Update on p. 5 - Twins are losing weight - help please

[prairiewindmomma]

Fenugreek and Hashimoto’s and nursing: https://lactationlab.com/blogs/the-drop/mothers-with-thyroid-issues-should-be-cautious-in-using-fenugreek-as-a-lactation-aid

I was already on medication and already getting labs every 6 weeks, so I was given the ok to use Mother’s Milk tea, but yes, there is a question about the use of that herb.

[Ellie]

On 3/11/2023 at 10:46 AM, Ann.without.an.e said:

When they first came home from the NICU they were adding NeoSure but I don't think they were tolerating it well. Which makes sense - we are all severely allergic to dairy or severely lactose intolerant. They would spit up so much of it that it seemed counterproductive. So she's just been using breast milk. They can just take it quicker from a bottle since their little bodies are not quite strong enough yet.

The problem is that when they take even breast milk from the bottle, their mother's milk production is not stimulated (even a breast pump mostly doesn't stimulate milk production the way that nursing baby does). So in addition to possible nipple confusion, there won't be as much milk next time they nurse, so they'll be frustrated as well as not getting the calories they need. So eating "quicker" isn't necessarily a good thing.

The longer she continues to supplement, including bottle feeding with breastmilk, the less likely she'll be to continue breastfeeding on a long-term basis.

It's a hard situation for everyone, and the "best" solution is the one where the babies are happy, even if that means she doesn't breastfeed them as long as she wanted to. Any time breastfeeding means success. So while I'm holding a hard line for breastfeeding exclusively, I'm not throwing shade on her. 🙂 I'm just telling you how it is.

And I'm really sad that LLL wasn't much help. In general, I trust LLL over any doctor or other specialist. o_0

[KSera]

3 minutes ago, Ellie said:

The problem is that when they take even breast milk from the bottle, their mother's milk production is not stimulated (even a breast pump mostly doesn't stimulate milk production the way that nursing baby does). So in addition to possible nipple confusion, there won't be as much milk next time they nurse, so they'll be frustrated as well as not getting the calories they need. So eating "quicker" isn't necessarily a good thing.

The longer she continues to supplement, including bottle feeding with breastmilk, the less likely she'll be to continue breastfeeding on a long-term basis.

I get what you're saying, and may have said the same before I had a baby I actually faced this with, but under the circumstances, it sounds like she is on the right track. As long as they are not having nipple confusion issues, and mom is extracting more milk with the pump each day than the babies are getting supplemented with each day, her breasts should continue to make at least that much milk and she will be making more than what is needed. If she had a supply issue, I would be more concerned about her switching to an SNS, and it would still be my first suggestion. They're tiny and need a balance of getting enough calories in without burning too, too much to get them in. They will get bigger and stronger fast and supplements should be able to be slowly decreased and eventually dropped.

Anne--is your dd using an app to track pump output and what they are being supplemented with? I found that very helpful (and it allowed me to obsess over seeing my supply slowly go up and his supplment intake go down). I used "Pumping tracker" which has an easy interface that keeps track of the time for you.

[Ann.without.an.e]

Update:

They have gained a good bit of weight since the LC appt on Thursday. I'm suspicious that they are now being a bit overfed since DD said they both started spitting up a lot on Saturday. They are nursing stronger so I think that might be the case and the ped agreed today. I have a high quality kitchen scale that measures grams. I used it to check a weighted feed using the bottle amount so I would know the accuracy and it was dead on so we have that now. I just rigged a small plastic container to it to hold babies 🙂 

According to that, Nectarine is now taking in almost double what she was in breastmilk at the LC appointment so we are on the right track. I will do a few more weighted feeds today to estimate if we even need to keep supplementing and how much for each baby. 

Nectarine was up to 5 pounds 4.3 ounces and Peach was 5 pounds 6.7. So that is a big increase for Nectarine especially when you consider Wednesday afternoon she was 4 14 and we didn't start supplementing until Thursday late afternoon.

