Author and La Leche League Leader Karen Kerkhoff Gromada

Karen Kerkhoff Gromada recently released a third revised edition of her book Mothering Multiples: Breastfeeding and Caring for Twins or More! Ms. Gromada is a long-time La Leche League leader, registered nurse and lactation consultant. In addition to writing Mothering Multiples she co-authored Keys to Parenting Twins, Keys to Parenting Multiples, and Care of the Multiple-Birth Family: Postpartum through Infancy.

B123: What are some of the significant changes and additions you made to this revised edition?

KKG: Hmm, there have been revisions to just about everything – every chapter includes some changes and updates. Amazing how the science of lactation and “standard” practices can change in a few years. And I’m always learning new things or new thinking from the mothers of twins and triplets (MOT/T) in our Cincinnati La Leche League (LLL) Multiples group and from MOT/T in online groups to which I belong. The section on preterm babies has been expanded as have chapters on nighttime mothering, partial breastfeeding, and fussy babies. The chapter on fussy babies includes more about GERD, lactose overload, sensory integration, etc. Finally, key points for each chapter have now been added at the end of the chapter, so the busy MOT/T can easily find the nitty-gritty when there is not enough time to read more!

B123: Tell us a little about your experience mothering multiples.

KKG: My monozygotic (identical) sons were our 3rd and 4th children. Their older sister was 5 and their older brother was 3 within a couple of weeks of their birth. My husband was a medical resident then, so I was on my own a lot. He was “on call,” meaning he was at the hospital from 7 a.m., through the night, to 5 p.m. the next evening every 3rd day; every 3rd weekend he’d leave Friday at 7 a.m. and return Monday evening.

I was lucky because I carried the boys to 40 weeks, 5 days gestation – almost unheard of today. A (Tony) weighed 6 lbs. 6 oz. and B (Joey) weighed 7 lbs. 11 oz. – 14 lbs. 1 oz. total. They roomed in from birth and were fully breastfed their first 6.5 months – usually gaining 2-3 pounds per month. Because of latching issues, it took 2-3 months before we got the hang of simultaneous nursing. But once we all figured it out, almost all daytime feeds were simultaneous because they usually wanted to eat at the same time. Lucky me – they usually woke on alternate hours during the night. We had a crib in our room and I played musical beds, rotating the one who woke to nurse with the sleeping one I’d drifted off with while breastfeeding an hour or so earlier.

Breastfeeding was the easiest part of mothering my twins! (I honestly cannot even imagine the work involved in feeding multiples any other way! Breastfeeding may take a bit longer for babies and mother to learn, but once learned it is sooo easy!) My sons were high-need babies, needing lots of contact. We lived in our rocking chair. But I felt lots of guilt about my older two children, whose lives changed so quickly, and about the babies because I couldn’t always meet one or the other’s needs as quickly as I had with my singletons….

I won’t even go into toddlerhood, which I thought was the most difficult period because of all they constantly got into – when they weren’t pushing, biting, or punching each other! But there’s a reason for the last few chapters in Mothering Multiples, and it isn’t because I’m the only MOT who found this a difficult phase!

B123: What bit of parenting or breastfeeding wisdom have you learned in your work with mothers of multiples that mothers of singletons might find helpful too?

KKG: Lots of bits. My LLL co-leader and I may do a presentation on this very topic this summer. Perhaps the most important thing is that some/partial breastfeeding truly is better than no breastfeeding – and that partial breastfeeding can work but it still has to work within principles of lactation physiology.

B123: What’s your top tip for breastfeeding multiples? What’s your favorite piece of mothering advice?

KKG: No fair asking for a “top tip” – but I guess it would be to hang in and keep breastfeeding (or pumping if both are preterm/near-term or either has difficulty). Unless a baby has an underlying physical problem, tincture of time, skin-to-skin mother-baby contact and a realistic method for supplementing that reinforces breastfeeding oral behaviors almost always leads to effective breastfeeding for all babies. It IS worth it – although it may be difficult to believe that when stuck in the middle of it!

B123: Is there a particular product (breast pump, nursing pillow) etc. that you routinely recommend to mothers of multiples?

