Breastfeeding Twins

Breastfeeding has many benefits for both mom and baby, and naturally the benefits double when nursing twins. As you know, breast milk is uniquely designed to meet the specific developmental needs of your baby, and the breastfeeding experience fosters a very special bond between the two of you. Nursing twins can be a challenge in the beginning, but it can also be a wonderful experience when moms are given the support and encouragement they need. Also, breastfeeding twins is more economical, more convenient, and less time-consuming than preparing bottles.
 
For moms of twins, it will be most important to establish an adequate milk supply early on and to maintain the supply to meet the growing demands of the babies. This can be facilitated by early and frequent breastfeedings – at least 8 times in 24 hours for each baby. As is the case with all newborn babies, do not let more than 3 hours go between the start of one feeding and the start of the next feeding. If the twins are born prematurely and have an immature suck, mom will need to pump frequently until they are able to nurse at the breast. This frequent stimulation is necessary to ensure that mothers will be able to produce enough milk.
 
There are a number of options for breastfeeding twins and it may take some experimenting to find what works best for you. The babies may breastfeed separately or simultaneously and this can be accomplished with various positions. When babies are fed separately, mom can breastfeed one infant and then the other, or one can be breastfed and the other bottle fed. You may have to wake the second baby to feed, but this will keep them on a consistent schedule. It will be important to nurse each of the babies on both breasts, especially in the early weeks, so that they are both evenly stimulated, particularly if one twin has a more vigorous suck than the other.
 
Some moms prefer to nurse their babies at the same time which saves time and ensures that both babies are eating on a similar schedule. Remember to alternate breasts with each baby for even stimulation and drainage. You should comfortably latch the less vigorous nurser first and then the other baby. In the beginning, you may need help getting comfortable with extra pillows, and of course good back support.  
 
There are 3 nursing positions you can try:

1- Both babies in the football hold or the double football: This position allows for better head control with smaller babies and moms can support their breasts better when latching and during the feeding. Mom also has good visualization of both babies in this position, and it is easier on a mom who has had a C-section.

2- Both babies in the cradle or cuddle hold with their legs crossed over or next to each other. This position may be more difficult in the beginning since mom can not support the babies’ heads as well.  However, as the babies gain more head and neck control, mom’s hands will be freer and she will have better eye contact with her babies in this position.

3- One baby in the cradle hold and one baby in the football hold.

As your babies mature and need less support, nursing will get easier and more comfortable. Hang in there!
 
Frequent feedings that drain the breasts will keep your supply up and will decrease the likelihood of developing sore nipples, plugged ducts, and breast infections. A breastfeeding log will help you to keep track of breastfeeding sessions in these first few hectic weeks. You can also keep track of the number of wet and soiled diapers in your log which is the best measure of breastfeeding success. You will also want to share this information with your Pediatrician and/or lactation professional.
 
I do not have personal experience nursing twins, but I have two very close friends (who happen to be twins themselves) who nursed their twin sons happily and successfully. They wanted to share some personal advice with you.

Dee – Mom of twin boys that nursed for 12 months:
 
“I remember going to La Leche League and buying a ‘twin pillow’ so I could nurse them both at the same time. It was the best investment because you are nursing so much. It gave me a little break in between. Nurse them on demand for the first couple of weeks to bring your milk supply in and remember, what seems like non-stop nursing will end. New moms have to hang in there for the first 4-6 weeks! Nursing gets so much easier after that (babies go longer and learn to nurse more efficiently so they are not on your breast as long), and it becomes so much more convenient than bottle feeding. Have someone leave snacks out for you to munch on during the day, such as graham crackers with peanut butter, because new moms forget to eat and drink…you’re so busy nursing, but you need the nutrition to build your milk supply! I had a doula for the first couple of months which helped me immensely, and she had twins so she knew what it was like.”
 
