Today is a Twin Pickle first… I’m handing over the blog to someone with far more experience and knowledge on this subject than myself. We were lucky enough to avoid the NICU when I had the Twins at 36wks, but I still didn’t manage to successfully breastfeed. This was partly because I panicked about their weight loss, when preemie’s don’t have much to spare; and partly because I lacked knowledge on preemie babies and pumping. Therefore I’m extremely happy to have Katharina offer her expertise, for any moms-to-be or new mums worried about how breastfeeding at the NICU is possible.

“Don’t stop pumping the plane! My wife is still boarding for our baby!”, my husband blurted out, while sprinting towards the airport terminal staff, after they had made the final boarding call for our flight. By the time I walked up, the airline staff welcomed me with a chuckle and by saying “Good job pumping, Momma!” We had just spent the first 7 days of our precious baby’s life at the Neonatal Intensive Care Unit (NICU), after being air ambulance to a different city shortly following his birth. Needless to say that my husband and I were excited, exhausted, and apparently we were both suffering from major “Mommy Brain”.

To this day, I still tear up every time I see a picture of a preemie. We only spent 1 week at the NICU, but other parents spent much, much more time there. If you’re expecting twins, then your doctor may have already mentioned that depending on how early your babies arrive and depending on their birth weight, they may be admitted to the NICU. Even though it probably is not what you’re hoping for, you are already ahead of most expecting moms by facing this possible scenario head on and mentally preparing for it. This way you’ll enter and exit the NICU much stronger and more confidently, and you’ll be able to keep your focus on your sweet babies.

If your goal is to breastfeed your twins, know that premature babies are often too weak to start breastfeeding after birth, and they may be tube or bottle fed at the NICU instead. Therefore, the foundation to successfully breastfeeding your twins later down the road, is to first learn how to pump successfully. Many other moms of twins have done this before, and while there are some challenges to overcome, it’s completely doable!

“Will I have enough milk for my babies?” is a very common question, especially for moms of twins. It can be easy for people (even well-intending family and friends) to knock your confidence, when it comes to producing enough milk. Your best strategy to silence your inner critic and to create a generous milk supply is to thoroughly understand how milk production works. Breasts create more or less milk, depending on how frequently and efficiently they are emptied. So, the more often and the more thoroughly your breasts are emptied, the more quickly your body will replenish. Usually, it’s your babies’ job to empty your breasts and to tell your body how much milk to produce, but if things start off at the NICU then you’ll take charge of this yourself via pumping. If managed well you can get explosive results.

What kind of pump should I get?

While your NICU will provide you with a pump, you may still choose to buy one ahead of time or know where you can rent one in a jiffy, so you are also prepared for pumping at home. If you’re expecting twins, a hospital grade double-pump will cut your pumping time in half, because you’re emptying both breasts at the same time. That’s a huge time saver! When shopping for a pump, pay attention to reviews of other moms about how thoroughly the pump empties their breasts.

Pumps usually have a “Stimulating Phase”, which is a single setting that lightly stimulates your breast to trigger the milk flow. Once the “let down” happens and your milk begins to flow, you’ll switch the pump to “Expression Phase”. In this phase, you’ll be able to choose from several intensity levels. Don’t use the highest level when you first start pumping. Work your way up towards it, so you can get used to the higher settings more slowly. For the first few pumping sessions, start by pumping only one side at a time. You’ll learn how to handle the pump more easily and also have a free hand to massage your breast during pumping. Light massages and compressions can help ease breast engorgement, which is quite common in the early days. Later on, a pumping bra, will free up your hands, so you can enjoy a little mobility while pumping. By the way, do not do any pumping, while you are still pregnant, because stimulating your breasts towards the end of pregnancy can actually bring on your labor.

Where will I pump?

