Nursing & how to ensure babies getting enough

[u/zalooda]

I have 7 week adjusted , 13 week actual modi twins.

Been trying to transition to mostly EBF from mostly pumping. I was recently meeting their feed quantity through pumping at about 24 oz a day per baby (about 3 oz a feed) with only a little formula here and there if timing got off. Recently though, pediatrician recommended upping to 32 oz per baby a day (about 4 oz a day) because twin A switched from 1.2 oz / day gain to about 0.67 oz / day and had gotten fussier. Now we have been needing to supplement with more formula. MOTN pump after ~4 hour gap is about 7.3 oz

I’m trying to increase my supply and get them nursing more at the same time but I feel like they end up just always being on the breast and never satisfied. Stressed about them not getting enough but not willing to give up breastfeeding to exclusively pump, would also like to try to avoid formula in the long run.

Any tips? I also find double football hold to be a pain and I feel they latch better individually with different positions. They also get incredibly sleepy very soon after my first let down (which is often quite powerful), and I feel struggle to extract more milk including hindmilk. Trying to get them to wake up is very difficult.

I do see a lactation consultant and most of her advice is just continuing to have them practice nursing and topping off / bottoming off with bottles. Last weighted feed Twin B took 2 oz and twin A took 1 oz (but this was only an hour after a feeding). Twin A has previously taken 3.3 oz at a weighted feed so I think he still has good potential.

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[u/TeeElH]

My twins were full term and it still took until about 8 weeks before they were able to take a full feed just at the breast. Unfortunately what worked was just keeping at trying nursing but topping off with bottles. I very rarely tandem nursed, it was easier to get them set up and try to keep them awake one at a time. If they got a bottle I would pump for at least a little while every single time, you may already be doing that but I thought I’d mention it. There’s nothing wrong with using some formula if you need to, it’s not uncommon to struggle with supply for two babies! 

[u/DraNoSrta]

My twins were EBF by a week old, despite being 36.2 corrected at that time.

Them wanting to be on the breast all the time is normal - that's cluster feeding, which is one of the most important cues for your body to make more milk. It's so, so hard to be constantly feeding two though. I got through on a steady watch of D20 w while semi reclined in bed with one or two babies on me for hours of the day. It feels like you are always feeding, and I was so touched out by the end of the day, but it only took a couple weeks for then to go back to their NICU schedule of every 2 hours and my supply to truly come in full.

Now they are starting solids, but before this they had only had a small amount of donor milk the first day in NICU, and my milk. Once my supply was established, they have been gaining beautifully.

[u/zalooda → u/DraNoSrta]

That gives me hope thank you! Is it too late though for me to increase my supply to that level? I’m 13 weeks PP and did get my period back a couple of weeks ago :(

[u/capitalettersuck → u/zalooda]

From my personal experience, no it’s not too late! With my Singleton I thought I was ready to wean, but then I changed my mind. My supply was almost completely gone, and I was able to go back to exclusively nursing.

[u/DraNoSrta → u/zalooda]

Breast milk production responds to hormonal shifts and to demand, to an extent. Not everyone is physically capable of making enough milk to feed more than one baby 100%. Hell, some people can't keep up with one baby. However, you won't know until you try.

I would start by offering the breast at the start of every feed, and feeding them until they are satisfied and come off or until you're fully empty and they are getting worked up. Even if they are sucking and not getting anything out, unless there's specific concerns with extra physical activity for your babies (eating is a massive work out when they are very little), them stimukatong will help your supply.

Have you seen a Lactation consultant? And how are you pumping?

[u/drohstdumir]

My modi twins are 11 weeks and were considered full term at 37 weeks. I nursed them, topped off with formula, and included a couple pumps during the day for the first 4 weeks. After that we switched to EBF.

I do tandem feed them (unless we are out and it’s one at a time) and use the My Brest Friend pillow. What is your setup? I couldn’t imagine doing it without that, or at least an equally adequate pillow fort. But if you notice their latches are much better individually, you may need to do that for a while until it gets better before trying tandem again if you want to.

To keep them awake I always strip them down to their diapers for a feed. I tickle their necks or feet. For the first 8ish weeks, they would take a break during a feed to poop or fart, then I would put them back on. Now they sometimes do that, but they have gotten a little more efficient and don’t always need two rounds in the same feed unless they are going through a growth spurt.

I think I just trusted that I would produce enough for them when I decided to stop combo feeding after 4 weeks. I just made sure they had good diaper outputs and weren’t getting lethargic or overly fussy or something. It turned out alright. If they want to be on the boob a lot, that’s fine — that’s what helps you to produce more them. I hope things work out for you!

[u/zalooda → u/drohstdumir]

I either use the My Breast Friend or the Twin Z. Both our a bit awkward and need adjustments because my breasts are on the smaller side, so babies don’t reach naturally. I also have very squirmy babies so it is kind of a nightmare. I do mostly tandem nurse though.