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Breastfeeding Twins

Penelope Katsaras
From New Beginnings, Vol. 26 No. 1, 2009, pp. 27-27

When I became pregnant with twins, I intended to breastfeed just as I had my first child. I had grown to love nursing my son and we had continued for over 16 months. I cherished those moments holding him on the glider in the morning while he nursed, or when he nursed to sleep.

After three weeks of strict bed rest, my daughters, Antigone and Dimitra, were born at 34 weeks. They were born quickly and vaginally without medication. The doctors showed the girls to me across the operating room for a minute (it was hospital policy that twins be born in the operating room) and whisked them away to the neonatal intensive care unit (NICU). I didn't see them again for another five hours when a nurse finally wheeled me to them. I missed the beautiful experience of holding my newborns on my chest after giving birth and letting them find my breast.

The girls were healthy, yet, at first they received fluids only from an IV. They graduated to a feeding tube and then to bottles. When on bottles, they were fed every three hours. All was scheduled and uncomfortable. I pumped eight times a day to build up my milk supply. Unfortunately, there was no International Board Certified Lactation Consultant on the staff and the nurses' advice on breastfeeding management was inconsistent. Breastfeeding in the NICU was extremely difficult.

I called a wonderful lactation consultant, the renowned Catherine Watson Genna, who had helped me to breastfeed my son two years earlier. My girls' mouths were small and my nipples big and flat. She advised the use of a nipple shield. My smallest baby, Dimitra (three pounds, 12 ounces) latched onto the nipple shield right away; Antigone (four pounds, 11 ounces) wanted only to sleep.

At the hospital I would alternate "kangarooing" and practice nursing sessions with nipple shields. I would leave at night exhausted and feeling empty without my girls. I thought all would work itself out once we were home. Antigone came home after 10 days and Dimitra after 14.

I slept with them in my king-size bed and called them my "squeaky girls" (because they made squeaky sounds all night). My husband slept with my son in the guest room. My mother-in-law, who came from Greece to help us, slept on the couch in the living room. Our babies would never fail to wake together screaming. I wished I could take care of both of them at the same time so everyone else could sleep. However, it was impossible for me. I would alternately wake my mother-in-law and husband to help.

The girls were still not able to drink milk directly from me. Cathy Genna recommended that we do whatever we had to in order to get through the night. This meant bottles. The girls would wake, be fed bottles, be rocked, spit up, fall asleep again, and, finally, I would have to pump for half an hour and then prepare bottles for the next shift. By the time I got into bed, they would wake again. Between the hours of 10 pm and 7 am, I would average two hours of sleep. It was a sad feeling to sleep next to my babies, wake engorged, and not be able to feed them directly from the breast.

I started with only two bottles a day. Friends told me I needed more but I insisted that this was only temporary. I believed they would be nursing in a week. Three months later, I had 15 bottles a day.

We rented a hospital grade pump and a special scale that measured milk intake. I introduced a nursing supplementer -- which I had used with my son two years earlier -- because I felt as though my breasts were always empty from pumping. A nursing supplementer is a bag full of expressed milk or formula with a tube protruding out that one adheres to the breast. The baby drinks from it like a straw so she is feeding at the breast. I would fill it with expressed milk and use it with the nipple shields.

I began a log detailing when and how much milk I pumped. I felt chained to the pump and would not allow myself to leave the house for very long. Carrying bottles, a breast pump, nursing supplementer, nipple shields, twins, and a two-year-old out of the house was nearly impossible. I longed for the day when the girls would breastfeed so I could take a long walk or visit a friend.

In order for me to pump, all the children had to be reasonably quiet and happy. Sometimes I would pump surrounded by my children. My two-year-old would tug at the wires and turn the machine off and on. Without my mother-in-law's help, I could not have managed.

After pumping, washing bottles, and preparing the nursing supplementer, we would have our practice nursing sessions. Nursing was crazy. I would put the nipple shield in a cup with a little water to help it stick. The nursing supplementer baggies would be in another cup to hold them upright. A third cup would be filled with juice for me. Just to set up for the girls to nurse was time consuming. The girls would cry while I got it all together. To top it off, my two-year-old would jump around and attempt to dump the contents of the cups. When I finished nursing it was time to clean everything and pump all over again.

I was sad and would cry frequently. Was I asking too much to want to breastfeed my girls? I felt as though I had done something wrong, that I was a failure. I hated the bottles. They took up so much room in the dishwasher and there was nowhere to store them in my small kitchen. Moreover, my husband would come home from work and ask how many ounces the girls had drunk. I would say, "I don't remember, ask your mother." Then he would ask what time they drank. Again I would say, "I don't know. Ask your mother." He would ask her and she would say that she didn't remember either. My mother-in-law would say, "That is why she feeds the babies and you don't!" There was no way I could think in terms of schedules and numbers either.

Cathy Genna discovered that my daughters were both tongue-tied. My son had also been tongue-tied. Clipping his frenulum allowed him to develop into a happy, growing, breastfed boy. A doctor clipped the girls' posterior tongue-ties at six weeks.

At this point, the girls would not latch on without nipple shields. Every time I took the shields away they would cry. When I returned them they would happily suck as long as milk poured through the nursing supplementer. When I measured their milk intake from me on our rental scale, it showed none. All these difficulties continued for what felt like forever. I became used to the routine and began to lose hope.

Finally, at two-and-a-half months, Antigone latched on without the nipple shield! Now we were making progress. Yet, I knew her latch-on was shallow and her upper lip would slip up and down on my breast. There was still no milk intake. At this point I had almost given up. Sadly, I told Cathy that I would keep it up until the girls were six months and then quit. She advised me to go back to the doctor to check the girls' tongue movement again. We did, and the doctor believed there was a residual tongue-tie. I hated having the procedure done again, but agreed to it with hope in my heart.

Afterward, the girls were slightly uncomfortable and Antigone returned to using the nipple shields. However, an amazing thing happened. (You know this story has to have a happy ending!) Her suck finally felt stronger, and after giving her a week to heal, she no longer needed the nipple shields. Then, one day, when she was nearly four months old, I was taking a nap with her. I offered her my breast and she began to drink. I could tell Antigone was drinking my milk. It was a wonderfully warm feeling. Two weeks later Antigone was a pro.

I thought Dimitra would be far behind. Yet she learned only two weeks after her sister. I think the girls were happy with their new skill. They cried less because they no longer had to wait for their milk. I could finally feed them together and was able to get rid of the bottles, nursing supplementer, and pump. When they nursed together they would hold hands sweetly.

I now understand why so many mothers of premies and/or twins fail to breastfeed. While almost every mother can succeed in breastfeeding, for some it can be extremely difficult to accomplish. Two necessary ingredients to my success were the support of others (my mother-in-law, my mother, my husband, Cathy, and the doctor) and time with my babies. I couldn't have done it if I had had to return to work at six weeks postpartum.

As I write this, my girls approach their first birthday. They crawl, wave bye bye, clap hands, nurse, and do everything else an almost one-year-old is supposed to do. I don't know how long I will continue to breastfeed them, but I guess I will wait until they are ready to wean. I will always be glad that I persisted. If there is a moral to this story that I might convey to my daughters it is: never give up!

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