Thursday, February 3, 2011

Pearls of Wisdom

Did I say tomorrow? I meant next Thursday, clearly. So here are my breastfeeding tips so far. I'm not an expert. I'm not even an intermediate breastfeeder. Novice at best, but I'm trying so hard.

Sticking with it

Have a support system - your husband, an LC, friends, whatever. You will need people to support you and convince you to stick with it (and to tell you how good you are doing along the way). I've joined two breastfeeding support groups and have been working with two lactation counselors - one in our home and one at our hospital. This has been integral to keeping my morale up and keeping me going. And when it's 11 p.m. and my kids (and I) are melting down, I text message one of my mommy friends for a shoulder to lean on (thank you Rebecca!!)
  • You can find an IBCLC here.
  • You can find information on La Leche Meetings here.
Establishing Your Supply

At the beginning, keep the babies on a tight feeding schedule. We stuck to nursing every three hours. No matter how tired and frustrated you are, if the baby is hungry between scheduled nursing sessions, feed on demand.
  • Many people will offer to take a feeding for you whether that be with formula or a bottle of expressed breast milk. As tempting as it may be to just sleep through a feeding (or three) don't do it! They key to establishing your supply is bringing the babies to the breast as often as possible. 
  • Formula does not make babies sleep better or longer than breastmilk.
  • In the hospital, your baby will maintain (most) of their weight with just colostrum. Make sure the nurses are bringing the babies to you every 2.5 to 3 hours. This was the key to us not having to supplement them after they were born. 
  • Water, water, water. In the first two weeks after the twins were born I drank upwards of 200 ounces per day. Stay hydrated. It will help your milk come in and help with things on the back end too (if you catch my drift).
Getting Babies on a Schedule

With two babies at home, making and keeping a schedule was key to our success. I made a schedule using excel that I could track the babies' feeds and diapers on - you can see (and print) that schedule here. Trust me, write things down. You won't remember stuff, especially when you are up at 3:42 a.m. nursing a baby (or two) for the third time that night.
  • Remember that when scheduling feeds, the clock starts ticking when the baby latches on (i.e. a schedule goes from the beginning of one feed to the beginning of the next feed). 
  • I keep the babies on a modified 3 hour schedule since that is what they were on at the hospital. If you tandem feed you have more wiggle room with your schedule, but since I am nursing individually I live and die by the clock to avoid over-hungry, unruly babies. I put one baby on fifteen minutes early at 2:15 and one on fifteen minutes late, at 2:45. By the 3 hour mark the babies are both fed and back down for a nap and the clock is already ticking.
  • Once they hit two weeks old, they were gaining weight and their diapers were good I stopped waking them to eat at night. I just put them down and let them wake us. Reese can go a full 5 hours between feeds at night. Ryan can only go three to four hours, but tends to wake up more. Just make sure that they are eating 8-10 times in a 24 hour period before you do this! 

If your goal is to breastfeed and you're not going back to work, then don't worry too much about pumping, especially at the beginning. Once the babies hit two weeks old, I started pumping once a day until my breasts were "empty" to help stimulate supply and build my freezer stock so when we start using bottles regularly I won't be strapped to the pump.
  • If you are letting your babies wake you at night, make sure that you pump every 3-4 hours while they sleep (just to keep up your supply). I usually just set an alarm and pump for 15 minutes and then go back to bed, or if one baby wakes up I offer it both breasts (the way you would nurse a singleton) so that I don't have to pump.
  • Pump at the end of a feed if you still feel full, normally I just pump for 5 minutes and it helps to relieve the pressure.
  • We were able to get 90% of the cost of our pump covered through our health insurance. Call yours to find out if you have a durable medical equipment policy and how a breast pump is covered under that policy. For us, we just needed a letter from our pediatrician saying that the pump was a medical necessity. Saved us $270!
Introducing Nipples and Pacifiers

According to my LC, pacifiers don't cause nipple confusion (because they don't supply the baby with milk) but bottles do cause nipple confusion. Here is some of the advice she gave us:
  • Pacifiers are okay to use on a limited basis after the first week, as long as the babies are still nursing efficiently after the pacifier is introduced. If the baby refuses the boob, take away the pacifier for a week and start over again.
  • Do not introduce bottles until after the fourth week, but introduce them sooner than 6 weeks so that the baby does not refuse the boob or (eventually) the bottle. After the fourth week of breastfeeding the mother's supply is established and most babies have mastered latching. 
Man, I wish we listened to her about the bottles. Around the two week mark, Reese got really fussy one night and I couldn't get her to calm down and nurse. In a fit of frustration I pumped and gave her a bottle. It worked and she slept five hours straight. After that, she had two more meltdowns and two more bottles. Here we are a week later with a baby that's still very fussy during night feeds (when she is waking us to eat), who now also has major latch issues at night. The bottle has made her completely lazy at the boob - but only when she's already tired. I literally have to manually express my milk into her mouth for five minutes before I can get her to stop crying and just latch and, even then, she is a lazy nurser. I wish we would have just waited. If she doesn't get better with these night feeds I'm going to try to introduce an SNS to see if that helps her. What a pain in the ass. 

Anyway, I hope my trials and tribulations help someone else just starting out. I hear it does get easier and I will say that each week is easier than the last, but each week also presents new challenges. My original goal was to make it six months. That is still my goal, but right now I'm focusing on making it six weeks. Keep your fingers crossed for me!

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