Breast feeding

Thanks for the mammaries

Given how much of my time and energy is spent feeding Hattie and Joe, I thought that I should write a post to talk about how we’ve been getting on. I last wrote about feeding in late January, when the babies were nearly two weeks old. I wrote primarily about my realisation that, despite my pre-birth pragmatism regarding breast feeding, I’d realised how important it was to me to be able to feed my children – I hadn’t anticipated that breast feeding would be such a good bonding experience. I also wrote about being happy that both babies had learned to latch on so easily, and I mentioned that I was supplementing with formula.

For the avoidance of doubt, what follows is entirely my own breast feeding ‘journey’: it is not designed to in any way suggest that breast is best, or any of that lactivist nonsense – as long as a baby is being fed, that baby is going to do well, and no mother should feel any pressure to breast feed – indeed, mothers should do it for a day, a week, a month, a year, or not at all: it is entirely their businesss. Like I said in my earlier breast feeding post, if you’re not the one holding the yowling baby at 2 am you have absolutely no right to an opinion, as far as I’m concerned. I’m writing this post primarily because I’ve been told that some people can’t fathom what it must be like to feed two babies, or even imagine that it’s possible, so I thought it might be interesting to lift the curtain on it, so to speak.

As I mentioned in my earlier post, Hattie and Joe latched on in the post-op recovery room, and for the first couple of days we jogged along quite well, with me tandem feeding them most of the time. Every now and then a lactation consultant would appear in my room and ask how we were getting on, and I’d cheerily reply that we were fine, and they’d then congratulate us and continue on their way. In hindsight, I’ve realised that both they and I were at fault: I shouldn’t have tried to appear so competent (particularly given that I didn’t actually know what I was doing); and they should have actually checked what was going on, and not just taken my morphine-addled and totally ignorant word for it. The upshot was that my milk was very slow to arrive (blame my horrendous birth experience), the babies lost a bit too much weight (and it was very marginal – they lost 11% of their body weight, and anything up to a 10% loss is considered absolutely normal and fine), and suddenly it was all a mad panic, with midwives freaking out and telling us that we’d have to supplement with formula. They said this almost like they were suggesting something profane, but we were absolutely fine with it and were willing to do whatever was required. The answer came in the form of the Lactaid system, which involves breast feeding while wearing nipple shields. A very thin tube is also fed into the nipple shield, and formula is fed to the baby via the tube: the idea is that the baby gets the extra nourishment it needs, but without having to given a bottle) – as far as the baby is concerned, it’s still being breast fed.

The Lactaid system worked well for us for the 36 hours that we used it, although it was definitely a two person job – whenever the babies were due a feed I’d have to ring for a midwife to come and help me, and they’d bring the formula with them. It helped them to gain some weight quickly, but it obviously wasn’t going to be a good long term solution, so for the last day or two of our time in hospital we supplemented the feeds with formula out of a bottle. We spent a day in hospital supplementing with bottles, and then realised that it was a tremendous faff – washing bottles, sterilising them, preparing them – and that doing that by myself was going to be a major challenge overnight, so we were discharged that day and took our feeding regime home.

And man, what a regime it was! The lactation consultant wrote up a plan for us that involved three-hourly feeds, each of which involved three courses: a breast feed; a bottle of expressed breast milk; and a bottle of formula. After we’d got through all of that, and burped the babies (which is bloody time-consuming with little babies), it would then be time for them to go back to bed, and then I’d have to express milk to use for the next feed. This left me between an hour and 90 minutes before it would be time to wake the babies for the next feed. It was madness, I tell you – madness! It did the trick, though – the babies gained back the weight they’d lost, and then we were faced with the challenge of when and how to modify the regime. The lactation consultant hadn’t left much in the way of guidance regarding this – perhaps she thought that we’d continue it until Hattie and Joe left home? – but we worked with our midwife and eventually removed the expressed milk component and kept on with the formula top-ups.

We continued with a three hourly feeding schedule, which included waking up the babies for feeds at night. That all went well until the babies were nearly three weeks old, at which point they suddenly went completely and utterly mental, crying all the time and wanting to feed incessantly. I had NO idea what was going on and what to do: my only way of dealing with it was to breast feed them far more often. I also googled like a mad googling thing and discovered, for the first time, all about growth spurts. And I was pretty bloody annoyed that nobody had warned me about them – the stupid antenatal teacher, for example! I guess that people who are demand feeding their newborns might not notice them, but if you’re feeding to a schedule, like I was, that first one is very obvious. Anyway, I fed and fed and fed and fed, and eventually – after a couple of days – things settled down again.

