I was as prepared as possible to nurse my twins, until I spontaneously went into labor at 32 weeks, 3 days gestation. Though we had planned to return to the states for their birth just four days later, we were currently living in Egypt so they were born there. The doctors were very uncomfortable with me birthing breech, premature twins vaginally and they did a last-minute emergency C-section which included me being put under general anesthesia. Neither a C-section, nor premature twins had ever been in my plans for their birth and all of this had an impact on breastfeeding.
Those first few days were a blur. When I woke up from anesthesia I asked for my breast pump and began to express every 3 hours. The boys were given IV fluids, but no formula, that first day. They were in the NICU. On Day 2 they came off the supplemental oxygen and I met their pediatrician – who was cautiously supportive of me breastfeeding premature twins. He agreed it was good but never thought I would carry through with so many strikes against me: C-section, preemies, twins. He didn’t know my resolve nor my passion for breastfeeding. He told me once we knew they could suck, swallow, and breath at the same time (a skill developed between 28-37 weeks gestation) and were nursing efficiently I could take my boys home. I was ready to get started.
Nursing my daughter had been a breeze compared to what I was now undertaking. She was a healthy, full-term baby, who I birthed naturally and was immediately placed on my tummy for skin-to-skin time and to nurse. In contrast, the first time I tried nursing my boys was nearly 26 hours after their birth and, though they were healthy, they were small and it took great energy to nurse at the breast. It was difficult with the doctors and nurses “micro-managing” each feed by being concerned about the amount of milk taken in, weighing the babies before and after nursing, and then topping them off with my expressed milk in a syringe and later a bottle. By day 5, the doctors were satisfied that they were eating enough for us to take them home – though they had already lost a significant amount of birth weight. (They were 3 lbs 15 oz and 3 lbs 13 oz at birth and were now down to 3 ½ pounds each.) I was just excited to be able to have my whole family at home. . . and, looking back, glad no one told me what the next couple months would hold!
The days, weeks, and months that followed were a blur of sleepless nights trying to breastfeed premature twins and take care of their 2 ½ year old sister whose world had just changed dramatically. Being preemies, they didn’t wake up on their own so I would wake them and nurse them. Then I would top them off with my expressed milk in bottles. Then pump, clean and sterilize bottles. I did this routine every 3 hours, day and night, and it would typically take 1 ½ to 2 hours per feed (it took them a long time to drink milk when they were so small). With the remaining hour I would eat, or sleep, or play with our daughter, or try to talk with family back in the states to update them, or try to grab a shower for the day, or consult with our doctor in the states, or try to sling skin-to-skin against me. . . but I became utterly exhausted. I wanted to be diligent about pumping because I wanted to ensure I had a good milk supply for twins when they began to eat more. I wanted to nurse them each feeding because I didn’t want them to begin to prefer a bottle over my breast. And obviously I was the only one who could pump and nurse. . . and it was exhausting. Looking back, I would definitely counsel a mom in my position to not worry so much about nipple confusion/preference before 40 weeks gestation and let others help more with bottle feedings, especially at night, so she could get more sleep. It got to the point where the alarm right by my bed would not wake me, though it would wake my husband across the house who would have to come and get me up!
I was extremely diligent in the first few weeks to pump every three hours 24/7. Though my boys were tiny and couldn’t drink much milk yet, I wanted to make sure to build my supply so I could exclusively nurse them once they were bigger. I pumped with a double electric pump for 20 minutes on both sides, while doing breast compressions, and made sure to write down how much I got at each session. Once my supply was strong, I began to drop down the time I pumped, first to 15 minutes and then to 10 minutes. Eventually I dropped one of the nighttime pumping sessions. Still, months later I counted how much frozen milk I had stored in my freezer and there was 13 gallons!!
I never anticipated the incredible pressure I would be put under from doctors to “fortify” my milk. I had loved breastfeeding my daughter and I knew breast milk was best for my boys but it is very, very difficult when the medical establishment pushes you to supplement or “fortify” – there were many times I felt like if they didn’t grow it would be all my fault since I had gone against all medical advice. I was so thankful to be able to consult with a lactation consultant who was a great encouragement to me. One thing in particular she kept reminding me was to wait until they were 40 weeks gestation and then notice the difference in their ability to nurse. And I’m thankful I never gave in and “fortified” my milk.
Because one of my boys continued to lose weight and /or stop gaining whenever I went exclusively to the breast (without topping him off with the bottle) I had to continue this nursing routine until they were around 40 weeks gestation. And then, suddenly, it really was true! They began nursing more like newborns rather than preemies! I began to get more sleep – in fact I remember the night when I got 7 hours of sleep – it was all broken up, but still, it was sleep. I felt like a new woman! They were nearly 3 months old at this time, but, before then, a good night was 4 hours of broken sleep.
I truly believe the biggest challenges I faced in the beginning were on account of the boys being preemies rather than twins. The day I packed up my pump was a day of celebration and from that time on I just enjoyed nursing my boys. I used many nursing positions, but typically nursed them together for efficiency sake. However, if one was asleep and the other wanted to nurse I always just nursed the one. I loved being able to lie down and nurse them together and go right back to sleep – something I continued to do until they were at least a year old and just became too big. Having already nursed a child, I knew how wonderful and easy a good nursing relationship could be and that definitely gave me a goal for the hardships I faced in the early days. I would almost always nurse them together and I had a large pillow that I put underneath them so we could all relax. My most common nursing location was the couch with my feet propped up. Not only was it comfortable but it also allowed me to interact with my daughter as I nursed her brothers. My very favorite way to nurse them, though, was lying down. The three of us would almost always fall asleep this way! I also found an added benefit nursing twins: when you breastfeed your body produces oxytocin for the Milk Ejection Reflex. One of oxytocin’s many wonderful benefits is relaxation. I could become so relaxed nursing twins I could fall asleep almost anywhere! It was a great way to wind down throughout the day and I loved the opportunities I had to nurse them lying down.
I nursed my boys until they self-weaned at 2 1/2. It had been a wonderful nursing relationship and I’m so thankful I was able to nurse them the way I did!