Deirdre – Mom of twin boys that nursed for 14 months:
 
“I agree with everything my twin sister said, but I would like to add a few things. In the first couple of weeks my nipples were a little sore when the babies first latched, but I hung in there and it passed and I’m so glad I did! I nursed each baby separately with soft music playing in the background. My husband would sometimes hold the second baby while I nursed the first one who was a more active, vigorous baby. In the middle of the night I would just roll over and nurse them. There was no need to get up and warm a bottle. It was so easy. Sometimes at night when the babies slept a little longer, I felt fuller, so I would pump a little milk off to keep my supply up and save it for when I had a chance to go out. I kept a breastfeeding ‘clip board’ to keep track of which baby was on which breast so I could alternate them. I sometimes wore two breast pads in my bra to help absorb leakage.  I would tell new moms to accept help from family and friends, eat well, and get rest when you can.  If I had an hour off, I wanted to be by myself, so I would take a bath with a glass of wine, or I would go out for an hour of shopping! Breastfeeding was the most rewarding experience of my life.  It is an incredible bond. Don’t quit!” 
 
The first year of life for parents of a new baby is an adjustment, and for the parents of twins it can be very hectic, and at times it may seem overwhelming. Accepting the help of family, friends, and professionals if needed, will be essential in the first several weeks to ensure adequate rest and nutrition for mom. It is also a wonderful idea to contact other moms who have nursed twins for their support and suggestions. We are happy to be offering our own support group for mom of multiples beginning on January 30th. Below is a list of some additional resources to turn to for support.
 
Resources for Breastfeeding Support with Twins:

Trust Yourself

This New Year, make a resolution to trust yourself in all things related to your baby.   Trust myself, you are thinking?  I have no idea what I am doing.  I am winging this motherhood thing.  I just want someone to tell me what to do with this kid, and I will do it!  

Often, I am the someone you want the guidance from, and I am happy to give it. It usually involves seeing you and your baby in person, and spending quite a bit of time asking a lot of questions about what is happening.   I frequently apologize for the interrogation. But I am trying to get a handle on the situation, and you are the person with all the clues about what is going on.  I am just here to help you sort through it all.

Many times, I am confident I have it all figured out and start to tell you what I think is taking place. At that point, you might tell me all the things you have read and heard that contradict what I am telling you. You have read every book on the subject, consulted every girlfriend, your mother and mother in law, sisters, and of course, every website that popped up in your Google search. You also tell me how you tried each and every suggestion, and nothing worked.

I have addressed this topic multiple times- once about handling conflicting information and in another article about the “perfect” mother.  What I have come to realize is that in these situations, women don’t trust themselves.  They let the comments of passing strangers cause them to doubt themselves and their ability to care for their baby. They have somehow decided that a stranger that has never met their family, and is giving general advice online, knows more about their baby than they do. Nothing could be further from the truth.

And I know what I am talking about, because I have been that mommy. I have two vivid memories of my life with little boys.  One is of me freaking out because one of them (I believe boy #2 at about 7 months) fell down the stairs. (Very Bad Mommy-can’t remember how or why that happened!)  I called my husband at work, hysterically crying and asking him what I should do.  His calm response to me was, “I don’t know Kath, you are the neonatal ICU RN, what do you think you should do?”  Stunned, I examined him as any RN would.  He was fine.

The other memory is of a baby that wouldn’t sleep, unless he was on his stomach.  The AAP had just come out with the Back to Sleep recommendations.  So obviously, I couldn’t let him sleep on his stomach.  Exhausted, I stood over his crib crying, while he struggled, unable to be comfortable and sleep on his back.  I watched amazed as my husband got out of bed, rolled the baby over on his tummy, patted his bum and climbed back into our bed, both of them sleeping comfortably in a matter of minutes. That was the end of the Back to Sleep Campaign in our house.  I slept great from that moment on.

Please believe me when I say you really do know your baby best. You are the one living with him 24/7.  Sometimes, you are just too tired to clearly see what is happening.   That is where I hope to help.   I am usually telling you something you already know, you just didn’t trust yourself enough to believe it and act on it.

One of my MD friends posted a picture on Facebook of a coffee mug that said. “Don’t confuse your Google search with my medical degree.”  It gave me a good laugh, but I think I we all need to remember not to confuse our Google searches with our maternal instincts. Those instincts are pretty strong, and if we listen to them, instead of everyone else, our anxiety levels will dissipate, and our babies will be just fine. So please, make a New Year’s resolution to trust yourself and act on those instincts. Your baby, and probably the rest of your family, will thank you!

