Stopping breastfeeding toddlers

So hopefully we all know that breastfeeding well into toddlerhood and beyond is recommended by the WHO and that it is normal to do so (although this message still seems to be a bit slow to filter through to some!).

But sometimes breastfeeding just isn’t working for the parent. Maybe they have aversion, maybe they’re feeling totally exhausted and touched out, maybe they’re uncomfortable with still breastfeeding, maybe they just need to stop!

Breastfeeding is a two way relationship and anyone who says a parent is breastfeeding their toddler for them hasn’t breastfed a toddler. And especially if you are breastfeeding 2 or 3 toddlers! It is INTENSE! They often seem to want to feed all day.

So the first step is try getting into a loose routine. A lot of parents find feeding first thing in the morning, mid morning before or after nap depending on whether they still feed to sleep, mid afternoon before or after nap and bed time works well. (They may still be having night feeds as well, I have written a separate blog on gentle night weaning, here. I wouldn’t try to do both at once!) You may find just cutting back a bit like this and taking a bit more control makes it more doable anyway and that then you feel you can keep going for a bit.

But if you still want to gradually wean then the easiest feed to drop is usually mid morning, especially if you go out to groups a lot as you can distract whilst out and baby will tend to fall asleep on the way home in sling/car or buggy. Have lunch ready for when for wake up.

Then once you’ve done that, try stopping the mid afternoon feed. Again get ready with drink and snacks to combat the post nap grumps if they happen.

Once you’re down to morning and bedtime, a lot of people actually enjoy it again and hang on to those two feeds for a while. Once you’re ready to drop the first thing in the morning feed just get up straight away and have breakfast (although I left this feed until last as I preferred to stay in bed at 6.00am having a nice breastfeed than get up and make breakfast!).

For bedtime feed you can switch around the order of the bedtime routine. So instead of feeding to sleep or feeding as the last thing to settle, you can try feeding them first, then do teeth, pyjamas, story and cuddle to sleep instead. This breaks the feed/sleep cycle and will make it much easier to stop the feed completely.

Once you have weaned be very gentle on yourself as the drop in hormones can make you feel very down for a while. It takes your body a bit of time to function normally again. Lots of cuddles will get the oxytocin flowing and help everyone adjust.

Kathryn Stagg IBCLC – Oct2019

Breastfeeding twins/triplets in the Neonatal Unit

Around 40 per cent of multiple births need some extra support after birth and end up having to go to the Neonatal Unit (NNU) of Special Care Baby Unit (SCBU). It the babies need more intensive care they may go to the Neonatal Intensive Care Unit (NICU). This can be a very worrying time for parents. We have put together some tips to help parents survive and also to help ensure they meet their breastfeeding goals, despite having to be separated from their babies.

If you have warning that the babies might come early, prepare yourself by researching breastfeeding, and go to see the NNU so you know what to expect. It can be quite a daunting place full of wires and beeps.

Try to go to a breastfeeding class before babies arrive. If there is a preparing to breastfeed session in the hospital once your babies are in NNU you could attend to learn about it then, even though your babies are already out!

If you have some notice of your impending birth you may want to try collecting some colostrum before they arrive. This might give you a head start. Talk through this with your doctor if you are less than 36 weeks pregnant.

Once babies arrive, make sure you are shown how to hand express, ideally within the first hour after birth. If you are too unwell then try to do it as soon as you are able. You can collect drops of colostrum in a syringe. Here is a really great video tutorial from Global Health Media

Once your milk begins to come in, usually around day 3, you can move on to the pump. Hospital grade pumps should be available for you when you are in hospital. Often hospitals have a pumping room. You may also be able to pump by the side of your baby’s incubator.

Make sure, once you are discharged, that you have access to a hospital grade double pump. Sometimes hospitals or children’s centres have pumps to borrow. If not, you can hire them from the manufacturer. Some NNUs will have a discount code for you to use.

Ask questions, nothing is too silly. Make sure you are consulted on everything and if you do not understand something, ask what it means. Write down questions as you think of them or you won’t remember when the doctors comes round.

Write notes about what they say. It’s hard to remember later. Especially if trying to relay things back to your partner or family members.

Try to be fully involved in their cares. It may feel like your babies aren’t yours as they are being looked after by the nurses and doctors. But there are plenty of things you can do. And they are you babies. It is very important to remember this.

Do not let anyone tell you breastfeeding preemies is not possible. Yes, it is a more difficult journey, but there are many, many families who have managed to breastfeeding their babies.

Find supportive staff. You won’t get on with everyone. But there will likely be one or two nurses who you really click with and you feel you can trust.

Ask to see the Infant Feeding Lead and talk through your plan to breastfeed your babies. They will be able to talk you through the different stages your babies will go through.

Ensure that the staff talk through the risks and benefits of giving formula or fortifier. Make sure you are fully informed before you make a decision to supplement.

Ask about donor milk. Hospitals often have certain criteria a baby will need to meet but it is always worth asking.

Pump as frequently as you can. The more often you express the more milk you will make, ideally 8 to 10 times a day for around 15-20 mins. Try to set alarms so you don’t forget.

Pumping sessions do not have to be evenly spaced.

It is however, very important to pump in the early hours of the morning, between 1-5am, as this is the time that your body has its highest levels of prolactin, the milk-making hormone.

Have something to remind you of the babies when you’re not there, photos, video, cloths that smell of them, some NNUs have fabric squares you can leave in the incubator with the babies and take home with you. Smell is a very evocative scent and this can help with bonding and milk supply!

If you can, pump by the incubators so you can continue to be with them and see them.

If you miss a pumping session, try to squeeze up the others so you still get to your total in 24 hours.

