Category Archives: Breastfeeding

GUEST BLOG!! ‘Breastfeeding Twins’ by Patricia Murray

Tricia’s top ten tips – Breastfeeding Twins

Breastfeeding twins is such a positive achievement for many families. For some, it means overcoming a number of challenges, relevant to many singletons too, yet widely prevalent in this community. There are a number of common contributing factors to breastfeeding twins as follows:

prematurity (50% born before 36 weeks)
70-80% born by c-section
learning to breastfeed, possibly for the first time, but with two different feeders
little opportunity to sleep
establishing milk supply for two babies
often encouraged to give top-up in the hospital as babies weight loss often more than 10% (due to all of above)

Many of us have managed to overcome these challenges and managed to successfully feed for many months and some years. So here’s my top tips for successfully feeding twins (these should also be used in conjunction with my general top tips for breastfeeding – available from http://nurturemeedinburgh.com/2014/05/19/tricias-top-ten-tips-for-breastfeeding/):

Feeding twins is a team effort. Partners and family support is vital. They can focus on general baby care (including skin-to-skin) and ensuring mum has got a steady supply of food and water enabling mum to fully concentrate on feeding. Mum needs lots of positive comments, encouragement and support. This will enable her to keep focussed. Partners can help researching and also can be responsible for drafting in help or taking mum to feeding clinics etc. Consider hiring someone to help you on your return home from hospital for those first few weeks.

In those first few days in the hospital, if you are on pain relief medication (such as tramadol or di-hydro-codeine) whilst recovering from a section and/or you have babies born 37/38 weeks or earlier, you might really struggle to have babies awake enough to feed. Carrying out as much skin to skin contact with mum and dad (or partner) and sleeping babies, can really help to overcome this and encourage babies to rouse enough to feed. There is no substitution for patience with this.

Top ups. One of the issues many mums have is being able to produce enough colostrum until the milk arrives. Milk usually arrives between days 2-4 (generally on day 4 for sections). However, in the meantime babies are losing weight. Whilst this is normal, if babies lose more than 10% of their body weight a schedule of 3 hourly feeds with babies topped up with expressed colostrum in addition to feeding will be started by the hospital. This whole process can take up to two hours (feed one baby, express, give expressed colostrum/milk/formula and then repeat) leaving very little room to sleep in between the three hour schedule (this really brought me to my knees). In my opinion, this is the biggest challenges for breastfeeding twin mums – it is an exhausting process. It can be difficult then to remove this need for top ups or for mums to believe they can produce enough for a feed. Top ups should be seen (in the majority of cases but not all) as a short term fix until mums are producing enough milk.

Building up a milk supply. There is no substitute for a well-attached breastfeeding baby to build up a good milk supply. Encourage frequent feeds (skin-to-skin will help). Let babies feed for as long as they want – the range for new babies can be 20 minutes to 100 minutes – don’t feel you need to remove them after a specific time (unless YOU want to). Middle of the night feeding is essential as this is when your prolactin is highest. If you want to encourage more milk, express for 10 minutes after a feed on each breast. Hire a hospital breast pump or dual pump as they are better and quicker letting you try to rest more in between feeds. There are also supplements such as fenugreek seeds, brewer’s yeast and lots of lovely herbal breastfeeding teas that can help.

Learn to feed each baby as an individual. For those first few days, learning how eachsian breastfeeding baby feeds is important. If you are a first time mum, you yourself are also learning about feeding and what is good attachment, how to be comfortable, and getting the babies positioning right. Don’t rush this stage to move onto tandem feeding as if feeding isn’t going well, you might feel that you’re taking a backwards step.

Adapted feeding on demand. Whilst with one baby, feeding on demand is essential, with twins it’s also essential that mum can optimise rest time. Therefore, mums should try to feed one baby after the other for the first few days/weeks and then if possible, tandem feed the babies so mum can optimise rest time in between feeds.

Tandem feeding. Tandem feeding is the ideal for feeding twins as it means that you can synch up your babies into the same pattern of feeds and sleeps meaning more rest time for mum which is vital. There are a number of positions – available in this handout from the multiple births foundation - http://www.multiplebirths.org.uk/MBFParentsFeedingGuideFINALVERSION.pdf. Many mums find a breastfeeding cushion can really help as it’s tilted meaning babies naturally roll towards you. Popular brands are EZ 2 Nurse Twin feeding pillow or Harmony Duo feeding pillow. Pillows don’t suit every breast shape and size, so bear that in mind that you might need to look at other options. Pillows are definitely suited towards larger breasted woman, whereas smaller breasted woman might prefer other positions. Keep experimenting until you find a position that suits you. For some mums, tandem feeding doesn’t work and you should very much feel that you can choose to feed one at a time. For some, they really enjoy that one to one time.

