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Thread: Breastfeeding twins, how else can I increase production?

  1. #1
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    Default Breastfeeding twins, how else can I increase production?

    My twins are 3 months (chronologically), but 5 months by birth date of January 19, 2012. I have had help with breastfeeding with lactation nurses in the hospital/NICU and also by an LLL leader. I am not able to produce enough milk for them to be purely breastfed. They receive (each) about 8-12oz of formula/day. I had made the decision to try to wean them once they came home from the hospital, but it never happened (I think my mistake was to supplement them after nursing with formula thinking that my supply was not enough). While they were in the hospital, I was pumping milk for them every 2 hours (3 over night). My right breast would be dominant for production with about 1-2oz and my left would be less at about 1 oz or less. Now that my babies have been home for awhile, they nurse throughout the day and I supplement with pumped breast milk. When I put them to bed (around 6p), they are out of pumped breast milk and I nurse, then supplement with formula (which they take about 2 oz each at 6p feeding and then 2 oz at their 10p feeding). At night from 7-11 or 12, I cluster pump every hour to acquire about 6 oz of breast milk for their supplemental feeding for the next day. At night, they may wake at about 4 and I will stagger their nursing (during the day, I feed them at the same time on a nursing pillow) so I can sleep while they nurse. At the 7a feeding, I give them each 2 oz of formula with the 1ml of vitamin. I then feed them every 2 hours throughout the day (nurse them until they get frustrated) and then I supplement with the pumped breast milk. I will then pump after they have nursed to ensure I am well drained and I only will get about 5-10ml from each breast.
    With this routine and my cluster pumping at night, my production still has not increased. Before the babies came home from the hospital, my pumpings would be about 1-2 oz from each breast (the left being a little less than the right). Now, with my pumpings when the babies are sleeping at night, I only get about 5-10ml??? Also, my left breast is the breast that is supplying more now and the right breast is lagging behind it.
    Everything I have read says supply and demand, the more your nurse, the more you pump, the supply will come up - well, it hasn't. I drink about 2-4 liters in a day too and drink mothers milk (I used to take fenugreek, but that wasn't working at all). I still am not going to give up. I am trying my hardest to give these babies breast milk, but it seems my supply is maybe dropping and definitely not increasing. I have gotten my period twice, irregular. But I have heard that your supply increases again once your period is over? Someone else mentioned thyroid, but I have no symptoms of hypothyroidism as far as I know?
    I wish with all my efforts, I could feed these babies. I so desperately want to, but it seems something is wrong.

  2. #2

    Default Re: Breastfeeding twins, how else can I increase production?

    There are many other herbal galactogogues to try, and also prescription galactoagogues. For a very complete discussion of low milk supply and it’s various causes and remedies, I suggest the book Making More Milk. I assume you already have the book Mothering Multiples and have checked out this website: http://www.karengromada.com/

    Your schedule sounds exhausting, never mind that of course twins are exhausting, plus you are stressing yourself out over how much you pump, which is understandable but may not be helping. How much a mother pumps is a very poor indicator of milk supply, and certainly you would expect to see a much lower pump output now that babies are home and nursing around the clock, than when they were in the hospital and I assume you were not also nursing or not nursing nearly as much?

    although if you are seeing a dramatic decrease in pumping output right now, while you have had babies home, I would suggest troubleshooting your pump-change membranes, check connections, make sure the breast shells are still the correct size, maybe have suction tested.

    Plus if you have to do that much pumping, I would think the appropriate pump would be a hospital grade rental pump-is that what you are using?

    At this point are your babies able to transfer milk well at the breast? What if you backed off some on the pumping for a bit and just hung out for a few days and relaxed and nursed?

  3. #3
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    Default Re: Breastfeeding twins, how else can I increase production?

    Excellent advice from LLLMeg. I think you definitely want a hospital-grade rental pump and also to try simply nursing the babies and watching diaper output. This might mean nursing both babies literally all. day. long. for a few days, but if the babies are able to transfer milk at a good rate, you very well might be able to ditch the pumping and the bottles and simply nurse, which I am sure would mean an immense reduction in the amount of energy you are expending, what with all the pumping.

    Many moms experience a drop in supply before their period. Milk supply may spontaneously rebound after the conclusion of the period, but often it takes work to get supply to bounce back. When the baby or babies are nursing, they will simply nurse more often and for longer periods. When mom is pumping, she needs to work even harder and mimic that increased frequency/duration feeding pattern using the pump.

