Breastfeeding advice from a certified lactation consultant - part 3 - Nashville Parenting Multiples

Maternite by Mary Cassatt (1890)

Today we have the conclusion of our interview with Micky Jones, ICBLC. Micky is going to share some advice about breastfeeding multiples, and coping with the caesarean births and premature infants. Micky gives general advice to help prepare for these situations ahead of time, but if you do find yourself with premature infants you’ll probably want to consult with your child’s doctor and a lactation consultant familiar with your individual situation. You may also want to read part 1 and part 2.

Question: Do you think a mother of multiples might have any more need for a hospital grade pump than a singleton mom?

Micky's response: For a mom of multiples, a hospital grade pump may be her best friend. If your babies are premature, sick or have any complicating factors (many of these things come up with multiples), you may need to pump until they can breastfeed effectively. If your babies are full term, alert and able to feed well, you may never need a breastpump. For many hospitals, it is standard practice to encourage moms of multiples to pump right away in order to get the mature milk to "come in" or increase in volume faster, to provide milk for any necessary supplementation and as insurance in case the babies are not nursing enough (or strongly enough) to properly stimulate mom.

Q: What sort of special needs might a premature baby have?

M: Premature babies have special needs and challenges no matter how they are fed. Sucking reflexes and the ability to coordinate suck-swallow-breathing movements are some of the last reflexes and abilities to develop. Babies who are missing those last few months or weeks in utero may not be able to effectively remove milk from the breast. That is why it may take time and practice before a baby can actually breastfeed in a way that actually removes milk from the breast. But you never know, some very small babies can breastfeed, or can "practice breastfeeding" by breastfeeding and still be fed by tube through the stomach or still take bottles.

Skin-to-skin or Kangaroo care, access to mom and a mother who is supported to establish and keep up her supply through pumping, hand expression and support are all factors that may contribute to the possibility of a premaure baby going to the breast eventually.

Q: Caesareans are a common complication of multiple births. Are there any special considerations when starting to breastfeed after a caesarean?

M: A mother beginning to breastfeed after a cesarean may have no challenges at all or may encounter some issues fairly common for those who welcome their baby through surgical birth. It doesn't have to be the end of breastfeeding though. I would offer these 5 tips for breastfeeding after a cesarean/surgical birth.

Ask for help/arrange for support. Hire a postpartum doula or ask for help from friends or family members (that truly support breastfeeding). You need to be able to do NOTHING but breastfeed, sleep and eat for at least 2 weeks if you can. You need to heal from major abdominal surgery AND navigate the waters of being a new mother.
Practice Kangaroo Care with your baby as soon as you are able. Sometimes called "skin-to-skin" care, this consists of stripping baby down to diaper only and placing baby on your chest between your breasts and just enjoy your baby. Place blankets over both you and your baby to keep the both of you warm. Your body temperature will regulate your baby's body temperature. Do nothing, just hold your baby. Many mothers aim for at least 4 hours a day of Kangaroo care, but you can do it as long as you like.
Breastfeed in a position that will be comfortable for both you and baby. Some mothers find positions that don't come near the cesarean scar such as the clutch hold (sometimes called the football hold) or a side lying position are the most comfortable for breastfeeding but it is important that you do what is most comfortable for you.
Get help from an IBCLC as soon as possible - especially if you are having difficulties or have any questions about soreness or about the baby getting enough milk. Ask to see an IBCLC in the hospital (if they have one on staff) or once you get home.
Realize that it may take a little extra time (sometimes up to 5 days or longer) for your mature milk to increase in volume. Hand expression, pumping with a hospital grade pump along with lots of breastfeeding will help your milk increase as fast as possible.

Q: Do you have any special advice or techniques for mothers with multiples?

M: Mothers with multiples can first prepare for breastfeeding by educating themselves during pregnancy. They can read books on breastfeeding multiples and attend a breastfeeding and/or multiples support groups in order to get information and inspiration from the stories of others. The most extensive book on breastfeeding and mothering multiples is Mothering Multiples by Karen Kerkhoff Gromada. I suggest every mother of multiples I work with read that book.
In the postpartum period, spend time skin-to-skin with your babies (baby in diaper, mom or dad with shirt off), breastfeed each baby as much as possible shooting for at least 8 times in a 24 hour period. Some mothers find it easier to nurse both babies at the same time and others find it easier to nurse one at a time. Give yourself time to find out what pattern and techniques work best for you and your babies.

