Weaning twins

Because my blog is called Scattered Excerpts, I can post now about weaning SB and BW, even though that happened a few months ago, right?  I was still breastfeeding SB and BW when I got pregnant with the nugget, although we were down to 2-3 times a day, usually upon wakeup and before bed, and also sometimes before nap.  When I went in for my first appointment, the OB education nurse scolded me, telling me I needed to stop nursing immediately, without explaining why.  I knew from reading about nursing during pregnancy about the risks, and that they were likely small for me, so I basically ignored her.  However, I also have two very strong-willed toddlers, and I knew that I wanted to wean well in advance before the nugget arrived so I didn't inadvertently end up with them thinking they could still nurse too.  I also started to lose weight.  Although I had some food aversions and nausea, I was still eating plenty, so I decided it would be best for all of us to move on from nursing.

I ended any nursing before nap easily - I just explained to SB and BW that we only had snack upon wakeup and bedtime.  Then, DH was able to take morning duty a few mornings - usually I nursed SB and BW first, then got them changed, dressed, etc.  Simply by having him go in a few mornings and get them all dressed and ready for the day before they saw me was enough deviation from their normal routine that we were able to drop the morning session.  BW asked for "snack" a few times, but I explained we only had snack before bed now, and she didn't have any issues with that.  I approached the before-bed session a bit more gradually.  I had been introducing bedtime books while nursing for some time prior to this, allowing both SB and BW to each choose a bedtime book we would read "while" nursing.  This created a less than ideal nursing environment, as they would both frequently latch and unlatch, or turn their head to see the book, but I think it really helped with the transition once we got to that stage. The week I weaned, when I was around 14 weeks pregnant, I had DH alternate nights of bedtime routine with me, and skipped the nursing session - which wasn't an issue.  The last time I nursed them, I knew it would be the last time.  They had done just fine without nursing sessions when DH put them to bed.  I had DH take pictures of our last session.  Although I had always protested when he took pictures of me breastfeeding before, I now cherished those pictures and wanted one last moment captured.  The girls were goofy, there were a lot of nip-slips, but I'm so glad we have those pictures.  I get a little emotional when I think of our nursing relationship (damn pregnancy hormones), but I'm glad our transition went so smoothly.  The next night I did bedtime routine, I gave them pacis instead of nursing while we read books.  BW still asked about snack, but didn't protest when I told her no more snack.  In the time that has passed, we have eliminated pacis during reading time, and they don't get them until they are in their cribs.  I am not looking forward to paci elimination.  They are very dependent on them for falling asleep and getting rid of them is not going to be pretty.  I keep going back and forth about getting rid of pacis or getting rid of diapers, and right now potty-training is winning out.  I am really, really hoping I can get SB and BW potty trained before the nugget's arrival.  Three in diapers is very daunting.

Breastfeeding twins - the financials

You often hear proponents of breastfeeding assert that it is "free" - while the actual milk is free, the methods of extracting and storing it, particularly for working moms, can add up quickly. I've assembled a list of my estimated purchases to breastfeed twins through seven months.  This is not a "must have" list - just a list of what has worked for me up to this point.

1. $190. Breast pump - A necessity if returning to work or if you have inefficient nursers. I got my Pump In Style advanced on sale for $190. Here it is in use. It looks really gross, I know.

Side note - your insurance may cover a breast pump due to the requirements of the Affordable Care Act. Because the ACA just requires coverage of a pump and does not specify what kind, your insurance may offer you a single hand pump, like mine did. I passed on that, although I've heard some people actually have better luck with hand pumps. 

2. $200. Second breast pump. After being back to work for two days, I decided there was no way I was transporting a pump back and forth every work day for the next 9 months. I found a PISA metro bag on Craigslist, still new in the box, and bought it for $200. This is my at home/travel pump because the "guts" of the pump are removable from the tote bag in a separate bag. I can leave it sitting on my nightstand or toss it in my suitcase for trips, and I don't have to transport my work pump back and forth. I never use the included tote bag. 

