Effective Breastfeeding It takes time to learn to recognize and adapt to the different, yet normal, approaches of two, three, four, or more babies. Many of the questions LLL Leaders get from worried mothers of multiples are about perceived rather than actual breastfeeding problems. Understanding how enough milk is produced, what infant behaviors and feeding patterns are considered normal, and how to coordinate multiples' multiple breastfeedings may increase your confidence during the early learning period with your newborns. Establishing and Maintaining Lactation Making Enough Milk for Two, Three, or More When you are lactating, or producing milk, demand for the product (your milk) determines the amount made. Milk is produced within each breast in cells that cluster to form numerous balloon-shaped alveoli. One such cluster is called an alveolus. Milk is made in these cells from nutrients taken from your blood and then secreted into the lumen of the alveoli, which may be likened to the inside of a balloon. The milk stored in these lumen empties into small milk ducts, which in turn empty into larger ducts that transport milk to even larger mammary ducts before widening into what are called the lactiferous, or milk, sinuses lying just beneath the areola. There are about 15 to 25 lactiferous sinuses that open at the nipple tip. It is through these openings, or nipple pores, that milk is released during the milk-ejection, or let-down, reflex. This occurs when the hormone oxytocin causes muscle cells around alveoli to contract, forcing milk stored in alveolar lumen into the ducts and eventually out through nipple pores. When a baby breastfeeds effectively, the breasts are "told" to produce more milk in two different ways. First the hormone prolactin is released, which stimulates the alveolar cells to make milk. Also, the removal of available milk from the alveolar lumen signals the milk-making cells of that alveolus to increase production. An alveolus is essentially a milk-making factory and the lumen its warehouse. When the milk is removed from this "warehouse" through breastfeeding, biochemical messengers inform the "factory" that the product is in demand and to step up production. On the other hand if milk builds up in the warehouse because of infrequent breastfeedings or from a baby's ineffective sucking, messengers let the factory know that demand for the product is down and the factory slows production. If no milk is removed for several days, the alveoli "factory" begins to close down.. When multiple newborns breastfeed effectively, they kick the factory into high gear. The more often multiple babies breastfeed, the more milk the "factory" makes. The "factory" usually can produce enough for all multiples as long as their mother trusts her babies by putting them to breast whenever they "ask" to feed, or she expresses her milk frequently when one or more is not yet feeding effectively or is not yet able to breastfeed. Chapter 12 Coordinating Feedings The breastfeeding "learning period" lasts longer with multiples for both babies and mother. It takes about four to six weeks for a mother with a single newborn to learn how she and her baby work best together as a breastfeeding couple. Don't be concerned if it feels as though you and your babies still need learner permits at four to six months! When you have double, triple, or quadruple the number of babies, it only makes sense that it may take at least double, triple, or quadruple the time to learn to work as two or more breastfeeding couples. Coordinating breastfeedings for multiples is easy-virtually anything will work. You will be amazed at the adaptability of your fantastic female body! As long as each baby latches on and sucks well, all you have to do is respond to each one's feeding cues by offering a breast on cue. Feeding Rotation Mothers of multiples tend to use some variation of three different feeding rotations. Some initiate and continue breastfeeding and never change how they rotate their multiples at the breast. Many begin using one "plan" but try a different one as babies grow and milk production adapts. Since almost anything works, work out a rotation plan that suits you and meets your babies' needs. Alternate babies and breasts every feeding. For instance, Baby A (and C) begins feeding on the right breast, and Baby B (and D) begins on the left. The opposite, or second, breast is offered when any baby indicates interest after self-detaching from the first even when another multiple will or already has fed on the opposite side. For the next feeding, Baby A (and C) begins on the left breast and Baby B (and D) begins on the right. If Baby A fed from both breasts before Baby B fed at all, Baby B probably will cue to feed first at the subsequent feeding. Likewise, quads C and D are likely to wake first for the next feeding. A variation of this plan is to offer the fullest breast to the first to wake or cue for a feeding. Mothers of odd-numbered multiples, such as triplets or quintuplets often continue to use some variation of this plan until their babies wean. Many mothers use a variation of this plan for the first few weeks after birth, especially if one or all babies do