We’ve all heard the phrase ‘Breast is Best’ at one time or another. However, not every woman has an easy time breastfeeding, especially if you’re trying to feed more than one baby at a time.
You see, challenges with breastfeeding were first mentioned in a medical encyclopaedia in 1550BC. That information came from Egypt where the prescription to help a woman’s milk supply included warming the bones of a swordfish in oil and then rubbing the oil on her back.
Now, in Greece at around 950 BC, women of higher social status would often demand wet nurses to feed their babies and there’s even mention of it in the bible.
In the 17th century, a French obstetrician came up with several objections to using a wet nurse, including that the affection felt between the child and the mother will diminish, despite this the practice was favoured over breastfeeding one’s own baby.
By the time we reached the 18th and 19th centuries, it wasn’t just the wealthy who employed wet nurses, there was a shift to labouring, low-income families. This was mainly due to women leaving the home to find work, which made it impossible to breastfeed.
Of course, this was all before the formula revolution and today there is an abundance of bottles and formula to choose from. There are also breastmilk banks in many countries where mothers who have an oversupply can deposit their excess for others to use.
However, as Lactation Consultant Judy Adams from King Edward Memorial Hospital in Western Australia tells us, the business of breastfeeding multiples isn’t easy, and many women feel enormous pressure to exclusively breastfeed their babies, which is often an incredible emotional upheaval especially if the babies are born preterm.
Judy says it’s important to get comfortable feeding one baby first using the traditional hold across the body.
“And then as quickly as mum is able to, we’d get her used to the underarm hold with one baby and then it’s just a matter if the mum wants to, or when the time is right to put them both on the breast at the same time,” says Judy.
“If this is too overwhelming, you might choose to express and bottle feed one baby, breastfeed the other, and change over at the next feed,” Judy suggests.
However, when you have three or four babies, breastfeeding is another story. Judy explains that in this situation, some mums often choose to twin feed and then give expressed breast milk to the third or fourth baby, while other mums choose to do replacement feeds with expressed breast milk.
“If they choose to do that, we recommend they pump in the absence of a breastfeed,” says Judy.
Pumping is encouraged when giving a feed of expressed breast milk because of the huge volume of milk you need to produce to feed your babies.
Full-term babies require:
Singleton – 500mls of breastmilk/day.
Twins – 1 litre/day.
Triplets – 1.5 litres/day.
Quads – 2 litres/day.
Is it important to introduce the bottle as well as the breast?
Part of being a preterm baby means that you have to have bottles, you can’t go home unless you can suck all of your feeds. However, creating an individualised plan as to what the maximum amount of breastfeeds you can handle is the best strategy.
“Once she’s got to the maximum amount of breastfeeds she can do, then the bottles will follow,”
“If the babies start to get tired and go off the breast, we just backtrack a bit and drop a bottle out and keep the tube feed going a bit longer,”
“We just go backwards and forwards until the baby can do all sucks but still maintain beautiful breastfeeding. It’s different for everyone, there’s no black-and-white,” says Judy.
Supplementing with Formula
The baby has to be able to grow, that’s the bottom line. So, if you haven’t got enough breast milk then you don’t have any option and formula is a necessity. And, if the baby isn’t thriving then you’ll run into all sorts of other problem.
“As hard as it is, I know very well myself, I burst into tears when I first bought (formula) and I ended up throwing it out anyway,”
“But it’s very emotional, you’re in the supermarket and you reach for it, and then you put it back, and then you reach for it again, and I thought I better have some just in case,” says Judy.
Some of you don’t have a choice. Whether for health reasons, or some other complication, you simply can’t provide milk for your babies, you shouldn’t feel guilty about giving your babies formula.
Remember, Fed is Best.
Nutrition and Breastfeeding
Just as ensuring you are getting adequate nutrition during your pregnancy, eating right while breastfeeding is also just as important.
And, pretty much as with your pregnancy, water is incredibly important when you’re breastfeeding. The best guide is to drink to your thirst, however, if you’re not someone who gets thirsty you should aim for about two-litres of water per day.
You would have heard many stories about what-to-eat and what-not-to-eat while breastfeeding and if you haven’t already you’ll soon discover that there are plenty of myths to these tales. The bottom line is that you should eat a normal diet, in moderation.
“So, if you love chocolate you can have a bit of chocolate, but we wouldn’t want you to eat a huge bar of chocolate,”
“You just need your normal triangle, you know fruit, and, veg, and cereals, and if it upsets you it’ll probably upset the baby,” says Judy.
For example, Indian women who have been eating curry throughout their pregnancy don’t have to usually stop eating curry because their babies have been primed for that inutero. Whatever is normal for you is usually normal to carry on with.