You may find power pumping once a day helps your supply. It mimics babies cluster feeding.

For more detailed info, read “Establishing Milk Supply With a Pump”

Expressing milk for your babies feels great as it is something you can actually do for them whilst they are in the NNU.

As soon as the babies are well enough, ask for skin to skin. And as soon as they have reached around 33 weeks gestation they should be able to begin trying to breastfeed.  

Ask for support with transitioning your babies to the breast. The nurses and infant feeding team should be able to talk you through the steps needed to get baby breastfeeding. For more info read our article “Transitioning Premature Babies onto The Breast”

See if your partner can stay overnight, some hospitals have facilities for this.

Try to have a support network around you to feed you and look after you whilst you look after the babies, especially if you also have older children to think of. Get them to fill the freezer with nutritious food, run the vacuum round, give you lifts to the hospital, do the school run….

Make sure you have plenty of snacks! Get food delivered to the hospital by friends or family so you don’t have to live on hospital food all the time. Have a bottle of water on you at all times. Hospitals are hot and dry.

Find other families in the same situation. Get chatting to others in the pumping room. Join support groups online and on social media. This will be a massive support to you whilst you are in hospital and once you are discharged.

Self care. Make sure you eat and sleep. Have a break. Do something for you whilst babies are being looked after by very capable hospital staff! Allow yourself to leave.

Take pictures of everything. Even the painful bits. You will want to be able to look back at this time one day.

Celebrate every tiny milestone. Celebrate every drop of breast milk. 

You do not have to introduce a bottles to get home. But you may find that babies will continue to need to be topped up for a little while once they are discharged. Many babies are discharged around 36 or 37 weeks gestation if they are well enough and there can still be some feeding issues at this age. Have a read of “Breastfeeding 36 or 37 week babies”  for more info on the issues you may come across.

Once discharged try to make contact with your local breastfeeding support so you have ongoing support throughout the rest of your breastfeeding journey. And of course Breastfeeding Twins and Triplets UK Facebook Group is a fantastic resource.

 

 

Kathryn Stagg IBCLC, Sept 2019

Surviving fussy periods with beastfeeding twins

Babies are fussy sometimes. They have developmental leaps. They have fussy evenings. Sometimes they just have a day when they are not happy for some reason. But when there’s two, it can be quite difficult to cope with. But as long as nappy output is appropriate for their age (generally 2-3 poos in and 5-8 wet nappies in 24 hours, although after 6 weeks babies can go a few das without poo and that’s fine) and weight gain is consistent, it is a completely normal, if difficult stage.

Twins sometimes have their fussy periods at the same time. This can be pretty intense! Sometimes they decide to tag team. Less intense but then it goes on longer. I am not sure which is easier. But unfortunately, as parents we do not have much say in the matter.

So here are some tips to help cope:

Let them cluster feed

Babies like to stock up with milk. Mostly once breastfeeding is established, babies will generally be happy after just one, or possibly two goes on the breast. But during fussy periods they often want to go back onto the breast time after time. This is called cluster feeding. You give them a feed, they begin to snooze, come off, you put them down, they wake up and start routing, you feed them, they snooze and come off, you put them down, they wake and start routing….. repeat for a few hours. The good news is you will get a let-down of milk each time. Your breasts are unlikely to feel full during these periods, but breasts never actually run out. They are constantly making milk, and an empty breast makes milk much more quickly than a full breast. So milk production actually increases. So get set up with everything you need, snacks, drinks, phone, remote control and something good on the TV, and let the babies feed, feed, feed. This is where tandem feeding really helps as you can plug them both in and quieten them down. If you are struggling with tandem feeding then having someone else to entertain the second baby is a massive help and you can keep rotating the babies.

Other settling techniques

But you may find you get to the stage when the babies do not want to feed any more but are still not happy. Often this will mean they try to latch on for comfort but as soon as they get some milk, they come off again as they are not actually hungry. It does not mean you have run out of milk. Babies often like to suck for comfort, so sometimes substituting the nipple for a clean finger can work. But babies also like movement and closeness. So you could try skin to skin (especially with the non-breastfeeding parent as the smell of milk can just mean they want to latch on), rocking, patting, swaying, tiger in the tree position (see pic below), walking or bouncing with them in the sling, baby massage, maybe a bath or sharing a bath with a parent, or even taking them out in the car (many a parent has found themselves driving around late at night willing the baby to sleep!). Often after a bit of a break, the babies will latch on again and have a good feed an eventually settle down to sleep. And often you will find that they sleep for quite a good period of time after a fussy period like this, so this is time for mum to sleep too!

 Some mums prefer to express earlier in the day and offer a bottle during these fussy times. But remember breastfeeding is not just about the milk, it’s about comfort and connection as well. And remember it is important to express if you are missing a feed otherwise it will affect your supply.

Babies often grow out of these fussy, cluster feeding type periods at around 3 or 4 months of age. So although very difficult when we are in the middle of it all, it is reassuring to know it will not last long. 

 June 2019, Kathryn Stagg IBCLC

Twin Feeding Pillow Tutorial

feeding pillow tandem pic (2)

With all U-shaped twin breastfeeding cushions, make sure you are sitting upright and push the cushion right in so there’s no gap by your tummy. Use the back support cushion and maybe add another cushion to make sure there’s enough room for babies’ legs to wrap round you. The cushion should bring your babies to exactly the right height to latch on to the breast. Add some extra cushions if the babies are not high enough or sit on a softer surface so you sink a bit lower. If the cushion is too high try sitting on a cushion, or on a harder surface, like a firm sofa.