    Hypothyroidism is quite common in postpartum moms, and can impact milk production. If you exhaust all the avenues suggested by LLLMeg above, and still cannot get all the milk you need, you might want to consider stopping by the doctor's office for a test.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  4. #4
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    Default Re: Breastfeeding twins, how else can I increase production?

    I have heard of medications like Reglan, but not herbal galactogogues? I imagine I can find them at whole foods and the like?
    Thanks for the suggestion of the book Making More Milk - I have not heard of it and will definitely get it asap. Yes, I own and have read the book Mothering Multiples.

    Pumping - yeah, I've heard it is a poor indicator of how much the mother makes, but I do know that I was making a bit more when I was solely pumping (breast feeding, they would only let me do for about 5min. a day or so in the hospital and I would only do one baby usually in a day). Another thing, is that at night, when the babies are sleeping and I am pumping, it takes me from 7p to about 11p (give or take an hour) to make only about 6 oz. I could usually make that much in half the time when I was solely pumping. I noticed this drop in my pumping shortly after the babies came home. I do have a hospital grade pump that I had rented the day the babies were born and started pumping right away. I get good suction and have even turned it up a few levels from what I started, which was the preemie level. I don't *think* it's the pump, as I do see my nipples being pulled in through the flange as they have always looked when I first started with pumping.

    My babies do transfer milk well, as far as I know. While the babies were in the hospital, I have seen a few different lactation nurses and they were all very surprised that the babies were latching so well (for preemies) and also, apparently, they have told me I have good nipples for easy breastfeeding (ha).

    I was advised by my local LLL leader to do just as you have suggested - take a day in bed and just nurse with no supplemental bottled breast milk. Well, I was all gung-ho about this, but lost it after the first hour of that day. The babies show frustration at the breast like they are not getting enough or that there is no milk let down (I do feel let downs and it seems they happen in short duration and then there is a minute or so before the next let down - I don't believe anything significant comes in between these let downs?). This is when I take the babies off the breast and give them the bottle (I'm guessing anywhere between 5minutes to 20minutes?). So I gave up and returned to the usual routine. I do not know where to go with this? If there is no milk coming out after a let down and the babies are crying and frustrated, what is the next option other than break down and give them the pumped breast milk? I do not want to keep re-latching them over and over if there is no milk.

    Thanks for your help Meg and Mommal - I appreciate your time.

    Oh I will also make an appointment with my Dr. just to make sure there isn't anything underlying like hypothyroidism.

  5. #5
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    Default Re: Breastfeeding twins, how else can I increase production?

    Quote Originally Posted by @llli*twincon View Post
    but I do know that I was making a bit more when I was solely pumping
    Everyone produces milk more per pumping session when they pump to replace nursing than when they pump in addition to nursing. Everyone. Your babies are nursing to get some of the milk directly so you aren't able to get as much when you pump. That's normal. It can take awhile, but pumping after nursing will eventually increase your supply.

    If there is no milk coming out after a let down and the babies are crying and frustrated, what is the next option other than break down and give them the pumped breast milk? I do not want to keep re-latching them over and over if there is no milk.
    There is always milk; it's just that the milk gets more difficult to get out as the breast becomes emptier. The problem with bottles is that babies don't learn to work for that milk. I'm sure it is super hard with twins and not all of this may work in that situation, but here are some things that I did with my son to calm him enough to nurse when he would fuss at the breast: Rock him while nursing; bounce him on my knee while nursing him; walk around while nursing him (I'm not sure how possible that is with twins - two slings maybe?); nurse him outside; nurse him in the bath. Hopefully some mamas of twins here will have some more twin specific suggestions.

    As difficult and frustrating as it is, taking a nursing vacation (no pumping, no bottles) with your babies absolutely is the best way to up your supply and get your babies more proficient at nursing. Just work on finding some ways to soothe them while they nurse so they don't get so frustrated at the breast. Bottles are only going to make that worse.
    K. Sophia - Mama to my little lactivore, the amazing Mr. X (11/10).

  6. #6
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    Default Re: Breastfeeding twins, how else can I increase production?

    You breast are never actually out of milk. And that is why the week end long nurse in is the best option. Even if your babies are showing signs of frustration. Because they have learned by being continually supplemented that they only have to work through a letdown. And that as soon as they fuss you will give them food an easier way. Which a bottle absolutely is. So I imagine it is actually affecting your supply because the less work they are willing to do at the breast, the less you will produce. Crying isn't the end of the world. Especially since you are right there with them. Their frustration is part of their routine. They fuss, you give them a bottle. If you don't give them a bottle what is the alternative? When you are there and they can smell your milk? To get hungry enough to do the work. We are creatures of comfort, but we are also mammals that are hard wired to survive. If they understand that the "easier way" isn't coming, they will eventually do the work. Which they will have plenty of opportunity to do if they are in bed skin to skin with you all day long. Try it again. And prepare for some crying. And some refusal. But if you aren't getting up to pump, and the boobs is all there is, eventually they will eat. You may very well have a rough first few hours. Tough it out. Because what you are trying to do is get them to FORGET about the easier way to eat. Eventually their instincts will kick in and they will suck.

