Breastfeeding Multiples, Increasing Milk Supply... and Eventually Weaning

It's seems like another lifetime when I was tandem breastfeeding with the big green pillow. Really, it was just a year ago. While I was still pregnant, I attended a 'Breastfeeding Multiples' class and though at the time it seemed pretty straightforward, covering the different holds, etc., once I was in the thick of it, I realized I knew nothing.

I feel like a lot of breastfeeding can't be learned from a book and while taking the class didn't hurt, I often recommend to other twin moms-to-be to save their money for a lactation consultant once their babies are here.

Two of my biggest regrets about the first year are 1. the lack of knowledge I had about pumping, especially when it came to milk supply and 2. not getting good lactation help earlier.

I debated about breaking this up into several posts, but so much of it overlaps, that you'll have to bear with me for a marathon post...

I feel like pumping was sort of skimmed over in my breastfeeding class and anything I read just said, 'don't let anyone tell you breastfeeding twins isn't possible, your body is fully capable of producing enough milk for two babies.' I just sort of expected it would work out and that I wouldn't have to work too much for it. The nurses at the hospital did encourage me to pump after each feeding to get my milk to come in, and it did by day 4 so I thought I was all good. When I came home though, I really had no idea what I was doing when it came to the basics of pumping and I think I was just holding out hope that I'd be able to actually breastfeed both, that I wouldn't need expressed milk. I'd like to see the stats on how many twin moms are able to do that. I definitely know some that have, but I think many have to work at it, and I know many go to exclusive pumping, or move on to formula.

The first weeks are a blur and looking back at my posts from that time, I reference pumping, but I think between nursing the babies for at least 45 minutes (at the same time), and them eating at least every three hours, I was not pumping after every feed. I was exhausted, obviously, but I think if I knew what I know now, which is how important (at least for twin moms) that first month is in establishing a good supply, and that pumping after every.single.feeding would help tell my body that it needed to produce more, I would have done it in a second.

Unfortunately, I feel like instead of a few really tough weeks, I endured months and months of endless research and trying every possible suggestion to increase my milk supply. Who knows, maybe my supply is what it would have been, but I definitely regret not knowing how important it was to pump so frequently in the beginning.

While I didn't expect such a commitment to pumping, I was prepared for latch issues or having to work at breastfeeding. I met with lactation consultants in the hospital daily, sometimes twice a day and I felt like the boys did their best when they were present, but when I was on my own, they just didn't get it. I had various nurses help me and everyone had a different technique. I don't think they got much milk from nursing and after a few days, and the boys losing 11% of their body weight, we had to start supplementing. I did not want to, and while Dave was always supportive of breastfeeding, he wanted his boys gaining weight and was happy to hold a baby and feed a formula bottle. I'm not sure why at that moment I didn't start researching 'increasing milk supply'; again, I think I was convinced they would catch on to breastfeeding and it would all work out without formula or pumping. Also, when we got home from the hospital and our night nanny was feeding them bottles at night, after attempting nursing, I think I felt they were being overfed and that I was actually producing enough. They gained a ridiculous amount of weight their first week home, so we did scale back a bit on the supplementing, but it still wasn't quite enough.

I had a lactation consultant come over to help with their latch a couple days after we got home from the hospital and it was an absolute disaster. She showed up 40 minutes late, and I had schedule it right before our doctors appointment, so they would be fed when we left. So I ended up rushing through 20 minutes with her, if that, and got very little help. Here comes my bigger regret (than just hiring her in the first place): that I waited at least a month to see another lactation consultant.

Tandem nursing at its sweetest
I guess I kept thinking it would resolve itself, especially William's eating issues. Again, hindsight is 20/20 so who knows if it would've made a difference or not, but I battled through feeding after feeding of trying different things, almost always needing to supplement afterwards.

In the end, who knows if it was just too late, or if things worked out the way they would have regardless, but I attempted tandem, or at least breastfeeding both of them, even if separate, for 4 months before finally going 100% bottles for William. George continued to nurse pretty much full-time.

We still don't know what William's eating issue was. After multiple reflux medicines, different bottles, just about every feeding technique in the world and even a visit to the feeding clinic, it just eventually ran its course and he started to eat fine. What I'm most grateful for is that these eating issues have not continued into solids. He doesn't eat quite as much as George at many meals, but he's still a good eater.

