Marian. Dinner for Two.

Elisabeth holding my thumb while feeding

Elisabeth holding my thumb while feeding

Maggie not long after we got home

Maggie not long after we got home

The following story, about breastfeeding premature twin babies in the NICU is reblogged with the kind permission of Marian Hazel. In her blog, The Hut Chronicles, she talks about babies, good food, motherhood, gardens, flowers, baking, recipes, and her dogs.
In the first few weeks after the girls were born Kanga cuddles were the highlight of our NICU visits. During a Kanga cuddle the parent removes any clothing on their top half and dons a lovely hospital gown (backwards) and then your tiny premature baby is placed carefully onto your chest with all their wires, sensors and breathing support. The skin to skin contact has benefits for the baby (stabilised breathing, heart rates and body temperature) and parent (particularly the mother, helping with milk production).
On day 18 (equivalent of 28 weeks 4 days pregnant), I was enjoying a Kanga cuddle with Maggie. She was still so tiny, only 865g. As much as I was enjoying it, Maggie was quite disgruntled; as I would be if I had hard plastic breathing prongs in my nose pushing up against someone’s chest. The girls were normally placed high up on your chest just under your chin. Maggie’s nurse on hearing her cry suggested we move her down towards my breast to see if that might make her a bit happier. I remember as she was placed there she immediately tried to suckle my nipple with her tiny mouth and was even swallowing. Rob and I looked on in amazement at the most basic of survival instincts in our tiny daughter and cried with joy. Even though she was unable to breathe on her own, if given half a chance she was going to try and feed herself! Not long afterwards I had a similar experience with Elisabeth, although once attached she just wanted to stay there, as if claiming her territory, and was not bothered with swallowing.
During those three and a half months in hospital, I had many opportunities to practise feeding with the girls. As they were so small, they generally weren’t strong enough to eat an entire feed on their own, so we would guestimate and top them up via their nasal gastric tube (NGT). Feeding was very clinical, the amount of milk they were given carefully calculated as they grew, and when I wasn’t there to attempt a feed it was given to them via their NGT on strict time intervals! Eventually they were fed 80mL every four hours.
Feeding a premature baby is a little more complex too. First of all, their little mouths are just too small to get that mouthful of breast as well as the nipple in, so they struggle to latch on. The solution was to use a silicone breast shield. While these felt awkward at first, it meant the girls once they started feeding could rest without having to keep the suction going. It also stopped too much milk flowing into their mouth. I still use a shield for Elisabeth after four months of feeding at home, as she grew used to it, whereas Maggie could latch onto anything so hasn’t been using one after the first few weeks.
Added complications include the NGT taped to their face with a dangling tube that easily got caught on things. Maggie had high flow breathing support as well, so had a plastic tube running under her nose and across her cheeks making it difficult for her to get her mouth in close enough. Both girls were also attached to various monitoring devices which meant a few more cables that you needed to be mindful of.
Sometimes the girls for whatever reason were too tired to feed very well, they may have had a bath, or had a needle or blood transfusion.  After a few minutes of trying I’d usually let the nurse feed them via the tube and hold them close instead. Timing a feed with both girls around my expressing schedule, toilet or meal breaks for myself and their regular care and feed times was always a bit of a challenge. Usually once they were topped up via the tube you couldn’t move for at least half and hour as they could spill the whole feed back up. I can’t tell you how many times I sat down ready to snuggle the girls after their feed and top up and realised I was busting to go to the loo, or starving, or as the cuddle went on could feel my breasts getting more uncomfortable.
But despite all of that, those moments when it all worked were some of the best in NICU. Maggie and Elisabeth unfortunately caught a cold near the end of their stay in hospital which hampered their feeding for a few weeks, as they couldn’t breathe and feed. At the height of their cold, I was actually at home as I had it too, so they went back to receiving all their feeds via the NGT.  When I returned to visit them in their isolation room and attempted breastfeeding again, they both desperately grabbed onto me and latched straight on, it was only then I realised just how much it comforts the baby as much as the Mama.
Finally after 3.5 long months I decided it was time to room in and breastfeed them exclusively for 48 hours. Luckily their Doctors agreed with me. The final removal of those pesky NGT tubes was when it felt like they really would be coming home with us. I would be like any other Mama with their newborn babies in hospital. Those two days were, I have to say, pretty horrendous, Rob and I probably got a total of four hours sleep over the two nights! But I was feeding our daughters without any nurses and after a final weigh in (Elisabeth gained weight but Maggie lost some), I felt reassured we could do it, and we were free.