    Way too lazy for formula

  7. #7
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    Default Re: Breastfeeding twins, how else can I increase production?

    with the PPs. I know it seems like baby torture not to give them the bottle when they start to fuss, but toughing through the fussiness and basically saying "Kids, if you are hungry you need to get back on the breast and WORK for your meal" is often the best way to cut bottles out of your life.

    How much milk do you put in the supplemental bottles? If you are unable to be as tough as suggested above, you could try giving a very small supplement- say 1 oz or 1/2 oz- and then return the babies to the breast for more nursing. The "finish at the breast" technique can be helpful with babies who think that every feeding concludes with a bottle. If they learn that every feeding begins and ends at the breast, they may eventually forget to fuss for a bottle. The breast is a much nicer place to get your comfort sucking done than a bottle, after all!
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  8. #8

    Default Re: Breastfeeding twins, how else can I increase production?

    For herbal galactagogues info, see Making More Milk when you get it and kellymom.com has a few good articles on this and low supply in general in the meantime. They do not work for everyone, but for some moms they help quite a bit.

    Domperidone is considered by some more effective and safer than Reglan if you go the prescription route. Whether or not you can get it prescribed for low milk supply is another story.

    But the single best way to increase milk supply is to nurse more. Great suggestions above about this. Mom's who have struggled with supply often find it very hard to "make" baby nurse. In large part it's a confidence game and mom may see every fuss and sign of frustration as in indicator they don't have enough milk.

    This is why bottle feeding, even when it was/is completely necessary, can cause so much mischief, as a baby who is used to the ease of taking a bottle may indeed fuss when having to work for it more at the breast. But your babies are made to nurse at the breast, so they can do it! And also remember babies fuss and get frustrated for any number of reasons.

  9. #9
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    Default Re: Breastfeeding twins, how else can I increase production?

    Wow, I'm impressed with all you've been able to do with twins! Great job!
    With the advice of my IBCLC, I took herbal galactagogues to increase supply in the early months. This is what I posted on another thread about increasing supply:

    "The herbs I was taking to increase supply were fenugreek, alfalfa, and blessed thistle - henry's/sprouts carries all of them. I took them all 3x/day, and memory is fading but I think it was 3 fenugreek, 2 blessed thistle, 3 alfalfa capsules each time (a lot, but it was early and I was trying to get a better supply going). This was under the consultation of an IBCLC, so your coworker might want to get advice from one in this area. I did notice that it helped after a few days!"

    I don't know if these will help you but if you're trying different things, it's probably worth a shot?

  10. #10
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    Default Re: Breastfeeding twins, how else can I increase production?

    Quote Originally Posted by @llli*phi View Post
    Everyone produces milk more per pumping session when they pump to replace nursing than when they pump in addition to nursing. Everyone. Your babies are nursing to get some of the milk directly so you aren't able to get as much when you pump. That's normal. It can take awhile, but pumping after nursing will eventually increase your supply.
    This is so relieving to hear. I was hoping this was the case, but when I talk to other mothers who are breastfeeding and pumping, they say the opposite and say their pumping has increased? I've been doing the pumping after nursing as suggested by another local LLL leader and it's been a few months now with no increase. I mainly gauge if there is an increase or decrease by how the babies are acting at breast and also what I am cluster pumping when they are asleep at night (which is only, as said before, like 6 oz give or take).

    As difficult and frustrating as it is, taking a nursing vacation (no pumping, no bottles) with your babies absolutely is the best way to up your supply and get your babies more proficient at nursing. Just work on finding some ways to soothe them while they nurse so they don't get so frustrated at the breast. Bottles are only going to make that worse.
    I will try this again. I get so whimpy when it comes to seeing them both crying and frustrated when nothing is seemingly coming out (even to confirm this when they are acting this way I make sure by trying to express and not even a drop will come out). But it makes sense what you are saying and I know I've heard it from one of the local leaders I've been communicating with, but I am so not confident yet about what I am giving them. I just have heard that some moms make enough and some moms don't and who knows what ratio there is with moms with twins. I just know I'm not willing to give up - even if it just a few drops I can give them. Thanks for your help.

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