In those early weeks Joe fed very easily, but Hattie had the most incredibly painful latch – I described it in that earlier post about breast feeding as feeling like a barracuda attacking me. I fed her with a nipple shield nearly all of the time, because I just couldn’t handle the pain of having her latch on directly. And I found it physically exhausting to breast feed. Tristan would often look over at me in the evening and find me nodding off, or fully asleep, while feeding (one of the reasons why I was so reluctant to feed in bed). And I was hungry and thirsty all the time.

I was keen to end the formula supplements – partly because it was such a pain in the neck to have to sort out bottles, and partly because, if I was going to breast feed, I wanted to see if I could solely breast feed. It just didn’t seem to make sense to me to be endlessly giving the babies two forms of nourishment. I liked the fact that I could breast feed, but I also struggled with the idea that I didn’t really know how much milk the babies were getting. I did ramp up the formula supplements for one week in particular, and saw a correspondingly good weight gain from both babies – did that mean that I should just knock the breast feeding on the head entirely and switch to formula? I really didn’t know what to do.

When faced with baby-related confusion, I tend to turn to the network of twin mothers that I have formed in the past year. On Facebook, in particular, I’m lucky enough to be able to access the advice of a huge number of very smart women, so I asked one group about how I should proceed. Was I better off continuing to supplement after most feeds, like I had been doing? Or should I drop the breast feeding and switch to formula full time? Or would I be best off breast feeding one baby and formula feeding the other (as my Plunket nurse had suggested as an option)? If I expressed milk more often, would it increase my supply? I didn’t even think that exclusively breast feeding was an option, because I feared that I wouldn’t have enough milk. From hospital onwards I’d been on a medication called domperidone, which helps to promote milk supply. I was really reluctant to even consider stopping it, in case I had no milk at all without it.

Anyway, this great group of twin mothers responded to my cries for help by suggesting ways to juggle formula and breast milk. In addition, a couple of respondents asked if I wanted to keep breast feeding and give up formula entirely. Yes, I replied, so they told me how to do it: demand feed, to build up my milk supply. No formula for a weekend: just breast milk, given to the babies as often as they wanted it, with no thought of a schedule. I was advised to stop thinking about my breast milk as the stock in a factory – a finite supply, in other words – and to consider it more like a production line: there would always be more milk. They pointed out that babies are far more effective than breast pumps when it comes to draining a breast, and so they were the best ‘tool’ I had available to me. So the advice was simple: spend a weekend doing absolutely nothing but eating, sleeping, and breast feeding.

It made sense, but it was such a daunting prospect after demand feeding through that knackering three week growth spurt! As luck would have it, we had a session with Sharlene just before the potential demand feeding weekend, so I asked her for her advice about building up supply. Her take was totally different: she felt that demand feeding twins would be too exhausting, and that I would be better off expressing a lot for two or three days (like, every couple of hours during the day). So I REALLY didn’t know what to do, with two conflicting opinions: one from a baby whisperer, and one from other twin mothers.

As it turned out, the decision was taken out of my hands when Hattie and Joe hit the six week growth spurt that very weekend. Saturday morning was normal, we went out for brunch in the middle of the day, we got home at 2ish, and then both babies went stark raving mad and did absolutely nothing but grizzle and feed until late on Sunday night. I could have supplemented with formula to take some of the strain, but it seemed silly to do so when this was my golden opportunity to try to bolster my supply once and for all, so I gritted my teeth, ate a lot of snacks, and just went for it.

A couple of days after the growth spurt was over my boobs were enormous and uncomfortable, but then things settled down a bit. I continued to give the babies some formula supplements – Hattie still had a few small bottles each day, and both babies had a late night bottle – but I was becoming more confident that my supply was starting to match their demand.

Joe was gaining weight well, but Hattie was still pretty tiny. I’d pumped her up with formula for one week, but now I wanted to nourish her more effectively with breast milk. My Plunket nurse pointed out that feeding her with the nipple shield was less effective than having her latch on directly, so if I could, I should ditch the shields and go for it. And so I gave it a whirl, and oh my GOD the pain. The best description of the feeling of a painful latch – the description that countless women have used – is ‘toe curlingly painful’, and it really is accurate. I was having to psyche myself up for each feed, which was fairly awful.

