My friend just had twins five weeks premature a week ago. They haven't actually started breastfeeding yet, but she's pumping every three hours to get milk for them, but she's barely getting anything. The nurses suggested Mothers Milk tea, but what else can she do? I told her to get some of the tea and eat lots of oatmeal too. She says she's barely getting anything whenever she pumps, but she's engorged. (she has a hospital grade pump) She's got some blocked milk ducts I think too b/c the nurse showed her how to massage her breasts to get more milk and was rather rough with her and she heard a pop and then milk started coming more. I suggested she try hand expressing into a bowl. I know some women have better luck with hand expressing, than pumping. (I for one couldn't hand express for anything.. lol) Anyway, any suggestions I can pass along to her? I told her I'd ask around.. see if there was anything else I could find out for her. I'm not sure when the babies will actually be allowed to try breastfeeding, but I'm sure once she is actually breastfeeding them, it will be less of a problem for her, and I've told her that to try to ease her fears. However, I'm not sure when the docs will let her try to bf the babies.. hopefully soon.. :) TIA for any suggestions to pass along to her.. :)

not sure if she really needs galactogogues, but...

fenugreek. blessed thistle. from what i read, oatmeal is more of a comfort thing than a true galactogogue. marshmallow helps me, too. i take solaray brand of all those, from my co-op...

hth!

My son was a preemie and I had to pump for him too. I took fenugreek and blessed thistle. As well as mothers milk tea, And warm compresses seemed to help for me. As well as doing Kangaroo care at the nicu, then pumping right afterwards. Once my milk got going I could pump 540z a day! So she should have no problems. Do tell her to work closely with her Lactation consultant when they begin to nurse. It took my ds 4 mths to learnm how to do it( he had tongue thrust) but w/ help from our LC and some chiropractics he nursed likea champ.
She should be able to do kangaroo care with them even if they are intubated. She has to be adament about it as it is so very important for her and for them. I could find some links to more info if she needs them. I hope they are doing well! Kate

She should pump more often that every 3 hours in my opinion....

and increase her water dramatically....and she can also try domperidone....(used to induce lactation in adoptive mothers)

There is a place in New Zealand that she can order it from very cheaply and it will be here in about 7-10 days.

She should start taking fenugreek, blessed thistle, and alfalfa, 3 capsules of each 3 times a day, ASAP. If she can't get blessed thistle locally here's a good place to order from:

http://www.breastfeed-essentials.com/herbs.html

She can up the pumping to every two hours during the day. She should have a lactation consultant (IBCLC certified) make sure she's pumping correctly.

Here's some links on pumping:

http://www.breastfeed-essentials.com/pumps101.html

http://www.breastfeed-essentials.com/breastpumpingtips.html

Here's how to express manually:

http://www.parentsplace.com/features/primer/articles/0,10335,258693_110540,00.html

If she is still having supply problems she should consider taking domperidone (she will have to get it from overseas, but it's much better than Reglan, doesn't have the horrible side effects).

http://www.kellymom.com/newman/domperidone_01-03.html

http://www.kellymom.com/newman/domperidone2_01-03.html

She should really get an IBCLC certified lactation consultant to help her no matter what. Many NICU nurses and docs know little to nothing about breastfeeding, and actually give parents misinformation.

For example, it isn't true that it's "easier" for a preemie to take a bottle than breastfeed. Studies have shown that it is less stressful for the premature baby to breastfeed than bottlefeed. If the baby is strong enough to take a bottle, she's been ready to breastfeed. Bottlefeeding is a recipe for disaster; nipple preference is a real threat to the breastfeeding relationship.

http://www.kellymom.com/newman/more_bf_myths_01-03.html#9 (see myth #9; Newman's book has more information on this).

If the babies won't latch on, feeding them via finger feeding or a lact-aid/supplemental nursing system is much better than bottle feeding.

http://www.midwiferytoday.com/articles/ffpreemie.asp

Here are some LLL links on breastfeeding the premature baby:

http://www.lalecheleague.org/FAQ/FAQSubject.html#Premature Infants:

Again, I think the best thing for her to do is get a lactation consultant ASAP! And call the local La Leche League for a leader who can help. Maybe you could help her out by tracking down some IBCLC certified lactation consultants for her? Here's where to find them:

http://www.iblce.org/us_regional_registry.htm

Good luck to her!