One For The Dads

My brother-in-law, Greg Wind, wrote the article to share with our Dads back in 2007. There is some great information in here on how they can participate in and support your breastfeeding endeavors. Enjoy!

Dads, you just had a screaming, beautiful, pooping, sleeping miracle.  Have you noticed the difference in how time passes yet?  Not so much in a line as in fits and starts, right?  When your baby looks at you, time can stand still, and then you make up for that golden moment trying to feed, change and bathe that child before the next chorus of “the Overtired Breakdown.”  Maybe time will crawl when you try and do the math of infant feeding schedules superimposed on infant sleeping schedules and sprint again as that math goes out the window with a missed nap.  Oh, and don’t forget to take time to enjoy every stage because you’ll never get it back.

 The feeling probably goes double for the mother of that miracle, and if she’s getting up for night feedings and pumping on a regular basis, she’s got less of a day to accomplish everything.  I’d add up the hours for you, but it might depress you and I want you to get to the happy ending below.

 In our over packed lives, why would anyone go for a Stone Age strategy like breastfeeding?  It hurts, it takes longer, it requires exposure of otherwise hidden skin, and on top of it all, if reinforces those nasty prejudices of the woman as primary-to-sole caregiver.

 If you’ve made it to this article, you’ve probably heard about the health benefits for the mother and the baby.  Even the formula people say breast milk is best.  If you’re taking the time to read this, you’re likely in no danger of dropping all of the baby care in mom’s lap.  Plus, there’s that bonding we hear so much about.  My wife, a working mom, says of breastfeeding “you have to, but you get to, too.”  The benefits are real. So why not give it a spin to see if it’ll work?  Remember that no one – no one – talks about the hidden long term benefits of formula.

 If you and your baby are lucky, the tike has a mother that lets you weigh in on baby care decisions – even if it’s to grunt and say “I dunno.”  If you chose to support the breastfeeding decision, you are now committed to supporting the breastfeeding process.  You thought you were getting off the feeding hook, right?  Sorry.  The actual breastfeeding will forever remain a mystery to me and most men, but there are things you can do to help.  Here are just a few:

> Get over it – If you’re squeamish about feeding in public or even being around during feeding, get over this as soon as possible.  Not only is America coming to the realization that breastfeeding is natural and normal, but it’s actually been legislated in many states that women are allowed to breastfeed wherever they darn well please.  If breastfeeding can take place during an outing or while enjoying your company, that’s like adding time to her day.  Doing two things at once = more time! 

> Feed the baby pumped or “expressed” milk – Expressed is actually a good word for it because it takes less time to pump than to feed a baby.  The baby will also usually take a bottle feeding faster than a breast feeding.  If you give the baby a bottle, you are putting time back into the mother’s day and you get a taste of that bonding everyone talks about.  Expressed = faster = more time + bonding for you.

> Wash stuff – You may have noticed that time has become a theme here.  A significant amount of the time required for pumping is in washing the pump components.  You can wash stuff.  You’ll still be a man when you’re done.  If you find this works for you, go ahead and find other stuff to take care of.  Every chore you take off her plate counts double during infant care.  Not that you could ever cash those brownie points in, but it might help you to know that you’re getting twice the credit.

> Keep the list of benefits top of mind – On top of being time consuming, breastfeeding will be frustrating from time to time.  It’s the stuff of thousands of support groups.  I’m not exaggerating.  When mom reaches the end of her rope, it doesn’t always mean she wants to stop.  She might just need support so she can keep going.  Remind her that her options are always open, but she chose breastfeeding for very good reasons.  And it will help you to remember the benefits, too when you aren’t getting the attention you’re used to.  Longer, healthier life for your family = more time.

> Talk to other dads – I’m lucky enough to have a sister and three sisters-in-law going though infant care at the same time.  Talking to them makes my wife feel more confident and happier.  And while they discuss pumping and feeding, I hang out with the boys.  Not only do we all get time out to talk about sports, but on the occasion we feel like talking about breastfeeding (yep, it happens) we’re all coming from the same point of view.  Trust me – you’ll feel far more comfortable talking about it with other new dads.  Try discussing a slow flow nipple with non-dads and see how far you get.