not breastfeed effectively and when one or more usually wants to feed at both breasts. Once lactation (milk production) is well established, multiples sometimes overfeed when offered both breasts during a single feeding. When this occurs, mothers often change rotation plans to make it easier to keep track of who ate where and when. Alternate babies and breasts every 24 hours. Feed Baby A (and C) on the right breast and Baby B (and D) on the left today, and switch who feeds on which breast tomorrow. Most mothers like this plan because each baby affects milk production in both breasts, yet it is easy to keep track of who ate where and when. Mothers with triplets sometimes adapt the plan by rotating breasts and babies every eight to twelve hours. Assign a specific breast to each of even-numbered multiples. Each breast then adapts to that multiple's intake. Although this plan may sound the least complicated, and it has worked well for many mothers, it can have drawbacks. You could end up with a lop-sided chest measurement for a few months if the babies' food intakes greatly differ! This problem is merely cosmetic when both babies are gaining weight adequately, but it may reflect decreased milk production in one breast if any multiple breastfeeds ineffectively. And once used to a particular breast, some babies later refused to feed from both breasts when another was unable or unwilling to breastfeed for a period of time, such as when one multiple had a nursing strike. If assigning each baby a breast works best for you, alternate feeding positions occasionally so that your babies' eyes receive stimulation similar to feeding from both breasts. Feeding Routine vs. Schedule Unrestricted, "on cue," or "demand" breastfeeding is best during the early weeks after birth. Always responding to the babies' feeding cues by offering the breast helps establish sufficient milk production for multiples. Respecting multiples' cues can help you develop a sense of each baby as an individual with a distinct feeding pattern and sleep-wake cycle. Also, putting babies off in an effort to lengthen the time between feedings and develop a schedule can result in insufficient milk production and fussy babies who may not gain weight. Mothers of identical multiples are more likely to report that their babies fall into the same or very similar feeding routines without their help. This makes sense since body clocks have a genetic component. When body clocks have babies awake and hungry at about the same times, simultaneous feedings really help out. (See next section.) Fraternal multiples may develop very similar or very different routines, since they may share as much as 75 percent of the same genetic material or as little as 25 percent. If your babies fall into the "different" category, you may find it saves time if you can wake one and feed him along with the other. Or you might want to breastfeed one alone, then wake and feed another. Some mothers combine unrestricted, or demand, feeding with these more "scheduled" feedings. One mother may feed "on cue" during the night, but wake one to feed with or after another during the day. Another mother might feed on demand during the day and wake both at once during the night. The part of the day when babies are fed on cue and the part that is more scheduled are optional depending on what works best for an individual mother and her babies.* There are pros and cons when possibly disrupting a baby's body clock. On one hand feeding babies together or one after another may give you some time for yourself and other family members, but it also means you are always dealing with at least two babies at once-which can seem overwhelming. And on the other hand, opportunities to hold one baby and look into his face are luxuries to be enjoyed, yet it means you are caring constantly for a baby because one wakes just after another falls asleep. You may also miss the baby ready to lengthen time between feedings during the day or at night. Some babies seem perfectly willing to be awakened to eat with or just after another. Others will have nothing to do with manipulation of their natural routines. Some may be willing during early infancy yet balk as they get older. And of course, others cannot tolerate "scheduled" feedings when tiny but several weeks or months later they think it's a grand idea. Give yourself and the babies a break when trying to manipulate feeding routines isn't working. You only create extra work and feel more frustration when you persist. You can always try again later. Simultaneous-"Twogether"-Feedings Feeding two multiples at once saves time and often tears when two are hungry or need attention at once. A few mothers simultaneously breastfeed for every feeding to save time or because babies want to feed at about the same time. Some mothers always feed multiples separately. They may enjoy the individual time with each baby, find it easier to manage, or have babies with very different routines. Most mothers combine simultaneous and separate feedings. As with other aspects of breastfeeding, the beauty of feeding multiples simultaneously is in the adaptability to meet your babies' changing needs. There is some evidence