Edited March 13, 2023 by Ann.without.an.e

[Ann.without.an.e]

10 hours ago, Ellie said:

The problem is that when they take even breast milk from the bottle, their mother's milk production is not stimulated (even a breast pump mostly doesn't stimulate milk production the way that nursing baby does). So in addition to possible nipple confusion, there won't be as much milk next time they nurse, so they'll be frustrated as well as not getting the calories they need. So eating "quicker" isn't necessarily a good thing.

The longer she continues to supplement, including bottle feeding with breastmilk, the less likely she'll be to continue breastfeeding on a long-term basis.

It's a hard situation for everyone, and the "best" solution is the one where the babies are happy, even if that means she doesn't breastfeed them as long as she wanted to. Any time breastfeeding means success. So while I'm holding a hard line for breastfeeding exclusively, I'm not throwing shade on her. 🙂 I'm just telling you how it is.

And I'm really sad that LLL wasn't much help. In general, I trust LLL over any doctor or other specialist. o_0

I think all of this is good advice for a full term baby. We are just hearing and learning all around that it really doesn't apply to preemies. Sometimes they just cannot nurse efficiently enough to get what they need at first. 

[BusyMom5]

Amazing!  I think they are going to be just fine, and hopefully this will relieve some stress for your daughter. 

[Ann.without.an.e]

Just now, BusyMom5 said:

Amazing!  I think they are going to be just fine, and hopefully this will relieve some stress for your daughter. 

Yes, she is feeling so much better about it. She was carrying a lot of stress about it all. 

 

[prairiewindmomma]

Yay!!! Are their temps holding steadier also? It’s such a cycle—keeping a preemie warm enough to prevent excess calorie burn, keeping the balance of feedings right so they don’t burn too many calories trying to b-feed, and also getting enough into them so they have the calories to regulate their temperatures and eat. 
 

Well done, but don’t be overly concerned if it’s still kind of a struggle/not able to drop the bottle until they are a week or two past term and over 6 lb. Preemies really are just different.

[Kassia]

Yay!  What a great update.  Doing a happy dance for your dd!  What a relief.  ❤️ 

[LifeLovePassion]

Yippee! (And I think we need pics to see their progress!)

[Eos]

17 minutes ago, LifeLovePassion said:

Yippee! (And I think we need pics to see their progress!)

Second this!  Great news.

[Elizabeth86]

Wonderful news!!

[Arcadia]

1 hour ago, Ann.without.an.e said:

I think all of this is good advice for a full term baby. We are just hearing and learning all around that it really doesn't apply to preemies. Sometimes they just cannot nurse efficiently enough to get what they need at first. 

My SIL with twins exclusively pumped until they could nurse and never had supply issues. Her twins were close to normal birth weight. My other SIL nurse and pump for all her kids (all full term, not twins) and has no supply issues even when she went back to work after two months of maternity leave. Priority is getting “food” in especially with brain’s growing. That’s why very cautious pediatricians would harp on failure to thrive. We changed pediatricians from a very cautious one to a moderate one for our kids. 

[Ann.without.an.e]

1 hour ago, prairiewindmomma said:

Yay!!! Are their temps holding steadier also? It’s such a cycle—keeping a preemie warm enough to prevent excess calorie burn, keeping the balance of feedings right so they don’t burn too many calories trying to b-feed, and also getting enough into them so they have the calories to regulate their temperatures and eat. 
 

Well done, but don’t be overly concerned if it’s still kind of a struggle/not able to drop the bottle until they are a week or two past term and over 6 lb. Preemies really are just different.

Yes, they are doing better with temps too. So far, so good. It is such a tedious cycle with preemies. I really didn't anticipate a month early being this much added work. They were doing amazing inside the womb so a part of me is frustrated that they were induced early but another part of me knows the risks seemed too high to leave them inside. Also, the placenta study showed lacerations in Nectarine's cord and its attachment was abnormal so it is probably a good thing they were induced early. 

