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Monday Apr 17, 2017

Twins Multiply Challenges -- and Rewards -- of Breastfeeding

I had a great breastfeeding journey with our first daughter. She latched well, I had milk to spare, and we nursed until she was 2 1/2. When I found out I was pregnant with twins, I knew the road would be harder, but I figured, hey, I've done this once -- how hard can it be?  

Short answer: hard.  

Breastfeeding twins Maya and Merrick was one of the hardest -- but most rewarding -- things I've done.

Our babies, Maya and Merrick, were born at 36 weeks and weighed less than 6 pounds each. This meant that the ratio of their mouths to my nipples was way off, which did not allow them to latch. They also lacked the energy and strength to nurse effectively. Every two hours during their first two weeks, we finger-fed them (feeding them through a small tube attached to a syringe while we placed a finger in their mouths to suck on so that the sucking-food connection was made without introducing a nipple).  

Every two hours.  

Around the clock.  

With two babies.  

Thankfully, my milk came in quickly and well, so they had minimal formula supplementation for about four days until they were fed exclusively breastmilk. I was pumping every two to three hours around the clock. Sleep deprivation is an extreme understatement, but we persisted.  

At two weeks, we switched to a bottle with a preemie nipple and used paced bottle feeds (a bottle-feeding technique that most closely mimics breastfeeding). They were getting stronger and sucking better, so I started trying to put them to the breast.

Once they were ready to start working on nursing at the breast, it was an almost impossible task of timing. I could only work with one baby at the breast at a time, so I would have to pick a baby and have someone else bottle-feed the other twin. After the baby nursed, he or she would still need some supplemental bottle-feeding. After that, it was time to pump and store that milk. 

This process would take about 1 1/2 hours, so 30-45 minutes later it was time to start working with the other twin. This didn't leave much time for anything else. It was almost three weeks of this before they started nursing effectively and nursing together in tandem breastfeeding.

There were many times I was close to giving up, saying I would exclusively pump and that would be fine. Without the support of my sister (who was staying with us at the time and helped juggle the twins during those alternating breastfeedings) and our lactation consultant, I never would have stuck with it. The lactation consultant from our hospital (who is also a nurse, our facility's doula and a wonderful friend) was the best support person I could have ever asked for. She made me feel like I had permission to cut myself some slack, to just bottle-feed when I was too exhausted to do the nurse/bottle/pump dance, and to keep reminding myself I was doing the best I could. 

One day she said, "You'll look back at this as one of the hardest things you ever did, and one of the things that you are the most proud of." 

She was absolutely right. The twins nurse so easily now. I get the amazing experience of looking down at them gazing up at me while we nurse, them reaching out to touch me, to hold hands with each other, to smile back at me when I talk to them. 

When I delivered the twins, I had a valuable lesson in being a patient, off to be at home, a few weeks of in-home help from family and an amazing lactation consultant who made house calls. Without all this support, I don't believe that I would have had my successful experience. I would have exclusively pumped and missed the bonding of having them at breast.

I am a fierce breastfeeding advocate, but I am also someone who understands now more than ever that each mother must make the best decision for herself. I realized that I wanted to be equipped to better support my patients through their struggles and successes with breastfeeding. We get little education regarding breastfeeding in medical school and residency, and I have found myself able to answer questions based mostly on my own experience and what I have learned from working with our lactation consultant to help my patients. I was excited a few months ago when the AAFP launched a member interest group (MIG) focused on breastfeeding. It has allowed me to network and reach out to other family physicians who are passionate about breastfeeding medicine.  

As family physicians -- especially those of us who practice OB and are there to help the breastfeeding journey along from the first moments -- we are in a perfect position to care for the mother/child dyad. I recently reached out to my colleagues on the MIG who were International Board Certified Lactation Consultants (IBCLCs) to help me start on the path to gain this certification, as well.

I am encouraged to see breastfeeding becoming more accepted in our society, and I have seen a great increase in the number of my patients, especially young women, who are choosing to breastfeed. I will continue to do what I can as their physician to make successful breastfeeding a reality, and to be there as a resource, a partner and a cheerleader in their story. And if, for whatever reason, breastfeeding is not part of their path, I will be there to let them know I still support them in this crazy, wonderful, exhausting ride of parenthood.

Beth Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 01:04PM Apr 17, 2017 by Beth Oller, M.D.

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