Rebecca Perrie says having gestational diabetes during her twin pregnancy meant her girls needed some nutritional support after they were born. She admits that after breastfeeding her daughter two years earlier, attempting to breastfeed two babies at once was a whole different story.
“I breastfed with my first child until she was four months, but she lost quite a bit of weight and I hadn’t noticed, so we also introduced formula to my eldest one,”
“So, I knew that formula may be something that we would be using with the twins anyway, but I was going to try my hardest to get the golden liquid, you know the golden medicine, the magical stuff into them,” says Rebecca.
Rebecca says her determination to breastfeed her twins meant she pretty much didn’t have a shirt on for the entire summer. She says she would feed one, then feed the other, then express for a while and try and get as much into them as possible.
“Saying that, I think the bottle helps the dad bond with the child as well, and it also helps the mum of multiples because you only have one set of arms and being able to give one of your twins to a family member or your husband to bottle feed I think is really important and helpful,”
“There’s a lot of pressure on every mum, even of singletons, but when you’ve got two of them and they need burping and they need a cuddle, they need a cuddle you know,” says Rebecca.
Jannelle Snaddon laughed when asked about breastfeeding her quadruplets, who were born at 30-weeks gestation. With a challenging c-section delivery and recovery, she admits she gave it a go, but it didn’t last long.
“To start with my kids were lucky enough, they actually had donor breast milk while they were in the hospital,”
“I was in recovery, so I couldn’t express straight away,”
“I think it was a good few days or even a week possibly that I was able to start expressing myself,” says Jannelle.
Jannelle remembers getting hold of the breast pump and expressing constantly, however, she wasn’t able to produce enough milk to feed four babies.
“I spent all of the day and most of the night with the babies but that middle of the night where I’d wake up to express, but my babies aren’t here, was a very odd feeling,”
Jannelle attempted to breastfeed while her babies were still in the hospital, however, with four babies it was a huge task just trying to get them to latch. So, most of the time was spent expressing and trying to increase her milk supply.
“I remember getting home and I’d bought one of those twin pillows thinking that yes, I’ve got this, and I put two babies on, and then I just looked at Matt and said, ‘go make the bottles’,” says Jannelle.
Although Judy Adams is a lactation consultant and had guided hundreds of women through the initial stages of breastfeeding, she admits she found it difficult when it came to feeding her own twins.
When Judy had her babies, they were just short of 35-weeks’ gestation, she admits they were big boys, but they were still tube fed for a while. Judy admits that when it came to using the electric breast pump she had to be shown how.
“I’d shown dozens, that’s all I do show women how to express, but I’d never expressed my breasts myself,”
“I found it hard being a mum and not being a lactation consultant/neonatal nurse. It was difficult,”
“I had this huge pressure that I had to succeed at this because this is what I do. But I was very, very lucky I had two very hungry babies who just wanted to feed all the time,” says Judy.
Judy was fortunate in that twin feeding worked out well for her. And, she credits the support of her husband for being able to achieve it.
“It was a beautiful experience for me,”
“But, I’m well aware of the challenges, I had mastitis three times so that was pretty ordinary, and I nearly gave up, well I had pressure to give up,”
“But, I was determined,” she adds.
For me, well the girls spent the first 3-months in hospital following their birth, so initially, I expressed breast milk every three hours. At first, there wasn’t much but as time went on my supply increased … slightly.
By the time we left the hospital, I had a large freezer full of milk because in those early days the girls were only having such small amounts.
Bella preferred the breast, whereas with Aasha I could alternate between breast and bottle. However, my supply didn’t grow with the girls and my frozen supply ran out when the girls had been home for about four months.
I tried to switch to formula because I just didn’t have much milk, which worked okay for Aasha but Bella refused the bottle. I bought every type of bottle I could find but nothing seemed to please her, it was such a stressful time as they were still so small from being born at 28-weeks’ gestation and I was so worried Bella would get sick
Then one day, while the girls were sitting next to each other the floor, Bella reached over and grabbed Aasha’s bottle and started drinking. And, it continued from there.
Remember, there is enormous pressure to exclusively breastfeed your babies. When I was pregnant with the girls I had a twin mum tell me that the only reason women fail to breastfeed their multiples is that they’re lazy. This one comment months earlier stuck in my mind and added to my anxieties around providing for my babies. I now know better and I believe that Fed is Best and if that means you need to supplement with formula, then go for it.
When breastfeeding, you need to eat your normal triangle of fruit, vegetables, and cereals.
If a food upsets you it’ll probably upset the baby.
A full-term singleton baby needs 500mls of breastmilk per day, so for twins, it’s a litre, and for triplets, it’s 1.5 litres, etc.
Eat your normal diet, in moderation.
The bottom line is that your babies need to grow, so if you need to supplement with formula, go for it.
Until next time.
I wish you Double Happiness Multiplied.
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