The logistics of breastfeeding premature twins

One of the first times Jule breastfed her twins.
One of the first times Jule breastfed her twins. Photo: Keith Miller

Yesterday at 4am the now oh so familiar sound of "whoo-phew, whoo-phew, whoo-phew, ..." suddenly changed its tune to "whoo-brrrrrrrrrrrrr-silence". My double breast pump just died.

In the six weeks since I gave birth to my twins, the breast pump has become my constant companion. It does take some of the joy out of breastfeeding but as a mum of premature twins it's absolutely necessary, just as it is for other mums for different reasons.

A breast pump is one of those weird pieces of equipment that you've likely never thought about before and then end up strapped to for hours and hours of your life. When mine broke down in the middle of the night I panicked a bit as I have to express milk every four hours to feed my babies. But thanks to the wonderful mums in the Wellington Multiple Birth Club, all it took was one shout out for help via Facebook and I had a new one by midday.

Bottle top-ups were essential for the twins to go home.
Bottle top-ups were essential for the twins to go home. Photo: Keith Miller

But what is it about using that awful contraption that makes you feel like a prized cow?

For a lot of new mums breastfeeding doesn't come easily. Although it seems like it should be the most natural thing, it's much trickier than just shoving your wee baby on your boob. Breastfeeding premature twins is even more of a challenge.

My two daughters were born at 34 weeks and although they were healthy as they could be, they were too weak to feed directly from the breast. Premature babies need lots of sleep to grow and develop, and they tire easily. So breastfeeding them every couple of hours like you would do with a mature newborn sadly isn't an option.

I found it really tough when my babies finally arrived as all I wanted to do was cuddle them, tell them that they're loved and feed them in the healthiest way I knew how. But for their first days my twins were housed in incubators and I could only touch their tiny hands through the holes in the plastic box. They were fed through through the nose using a nasogastric tube with breast milk that I'd expressed.

After a couple of days the girls moved out of their incubators and I was allowed to try breastfeeding them for the first time. I used a horseshoe-shaped twin breastfeeding pillow so that I could try feeding them both together right from the start. It was the first time since birth that I'd had both of my children in my arms at the same time and looking down at their tiny heads snuggling into me made me feel incredibly happy and very proud. They latched on for all of two minutes and then fell asleep, completely exhausted.

It can be a long journey to  establish breastfeeding properly with premature twins. They just don't have the strength and endurance to feed straight from the boob for more than a few minutes. Even handling them every couple of hours takes it out of them.

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So for the first three weeks I had to express breast milk every three hours around the clock to get my supply going so that I'd have enough milk to feed the girls through their tubes. During their time in NICU, we tried to be there as often as possible so that we could help with their regular feeds - initially every three hours and then every four hours after a couple of weeks.

During the first week I was only allowed to put them on the breast once, and then twice a day. They sucked away for a bit and then happily dozed off while we topped them up through their tubes. At first I thought my poor babies looked so sick with their nasal tubes but after a while I hardly noticed them anymore.

As time went by in NICU they spent longer periods on the breast but still needed their top-ups to flourish and grow. The main thing that kept us from taking our babies home was their inability to feed for themselves.  We weren't allowed to go home while they were still being fed through the nose. And so with the help of the wonderful NICU nurses we started offering H and N expressed breast milk in bottles which they guzzled down with delight.

But wouldn't that set them up for terrible nipple confusion some of you might ask? Of course I was concerned that they might find bottles just too easy and would flat down refuse to feed from the breast now or later on. However, making sure they got the nutrition they needed was simply more important.

About three weeks into our time in NICU, Keith and I eventually started 'rooming in' at the hospital so that I could breastfeed the girls around the clock, still always followed by a bottle top-up.

The whole feeding routine took (and still takes) quite a while. First they nurse, then they get their bottles and then I have to express milk which we'll feed them next time. A whole round of feeding takes the two of us up to 1.5 hours.

We've been at home for almost three weeks now and (so far) life is going remarkably well. I'm incredibly lucky that my wonderful partner was able to take three months off work so we can look after our girls together.

Our life is more or less divided into neat four hour parcels of time and it's hard to get much of anything done in the time between feeds (hence it took me weeks to write this blog post). I still have to express and we top them up with bottles but they're getting better at feeding from the breast all the time. One day soon they'll hopefully be able to get most of their meals straight from the breast and I won't spend so much time strapped to my breast pump.

This is an edited version of Jule Scherer's blog  post.

You can follow Jule's journey through the highs and lows of a twin pregnancy on her way to double mummydom on Facebook and Twitter. Her blogs are also published on Stuff NZ.