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Thread: 5 week old twin, low supply, realistic expectations?

  1. #1

    Default 5 week old twin, low supply, realistic expectations?

    Hello everyone. I am a first time mom of 5 week old twins. The boys were born at 36 weeks via c-section and from the first day they were given formula since they did not latch and I was not making any milk. We were in the hospital for 5 days during which I started pumping using a hospital grade pump (ameda elite) and gave the babies whatever I could express. We were sent home with formula and I also rented the breast pump. I was pumping every 3 hours, not so religiously but my milk never "came in" and the boys were fed mainly formula supplemented with whatever expressed milk I can get. During this time, I tried to get them to latch but it was a total nightmare and never lasted.

    At 2-3 weeks, I started working with a lactation consultant and she got me pumping every 2 hours and put me on fenugreek. By the end of the 3rd week, I was only pumping about 11oz total per day and I was exhausted from pumping & bottle feeding the boys that I really had to cut down. The lactation consultant was not happy with the lack of increase in milk output and when she heard that my breast did not change during or after pregnancy, she sounded very discouraging and suggested that whether I continue to try pumping/breast feeding was up to me. She also said that getting the babies to nurse (at this point they will not latch without a nipple shield if at all) would not help with my supply. Basically it felt like a lost cause. I continued to pump and take the fenugreek and now at 5 weeks, I am able to express about 14-20oz per day. I also saw another lactation consultant who checked the boys' latch and she encouraged me to continue what I am doing and get the boys to feed at the breast as much as I can.

    I had read that the amount of milk that is produced at 10 days is predictive of future production. Together with this and the comment from first lactation consultant, I am contemplating giving up altogether but I'm not quite there yet. 3 days ago, for the first time ever, one of the boys latched without a nipple shield and stayed on for 15 minutes. This gave me enough motivation to keep going but I would really like to know if it realistic for me to keep at this. I would like to get to the point where I am supplementing with formula rather than supplementing formula with breastmilk. At this time, both boys are taking 2-3oz (either formula or breastmilk) every 2-3 hours. At most I am making 20oz per day (this is from pumped milk). Is it even possible that my supply catch up with demand - or at least increase some more at this point?

    Thank you for reading. Sorry this is so long but I am so frustrated and sad about this whole situation.

  2. #2
    Join Date
    May 2006
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    Default Re: 5 week old twin, low supply, realistic expectations?

    Welcome to the forum! I'm sorry you have had such a rough start. Taking care of 2 premature babies, recovering from a c-section, trying to pump and get the babies to latch- those are really significant challenges and you really shouldn't beat yourself up for things not going perfectly. Okay?

    If you are getting 14-20 oz of milk per day, your milk did come in. When we talk about milk "coming in", all that means is the switchover from colostrum production to the production of mature milk, which typically occurs around 2-5 days postpartum. So you have milk, and your only issue is volume. That's encouraging, right?

    Milk volume at 10 days postpartum may have predictive value for future production, but it is possible to increase production at any time given the right set of stimuli. In this case, that means working on getting the babies to latch and nurse, and keeping on with as much pumping as you can manage. I know it's extremely hard to pump frequently while taking care of a single baby who will nurse pretty well- BTDT- so your situation is at least twice as challenging. So if you find that you can't squeeze in the ideal 10-12 pump sessions a day, please don't worry too much about it. You do what you can!

    On average, exclusively breastfed babies take around 20-30 oz of milk per day. You are about halfway to having all the milk you need, and I see that as extremely positive. So I personally think your goal of getting to a point where you supplement breastfeeding with formula is totally realistic, and see no reason why you should not eventually be able to simply nurse and not supplement at all.

  3. #3
    Join Date
    Jun 2009
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    Default Re: 5 week old twin, low supply, realistic expectations?



    I strongly suggest two books. Making More Milk (all about milk production and how it works and how to increase it, with many tips on handling the pumping/nursing/supplementing treadmill. Also, Mothering Multiples.

    This is the first I have heard the 10 day thing. Can someone point me to an explanation of who and what was studied to come up with that?

    also, I am curious how bottles are being given and if LC discussed alternative supplementing measures. How are babies gaining now? How much a baby 'takes' when being fed with a bottle is not always a good measure of what baby actually needs, as a baby, especially very young babies, will often take more in a bottle than they actually need for a couple of reasons. Paced bottle feeding positioning and technique can help with this problem. Remember the numbers 20-30 is a very general estimate, and in part it is based on an intake study that included babies who are getting a tremendous amount of milk in the early months, presumably because mom has over production and baby is getting more than baby actually 'needs", more common than you might think. Some breastfed babies do not even need 20 ounces a day to grow and thrive, in other words. it depends on the baby and the actual intake needed is actually extremely variable.
    Last edited by @llli*maddieb; February 21st, 2015 at 10:55 AM.

  4. #4

    Default Re: 5 week old twin, low supply, realistic expectations?

    Thank you!

    I used to go to a breastfeeding group where women talked about pumping 6-8oz at a time so it was really discouraging. it is encouraging to know that volume can be increased any time.

    U have been pumping for 20 minutes each session. Is it better to pump shorter time and more frequently than longer less frequently?

    Thank you for being positive. I just wasn't prepared for this to be so challenging.

    Quote Originally Posted by @llli*mommal View Post
    Welcome to the forum! I'm sorry you have had such a rough start. Taking care of 2 premature babies, recovering from a c-section, trying to pump and get the babies to latch- those are really significant challenges and you really shouldn't beat yourself up for things not going perfectly. Okay?

    If you are getting 14-20 oz of milk per day, your milk did come in. When we talk about milk "coming in", all that means is the switchover from colostrum production to the production of mature milk, which typically occurs around 2-5 days postpartum. So you have milk, and your only issue is volume. That's encouraging, right?