3. $12.99. (?) Cooler bag.  I pump approximately 30 oz during the work day - plus I store my pump parts in the cooler between pumping sessions. The small black cooler that comes with the pump just isn't a great option for me.

4.  Free -(well, paid through my hospital bill) the small 80mL containers (and extra tubing, flanges, etc) for the medela pump. Because I pumped in the hospital, I received like 8 of these - I use them frequently, as I only freeze BM in 6,8, and 10oz quantities - so I'll store the overflow in these to reach even quantities for other pumping sessions. It's also helpful to have the extra flanges, valves, etc so you aren't constantly washing parts. 

5. $12.99 - Munchkin high capacity drying rack. I hand wash my pump parts because we only run our dishwasher intermittently. This drying rack holds a TON of stuff in a relatively small area. Skip the boon grass. Seriously. 

6. $13.99. 100-count Lansinoh freezer bags. (Multiplied by 4). I pretty much freeze all my pumped milk each night, except for the odd bottle here and there, as daycare will prepare bottles and take milk frozen in any quantity. I bring in about 150oz frozen at a time. Note - I routinely put 10oz in these bags, even though the max measurement on the bag is 6 oz. In all the bags I have used for the past 4 months (about 18-20 a week, probably) I have had two leak. Not bad. 

7.  $35. Hands-free pumping bra. I know some people cut holes in an old sports bra, and when I forgot my hands free bra in a hotel room, I did that for a few days to get me by - but for working, I find the hands-free bra much more convenient. 

8.  Evenflo BPA-free 8 oz bottles - 12 pack. I bought two of these when I had to travel for work - I used one set to transport my pumped milk home, and I used the other set to store fresh milk in the fridge for DH, as I wasn't sure how many ounces the girls would take for feedings when they normally nursed. These bottles are compatible with the med.ela parts, so I usually use one of these for pumping, too, as I occasionally overflow the 5 oz bottle otherwise.

9.  AA batteries. The little battery pack is handy for pumping in the car in a pinch, or in an airport bathroom stall...

I'm sure I could think of other expenditures, but these are the things that have made being a working, occasionally traveling, nursing mom of twin infants easier. 

Traveling while breastfeeding - aka pumping in an airport bathroom

I've had to take a few trips for work since the babies were born. This is tough, for two reasons: (1) pumping and traveling with breast milk, and (2) ensuring care for babies while I'm away. I have gotten completely comfortable with caring for both babies on my own - dr. appts, overnights, etc. Is it tough? Yes. Is it doable? Definitely. Kudos to single moms of twins, though - I'm certainly glad I don't have to do it all the time. Although DH has become more comfortable with caring for the girls on his own, so far the overnight care has been pretty daunting for him, so my mom usually comes to help out. Luckily my work trips are usually somewhat flexible so I have been able to plan around DH's schedule and my mom's schedule.

 My trips have been for one overnight, two full days - I'm not comfortable with anything longer than that yet, and I think the amount of milk I would have to bring back for anything longer would be prohibitive - a two-full day trip is 100oz plus pumping and dumping some... 

 For the few days prior to my trip, I don't freeze any milk, and instead store it in the fridge in 8oz Evenflo bottles, numbered 1-9 or 10 so DH can easily tell which is the oldest and should be used first. This allows him to prep bottles with the least amount of hassle, and he can always give an additional ounce or two without having to defrost extra. This was especially helpful for the first trip where I wasn't sure what the girls would drink in their "at home" bottles. (SB in particular goes on a bit of a nursing strike when I'm gone). Here is my packing list for pumping while traveling: 

 -handsfree bra 

 -medela pump - "pump" only, plus wall adapter and battery adapter 

-nursing cover (in case you have to, in a pinch, pump in public) 

-medela cleaning wipes 

-zip lock bags (for storing pump parts in between pumping sessions) 

-large hardside cooler. I think this keeps things colder than a softside, but it may be more difficult to stow under your seat on the plane - I use one that still has a canvas exterior and shoulder strap so I can carry all the other items for pumping. My pump and pump parts fit in the main section of the cooler. 

