as a breast feeding Mamma. I hope that you give yourself a massive pat on the back; what determination and commitment. Absolutely amazing. I’m sure in whatever you decide to do in the future; your babies will feel content and loved.
Zandria
March 2, 2013 11:37 am
I’m not a mother and yet I read every word! Very interesting. (Probably because I DO plan to be a mother one day, and who knows? I may have similar issues.)
I knew you had a lot of “adventures” with breastfeeding, but I had no idea it was so extensive. GOOD FOR YOU for being so on top of things! For real, Janet. Less dedicated women would have given up a long time ago — so many women either don’t have the interest or time needed to follow this through. (A lot of times it’s not their fault, though — like if they have to go back to the workplace after the baby/babies are born and can’t take out so much time to pump.)
I don’t think you should feel bad AT ALL that your babies mostly drink from the bottle. They’re still drinking breast milk! Yes, there’s a connection from being fed directly from the breast, but they’re still getting all the important nutrients they need.
You are doing a truly awesome job!
Hotpotatokate
March 3, 2013 3:16 am
Wow, wow, wow. BFing = hard. EP = differently hard. BFing twins = HARD and BFing and semi EPing twins = positively mindblowing!!
So glad domperidone worked well for you- it’s been my saviour, but I didn’t have particularly dramatic results.
Katie
March 4, 2013 9:00 am
I have never commented on your blog before, but I just had to say how phenomenal what you have done/are doing is! I have had two singletons and there is NO WAY I could have handled it. Whatever the end result, you should be immensely proud of yourself and your boys are so incredibly lucky. It is so nice to read a bfing post that puts things is such a proper perspective re: the pros and cons of keeping it up. Love it!
Audrey
March 4, 2013 12:44 pm
Janet, you are so amazing! I am beyond impressed with how well you’re handling this entire situation. I’m not sure I would have been strong enough to stick with it the way you have. Seriously, you’re incredible! I think the most important thing about all parenting decisions is knowing what battles to fight, and when to just let things go. Like you and the nipple shield — “It helps, so we use it.” I could say this about SO MANY things in my experience being a mother. Whenever I start to stress out about things we “should” (or shouldn’t) be doing with Alexander, I try to remember this attitude — it helps, it’s not hurting anything, so why fight it?
I’m so happy for you and your amazing little boys. You’re doing a great job!
K
March 4, 2013 1:48 pm
Your commitment to this is astounding. You’ve managed each bump in the road the smartest and best way for you and your family. You’re such an incredible mother, Janet.
Elaine
March 4, 2013 2:49 pm
This is seriously the most amazing thing I have ever read. You are working so hard!!! xoxoxo
Betsy
March 4, 2013 10:44 pm
You are insane, but I’m so proud of you for it. I told you before Liam used the nipple shield until 6 months and then decided one day he was done with that. I agree that is a battle I wasn’t willing to fight. You are an amazing mom.
I am so excited to see you soon and meet the boys!
I have to go pump now.
Isabel
March 6, 2013 11:03 am
HOLY COW. You are a total breastfeeding rockstar. And you should feel a huge sense of accomplishment for what you’ve done. AMAZING.
(Make sure you print out this post and save it in their baby books to show them when they are adults. They need to appreciate the depths of your love!)
lauren
March 7, 2013 10:06 pm
i put my stuff in the fridge too. was quite interesting when we had company…
i also had every size flange and every size nipple shield. i spent more on trial and error than another visit with the LC.
on another note, i was pumping and pumping and pumping round the clock – 8 times each day – and producing about 50oz. i don’t remember the exact numbers but i slowly went down to 7, then 6, then 5 sessions and still produced about the same amount. not sure if you’re interested in putting more time between sessions, but just an fyi.
Susie
March 8, 2013 11:53 am
Wow. WOOOW. I am so impressed. I struggled a lot with breastfeeding my daughter, due to low supply and latch issues and pain from Raynaud’s, and baaarely made it to 5 months, almost exclusively pumping for most of that. I’m hoping it’ll go better this time around, and more than that, I’m hoping I can maintain a reasonable outlook about it. I got very wrapped up in the emotions, guilt, resentment, and I’m so hoping I can be more zen about it this go round. You seem to have managed that with aplomb.
I am planning on having ready access to domperidone this time – I think if I can get rid of at least that one worry (insufficient supply), I might handle the other obstacles better. Can you explain how you went about getting it?
Elizabeth
March 8, 2013 11:44 pm
Wow. My twins are 5 months old now and I feel like I’m reading my own story! Mine were born at 36 weeks but we didn’t need any NICU time. We’ve battled latch issues, low milk supply, lazy eating, flow preference, and just plain stubbornness. I can relate to the envy of other successful breastfeeding twin moms. In fact one of my close friends has 2 month old twins and they are great breastfeeders! It’s so frustrating to want something that bad and do everything in your power to make it happen, and then it doesn’t happen like you dreamt it would. Breastfeeding for us is now so much easier than all the junk involved with bottlefeeding. I also can relate to not wanting to give up breastfeeding because you want that relationship. It’s a special relationship and I’m so glad I didn’t give up months ago. We’re already 5 months in, so what’s the point in giving up now?!
I also figured out the not washing bottles/pump parts every time. We actually only wash and sterilize once a day and have never had any issues.
You’re doing an amazing job and I hope you and your babies can keeping trucking along!
nancyholtzman
March 9, 2013 3:10 pm
What they all said.
You’re such a strong mama. Lucky boys and lucky you.
!
(and thanks!)
Nancy