Edited March 13, 2023 by Ann.without.an.e

[Arcadia]

10 minutes ago, Ann.without.an.e said:

. It is such a tedious cycle with preemies. I really didn't anticipate a month early being this much added work.

My mom was an NICU nurse and even she needed lots of help until I reached “normal” weight. You and your daughter are doing good. Make sure your daughter gets lots of rest, postpartum care is very important. Asians believe postpartum lack of rest and nutrition can cause health issues later. Of course you should get more rest too.

[KSera]

So glad to hear the good update! Remind me how old they are now? Are those new weights both  back up to birth weight?

[Matryoshka]

2 hours ago, Ann.without.an.e said:

I think all of this is good advice for a full term baby. We are just hearing and learning all around that it really doesn't apply to preemies. Sometimes they just cannot nurse efficiently enough to get what they need at first. 

Yes, so much this.  This is why I said to base everything about 'when will things get better/turn a corner' based on due date, not birth date.  And yes, preemies often need supplementation in a way a full-term baby doesn't, based on a range of issues that are often different for each baby - motor and neurological orgainzation where reflexes and connections kick in that weren't quite 'cooked' yet, lack of fat reserve so they don't have the wiggle to lose a bit like a full term baby does, and also the energy - they can get tired/sleepy before they've emptied the breast - and also just sheer size.  "Put the whole areola in baby's mouth" doesn't work when the baby's mouth is physically not large enough for that to be possible.  A message that supplementation may sabotage long-term nursing goals to a mom of preemies can be extremely counterproductive.  

19 minutes ago, Ann.without.an.e said:

Yes, they are doing better with temps too. So far, so good. It is such a tedious cycle with preemies. I really didn't anticipate a month early being this much added work. They were doing amazing inside the womb so a part of me is frustrated that they were induced early but another part of me knows the risks seemed too high to leave them inside. Also, the placenta study showed lacerations in Nectarine's cord and its attachment was abnormal so it is probably a good thing they were induced early. 

I think it will get better faster from here.  Are they past their due date now?  It's absolutely amazing what a difference those few weeks make.  But you're so right that these babies were high-risk sharing a placenta; it sounds like this is a case where the induction was the right call.

[Ann.without.an.e]

20 minutes ago, KSera said:

So glad to hear the good update! Remind me how old they are now? Are those new weights both  back up to birth weight?

 

8 minutes ago, Matryoshka said:

Yes, so much this.  This is why I said to base everything about 'when will things get better/turn a corner' based on due date, not birth date.  And yes, preemies often need supplementation in a way a full-term baby doesn't, based on a range of issues that are often different for each baby - motor and neurological orgainzation where reflexes and connections kick in that weren't quite 'cooked' yet, lack of fat reserve so they don't have the wiggle to lose a bit like a full term baby does, and also the energy - they can get tired/sleepy before they've emptied the breast - and also just sheer size.  "Put the whole areola in baby's mouth" doesn't work when the baby's mouth is physically not large enough for that to be possible.  A message that supplementation may sabotage long-term nursing goals to a mom of preemies can be extremely counterproductive.  

I think it will get better faster from here.  Are they past their due date now?  It's absolutely amazing what a difference those few weeks make.  But you're so right that these babies were high-risk sharing a placenta; it sounds like this is a case where the induction was the right call.

 

They are almost 3 weeks old and their official due date is this Friday. 
 

They are both up to birth weight now. Nectarine was 5 pounds 3 ounces and Peach was 5 pounds 6 ounces at birth. 
 

They’ve made so much progress with nursing already so I really think we’re almost there. 
 

I’m so thankful for the help and encouragement I’ve gotten here 😊

[Lecka]

This sounds like good progress!

 

My son that got some bottles when he was a newborn (with lack of brown fat) didn’t have nipple confusion.  I think it must not happen with everyone.  
 

 

[Lecka]

Good news!!!!!!

