This is a question I’ve gotten several times, and the full answer is a long one that brings up a lot of emotions.
Before the babies were born this was my biggest source of anxiety. Logistically, I just didn’t know how it would work to feed three babies. I searched message boards, watched videos, read books and got tips from other moms of multiples. I knew that it would be difficult and time consuming but I also knew that the benefits were great. It was (and is) very important to me that the babies get as much breast milk as possible. Now that they’re here and the questions and hypothetical situations have become realities, what works is for me to pump and give the babies expressed breast milk in bottles. It makes the most sense to explain it from the beginning, so here goes…
Since the babies were 7 weeks early they were taken immediately to the NICU after they were born. I spent the first two hours immediately after they were born in a recovery room. Obviously this is a little different experience than the typical one in which your baby is immediately placed on your chest and you can start nursing and bonding right away. After a long two hours in the recovery room I got wheeled up (still in bed) to the NICU to meet the little ones.
I spent just a few minutes with each of them—only getting to touch their hands briefly—before being taken to my post-partum room where I waited for another hour or so for a lactation consultant to come by with a breast pump. The lactation consultant I had met with the weekend before they were born said that I would need to start pumping within 1-2 hours of them being born. I wonder if the doctors don’t communicate to the lactation consultants how long it is before moms are actually in their rooms and able to pump after having a c-section. I received great care at our hospital but this was one of several frustrating inconsistencies.
I knew not to expect too much milk at first based on my reading, but it really is SUCH a small amount that comes out that first day. The nurse gave us 5mL syringes to try and get any of the milk into to take to the babies but there wasn’t even enough to pull into the syringe the first few times. I continued to pump every 2-3 hours round the clock and by the time I got discharged from the hospital I think I may have started to get about 10 mL or so each time I pumped. Justin dutifully delivered any milk I did get to the NICU for the babies. I’m not sure exactly how much they got at each feeding that early on, but I think it was only an ounce (3o mL) max. The babies were still not big enough or strong enough to attempt to take any feeds by mouth, so they were given all the breast milk I could make and then given formula for the rest through their feeding tubes.
I rented the hospital grade pump to take home with me when I was discharged. I think a lot of people had the misconception of us getting to sleep while the babies were in the hospital, but I still had to pump every 3 hours whether they were home or not. Thank God for Hulu to keep me company at 2am while I was pumping. When I went to the hospital to be with the babies I would pump there in a small private area specifically for NICU moms. I hated getting up to the NICU just in time to have to go off and pump instead of being with the babies. Once they were moved to the Special Care Nursery our family had our own private room so I was able to pump there which was a whole lot easier. It took a couple of weeks but I finally started making enough for the babies to be getting almost all breast milk for their feeds. They were still only taking about 1.5 ounces each every 3 hours. I worked so hard for every drop (literally) of breast milk and remember my heart dropping out of my chest one night when I spilled about 30 mL (just an ounce) all over the floor. At that point that equaled an entire feed for one of them.
Being up by myself in the middle of the night pumping for these babies who I felt I hardly knew was one of the most difficult periods I’ve experienced so far as a parent. It gave me a lot of time to think about all of the things I had always thought I’d experience as a new mom that I didn’t get to…holding them right away, staring at them without any other thoughts or concerns in the world, being alone with just them and Justin…we weren’t truly alone as a family for 5 weeks. That part isn’t something I thought about much before, but when I reflect on it I can’t believe how long that took. Five weeks before it was just us with our babies. This was something I had taken for granted before having preemies and something I mourned the loss of during their time in the hospital.
I had always imagined that I would have an intense flood of emotion and deep connection with my babies right away just like you hear so many moms talk about, but that didn’t happen for me. I knew I loved my babies, but I felt far away from them. It wasn’t until we brought them home that I was really able to start bonding with them and feel the closeness that I had been longing for.
When the babies were around 2 weeks old they were able to start attempting to eat by mouth. Since I had planned to breastfeed, the hospital waited to give them bottle feeds for the first 72 hours. During that time I tried to be at the hospital for as many feeds a day as I could. My c-section recovery was a little longer than normal due to how long I was on bed rest and an infection in my uterus that developed after the surgery, so I didn’t spend as much time at the hospital as I felt I should have. I spent 30 minutes with each baby at each feeding teaching them to latch. They say you lose all modesty when you have a baby, which is true. You definitely lose it if you’re the nursing mom of a preemie. Every day and night shift there were different nurses for five weeks, all of whom saw me every time I awkwardly lifted my shirt for them to place my babies—still tethered to their monitors—on my chest. Breastfeeding all three babies in a row was completely exhausting. After I finished with all three I had to pump, which left maybe an hour long break until the next feed started. This is when the idea of them coming home terrified me. How could I possibly do this? They were so small that they weren’t strong enough to get more than 5-10 mL (a third of an ounce) after 30 minutes of trying, so after they spent time breastfeeding they would still get the rest of their feed through their NG tubes.
