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Thread: Establishing supply for preemie twins in NICU

  1. #1
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    Oct 2009
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    Default Establishing supply for preemie twins in NICU

    My twins were born at 35 weeks gestation and are acting very much like late preterm infants. They are now in NICU and I have just been discharged so I am home evenings through morning and will be spending 6 a.m. to 8pm with them and then coming home and sleeping and pumping. I need to get my supply up and communicate to my body there's two babies to make milk for.

    I have rented a hospital grade pump and am pumping every 3 hrs. Now I wonder if I should pump every 2 hrs while separated because the LC said realistically when they're both home they'll nurse every 2 hrs. The NICU uses a 3 hr schedule although they said we really don't need to follow it. But the problem is they nurse, they are topped off with pumped milk in a bottle, they are on IV dextrose (sugar water) and then I pump so it's really hard to deviate from that too much since it's already so busy and I can't nurse again right after pumping since they expend most of their energy through nursing.

    I'm just wondering what the best pumping schedule should be while we're apart, more or less. Tonight I nursed them both at 6 pm then pumped. Pumped at 8 pm now again at 10 pm, I am thinking maybe 12, 2, 4:30 and then just stay up to get ready to go back to NICU? that's about 5 hrs of sleep if I can sleep right away after pumping. DH is washing pump parts. I will try to nap at NICU on the recliner in my babies' room although I'm not counting on being able to fall asleep there.

    I know I need some sleep to make milk but I really really want to make enough. They are 4 days old, my milk came in yesterday pretty much. I pumped about 5 oz total yesterday over 8 sessions, nursed them 6x if they were awake (sometimes I put them to breast and they are too sleepy to nurse, then we do skin to skin).
    Nursed my sweet daughter 3 years, 3 mos.

  2. #2
    Join Date
    Jul 2010
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    Default Re: Establishing supply for preemie twins in NICU

    congratulations on the birth of your babies. You are doing great, expressing on a 3 hour schedule sounds fine, esp. considering that your lO's are latching when offered the breast. I am sending good vibes your way.
    DD#1 July 1986 VB
    DD#2 April 1988 c/sec
    DS#3 April 1990 VBAC
    DS#4 June 1993 VB
    and suprise!
    DD#5 April 2001 c/sec
    BTDT scars and stretchmarks,: wrinkles and grey hair

  3. #3
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    Default Re: Establishing supply for preemie twins in NICU

    Congratulations on the births of your dear babies!

    I suggest you pump as much as you can, without over exhausting yourself. A big plus here is that you are nursing when with your babies! This is great, and will make a huge difference when you are home and transitioning to exclusive breastfeeding. However, I am wondering if some pumping or hand expression when you are at the hospital will be helpful-because your babies are being supplemented, they are (possibly) not going to nurse as much as they normally would, and I am concerned about your milk production due to that. You are spending 14 of your 24 hour day with your babies, you want the milk removal to be frequent and effective during that time just as much as when you are at home. If your hospital has an IBCLC on staff I suggest you speak to her about how to realistically increase nursing or (if needed) pumping time while you are with your babies.

    For pumping at night- The general rule of thumb for pumping when a newborn cannot nurse at all is to aim for pumping at least 10 times a day.
    You will be home 10 hours. If you pump 4 times during that time I would consider that very good.

    If pumping on schedule works for you, great. But you do not have to pump on a set schedule as long as you are pumping ( or nursing) enough times each day overall. I can tell you right now your babies will NOT nurse every two hours or every three hours. Babies are not born with watches. Like every one else, newborns eat when they want to eat, which may be every 30 minutes some of the time with longer breaks of up to three or even (maybe once a day) 4 hours other times. So pumping also need not be on a set schedule. So if (as one example) you wanted to pump at 10, 11 and 12, sleep until 4 am, and pump once more before going to the hospital that would be ok too. kwim?

  4. #4
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    Default Re: Establishing supply for preemie twins in NICU

    Thank you. I pumped 11x yesterday - 5x at home. We do have a hospital grade pump in their room and after they both nurse I pump. Fortunately we also got them off a 3 hr schedule since they were showing feeding cues so they're more like 2-2.5 hrs. They got their IVs out yesterday so I'm going to have a LC help me with attempting tandem nursing today. I think it might be ambitious but we'll try. They do have IBCLCs on staff and I've used them almost every day.

