May 15, 2014

Breastfeeding and Weaning Twins [one year and beyond]

Warning: this post contains breastfeeding pictures. If that is offensive to you, stop reading now.

 

A few awesome mom bloggers launched a new series last week looking at topics of interest for parents of older babies. Last week they offered some great advice on toddler tantrums and how to deal with them. This week the discussion is about transitioning to milk.

I've never blogged about our breastfeeding journey so I'm going to take the opportunity to start at the very beginning.

 

The NICU

The twins were born at 33w3d on January 13, 2013 and were immediately taken to the NICU. I got to go spend my time after delivery in recovery instead of with them. (For more on my labor story look here.) All of my plans to build a great supply through immediate skin to skin were ruined.

 

Hospital Grade Pump: Medela Symphony.
My constant companion for 9 months before I switched to a purchased pump.
 

Luckily, I had an amazing L&D nurse who came into my room with a pump and completely overwhelmed me by strapping me to this contraption and turning it on. I may have been overwhelmed, but I know I owe that night nurse so many thanks. Pumping early and pumping often is probably a huge factor in why I had adequate supply for two babies.

The next three weeks the boys were in the NICU and I felt very sidelined as a mother. I didn't know where I fit. They needed their doctors and nurses more than they needed me. Their was just one thing I could do for them that no one else could: pump. And so I did. I pumped every three hours. Without fail. Without exception.

 

The beginning of our home freezer supply.
Each NICU storage bottle holds 4.5oz.
The 150oz pictured was joined by nearly 500oz that was stored at the NICU.
 

Through all of my pumping I established my supply and FILLED the freezer in the NICU. In fact, by the end of the boys NICU stay they told me to stop bringing milk to the NICU!

After a few days, we were able to start practicing nursing. And so we practiced multiple times a day, but the boys were too small to latch well and would fall asleep before finishing a feed. They weren't strong enough for that level of work. I loved the skin to skin snuggles though!>

Skin to skin in the NICU.
 

While they were in the NICU, I would nurse one baby. He wouldn't eat enough. We'd wake him up and try a bottle. He wouldn't finish so he would take the rest of the feed by gavage. I would nurse the next baby. He wouldn't finish. He would take a bottle and not finish. He would take the rest of the feed by gavage. I was fortunate to work with a lactation consultant (LC) nearly every day during that time and so while things weren't working, I knew all the right things to do and try. And because of her support and encouragement I wasn't discouraged.

Tiny little bottle for Tripp.
 

Before they could be discharged from the NICU, they each had to go 48 hours without a gavage tube. So, for 48 hours I stopped nursing and let them complete all their feeds by bottles and they were successful. This was the first time I felt discouraged. It felt like a "condition of their release" was me giving up my plans to nurse. I was told this wasn't the case and in fact, the LC at the hospital wanted me to return to the nurse, then bottle feed, then pump model when we got home. It didn't make me feel better.

The Early Days at Home

After our first week at home, I was exhausted and frustrated. The boys went three hours from the start of one feed to the start of the next and the feeding plus pumping process was taking close to ninety minutes. I couldn't keep going. I was truly suffering. I wasn't bonding with the boys. I was crying. A lot. Things weren't good.

I made an appointment to go see the LC at the boys' pediatrician office. She told me to stop nursing. Not because we would never nurse, but to give the boys time to grow and mature and try again in a few weeks when they were past their due date. At that point I was so frustrated and so tired of the ordeal that permission to "give up" was exactly what I needed.

I stopped nursing and determined that if I was going to exclusively pump I'd be great at it. So I pumped. A lot. And by the end of March our freezer was overflowing. In fact, I was able to donate on multiple occasions to multiple moms because my supply was abundant. Moooo. For full stats on my milk production read this by the numbers post. It also contains really helpful information about tracking pumping and nursing.

Milk in the fridge.



Milk cubes.
I froze in ice cube trays and stored
in freezer bags. Much more space
efficient than any other system I tried.