She really needs to work with a lactation consultant now! There are some good ideas here-but breastfeeding is tough enough for some people. Pumping until your preemies can nurse is tougher. If she is getting engorged and getting plugged milk ducts she is at risk for mastitis which will make everything more complicated. She needs hands on help from someone who knows what they are doing.

I think that Kangaroo care, and then pumping afterwards is a great idea. (I also think that nursing them NOW is a great idea) I also have heard from many moms in my La Leche group that a manual pump like the avent Isis worked much better for them than a mechanical hospital grade pump. If she is really desperate...and can find a friend who has a baby that she can nurse to help get flow-then I say go for it.(I realize that is not for everyone...)

I agree that many NICU and nursery nurses know nothing about nursing...(I am a nurse) If you think about it what real experience can they get in a NICU?

Jane has given some very valuable info that I wholeheartedly agree with. Take it from a mom who didn't have preemies-but who had MANY problems breastfeeding and would have most if not all of my problems eliminated if only I had the help that I needed!!! Good luck to her-Linda

I wanted to add too that long before my DS could nurse ( or was even being fed breastmilk by nasogastric tube) I held him ( kangaroo care) with his face layig against my breast so that he could nuzzle etc. The skin to skin contact was great gfor him and helped me to pump and somedays he was strong enough to "play at nursing" as my LC said, which meant he was interested but couldn't quite do it. I got alot of peewee kisses I called them :) So just them being that close is a good idea too. I know alot of the time kangaroo care is done with thier head on your upper chest. HTH Kate


**oh, and I second the Avent pump. It is awesome!

I've never pumped for a premie, but I had one thought. . .

If she's engorged, than taking mothers milk tea, oatmeal, etc is only going to make her more engorged. She needs help getting the milk OUT.

I know she needs to have the pumped milk saved, but I could never get a pump to work for me when I was engorged. The only thing that would get the milk flowing for mw was to fill two bowls with warm water, put them on the bathroom counter, and lean over into them. Maybe she could try this to get the milk flowing and then dry off and start pumping?

Also, I agree that every 3 hours is not really enough. . . I've not yet had a newborn go that long between feedings! I would tell her to shoot for 2 hours. . .

And where is she pumping? Many mothers find it hard to get a let down in the beginning if they are under stress, or physically uncomfortable. I'm assuming that she wants to be with her babies as much as possible, but if the hospital doesn't have a comfortable place to provide her, she might want to consider finding one, at least until she has some success. Even her car might be a bit more familiar. She could bring blankets with her babies scent on them to hold, that helps let down too.

Above all, stress to her that a rough start doesn't mean she will have to give up on breastfeeding. I've known 2 mothers that had their babies in NICUS that preferred the bottle feeding method in the beginning, and for many good reasons, secided not to argue the case too hotly. They just made it known that they only wanted the babies fed EBM, and that they wanted to "try" nursing as early as possible, even if the babies couldn't sustain a suck long enough for nutrition purposes. Both have fabulous nursing relationships now. It was more work, and it took a while to establish a relationship, but after a little bit, no oone would have known that neither of these babies breastfed for the first few weeks (actually for one it was 2 months) of their lives.

I agree with holding them as much as possible barechested. When my baby was born, she was in the NICU stepdown unit of our (in my definition) very breastfeeding unfriendly hospital for her first night. because it was stepdown, we were able to hold her the whole time, but the nurse put up a screen for us and had me hold the baby up to my chest as she slept. lol, she kept walking by and saying "get that breast in her face! you want her to smell you as she sleeps so she can wake up good and hungry!" It worked :eek: that baby latched on, and nursed for 2 hours straight. then again for every 20 mintues for the first 48 hours of her life.

Thanks mamas.. :) I did tell her to contact LLL when I spoke to her the other day. I told her they would definately be able to help her out, and if she doesn't like the first group she finds, call another b/c there are several in the city she lives in. She is also working with the LC at the hospital, but if it's the same one who helped me when I had Connor, she wasn't worth a crap.. I think she did more harm than help with us! I will e-mail her the links that were listed though.