2005_0527_142449AA

To get both babies in to position, put one baby in a safe place within reach so you can set up the cushion and get comfortable. Don’t forget to grab a drink, snack and your phone and make sure the remote is within reach! Place first baby on cushion, then reach to pick up second baby. You could roll a muslin and put behind first baby’s back to prevent them rolling off the cushion if you like. Grab the baby grow of the second baby under the chin and lift gently, slide your other hand under as soon as you can. The back of the baby grow will support the neck of the baby, but move slowly. Lift second baby into position on the cushion.

Make sure you’re starting nose to nipple, this means the babies have to be quite far back. Don’t hold the back of their heads or they will not be able to open their mouths wide, support at the shoulders. Baby should be half on their back, half on their sides looking up at the breast. Wait for an open mouth and bring one baby onto the breast chin first. The bottom lip should be quite far from the nipple, the nipple then goes into the roof of the mouth. You can assist by lifting the breast a little by pressing in on the top of the breast with the other hand. Then do the same with the second baby. The cushion should be set up correctly so that once they’re feeding you should be able to let go and feed hands free.

tandem feed above

For babies who are often sick or suffer from bad wind or reflux, it is possible to tilt the cushion a little so babies’ heads are higher than their hips. Try putting your feet on a foot stool to lift your knees a little and then lean back a bit. Or maybe sit cross legged or with your knees bent on the bed. This means the angle of the cushion and your body is still the same but babies’ heads are raised a little.

For the M shaped cushions, start with it in W position, put behind your back, then fold the two sides down and clip together (if you have a clip, some cheaper ones do not have this feature). The centre section becomes the backrest. Then follow the same procedure for latching as the other pillows.

Image result for twin z feeding pillow

May 2019, Kathryn Stagg IBCLC

Breastfeeding babies born at 36 or 37 weeks

A baby born between 34+0 weeks and 36+6 weeks gestation is defined as a late preterm baby. A baby born between 37+0 weeks and 38+6 weeks is defined as an early term baby. The average length of a twin pregnancy is 36+4 weeks. Many twin babies are born between 36 and 38 weeks gestation due to the NICE guidelines.

For babies who are born at this time, establishing breastfeeding can be quite difficult. They are often well enough to remain on the postnatal ward with their mothers, which is great as they do not have to go to special care. But as such they often get treated the same as a full term baby and are left to “demand feed”.

The problem is that these babies often do not “demand” enough and prefer to sleep, although I prefer the term “cue-based feeding” or “baby-led feeding”. They are often too sleepy for the mother to be able to follow their lead completely. And if they do not feed enough, they get even sleepier and harder to rouse to feed. Also a lot of slightly early babies are not physically strong enough or coordinated enough to fully breastfeed, often until around due date or even a bit after. They have a few sucks, take on a little milk, and then fall asleep before they have had their fill.

This can lead to real problems! Babies can lose weight, or jaundice can set in. Mum’s milk supply may not be stimulated enough, or she may lose her hard-earned milk supply if she was pumping in NICU. After a week or two it is decided the babies need supplementing, but the lack of breast milk may mean they need to use formula.

These problems are also experienced by parents of more premature babies as they are often discharged around what would have been 36-37 weeks gestation with minimal breastfeeding support. They are often given the chance to “room in” for a couple of days to practise feeding and looking after their baby or babies full time, and this is often the first time the breastfeeding mother is allowed to follow her babies’ lead.

These families need lots of support. They need good quality face-to-face breastfeeding support after discharge. They need to be shown the subtle cues their baby makes to show that they need a feed; stirring, mouth opening, turning head from side to side, and the later cues including stretching, moving arms and legs, trying to bring hand to mouth. Crying and agitation are late cues. (Maria Biancuzzo, Dec2018) They should be encouraged to feed their babies frequently. Dr Tena Fry said in her interview with Maria Biancuzzo: “If a baby’s eyes are open they should be offered food”. Parents also ned to be supported to understand when their baby is not cueing frequently enough. We would suggest not to let a baby of this gestation go longer than 3 hours from the start of each feed to ensure they have a minimum of 8 feeds in 24 hours. 

Parents should also be shown how to ensure the babies are latching on well to feed. And tandem feeding positions can be discussed to help with the intensity of breastfeeding new baby twins. Also breast compressions are a very useful tool to help transfer a bit more milk to the babies during the feed, and to remind them to keep feeding when they get a bit sleepy towards the end of the feed. Sometimes a baby of this gestation may have trouble latching directly on to the breast. Babies who are a little early sometimes latch better and feed more efficiently when using nipple shields. Close attention should be paid to milk weight gain and nappy output if shields are used as they can inhibit milk transfer.


Parents may need support with continuing to pump for top ups if the babies are not ready to fully breastfeed. And they need to be shown how to tell that their baby is developmentally ready and feeding efficiently enough to move away from 3 hourly feeds and on to baby-led, cue-based feeding. The problem is each baby is different. Some will be ready to fully breastfeed at 36 weeks, others at 42 weeks, and everything in between. But mums often continue to supplement and schedule far longer than they need to. We would normally look for each baby to be putting on weight as expected, generally waking themselves for feeds before the 3 hour schedule, and having a good proportion of “active feeding” during a breastfeed. Then if mum is pumping for top ups this can be gradually phased out. They will be safe to move on to baby-led feeding. If parents are using formula to top up this can be gradually phased out. See our guide here 

Ideally each family would be guided by somebody highly qualified such as an IBCLC or experienced breastfeeding counsellor. This is a scenario that deserves specialist breastfeeding support in the home on discharge from hospital, to ensure they can maximise the breast milk intake of their babies.

 

Kathryn Stagg IBCLC 2019

https://mariebiancuzzo.com/2018/12/04/cue-based-feedings-for-late-preterm-infants/

https://www.unicef.org.uk/babyfriendly/

The Case for the Floor Bed

Many parents worry how they can get their co-sleeping older babies into their own room and into their own cots. However, there’s another way which can be much easier, much more gentle and less stressful for everyone. The floor bed!