[Faith-manor]

4 hours ago, Ann.without.an.e said:

I think all of this is good advice for a full term baby. We are just hearing and learning all around that it really doesn't apply to preemies. Sometimes they just cannot nurse efficiently enough to get what they need at first. 

This. Our T was 6 weeks early and not strong enough to suckle properly, period. He had to be taught to eat. He had an NG tube for 2.5 weeks before he could take enough by bottle to be weaned off that. He would be dead if breast feeding exclusively was forced on him preemies are very different, and just because they come home from the hospital, that doesn't mean they are now "normal". They aren't full term newborns u til their due dates passes so for T he is only just today 41 weeks. He now acts like and has the strength associated with a term newborn. He is nursing with a nipple shield and is supplemented with bottle and on Wednesday his very tongue tie that prevents him from nursing properly will be taken care of by the pediatric orthodontist. Then he can begin the process of slowly weaning off his bottle.

Dd has worn herself out pumping for that kid. She has a large freezer of milk and is going through the process of being vetted for donation. I swear she could feed a calf! I also think she could make butter with it. 😂

No advice about feeding full term, perfectly healthy newborns applies to preemies, and many people do forget that. 

Edited March 13, 2023 by Faith-manor
Spelling

[Ann.without.an.e]

33 minutes ago, Lecka said:

This sounds like good progress!

 

My son that got some bottles when he was a newborn (with lack of brown fat) didn’t have nipple confusion.  I think it must not happen with everyone.  
 

 

They don’t seem to struggle with nipple confusion. They prefer breast and always seem a little hesitant with the bottle at first and then I push it some and they take it. 

[ktgrok]

It IS startling how much difference a few weeks can make! For so long the prevailing idea in common culture at least  was that once the lungs were ready for birth, that was all that mattered, and the rest was just about size. Now we know (or should know) that those last few weeks are important, and babies born before that for whatever reason are going to need more support (with exceptions I'm sure). Feeding is one of the biggest things - as others said there is the issue of size, plus strength, plus not having any body fat to spare, etc etc. Human babies are born so so so "early" already, compared to most mammals - to cut that even shorter does have impact, as you have seen first hand. I know with my own babies, the one born at 38 weeks had a lot more struggles than the rest who were born between 41w5d and 42 weeks. (I was born at about 43 weeks myself!). He was skinny, uncomfortable constantly, struggled to latch properly, and it was just miserable for both of us for that first month. My others were bigger, ate like champs, slept better, and were just happier with the outside world than he was. He wanted back inside for another few weeks! 

I agree with everyone else, as they hit that due date or a bit beyond (we all know some babies cook longer than others) they will be more like actual infants - which is hard enough! 

Twin mamas are rock stars. Preemie mamas are rock stars. Moms of preemie twins are super heroes! And so are the grandmas that help out!

[Ann.without.an.e]

Since y’all have been so helpful ….

want to see the artwork dd did on their nursery wall? This was well before they were born (she doesn’t have time for this now lol). The first one is fairly large and takes up the upper half of one wall. The last one is small and by the light switch. It is a mix of a children’s book and flowers that have meaning 😉 

 

 

 

 

Edited March 13, 2023 by Ann.without.an.e

[Faith-manor]

13 minutes ago, Ann.without.an.e said:

Since y’all have been so helpful ….

want to see the artwork dd did on their nursery wall? This was well before they were born (she doesn’t have time for this now lol). The first one is fairly large and takes up the upper half of one wall. The last one is small and by the light switch. It is a mix of a children’s book and flowers that have meaning 😉 

 

 

 

 

This is just lovely! A wall of happiness.

[Scarlett]

Awww it is little nut brown hare!

[Kassia]

Just now, Faith-manor said:

This is just lovely! A wall of happiness.

Perfect description! 

She did a beautiful job!  Thank you for sharing.

[Bnogo24]

Wonderful update!!!! Great work by all of you!!

