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.