Oh and what is kangaroo care?? (I know I've heard of it before, but I forgot..) She was not able to hold the babies very much at all the first week. :( They had the babies in two different isolettes across the room from each other. :mad: But they finally moved them into the regular nursery over the weekend and put them in a crib together. She really hasn't been allowed to just go in there and hold them.. during different times the nurses won't even let them in to see the babies and they can't hold them much either when they are there!!! Hopefully in a week they will be released. The docs said they would be in the hospital for two weeks.

Kangaroo Care is when you hold the babies without clothes on your bare chest. Skin to skin conact. Your friend can DEMAND in a nice way-but without budging -whatever she wants for HER children. IIf she wants them in the same crib they should do it. Even when they were in isolettes they could be near eachother. This is the standard of care in many NICU's. She has the right to be with her babies whenever she wants to. Her babies need that closeness. Her babies need to be held by herself and her husband...That is outrageous. My best friend held her preemie twin boys with all the tubes, bells and whistles right from the start.

Just because she is talking to a lactation consultant-if her problems are NOT resolving-then that is NOT the right lactation consultant. She needs to see another one until her problems are solved. IT is annoying, it is inconvenient, but it is up to her to find the help that she needs.

She is the mama-she needs to follow her heart and her instincts. I know it is hard...I am a Nurse and couldn't believe how stupid and unhelpful my own medical community was when I needed help. I basically got the "keep up the good work-breast is best ' line....and no help when I had purple cracked an bleeding nipples-mastitis etc. I has so exhausted...my c-section incision was wide open and a had a newborn after 5 mos of bedrest. I say this not to dwell on ME, but rather to illustrate how even I got lost in the shuffle, because I didn't have the energy to advocate for myself. And I didn't know who to ask for help. Hadn't I already asked the pediatrician, OB, hospital lactation consultant, and the Nurses for help? (and received no real help)Just because the medical staff may be taking care of her babies in the hospital, and just because the hospital has a lactation consultant doesn't mean that is the right place for help.

So, your advice about contacting La Leche League is wonderful. And I agree, if she doesn't like one group-she can probably find another. If you can help her-make phone calls whatever-I bet that she can really use it. Maybe you can drive her to se another Lactation consultant(though they could go to the hospital or her house.) It will cost money-unless she gets a volunteer one from la lache. That was a slight barrier for me-because so many people had already failed me and I didn't want to spend money for someone else to be useless...but she will get the help she needs if she perseveres. La leche league Leaders will talk to her on the phone and even meet with her. She doesn't have to go to a meeting.

I am sorry this is so lengthy. But when I hear about bad medical care I get very upset. The hospital may be taking care of that familly in a technical manner-but not in a spiritual manner. That is Not right. And, The whole breast is best is true-and who needs it more than preemis? However, the Doctors and Nurses say that-then they don't know anything at all about breast feeding...or even refer you to people who do know what they are talking about that is how MANY people fall through the cracks. Because they think that the Hospitals and medical staff should have all the answers and don't.

Good luck to her. Linda

I totally agree with mowglimonster. I just would not have said it so nicely LOL I am a total Mama Bear when it comes to babies in the NICU, and they are her kids, the nurses cannot tell her when she can hold them. They can suggest when is a good time to do it, but they cannot make that decision. Those babies need her contact, and especially contact with each other. They were all cuddled together in the womb, I am sure they are missing that contact. My sons isolette was moved twice to accomodate for putting twins side by side. ( I did not mind this) and those twins were snuggled all the time, usually together by mom so they got her contact and from each other as well. KAngaroo care should continue at home too.

http://www.geocities.com/roopage/

http://www.prematurity.org/baby/kangaroo.html

http://www.breastfeeding.com/all_about/all_about_kangaroo.html

The last one is from breastfeeding.com- also another good site for her. HTH Kate

** edited to add** I had to be very adament that I would nurse DS come hell or high water. It was not easy but luckily I had an LC who believed in me and my DS and was a lifesaver!

This is a great link too... I print it out for every new mom who wants to or is breastfeeding. I think it's great! :)

http://www.bflrc.com/ljs/myths/glct_dum.htm

p.s. It is a funny.