    Milk volume at 10 days postpartum may have predictive value for future production, but it is possible to increase production at any time given the right set of stimuli. In this case, that means working on getting the babies to latch and nurse, and keeping on with as much pumping as you can manage. I know it's extremely hard to pump frequently while taking care of a single baby who will nurse pretty well- BTDT- so your situation is at least twice as challenging. So if you find that you can't squeeze in the ideal 10-12 pump sessions a day, please don't worry too much about it. You do what you can!

    On average, exclusively breastfed babies take around 20-30 oz of milk per day. You are about halfway to having all the milk you need, and I see that as extremely positive. So I personally think your goal of getting to a point where you supplement breastfeeding with formula is totally realistic, and see no reason why you should not eventually be able to simply nurse and not supplement at all.

  5. #5

    Default Re: 5 week old twin, low supply, realistic expectations?

    Thanks for the book suggestions. I just ordered it today.

    I can't remember where I read the 10 day thing but I read in different sources. I'm not sure what the research behind it is.

    I was sent home with a syringe and I also bought a sns system but I am terrible using it. During the day I am alone so I haven't been able to master nipple shield, baby crying plus sns.

    I do think the babies appetite has grown more than their needs. they were born at 5lb 5oz and 5lb12oz. At week 1 they were back to birth weight and since then they have been gaining about 1lb a week. So they are now both almost 8lbs. They are on the high calorie formula so I think that is getting them to gain weight. So now when either of them nurse, they will stay at the breast for 10 to 20 minutes, fall asleep for about 20 minutes then wake up hungry and will only take the bottle...I tried to put them back to the breast but the milk must not come fast enough since they cry with as they suckle at the breast With the saddest little faces which I cannot stand seeing. Then they will take anywhere from 1 to 2 oz from the bottle.

    Quote Originally Posted by @llli*maddieb View Post


    I strongly suggest two books. Making More Milk (all about milk production and how it works and how to increase it, with many tips on handling the pumping/nursing/supplementing treadmill. Also, Mothering Multiples.

    This is the first I have heard the 10 day thing. Can someone point me to an explanation of who and what was studied to come up with that?

    also, I am curious how bottles are being given and if LC discussed alternative supplementing measures. How are babies gaining now? How much a baby 'takes' when being fed with a bottle is not always a good measure of what baby actually needs, as a baby, especially very young babies, will often take more in a bottle than they actually need for a couple of reasons. Paced bottle feeding positioning and technique can help with this problem. Remember the numbers 20-30 is a very general estimate, and in part it is based on an intake study that included babies who are getting a tremendous amount of milk in the early months, presumably because mom has over production and baby is getting more than baby actually 'needs", more common than you might think. Some breastfed babies do not even need 20 ounces a day to grow and thrive, in other words. it depends on the baby and the actual intake needed is actually extremely variable.

  6. #6
    Join Date
    Jun 2009
    Posts
    10,754

    Default Re: 5 week old twin, low supply, realistic expectations?

    Well of course 6 to 8 ounces per-pump session is highly unusual output. It certainly would not be what a mother would typically extract per session especially in the early weeks of breast-feeding unless the mother had both very high production and a very large breast storage capacity neither of which is required for successful breast-feeding. I'm sorry no one mentioned that at a breast-feeding support group.
    Babies who are gaining a pound a week are gaining twice the norm. I'm sure no one is going to argue with little babies gaining quickly. On the other hand your babies aren't that little and they were born very close to term so I think you should talk to your doctor or your or a lactation consultant about this. Again I am not saying anything is wrong with the gain except that it may be interfering with your ability to nurse your babies or pump enough for them if they are being overfed at this point. A baby who is getting too much milk too fast with bottles is going to very rapidly lose interest in nursing at the breast. This need not be permanent however.

    I am on my phone so I can't make the links but I have them elsewhere on this forum. There is a very good YouTube video that shows paced bottlefeeding which is done by the lactation consultant I believe her name is Jessica Barton.
    If you search on this site the term toolkit you will find the tearsheet tool kit which has a good description of how to bottlefeed the breast-fed baby.
    Dr. Jack Newman you can find him by googling Jack Newman breastfeeding has great videos including one about inserting a lactation aid during a nursing session. He does not have one with a nipple shield and lactation aid but I know it certainly can be done. I'm wondering if you have had ever had success nursing babies without the shield? Of course if the shield gets baby nursing absolutely still use it.
    The lactation consultant Catherine Watson Genna has on her site a good article about the use of lactation aids and tweaks you can try. It is called helping mother's work smarter not harder.
    If you have not seen a lactation consultant recently for a full appointment or consult I would strongly suggest doing that as well. On the Genna website she also describes what you can reasonably expect from a really good lactation consultation.

    The website W WW.Kelly mom.com has a very good article called help my baby won't nurse. It gives many many ideas for encouraging babies to nurse who are not nursing for whatever reason.

    A mom with five weeks old twins alone much of the day? That is difficult in any circumstance-Is there anything you can do about that?

    One thing you can try with fussy babies is to give them a little supplement before they nurse instead of after or as well as after as needed. Also I know it is hard with the nipple shield having used one myself but try as much as you can to bring baby to the breast at the earliest cues before baby begins to get upset. Babies nurse for both comfort and for hunger. It's all the same to a baby so encourage comfort nursing as much as possible that is often the way to get babies back to or on to the breast.

    I think you are closer than you know to making enough for your babies or very near , anyway, and nursing as well I really do it sounds like they are doing wonderfully. You have done a lot of hard work and that has put you in a not so bad position for reaching your goals taking all the evidence into account.

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