My Plunket nurse also suggested that I spend some time with the lactation consultant at the local Plunket Parents’ Centre, so I rang and booked the babies and myself in. The lactation consultant couldn’t see me for a week, so I continued to try to feed without the nipple shield. Eventually, I had to concede defeat and put it back on, though – the pain was just too much.

I went to see the lactation consultant more in hope than expectation. When we arrived Hattie and Joe were due a nap, so they had a sleep while I watched a DVD that explained the mechanics of breast feeding… and I realised that, although I’d thought that I’d understood how to latch on a baby well, I really wasn’t doing it properly. Joe was managing a reasonably decent latch more by luck than good judgement, and Hattie wasn’t managing it at all. My self-diagnosis was that she wasn’t taking the nipple far enough into her mouth, so it was pressing against her hard palate and the front of her mouth (excruiating for me, and totally ineffective as a way of getting milk), rather than having the nipple press against the soft palate at the back of her mouth (which would then mean that she’d be putting pressure on my milk ducts with every swallow). The babies woke up, the lactation consultant sat with me, I latched them on in the manner suggested in the DVD – ‘rolling’ the nipple down into the baby’s mouth – and lo and behold, we managed it. For the first time in her eight and a half weeks of life I was able to feed Hattie comfortably. Yay!

One side effect of the improved latch for both babies was their ability to feed much more quickly. This meant that they could take in a greater volume of milk, which was excellent from the whole ‘gaining weight’ perspective, but it also meant that they were suddenly guzzling milk and, at times, half-choking on it. Hattie was a good guzzler and could cope quite well, but Joe would frequently end up coughing and spluttering, and literally dripping with milk. Up until this point I’d swapped the babies and boobs for each feed, but it soon became clear that my right boob was my ‘turbo boob’, with a really fast let-down – Joe just couldn’t handle it. Ever since, he’s been allocated my left boob and Hattie’s in charge of my right boob. Hopefully this won’t lead to me having a totally uneven rack after I’ve weaned them.

When the babies were around ten weeks old we found that they no longer wanted a formula top-up. At this point we’d pretty much reduced the top-ups back to one small bottle with their last feed of the evening, but we kept making it and they kept refusing it. The bottle was offered after their breast feed, and they would be too sleepy after coming off the boob to drink anything else. So we stopped offering it, and Hattie and Joe have been officially exclusively breast fed ever since.

The great news is that my supply has been ample, and that both babies have been growing at a good rate: they’d each gained a kilogram in the four weeks between two weigh-ins. The other barometers for breast fed babies – whether they’re producing plenty of wet and dirty nappies, and whether they’re generally happy and settled – continue to reassure me that I can actually feed my two babies. I’m not going to lie: it’s a weirdly satisfying feeling. I hadn’t really thought about it too much, but when I said something about breast feeding yesterday, Tristan pointed out that I’d worked very hard to get to the point where I could feed them myself. I guess that I have been reluctant to give up, and I really have no idea why I’ve been so bloody-minded about it. My initial long term aim was to breast feed for the first six months, but I’m now thinking that I’ll push on for a full year. My body has totally adjusted to the demands being placed on it now – I don’t even find myself getting particularly knackered.

There are still challenges, though. I’d continued with the domperidone because, again, I was paranoid about not producing enough milk. However, I’d started getting blocked milk ducts on Joe’s side, which is generally a sign that you’re not fully draining the breast – that supply is outstripping demand, in other words. I mentioned this to my Plunket nurse and she suggested that I give up domperidone, so I’ve gradually weaned myself off it. I’ve gradually had fewer blocked ducts, thank goodness – they are really painful and very unpleasant.

My other main challenge is Joe’s newfound refusal to drink from a bottle. When both babies gave up that final formula feed I didn’t think twice about ensuring that they would still accept a bottle when required (for example, if I want to be away from them for more than three hours, and Tristan wants to give them some expressed milk) – I assumed that, because they’d been fine with drinking from both a bottle and the breast in the past, they’d retain the knack. Sadly, I was mistaken! I went to a gig a couple of weeks ago, and tried the babies on a bottle beforehand, only to discover that Hattie the guzzler would happily receive her breast milk in that way, but Joe wouldn’t have a bar of it – he pushed the teat out of his mouth and cried in dismay. He wouldn’t take it from me, or from either of my neighbours. Tristan tried again with him a few days later, and still had no luck. We really need to tackle this issue again, but we’ll have to make sure that a) Joe’s really hungry, and b) I’m nowhere to be seen.

