Welcome to Triplet's House! : 04/10/12

There are some things normally people take for granted- like having eyes. Only when you don't have them do you realize their value. A new mother's ability to breastfeed her baby is similar to this. When she suddenly finds that she does not have any milk to feed the baby, she feels absolutely inadequate, and feels that she missed a very important phase in her life.

It took a while for me to come to terms with my guilty feeling over formula feeding my babies. I read about Breastfeeding vs Formula in many places, and I was sure I was going to breastfeed. But for a mother of triplets formula feeding may not be a choice she makes, but a necessity. But here I am, voicing my thoughts on the subject, based purely on my experience. I hope this helps at least a few new mothers in alleviating their emotional stress. Probably it is not an issue in societies where formula feeding babies is a way of life, and is not frowned upon. But in our society babies are always breastfed, so a mother feels like a failure when she is unable to breastfeed her baby.

It was always taken for granted for me that I would breastfeed my babies, given the nutrition, the immunity it provides, the bonding that would develop between mother and child, and the sheer pleasure of breastfeeding. That I should think about what to feed my babies long before I actually gave birth was not something I knew. Much later, after I passed all the stages where I could actually make any change, I saw some websites and books where the mothers (especially those of multiples) took the decision to breastfeed and worked towards achieving that. However I hadn't thought about it because I was too preoccupied with making it to the 37th week. And somehow I assumed in my subconscious that I was actually going to be able to breastfeed the threesome, only that they should come out safely.

Then during the 33rd week (20th Jan 2012), the nurses came to me and asked if I was ready to breastfeed physically- because nipples tend to depress while undergoing bed rest. I said I was ready, but after checking the nurses told me that it was not actually enough for babies to suck. So they brought a syringe without a needle, attached its open end to the nipple and sucked it out. It was quite painful when they did it, so I took the syringe and started practicing by sucking them out. Not good enough. Besides, I read that they should start producing milk long before delivery. Mine did not. Then many mothers, many books and many doctors told me that it was not a problem, once baby started sucking, naturally breasts would start producing, they told me. The more they sucked, the more lactation would happen. I certainly hoped so. I had never even considered feeding them anything else for the first six months.

(Wikipedia on breastfeeding, as well as many other wonderful sites give detailed information on the topic- the hormone production, lactation etc. I strongly recommend that all would be mothers, especially of multiples, or pregnant after IVF, or mothers in their 30s, should read it and be informed)

After babies were born, I could see them only on the second day. It is always best to start breastfeeding within an hour of delivery, but for me, they were in the NICU and I was in the room. Nurses asked me to express milk (suck it using pumping machine ad collect the milk, or as in my case use the syringe and collect the milk in a bottle.) and give it at NICU. No luck. I could not get even 10ml of milk. Dr.AG, the neo-natologist who had met us before, advised that I stick with formula and not try to breastfeed. I said I wanted to, so he said OK, try it. He asked the nurses if they got any colostrum from me, and they said not really. I was crestfallen at that moment. I hated the doc, hated the nurses, hated myself, hated all other mothers who could so easily hold their babies the moment they are born and breastfeed till the baby was full. Oh, how jealous I was! I heard stories about triplets' moms who could feed all three till they were full. Here I was, not producing enough to satisfy even one, even partially.

This went on till we were discharged. We got the babies one by one to our room. Doc said I shouldn't force the babies to suck, as sucking a lot and not getting milk would cause the babies to lose weight even more. Also it would frustrate them. The first day after I got my first baby, nobody would allow me to try feeding. The nurses would come every hour and tube feed him through the nose- 5ml of formula in the first couple of days. We were supposed to prepare the formula and keep it ready every hour (the recommended formula was Enfamil). At precisely every hour, baby would wake and start crying. Nurse would come, feed through nose, and he would stop crying and sleep. I would watch helplessly, like the ignorant and inadequate mother I was. I can still feel the frustration of not being able to pick up, cuddle the baby, or feed him. I was also fighting the raging hormones in me, getting depressed every now and then, crying at the silliest things. After the bed rest and all the care I enjoyed, I was suddenly supposed to get up, walk, prepare formula, change diapers, pick up the baby (damn, I have never held a newborn before, let alone a premature, low-birth-weight one) and do everything a normal person does.

The nurses were quite condescending towards me, as I was not even able to hold the baby properly. Also I wanted to be technically correct, and since the doc said the baby should not be overfed but just 5ml per hour, I wouldn't let the nurses feed him more, even when he cried. The nurses were talking among themselves that what a strange mother I was, not giving enough food to the baby. One nurse, who was especially concerned, advised me that it was only right to feed the baby till he stopped crying, whatever the doc said. I wasn't sure, so we limited the milk intake to precisely what was prescribed. And baby sometimes cried even after feeding.(Thankfully the dosage increased everyday and soon he got enough).