Swapping breasts? For the first few weeks, swapping breasts between feeds is the ideal. You may even want to consider swapping breasts half way through feeds when you’re tandem feeding as it might help if you have a stronger feeder to increase your milk supply. However, you might also decide to eventually allocate one breast to one baby. I eventually did this as I found one preferred one side. It also meant if I wanted to to give an extra in between feed, I could without thinking I was stealing milk from the “other’s” breast. You can end up a bit lop sided (just a little bit!). This is a very individual choice and there isn’t one right answer.

Get support – find out what local support there is. In Edinburgh and the Lothians, the Edinburgh and Lothians Twins and Multiples Club have a peer support system where one of our peer supporters will come to see you in your home. In addition, we run a weekly feeding support group (in my home). We also have an active facebook community where mums get lots of support. TAMBA has a breastfeeding information line if you’re in other parts of the UK (http://www.tamba.org.uk/support/Breastfeeding-Peer-Supporter-Scheme). There are lots of places to get help from like local breastfeeding clinics, cafes and the La Leche League branches. The issue that I found with these, is they just weren’t suited as a place to go with two babies and try to sit comfortably with two babies which is why we set up the feeding support in Edinburgh.

Look after yourself. It cannot be strongly emphasised enough how important it is to look after yourself. Mums need to be rested, fed and well hydrated. Physical needs such as being able to look after their recovering bodies is vital too – so time to have a bath, shower and feel clean. Self care is essential when caring for newborn twins.

There are so many more things I could go on and on about – I love talking twins and feeding…. but these are the TOP tips…..

I loved feeding my twins (well once we managed to get it established). I fed mine until they were 13 months. I had a number of issues with cracked, blistered, bleeding nipples but so thankful to an NCT counsellor who came to my home and spent time making minor changes to my positioning. And whilst there were so many tears over it, and challenges to overcome, I would love to have that opportunity to have one more middle of the night quiet feed with my two boys. I’m also so sad I have no pictures of me feeding – so advice to any twin mum – get lots of pictures taken of your achievement!!

If you need help with breastfeeding, with any number of babies, NurtureMe offer’s breastfeeding support as well as general postnatal care for those first few weeks helping with each feed. It will help to get breastfeeding off to the best start.

Much love, Tricia xxxxx

Lecture Topics Confirmed

Dr. Jack Newman will present a breastfeeding lecture for us, on Monday the 3rd of March 2014. The lecture will take place at the Wolfson Education Centre in Hammersmith Hospital, London.

The topics which Dr Jack Newman will cover, have now been confirmed as:

What they didn't teach you about breastfeeding in your training.
Controversies in Breastfeeding - covering Jaundice, Tongue Tie and Nipple Shields.
Colic in the breastfed baby.
Effects of birthing practices on breastfeeding.
Breastfeeding the premature baby.

The day will start with registration at 9am and a prompt start at 9:30am. There will be a 15 minute break mid morning and mid afternoon, with an hour for lunch. The day will finish at 5:30pm.

Fo more information, please see our other blog posts, or email us - info@theabbp.co.uk

About Dr. Jack Newman

Dr. Jack Newman graduated from the University of Toronto medical school in 1970, interning at the Vancouver General Hospital. He did his training in pædiatrics in Quebec City and then at the Hospital for Sick Children in Toronto from 1977-1981 to become a Fellow of the Royal College of Physicians of Canada in 1981 as well as Board Certified by the AAP in 1981. He has worked as a physician in Central America, New Zealand and as a paediatrician in South Africa (in the Transkei). He founded the first hospital based breastfeeding clinic in Canada in 1984. He has been a consultant for UNICEF for the Baby Friendly Hospital Initiative, evaluating the first candidate hospitals in Gabon, the Ivory Coast and Canada. Dr. Newman was a staff paediatrician at the Hospital for Sick Children emergency department from 1983 to 1992, and was, for a period of time, the acting chief of the emergency services. However, once the breastfeeding clinic started functioning, it took more and more of his time and he eventually worked full time helping mothers and babies succeed with breastfeeding. He now works at the Newman Breastfeeding Clinic and Institute based at the Canadian College of Naturopathic Medicine in Toronto. Dr. Newman has several publications on breastfeeding, and in 2000 published, along with Teresa Pitman, a help guide for professionals and mothers on breastfeeding, called, Dr. Jack Newman's Guide to Breastfeeding, as it's known in Canada (revised editions, January 2003 and January 2005), and The Ultimate Breastfeeding Book of Answers, as it's known in the US (revised edition, November 2006).