One additional challenge: Joe has been very ‘spilly’ in the past couple of weeks, up-chucking partially digested milk that smells foul and resembles cottage cheese. When I described this to my Plunket nurse last week she immediately declared that it’s a sign of his inability to cope with the amount of dairy products I eat. I do scoff a lot of yoghurt, milk, ice cream, butter, and cheese, so I suppose that this isn’t too surprising – he’s not allergic (or else he’d be projectile vomiting), but he must be at least slightly intolerant. This means that I’ll definitely have to stick with breast feeding for Joe’s first year, as most formulas are dairy-based and will almost certainly cause him similar problems. To remedy the problem, I’ve almost entirely given up dairy products – I’m having milk in my tea, and a bit of butter on my breakfast toast, but that’s pretty much it. I’m also continuing to avoid caffeine and alcohol while I breast feed. Giving up dairy products feels harder than doing with out a can of Coke or a vodka and tonic!

I suppose there’s one last challenge of exclusively breast feeding: I have to do it every three hours during the day, and usually at least once overnight. There’s no way to pass on this job – I am essential! And with breast fed babies there isn’t much prospect of stretching the feeding schedule out to four hours so quickly, because they digest the milk so quickly. Sometimes, when they’re particularly hungry, I’m feeding every two hours or two and a half hours (Hattie is such a screamer if she decides that she’s hungry – trust me, nobody could wait it out and resist her). Life is pretty relentless when you’re at the beck and call of your babies, 24/7.

But these are all minor quibbles, and should all be fixable in the fullness of time. The positives far outweigh the benefits, and aside from pragmatic benefits like not having to spend money on formula or spend time washing bottles, the main advantage for me is still the bonding element of breast feeding. I still do 95% of Hattie and Joe’s feeds on the tandem feeding pillow, and while those tiny peach fuzz heads have grown substantially since I wrote my earlier breast feeding post, the bonding experience provided by feeding my children has only intensified. These days, Hattie and Joe often reach out to clasp hands while they’re feeding, which is a sight that would surely melt the hardest heart. And although Hattie still screams like a banshee if her feed is delayed by as much as a whole minute, and then vibrates with impatience while waiting for me to undo my bra, she makes up for this imperious pre-feed misbehaviour by being absolutely adorable after she’s finished – she invariably drinks more quickly than Joe, and then lies on her side of the cushion, beaming with joy when she looks up at me. The urge to scoop her up and shower her with kisses is one that I can rarely resist. And Joe’s equally adorable – he tends to lie there sleepily at the start of the feed, beaming at me and looking like he can’t believe his luck.

No post about breast feeding is complete without an action shot, so here you go:

8 weeks 006

Oh – and I’ve already warned Tristan that I am planning a boozy weekend away with friends as soon as the babies are weaned! I think I will have earned it by then…

UPDATE: well, Hattie and Joe are now nearly seven months old, and we’re still going strong with feeding. My new aim is to feed them until they’re ready for cow’s milk – around a year old, in other words.

Regarding the spilliness and possible dairy intolerance: after depriving myself for a few weeks, and not seeing much difference on the spilly front, I talked to more people and concluded that there was no link to what I was eating: some babies are just spilly. I’m a dairy eater again, and the spilliness is improving as the babies grow bigger.

Both babies are much more patient about waiting for feeds now, thank goodness. And I was wrong about not being able to stretch out the time between feeds: I feed largely on demand during the day, but it’s very rarely more often than three hourly, and quite often four hourly. And Joe can last for at least seven hours between feeds overnight (helped to some degree by the enthusiasm with which he’s embraced solids).

And both Hattie and Joe remain very unwilling bottle drinkers…

ANOTHER UPDATE: Here’s a sequel post – ten months later!

2 thoughts on “Thanks for the mammaries

  1. Your description of Hattie waiting for a feed is great. What type of bottle/teat have you been using? We went through several before we finally found one Holly liked and could manage without choking – pigeon brand from the Warehouse of all places. Total impulse buy that made life soooo much easier.

    1. We were using the Tommee Tippee Miomee range, which has a teat that’s very similar in shape and size to a nipple. We’ve got some other ones to try as well – at the moment it seems to be any rubber in his mouth at all. I’ll wait another week to let the dairy products fully exit my system, and then I’ll get Tristan to try feeding him without me around.

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