Breastfeeding Twins: Essential Tips for Success and Support
School
Ain Shams University**We aren't endorsed by this school
Course
PEDIATRICS 1
Subject
Nursing
Date
Dec 10, 2024
Pages
6
Uploaded by ColonelScience99416
Breastfeeding Multiples An increase in the number of women delaying childbirth until after age 30 and advances in techniques to treat infertility have contributed to a large increase in the number of multiple births in the last decade. Lactation consultants are likely to work with these families, as these women choose to breastfeed at about the same rate as women giving birth to single infants. The Right to Breastfeed: Many mothers are told that it is impossible to breastfeed more than one baby, unfortunately by health care workers and pediatricians. 1- Twins are more in need for the advantages of breast milk 2- Health workers, family and community support is critical for breastfeeding success. Pregnancy factors affecting breastfeeding: ® Maternal factors: 1-Pregnancy induced hypertension: 2-Gestational diabetes 3-Anemia two or three folds higher than singleton pregnancy 4-Perinatal hemorrhage, antenatal due to placenta previa or abruption or postnatal uterine atony 5-Surgical delivery 6- History of fertility that necessitated induction c=may be a cause of low milk supply. 7- Perinatal mood disorders including depression, post stress anxiety. ® Infant factors: 1. Preterm birth 2. Intrauterine growth restriction 3. Low birth-weight 4. Congenital anomalies: Down syndrome, cleft lip or palate or torticollis. ® Effect of maternal or infant complication on breastfeeding initiation: 1. Overwhelming of maternal physical and psychological capacities. 2. Perinatal mood disorders. 3. Delayed initiation of infant suckling or compensatory milk expression. 4 Delayed or lowered milk production. Prenatal preparation: ® [nfant feeding decision: 1. Full information about the ability of any women to produce enough milk, advantage and disadvantages of breastfeeding.
Advantages Disadvantages 1-less risk of infection. 1- Sleep deprivation 2-obligatory maternal contact. 2- Delayed return to work proved maternal bonding. 3- Intensive stress and work. ier to feed two simultaneously. 2- Develop short and long breastfeeding goals: 1) Direct breastfeeding and or milk expression. 2) Full or partial breastfeeding. 3) Length of breastfeeding duration. 3-Provide anticipatory guidance for breastfeeding issues: 1) Facilitated normal vaginal delivery 2) Plan for early breastfeeding initiation. 3) Maximizing milk production: " milk expression, breast pumps, galactogouges" ® |nitiating breastfeeding 1) Immediate skin to skin contact within 60 minutes of birth. 2) Allow rooming in. 3) Allow cued feeding. 4) Assure family and physician support. 5) Encourage around the clock feeding for around 8 times per day. 6) preterm or sick baby: a) start milk expression b) use hospital grade electric breast pump alternating with hand expression and massage. c) Develop realistic goals. d) Use of different breastfeeding aids to give the milk eg cups and supplemental systems. e) Continue skin to skin care f) Full maternal support ® Maintaining breastfeeding: 1- Make a feeding chart. 2- Continue assessment of the breast latch and adequate milk removal. 3- Feeding rotation options: = alternate breasts and babies with each feeding = alternate breast and babies every 24 hours = assign each infant to one breast
Advantages Disadvantages 1-Incresase breast self regulation which 1- May affect milk production if ol reduces overactive milk ejection and infant has week suckling. enhances suckling ability 2- May affect infant's growth if thy 2-Minimizes cross infection. is reduced milk supply. 3- Discrepancy of breast size. "temporary" 4- Breastfeeding positions: Figure 8-6 POSTIONS roR NURSING TWINS. (A) DOUBLE CLUTCH. (B) DOUBEL CRADLE. (C) CRADLE- cLuTcH.