 

A few tips for pumping:

  • You should be eating as much while nursing as you did while pregnant. My LC explained that it takes MORE calories to nurse than to grow a baby!
  • You should be drinking MORE than you did while pregnant. If you aren't floating you aren't drinking enough. Every mL you pump has to come from liquid you take in. Your body needs it's normal liquid intake PLUS the amount you are pumping.
  • Pay attention to your body. I was originally told to pump for 15min but I learned I got a second letdown at 18min and a third around 25. I did the best when I pumped approximately 30min. This is different for very woman so pay attention to how your body responds.
  • Relax. Easy to say right? But when I was comfortably situated and distracting myself I pumped better than when I tried to stare at the bottles and will them full. I found my favorite place to pump was propped up in bed with the TV on and scrolling through my twitter feed. I obviously couldn't pump like this when the boys were awake, but I tried to pump during naptime. And I always pumped in my comfy position in the evenings while Casey fed them.
  • Know that ANY breastmilk your baby gets is good. Formula isn't the enemy and if you have to use it, either exclusively or to supplement remember that fed is best.
  • Get a good pump. I rented from the hospital for the first 9 months and so had an amazing Medela Symphony. Then I changed to a Pump In Style Advance. It took a lot of fighting with my insurance company, but I really wanted a pump with dual phase expression since I was exclusively pumping.
  • Invest in a good hands free pumping bra. I started with a Medela Hands Free they I was given and it was a Godsend in the NICU but didn't work great. I then switched to the oft praised Simple Wishes and it was only okay. I found I preferred pumping tanks and pumping bras. (Favorite brands: Milkalicious Tanks and Dairy Fairy Bras. Since I stopped pumping for the boys, Dairy Fairy has released a tank I'm excited to try.)
  • Buy Pumpin Pals. Don't question this advice. Just do it. These flanges are FAR more comfortable AND better mimic the angle of a nursing baby to stimulate greater supply.
  • Figure out your best way to entertain the babies while you pump. For me it was to frequently keep them in my lap where we could sing songs and chat together. Hello hands free bra!
Excuse the awkward photo blurring.
Attempting to leave some things to the imagination.
 

Nursing

On April 2, I tried to nurse for the first time since before the boys due date. And it was fairly successful! As in, no one cried. Yeah. I call that successful. We had low standards.

I continued to attempt nursing once a day until end of April when both boys really "got it." At 3.5 months old, I was nursing both boys nutritively. They were still getting one bottle at night before bed from their daddy so I could have some alone time (which I spent pumping, but hey at least I was alone!).

I can't even explain the amount of joy I got from being able to nurse. I was elated. Was it this amazing bonding experience I had heard about? No. Not at all. Was it convenient? Yes! Was it great that they still took a bottle? Yes! At this point I think I had the best of both worlds. Things were amazing.

I am not one of those moms who push breastfeeding. It was right for us for this time. I heard a great piece of advice at my twin club meeting while I was still pregnant. I clearly am too stubborn to have followed this good advice, but I thought on it often.

  • For 6 days... Try nursing/pumping. If you don't have a groove or your milk hasn't come in, then stop. Fed is best. A happy mommy is best.
  • For 6 weeks... Try to establish your breastfeeding/pumping routine. If it still isn't working for you after six weeks, then stop. Fed is best. A happy mommy is best.
  • For 6 months...Attempt to give your baby exclusively breastmilk. Then they start solid foods and many things change and if you need to stop, then stop. Fed is best. A happy mommy is best.

Tandem Nursing



We began working on tandem nursing as soon as they had nursing down. It freed up so much of our day to do other things! I honestly don't feel qualified to give advice on tandem nursing. It worked for us. I had to always use a pillow (I liked the My Brest Friend). I have no clue how I got them both latched at the same time. I almost always did it sitting on the floor so I could easily pick up/put down a baby and so I didn't have to worry about dropping anyone while burping. Once I realized I liked to sit on the floor to tandem nurse I bought a floor chair off of Amazon (they call it a stadium chair for sitting on bleachers. I call it the perfect floor chair!) and it changed my life. No more back ache! I was comfy! I've had moms ask how I got both boys to latch. How I picked them up. How I did... And honestly? I don't know! While nursing was difficult and took a lot of work, a lot of practice, and a lot of trial and error, tandem nursing just happened.