that mothers make more milk when multiples breastfeed simultaneously. However, many mothers have breastfed multiples individually for all, or most, feedings and made more than enough milk to completely feed all of them. The important issue in feeding multiples is to allow unrestricted breastfeeding by responding to each baby's cues to breastfeed at least eight to twelve times daily. Your babies will have as much to "say" about any decision to breastfeed two of them together as you do. Some babies latch on quite well from birth. Others continue to need help for several weeks or months, which makes it more difficult to physically manage simultaneous feedings. Some babies seem to resist simultaneous feedings, yet other multiples have refused to breastfeed unless they could hear or touch another feeding on the opposite breast. You may need time to feel comfortable and able to coordinate one alone before feeding two at once. If simultaneous feeding is not practical during one period of infancy, try it again when the babies can latch on with little or no extra help and have gained more head control. Simultaneous feedings are very helpful if you have multiples that are awake and hungry at about the same time. It is difficult to enjoy feeding Baby A if Baby B is breaking your heart with cries of hunger. Of course, you then may feel guilty as you feed Baby B because you rushed poor Baby A through her feeding. When simultaneous breastfeeding isn't yet possible but two (or more) are hungry at the same time, mothers usually rotate babies onto and off the breast every few minutes until everyone is satisfied. Also, it often helps to at least touch a crying baby while feeding another. (See Chapter 18, "Enhancing Individuality," for ideas.) Whether you choose to breastfeed multiples simultaneously because two are hungry or because it makes life easier to wake one with another, don't worry that you aren't spending individual time with each baby. You can interact with only one baby at a time, anyway. Make eye contact with one and spend a few minutes talking to that baby. Then do the same with the other. Actually simultaneous feedings can help you get to know each baby because you don't feel as though you are rushing one to get to another. And it probably will be months before the babies realize or care that someone else is around the bend and feeding on the other breast. chapter 25 Older Siblings of Multiples The life of an older child is turned upside down when multiples join the family. The free arm that would have been able to hug an older child when caring for one new baby now holds a second baby. Mother is occupied with babies around the clock, which means she isn't getting much rest-which means her level of patience probably is lower. Sleep deprivation can lead to a build-up of tension. Everyday child-related occurrences that once were considered only mildly annoying may now loom as major catastrophes. The spilled milk that used to be a minor aggravation may produce tears in a mother coping with the needs of multiple infants and an older child or two. Fitting in a clean-up time may seem too much to add in an already overfull day. The older child who accidentally tipped the milk glass may wonder what happened to the "old" mother who would never "cry over spilt milk." Multiples are instant celebrities, attracting attention wherever they go. Older sister and brothers are often completely ignored. It can be very difficult to watch an older sibling's face as the minutes tick by and the person gushing over the babies never even thinks to acknowledge an older child. Many mothers of multiples say the hardest thing for them to deal with is the anguish they feel because of the abrupt changes in the lives of their older children. You probably wish you still had the same amount of time to devote to your older children. But you don't. That can't be changed. When you feel sad for an older child, it can help to remember the firm foundation you've already developed with each. As an infant, each older child never had to share you as multiples always will. Each multiple now needs that same time and attention with you to develop a similar foundation. Meanwhile, the older children may surprise you with how well they adapt. Mothers of older multiples often report that not only do the older siblings survive, they often develop self-confidence by having to learn to clean up that spilled milk for themselves. Of course, an older child still needs your help while adjusting to life with multiple siblings. And you will have more time for all your children as the months go by. In the meantime, there are ways to provide attention and ease the period of adjustment. * You do not need any free hands to say to an older child, "I love you." Say it often throughout every day. * Five minutes of time when an older child needs it is often more beneficial than an hour when it is convenient for you. There usually is time for hugs and kisses even when you can't sit and hold a child for a long period. * No matter who now performs the bedtime ritual with an older child, make time to give each a brief backrub before the child falls asleep. It helps the two of you reconnect, which is