We have been dealing with a weight issue pretty much since we found out we were pregnant.
At the beginning, our first couple of ultrasounds yielded healthy heartbeats, but the fetuses were not large or developed enough to be measured for growth. As we neared the halfway mark, though, our ultrasounds indicated the babies were underweight – only in the 12th or 13th percentile for growth.
Now, here we are, 2 1/2 weeks into life with twins, and the pediatrician is telling us the girls are underweight and not catching up fast enough.
First, some hard numbers:
- Birth weight: 5 lbs, 2 oz
- Discharge weight: 4 lbs, 10 oz
- First visit weight (11 days old): 4 lbs, 5 oz
- Birth weight: 4 lbs, 11 oz
- Discharge weight: 4 lbs, 3.5 oz
- First visit weight (11 days old): 4 lbs, 1 oz
And now, some color:
We knew the girls were small, but we were thrilled when they were born at about 5 lbs and at 37 weeks; our chances of being able to bring them home immediately without complications were excellent. We also knew that the girls would lose weight, but then gain it back within about 2 weeks.
Well, when we went to the pediatrician (the girls were 11 days old), they weighed in at their lowest (see above). The pediatrician, who is not our regular doctor, and who has terrible bedside manner and is painfully socially awkward, said, plainly, “That’s not good.”
We felt punched in the gut.
He asked us some questions about how the girls were eating, peeing and pooping – all indicators of healthy babies – and we gave all the right answers.
He had us go to the birthing center at the hospital for a breastfeeding consultation, and after meeting with the much more chill, much more caring nurse/lactation consultant, we came up with a slightly more aggressive feeding plan.
Basically, we have to:
- Feed the girls every 2-3 hours
- Have them at the breast for at least 10 min.
- Supplement them with 5-10 mL of pumped milk every time
I also have to pump for 10 minutes after every feeding.
We were doing most of that, but we weren’t entirely diligent about it. We definitely were good about feeding them every 3 hours, even setting an alarm for the middle of the night, but we weren’t always good about leaving them at the breast for 10 minutes or supplementing them with as much pumped milk.
Plus, Anna is (was) a spit up queen, so we were backing off the hammer with her. If she coughed, got lazy or tired, etc. at the breast, we let her stay off. And sometimes, she got no extra from the stash in the fridge. We also started aggressively burping her and keeping her upright for 20-30 min. after she fed, which helped drastically.
Like I said above, we felt punched in the gut at our last appointment. I do not want to resort to formula, if we can help it. I know supplementing with formula does not mean I am a failure as a mother. But I can’t help but feel a little that way.
I left the appointment pretty weepy, while Christopher came away challenged to stick it to the jerk doctor.
So, we’ve been on our new feeding plan for 5 days now, and it’s going really, really well. We’ve even gone back to feeding the girls at the same time (one on each breast). We’ve had a couple of “monster” sessions, where the girls might be at the breast for 20-30 minutes, then take down 10+ mL of pumped milk. And neither one of them has spit up much.
We’ve also gone back, briefly, to disposable diapers because the girls were sweating so much in their cloth diapers. The disposables have allowed us to better track wet diapers, because they have a color-changing line on the outside (foolproof, eh?). The cloth (especially the fleece) diapers were so absorbent that we couldn’t tell the difference between sweat and potty.
The kicker with all of this? The girls are healthy and beautiful in every other way… Maybe they’re a little small. Maybe they’re a little slow to put on weight. But they are breathing, eating, peeing, pooping, gurgling, burping and wiggling like healthy newborns.
** ** **
Well, our follow-up weight check showed the girls have grown a bit. Anna has put on 3 ounces, while Elise has put on an ounce in the last five days. It’s not the growth that the doctors want – they expect babies to put on about an ounce a day – but it’s something…
(Side note: The pediatrician – our regular one, not the jerky, fill-in one – said both girls are healthy. They simply need to put on weight more rapidly.)
The pediatrician recommended we keep up with our breastfeeding but supplement with preemie formula “a couple of times a day”. The instructions were pretty vague. Christopher and I, naturally, had a lot of questions.
So, as instructed by the nurses and lactation consultants in the birthing center at the hospital, we had a sit-down to discuss our next steps. (They told us that the moment we were urged to introduce formula, we should come see them.)
The big X factor, because the girls are considered late pre-term babies, is whether they are strong enough to get the nutrition they need from the breast and subsequently whether they are stimulating me enough to produce enough for two babies.
So, we were instructed to “pump a feeding,” that is, instead of putting the girls to breast, pumping for about as long as they normally spend there (15 min.) plus the 10 minutes…or a total of 25 minutes. The object was to find out exactly what I am producing.
The answer? Not enough, it turns out. I yielded just shy of an ounce per breast, and I really should be producing 1 1/2 to 2ounces per breast.
Luckily, we had enough stored in the fridge to make two 45 mL (1 1/2 oz) bottles, which we fed them and they took down in about 10 minutes.
The trick now is figuring out how to proceed. I’ve been instructed to pump every hour for 10 minutes to increase stimulation and, hopefully, increase production. I’ll do that until we go to bed tonight, then we’ll proceed with feedings as normal, and then I’ll pump every hour again for a while in the morning.
Christopher and I are basically holding out as long as possible on using formula. If we absolutely need it, we’ll use it, but if we can get by and get the girls the nutrition and satisfaction they need with just breast milk, then we’ll consider it a huge win.
In the meantime, we’ll continue to check in with our lactation consultant, Kim, in the birthing center at the hospital; she has been a doll and such a kind, level-headed person with whom to work – just like several of the nurses up there. She had me call her after I pumped the feeding this afternoon, and she wants me to check in with her again tomorrow. She even texted us her number, so we can check in or call/text with questions. How awesome is that?
So, wish us luck in the next 24-36 hours. Send good vibes and pray these girls fatten up a bit.