-12 8 oz evenflo bottles These don't have screw on caps, but I use the medela ones - I have almost 12, and I use the inverted nipple/cap combo on the few remaining. You can buy extra caps, I believe, but I haven't searched to hard for them since I don't need them often. 

-ice packs 

-pump parts - one full set. I usually plan out my pumping so that I can pump and combine bottles and use every bottle for storage. I don't combine cold and freshly pumped milk, as I believe this is a no no, so this sometimes takes some coordination. 

-dish soap to wash parts at the hotel 

-2 80 mL snap-lid containers 

-8 AA batteries 

 -hand sanitizer 

 My trips have, for the most part, gone off without a hitch. A few things I've learned: (1) Nursing/pumping will allow you to travel with breastmilk in excess of the 3 oz rule. You also can bring items greater than 3oz if they are frozen solid when you pass through security. They will test a random number of bottles, depending on the volume you are traveling with - they no longer open the bottles or use the paper strips. 

(2) The TSA website says you should tell them a TSA agent if you are traveling with breastmilk. Even if you do, they will still run it through the xray without telling anyone else, you will have to tell the person operating the xray that you are traveling with breastmilk, too. 

(3) Make sure you ask for a fridge for your hotel room, and make sure it will be turned on and cold prior to your arrival. Also make sure that it isn't so cold that it will freeze your breast milk - if you freeze then thaw breast milk, you have to use it in 24 hours. 

(4) airports are surprising unfriendly for pumping. If you can find a family restroom, use that. Otherwise, sometimes the handicapped stall may be your best bet, or a quiet corner under a nursing cover. 

 (5) Don't be afraid to inquire about time and a place to pump at your destination.

(6) people will be very curious why you are traveling with a large cooler. 

(7) plan to nurse as soon as you get home if possible - even if it's a dreamfeed. 

Breastfeeding twins - six months and beyond

Once I returned to work, breastfeeding became a little more complicated because of time constraints, but is overall easier. I returned at 12 weeks, but I still have essentially the same schedule. The babies usually wake up between 6 and 7. If it's earlier than about 6:15, we try to get them back to sleep, or they turn into weepy puddles of tiredness around 7:45 am. I usually tandem nurse them at 7 am, unless they are unhappy with waiting. They then got 5 oz bottles at daycare at 9, 12, and 3. I pick them up around 5:15 from daycare, tandem nurse at 5:30, then tandem nurse them to sleep at bedtime (usually around 7 pm. I still nurse them separately in the middle of the night unless both are awake and fussing to eat at the same time. Since starting solids, they still nurse at 7 am, then have a fruit puree at daycare around 8:30, a 5 oz bottle at daycare at 9:30, 5 oz bottle at 12:30, and 4 oz bottle at 3:30, then tandem nurse at 5:30, veggie puree and other solids at 6 pm, then tandem nurse for bed between 6:45 and 7. Around 5 months their nursing time started to drop, first to around 15 minutes, then to 10, and they average about 6-8 minutes at a time now. I still need to tweak the feeding schedule, as I'm needing to continue to increase solids intake, and I thin they are consuming more than enough breast milk at daycare and not nursing enough at home. They are also reverse cycling to some extent, and are eating more at the middle of the night feeds than they do during the daytime nursing sessions - we're still at two nighttime nursing sessions, and occassionally three, Zombies. We are still Zombies. Although not ideal for mom and dad's rest (dad still gets up to help with babies in the middle of the night if necessary), BW has gone from the 30% for weight to the 75%, and SB went from 30% to 50%. Of course, they are both also in the upper 90th percentiles for length.