important on days when a child managed to spill five glasses of milk, or you've said "wait a minute" (and a minute turned into five or ten or twenty minutes) a hundred times. It's a hands-on "I love you." It says that in spite of any mischief-making or loss of time and attention, you care-a lot. * Your husband becomes even more indispensable to an older child and to you. As an older child depends more on him for time and attention, don't be surprised to see the bond between dad and that older child grow stronger. You probably will enjoy your time with the babies more when you know dad and an older child are enjoying time together. * An overnight or weekend vacation with grandparents, relatives, or special friends often allows an older child to enjoy time as the center of attention again. These quick trips also take some responsibility off your shoulders for a day or two. However, the older child's age and stage of development should be considered. One toddler or preschool child might feel "big" going away for the weekend, but another may be able to handle only a few hours away. It may not be a good idea to "push" such visits when a child's behavior indicates feelings of being "shut out." The idea can always be brought up again later. * Once the babies develop a dependable naptime, ask your husband, friend, or relative, or hire a babysitter to stay in the house with them while they sleep. This allows you to take an older child somewhere special. An outing may be as exciting as a trip to the zoo or as simple as a walk around the block. Another option is to have a friend take the babies for a walk, so you can read a story or sit in a rocker with an older child without interruption. In either case, take advantage of the opportunity to talk with your older child. If you have more than one older child, there may be times when you take all of them on an outing while the "poor" babies have to stay home and sleep. You may also want to take turns taking only one older child somewhere. Most mothers have children take turns for some outings and take everyone on others. Outing time may be limited when the multiples' naps or calm periods are brief. Fortunately, most toddler through school-age children aren't clock-watchers. The older child is only aware of being on a special outing and having your undivided attention-whether for 15 minutes or a couple of hours. Downplay the fact that family outings may occur less frequently for awhile. It is harder to get up and go with two or more babies. Yet an older child might come to resent the babies if you blame them for any curtailment in social activities. Simply say, "I'm sorry, but we can't go. Maybe we can go some other time." This sounds much different than, "I'm sorry, but we can't go now because of your baby sisters. Maybe we can go when they get bigger."

From At the Root of this Longing - Reconciling a Spiritual Hunger and a Feminist Thirst,
by Carol Lee Flinders 
 

Initially, I don't think I framed my vacillations over nurturance and womanhood in terms of feminism. The closest I came to doing so was when I was wavering over whether to include in the introduction to Laurel's Kitchen a glimpse of South Indian village life: "Every evening, as the sun set, one of the women of our family would light an oil lamp, and as she carried it out to the veranda, everyone would look up in quiet delight to see her soft black eyes and warm brown skin glowing above the polished brass lamp. The beauty of this simple ritual made unforgettable the words Granny used to repeat time and time again: "Be a lamp in your home, my daughters - be a lamp to everyone around you." I knew very well that images of this sort were under severe scrutiny by feminist critics. I knew how double-edged and dangerous to women the "angel in the house" motif was that poet Conventry Patmore had made so popular in Victorian life and thought. I knew it had required women to stay in their houses and be angels precisely so that men could raise hell everywhere else; that it imposed a superhuman purity on women that was in some way supposed to offset the incorrigible naughtiness of their empire-building male counterparts; that by defining women as caregivers to the exclusion of all else, it barred them from becoming proficient in any other area of life and blinded them to the terrible iniquities of the colonial policies that had built and over furnished the houses they maintained. I knew some of the appalling effects of this kind of arrangement can have on women's life, and I knew enough about other cultures, including India's, to know that this pattern of cruelly unfair expectations is not limited to British or American family structures. I knew all of that, and I thought hard about the decision. But finally I did include this cameo glimpse of Kerala womanhood because... I think because I knew that if I had tried to explain my reservations to the Kerala women in question (and in fact I had met a half dozen of them), they would have shaken their heads in disbelief and laughed and laughed and laughed. I didn't know exactly what it was, but I was pretty certain these women had hold of something that was still eluding Western feminist analysis.