The book has been translated into French, Indonesian and Japanese and is in the process of being translated into Spanish and Italian (expected publication for both in the fall of 2010). In 2006, Dr.

Newman, along with Teresa Pitman, published The Latch and Other Keys to Breastfeeding Success (Hale Publishing) and this book is in the process of being translated into French (expected publication in the fall of 2010). He has also, along with Edith Kernerman, developed a DVD as a teaching tool for health professionals and mothers. It is available in English and French. As well, it is subtitled in Spanish, Portuguese and Italian.

Jack Newman's breastfeeding resource site is http://www.breastfeedinginc.ca/index.php.

How to Initiate or Boost Your Milk Supply

If you are just about to give birth, or have given birth recently, the chances are, you have milk on your mind. If you have decided to breastfeed, then establishing a good supply will almost certainly be one of your biggest concerns.

The best time to initiate supply is within the first hour after giving birth. If it is possible, keep your baby close to you, with as much of their skin touching yours - this is often referred to as 'skin-to-skin' As soon as you can, offer your breast and give your baby a chance to feed. If you and your baby are separated, try to hand express as soon as possible.

The more often you feed (or hand express) in these early hours and days, the better your breast a 'primed' for breastfeeding, and the more they will produce.

If you imagine that your breast are full of pumps, and each pump needs to be plugged in to work. Each time you feed your baby, you plug one of theses pumps in and they begin to produce milk. After the first few days have passed the feeds don't contain any more plugs, and the only way to start these pumps is with hard work. (But it can be done)

Boosting your milk supply

If you have begun breastfeeding and are worried about your milk supply we have some tips for you.

It is normal for your milk to 'come in' on days three to five, and it is important to keep feeding so that you avoid becoming engorged. It is also important to keep feeding, because the more your baby drinks (or you express) the more your body will produce, creating a good milk supply.

If you are already feeding every 3 hours or less, and you know that your baby is feeding effectively (Our next blog will cover this) you can also try:

Eating and drinking plenty - It is not true that you have to 'drink milk to make milk' but if you don't put anything in to your body, you cant expect to get anything out. So often we find mothers who come to us have simply forgotten to eat - have lots of snacks on hand (especially when you are breastfeeding) We recommend dark chocolate hobnobs...
Rest when you can, even a cat nap will do.
Express from one breast, whilst feeding from the other - this will trick your body into thinking it has to produce milk for two babies, and will increase supply.
Lots of people recommend eating oats, and they really are great for milk production, so porridge for breakfast, or flapjacks and oatcakes as snacks etc.
Fenugreek capsules - a great herbal supplement which can boost milk supply.
Express after each breastfeed - just to make sure your breast have been emptied - anything left sends signals to make less milk, but empty breast begin to produce more and faster.
Make sure you don't skip night feeds - the 2-3am feed is THE MOST IMPORTANT feed for milk supply. At this time you milk production is at its best, and if you empty your breast properly at this time (breastfeed and then express) you will certainly boost supply. You should be able to drop this feed again when your supply is better established. If you really cant express after, or miss this feed completely, make sure that in the morning you are sure to fully empty your breasts.

If you are worried and would like more advice, or a plan which is tailored to your individual needs, please to not hesitate to contact us. All of our online advice is free and we are always happy to follow up.

Antenatal Expressing

We LOVE the subject of antenatal expressing! Despite some of the controversial points raised about antenatal expressing, there are so many benefits, especially for babies who's parents suffer from diabetes (or gestational diabetes), or babies who are born with a low birth weight (especially multiples).

What is Antenatal Expressing?

Antenatal Expressing, is expressing colostrum in the last few weeks prior to your baby arriving. It is advised for mothers to wait until 36/37 weeks, although for mothers who are having multiple births, they should start a few weeks earlier than this, due to their higher chance of giving birth from 37 weeks.

Why do the ladies at South West Maternity love Antenatal Expressing?