[Ellie]

7 hours ago, Ann.without.an.e said:

Update:

They have gained a good bit of weight since the LC appt on Thursday. I'm suspicious that they are now being a bit overfed since DD said they both started spitting up a lot on Saturday.

They don't spit up because they are "overfed." It is most common for babies to spit up if they have ingested dairy somehow. That includes any dairy their Mom might have ingested. While breastfeeding, it is really important for mothers to avoid all dairy products (which, as it turns out, is a good idea for people with Hashimoto's.).

[Kassia]

5 minutes ago, Ellie said:

They don't spit up because they are "overfed." It is most common for babies to spit up if they have ingested dairy somehow. That includes any dairy their Mom might have ingested. While breastfeeding, it is really important for mothers to avoid all dairy products (which, as it turns out, is a good idea for people with Hashimoto's.).

I do think one reason babies spit up is being overfed but certainly there can be other causes (including problems with dairy).

Edited March 13, 2023 by Kassia

[Ann.without.an.e]

10 minutes ago, Ellie said:

They don't spit up because they are "overfed." It is most common for babies to spit up if they have ingested dairy somehow. That includes any dairy their Mom might have ingested. While breastfeeding, it is really important for mothers to avoid all dairy products (which, as it turns out, is a good idea for people with Hashimoto's.).

DD is anaphylactic allergic to dairy so that’s not an issue but in this case when they are nursing and then we’re practically force feeding more on top of it with pumped milk, yes they absolutely can get over fed and that can lead to spitting up a lot. They don’t love the bottle but they also had to have more calories than they were getting. So we force the issue some. My point was that maybe since they seem to be getting a little more via breast, we need to cut back on what we’re force feeding via bottle.

[Clarita]

First thing I spent 3 weeks exclusively pumping for my first. We just had trouble nursing between him being a newborn and me with my oversupply. After that he nursed great from the breast no nipple confusion ever. Can we just let mom's do what they have to do instead of scaring them with nipple confusion and undersupply? There can be ways to handle nipple confusion and undersupply if those are or become issues.

My babies spit up a lot too sometimes it also has to do with how greedily they suck (like they are taking in a lot of air while they guzzle). That may happen more on the bottle because of the bottle mechanism. I want to say let the professionals, the weight gain, and the babies dictate how much longer to supplement. Honestly I think pretty soon the professionals will tell DD to dial down the supplementing. 

 

[prairiewindmomma]

Heads up, in case you weren’t warned, preemies are more prone to reflux because the sphincter muscle is immature. It can just be over feeding, and it sounds like it is, but if it becomes more of an issue, they generally have you do positioning as the first intervention (keeping them fully upright for 30 min after feeding).

[Ann.without.an.e]

2 minutes ago, prairiewindmomma said:

Heads up, in case you weren’t warned, preemies are more prone to reflux because the sphincter muscle is immature. It can just be over feeding, and it sounds like it is, but if it becomes more of an issue, they generally have you do positioning as the first intervention (keeping them fully upright for 30 min after feeding).

Yes and that my be the case but my thinking on this is they didn’t do it at all until this last weekend? About the same time they were nursing a little better but we’re still force feeding a certain mL of pumped milk into them? If they’d been doing this the whole time then yes, that would be more likely. If my thinking is off please correct me

[prairiewindmomma]

I think your thinking is spot on….which is why I said you are probably right on the overfeeding issue…but also, with Youngest, the reflux really didn’t become a prominent issue until she was home for a week or two. She had had a NG tube until 48 hours before NICU dismissal, and then her feeds were so tiny because of her energy… It was only when she was taking more in by breast that she really had stuff to reflux, iykwim. Reflux wasn’t as issue for us until she was about term.
 

 I mentioned the positioning thing only as a heads up in case this doesn’t sort out naturally soon. Hopefully just cutting back on bottles a bit will be enough! 

