Breastfeeding Multiples, Sort Of

August 9, 2013

“OK, it’s time for your babies to get used to nippling as we prepare for breastfeeding,” our neonatologist said matter-of-factly during one of my daily visits to the NICU.

Avery and Lily resting after a feeding

Avery and Lily resting after a feeding

“Really?” I asked, not truly believing we were on the cusp of such a milestone.  She assured me it was indeed time as she wrote the order and then I felt my body get hot and tingly as panic slowly climbed up my back and neck.  “What if I do it wrong?  What if I can’t do it?  How am I supposed to do this?” were just a few of the questions that ran through my mind.

I dreamt of this day from the moment I knew I wanted to be a mother.  The idyllic image of mother and baby experiencing those private, loving moments had been etched in my thoughts and seemed so far away when my girls were born fifteen weeks early; yet here we were.

The doctor stepped out and our nurse Susan tenderly looked at me, sensing my anxiety and said “Don’t worry, it takes time for these little ones.”  And then she turned to Lily’s isolette to change her diaper and remove her onesie, as I readied myself.

My hands shook nervously as I unbuttoned my blouse, still self-conscious about my body, which had changed so drastically during and after pregnancy.  Susan gently handed Lily to me who still seemed so tiny.  Six weeks after her birth, she was just barely 32 weeks and around 3 pounds.  With the boppy nestled around my waist and my back supported, I held Lily gingerly and looked at her as if to say “OK, kiddo, here we go.  I have no clue what I’m supposed to do or what I’m supposed to expect so just bear with me in case I mess up.”

As I held Lily in front me, nowhere near my breast, as Susan seemingly read my thoughts.  She took Lily and said “Here, just like this.  Like you’re cradling a football.”  And she laid Lily on my left side, tucked under my arm.  Lily squirmed a little, moved her head side to side and soon started to make little suckling noises.  Just as I got comfortable with my baby lying comfortably next to me, she unexpectedly latched.  My head shot up as I looked at our nurse and said “Oh my gosh!  Is that right?”  Susan, smiled warmly and said, “Yes.  Try to relax.”  Lily took a couple of sucks, but wasn’t quite strong enough to get any milk.  Relief and joy settled in; my daughter and I had just done our first practice run.

Breastfeeding was so foreign to me.  For the last six weeks my only experience was with a pump every three hours.  Now at least two of my triplets could try actual feedings.  I got comfortable with Lily and Avery nippling for several days until I had a lactation consult to work with me on feeding them, going beyond nippling and helping my girls to get real nutrition, straight from my body!

I was feeling confident and like a “real mom” because “normal moms” breastfeed without any issues, right?

Not quite, as I soon found out.

During my lactation consult, Lily and I were getting into our groove when all her monitors started going off, she went dusky, and her heart rate plummeted.  The lactation nurse gently rocked Lily back and forth and sat her up to stimulate her.

“What happened?” I asked, my voice cracking with fear.

“It looks like she aspirated.  Some of the milk went into her lungs causing her to choke a little.  That’s probably enough for today, let’s let her rest and try again tomorrow” she said with a slight smile.

Both Avery and Lily continued to aspirate at the breast during the ensuing weeks that we still had left in the NICU. That sense of failure took hold of me again as I realized breastfeeding wasn’t an easy thing to do, and in our case, was actually dangerous to my girls.

We tried different holding positions and nipple shields to slow the milk flow and reduce the risk of aspiration.  Nothing worked.  Every time I tried to breastfeed they both aspirated.  As guilty as I felt about giving up on breastfeeding, it was more than I could take to watch my daughters’ heart rate drop and lips turn blue while I was feeding them.  This experience, that I had dreamt about, that was supposed to be so natural and easy, was filling me with anxiety.

My lactation nurses were wonderful. They tried every trick in the book and never made me feel like I had failed.  After a swallow study on both girls it was apparent that they both needed thickened feeds to avoid aspiration.  Unfortunately there was no way to thicken the milk straight from my breast to their mouths.  Breastfeeding just wasn’t going to happen.   The reality of the situation was that in order for them to grow and gain weight they had to take bottles and be tube fed what they weren’t strong enough to take orally.  Their tiny bodies had little endurance to handle the extra work that the bottle feedings required.

During one of my last consultations the lactation nurse said “So Keira, what do you want to do?  You have three special needs babies, two about to come home with NG tubes.  We can keep working with the girls and as they get bigger and their reflexes develop you may still be able to breastfeed.  For now you can keep pumping and feeding them with a bottle and through their tube.  I want you to know there is nothing wrong with that.  Absolutely nothing.”

Every less than perfect feeding session felt like a failed session to me.  Every ounce of milk that was spit up looked like wasted calories.  The underlying fact remained that my girls needed the best nutrition possible and my ever-supportive husband said “It’s going to be OK, Keira.  The tubes ensure that they get what they need to grow and gain weight.  You’ve done a great job pumping and you’re still pumping and that’s the best they could ever get.”

Former 25 weekers now 6

Avery and Lily Today

So my image of tandem breastfeeding two of my three girls was not to be.  It is something I feel robbed of at times. Yet, seeing my now healthy 6 ½ year old daughters tells me that I did the best I could. There is no doubt that they got what they needed to grow into the beautiful children they are today.