Antenatal expressing gives a mother a chance to learn the valuable skill of Hand Expressing. A mother who is confident when expressing, and handling her breasts, will be confident she can produce milk, and has a much better chance of a great start when breastfeeding her baby. She is also much more likely to continue to breastfeed for longer.
When a baby is born, a blood sugar level is taken. Even in healthy babies, this level can sometimes be considered low (although it is much more likely in babies with a low birth weight) and often the hospital will suggest a formula 'top up' (or just go ahead and administer one if you have signed consent forms). This top up can often stretch a baby's tummy and can make the initial days of breastfeeding that little bit harder. If a mum has expressed antenatally, she will have a store of frozen colostrum, which she is able to give to the hospital staff in the event of a top up being needed.
Babies who's parents are diabetic, are much more at risk of needing a top up due to low blood sugar levels. Studies have shown that the bovine serum albumin in formula, can trigger an auto-immune response, which is linked to an increased risk of Type 1 Diabetes. In simple terms, Babies with diabetic parents are more likely to receive formula. which increases THEIR risk of also becoming diabetic. If a mother has been able to express antenatally, she will have a store of colostrum which can be given instead of formula. Further to this, mums who breastfeed decrease their chances of gestational diabetes in subsequent pregnancies.
Babies who may have difficulties after birth, and need hospital care, benefit greatly from ALL breast milk, and if you have already been able to begin a supply antenatally, your baby will have that much more support from you.

How do you Antenatally Express?

We would suggest starting at 37 weeks if you are experiencing a normal pregnancy, and 35 if you are having a multiple birth, or are at risk of delivering early.
After your shower (when you know that you are clean, warm and relaxed) begin by massaging your breasts gently toward the nipple.
You can begin to hand express - Use your thumb and forefinger to create a 'C' shape, and place them on your breast, about an inch back from your nipple. Press in towards your chest and then squeeze gently together. Your fingers should stay in the same place, and not slide down the nipple, as this would be likely to cause you pain.
Continue for up to 5 minutes, once or twice a day (if you have not had a shower, it is important that you make sure that your hands are clean)
If you experience ANY cramping in your uterus, STOP IMMEDIATELY - some studies have show that excess (4hrs plus) nipple stimulation can cause early labour. This is due to the oxytocin released. BUT you also release oxytocin when arroused, and no one advises you against night time activities 😉

How do you collect and store the colostrum?

Pick up some 2.5ml syringes from your local Chemist (or boots)
Use the syringes to suck up the drops of colostrum from your breast. (this can take a little practice!)
You can use the same syringe to collect for 24 hours, as long as it is placed in a sterile container in the fridge in between sessions. (even 1ml expressed is a great amount - so don't be disheartened if you only are able to produce a small amount - it is all useful!)
After 24hrs freeze the syringe in a sterile plastic bag, and remember to label it with how much was in the syringe and the date it was expressed, along with your full name.
Remember to take the syringes with you to the hospital in a freezer bag (so that they remain frozen on your journey)
Make sure that the hospital store them for you and that they are aware you have brought them! This can also be written into your birthing plan. Some hospitals may even allow you to bring some in prior to labour, so that you know it is safely stored before your arrival.

We hope that you have found this interesting, and if you have any questions at all, please feel free to ask us!

‘Tippett Timings’ and our online advice.

A few months ago, a lady came to South West Maternity for some online advice. It started with a little about latching her baby, and what she might look for, to make sure her daughter was getting the most out of each feeding session. We also discussed how to teach her baby the difference between night and day.

At 6 weeks we had a small chat about increasing milk supply, and storing any excess safely, for use at a later date.

At 16 weeks, we were very pleased to hear that She had an amazing breastfeeding routine and relationship with her daughter. She asked us if we might possibly be able to give her a little advice, on suitable sleeping routines. We discussed how her daughter was behaving on a day to day basis, with her rough timings etc, then were able to devise a new routine which would suit them both. We were able to outline a plan for her to put the routine into place, and of course, we were on hand at any time for tips and tricks.

We were thrilled to receive this comment in an email 2 weeks later.

" (Our daughter) is sticking to the Tippett timings well, eating well and has done 8pm-6am 4 out of 5 nights now!!!! I'm pumping like mad thing, enough to freeze some, which is ideal!!"

It makes our day when our clients achieve their goals, and we take pride in the fact that our advice really does make a difference to families. We also love it when they coin new phrases for us! 'Tippet timings' has definitely stuck in the South West Maternity Office!