This is the 40th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.
We are so very pleased to share the first of a two part guest post by Karen Gromada, MSN, RN, IBCLC, FILCA, on Booby Traps for moms of multiples (click here for part II). Karen is the author of the classic Mothering Multiples, and is recognized as a leading expert on breastfeeding twins (and more).
While a lot has been written about nursing multiples, we haven’t seen a comprehensive explanation of the barriers moms face. So we think this post will be a classic!
Booby Traps for Mothers of Multiples
Women expecting multiples report a desire to breastfeed at rates as great or greater than
those having a single baby. More than 70% say they plan to breastfeed. And if women find all kinds of Booby Traps hidden along the road when breastfeeding a single newborn, the woman planning to breastfeed two, three or more newborns steps onto a minefield! Here are a few of the typical booby traps mothers of multiples face.
Prenatal Booby Traps
Prenatal Booby Traps include both institutional and cultural ones. Often there is overlap, such as the healthcare professionals, family members, friends, members of a parents of multiples club or total strangers who seem compelled to say, “Breastfeed twins (triplets, quadruplets, etc.)? That’s a nice idea but…
- “You’d have to be crazy to do that!”
- “It will be too hard on you.”
- “It’s not worth the hassle.”
- “You can’t make enough milk for two (three, four, etc.) babies.”
- “You can’t breastfeed twins (or more) exclusively, so why even try?”
- “You’ll need to supplement or you’ll never get any sleep.”
- (Yada, yada ad nauseum!)
These comments are often accompanied by a patronizing rolling or winking of the eyes, giving the impression the person is adding, “Yeah, sure you’ll breastfeed twins (or more), ha, ha.”
Actually, many, and perhaps most, mothers can exclusively breastfeed twins or more whether their breasts are small or large. The issue is often more one of enough hours in the day for cue-based feedings than the body’s ability to produce enough. And there may be a bit more of a learning curve when breastfeeding two or more newborns, especially if they are preterm or small for gestational age but, once working as a breastfeeding team, nothing could be easier, more convenient or more restful. Breastfeeding means spending more time with the babies rather than investing time in shopping/purchasing, cleaning equipment, preparing (sometimes different artificial baby milks for different babies), heating, storing, etc. – and for an inferior product!
When obstetric healthcare providers approach multiple pregnancy as a disease and treat all expectant mothers of multiples in a “one size fits all” manner, it reinforces a notion that one’s body doesn’t work right, especially for women whose multiples are the result of assisted reproductive technology. It also may trigger a cascade of medical interventions that can contribute to a delay in initiating breastfeeding or milk expression with multiple newborns.
Hospital Booby Traps
Hospital Booby Traps occur more often with early breastfeeding because multiples are more likely to be born preterm and small for gestational age. Mothers are somewhat more likely to experience certain complications, such as pregnancy-induced hypertension (PIH, also known as pre-eclampsia) or postpartum hemorrhage. So babies are more likely to require special care and mothers may receive medication or treatments that interfere with early breastfeeding.
However, institutional Booby Traps may also occur as the result of “one size fits all” multiple birth care. More than half of twins and almost 100% of triplets and higher multiples are delivered surgically; some of these deliveries are not related to a complication but are performed electively, “in case a complication develops.” Even in uncomplicated twin or triplet pregnancies, induction or elective cesarean is often “pushed” by late preterm or early term gestation. Then early mother-babies skin contact and breastfeeding (or milk expression) within the first hour get lost – often unnecessarily – within the “drama” of a multiple birth.
Institutional and cultural booby traps bombard the breastfeeding mother of multiples
during early and later postpartum. Mothers report pressure to supplement from postpartum staff or family and friends before they ever leave the hospital – no matter how each baby is breastfeeding. In addition to NICU booby traps already cited, some NICUs still place multiples in different areas rather than close together in the same area. Also, staggered discharge of one baby before the other(s) affects frequency of breastfeeding or pumping for each baby. Poor post-discharge support includes failure to develop realistic plans for continued milk expression and of transition babies to breast once home and coping with the needs of two or more young babies.
The Booby Traps continue when (or once) each baby is breastfeeding well. Feeling exhausted? Feeling overwhelmed? Having a low-confidence day? Rather than praise the mother for how well she is doing and point out that most of her feelings are related to having more than the usual number of babies, everyone from the pediatrician to family, friends, parents of multiples club members and total strangers rarely hesitate to provide an “out” for the mother of multiples by suggesting she supplement with formula or introduce some early solid food. (A personal “favorite” is the pediatrician who says, “Hey, don’t feel bad. I’ve never had a mother who could exclusively breastfeed twins [or triplets, etc.].” Really? I wonder why this pediatrician doesn’t see exclusively breastfed multiples after voicing that kind of self-fulfilling prophecy concept!)
Breastfeeding Support Booby Traps
On the other side of the booby trap coin is the breastfeeding advocate who fails to recognize that breastfeeding (or breastmilk-feeding) two, three or more the usual number of babies is not the same as breastfeeding a single baby. Mothers will tell you that breastfeeding multiples is more than the mechanics of latch or observing for signs of effective milk transfer during suckling. It’s also the logistics of juggling more than one newborn when two (or more) are crying at the same time! It’s the exhaustion of week after week of no more than an hour or two of uninterrupted sleep. It’s a feeling of being overwhelmed when giving more than 100% yet feeling as if no one’s needs are being met.
Mothers of multiples report they’ve been told by lactation consultants or counselors and peer supporters or leaders who have never breastfeed multiples themselves that “You may not have enough milk for two (three, more) unless you…
- “Always breastfeed two at once.”
- “Always assign each a particular breast,” or “Never assign each a particular breast!”
- “Pump after every feeding (even when babies are term and breastfeeding well).”
- “Pump every 2 hours for 20 minutes (for preterm multiples).”
- “Sure, a nice personal double pump is as good as a hospital-grade rental pump once your milk ‘comes in.’”
- “Use a tube at breast (finger-feed, syringe-feed, etc.) for any supplements. If you give a bottle, the babies will get nipple confused and then have trouble latching.”
How demoralizing! Many of these “rules” don’t take into account the research evidence about milk production nor do they acknowledge the physical and emotional toll of caring for multiple (often preterm) newborns and figuring out the differences in their individual needs. Mothers of multiples need strategies for breastfeeding and expressing milk that are based in their current reality. Whether for physical or psychosocial reasons, some mothers may also need strategies for offering occasional or regular supplements of mom’s milk, or possibly artificial infant milk, if they are to continue to breastfeed (or pump). Also, different strategies work for different breastfeeding “teams” – there is no one way to breastfeed multiples.
This concludes the first part in this two-part post on Booby Traps for Moms of Multiples.
In the second part of this post, Karen will discuss Peer Booby Traps, how Moms Booby Trap themselves, and her best advice for How Moms of Multiples can Avoid the Booby Traps.
Are you a mom of multiples? Did you experience any of these Booby Traps? What made a difference for you in breastfeeding your babies?
*Image credit: International Symbol for Breastfeeding, modified for twins tandem nursing by Robby Poore.