The difficulty of using a cot is having to settle them into it. Contrary to popular belief, many children under the age of 2 do not lie down and go to sleep happily on their own. Many still need a feed or a cuddle to do this. But getting them to go into the cot after feeding or cuddling to sleep can be difficult. As soon as you lower them down and let go, they’re awake again, either almost straight away or at the end of the first sleep cycle.

A floor bed can remedy a lot of the problems. Either just a mattress on the floor, or on a low slatted bed base, or on conjunction with a cot (or two) with the side taken off.

Here are some of the positives:

* Baby is settled to sleep in the bed they are expected to sleep in. Often a baby falls asleep in its parent’s arms or bed as this is the easiest way to get them to sleep. Then when the baby wakes up, they find themselves in their cot, sometimes in a different room. This can be very disorienting as any adult who has awoken somewhere different to where they fell asleep can testify!

* If the baby wakes in the night, the parent can settle them back to sleep in the baby’s own bed easily with a feed or a cuddle. No need to move them out of their environment.

* The fact it is on the floor means it is safe if they roll out or get up and wander in the night. And they will not try to climb out of the cot! Ensure furniture is screwed to the walls for safety and nothing can be pulled on top of them. Parents can also use a baby monitor.

* Parents can co-sleep part of the night in baby’s bed if necessary ensuring a good night sleep for all. This also means that the other parent can remain in the parental bed. The co-sleeping parent can sneak back to their own bed if they are still awake once baby has settled.

* It is a very gentle way to encourage a baby to move into their own room or in with their sibling whenever the parents think this is the correct time for their family.

* Later on the parent can gradually retreat by lying next to the child, lying a bit further away, popping out for a minute, until eventually they are happy with a story, a kiss and a cuddle and then sleep.

So for parents wanting a gentle way to transition a child to sleeping on their own space, this can be an ideal solution.

Photos courtesy of Gentle Parenting Twins and Triplets UK & Ireland facebook group.

Establishing milk supply with a pump

There are several reasons milk supply may have to be established by expressing and not by directly breastfeeding. Mother and baby may have to be separated after birth due to prematurity or illness, or maybe baby just cannot latch on for some reason. Maybe baby is tongue tied, has a cleft palate or is too sleepy to feed effectively.

So how does a new mum start to establish a milk supply if she is not directly feeding her baby?

After birth you should be encouraged to hand express colostrum within an hour of birth if possible, or at least within the first 6 hours. Ask to be shown the technique by your midwife, or there are plenty of great video tutorials online. This one from Global Health Media is particularly good, click here. It is important to massage the whole breast and the nipple for a couple of minutes before starting. Hand expressing is recommended for the first two to three days until the milk begins to come in as colostrum is very thick and sticky and is in small quantities, so will get lost in a pump. However, if large quantities of colostrum are being expressed, you could move onto the pump earlier. Also there are settings on some hospital pumps designed for expressing colostrum and some mums respond better to this. The pump can also be used just for stimulation.

Babies only need a small quantity of colostrum, so every drop counts. These small drops can be sucked up with a syringe direct from the nipple or dripped into a small cup and then sucked into a syringe. This can then be given directly to the baby. You should be encouraged to hand express 8 to 10 times in 24 hours to mimic the baby’s feeding patterns. This will give enough colostrum to feed and to prime the lactation sites so that you will have the greatest chance to make a full supply or as near as possible. Some mums do struggle to express any colostrum in the first few days. It does not mean it’s not in the breast, we all start making colostrum in the second trimester of pregnancy, but it can be a bit challenging to get it out. If it is proving difficult then maybe ask about donor breast milk until your milk “comes in”. Most mums find they can express mature breast milk much more easily.

 

 

lilli put pumping

Moving on to the pump. Milk begins to “come in” around 3 to 5 days after birth, a process called “lactogenesis II”. It is triggered by the birth of the placenta and will happen whether a mum is breastfeeding, pumping or doing neither. Breast milk gradually changes from colostrum to mature milk over a number of days and volumes should begin to increase. Continuing to pump 8 to 10 times a day will help ensure you establish a full supply.

Top tips to establish a good supply!

Frequency – There really is no better way to get a full supply than to pump frequently; 8 to 10 times a day to begin with is essential. Some mums with large storage capacities may be able to drop a couple of sessions and continue to make enough milk, but for many frequency is the key. Expressing sessions do not need to be equally spaced. And if you miss one for some reason, try to shuffle up the others so you still get the same number over 24 hours.

Efficiency – Using a hospital grade pump is recommended. In hospital the staff should be able to provide one for you to use, normally in the pumping room, sometimes by baby’s cot or incubator. Once discharged, hospital grade pumps can be hired either direct from the manufacturer or from a local pump agent. If baby is in NICU there is often a discount code.

Breast shell size – It is really important to get the pump’s breast shell size correct. This will mean pumping should be comfortable and not cause any damage to the nipples, and it will also help maximise milk production. Just a note to say sometimes a pair of breasts need two different sized shells! And sometimes you need to change size as you go through your pumping journey as breast size changes. Nipple diameter is the key. Check your manufacturer’s information on this and experiment a bit.

Power pumping – This mimics a baby’s natural cluster feeding pattern and can help stimulate milk production. The pattern is as follows using a double pump: pump for 20 minutes, have a 10 minute rest, pump for 10 minutes, rest for 10 minutes and then pump for a further 10 minutes. This can be done once a day to help boost supply. If you are using a single pump then you can power pump by pumping 10 minutes on the left and then 10 minutes on the right, rest 5 minutes, pump 10 minutes on the left and 10 minutes on the right, rest for 5 minutes and then pump ten minutes on the left and 10 minutes on the right again.