5-Maternal comfort: = Wide padded chair. = Nearby snacks and drinks, tv, and mobile phones. 6-Maternal nutrition = A mother of multiples can be too busy to eat, so ready-made healthy snakes should be available with the help of friends and family. = Suppressed appetite maybe a sign of postpartum depression. 5- Co-bedding safely can reduce maternal exhaustion and ease breastfeeding in laid back position and helps improve quality of sleeping. 6- Use of expressed breastmilk by someone else can give the mother extra hours of rest. ® Ongoing breastfeeding difficulties: Infant related Maternal related 1- Weak suckling 1- low milk supply 2- Difficult latch o Real : due to pregnancy complication 3- Lack of time to work and train the o Perceived: due to increased baby. frequency of feeds or catch up 4- Down regulation of milk volume. growth. 5- Poor weight gain: o intervention: o Real due to weak suckling or < suck training poor latch <+ more milk expression o Perceived due to follow up on <+ galactogouges. formula based growth charts or 2- nipple or breast pain: genetic factors. o poor latch o fungal infection o poor immunity o cluster pumping ® Partial Breastfeeding and Human Milk Feeding Because mothers of multiple infants are more likely to be affected by complications or other factors that may interfere with effective early breastfeeding and milk production, they are more likely to supplement or complement breastfeeding with formula, even though this may be more challenging than exclusive breastfeeding. Complementing may take the form of “topping off” an occasional or daily breastfeeding, or it may involve replacing one or more breastfeedings with an alternative feeding. With guidance from a lactation consultant who respects the overwhelming amount of infant care the mother faces daily and the lack of time to work on resolving problems, most mothers will be able to decrease the use of alternative feedings in favor of direct breastfeedings. Some mothers continue to offer an alternative feeding on a daily or weekly basis to have help with feedings or to sleep without
interruption for a few hours. Many mothers prefer to express their own milk for feedings. Caution the mother that milk production might decrease if the total number of breastfeedings or pumping sessions dips below 8 to 10 in 24 hours. Alternative feeding methods to provide expressed human milk have become more common with the increased availability of hospital-grade, electric breast pumps. Mothers of higher-order multiples find it helpful to pump, as it can be daunting to directly breastfeed three or more babies. Mothers have maintained lactation and human milk feeding without the use of other supplements for several months. Pumping leaves the door open to later direct breastfeeding. Multiples wean as individuals; they may stop breastfeeding at about the same time or one may wean before the other(s). Triplets You may need a more rigid schedule overall for triplets and quads. It is extremely time consuming! Even when you feed in pairs, you will be spending a lot of time nursing them. BUT Remember though that formula feeding is time consuming too....if you are alternating breast and bottle feeds this should not be done on a regular basis) So don't let the time factor prevent you from nursing! You have 3 babies, 2 breasts, 2 arms and one lap!!! SO: Let's say we'll name the babies A, B and C. For the first feeding of the day: A and B nurse together first and C finishes off both sides. Feeding number two: A and C take the first round and then B gets her turn. For the third feeding, babies B and C would go first, followed by A. This would alternate throughout the day so that each baby gets equal amounts of breast milk and time at the breast and each will have equal chances to get the hind milk. Another option would be for the third baby to take a feeding of expressed milk or formula. Some moms consider a rotating formula feed to be more feasible than exclusive breastfeeding, but caution the mother that this can reduce her milk supply. Tell the mother this golden rule “You will only produce enough to feed three if you are nursing three! Again, do what works for you”
d) f) Quads Quads are actually a bit easier to coordinate feedings for, because you can keep them paired up for feedings. Let's toss baby D into the scenario above and see what happens. First babies A and B can nurse, followed by babies C and D. The next feeding, C and D get the first turn followed by A and B. Much simpler! Frequently Asked Questions by mothers 1. How much do | need to eat, drink and sleep? Hopefully, you will have some help around the house so that you can focus on taking care of yourself and nursing your babies. Drink to thirst, eat nutrient food and sleep when the babies sleep. 2. How can | make more time in the day? Set priorities: You need to nurse your babies. You need food, rest and more rest. You don't need to clean the house.....for a while anyway! Especially if you have triplets or quads you will likely need help at home. Not everyone can afford to hire help so consider the following free resources: You can't do everything by yourself! People can take turns dropping off an oven ready casserole. They can go grocery shopping, clean the house, do laundry, etc. Always feeding two babies at once, keeping a feeding chart that enables you to see who ate what and when at a simple glance, getting creative about diaper and clothing changes (consider several portable containers with diaper stuff and clothing changes to be placed strategically around the house), learning how to carry two of your babies at once in slings And above all, Learning how to relax your standards. Decide what you can "let slide" & focus on yourself and your babies. The benefits of loving, breastfeeding & nurturing your babies will last forever.