During my pregnancy, I always imagined spending the first couple of days of my baby’s life bonding in the privacy in our own hospital room together with my husband, with the occasional doctor, nurse, or close family member checking on us. NICU life is quite different. Your babies will likely be inside an incubator, in a large, open room together with several other babies. Our NICU had approximately 20 babies in the same room, with a nurse to baby ratio of 1:2. You’ll be sharing the room with the NICU staff, the other parents, as well as the visitors of other babies. The only means to create some privacy are mobile wall panels, that you can set up to create a “quiet corner”. Pumping bedside allows you to spend more time with your babies and also gives you an opportunity to ask the nurses for help if needed. If you’re having any difficulties, ask multiple nurses, because each nurse may have a different suggestion or solution. Also, take advantage of the hospital’s lactation consultant and discuss your progress with her as frequently as possible.

During busy visitor hours, you can seek out the “Mother’s Pumping Room”, which every NICU has. It’s probably not the fanciest of rooms, but it will give you some well-deserved privacy. During the night, you’ll be pumping either at your hospital room or at home. If you’re able to set up your pump beside the bed, you may be able to “rest” a little while pumping in bed. Just use some pillows to prop yourself up and get comfortable.

How often and how long should I pump?

Due to our delayed transfer to a different hospital, I didn’t get my hands on a pump until almost 16 hours after my son’s birth. Delaying pumping past 6 hours after birth is never recommended, but it goes to show that you can have success with pumping, even when things start out less than perfect. When I was finally handed a pump by a nurse in her early 20s, who undoubtedly had never pumped or breastfed herself, she told me “Here you go. Pump for 10 minutes on each side, every 3 hours”. So, off I went and started pumping, strictly abiding to her instructions. Once my milk came in more heavily, 10 minute pumping sessions weren’t nearly long enough to get the job done, leaving me completely engorged. At the time, I didn’t realize what my breasts should feel like during this stage. I had heard so much about how sore and uncomfortable women’s breasts get, so I figured this must be all part of it. I was so grateful, when a more experienced NICU nurse told me to keep pumping each side until my breasts were empty and felt “soft” again. No more of this 10 minute nonsense! Remember how important emptying your breasts frequently and thoroughly is for your supply? I quickly learnt that pumping more often than every 3 hours and emptying my breasts completely did wonders to my milk supply. So I aimed for more frequent pumping during the day, and stuck with a 3 hour routine during the night. Also, if one breast still feels heavier and lumpy in certain spots after pumping, there is still some milk left. It may indicate plugged ducts. Keep pumping, and massage the lumpy area, starting from the top working down towards the nipple. You may pump quite some time without any milk flow, when all of a sudden the duct unplugs and milk flows full force for a few seconds, until the duct is completely emptied.

Why is no milk coming?

Pumping during the first 3 days, can be mental torture. Sure its physically exhausting, but what’s even more difficult is staring at an empty bottle, session after session. It can be outright disheartening and cause moms to throw in the towel, saying “I literally had no milk!”. I remember panicking over this, too!

Generally, colostrum is produced over the first 3 days, followed by a noticeable increase in milk supply after day 3. That is textbook milk supply, though! If your story is different that’s completely OK. Multiple factors, can trigger delays in milk production, such as being a first time mom, large amounts of IV during labor, medications during labor, traumatic birth, c-section, long pushing stage, delay in pumping, and many more 1. I checked off at least 6 of these factors, which caused my milk to come in quite late. I still stuck to my pumping routine, remained focused, and was eventually able to exclusively feed my son with breastmilk. Know that under difficult circumstances, it may take over a week or two (even several weeks in severe cases) to slowly build up a full milk supply. If your twins are born quite prematurely, it may mean your breasts missed part of the growth period of late pregnancy, resulting in less milk producing tissue at birth 1. Again, frequent and thorough pumping, will help your breast tissue to continue to grow and develop after birth 1. Once you’ve done the hard work of developing your supply, you’ll reap the reward of watching your twins getting “milk drunk” on momma’s milk.

Almost no milk is coming!

When you finally start seeing a thick drop of colostrum slowly coming out of your nipple and running down the horn of your pump there is a good chance the precious drop will go completely to waste. Why? Because by the time it has made its way from the horn, through the pump’s valve, all the way down the inside of the bottle, it’s likely going to have dried right up. That’s why hand-expressing is usually more effective at this stage. Simply press a spoon or tiny cup tightly against your breast, just below your nipple. Use your other hand to compress and massage from just above and below your areola down towards your nipple. Ask a NICU nurse or a lactation consultant for help with this if you need any. They will also help you feed your colostrum to your babies. Always remember to still pump after hand-expressing to stimulate your production. It’s absolutely fine if no or almost no milk is released during your pumping sessions. You’re simply sending your body a message to start producing milk. Give it some time.