 

power pumping

Hands on pumping technique – This is a technique which incorporates massage, hand expressing and pumping all at the same time. Many have found that this can greatly increase output. For a more detailed explanation watch this video

Hand expressing – after the flow has slowed you could try finishing off by doing some hand expressing. Often a little more can be squeezed out by hand

A hands free pumping bra – This can make the above massage much easier, as you use the bra to hold the pump onto the breasts and so hands are free. It also means you can pump and do other things at the same time. This can be essential, especially if you have older children. You can buy them or make your own by cutting vertical slots in an old bra or sports bra where your nipples are, and you can insert the cones through the slits.

Warmth – Applying a warm compress just before you express can help the let-down reflex.

Skin to skin with baby – Skin to skin, or kangaroo care as it is often referred to, helps boost oxytocin and encourages the milk to flow. Oxytocin is one of the key hormones involved in the production of breast milk and, amongst other things, stimulates the let-down reflex, meaning milk flows more easily when pumping.

Look at baby – Photos, videos, pictures, pumping next to the cot, listening to your baby. All these remind the breasts what they are supposed to be doing! They also stimulate oxytocin and help with supply.

Latch baby – If baby is beginning to latch on to the breast, pumping straight afterwards can make it much easier for the milk to flow as the baby will have stimulated the let-down reflex.

Distraction – “A watched pot never boils”. It’s the same with pumping. If you watch what you get, you will likely not get so much. Distracting with listening to music, relaxation recordings, mindfulness, watching comedy, chatting to other mums or friends and family all have been shown to increase milk production. Stress can inhibit the let down reflex so these techniques can help keep you relaxed.

Eat and drink – Good for health and energy of the mother, not necessarily for milk production.

Rest – It is really essential for mums to rest. Yes we also want them to wake once or twice a night to pump, but getting a good amount of sleep is so important to cope with the stresses and strains that you feel when a baby who is latching. Get help with all the usual household chores, looking after older children and cooking. Mother the mother so the mother is able to mother the baby.

Galactagogues – There are many foods or medications out there which either have some scientific evidence behind them or have anecdotal evidence that they can increases milk production. However, none of these work unless the milk is being removed frequently from the breast. They are not a magic wand. For more info on galactagogues have a look at this link
pump Sophie De Sousa expressed stash

It is important to look at 24 hour output, not necessarily what is expressed in each session. This is because there is often a wide variation in amounts from different times of day, and also each breast often gives a different amount. Over the first few weeks, we hope to see a gradual increase in volume in each 24 hour period.

Once babies are strong enough or well enough they should be able to move gradually on to breastfeeding directly. Make sure you seek some support from a trained breastfeeding specialist to help you achieve this.

Kathryn Stagg IBCLC 2018

 

Breastfeeding 4 under 4: Lilli Docherty blogs about feeding baby twins and two older siblings,

Not one to do things by half, I was very fortunate to conceive in February 2017.  With an already 18 month old and just turned 3 years old nurslings, I was very aware of the forthcoming task ahead.  With the world’s average self weaning age being between 2-7 years old, I realised that this pregnancy and the changes in milk taste could lead to my eldest and possibly my (now) middle child’s end to their breast feeding journey.  Though, equally I had already fed throughout one pregnancy and managed (purely at the grace of hormones) to maintain supply.  I could do it again couldn’t I?  The longer I have nursed, I’ve received increased disapproval and adoration.  Society and the culture in the UK is sadly a little detached from our mammalian purpose… I admit there was a time when I myself was uneducated in the value of breast feeding , and I remember thinking, ‘surely its wrong to feed a baby who can walk up to the mum and lift her top to ask for milk’… oh the irony…I spend much of my home life with my top and bra straps dropped down ready for quick presentation of boobs when needed.  Here I was, feeding two walkers with a growing belly.

Wowsers! there’s nothing like the bedtime nursing session and pregnancy to completely zap all energy.  I was shattered each night but was generally having undisturbed sleep now that both nurslings seemed content to snuggle with me instead of nurse during the night.  (This wasn’t a process I could rush, and my husband and I very much went at their pace. My second baby needing to have hold of one boob though the night as if to confirm ownership).

My eldest had always required a bit of support (in the form of one hand shaping the breast to ensure a deep enough latch ) to feed due to a tongue tie. My confidence with feeding her in alternative positions was limited to ‘needs must’ like during mastitis and blebs, all part and parcel of feeding tongue tied babies.  So sticking with her in cradle position and my second being too fidgety in rugby hold, meant I limited tandem feeding sessions for when their toddler melt downs meant there was not other option. Generally though, they took their turns in stead.  I have no idea how to parent without breasts. I nursed them both to sleep and transferred them to their beds. Tantrums, toothache, bumps and falls, were all solved with boob.  Yup, I not thought of how I was going to do all that with number 3 in my arms too!