So when you add all of that time back into the day, bond with the baby and take time out to discuss the designated hitter, you’ll find that breastfeeding is a pretty good deal for you.  You get a chance to be an everyday hero just by washing stuff and understanding.  Mom will feel the pride of feeding her baby with her body and that will make you both happier.  Everyone will be healthier.  Plus (I promised a happy ending, remember?) it’s free.  Take those thousands of dollars and put it toward the college fund, or better yet, reward yourselves for all of the time you gave the baby and take some time to feed the parents at the nice restaurant or sports stadium of your choice.  Just remember to have a couple bottles ready for the sitter.

Introducing the Bottle

Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!

When can I get my baby on a Schedule?

An oldie but goodie that we first shared in 2007.

This is the one question I am asked most often! Many new parents are anxious to get their baby into some kind of a routine and restore order to the chaos a newborn creates in their home. Unfortunately, imposing any kind of structure on a newborn that suits the parents’ schedule, usually results in a tired and cranky baby. Eventually, that baby will have tired and cranky parents and your family life will be anything but peaceful!

But what if you took a different approach to trying to get your baby on a schedule? What if you simply accepted that your baby has basic needs related to hunger and sleep that are beyond your control? What if, instead, you did everything you could to accommodate your baby’s natural schedule rather than trying to force him or her to follow yours? I can guarantee that if you did that, your life would fall into a very predictable routine. It would allow you to plan your day and actually feel as if you are able to accomplish things and in control. Why not give this approach a try? What have you got to loose, other than some more sleep?

A baby’s sleeping and eating pattern really does have some predictability to it throughout the newborn period.  Unfortunately, most parents of newborns are too tired to even realize it. I am certain at some point you will read this and think “That’s what my baby is doing right now!” Learning about it beforehand makes it much easier to recognize and deal with when it happens to you.

The first few days of a newborn’s life are full of sleep. The baby will usually be alert and awake for the first 4 hours after delivery, which is just one more reason to keep him with you and nurse in the delivery room! This is a great time for Mom, Dad, and baby to bond. After that, it’s lights out for days. Many parents tell me at this stage how good their baby is! I am constantly reminding them to make sure they wake the baby up every 2 to 3 hours during the day to feed him. If you don’t, he won’t eat. On or around day 4, Mom’s milk comes in and it’s a new ballgame! The baby eats all the time and is now vigorously demanding feedings. If he is doing this, you probably will not need to wake him anymore, provided he is voiding, stooling and gaining weight. Just feed him when he wakes up and asks for it! In addition, babies will start to have a fussy period that lasts a couple hours a day, usually in the evening. This fussiness usually peaks around 3-6 weeks and is almost always over by 3 months. This is a great cause of concern for mothers especially, who will begin to doubt their milk supply. It’s the perfect time to take a walk or ride in the car or break out the Snugly, swing, or vibrating infant seat. Don’t fight your baby’s fussiness! Feed him as much as he wants and do whatever else helps to make him happy. Nothing you do now is going to start bad habits and ruin him for life. You are simply giving him what he needs now, as any good parent would do.

At around 3 weeks of age, your baby will have a growth spurt. It is usually preceded and/or followed by a lot of sleep. He will nurse constantly for days, until you think you can’t stand it anymore! But when it’s over, he will fall into another predictable pattern. He may go as long as 3 hours between feedings during the day, and start sleeping for longer stretches at night. Another growth spurt happens again at 6 weeks and by that time, your baby should be sleeping from about 10pm to 4 or 6am. They usually nurse at that morning feeding and go right back to bed for a couple more hours. Another growth spurt then occurs again at 3 months of age, and is in many ways identical to the ones that preceded it. The best part about it is that when it’s over, the fussiness tends to diminish significantly and the sleep tends to become more regular and last longer. You may get a few good daytime naps and a good 8 hours of straight sleep at night!  It is at this time that I strongly recommend your baby is in his own crib in his own room (if possible of course!). I also advise parents to keep the baby in his bedroom from around 7pm to 7am, so he gets used to being in his room at night. The baby may go down at 7 and wake a few times throughout the night. But with a feeding and minimal stimulation (no TV, siblings, other adults) they usually eat and go straight back to sleep. This is usually a welcome relief to parents who have been up for hours during the night with their newborn.

