Breastfeeding update

I am a member of an online forum for people with twins who breastfeed, I rarely post, but I do read it all the time (thank goodness for my iphone when I'm nursing the boys!). I made a special point to actually pull out the computer to write out a response to a woman who was frustrated and confused about poor weight gain in her 4 month old twins who are breastfeeding after a LOT of work to get them exclusively breastfeeding...it was a VERY familiar problem for us. I realized that I never updated the blog with what has happened in the last few months with breastfeeding, so here is the post in response to that woman's question. Besides that, finding time to post to the blog is so hard that since I spent time to write to this woman I figured I would leverage the work!

Here is my response with some clarifying edits:
Oh I'm so sorry you are dealing with this! I was there about 1.5 months ago, my guys had fallen off the weight curve at their 4 month visit, particularly baby B [Odin]. My pediatrician didn't immediately suggest supplementing [with formula], but he did want us to try and get an additional feeding in [at the breast]. I, like you, was so confused because my guys always seemed so satisfied and happy, they slept 7-9 hours in a stretch at night, napped well, and all in all we were feeling like life was going really well, particularly after all of the problems we had with establishing exclusive breastfeeding. I decided to get data (I'm a chemist and DH [online forum speak for dear husband] is an oceanographer...we like data). I rented a breastfeeding scale and for 2 days fed as usual with trying to get an extra breastfeeding session per day in while weighing before and after each feeding. Baby B [Odin] was only getting 17 ounces and Baby A [Lars] was getting 20-22 ounces, Kelly mom [a fantastic online breastfeeding information site] says the average is 25 ounces for a breastfed baby and the range is 19-30. Looking at the data throughout the day, it was obvious that I had enough milk for them in the first 2 feedings of the day because they would take 5-6 ounces each from the breast, but then after that they were only getting 1-3 ounces in the subsquent feedings. It became obvious that I had a supply issue. Only after we had that data and I had talked to an LC [lactation consultant] did we start offering a bottle after feeding (at first it was EBM [expressed breast milk] from my small stash for going back to work) and they were obviously ravenous (the LC warned that they would probably be bottomless pits with the bottles afterwards for a few days, and she was right!). We used preemie flow nipples and held the bottles almost horizontal so that the bottle wasn't significantly easier than the breast in order to try and avoid them developing a bottle preference. I've done everything I can to increase my supply (domperidone, pumping after each feeding, oatmeal and lots of water) and through continued use of the scale, I saw no increase in what they were getting from the breast...and they are still very happy to eat at the breast, it's not like they were just waiting for the bottle. It took some time, but we have settled into a routine where they tandem feed at the breast for the two first feedings of the day, they alternate for each feeding since lefty just doesn't produce as much as righty, then for the next feedings I feed one from the breast and give him both breasts and the other baby I give a bottle (I do this in tandem using the EZ to nurse pillow, the baby with the bottle sits with his back against me and I give him the bottle). The boys both get about 10 ounces of formula a day and it works out that they get about 2/3 of their intake from the breast (or EBM if I'm at work, I work 3 days a week).

I still don't understand how they could have been so happy if they were not getting enough to eat, it completely baffles me. I struggled and struggled with giving my boys formula and still hate that I have to do it, but I do. It is really gratifying to see them growing and gaining weight before my eyes, it takes some of the sting out when I look at it from their point of view...not as a personal failing. I think I've mostly accepted that they aren't getting breastmilk exclusively, but it has been a process. They came at 34 weeks and I had to bring my milk in with a pump since I couldn't get them to the breast for about 3 weeks, and I think that my body just didn't get the message that there are 2 babies to feed. I keep telling myself that there were many things about their conception and birth that didn't happen as I wanted, but in the end I have the ultimate prize--2 healthy babies who I still do have that breastfeeding relationship with. I intend to do extended breastfeeding and I think my guys will do it...they like the boob. Their weight gain is right on track now, there is just a dip at 4 months.

I hope that you have a case of just needing to up your supply and that your body will respond...by no means do I think that you have the same issues as I do, but I wanted to share my story in case it helps. I've been there and it is SO hard, I can't tell you how many tears I shed. Since your babes are happy, I would suggest you take a couple of days to determine your plan of action so that you can act logically and not too emotionally, that was important for me. I wish you the best of luck and please PM [personal message] me if you want to talk more offline. Take care.
[end of forum post]

So you can see that things were pretty rocky, but we have figured out what works best for all 4 of us. The boys are gaining weight and growing like crazy! I weighed them this morning and Odin was 12 lbs 14.25 oz and Lars was 14 lbs 5 oz. I'm sure the pediatrician will be happy with what he sees at their 6 month appointment in 3 weeks! For reference, Odin weighed 10 lbs 1 oz and Lars weighed 11 lbs 2 oz at their 4 month visit 6 weeks ago.