I wrote this in response to a thread over at the multiples forum at MDC, but it's very long so I thought I'd go ahead and post it here.
I should have kept more notes while I was going through the process. I didn't, and I'll have to try to remember everything. Fortunately for me, but unfortunately as far as my ability to give advice is concerned, it was all really smooth going and not a struggle really at all.
My boys were born at 30 weeks 6 days (due to placental abruption). They were fairly big for gestational age: Toby was born first at 3 lbs. 12 ounces, and Ari was born second at 4 lbs. 4 oz. Toby was breathing without any assistance from birth, and Ari had pressure-only CPAP for about 24 hours. They initially had only IV nutrition via umbilical lines, but progressed very quickly to NG feedings.
I had a c/s under general anesthesia. When I woke up, the first thing I asked was if the babies were ok. The second thing I asked was if I could have a breast pump! I got one as soon as I was moved into a room, so within hours of the surgery, and started using it immediately. Here is where I do think I can give good advice for mothers who haven't had their babies yet: I figured out pretty quickly that I wasn't getting much colostrum from the pump, but I was able to hand-express large amounts. The NICU people were apparently amazed when within hours of birth I sent up about 14 mLs of colostrum! Apparently it is easier to hand express at the colostrum stage than it is to use a pump. I would recommend hand expressing first and then using the pump for a bit to stimulate milk production.
I was lucky because the babies were born on a Saturday morning and my milk was in by Monday. Started coming in Sunday night I think. I was a slave to the pump. At first I pumped every 2 hours, and every 3 at night. Then after a few days I started sleeping 4 hours at night and pumping every 2-3 during the day. After a week or so I was going 5 hours at night and 2-3, once in a while 4 (if I was in the NICU with the babies), during the day, only because I was pumping so much milk. I have small breasts, but apparently I can store large amounts of milk, because after a long stretch of sleeping at night I could easily pump 10 or 11 or more ounces at once. I just looked at my pumping record and I once pumped 14 ounces in one sitting. I never pumped for more than 10, maybe 15 minutes. I pumped 60+ ounces a day (my record was 68). My babies never had anything other than my colostrum and milk, except for the short period of time when the NICU was adding human milk fortifier (basically formula) to the milk they gave them.
Well so basically what I'm saying is that I'm blessed, and although part of my success was definitely my perseverance, I also just have super-boobs. That much is just not something that I have control over, I'm just really lucky. My advice with regard to establishing a supply is just to pump very often, starting as soon after birth as possible. Which is the same advice you'll get anywhere. I used the hospital pumps and also a rented Medela Symphony. And I admit I did not sterilize the pump parts very often; I washed them in super hot water and air dried them, mainly. If I'd had much smaller preemies with any medical problems I probably would have been more careful, but I really didn't have much energy for stuff like that.
I thought I couldn't remember timing on when they started nursing, but I realized just now that I have the daily emails from the NICU, so I can use those for reference. It looks like the first day I nursed them was April 30th, so when they were 11 days old. At that point they were still getting everything via NG tube. The first few days it was sort of "practice" BFing. On May 3rd, so when they were exactly 2 weeks old, I convinced the nurse to bring out the baby weigh scale to record our BFing. She humored me, thinking the babies still weren't getting much nutrition at the breast (they would have been 32 weeks 6 days gestation). She was pretty surprised when Toby took his entire feeding at the breast, and Ari took a large chunk of his (the rest was supplemented via NG tube). I think it was at that point that I told them to go ahead and do bottles whenever they wanted. The nurses were awesome. They started giving the babies bottles whenever they seemed up to it. I nursed them at least once and sometimes twice a day, mid-day when I was visiting the NICU (I also had my not-quite-2-year-old at home). It really wasn't long before the babies were taking all their nutrition via breast or bottle, and then they just had to wait a few more days until they could regulate their temperature well. They came home after 3.5 weeks, 25 days, in the NICU. They would have been, I think, 34 weeks 3 days gestation. We were lucky.
All of this nursing was using a small nipple shield. When they came home I rented a baby weigh scale. The first few days I nursed them maybe 3 times a day? Then I was nursing them every other feeding, or even more, except at night. I was pumping whenever I had a chance. Pretty quickly I got fed up with pumping and bottles and went to nursing them all the time. I used the scale a lot at first, for reassurance. Sometimes they would need a little extra in a bottle, but not for long. Ari has always taken more at a feeding than Toby. That's just the way they are. Toby has worse reflux, and I think eating more hurts him. So yeah, I got fed up with bottles and just stopped using them one day. I was trying to latch them without the nipple shield to start most feedings, but got a bit frustrated. When I took them to get weighed at our marvelous pediatrician's office, she said that she really didn't think they needed the shield (she is also an LC and knows what she's talking about!). So I went cold turkey. I just got rid of the shield. And it was pretty much smooth sailing from then on, although I sometimes had a little bit of a struggle with getting Toby to nurse enough. I started only doing pre- and post-feeding weights about once a day, and then stopped altogether when it was obvious they were doing fine.
That's it. I had a little breast trouble when they were in the NICU, maybe mild (VERY mild) mastitis? LC couldn't really figure it out, but it went away quickly. I had some irritation and pain with the pump on my right breast, but that didn't last too long either (and the LC helped me get the right size falanges or whatever they're called.) The hospital I was in was very supportive of breastfeeding. The NICU nurses were wonderful. The LCs were available whenever I needed them. And I never considered not nursing them, so I just did what I did, and thankfully it all worked out.
Ari is still my little piggy (see last post for sizes and weights). Toby is a thin little guy, but eats plenty and grows at the same rate as his brother. They both have reflux, but Toby's is much worse. They were both on meds for a little while, but it didn't help too much. I've recently considered getting them again for Toby. But they both just nurse really easily and well, and have since they started.
The amazing thing about my babies is that I just don't think of them as preemies most of the time. Developmentally they are just themselves, everything in the range of 5-7+ months. We haven't faced any of the problems many preemies face. They've been incredibly healthy. Every single day I am aware of how blessed I am.
I thought to add a bit more: Although I can nurse them together, I very rarely do. I prefer not to, especially now when they are very into pulling each other's ears and poking each other's eyes. And it's really just more trouble than it's worth. Thankfully they take pacifiers, something Ezra never did. They still use the newborn Soothies like they did in the NICU, although I'm thinking of trying some NUKs on them to see if they prefer them. They mostly take their pacifiers (we call them binkies, and it is also used as a verb, as in "please bink the baby") for sleeping and in the car or stroller, although now that they can pick them up and put them in their own mouths, they sometimes randomly suck on them at other times too.
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