[KSera]

2 hours ago, Ellie said:

 While breastfeeding, it is really important for mothers to avoid all dairy products 

There’s no reason for mothers who are not allergic to dairy and whose babies are not allergic to dairy to avoid dairy while breast-feeding. That would create a large barrier to nursing for a lot of women if that was the requirement. Fortunately it’s not. 

[busymama7]

3 hours ago, KSera said:

There’s no reason for mothers who are not allergic to dairy and whose babies are not allergic to dairy to avoid dairy while breast-feeding. That would create a large barrier to nursing for a lot of women if that was the requirement. Fortunately it’s not. 

I agree.  It's important too for allergy and sensitivity reasons for moms to eat everything unless the baby has clear problems with something.  Restrictive diets while breastfeeding cause other issues.  Babies get used to food through breast milk 

[WildflowerMom]

8 hours ago, Ann.without.an.e said:

Since y’all have been so helpful ….

want to see the artwork dd did on their nursery wall? This was well before they were born (she doesn’t have time for this now lol). The first one is fairly large and takes up the upper half of one wall. The last one is small and by the light switch. It is a mix of a children’s book and flowers that have meaning 😉 

 

 

 

 

Guess How Much I Love You was ds' nursery theme 21 years ago!   We had the bunnies on his walls, too!   Oh gosh, good memories.   I'm going to look at photos now!  🥰🥰🥰

 

so glad your 2 dgds are doing better.  💛💛💛

[ktgrok]

Love the artwork! That little snail is my favorite part. 

[Ann.without.an.e]

On 3/13/2023 at 11:00 AM, LifeLovePassion said:

Yippee! (And I think we need pics to see their progress!)

 

On 3/13/2023 at 11:17 AM, Eos said:

Second this!  Great news.

This morning pic 

I love this one because it shows their little personalities. Nectarine often has a little look on her face like she’s up to something? Something mischievous lol. She also studies things and thinks so hard on them. Peach is more sweet and laid back. Just easy going.

Edited March 15, 2023 by Ann.without.an.e

[LifeLovePassion]

So adorable! The one on the right looks a little milk drunk. 

[Ann.without.an.e]

Just now, LifeLovePassion said:

So adorable! The one on the right looks a little milk drunk. 

Her parents say she gets a little more than milk drunk so they call it milk stoned 🤣

[Arcadia]

5 minutes ago, Ann.without.an.e said:

Her parents say she gets a little more than milk drunk so they call it milk stoned 🤣

She sleep with her eyes slightly open in the photo like me. Gave my cousins and aunts a hard time figuring out if I was actually napping or pretending to nap.

[Ann.without.an.e]

Just now, Arcadia said:

She sleep with her eyes slightly open in the photo like me. Gave my cousins and aunts a hard time figuring out if I was actually napping or pretending to nap.

yes yes, she will be the one to keep us on our toes. Even in the womb, she’d dodge the u/s and she’d dodge the non stress tests. It was always “baby B” they were frustrated with. She’s the one I had a hard time tracking while dd was in labor. She was also more active in the womb in general. She’s smaller but feisty 😂. There’s just something about her- - - she’s deep thinking about it all. She will just stare right into your soul with the most inquisitive looks. She also smiles a lot. 
But Peach is my girl. She settles down with me easier. She just loves to snuggle and she’s very chill. Nectarine is a mommy’s girl, so sweet, but I’m pretty she’s trying to figure out how to take over the world 😂
 

[mommyoffive]

OH my gosh the cutest thing. They look so much bigger already.

[Ann.without.an.e]

5 minutes ago, mommyoffive said:

OH my gosh the cutest thing. They look so much bigger already.

We had to retire one of the preemie sleepers today. So sad but also so glad because we aren’t taking growth for granted ❤️

[Kassia]

Oh, they are so so cute!  Thanks so much for sharing - these photos always make me smile.  And that was fast to already retire a sleeper but definitely a good sign.  

[Faith-manor]

Melts my heart! So darn adorable!!! 😍

[El...]

My goodness, they are cute!

[ktgrok]

They are SOOOOOOOOO precious!!!!!