Babies at 4 months of age generally are capable of and need to sleep from 7 at night to 7 in the morning. They may still wake once for a feeding anytime around 4 to 6, but they generally grow out of that rather soon. Problems at this age usually arise because your baby is now a little social being and has a pretty good idea that things are still going on in his family while he’s in his room and down for the night. At this stage, you may get some serious protesting at bedtime. But in my experience, babies who have been allowed to sleep and eat as they need to, are well accustomed to their crib and room, and have learned to fall asleep on their own, have no problem making this transition. And it is a very important one, because it now provides the parents with some quiet time in the evening for each other, other children, or additional sleep! In addition, once sleeping thru the night occurs with regularity, daytime naps start to happen with predictability as well, and your days get easier.

This routine of 12 hours of nighttime sleep and 2 daily naps in the morning and afternoon usually lasts from 4 months until about 15 months. At 15 months, your baby will start to phase out the morning nap, and tend to take one long nap in the afternoon. Many parents are happy to see that morning nap gone, as they are now free to leave the house in the morning and take the baby out for activities or errands.

Does this all sound impossible and too good to be true? I promise you it isn’t! If you think of sleep as something that your baby needs just as much as food, love, shelter and safety, it becomes something you feel the responsibility to provide for him as well. To learn more about this very important topic, I highly recommend the book Healthy Sleep Habits, Happy Child, by Marc Weissbluth M.D. He discusses this topic at considerable length and teaches you how to recognize fatigue in your baby. He also reveals many good habits to start before that 4 month mark that make the transition to a full night of sleep an easy one. He believes strongly, as I do, that a well-rested baby is a healthy, happy child, with a happy mom!

If things aren’t  going this smoothly for you, we offer a sleep class and even a sleep consult if you need one.  Just call our office at 401-884-8273 to let us know what we can help you with!

Rhode Island is the First US State to Support Breastfeeding Mothers by Becoming Bag-Free!

Through the hard work and dedication of many hospital employees throughout the state, and the gentle insistence of our Health Department, Rhode Island became the first “Bag Free” state in the nation. I realize it is old news by now, but for those who don’t know, this means “women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital.”(www.banthebags.org) In an event held at the State House on November 28, 2012 Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign all celebrated this achievement and “spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding.”(www.banthebags.org)

I think that most everyone who heard about this knew that it was a good thing for the health of babies in our state. Some weren’t happy about it, but I really don’t think they understood what it means. And let me be clear: it does not mean that mothers will not be able to receive formula in the hospital if they choose not to breastfeed. The hospitals will still have formula, and will still provide it for your child if you want it. What they will no longer do, is routinely give out discharge packs with free formula to mothers as they leave the hospital. Dr. Melissa Bartick, a Boston MD, wrote in a very public debate with MA Governor Mitt Romney that giving formula samples to new mothers was akin to giving Big Macs to patients on a cardiac floor. As Marsha Walker has said many times, “Hospitals should market health, and nothing else.” When nurses send new mothers home with a bag of free formula, it is an implied endorsement of that product. “State health officials noted that studies link these giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.”(www.banthebags.org)

We all know the benefits of breastfeeding. This information has been well promoted among the public health community for years. But “because breastfeeding is the gold standard infant nutrition that provides optimal healt
h for both mothers and infants, lactation experts have recently shifted to describing the risks of formula feeding rather than the benefits of breastfeeding. For mothers, not breastfeeding is associated with an increased risk of post-partum blood loss, post-partum depression, and ovarian and breast cancer when compared with women who do breastfeed. For children, risks of formula feeding include an increased incidence and severity of a wide range of infectious diseases as well as chronic diseases such as diabetes mellitus and obesity.” (MacNamara et al, 2012) When framed that way, doesn’t it make sense not to promote an unhealthy behavior? Especially in a hospital, where we really have the opportunity to help mothers get off to a great start establishing healthy habits with their baby!