Here’s Quinn ready to eat! One day in the special care nursery she just ripped her tube right out of her face and didn’t even flinch. I think she was giving us a sign that she was ready to come home.
After the first 72 hours of them attempting to breastfeed they started getting bottles for any of the feeds that I couldn’t be there for or when I was there and just too tired to try breastfeeding. They took to the bottles really well. I continued to breastfeed when I could and they all got better at it. They latched well and the amount they were able to take increased, slowly but surely. Here is the part that, prior to having the babies, I didn’t realize would have such an effect on breastfeeding: in order for them to come home, they had to be able to take all feeds (8 per day) by mouth for 48 consecutive hours. Based on the amounts they were getting from breastfeeding, it would have taken many many more weeks than it did for them to be able to come home. They were rocking the bottles from the get go, so once they started finishing around 5 or 6 bottles per day I stopped attempting to breastfeed altogether so that they had more opportunities to finish bottles and come home. My plan was to start breastfeeding again once they got home, hoping that they wouldn’t forget how to do it.
Here’s a shot of Justin burping Zoey after the first bottle he ever gave her. Can’t believe how much she looks like a little old man!
Once we brought them home there were several things that kept me from starting to breast feed again. My main concern was with how to know if they were getting enough food. I know a lot of people say that as long as they have regular wet and dirty diapers and are gaining weight that’s how you know, but with preemies I feel its a different story. I knew based on the times I breastfed in the hospital that they weren’t strong enough to get an entire feed that way, so I would have to feed them with a bottle too, but I wouldn’t know how much to give them. They would also be exhausted after breastfeeding and not have the energy to take the rest of what they needed from a bottle. Premature babies aren’t like full-term newborns who will wake up when they’re hungry. These little babies have to expend so much energy to eat that they’ll sleep right through feeds unless you wake them up. With my breast milk being such a commodity for three babies I didn’t want to risk wasting a lot in a bottle that they wouldn’t drink much of. I didn’t feel comfortable waiting two weeks until their pediatrician visit to find out if they were eating enough based on weight gain, especially with them being preemies and weighing only about 5 lbs when we brought them home.
The other main reason was scheduling. Since I would have to give them a bottle after breastfeeding to complete their feed, it would take at least an extra 15 minutes for each of them, throwing off everyone’s eating times and decreasing the amount of time I had between feeds down to nothing. And most moms of singletons say it may take them up to an hour just to get one baby to finish eating at the breast. There just aren’t enough hours in the day to do that with three. And I would still need to pump even with them breastfeeding in order to place enough demand on my body for it to know to produce enough milk for three. Giving them bottles of expressed milk allows me to not have to do every single feed by myself. Justin and my mom and mother-in-law all help with feeds every day which gives me the chance to actually sleep, shower and eat throughout the day, which I think most would agree, is really a must for anyone. Its amazing how much a shower can change your outlook for the day.
Our daily schedule spreadsheet from the first week home:
I felt pretty guilty about not trying for the first few weeks, but I’ve just had to make myself get over it. There are three of them. Its different than trying to feed one. I’m not a bad mom because of it. Having enough for all their feeds was very short-lived as their intake increased. Before they were born I heard time and time again “Your body will make enough for the demand.” If I were actually putting them all to the breast then it probably would, but even with pumping every 3 hours for 45 minutes at a time, I’m not making quite enough for everyone. The kids are getting as much breast milk as I can make, which nowadays is ending up being about half of their bottles at each feed (the other half is formula).
This is a sample of feeds for half a day when we first came home. They’re all drinking about an ounce or so more than this now at each feed.
We’ve actually been on a wild goose chase trying to find formula that works for Mr. Fancy Pants Oliver. A few weeks ago we started seeing blood in his stool so we took him into the pediatrician right away and she said that he most likely has a milk-protein allergy. So, I’ve been dairy-free for the last several weeks to try and help the little guy out. We noticed very quickly that he was less fussy once the dairy was out of my milk and he was on a special non-dairy formula. After he started having some normal dirty diapers again our doctor said I could reintroduce dairy as a test to see if that’s what was really causing the blood. I had one (delicious) white chocolate mocha from Starbucks and just a couple of days later the blood was back. I’m glad to know that it is almost definitely an issue we can attribute to an allergy but boy do I miss my milk (a.k.a. Starbucks, every baked good ever and cheese, alas). The latest news in Mr. O’s tummy troubles is a $70 per can formula that, thank God, is covered by insurance. The plan is to have him on that exclusively until the blood clears up and then start giving him breast milk again.
So, that’s my very very long answer to how breastfeeding is going. The short answer, and the only thing that really matters is: they’re getting breast milk and they’re getting fat and happy.