So in my 'Breastfeeding Multiples' class, they asked what our goal for breastfeeding was, and I said, 'I'm hoping to breastfeed both until at least a year, but am realistic that that might not work out with twins.' I don't know where along the line I became so against formula and made it my utmost goal to increase my milk supply so I wouldn't have to use it. I know moms choose formula for various reasons and I'm fully supportive of that, and deep down, I know formula is just fine. My boys needed about 70oz of milk total per day and out of that, for the bulk of the months when we used formula (up until about 7 months), approximately 8oz of that 70oz was formula.

So why did I stress so much about increasing my supply?? Good question. I think after all my struggles, I just wanted to take one thing out of the equation. At one point I was attempting to breastfeed William, then bottle-feeding him while I breastfeed George, then pumping, and sometimes having to mix formula. At least if I could drop the formula out of the mix, that would simplify things, right?

Well, by the time they were taking a decent amount of solids and their milk intake finally dropped to about 25oz, I was finally able to keep up, and in fact, around 9 months, I was even able to start a mini-stash of frozen milk. What an accomplishment!!

What many don't understand, is that pumping is not as efficient as a baby nursing, so if I missed a feeding for George and needed to pump instead, I wouldn't pump as much as he would have drank in my absence, so for many months, I never wanted to miss a feeding as I was always trying to play catch up. Once I had that stash, it gave me a bit more freedom, that if I was going to be away for a few hours, even if I was off a few ounces, there would still be enough.

So while I don't think I ever effectively increased my milk supply to where it needed to be, I finally got their only because the boys' intake went down. Regardless, I read just about everything on the internet on how to increase milk supply and while many people see great results with just one or two of these things, I never saw a significant increase that I could attribute to any single thing. On the other hand, once I had all of this going, I wasn't going to take anything out and risk my supply dropping, so who knows what really worked and what didn't.

Here's my list of tips for increasing milk supply and/or getting the most from pumping:
  • skin-to-skin, especially when nursing
  • more time at the breast, feed as often as they want (I found this impossible with twins and had to put them on a schedule instead)
  • don't use a nipple shield (like I did for at least a month), unless you really have an issue with your nipple (inverted, etc) as it hinders the direct stimulation/milk transfer and isn't telling your body to make as much as it would if your baby was directly on the nipple
  • eating oatmeal (ideally not instant, quick-cooking is okay and you can still get that in the packets and just microwave)
  • eating enough calories in general
  • drinking lots of water (think 100+oz!!)
  • supplements (fenugreek is supposed to work even better when taken with blessed thistle. Go Lacta did help me a bit, main ingredient is moringa so I switched to taking just that (much cheaper than Go Lacta which is merchandised specifically for breastfeeding) but didn't seem to help as much, more milk plus, mothers milk tea (lactation consultant said the tea doesn't do much, but others have said it works for them). I also tried a tincture from Rainbow Grocery.
  • lactation cookies, who knows if they really helped, but they have tons of good stuff in them anyway and are a pretty tasty snack. This recipe makes a huge batch so I always rolled them and put them in the freezer so I could make another dozen when I ran out  http://www.drmomma.org/2010/08/lactation-cookies-recipe-increasing.html
  • massage during pumping/use heat
  • compressions - I never got the hang of these, but apparently they really work
  • extra pumping/power pumping sessions (10mins on, 10mins off, 10mins on, 10 mins off, 10mins on; or pump as often as possible in a 4-hr period, no need to wash parts in between - recommended by lactation consultant)
  • adding another pumping session (hard to do when you're already pumping after every feeding though!)
  • try not to stress about it... (yeah right!)
  • the best tip I got which totally worked for me - pumping between 2-6am when prolactin is at it's peak -- or figure out the time of day when you produce the most milk, for most it will be in the morning. There were many months after the babies where sleeping through the night that I woke up at 5:40 every single morning because I was able to produce up to 2/3 of my supply for the whole day in that single pump (sometimes over 20oz in 40 minutes)
  • use a hands-free pumping bra
  • rent a hospital-grade pump for the first month until supply is established. After that a double-electric is likely more efficient (per a lactation consultant)
  • get a double-electric breast pump and put it on the highest setting that is just the slightest bit uncomfortable (too high won't help, but needs to be on high enough)
  • for working moms or those away from their baby, looking at photos of the baby can help with letdown
  • try not to look at how much you're producing, in the beginning it might not be much which can be discouraging
  • a prescription for Domperidone, if all else fails

What's odd is that by April I had dropped down to just 3 pumps a day and I was still producing about the same amount of milk as I had been with up to 7 pumps in previous months. Does this annoy me to know I could have potentially gone down to just 3 pumps a day earlier on? Yes. But would I have tested this out? No. I wouldn't have done anything to risk dropping my supply.