So our tiny little state has really done a big thing for families who deliver their babies here. Next on our agenda: having Rhode Island become the first state in the nation with all birthing hospitals designated as Baby Friendly. “The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.”(www.babyfriendlyusa.org) Currently in Rhode Island, Newport, South County and Westerly hospitals have all achieved this status. Throughout the world, the majority of hospitals are Baby Friendly. It is only here in the USA, which is so heavily influenced by the business of formula marketing, that Baby Friendly hospitals are in the minority. Interested in helping to make this happen? Contact your local hospital and ask that they do everything they can to achieve this designation and deliver only at a hospital that has it. Consider joining the Rhode Island Breastfeeding Coalition (RIBC) and joining our advocacy efforts. You can read more about this wonderful organization and ways to get involved at the following link: www.health.ri.gov/partners/coalitions/breastfeeding. We hope that you will join us!

The Effects of Birth Control on Breastfeeding

Some of you might remember this article, but I feel compelled to run it again as I had two instances of this last month. A mom will start the mini-pill and quickly watch it affect her milk supply, sometimes with a very dramatic decrease. I wanted to remind everyone of what I see clinically in some of my patients who take the mini-pill, so I can prevent other mothers from going through the same thing!  Please remember that this is my anecdotal experience, not at all backed by research, and is different from what the pharmaceutical companies and many doctors and midwives believe. Also, I see moms with issues, so my population is skewed!  There are many who have no problems with the mini-pill at all. But it is something for all moms to be aware of, especially if they have concerns about their supply. 

So much of my work is about asking the right question at the right time. I had a perfect reminder of this over the summer. I was sitting by the pool watching my boys play with some of their cousins. My sister’s sister-in-law was sitting next to me and we were talking about her beautiful little boy who was 9 months at the time. He is happy, chubby and very well nourished by his mom who has been nursing him. And he has rock star hair to boot! She was lamenting the difficulty she has had with maintaining her milk supply for this baby. It was an experience much different than her first child, for whom she felt she had an abundant supply. And of course, we had been in contact regarding this since the baby was born. She was doing all the right things: eating and drinking well, pumping when necessary, nursing on demand and trying to get adequate rest. But she really felt she had to stay on top of this with this baby and couldn’t figure out why. And frankly, neither could I.

Then our conversation went on to other things and we eventually got talking about plans for the future. Nosey me asked if and when this little boy would have a younger sibling. And his mom replied that she would love to have another one someday, but was on the pill now and they were waiting a little bit longer for all the usual reasons. “You’re on the pill?” I asked. “Yes, since he was 6 weeks old,” she replied. “Wasn’t that when you started having problems with your supply?” I asked.

She went on to say that she was assured by her MD that it was safe to take this mini pill while nursing. I told her that she received correct information. It is considered perfectly safe for babies  to nurse when their mothers take the mini pill. What she wasn’t told though, was that in the fine print of the drug literature, it clearly states that it can cause a decrease in your supply. In fact in light of this new information, I was absolutely amazed that she had nursed this baby as well as she had! Many mothers that I work with in this situation lose their milk supply significantly within about 2 weeks. It is usually a very sad situation, as they were told it was safe for the baby, but not told that the side effect is a significant reduction in milk supply. They had no intention of weaning, but it happened dramatically and much sooner than they would have liked.

How did I miss this in someone who is essentially part of my family? It’s all in the questions I ask and I honestly am learning new stuff every day. I will never make that mistake again, but will probably make a new different one! In the meantime, I hope everyone reading this has learned a little something about birth control pills and nursing. And also, please tell me or any other health care provider you deal with everything you think they might need to know, even if you think it is inconsequential.

It just might be the one thing they need to know!

SIBLING RIVALRY

Written in 2010

My three younger sisters are the only thing getting me through this phase of my life. My relationships with them help me to hold out hope that one day my children will not only be civil and kind to each other, but they may actually want to spend time together. I vaguely remember tension between my closest sister and me, as she was only 11 months younger than I was. I recall viscous fights and terrible things said to each other. But with the two younger ones, I only remember fun. Now, as we all raise our children together, there really are no other women I would rather be with. Will my kids ever feel that way? If you spent an hour in my house, you wouldn’t think so.