Time came around to the 12 weeks scan at the end of April. My belly had really popped, though I was managing to avoid telling people about the pregnancy, preferring to have the reassurance of seeing the baby for real first.  I lay down on the bed in the sonography room, and all I see is black, an empty black space on the screen. I cupped my face and begged the sonographer in panic, “Please tell me there’s something in there”.  He flits the camera over my belly back and forth, my husband and I staring up and the screen holding our breath.  The man turns to me, his eyes sparkled and he said, “which one do you want to see first?”…

There you have it, the moment we realised we were now a family of 6.  The logistics of this wasn’t thought out until the time the babies arrived.  There was only so much we could plan for because a multiples pregnancy & delivery had too many potentials.  Heading into the Summer months helped burn off the children’s energy running around outside whilst I could sit and catch my breath, the weight of this pregnancy and my reduced lung capacity impacted on our usually active life.  My bulging belly made nursing increasingly awkward and uncomfortable.  And there was the joyous hormonal zinging pain lasting throughout the feeds, even with deep exaggerated latches.  All feeds required mental strength to complete but I treasured them.  I didn’t know if my supply would dry up, whether if it did, my babies would be happy to dry nurse, or how often I’d be able to nurse them once the twins arrived.  So many questions and none of which there were answers for. I carried on feeding as we were but asked the children if we could change the bedtime feeds to earlier in the day time so I didn’t need to try and roll around getting in and out from their bed. People say how resilient children are and my two were the true example of it.  By keeping the option of nursing available to them, it meant they were reassured and unphased by the impending changes.  My supply dipped around 22-26 weeks, my eldest said the milk tasted like strawberries (I think she meant sweet) but that there wasn’t much (handy when they can articulate to you exactly what is going on isn’t it?).  My son would latch and get bored from wasted effort at the measly offerings.  But the three of us stuck with it, dry nursing, hormonal nipple pain and taste changes, along with a persistent bleb, ensuring if their nursing journeys were to end, it was by their choice.  I felt it would help with bonding all the siblings and curbing my mummy guilt of having another baby/babies.

The twins arrived at 34 weeks after a speedy delivery where I arrived at the hospital with about 10 minutes to spare.  This meant the twins required some support and our hospital stay lasted 12 days.  Having nursed my big 2 to sleep literally 90 minutes before the twins arrived, to be so swiftly separated from them for an uncertain amount of time was, for me, distressing and draining, but their strength and preoccupation with Grandparents meant I was met with beaming smiles and kisses each day they visited.  I’m no psychologist but I can only assume children are protected in these scenarios by the ‘out of sight, out of mind’ concept.  The members of family who assisted with childcare said I was barely mentioned, which is obviously great, but being typical mum I punished myself still for not being there for them.  The fact they were still nursing was of huge help.  Here I was in hospital with two babies who weren’t able to nurse directly, pumping and hand expressing for them around the clock.  I became engorged when my milk finally came in. BLESS THOSE TODDLER/OLDER NURSLINGS! They swooped in to my rescue.  Although tender to touch, the relief from my older two, drawing out the blocked milk from my inflamed ducts was awesome.  For this reason alone, continuing to nurse them throughout pregnancy was well worth it.  This gentle transition between them meeting the babies in incubators, to cuddle opportunities, to coming home, all the while still having ‘boobie’, I believe, secured a united family bond.  It took another 3.5 weeks to have the twins off tube feeds of expressed milk and able to feed directly, but my older nurslings supported me, the expressing mission I endured and how their nursing sessions needing to fit in after a pump sesh.  I was bound to my bedroom nest and they would run in with newly sterilised milk pots from Daddy.  A support network is imperative for any breast feeding journey, but having my children at the helm of this was awesome.  Communicating clearly from the start how, “the babies need the mummy milk to get bigger and then they will be able to play with you”, and “you can eat food but the babies can only have mummy milk”, has helped even my 2 years old’s understanding and we’ve dodged any jealousy of how my time is used and more so how unavailable (by comparison) my breasts are.

 

Whilst the twins were tiny, their little mouths and shallow latches, meant their effectiveness at milk transfer was limited. Except, I had a couple of useful tools to help establish my supply.  In hospital I’d been advised to use the hospital grade double pump, and power pump as much as possible.  Well, with this in mind, by tandem feeding one of my older two with one of the twins, the let down was brought on in both breasts, reducing the energy the attached baby required to use and increasing the milk they received.  Every bit of stimulus my breasts received worked towards increasing the supply to service the twins who would eventually need to feed directly from me, and I was needing to stay a step ahead to keep them on my milk alone.  Some medical professionals were confused about the science of breastfeeding and felt my older two would be “taking the milk from the babies”, but I knew and valued the importance of demand=supply=demand=supply.  In the long run the twins’ muscle strength and latch would mature enough for them to manage and feed independently. For those initial weeks of learning, to have this inclusive way of feeding, I’m sure became fundamental to our overall success as well as minimising any negative impact that can be experienced when introducing a new born into the family and transitioning siblings to their new ‘big’ brother/sister role.

The expectation upon older siblings are immense and the huge changes mine went through to bring home premature twins were not to be underestimated. Ultimately though, by making them part of the survival plan, communicating through pregnancy about the how booby time will change but emphasising they very much have the choice to continue still and by ensuring my support network of my husband, the Grandparents and friends, I was happy to take on the ‘rods for my back’ I had willingly installed, even down to co sleeping and cuddling the big two until they were asleep. We are now 4.5 months into our ‘nursing 4 under 4’ journey, directly feeding the twins at the breast and tandem feeding in various combinations as needed. As mums we worry about how we cope, but as a twin mum, this statement  rings more true. A friend said to me, ‘just take it 10 minutes at a time’, and when I feel like the dysfunction level is reaching a high, I remember this.  Often 10 minutes later, one or both of the twins has nursed to sleep or has settled in the sling. Or my daughter has allowed me to brush her hair, or they have finally put their shoes on. It’s all little things, but it all passes. The evening cluster session can start any time from 3pm and tends to last until 8pm. But whilst tandem feeding the twins I can use pillows to assist with positioning enabling me to free my hands, so I can do story time with the older two and assist with getting changed for bed.  So for all the worry and mummy guilt we put ourselves through, know this: It can be done! Our bodies are amazing and so are our little nurslings, no matter how many of them there are.