Breastfeeding twins takes up a lot of my day. It would be more time efficient to twin style feed the girls at the same time, but I found it awkward to arrange them on my own (even with my special twin feeding pillow), and it was just too hard, one would slip off or need a burp and the other would get grumpy. So I feed them separately. I like it better as I get some one on one time with each of them. I also have a side for each girl, going against the common wisdom of swapping sides each day. My girls feed differently and I’m sure it caused a bad case of mastitis within a week of coming home. I have been very lucky not to have any milk supply issues so far. Although I know I couldn’t have prevented the onset of twin to twin transfusion syndrome and their premature birth, I think I would have felt even worse if I hadn’t been able to provide the girls with milk. It was the one thing I could do to help them grow in NICU that nobody else could do. It also provided a structure to my day, helping the days to go by quickly and ensured I took care of myself.
Just a few last points:
I’d like to thank a few people. Firstly, Rob. He has always encouraged me with the expressing routine and breastfeeding, made sure I ate and drank enough and got plenty of rest. He also got up for every one of the 2am expresses; as I’m such a heavy sleeper I might have slept through the alarm. He still gets up and helps with every feed during the night too.
Secondly, a friend who sent us her double electric pump, as soon as she heard of the girl’s early arrival. She had it checked over, stocked up on new bottles, pumping gear, tubes, and even plastic containers for milk storage. As a premmie mother herself, she understood what we were about to go through and we’ll never forget her generosity.
Thirdly, the Lactation Consultants at the Royal Hobart Hospital are an amazing and enthusiastic group of women. Even before I had the girls they were visiting me in my hospital room to give me information to read. Every week day during our NICU stay they would check in on me, ask how I was doing, check I had all the equipment I needed, make sure the expressing was going ok, and were the ones who helped me learn how to feed the girls. They were so helpful when I had mastitis, making sure I got antibiotics to fix it up. The NICU nurses were always encouraging too. On day 2, I made what seemed like an epic journey (after the caesarian) down the corridor from maternity to NICU (perhaps 15m) at 10pm with a syringe of colostrum. It was my first solo visit, and the nurses all exclaimed over the tube, told me how well I was doing and then let me help change my first nappy. It was worth the pain involved as I hobbled back to my room. They continued their encouragement all the way along our NICU ride.
Lastly, a fellow mother, whose son was born a few weeks after Maggie and Elisabeth. She and I would always end up chatting in the expressing room, checking up on each other, our babies, our husbands. Mostly we laughed and joked about our days, sometimes there were tears and hugs, but we forged a friendship during an incredibly stressful time over the rythmic sound of electric pumps!
In the first few weeks after the girls were born Kanga cuddles were the highlight of our NICU visits. During a Kanga cuddle the parent removes any clothing on their top half and dons a lovely hospital gown (backwards) and then your tiny premature baby is placed carefully onto your chest with all their wires, sensors and breathing support. The skin to skin contact has benefits for the baby (stabilised breathing, heart rates and body temperature) and parent (particularly the mother, helping with milk production).
On day 18 (equivalent of 28 weeks 4 days pregnant), I was enjoying a Kanga cuddle with Maggie. She was still so tiny, only 865g. As much as I was enjoying it, Maggie was quite disgruntled; as I would be if I had hard plastic breathing prongs in my nose pushing up against someone’s chest. The girls were normally placed high up on your chest just under your chin. Maggie’s nurse on hearing her cry suggested we move her down towards my breast to see if that might make her a bit happier. I remember as she was placed there she immediately tried to suckle my nipple with her tiny mouth and was even swallowing. Rob and I looked on in amazement at the most basic of survival instincts in our tiny daughter and cried with joy. Even though she was unable to breathe on her own, if given half a chance she was going to try and feed herself! Not long afterwards I had a similar experience with Elisabeth, although once attached she just wanted to stay there, as if claiming her territory, and was not bothered with swallowing.
During those three and a half months in hospital, I had many opportunities to practise feeding with the girls. As they were so small, they generally weren’t strong enough to eat an entire feed on their own, so we would guestimate and top them up via their nasal gastric tube (NGT). Feeding was very clinical, the amount of milk they were given carefully calculated as they grew, and when I wasn’t there to attempt a feed it was given to them via their NGT on strict time intervals! Eventually they were fed 80mL every four hours.
Feeding a premature baby is a little more complex too. First of all, their little mouths are just too small to get that mouthful of breast as well as the nipple in, so they struggle to latch on. The solution was to use a silicone breast shield. While these felt awkward at first, it meant the girls once they started feeding could rest without having to keep the suction going. It also stopped too much milk flowing into their mouth. I still use a shield for Elisabeth after four months of feeding at home, as she grew used to it, whereas Maggie could latch onto anything so hasn’t been using one after the first few weeks.
Added complications include the NGT taped to their face with a dangling tube that easily got caught on things. Maggie had high flow breathing support as well, so had a plastic tube running under her nose and across her cheeks making it difficult for her to get her mouth in close enough. Both girls were also attached to various monitoring devices which meant a few more cables that you needed to be mindful of.
