Tuesday, August 18, 2009

Guest Post: Tina on Breastfeeding in the NICU

I'm pleased to share a guest post today by Tina, a Southern California mom of a toddler and identical twin boys who are now 6 months old. Tina's post is about her experience breastfeeding while her twins were in the NICU.

I am the mother of three amazing boys. My oldest is 3.5 and my twins are just about to turn 6 months. Having breastfed my oldest son until he was 22 months, one of my major concerns when I found out I was pregnant with monoamniotic monochorionic (momo) twins was if I was going to be able to breastfeed them. Momo twins develop in the same sac without a separating membrane and are at risk for health complications due to the close proximity of their umbilical cords to the amniotic sac. Due to the high risk nature of the pregnancy, it is recommended for the health of the babies that they are delivered no later than 32 weeks. Facing an inevitable NICU stay, I studied up on how to develop and foster a breastfeeding relationship. Although it was one of my major concerns, amazingly, it is the one thing they had no problems with.

Fourteen hours after birth, I started pumping with a hospital grade breast pump. I got very little at first, but I wanted to condition my body to be prepared to feed two newborns. I pumped every 2 hours consistently. It was a pretty easy schedule to keep up in the hospital, but once I got home and was traveling back and forth it became more difficult. I occasionally pumped there, but also used the opportunity to stretch the time between my pumping sessions when necessary to 3 hours. The day I was discharged, five days after birth, my milk came in. I continued with the pumping every two hours, with the occasional 3-hour stretch. I was startled to pump 12 ounces in one sitting, so I started measuring to figure out how much I pumped in a 24-hour period. Twenty-three days after birth I pumped around 55 -60 oz a day. That's A LOT! I was very concerned about the amount because I read that you needed to pump 24 - 32 ounces for a singleton. I thought, "There is no way I can do that!" I was thrilled to learn I was doing that times two!

So, since my babies have been able to feed they have received my breast milk, whether in a bottle or directly from the breast. Now, for the latching onto the breast. I was actually very concerned about the boys receiving a bottle or pacifier. Everything I read said those are big no-nos if you want to have a successful breastfeeding relationship. The NICU was not willing to let them feed solely at the breast. I was initially very upset and then I realized I would do what it takes to get them out of the NICU and would work on feeding at the breast once they got home.
Little did I know how few problems we would encounter.

As for the actual "latch on" I wish I had suggestions. I used what I learned as a previous breastfeeding momma and doula training to position and offer the breast properly. That was really key for the boys. Then I wanted to make it as easy as possible. I initially pumped through a let-down and then offered the breast. After they appeared to get the hang of that I would do a little hand expression because they would initially get frustrated that they were working so hard and not getting much, so the expression allowed a little instant gratification.

I did have one problem that could have been a major one. I had a clogged duct that quickly turned into mastitis. I had a fever, the chills, the whole nine yards. It came on suddenly. I took a hot shower and massaged the affected breast. I continued to pump, drink water, rest, and put warm compresses on the breast. After 10 hours my fever went down dramatically so I decided to not go to the doctor and continue to rest and by 20 hours I was back to normal. The problem was I tried to stretch my pumping out to every four hours. Not such a good idea. I immediately returned back to the 2-3 hour routine. Now six months later, I continue to exclusively breastfeed. I started the boys on solids just shy of their 6 month birthday. I am so proud of my freezer full of milk that I had to share.

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