Q: Will a mother be able to supply enough milk for multiples?

M: Most women can make enough milk for multiples. Breastfeeding works by demand and supply (not supply and demand). By that I mean, the more milk that is demanded (taken out, removed from the breast), the more milk is made. It's kind of like a widget factory and milk is the widgets. If there are widgets on the shelf ready to leave the factory but they never get taken out by customers (babies) than the factory stops making milk. If the widgets are going out (milk is being removed), they keep gettingn made, faster and faster to keep up with demand. So when two babies are requesting/demanding milk your milk factory learns to make enough milk for both babies. Even if a mom can't make enough milk to fully supply her babies, any amount of breastmilk is beneficial.

Q: Are there prescriptions or herbal supplements that a woman can take to increase her supply?

M: Yes, these substances are called galactagogues. There are many herbs, foods and yes medications that are used in every culture and country to encourage or increase milk production. Some mothers report an increase in milk supply with certain foods like oatmeal. These foods vary by culture and the effectiveness may vary depending on prepation of the food. There is little research to back up how foods impact milk supply so evidence is largely andectotal. Herbs and medications are best used with the guidance of an herbalist, lactation consultant or physician as the correct dosage is needed to see results. A very good reference for increasing supply is makingmoremilk.org and the book The Breastfeeding Mother's Guide to Making More Milk by Diana West, IBCLC and Lisa Marasco, IBCLC.

Q: Do you provide home consultations for new moms, or does a patient have to come to your office?

M: We do both home and office consultations. Some moms just can't manage an outing when they have a young baby but really need the help. We are happy to come and help inside the home. Sometimes seeing baby and mom in their "natural habitat" helps even more in solving whatever breastfeeding dilemma we are dealing with. After an initial visit, many of our moms just follow up by phone or email or both, it just depends on the severity and complexity of the issue we are dealing with.

Q: So is there anything else you want to mention that I may have left out that a mom-to-be might want to know about breastfeeding?

M: It's 95% a confidence game! You have to believe you CAN breastfeed and that you can make enough milk and trust that your body was made to do this!

Q: What do you do when you’re not talking about breastfeeding?

M: I am wife to an incredibly talented, artistic husband who is currently a graphic designer for the Dave Ramsey Show, and mom to three beautiful, funny, talented, intelligent and well-adjusted (formerly) breastfed children - a 9 year old girl and two boys 6 and 3 years old. I love to teach and write and look forward to writing more, hopefully getting started on two books within the next few years.

Q: What kind of services does your company, Nine Months and Beyond, provide beyond lactation consulting? (You can find the details on her website.)

Childbirth classes in small group or private settings
Labor Doula Services (Team of 4 doulas)
Birth tub rentals for water births
Hospital grade breast pump rentals
Products for sale that make parenting easier - slings, Motherlove herbal supplements, Luna Lullaby Swaddle blankets, Pumpease and more...
Blessingway planning and facilitation
Belly Henna and decorative henna for baby showers, blessingways and other celebrations.
Free monthly email newsletter w/ specials, pregnancy and new baby tips and event listings
Baby Calming class/consultations
Weigh to go, Baby! Weekly weigh in and breastfeeding support group
Work it out, Baby! Breastfeeding and working class
Professional trainings and support (Hypno-doula trainings, lactation education for professionals)

That concludes the interview. If you have more questions for Micky, you can contact her at her website or attend the free monthly MaterniTEA Part to meet her staff, have a massage, get a goodie bag and food, and win prizes while you learn all about the company and how they can support you and your blossoming family.

I want to thank Micky so much for taking the time to answer all these questions, and apologize for any missed sleep from staying up late to meet my deadlines. The questions were based on my own second hand experience with numerous suggestions from my wife and her fellow mothers of multiples with first-hand experience breastfeeding more than one baby. We were trying to cover a lot of the topics that a mother-to-be of multiples might need to know when preparing to breastfeed her new babies.

You can read the previous parts here: Part 1 – info for the mother to be, Part 2 – info for the new mom.