Sometimes the girls for whatever reason were too tired to feed very well, they may have had a bath, or had a needle or blood transfusion.  After a few minutes of trying I’d usually let the nurse feed them via the tube and hold them close instead. Timing a feed with both girls around my expressing schedule, toilet or meal breaks for myself and their regular care and feed times was always a bit of a challenge. Usually once they were topped up via the tube you couldn’t move for at least half and hour as they could spill the whole feed back up. I can’t tell you how many times I sat down ready to snuggle the girls after their feed and top up and realised I was busting to go to the loo, or starving, or as the cuddle went on could feel my breasts getting more uncomfortable.
But despite all of that, those moments when it all worked were some of the best in NICU. Maggie and Elisabeth unfortunately caught a cold near the end of their stay in hospital which hampered their feeding for a few weeks, as they couldn’t breathe and feed. At the height of their cold, I was actually at home as I had it too, so they went back to receiving all their feeds via the NGT.  When I returned to visit them in their isolation room and attempted breastfeeding again, they both desperately grabbed onto me and latched straight on, it was only then I realised just how much it comforts the baby as much as the Mama.
Finally after 3.5 long months I decided it was time to room in and breastfeed them exclusively for 48 hours. Luckily their Doctors agreed with me. The final removal of those pesky NGT tubes was when it felt like they really would be coming home with us. I would be like any other Mama with their newborn babies in hospital. Those two days were, I have to say, pretty horrendous, Rob and I probably got a total of four hours sleep over the two nights! But I was feeding our daughters without any nurses and after a final weigh in (Elisabeth gained weight but Maggie lost some), I felt reassured we could do it, and we were free.
Breastfeeding twins takes up a lot of my day. It would be more time efficient to twin style feed the girls at the same time, but I found it awkward to arrange them on my own (even with my special twin feeding pillow), and it was just too hard, one would slip off or need a burp and the other would get grumpy. So I feed them separately. I like it better as I get some one on one time with each of them. I also have a side for each girl, going against the common wisdom of swapping sides each day. My girls feed differently and I’m sure it caused a bad case of mastitis within a week of coming home. I have been very lucky not to have any milk supply issues so far. Although I know I couldn’t have prevented the onset of twin to twin transfusion syndrome and their premature birth, I think I would have felt even worse if I hadn’t been able to provide the girls with milk. It was the one thing I could do to help them grow in NICU that nobody else could do. It also provided a structure to my day, helping the days to go by quickly and ensured I took care of myself.
Just a few last points:
I’d like to thank a few people. Firstly, Rob. He has always encouraged me with the expressing routine and breastfeeding, made sure I ate and drank enough and got plenty of rest. He also got up for every one of the 2am expresses; as I’m such a heavy sleeper I might have slept through the alarm. He still gets up and helps with every feed during the night too.
Secondly, a friend who sent us her double electric pump, as soon as she heard of the girl’s early arrival. She had it checked over, stocked up on new bottles, pumping gear, tubes, and even plastic containers for milk storage. As a premmie mother herself, she understood what we were about to go through and we’ll never forget her generosity.
Thirdly, the Lactation Consultants at the Royal Hobart Hospital are an amazing and enthusiastic group of women. Even before I had the girls they were visiting me in my hospital room to give me information to read. Every week day during our NICU stay they would check in on me, ask how I was doing, check I had all the equipment I needed, make sure the expressing was going ok, and were the ones who helped me learn how to feed the girls. They were so helpful when I had mastitis, making sure I got antibiotics to fix it up. The NICU nurses were always encouraging too. On day 2, I made what seemed like an epic journey (after the caesarian) down the corridor from maternity to NICU (perhaps 15m) at 10pm with a syringe of colostrum. It was my first solo visit, and the nurses all exclaimed over the tube, told me how well I was doing and then let me help change my first nappy. It was worth the pain involved as I hobbled back to my room. They continued their encouragement all the way along our NICU ride.
Lastly, a fellow mother, whose son was born a few weeks after Maggie and Elisabeth. She and I would always end up chatting in the expressing room, checking up on each other, our babies, our husbands. Mostly we laughed and joked about our days, sometimes there were tears and hugs, but we forged a friendship during an incredibly stressful time over the rythmic sound of electric pumps!
If you have a friend or family member who has just given birth prematurely and you’d like to encourage them as they undertake expressing for their tiny baby, may I suggest a little gift pack you could put together for them. Include a drink bottle, some milk storage bags, some snacks such as muesli bars, almonds, or chocolate, a jar of multivitamins, a notebook and pen, a small handtowel, some nice hand cream and offer them your freezer space!
Marian
Milky Mums is a community organisation established to provide support to Mums who are breastfeeding or expressing for premature and seriously ill babies in Australian neonatal intensive care units (NICUs).  Learn more about our work at www.milkymums.org.au
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