I never got too big of a stash so I don't have too many tips on milk storage, however I did use the lansinoh bags which can hold up to 6oz -- never fill above 5oz and even then, make sure to defrost in a cup, measuring cup, etc, as I had a handful totally leak and it would've been such a bummer to lose that milk. And let's just say, whoever coined the phrase, 'don't cry over spilled milk' certainly didn't have a breastfeeding/pumping partner. Though I was lucky and in all the bottles I poured I always caught myself before spilling more than an ounce, ask Dave, every bit of breastmilk down to the last drop is precious. It truly is liquid gold.

So after months and months of trying to increase my supply, and finally have enough and even a small surplus for both babies, it was time to stop. I always had the goal of a year in the back of my mind and though I toyed with the idea of continuing to breastfeed George and just stop the pumping for William, I ultimately didn't see any benefit. I knew George could take or leave nursing; as long as he was being fed, he would be happy. There were many days he'd go after William's bottle anyway so as the year-mark approached, I started researching how I would wean. I talked to the pediatrician, who is a twin mom herself and could offer personal advice. But as the days inched toward their first birthday, I still hadn't made an effort to reduce my milk much. Even though I knew I was ready to be done, it was definitely hard to take that leap just because I had worked so hard to get my supply where it was. Was I 100% sure I wanted to wean? The answer was yes.

First, I started by dropping pump session, mostly consolidating.

Here was the pumping/nursing schedule at 11 months:
5:40am - pump
 7:30 - G nurse
9am - pump
10am - G nurse
1:30 - G nurse
2pm - pump
4pm - G nurse
6:45pm - G nurse + 6oz bottle
8, 9:30pm - mom pumps

The nursing schedule stayed the same until they turned one, but about two weeks before their birthday, I dropped the 9am pump (I only got a few oz from that one anyway), and several days later, combined the 8pm and 9:30pm pumps into one, just pumping at 9pm. So the pumping schedule looked like this:

5:40am
2pm
9pm

Next, I started shortening the pumping times, dropping most down to a strict 20 minutes. For the first pump of the day, this meant dropping down from 40 minutes and saw an immediate dip. While at my peak I was producing up to 21oz at this first pump of the day, for the past month or so, 14-15oz was normal. On April 11, I produced just over 14oz that first pump, and then when I cut it down to 20 minutes the next morning, bam, 7oz. After a week without any problems (no engorgement, etc.), I dropped the 2pm pump so by their birthday, I was down to just

5:40am
9pm

I started using the freezer stash of milk at this point as I was just producing enough for William, and not George's evening bottle, but quickly my supply dropped further. I wanted to make sure I'd have milk left to transition them to cows' milk if they had any problems.

Around his birthday, George was consistently way too distracted to nurse before bedtime so I let go of that and just gave him a bottle.

From there it was pretty quick, I continued to pump twice a day, but had been waking up closer to 6am since I wasn't pumping as long. Then one morning, Friday, April 25, I just didn't set my alarm and for the first time in a year, I slept all night through to until 7am. I was still nursing George at 7:30am, 10am, 1pm and 4pm, though I dropped the 4pm around that time. On Friday and Saturday, I pumped just a few ounces before going to bed and though I didn't realize it at the time, that Saturday night was the last time I would pump. Hooray!!

Over the next week, I dropped the 10am feed for George (replacing it with a bottle of breastmilk), then the 1pm. By Tuesday, April 29, I introduced cows' milk, just for a single feeding at 10am. I never needed to mix half breakmilk-and-half cows' milk. While they're not drinking quite as much cows' milk as they did breastmilk, they luckily tolerate it just fine and taking in less is normal.

We left for Cambira last Friday afternoon and that morning the last of the breastmilk was used up. I was still nursing George in the mornings, though he wasn't nursing as long so I suspect my milk was about gone. So that Sunday turned out to be the last of the breastfeeding and I was finally done.