    It's just hard because my supply is increasing but not as fast as their appetites! We bought 12 oz of banked human milk and last night when I called their nurse at 2 a.m. they had just enough of my milk for their last feeding and when we get there by 6 this morning they'll be hungry and nurse and then we have 8.3 oz I pumped since I got home last night at 8 pm. I did pump every 2 hrs last night because I just feel so much like I need to make more milk and by the time I nurse them both and pump I have a little break before they both want to nurse again. That's one reason I really hope we can tandem once in awhile at least.

    When we discharge I'll become a consult client of a breastfeeding support center with IBCLCs just to make sure we're staying on the right track with feeding and weight gain. This has been very exhausting already and they're only 6 days old! But they're very sweet and adorable and I'm so thankful to have them, too.
    Nursed my sweet daughter 3 years, 3 mos.

  5. #5
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    Default Re: Establishing supply for preemie twins in NICU

    My husband bought another 8 oz of banked milk yesterday. When we get discharged I plan to rent a scale so I can know how much each baby is getting and monitor their weight gain.

    They were both alert and hungry in the evening and my nurse (also an LC) helped me get them both on and they tandem nursed a good 20 minutes, sucking and feeling like they were getting some quality nursing time in. I was really excited.
    Nursed my sweet daughter 3 years, 3 mos.

  6. #6
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    Default Re: Establishing supply for preemie twins in NICU

    They were both alert and hungry in the evening and my nurse (also an LC) helped me get them both on and they tandem nursed a good 20 minutes, sucking and feeling like they were getting some quality nursing time in. I was really excited.
    Yay!

    Do you have the book Mothering Multiples? be sure to get it. Here is the authors webpage http://www.karengromada.com/ lots of pictures!

    I also suggest the book The Womanly Art of Breastfeeding (8th edition)

    I also suggest this article about what is normal and expected in the early weeks with breastfed newborns and how to tell breastfed babies are getting enough. http://kellymom.com/bf/normal/newborn-nursing/

    You can use a rented scale if you like of course but they are not typically needed.

    Just because the NICU was running out of milk does not necessarily mean you did not leave enough milk. Plus what you pump is not going to give you an accurate picture of your production. (babies are better than pumps normally at extracting milk.) And milk production at this age (one week, right?) is still very much building. Hopefully once babies are home or very shortly thereafter, you will be able to JUST nurse. That will be soooo much easier than nursing/pumping/supplementing

    It sounds like you are doing great and have good support. So vital!

  7. #7
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    Default Re: Establishing supply for preemie twins in NICU

    I have both of those books, yes! Thank you. Neither of them are showing good weight gain yet but holding their own. My supply is increasing by about 1-2 oz/day. I'm pumping right now and will pump again before midnight and so far I have 500 ccs for the day so will probably will end up with pumping about 20 oz for the day.

    Yes they're just one week right now. I am so ready to just nurse. we tandem nursed twice today but Noah didn't like the football hold and once I put him in the cradle hold he settled right down and nursed! I didn't know a week old baby could be so particular!

    They're in the NICU at least until Thurs because one of them had an alarm today and they need 5 days without alarms/breathing events.
    Nursed my sweet daughter 3 years, 3 mos.

  8. #8
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    Default Re: Establishing supply for preemie twins in NICU

    20 ounces is what you will likely pump today-but you are also nursing, correct? in other words, the 20 ounces is your (likely) pump output, not your overall production for the day, am I understanding correctly?

    Weight gain-normal for this point or no? What i mean is, it is common for (term) breastfed one week olds to still be below birthweight. But I don't know what is considered ok or normal in this case...

    I have no idea if this is needed at all, but If you like, you can talk with the IBCLC to see if she thinks if and what galactagogues might be appropriate for you.

    Hang in there, having babies in NICU and having to "commute" is so difficult. Hopefully it is just a few more days. You can do it!

  9. #9
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    Default Re: Establishing supply for preemie twins in NICU

    Yes I pumped 20 ccs and the nurse guesses they're getting about 15-20 ccs per session because overnight when I'm not there they take about 50-55ccs per feeding and when I'm with them they are full after 30ccs. They are 6% below birth weight but are holding their own or gaining. Noah gained 22g last night and Josiah just 2g. They aren't really worried about their weight but need to see a pattern of weight gain in order to discharge us.

    I'll talk about galactagogues, I did take more milk special blend with DD. I am continuing to pump more, though and today actually was an ounce ahead of them (for what they drank in pumped milk vs what I pumped). I'll call their nurse tonight and see what they weighed.
    Nursed my sweet daughter 3 years, 3 mos.

  10. #10
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    Default Re: Establishing supply for preemie twins in NICU

    Congratulations, krystine, on the new babies! It sounds like you are doing an amazing job - I can't imagine how exhausting it must be. Hope you get to take your boys home soon.

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