Breastfeeding my Twins Despite Their Prematurity
by Lindsay Castiglione
After an emergent c-section at 30w3d due to fetal distress of my baby B, I had a deep fear that breastfeeding my twin boys would be impossible. I had read Mothering Multiples, so I had at least a little leg up on the average mom to preemie multiples, but I still thought it was a long shot with 30 weekers. I was lacking confidence in my body – it had failed me in carrying my babies to term, so what if it just didn’t measure up in the breastfeeding department as well? I still set out determined, using the fact that providing my babies breast milk was one of the major ways I could be involved in their care as motivation.
My journey of breastfeeding began with an intimate relationship not with my babies, but with my Medela Symphony rental pump. I had set a goal of pumping within one hour of release from the post-op recovery room, and after completing that I pumped every 2-3 hours around the clock. The nurses would tell me to sleep longer at night, I needed the rest, it wouldn’t make a big difference… but I had been warned of that and didn’t listen. I started taking fenugreek and blessed thistle while still in the hospital, before I had any supply concerns and more out of being proactive. I kept diligent records of how many mL’s I pumped, what time of day it was, how many minutes I pumped, etc. Seeing the daily total each day was a huge motivating tool for me. I pumped for 3-4 minutes past any milk flow every session, to stimulate supply. After about 3 weeks in, I was pumping 50oz/day. That is when I started allowing myself to sleep 4 hours at a time at night. I treated pumping like it was my job, and took it very seriously. A hands-free pumping bra was my BEST FRIEND. Seriously.
Before I was discharged, I had met with each of the three lactation consultants employed at the hospital. One in particular was a great match for me, and we clicked; From then on, I only made appointments with her specifically. She worked with me until the very end of our 7 week NICU stay, once or twice a week for an hour at a time. I was blessed to find out about primary nursing in the NICU shortly after I was discharged. We had bonded with a certain nurse, Betsy, who shared many of the AP principles that I wanted to follow with our boys. Whenever she was working, she was assigned to Hayden and Connor, and a big focus of our day would be on breastfeeding. She really helped instill confidence in me that I COULD successfully breastfeed my boys. In the beginning, while they would have their NG (tube) feeding, I would put them to breast and let them explore. This started about (gestationally) 32/33 weeks. Their tiny mouths struggled with my larger nipples, so we tried a nipple shield. Immediately I felt a difference, we could hear more swallowing, they kept latched for longer. I wouldn’t recommend a nipple shield to everyone, but for us it was a great tool in getting the boys to take full feeds from the breast.
I was so glad I had Betsy to help validate my feelings on breastfeeding and help advocate for me. There were older, set-in-their-ways nurses who I could feel rolling their eyes at me when I insisted they could do another nursing session that day, or who made comments as if I wasn’t holding the babies’ best interests at heart with my insistence. I heard the reasoning about nursing a baby burns too many calories, it will make them gain slower, they’ll end up staying in the hospital longer, etc. One even encouraged me to “give them all bottles and they’d be home in a week” at 35w, and that I could breastfeed all I wanted at home. The problem was, if we had done that I I don’t believe we ever could’ve had a proper breastfeeding establishment. It wouldn’t have worked, at least not for me and my babies. I know this. Thank God for Betsy and my determination, and for not being afraid to be labeled the “difficult” mother by some in the NICU.
At about 34 weeks, we started weighing them before and after feeds to see how much milk they were actually getting. We started at about 10-15 mL’s per feeding, so about 1/3 to 1/2 an ounce. The rest of their prescribed volume of a feed was pumped milk, given by tube feeding. When I breastfed them in the NICU, it was almost always individually. I wanted to give them (and me) a good shot at learning the basics first, as I had never breastfed at all before. I tandemed them a few times, but found it very hard to do and I needed help. For me, it was one of those experiences like watching figure skating on television, and then trying it out in real life. How on earth do people do this, I wondered! One baby would latch, then the other, but by then the first had come unlatched – I had already let down and milk was flowing everywhere… sigh. This was why focusing on nursing them individually worked best for us in the beginning.
We made the decision to not allow the boys bottles in the NICU until the very last minute. I made little signs for their isolettes and general area that said “We are learning to breastfeed, so our Mom asks, ‘Please no bottles!’ ” We were able to wait until they were taking pretty much their entire prescribed feeds by breast for the four feedings a day I was able to be at the NICU for before starting bottles. At that point we needed to see if they could still gain without the NG tube, so bottles it was. If I could have slept at the NICU and fed them 24/7, I would have, but they didn’t have any overnight facilities for parents. We lived about an hour away, so going back and forth wasn’t an option during the overnight. Anyway, at this point they were 36 weeks and more than capable of taking a bottle, which they both did successfully the first try.
After they were discharged at 37w3d, I started on the journey to having them EBF at home. I added one more breastfeeding session per day each week, but still kept the overnight feeding pumped breast milk by bottle while I pumped at the same time using my hands-free system. Once that was established I started trading replacing individual sessions with tandem sessions. It took me one month, but at that point I was doing all feeds tandem nursing. We also dropped the nipple shield around the same time. It was an AMAZING sense of accomplishment. I still pumped after some feeds where the babies didn’t feed well or in the morning when I was really full. Having a back stock in the deep freezer was comforting to me. Really throughout the 14.5 months I breastfed, I never was quite able to put the pump away. It always was what I turned to during a growth spurt to get my supply kicked up, or when I started making purees and used milk to thin them. I look at the whole experience as a labor of love. It was never easy, exactly, but I knew we were able to accomplish something that very few women can claim, and it was all worth it.
Around 8-9 months, one of my boys in particular started having nursing strikes where he would refuse the breast for an entire day at a time. It was very frustrating, but we’d push through and eventually get back on track. Then, one strike would just not end. I felt horrible about giving in and feeding him pumped milk in a bottle, but I was worried about dehydration. Sadly, that ended up being the end of our nursing relationship. I was absolutely beside myself after everything we had gone through, and it was so integral to my mothering at that point. I had read online about trying to create an experience for one more session, and somehow, I was able to get him to nurse one last, beautiful time. I had tears streaming down my face, because I knew it was the end, but I was so thankful for that closure. He would reach up and pat my tears, and it was very sweet. I still tried for quite awhile after that, but chose not to push it too much. At that point, I was pumping for him exclusively, and then nursing his twin. It was very difficult to coordinate, but those were the cards I was dealt. I had set my goal as the anniversary of their original due date (they’d be 14.5 months old) to be done breastfeeding, unless of course it was still working well and then we’d continue.
A few weeks after his brother stopped nursing, his brother followed suit. As emotionally difficult as accepting that part of my relationship with the boys was over, there was some comfort in switching to exclusively pumping for both at that point. I was confident I had done everything I could to breastfeed my babies from day one, and was glad I never made any decisions that compromised that even if it would have been ‘easier’ at the time. I continued to pump for them, right up until the anniversary of their due date, which was August 22nd, 2012. Overall, breastfeeding my boys was the most challenging, difficult, yet deeply rewarding and empowering experience of my life. I wish the same for any mom of preemies, and that they are not discouraged by the challenges of the journey; They will only make the accomplishment sweeter in the end.
Lindsay, once a social worker, is now a SAHM of her now 22-month-old mono/di boys. Hayden and Connor were born at 30 weeks, and are TTTS survivors, but celebrate being completely healthy today. Her husband is in the Navy, and home is where his service takes them. Their family looks forward to welcoming a second set of twins, Madelyn and Noah, hopefully in late July 2013.