You may see other moms entering the pumping room after you and leaving before you, holding two 8 ounce bottles of milk, filled to the rim, while you’re struggling to create a single ounce. Instead of getting discouraged and being struck down with milk envy, try to remember that this mom has likely spent much more time at the NICU than you. Stay focused on your goal: Building a generous milk supply for your sweet babies.

Once the pump starts to express some milk, you may want to attach the pumping horn to your breast upside down, resulting in the bottle being held upside down as well. This shortens the path your milk has to travel, saving your precious milk right inside the pump’s horn, where you can syringe it out of later on. NICUs carry syringes in various sizes, and you’ll feel incredibly accomplished every time you move up a syringe size, because you’re supply has increased again.

What about supplementing?

While you are working very hard at boosting your milk production, your babies may still need some supplementing in the early days. Trust your NICU staff about when and how much to supplement. It was gut-wrenching for me, when my baby wasn’t getting enough milk and needed to be supplemented. I unnecessarily put myself through the ringer about not having enough milk. It’s completely okay and absolutely necessary in this situation to supplement! Formula or donor milk can be heaven-sent, and you should never feel guilty about having to supplement.

Skin to Skin or Kangaroo Care:

The first time, I walked up to my son at the NICU, I couldn’t help but start crying. I had kept it together pretty well up until that moment, but seeing him inside the incubator, with cords attached all over his tiny body, and feeling that physical barrier between us unhinged something deep inside of me. All I wanted to do was to finally touch him and hold him. Luckily our head nurse was a huge advocate of “skin to skin”. She helped us take him out of his incubator and placed him properly between my breasts, so he could breathe well and so that the cords weren’t getting caught anywhere.

“Skin to skin” is also known as “Kangaroo Care” and has too many wonderful benefits to name them all. Honestly, we probably haven’t even discovered all of the incredible things it does for moms and their babies. Immediate benefits are stabilizing of babies’ breathing, sugar levels, heart rate, and temperature2. It is soothing to babies, and there are suggestions that it improves babies’ sleep cycles. Mothers feel more empowered and needed by their babies. It lessens the stress load and makes new moms more responsive to their babies’ cues. Most amazingly it is proven to increase the prolactin level in mothers, which is the hormone responsible for helping your body make milk2. So, skin to skin is absolutely wonderful for you, your babies, and for boosting your milk supply. A great time for skin to skin is after you’ve fed your babies. Go braless and have your babies wear nothing except their diapers. Be sure to ask the nurses to help you with placing the twins on your chest and placing pillows below & beside your elbows to help you relax your arms. Also, have them place a blanked over your babies backs to keep them warm. Tucking the blanket around your back will also help keeping your babies more securely on your chest. Dad can join in on the fun too, of course!

One last piece of advice: “Be patient with yourself. Be good to yourself. Be gentle with yourself.” This may be one of the more challenging and exhausting situation you’ll ever work through in your life. Don’t allow yourself or anybody around you to guilt you in any way, regardless of the path you choose. Your babies most and foremost need a strong mom. You may be struggling with a certain aspect of pumping or the NICU one day, and the next day you may have the most incredible moment with your babies erasing all the stress around you for a quick moment. Take it one day at a time, and you’ll do a wonderful job at handling pumping, the NICU, and eventually breastfeeding as well. But most importantly you’ll do a wonderful job being there for your sweet babies.

References

When will my milk come in? • KellyMom.com. (2016, March 15). Retrieved February 13, 2017, rom http://kellymom.com/ages/newborn/when-will-my-milk-come-in/ Skin-to-skin Contact. (n.d.). Retrieved February 13, 2017, from http://www.lllc.ca/category/faq-categories/skin-skin-contact

Katharina Siemens gives expecting and new moms the critical knowledge, practical info, and crunchy solutions to meet their breastfeeding goals.