I must stress that this was written for a purpose, for a magazine whose raison d'être was the promotion of breastfeeding - which I wholeheartedly support but it does affect the tone of the article.
I awaited the arrival of our twins eagerly. I was excited about breastfeeding two, I had not managed to breastfeed my eldest son beyond 8 weeks due to latching problems causing engorgement, his reflux, and the need to return to full time work when he was only 12 weeks old. I fed my second son to nearly 8 months but it was far from easy. We now know the difficulties were largely due to his Asperger’s Syndrome (he hated facing into me and being cuddled close) and he too suffered from reflux pain but at the time it was only sheer determination on my part which kept me breastfeeding.
Unfortunately things were not easy with the twins either. They did latch on and fed beautifully straight after what was by far the easiest delivery of all mine. But they failed to thrive and took 6 and 8 weeks to regain their birth weights. This was largely due to the fact that they too suffered from severe Gastro-oesophageal reflux and gut inflammation (now diagnosed with EGID) , which was complicated by food allergies. They would both reflux back nearly all their feed each time and I would have to feed them again. So in reality I wasn’t just feeding twins, more like quads! With two older children to care for it was hard going, and my twins fed every half an hour.
I have written about GERD (reflux) on my Recipe Blog - an article approved by a paediatric gastroenterologist at the time.
I knew if I had any chance of succeeding I had to demand feed. With their failure to thrive routine-based feeding would never work. We co-slept for a few months, with a bed guard at my side of our super king-size bed, the twins side by side then me facing them. Otherwise I would literally have been up all night every night feeding. At least this way I could latch them on one by one and sleep whilst feeding. We had a single cellular blanket over us and it worked so well. After that I had them in a cot bed together next to my bed.
By week three we were referred urgently to our local Children’s Day Unit at the General Hospital, where supplementation with formula was pushed on me. However, I was better informed than when my eldest was suffering and refused to give way without trying all options. I knew that breast milk is a natural antacid and ideal for acid-splashed throats. Formula is acidic and would aggravate the problem, plus I knew that they ingested plenty of milk from me - the problem was keeping it down! I had a fast let-down so I tried to feed them “uphill”, or take them off a few seconds and let the fast-flowing milk soak into a muslin before putting them back to the breast to feed. This helped a little, but they were still very windy babies, winding would take literally an hour sometimes, and would run into the next feed. If any wind were left they would bring up all the milk on top of it in their stomachs.
We tried several medications, of increasing strength to try and damp down their reflux symptoms. At 8 weeks I gave in and agreed to try 1-2 oz of thickened formula once or twice a day. It seemed bizarre really, I had two of the best breastfeeding babies I had seen, and they both latched beautifully, and fed really, really well. It was the reflux causing the problems and I was miserable about having to consider supplementation, believing it to be the “thin end of the wedge”. I also felt the push to formula feed was missing the point - the feeding was not the issue!
I had not managed to feed them together well since they needed to be kept upright after a feed, and with only two hands I could not wind one then the other. Feeding them one at a time worked for me thought, I had lovely cuddles with each in turn, although invariably the second twin would become upset waiting. I gave them dummies, which whilst not ideal, never interfered with the feeding in my experience and gave some comfort whilst waiting. Sucking also helps with reflux since it produces saliva. I was still spending most waking moments feeding one then the other though, and their weights were static.
The single ounce of formula per baby per day that they both tried produced more problems. K became very, very constipated, sometimes going 9 days without a motion. Twice we ended up at the Day Unit (where we went every week for almost a year and still attend monthly) for glycerine chips to help her “go”. A’s reflux was aggravated by it too and we were switched to a hypoallergenic formula. I also cut out all dairy in my diet at 12 weeks and things really started to improve. I then cut out Soya and all caffeine (I was barely having any but stopped my morning cup of tea) and we were beginning to see some progress. On medication (Proton Pump Inhibitors to damp down the acid, motility agents to speed food through the gut and later lactulose and anti-allergy medication) and my restricted diet we continued on almost breast milk alone. I really enjoyed feeding the twins and used the formula to top up when they regurgitated all their breast milk.
Topping up for us really did not signal the end of breastfeeding as it can for so many mums. I was very careful to use it wisely, and managed to breastfeed them approximately 95% of the time. I did not introduce any solids until 6 months, but sadly they still have food allergies. K is allergic to Dairy, Soya, Wheat and Gluten and A is allergic to Dairy (extreme reaction), Soya, and Wheat. They were breastfed on demand until 16 months old. At that age they tandem fed every time, as I could sit one on each knee and not worry about supporting them to the same extent. It was lovely to feed them together; a real bonding moment. Breastfeeding was a wonderful experience and I would most definitely not do anything differently given another chance. Their reflux really made it a battle, but a battle I would happily fight for any of my children, and one which has brought much joy for all three of us and also health benefits for the twins.
The key issue for us was focussing on the health issues to improve growth etc not the feeding, they fed well! Sadly breastfeeding is often blamed as a "catch all" when babies don't gain weight but is often not the problem.
The UK has one of the lowest rates of breastfeeding by six months in the West.
I totally believe that our low nursing rates in this country are as much due to lack of information as lack of support. It is our expectations that are at fault, and lack of community/family support. Mothers don't expect to be tied to a highly dependent baby for the first months and want freedom and independence. They are led to believe babies should "sleep through" and last many hours between feeds. The decades of four-hourly feed indoctrination and unlikely sleep expectations will clearly take many years to overturn but until popular understanding of babies’ behaviour changes, and breastfeeding becomes the expected "norm" rather than an option little will change.
Breastfeeding has been one of the most rewarding things I have ever done, but I faced many struggles each time – and many of these were unnecessary. Better information and support would make a world of difference. The website www.kellymom.com is a fantastic site, I cannot recommend it enough, and removing expectations that your baby will do anything at a given time is great advice. Knowing that every three months you will be feeding round the clock for a day or two during a growth spurt is essential knowledge - this is how your baby increases your milk supply. It is not only normal - but necessary. And the three month old who sleeps well will most likely no longer sleep well at four months - they undergo such a radical physical and developmental growth spurt and can see further, are aware of being alone and interact more with their environment. Life is too exciting to SLEEP!
And forget sleeping through the night - your milk is at its best in the small hours whilst you rest and anthropologically this was when it was safest to feed your baby.
Until mothers are better informed and have more realistic expectations breastfeeding rates in this country are unlikely to change. Our have-it-all, constantly rushing around society doesn't have much room for sitting quietly breastfeeding a baby. There is always too much to do - which I find very sad. For those who can't - there are excellent alternatives, but I don't believe mothers are given the real choice in the first place.
Tips for breastfeeding Multiples from La Leche League
Information on Milk Protein Allergy
Advice on weaning babies with reflux
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