The last week of pumping
So how does it feel to be done? Oddly, it already feels like a long time ago. I thought I'd be so ready to throw that pump out the window, but I still have it, thinking maybe I'll get engorged and will need it. I did pack it up today though so I think it's time for it to move on.  Update 5/12/14: A full week after weaning was complete (I had been weaned from the pump for about 2 weeks and weaned from nursing for a week), I got a plugged duct. I couldn't believe it after no problems during the whole weaning process. I looked online to see if it was common and I guess it is pretty common. I could tell it wasn't as bad as others I've had and everything I read said 'do not pump or nurse your baby' as that tells your body to start producing again. It recommended warm and cool compresses and massage, a lot of what I had done previously with plugged ducts. I was amazed that after about 5 minutes with a warm compress and massaging, it was relieved (in the past it's taken as long as a day to get rid of, including nursing and pumping at all the normal times). I continue to take lecithin which is supposed to prevent plugged ducts so hopefully I won't have any more issues, but am happy this was much easier to deal with than in the past.

Weaning was surprisingly straight-forward. I expected that with producing enough milk for two I'd need to take it really slow, but in reality, my body took the cues and it dropped pretty quickly. One other thing I didn't mention is that while I started to sort of wean from the Domperidone I was taking for milk production (at one point a while back I was taking 12 pills a day, about a month ago it was 6), I weaned really quickly off of it going from 6 to 0 pills in the course of maybe 3 days. That could have done the trick as well, though supposedly your body can maintain its supply even after weaning off of Domperidone. What's funny is that all along I didn't think the prescription was doing much as I never noticed a big jump in supply, but of course I was too nervous that it would drop-off that I didn't want to stop taking it. Based on the results when I did stop, I'd say it was working.

When I think of all the time spent pumping, which with a quick calculation I can estimate to be 730 hours -- yes, that's right, HOURS (and I don't say that for a pat on the back, I just had to see what that number would amount to) -- it sounds crazy, but just like everything with twins, you survive. Before they were moving, I thought, I'll never be able to keep up with this when they're crawling, then when they're crawling, you figure it out, maybe drop a pump or do more when they're napping or sleeping at night, but somehow it all works out. No, I didn't exclusively breastfeed twins, and no, I didn't successfully tandem breastfeed twins, at least not for long, but despite my several regrets listed above, I did the best that I could at the time and am so grateful my body was able to provide what it was for the boys.

I use an app to track my milk output and just looked at the complete numbers for the past year. Just over 11,000oz. That's about 86 gallons of milk, and that was just what I pumped for William. I'd expect that that number is about double since George mostly breastfed. So again, despite maybe not everything going as I had planned/hoped, I am grateful that the boys got what they did.

Would I do it again? Looking back, I don't think there was any way I would nurse one and give the other formula. It just didn't seem fair. I know other moms who have done this, for their sanity, which I totally respect, but for me, it was a way for me to provide for William when in many ways, I felt like I couldn't do enough for him.

I'm not sad that I'm done breastfeeding, George was ready and for him it was always about the food and not really about the bonding, which was fine with me. Now that he's so into solids, nursing had really taken a back seat and he had become more and more distracted and uninterested. I think the timing was right and I'm happy he's doing fine with cows' milk. I'm thrilled to be done pumping, though I have to say, it's been a bit anti-climatic. Especially since it's such a slow weaning process, you're down to once a day and then you just don't pump anymore and you're done. In fact, I didn't know the last time I pumped would be the last time. I always sort of expected that I'd be a bit engorged and need to pump a little bit more, but that never happened.

So just like that, breastfeeding and pumping, which occupied so much of my time, my worries and my life in general, is done. I'll be so glad to never wash those pump parts again and can't wait to be totally done with bottles. I've vowed to put my newfound time to good use and have been doing a Tracey Anderson workout video in the 20 minutes that used to occupy part of their morning nap. I've been so exhausted during their afternoon nap that I still use that time to relax, go on the computer, or watch a show. So no, it doesn't really feel like I have all this extra time, but now that I know it amounted to 730 hours, I really should commit that time to something productive over the next year. Like maybe running around after toddlers...

So long friend, I'll miss you (NOT!)

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