I'm still pumping at work, obviously, and I still pump every night around 10 pm. I loathe this 10 pm pumping session, but I am concerned about my supply/freezer stash dwindling, which is probably ridiculous, considering I have a 1000-ounce freezer stockpile, but I can't give it up yet - although I have started to skip it occasionally. Which I always regret when I'm engorged at about 1 am. I'm probably cut it out in another few weeks or so - I think when the babes get close to 9 months I'll be okay with dropping it.

Breastfeeding twins - the first six months

After two weeks, DH had to head back to work. We were also struggling with the time it took for the supplemental feeding with the syringe feedings. We had met with the lactation comsultant a few times and discussed paced bottle feeding, so we switched over to Tomm.y Tipp.ee bottles for supplementing. Because the girls had not been back up to birth weight at their one week appointment, we were also having to go in for periodic weight checks.  I also decided that I was going to feed the babies on demand, instead of on a schedule and supplement as necessary. The babies still stuck to about an every three hours schedule, but I would usually start the first nurser before the three-hour mark to avoid two very hungry babies at the same time, so the overall scheduling was fairly variable.

Because it took BW three weeks to get to one ounce over her birth weight and she was gaining slowly, I still had to set an alarm and not let the babies go more than three  hours nursing at night. This paid off, and around four weeks, BW suddenly figured nursing out. Her latch improved, she stopped falling asleep eating, and she was definitely getting adequate calories. This was a bit of a turning point for nursing. I stopped having to supplement, which freed up some time, nursing both babies was only taking about 45-60 minutes, and I got the all-clear from the doctor around 4.5 weeks to let them sleep as long as they wanted at night. (I stil remember the first time it only took an hour to feed and change both babies in the middle of the night. I was SO excited to get 2 consecutive hours of sleep).

Once we had nursing down, I started to try tandem again. I bought a twin nursing pillow, but my torso was too long for it to be effective - It was designed to be used with the football hold, and I ended up having to prop it up on my lap and still hold both babies' heads/upper bodies the entire time they were nursing. The only good thing about it was that it had a "lip" on the edge so I could balance a baby on the pillow while I lifted the next baby into position, but for the most part, I still needed DH's help. I then searched "tandem nursing" online to see if there were other options for positioning, and discovered a position that worked for me, which was to semi recline on the bed or couch and effecitvely lay a baby on each side and cradle them in each arm, with a pillow to support my arms. This was still pretty difficult when the babies didn't have good head control, and I only used it in a pinch when I had two babies who were hungry at the exact same time, but once the babies' head control and assisted sitting improved, this also became fairly routine. It also helped to have an overstuffed rocking recliner - I could recline a little bit, and use the overstuffed arms to balance the babes as I got them into position. The rocker recliner is a beast, not my first choice of decor, and dominates the baby room, but it was definitely a wise purchase.

Around 8 weeks, the babies started to sleep a longer stretch at night - and by 12 weeks, they were only waking once to nurse, around 3 am, which meant they were going about an 8-hour stretch. They also otherwise essentially reset themselves to the every-three-hours schedule that was originally started in the hospital. This was divine. My body adjusted quickly to the one night waking around the same time, I felt well-rested just in time to return to work, and I could pump around 10 at night to build my freezer stash. I joyfully told everyone that our babies were good sleepers, love it, so easy.... This lasted for about one month, and the babies went back to sleeping anywhere from 4-6 hours before their first waking. My body does NOT adjust to waking between 12 and 2 am. That must be some awkward place in my sleep cycle or something. Dreamfeeding doesn't help. But all in all, we were over the nursing hump and things were "easy"  

Breastfeeding twins - the first few weeks

As I stated in my prior post, during our hospital stay post-delivery we had an assertive nurse who got me started on a nursing schedule to make sure I was getting rest. Basically, I was to nurse the girls every three hours, each for 20 minutes. I guess a nurse tried to teach me to tandem nurse in the hospital - I have no memory of this. I simply wasn't functioning well enough to make tandem nursing work yet. BW also was struggling with latching, ineffective sucking, and falling asleep while eating, so if I tried to tandem, I imagine she probably didn't eat anything. Once I finished nursing each baby, I would then pump for 10 minutes. 