I am the mother of four boys. The youngest is 7 and adorable. His older brothers love him. He has not yet become annoying. The three other ones are 12, 15 and 18, so there is a lot of testosterone in my house. And with that comes trash talk, bullying, and the occasional “accidental” bat to the teeth. I wish I was kidding about that one. 

© Wernerimages | Dreamstime.com

© Wernerimages | Dreamstime.com

Coming from a family of girls, I am unaccustomed to the sheer physical nature of their interactions. My two oldest boys now have the bodies of men and tower over me. It seems that no one walks by the other without a nudge, flick or swat to the head. All when I have my back turned, of course. The verbal insults I can at least hear, but often wish I didn’t. I find it heartbreaking the way they speak to each other. Then I have to endure all the different versions of how things went down, who started it and how they should be punished. Invariably, someone is upset that I haven’t taken their side and I feel like I am the one beaten down in the end.

I hear from other men with brothers that this is normal behavior; that what I am experiencing is relatively tame and butting out is the best option. But don’t we have a responsibility as mothers to point out bad behavior? And to protect them from each other? Someone could get really hurt, right?

My mother-in-law stayed with us for a week once and she gave me advice that helped eliminate some volatile exchanges. She suggested that I not put the particularly combative ones together while doing chores, babysitting, on car rides etc. It really worked! My problem is that I frequently forget that advice. In my hurry to get things done, I bark out orders and put them in situations that foster the bad behavior. But I find that now that they are bigger and stronger, I really need to pay attention to what I am asking of them and determine whether they can handle it with everything else that is going on in their life. If they are having a good day and are relatively happy, they might find it fun to be with their brothers and endure a little good-natured ribbing. If not, look out. Someone else is going to bear the brunt of their difficult day.

I’ve tried to put some thought into what each child seeks from another. The older ones really want respect. They want the younger ones to take what they say to heart, to do what they ask the first time, to have their privacy, and their possessions left alone. The younger ones just want to be with the older ones and to be an important part of their lives. None of them need additional parents. I keep saying things like “Just be the cool big brother” or “Be what you want him to become.” Let the parents actually engage in the parental behavior.

Sometimes, I feel their bad behavior is an attempt to get some attention from me. I might be flattering myself, but I do know that if I make the effort to spend time alone with each one, things tend to be better at home. So when I can, I take a boy with me. Whether it is to the grocery store, bank or post office, you can learn a lot when alone for a half hour with a boy. In addition, almost

every day each of them wants/needs something from me- a permission slip signed, form filled out, a button sewn back on their pants. Silly little stuff, but important to them. And when I take care of it, they are more inclined to take care of each other. Sometimes I really have to stop myself and pay attention to what is important to them. I think that is important advice for mothers of children of any age. When we look them in the eye and take their requests to heart, it validates them and lets them know we think they are important.

So in a nutshell, here is what I have found works:

Don’t take sides. If you didn’t see it, you cannot make a judgment about it. Listening to all sides of the story makes you pick sides and someone will be unhappy. My husband came up with a grand plan of punishing all involved equally, regardless of who started it or did what. This has made them think long and hard before coming to us, and they tend to resolve things amicably themselves.

Physical and verbal abuse/ bullying is never acceptable. There is no excuse for it regardless of the behavior that provoked it. When you see or hear it, stop it immediately and remove the offender from the situation. Take away a privilege if the behavior continues.

Don’t put kids who are combative in a situation where they are forced to work together without adult supervision. I have learned who works well together and when I need to, I am involved in supervising the activity. My presence usually keeps the situation under control, without them realizing that is my intention. Sometimes they even have fun together!

Give each child some one-on-one time with a parent as often as you can, especially if they seem to be having a hard time within the family. Reinforcing your unconditional love and letting them know they have you to protect them does wonders for their self esteem and gives them the strength to stand up for themselves.

For the younger kids, teach and model empathy every chance you get. This has been reported to be a critical developmental milestone. If they are able to put themselves in another’s shoes and understand how they feel, it goes a long way in keeping them from treating others badly. And it can be the basis for everything ~sharing, taking turns, manners and respect.

And maybe someday, they will look back on this time fondly, while hanging out with their siblings and their own children. At least we can hope for that, right? I know I do, every day.