Breastfeeding and MPSI

No tale of my breastfeeding journey would be complete without talking about Davy's milk protein allergy. It was initially diagnosed as MPSI (milk protein soy intolerance) and later changed to a milk protein allergy. Due to his issue, I was completely milk and soy free beginning in April when he was diagnosed. At this point I had the added pressure of knowing if I gave up nursing, he would get a formula designed for allergy babies and the first ingredient is high fructose corn syrup. That made me so very uncomfortable. I believe fed is best and am so glad a hypoallergenic formula is available, but I struggled with the idea of feeding my child corn syrup. We were seeing a GI at the time who was also very pro-breastfeeding, particularly for babies having problems due to the numerous health and GI benefits from breastmilk. At every appointment he extolled the virtues of breastmilk and inspired me to continue. I became even more committed to making breastfeeding work and sticking to a dairy free and soy free diet. Thankfully, Casey was on board and was so very supportive through all of this and even went dairy free with me (or at least dairy free at home. He was eating his cheeseburgers at work!).

Weaning

Beginning mid-December I started losing weight at a decently rapid clip. I was pregnant and exclusively breastfeeding the twins and couldn't eat enough. It was clear weaning needed to happen, but in my head I needed to make it to the magical one year mark before I introduced milk (or in our case coconut/almond milk). We saw the GI at the end of December just two short weeks shy of the boys first birthday. At the appointment the GI said it was time to start introducing milk. Whoa! I thought the goal was exclusive breastmilk until one? Not according to the GI. The difference between 11.5 months and 12 months is just not much so supplementing with some milk product is absolutely fine.

The boys had been drinking water from a straw cup since they were 6 months old so I naively thought I would do the milk transition and bottle transition together. It didn't work. They did great with milk product but not so great with cups.

I started by offering a mix of milk product (we began with coconut milk) and breastmilk in a bottle. They did great. I slowly increased the amount of milk product and they still did great. Eventually I was giving pure coconut milk or pure almond milk. On days they seemed under the weather at all I could defrost breastmilk from the freezer and they did great with it. They easily went back and forth and drank whatever I offered them from a bottle. Weaning from breastmilk to coconut milk was painless, seamless, and easy. (Some part of this journey had to be right?)

Many women talk about the pain of weaning and speak of cabbage leaves and taking sudafed and many other tricks to dry up supply. I didn't have to worry about any of those. My supply was drying up due to pregnancy. I think this was also why the boys transitioned so well. They weren't getting what they wanted/needed nursing so a cup of milk product was exciting and welcome.

I nursed for the last time on the morning of January 14, one day after the boys first birthday. From then on it was all bottles and cups.

Still getting in some skin to skin even with bottles.
 

What wasn't easy was transitioning from the bottle to a straw cup. But, I have already written about how we finally succeeded in that here (spoiler: the right method made it painless but it took a while for me to find the right method) so won't retell the tale.

 

 

 

Take some time and go check out The Not Quite Military Wife to see other blogs on weaning. The expertise of other moms is invaluable!

The Not Quite Military Wife: One Year And Beyond

 

7 comments:

  1. WOW! This is an amazing post. You are a rockstar! :) I'm so so so glad you wrote all this down. This is going to help so many other moms that are struggling. Wonderful advice. I'm so glad it all worked out for you guys and that you didn't give up. My friend Julie at The Girl in the Red Shoes has a series on her blog called The Breastfeeding Diaries - this would be a great submission! You should reach out to her. Really great post.

    ReplyDelete
    Replies
    1. Thanks! I had never heard of The Breastfeeding Diaries before and enjoyed some time this weekend reading!

      Delete
  2. Amazing! You are a trooper man! One of my little sisters was born extremely early and was in the nicu for months. We had two deep freezers full of milk in our garage. You went through so much and to still have the desire to breastfeed is truly remarkable! Such a great post!

    ReplyDelete
    Replies
    1. Dealing with the NICU adds an extra challenge to everything but I'm so glad I stuck to it.

      Delete
  3. Wow! What an amazing feeding testimony!! Love this and your boys are soo cute :) Likeamorningcupofcoffee.blogspot.com/

    ReplyDelete
  4. Oh my heavens, you are SUPER MOM! I can't believe the milk supply you built up while they were in the nicu and nursing twins?? I remember my early days of nursing... I was wishing I'd had twins so that I'd have a good excuse to NOT nurse (ha ha) But if I ever have twins I'll be coming back to this post to gear myself up for it! You are truly amazing!

    ReplyDelete