We also utilized a supplemental nursing system- basically a syringe with a thin tube attached. This thin tube can either be placed next to the nipple or used with a fingertip to get the baby formula/breast milk without causing nipple confusion. We used this both during nursing, primarily with BW, to stimulate her sucking, and after nursing with both girls to supplement. I say "we" because DH helped with both - he handled the finger supplementation while I pumped. We initially supplemented with formula the first few times, but I soon was pumping enough colostrum to use for supplementing. Our instructions from the lactation consultant were to supplement using a certain number of milliliters based on how successful the nursing session was.  

This system seemed to work fairly well - until we were informed by the lactation consultant the day we were to be discharged that it was working too well, as SB had gained 5 oz in 24 hours. We were told to reduce the amounts that a were giving to supplement. End result? We had two miserable days/nights with two miserable, hungry babies before we went back for a weight & jaundice check - when we told the lactation consultant what had been happening, she told us we could supplement the babies until they were satisfied - understanding 60 milliliters, or about two ounces, was about the max they should have. 

Supplementing was a guessing game that made me doubt myself as a mom and caused some tense moments between two sleep-deprived parents. DH would ask me how much he should use to supplement, based on how the baby nursed. I would guess, and hated having to make any decisions when I was so tired. 

In the end, the nurse/nurse/pump/wash pump parts/supplement schedule took about 90 minutes, out of the every-three-hours schedule. Zombies. We were zombies. 

Breastfeeding twins - the prelude

I plan to do a series of posts on my experiences with breastfeeding twins, but in order to do so I've realized I need to post a bit about my birth experience to provide a bit of context.  I'm going to try not to dwell too much on the subject. I was induced a few days past 38 weeks. Both babies were head down, so I was able to deliver both babies vaginally. (Side  note - lots of people seem to want to know how you delivered twins, but they try to avoid using the "V" word at all costs, which can make the conversation interesting....)

Because I was a twin delivery, I delivered in the OR, and had monitors placed by the anesthesiologist. After BW was delivered, one of them started going off because my blood pressure was dangerously low. They couldn't get my uterus to cramp down, and every time they pushed down on my lower abdomen, blood would gush out. 

Long story short, I lost quite a bit of blood - normal hemoglobin is around 12; by the next morning mine had dropped to a six.  The babies arrived in the evening - when we returned to our room after delivery, I nursed SB first- she latched on immediately and nursed like a champ. I then began to nurse BW - she struggled a bit with latching and wasn't sucking effectively - we found out later, after she spit up tremendous amounts, that she had swallowed a lot of amniotic fluid prior to delivery, plus she had extensive bruising from delivery so she probably had a whopper of a headache. 

While I was nursing BW, the nurse suddenly came and said I had to stop nursing and lay down, as my blood pressure was quite low (80 over 50? I can't remember) and my pulse was quite high - near 200. I was also running a fever and shivering uncontrollably. 

We ended up spending four nights in the hospital, and I ended up with a blood transfusion. I have no recollection of large portions of the hospital stay. I basically remained lying down in bed unless i had to nurse. As I had never had a baby before, I had no idea that my fatigue was very abnormal and stemmed from the blood loss. 

It took four days for my milk to come in. The girls both lost a lot of weight in the meantime and developed jaundice. On day three I finally had an assertive nurse who got me started on a nursing and pumping schedule and use of a supplemental nursing tool. The lactation consultant for the hospital did not even visit me until the day before we were discharged. I think they expected that I would give up on breastfeeding, but they underestimated how stubborn I can be.