Lilli Docherty, Feb 2018

Tandem feeding twins

You have two babies, you have two breasts. Many twin mums like to feed their babies together to save time and to try to maximise sleep!

But should you try straight away or should you single feed first whilst you are all practising?  The answer is it really depends on your babies and you. Some babies struggle to latch in the early days so trying to juggle two babies and latching both on with one hand each can be quite stressful. And they often take a few goes each to latch. So some mums prefer to wait until they have practised a bit feeding singly. Other babies, especially if they are full term, a good size and nice and alert, can tandem feed straight away. So you will really have to wait and see. Some mums try tandem feeding and just don’t enjoy it. And that’s fine too. But I think its always a good idea to be able to tandem feed if you need to, even if you don’t do it all the time.

So how do you go about tandem feeding? The most popular position is the “double rugby hold”, or “double football hold” if you are American. The babies lie one down each side of you. Start nose to nipple, so the babies need to be quite far back with their legs curled round your waist; you may need an extra cushion or two behind you to make room for their legs, especially as they grow longer! Support the baby with your hand behind their shoulders with thumb and fingers round the neck behind the ears. Tickle top lip with your nipple to stimulate baby to open her mouth wide, and bring on to the breast chin first with nipple going up into the roof of the mouth. Many mums find a twin feeding pillow really helps to support the babies in a good position. You can read my blog about different twin feeding pillows here. If you have your feeding pillow set up well you should be able to let go of the babies and feed hands free (meaning you can eat ice-cream!).

Many mums are worried about how they will be able to tandem feed without help when their partner goes back to work. The most important thing is to keep everything nearby within reach. Then get you feeding pillow ready. Pick up one baby and put on sofa or bed next to you. Ensure baby cannot roll or push themselves off. It is surprising how early babies can move themselves! Then pick up the second and place next to the first. Get settled and make sure the feeding pillow is in position. Lift one baby onto the pillow, ensure they can’t roll off, you can either use your arm to support it or some prefer to roll up a muslin and just prop them up. Lift second baby onto the cushion. I usually advise mums to start with the fussier feeder as you can concentrate more on the latch and use both hands. Then once the first baby has settled into a deep feeding rhythm and the milk is flowing, latch on the second baby. Sometimes this knocks the first baby off the nipple and you have to start again! But with practice, you will get there.

But you don’t have to be constrained by the double rugby hold and needing to use a pillow to tandem feed. There are several other positions you could try. And especially as the babies get older, more able to control their heads, and faster at feeding, you really can be quite creative.

Commonly called “The Stack” you can feed one baby in cradle hold and one in rugby hold. This is quite a good position for feeding out and about as you can do it either without a feeding pillow or with just a couple of cushions to support your arms. Or you can sit cross-legged on the floor and have your legs support the babies.

The “double clutch” can be another good way of tandem feeding without a pillow. It is especially useful when babies are a bit older and can feed in a more sitting up position.

You can even tandem feed in the car. Just make sure you are not actually driving at the time!

And you can feed walking around if you can master the “tandem twin sling feed”. The ultimate food on the move.

And most importantly, there are ways you can tandem feed lying down, so you can lie back and relax whilst you feed. These positions can be used from birth when babies like to feed very frequently, or later on during the long, cluster feeding sessions during growth spurts.

 

And when the babies become toddlers, they can feed any old how.

 

Kathryn Stagg, IBCLC, Jan 2018

 

Night Weaning Toddler Twins

Babies wake in the night. We know that. Babies like to feed a lot in the night. That’s a given. But sometimes it all becomes too much. Sometimes its exhaustion, sometimes its nursing aversion, sometimes work commitments and sometimes it’s just that mum has had enough. Night weaning is generally not recommended until after 18 months by most Gentle Parenting experts. At this age they have some understanding of what is going on. Sleep is a developmental stage, like walking and talking, and babies and toddlers will do it when they are ready. Some will have large chunks of sleep from an early age and that’s fine, but others continue to wake frequently well into their second year.  There are definite genetic factors at play. And twins do not necessarily do it at the same time. Often one is ready much sooner than the other. Breastfeeding is by far the easiest and fastest way to settle a baby back to sleep when they wake. But there may be a point where mum needs to stop it. This should be for the mum to decide and nobody else. She will know if she is ready to night wean. If she is not sure whether she should, then it probably is not the right time yet. It is nobody else’s decision; not the health visitor, grandmother or even the partner. And just to make sure you understand, night weaning will not necessarily make them sleep any better. They may still wake, and you will have lost the easiest way to get them back to sleep. However with lots of consistent alternative reassurance they will begin to be able to transition from one sleep state to another. Toddlers not being too over tired during the day will also help with this.

tandem feeding in bed

Breastfeeding at night is not so much about nutrition for toddlers. There is a big emotional context to it. Breastfeeding is helping them feel safe, to deal with all the big emotions of being a toddler, to deal with the pain of teething, to reconnect after being separated due to work and child care. There’s a whole load of stuff going on. So it’s important not to take away the other comforts that they are used to whilst you try to night wean. Co-sleeping, bed-sharing, cuddles, using a comforter like a toy. These can help the transition away from relying on the breast to settle back to sleep.

Should you night wean both together? Or should you deal with them separately? This is a difficult one as it really depends on your own individual situation. Is one more settled than the other? Or are they both equally as wakeful? Is either of them happy to settle for your partner?  Are you bed sharing? Do they share a separate bedroom? Do they have separate rooms? There are all sorts of factors to take into account. If one baby is more settled, able to settle for a partner, or they are in separate rooms, then it may be easier to try separately. Otherwise it is probably easier to do both together.