Anyway,the first night after we got our first baby in the room (Feb 17th,2012). Doc instructed that only the parents should stay in the room, so my mother left in the evening and Ramesh and I stayed with our baby. Sometime during late evening Ramesh went out to get something, the nurses wouldn't come for another half an hour, I was alone with my baby. Perfect chance. When he started moving in sleep I gently picked him up. That was the first time I was picking him up without assistance. I held him, lay him on my lap and put him to my chest. He tried to latch on, but both of us, especially I, was clumsy. Suddenly there was a knock on the door and I got tensed. Just imagine, having to feed my own baby secretly. (It all seems so silly and immature now. I could have just started feeding as soon as I got him, no matter what anybody says. But on those days it was unthinkable. We were all nervous, scared, praying and grateful that the babies survived and were healthy enough) Anyway when I opened the door it was Ramesh and although he too was telling me not to feed the baby, this time he said he would hold the baby so he can try and latch on. He did latch on and tried sucking, but nothing came I think. It was one of the most beautiful half hour of my life.

And so it went on. Next day the nurses helped with the feeding, but still no milk. We got all three babies, got discharged, came home, still no milk. We continued the formula, now fed through mouth, with the syringe first and later with a gokarna (a bondla) and still later with bottle. I was upset and very angry those days. And helpless. Anybody could feed the babies. That too upset me, but I knew I needed all the help I could get. Me, my husband and parents took turns feeding them. (In fact this made the babies to connect emotionally with the whole family even at a very early age, and how my parents and husband loved feeding them!)

As part of my Prasavaraksha (a post-delivery care for the mother) everyday a lady came to bathe me in the traditional way, and after the bath I ate hot rice with drumstick tree leaves. I had fenugreek, I bought and ate a lot of Lactare- granules containing asparagus, I tried using a breast pump every three hours, but all to no avail. There was some milk, but never enough. Finally I gave in, and the babies were entirely fed on formula.

Once my hormones sort of settled down, I started thinking a bit rationally and concluded thus-

1. It was a mistake to not think about feeding earlier on, a mistake I will never be able to correct, and thus no point in thinking about it anymore.

2. May be I should have started breastfeeding as soon as I got the babies. But then doctors and nurses know more than me, and they all insisted it was not good for the babies to suck and lose energy.

3. May be even after all preparations I might not have produced milk, due to my age,my IVF, medicines I took for OHSS etc.

4. I don't know if this is medically correct- at one time my eldest only was breastfeeding as he had more weight than the younger ones, and after his feeding, he used to throw up frequently. We were careful to burp all the babies after each feeding, and we always held them and laid them on their stomach in such a way that there was no gas formation, still he threw up. And I think it could either be because he sucked and got only air(causing gas) instead of milk, or because of the food I ate(it happened especially when I ate a little sweet, or mango or something out of the regular diet). So it is my understanding that the quality of breast milk, with all the advantages associated with it, depends a lot on the food the mother eats. If she doesn't have a nutritious diet, then may be the milk also will not have all the qualities it is supposed to have. On the other hand, formula has constant supply of nutrition, however inferior to breast milk. I am not recommending formula instead of breast milk, but I am saying that it should not be considered too bad if the baby can have only formula. Besides, by God's grace, my babies were not lacking in their immunity either, as can be seen from the way they were not any more sick than any exclusively breastfed baby.

5. Penelope Leach in 'Babyhood' says a lot about how it is a personal decision whether to breastfeed, how a working mother cannot always do it, how a mother who wishes to breastfeed but cannot due to low milk supply can still bond with the baby while feeding with a bottle (there is a distance factor- a newborn baby can clearly see things at a distance of 25-30 cm only, which is the distance of the mother's face when the baby is breastfeeding), and how it is rewarding for the rest of the family also if they are allowed to participate in the feeding-and-bonding-with-the-baby process. It is wonderful the way she says it, and it was sort of liberating for me.

update on 11/10/2014: I still feel a little sad about the missed opportunity to breastfeed, but now I am clear- it was not a mistake to resort to formula alone. The situation demanded it, and we did a very good job of formula-feeding. They were always fed in bottles sterilized by boiling, they were fed the right amounts at all right times. Sure, the formula is expensive, but even now they are fed that, and not cow's milk, or any other health powder. Enfamil was given till they were a year old, then Nan-Pro was given till they were two and a half. They had Enfagrow for a while, but did not quite like it, so they are continuing Nan-Pro. Now they have formula every morning 150 ml each, evening 240 ml and night just before sleep another 150 ml each.