Breastfeeding more than one baby

2. Breastfeeding more than one baby

3. Mothers can makeEnough Milk for two babies, and even three

4. The key factors arenot milk production,buttime, support from health careproviders, family, & friends.

5. • Encourage the mother to:- Get help with:Caring for other children Doing household duties,.

6. - Breastfeed lying down to conserve energy, - Eat a varied diet and take care of herself,- Try to spend time alone with each of the babies so that she can get to know themindividually.

7. • A mother of twins may prefer to feed each baby separately:concentrate on the positioning and attachment. The mother can feed them together if she wishes to reduce feeding time.

8. If one baby isa good feeder andone babyless active

9. make sure to alternate breastsso that the milk production remains high in both breasts. The baby who feeds lesseffectively may benefit from breastfeeding at the same time as the baby who feedsmore effectively, thereby stimulating the oxytocin reflex.

10. INFLUENCING FACTORS • Maternal Age • Multiple births are more frequent among women in their thirties and forties. • Infertility Treatments • Approximately 35% of multiple pregnancies result from infertility treatments(drugs and in vitro fertilization ,IVF)-dizygotic multiples • Maternal Weight • Women with a pre-pregnancy Body Mass Index (BMI) of 30 or greater are at a significantly increased risk of conceiving dizygotic multiples.

11. Risk factors of Multiples • Perinatal Death • Preterm Birth • The average length of pregnancy is • Singleton, 38.8 weeks • Twins , 35-36 weeks • Triplets, 33 weeks • Quadruplets,29 weeks • Intrauterine growth restriction (IUGR) • Low Birth weight • The average birth weight for each multiple birth baby is approximately: • Twins 2,500 grams (5-l/2 pounds) • Triplets 1,800 grams (4 pounds) • Quadruplets 1,400 grams (3 pounds)

12. Risk factors of Multiples • Increased incidence of congenital or pregnancy –related anomalies • Increased incidence of infant mortality rate • Singleton, 6 per 1000 • Twins , 29 per 1000 • Triplets, 65 per 1000 • Quadruplets, 107 per 1000 births. • Mother problems

13. Deciding to breastfeed Like most mothers, you would like for your babies to receive your milk because you are aware of the special health benefits of breastfeeding. Breastfeeding Is BEST

14. Mothers can makeEnough Milk(EXCLUSIVE BREASTFEEDING)for two babies, and even three without the need for supplementation.

15. Breastfeeding more than one baby • The key factors are not milk production, but • Time, • Support & encouragement from: • health care providers, • family, • friends. • Maternal Nutritional management.

16. Securing support for your decision to breastfeed • First, • inform your husband, support person or helper, and your health care professionals as early as possible inyour pregnancy that you plan to breastfeed. • Second, • ask your health care professional to refer you to a breastfeeding specialist, such as the lactation consultant who is affiliated with the hospital where you will give birth.

17. Planning ahead You can avoid some of the problems that lead to a low milk supply if you know what to expect and make some plans.

18. Some of the problems that lead to a low milk supply • Some twins and most triplets and quadruplets are bornprematurelyand may not suckle strongly enough or regularly enough in the early days after birth to stimulate their mother’s breasts to make an ample milk supply. • Mothers may not feel well for 24 to 48 hours after delivery, when breast stimulation is so important, this is especially true if the mother had pregnancy related problems resulting in: • long periods of bed rest, • medications to treat blood pressure, • premature labor, • cesarean delivery. As a result, milk production and removal might be delayed.

19. Making enough milk • It is important • to start breastfeeding (during 1st hr)or • expressing(during 6 st hr) your milk right after giving birth • Recent studies have shown that a woman’s milk volume is determined mainly by the amount of milk that is removed from the breasts, rather than by a mother’s ability to “make” milk. • Mothers with an established milk supply were asked to use a breast pump in addition to feeding their babies.

20. Alternating breasts among babies • It's a good idea to switch babiesfrom one side to the other at alternate feedings. • Once both babies empty the breast effectively, you do not need to alternatebreasts and babies.

21. Twins Position(Two at Once) • Double Cradle(crisscross) • Double clutch or Football • Combination • Babies at Side • Cross Cradle Hold • Cradle and Football • Parallel • Other

22. Alternate between being first and second feeders (triplets) 1st Feeding 2st Feeding 3st Feeding 3 from two breast 2 from two breast 1 from two breast

23. Foremilk and hindmilk Ensure that each baby is fed a mixture of foremilk and hindmilk and receives adequate fat and calories to grow well.

24. Co-bedding of twins in a single crib appears to improve synchronous sleep for babies and assist in sleep near parent without increasing sleep related stimulation risk (ball,2006)

25. Feeding • Direct breastfeeding, supportive assistant • (partner, relative, fried, etc for positioning and holding infant) • Compensatory milk expression per self or caregiver • (at least 8 times or >100 min/24h)

26. Kangaroo care (KC) • Foster earlier initiation of feeding, • Facilitate milk production, • Decrease infant crying, • Increase breastfeeding duration, and • Enhance parent self confidence…. KC of multiples may take various forms: separate, sequential, or shared

27. Supplements • When milk insufficiency persists and standard measures to increase production are ineffective, a galactogogue (e.g., domperidonemaleate, metoclopramide) or rotation of galactogogues, including herbal galactogogues such as fenugreek (Trigonellafoenum-graecum) may be useful. • Use of pasteurized human donor milk • Use of BMS should be limited to situations where it is medically indicated.

28. Use of pasteurized human donor milk would be appropriate when: • The mother’s milk production is insufficient, especially when the infants are preterm, an intolerance to BMS exists, or an infectious disease is present. • Prevention and treatment of necrotizing enterocolitis. • The mother’s milk is deemed temporarily unsafe for the infants (e.g., specific maternal medications or infections).

29. A Word About Supplements(Formula and Bottle) • Parents need to be aware of the association between supplementation with BMS and negative breastfeeding outcomes. • Use of BMS is associated with shorter duration of breastfeeding multiples. • It may decrease your milk supply. • Your babies may have a difficult time switching from bottle back to breast. • Formula-feeding carries with it a higher risk of allergy and disease.

30. Numerous factors influencing Breastfeeding success with multiple birth • Positive maternal attitude and commitment, • A breastfeeding support system, • Early breastfeeding initiation, • Frequent suckling (and/or breast milk expression), • On-demand or modified-demand feeding, • Adequate home support/child care, • Maternal health, • Avoidance of BMS use, and • Luck.

31. What You Can Do • Bring food when you visit. • Change the babies. • Give her a back rub or a foot massage while she nurses the babies. • Bring her water or juice. • Watch the babies while she sleeps. • If a baby needs to nurse in the middle of the night, change him, then bring him to the mother while she is in bed. When the next baby wakes up, switch them. • Watch the babies while she takes a 15 minute walk or a bubble bath. • Listen if she is feeling scared, tired, or overwhelmed. • Hold her if she needs to cry. • Do laundry, fold the clothes, and put them away in the dresser. • Prepare lunch or dinner and serve it to her. • Tell her you love her. • Bring over current magazines, catalogues, or video tapes. • Help her find another mother of twins to talk to. • Clean up the kitchen, do dishes, vacuum, pick up. • Tell her what a good job she's doing with her babies.