Breastfeeding and Supplementing

hi ladies, i think i have several questions within my story... so i'll just describe what's happening and hope the questions emerge.

twin girls born at 33 1/2 wks.  started pumping right away (medela symphony), as babies weren't ready to BF.  only spent 2wks in nicu, but did take advantage of all the BF help from the LC nurses there.  BFing was really an uphill battle.  vivienne took to it first, and i thought was doing pretty well.  by the time we got home from the hosp she was nursing twice a day (with a shield some of the time).  audrey could nurse once a day (with a shield) by the time we left the hosp.  we supplemented with formula (neosure) and also fortified BM bottles with formula.

my goal was to increase a feeding for each baby, each week... so that eventually i'd be nursing them both 100%.  well that turned out to be a pie in the sky dream for me!  i gave my best effort, pumping after every BF, and pumping the rest of the time, totalling 8 or 9 sessions a day.  eventually both girls got off the shields. 

audrey clamping down like clam shells hurt incredibly.  vivienne kept (and still does) slipping off the nipple, which doesn't feel great either.  and she slurps both on bottle and breast... again, doesn't feel good. 

at most nursing sessions the babies would need a supplemental bottle afterward, or would be hungry again in 2 hrs (i thought that was a big success!).

periodically we went to a lactation clinic associated with the nicu, and the nurse advised me to go down to 7 times a day, b/c i was just a wreck.  the doc at the clinic noted that vivienne was a little tongue tied, but not too badly.

in the last few weeks my DH and i decided i needed to wean more... for sanity's sake and for the sake of our marriage.  all of a sudden audrey is nursing like a pro... and i'm thinking, "OH, this is what it's supposed to be like!"

so with audrey i could nurse her all day long...  no more clamping down with her clam shells :) 

meanwhile vivienne had started getting fussier and fussier at the breast.  she might take from one breast and then SCREAM on the other.  or she might scream right from the start.  or she might BF just fine a couple of times in a row and SCREAM at the third time.  the poor thing just can't latch well, and now that i have audrey to compare to, i see how vivienne would get frustrated.  if she doesn't get a good latch, how can she get milk out as quickly as she wants??  tomorrow we go see an ENT doc to have them look at vivienne's tongue...

so, does anyone have experience with having tongue-tied repaired?  anyone have it done after the 2month mark?

our ped says i need to cut way back on BFing and pumping... but i'm not ready to let go!  i'm fine with cutting back to 6 times a day, which is where the ped thinks the girls should be at this point anyway.

as of yesterday i am doing one long stretch 9pm - 2:30am (audrey's sleep at night), and then some 4 and 3 hr stretches.  dealing with a little engorgement here and there.  nothing like baby to help with that...   also, i am pumping after each BF at 2:30am, 6am, and any others i may do.

will i lose milk supply at this point, or have i been doing this long enough to have it well established?

when i pump on a strict schedule for the days i work (M-W-F 12-5), can i go off that schedule the other days to feed babies when they are hungry???  i'm so nervous about going down to 6 times a day, and not having flexibility to feed babies.  

i know this is SO long, and with twins BFing and pumping gets complicated.  thank you for any and all advice!!!  

Sorry it has taken me so long to respond.  So let me see if I have this right you basically have one twin feeding great at the breast and the other doesn't. 

So, the "good" twin do you supplement her at all?  Ped wants you to reduce the # of BF'ing per day?   Why?

"Not so good" Twin, did you have the tongue clipped?  Have you gone to a LC to have her BF'ing evaluated?  I know early on getting the tongue clipped can help a lot, I would think it would be the same at 15 weeks, b/c either way the tongue will be able to extend further...?  Let us know how that went. And how she is BF'ing now.  How much/ how often do you supplement?  She may just have a bottle preference at this point.  Try paced bottle feedings with her. (Description from lowmilksupply.com)

Paced Bottle Feeding Method

Many mothers also find that babies feed better when the bottle feedings are paced so that they are more like breastfeeding. Bottle feedings are paced by stopping and gently withdrawing the nipple after four or five sucks or whenever the baby expresses tension through facial expressions. The nipple stays in contact with baby’s lower lip, allowing the baby to draw the nipple into his mouth again when he is ready. This helps the baby retain control of the feeding, reminding him to stop when he is full. It also allows better coordination of the suck/swallow reflexes. This technique is known as “paced feeding.” For those babies who object strongly to having the nipple even partially removed, simply tip the bottle briefly, so that the milk stops flowing for a few seconds, without removing the nipple from baby’s mouth.

Holding the baby so that he is more upright allows him better flow control. There is no need to keep the nipple full of milk; he will fill it when he sucks. Indeed, the problem of swallowing air is more about marketing than reality; any air that a baby takes in from a half-filled nipple generally comes back up as a burp.

At 15 weeks your supply should be well established, so don't worry too much about dropping a session.  Keep your routine at work and just feed the babies on demand when you are home.

Keep us posted, it sounds like you are doing really well though.  Nursing twins!  What a huge challenge!  I couldn't even successfully nurse my singleton!!  So, you've got 1 of 2 down and I'm sure you'll be able to help the second twin learn to nurse successfully.  Let us know how else we can help.

Thank you to Chrissy for the great siggy!