KKG: LOL, mothers have been breastfeeding multiples for tens of thousands of years without today’s equipment. Today, everyone is convinced they need fancy-dancy equipment to breastfeed. I never pumped but occasionally hand expressed so I’d have “relief” milk in the fridge. Nursing pillows weren’t around 2-3 decades ago – yet we survived! So no, there isn’t a particular product I recommend. However, for babies who are preterm or near-term and not yet able to effectively breastfeed (remove milk from breast to GI system), I highly recommend an appropriate pump — an appropriate pump for this situation is a rental (let me repeat – rental), hospital-grade, electric, self-cycling breast pump that is used at least 8 times in 24 hours. If using a nursing pillow, a mother will get more for her money if she gets one that can be used for breastfeeding one or two at once. To breastfeed two most MOT/T suggest using a pillow with a wider and deeper “shelf” all the way around side-to-side, e.g. the EZ-2-Nurse.

B123: In your work as a La Leche League Leader and lactation consultant you’ve counseled thousands of mothers of multiples. What advice can you give to other breastfeeding counselors who have mothers of multiples come to them for help? Are there some key points to keep in mind when helping a mother of multiples?

KKG: Women breastfeeding twins or more deserve the best possible start, but they’re the least likely to get it. In addition to the increased likelihood of preterm/near-term birth, mothers are more likely to be affected by pregnancy or birth complications. Breastfeeding counselors of any kind often underestimate the impact of transitioning two or more preterm/near-term newborns to breast while still caring for them otherwise and recuperating from a more complicated pregnancy and birth. Helping strategies need to take into consideration the total situation. Strategies that make more sense for a woman with a single infant may overwhelm the mother with multiple newborns. Don’t lose long-term breastfeeding because of bias toward unrealistic (for MOT) interventions. (I’ve also found that strategies that work for MOT/T also tend to work for breastfeeding difficulties with singletons!)

B123: I’m assuming you’ve counseled some women who conceived multiples through advanced reproductive technology. I had a woman tell me that her reproductive specialist warned her she’d have trouble breastfeeding (why a doctor would sabotage a mother that way I don’t know). A recent study also indicated that mothers who conceived through IVF (whether or not they conceived multiples) need extra breastfeeding support. What are your thoughts on that? Are you aware of any data about assisted reproduction and breastfeeding success?

KKG: Probably most of the MOT/T I’m in contact with have been through fertility treatment. Most of these moms do great with pumping/breastfeeding IF pumping eight or more times in 24 hours, or babies are allowed to feed “on cue” vs. feed based on some ambiguous schedule. (Many organizations for parents of multiples seem to “push” more rigid scheduling instead of accepting that babies are babies no matter how many arrive at one time.) Inadequate milk removal, especially a concern in the first several weeks when lactation is being established, still leads as the top reason for insufficient production. There’s a perception that needing help to conceive means breastfeeding/lactation will be problematic, but that’s not necessarily so. The hormones that support conception are different than those that support lactation.

One condition that’s associated with fertility issues and insufficient lactation probably is polycystic ovarian syndrome (PCOS). Addressing some aspects of that condition often improves milk production. Thyroid conditions can also affect fertility and milk production.

Multiples are two, three, more times the usual number of babies no matter how they were conceived, but parents who were “blessed” with multiples via fertility treatment often believe they aren’t “allowed” to feel overwhelmed, negative, etc. when babies’ care is 24/7.

B123: Thanks for taking the time to speak with Breastfeeding 1-2-3! Is there anything else you’d like to share?

KKG: Breastfeeding multiples is not always easy but it’s always worthwhile. And once you’ve hung in and breastfed multiples, you know you can do anything (if you want and put your mind to it)!

I try to always be available to MOT/T via phone, email (kgromada@fuse.net), etc. and I’m a member of the Yahoo group AP Multiples as well as check LLLI’s mother-to-mother forums for mothers breastfeeding multiples. There are links to these groups in addition to FAQ, photos, articles, etc. via my web site: www.karengromada.com.

Beyond that there’s tons to share – so many tidbits, so little time or space! Heck, I can talk on this topic for hours – and probably days! Speaking of speaking, I love to do so! Info is available on my page at the LactSpeak site: http://lactspeak.com/speakers/KarenGromada/.

Thanks for having me here!

B123: Thanks again Karen! For more discussion of breastfeeding multiples, click here.