Find other ways to settle your toddler at night. There are many different things you can try as a replacement for breastfeeding; cuddling, stroking, patting, singing, use of a special toy or blanket, music, white noise, whatever works best for you. Some will work better than others and everyone is different. You will find the best option for your family.

One thing to try is to cuddle or stroke back to sleep whilst they’re stirring before properly awake. Toddlers go through sleep cycles from deep, slow wave, sleep to light REM (rapid eye movement) sleep regularly and it is during the REM sleep that they often fully rouse and need help to resettle back into a deeper sleep again. Unfortunately a toddler’s sleep cycle is much shorter than an adult’s. This only really works if you are bed sharing as you will need to be in close proximity to be aware when they are about to wake. But if you can cuddle or rest your hand on their body and settle before they are completely awake, you may find they go back into another deep sleep without fully waking and demanding to be fed. I found turning baby away from me and cuddling tightly from behind worked fairly well.

Try with just one of the night feeds. Try the first wake-up of the night and see if you can settle them in a different way. This is the most likely night feed to be able to drop more easily. As the night progresses and morning approaches, sleep often becomes lighter and toddlers are more difficult to settle back to sleep. They often like to get up very early at this age. The most likely thing to help you stay in bed for a bit longer is to continue to breastfeed in the early mornings!  

Find another comforter. Toddlers often like to have a comforter in bed and these can really help to transition away from breastfeeding being the major comfort. The comforter can be anything your toddler is attached to. It can be a toy or blanket, or sometimes physical touch can replace breastfeeding; my toddler would slide his hand up my sleeve for comfort. The replacement comforter should be introduced well before the night weaning process is begun as it should not be seen as a replacement for breastfeeding but a separate comfort. Then slowly you can encourage your toddlers to become more dependent on this and less dependent on breastfeeding.

Debra's twins cudding

Twins also have a built in comfort; each other! One of the plus points of having more than one baby is that they do give comfort to each other. In the early days many parents co-bed their twins or triplets and find this can help with settling them to sleep. However a lot of mums separate them later as they start to disturb each other. But sometimes as they get older, they may like to sleep together in a large cot or floor bed or even just in a standard toddler bed. I often found mine had climbed in bed together when they had gone to bed separately.

Shortening feeds. This can be especially effective if you are experiencing nursing aversion. Nursing aversion is a negative feeling some mums get when feeding. It is often hormonally driven, ovulation and menstruation can be a trigger, and pregnancy is a major culprit. So in order to continue being able to breastfeed, shortening the feeds can work well. You can talk to your toddlers about having “a little bit”. To start with, tackle the bed time feed, pull off the breast by sticking in your little finger and breaking the seal just before your toddler is about to drift off to sleep and encourage them to do that last bit on their own. You can always re-latch them if it doesn’t work. Once the toddler is used to this you can gradually unlatch sooner and eventually they may settle to sleep from awake on their own. Some mums like to sing a song during this feed and when the song is finished, the feed is finished. If you are having a particularly bad day you can sing faster! Once they are good at settling to sleep without the breast they may be more able to move between their night time sleep cycles without feeding. They may settle for the song. Or they may settle with just a few of sucks.   

Talk to your toddlers throughout the day about how boobies will be asleep tonight and how they can have some in the morning. Let them choose which comforter they would like to use. Remind them again just before bed time. Try to keep it positive. When will they be able to feed again, you can feed once the sun shines, boobies have gone to bed and will be back in the morning. Try not to focus on rejecting them. On saying no, not now. Some parents find a Gro-clock can be a great visual aide for this method. The Gro-clock can be set to go from day to night at a certain time and you can explain to your toddler that they can breastfeed once the clock says it is morning. You can set an early time to begin with and extend it later on, once they get the concept. There is also a lovely book called “Nursies When The Sun Shines” by Katherine C Havener which focusses on night weaning and explains to the toddler that she will be able to nurse when the sun comes up.  

Dad sleeping with babies

The partners in a twin or triplet family are often much more hands on than your average family, as there is much more to do! If your toddlers are happy to settle with your partner, and they must be truly happy, sometimes this can be a good technique to night wean. Your partner can go in first and see if they can settle them. If it doesn’t work then you can go in and breastfeed back to sleep. Some babies are more receptive to this than others. You may find one of your babies is fine with your partner and so this may help night wean one of them easily and you can concentrate on the other. Sometimes you can split them up and the non-breastfeeding parent take one of the toddlers and sleep with them and the breastfeeding parent can sleep with the other. But often only the breastfeeding parent will do and if this is causing further distress it may be a good idea to stop.  Remember for a toddler breastfeeding is a way to connect with you, their mum. So keeping the connection is important.

Night weaning is often a very gradual process. Aim for small goals and baby steps. And don’t be afraid to stop if it does not feel right. Teething, illness, changes of circumstances, can all increase night waking and sometimes it may just be easier to go back to breastfeeding in the night again. Then once the unsettled period has passed you can try again. Also don’t be afraid to stop at a certain stage if you are all happy. Sometimes mums find that one or two night feeds are actually quite doable and continuing with these can actually make night times easier. Each journey is very personal between mum and her toddlers and what will work for one family will not necessarily work for another.d and j in bed

www.isisonline.org.uk/twins/

www.parentingscience.com/baby-sleep-patterns.html

www.feedsleepbond.com/how-to-stop-breastfeeding/

www.emmapickettbreastfeedingsupport.com/twitter-and-blog/weaning-toddler-bob-and-pre-schooler-billie-how-do-you-stop-breastfeeding-an-older-child

“The No-Cry Sleep Solution”; Elizabeth Pantley

“The Gentle Sleep Book”; Sarah Ockwell-Smith

 

Kathryn Stagg, IBCLC and ABM Breastfeeding Counsellor, Dec 2017