I was having ultrasounds twice weekly because the doctors were very worried about twin-to-twin transfusion syndrome, a dangerous complication that happens sometimes with identical twins.  I drove to one of my Thursday ultrasounds, thinking that it would be more of the same: they are still different in size and very small, so you should lay around and do nothing all day.  Instead, they took a very long time to do the ultrasound, and when the doctor came in afterwards to give me the report, the first thing he said was, “So we have you scheduled for a c-section at 7:30 tomorrow morning.”  I was shocked!  I was only 35 weeks pregnant, and not feeling ready for the twins to be born.  But they had measured the blood flow from the placenta, and felt that Baby B, the smaller twin, was not getting enough oxygen and nutrients.  So it was time for them to come out.  Both babies were breech, and the doctors refused to allow me to even attempt a vaginal birth.  They told me that at 35 weeks, the babies should be healthy enough to come  home within a few days, and that “they might have to spend a day or two in the NICU, but it’s no big deal.”  I can’t believe they told me that!  And I can’t believe I bought it!

So the next morning, Jonah and Owen were born by C-section at 8:17 and 8:18 in the morning.  They were not breathing very well, so the nurses whisked them off to the NICU with nothing more than a quick wave to me.  My husband went off with them, and I was sent up to recovery.  It was so strange to be in the labor and delivery ward of the hospital with no babies.  I could hear babies crying in neighboring rooms, and I ached to be holding my two little ones.  When I went to see them in the NICU, they had their faces covered (for minimal stimulation), and were positively covered in wires and tubes and monitors.  We were not allowed to touch them or even talk to them above a whisper that first day, and the news just kept getting worse and worse.  I will never forget the moment when the doctor said to me about Owen, “Well, we don’t have many more tricks up our sleeve.  If he doesn’t respond to the Nitric, we’re going to have to call Boston.”  Both babies had severe respiratory distress syndrome, and they didn’t respond to hardly any of the treatments for the first 24 hours.

Meanwhile, I was pumping and trying to build my supply so that I could nurse them when they were strong enough.  At first, we were adamant that they not have pacifiers or bottles, but when the nurses said that bottle-fed babies go home sooner, I gave in.  It was two days before they even were able to have the first drops of colostrum swabbed on their gums.  Slowly, they started to be able to take little bits of my milk from a bottle nipple, once they were off the ventilators.  It was five days before we got to hold Jonah, the stronger of the two.  I kept asking when I could nurse them, but the nurses told me that it would make their oxygen levels drop, and they had to be on a certain type of ventilator, and all kinds of other excuses. 

I had plenty of milk, and I was pumping every 3 hours around the clock to build a supply for my little guys.  The hospital finally told me to store it at home in our freezer because theirs was full! 

But we still weren’t nursing.  Jonah was in the hospital for 2 weeks, and I nursed him 3 times before he came home.  Owen was in for 3 weeks, and I only nursed him once while he was there.   Once Jonah came home, we worked really hard to get him latched on and nursing.  He was getting stronger every day, but it was so hard to nurse him (he would nurse for an hour every feeding), then offer him a bottle of milk so that we could be sure he was getting enough, then pump so we would have milk to offer.  And I tried to go to the hospital every day to visit Owen, who was still there.  It was insanity! 

And it only got crazier when Owen finally came home.  We nursed every single feeding because I was so determined to get them on the breast.  And it was the same routine: nurse, bottle, pump.  All day and all night.  Owen had to have some special high-calorie formula that we mixed with breastmilk instead of water, because he wasn’t gaining weight very well. 

And when Owen came home, I started having excruciating nipple pain.  It felt like broken glass was coming out of my breasts at every feeding.  My husband would come home and find me nursing the boys and sobbing.  I started taking painkillers just to be able to feed them, because I refused to switch to formula.  Our doula told us that it was almost definitely thrush, so I went and got checked out by my doctor.  She told me that the boys’ latch looked good, and it probably was thrush, but she wouldn’t treat me unless their pediatrician also treated them.  Their pediatrician then told me that he wouldn’t treat them unless I was also being treated.  It took me three days to finally convince them that someone had to write the prescription first.  And so we all took nystatin, which did nothing for two weeks.   Then, my doctor switched me to Diflucan, and we used gentian violet along with it.  And, even though everything in our house was purple for a week from the gentian violet, it worked! 

We had four glorious, pain-free days of nursing before the pain returned.  And so I went nuts.  I read everything I could get my hands on about yeast.  I became the Hygiene Nazi, treating everything that touched breastmilk as though it were toxic waste.  We put vinegar on everything, and used grapefruit seed extract and gentian violet, and many courses of Diflucan.  Nothing worked. 

So I was in immense pain all the time, but we finally did get the boys solely on the breast, with no bottles at all.  What a triumph!  I wish I remembered more of it, but I spent so much time in a haze of pain that it all seems like such a blur to me.

Finally, six weeks after the pain returned, a lactation consultant at the support group I was going to said, “maybe it’s not yeast.”  The thought had never occurred to me (or, apparently, to my doctor).  So I went to the doctor and insisted that she culture my breastmilk, although she didn’t think it was necessary.  It’s a good thing we did, because it turned out that I didn’t have yeast at all; instead, I had a raging staph infection in my nipples. 

She put me on dicloxacillin, which didn’t make me feel better and gave me an allergic reaction.  When I told the doctor that I was still having pain, she told me she was just going to prescribe another course of Diflucan, because it was probably just yeast from the antibiotics.  I would not take any more meds without being cultured, so I insisted that they wait and do another culture.  And it’s a good thing, because it turned out that the staph was MRSA, a medicine-resistant form of staph. 

The doctor put me on Levaquin, another antibiotic that the culture indicated would work, but told me that I couldn’t nurse while I was on it.  And then told me that I could.  I asked our pediatrician who told me it was fine, and then another doctor in his practice said it was absolutely not.  I kept asking doctors, and kept getting conflicting answers.  Finally, I decided that I wouldn’t risk the health of my two boys who had already been so sick, and I decided that I would formula feed them for the fourteen days while I was medicated, and just pump.  I had to go stay with my parents so that they could help with the logistics of managing and feeding two babies and pumping.  After 24 hours of having the boys reject the bottles and then, finally, gulp down the formula and spit it all back up, I decided that I couldn’t do it.  I did a lot more research, and found some information saying that it was probably all right for me to nurse while I was on the Levaquin.  I still was wary of it, so I decided to nurse every other feeding, so at least they would still get the benefits of breastmilk, and any harmful effects from the medicine would be limited.  It was a disaster.  They had a lot of trouble keeping the formula down, and my supply dropped because the pump was not getting as much as the babies normally did. 

But the medicine was working!  By the end of the fourteen-day course, I was pain-free again.  And once I was done with it, I started nursing the boys for every feeding again, and trying desperately to build my milk supply back up. 

Unfortunately, the pain came back after only four days.  I had another two cultures done, because I wanted to make sure we were treating the right problem.  I was afraid that we had yeast again from the antibiotics.  But both cultures came back negative.  I was at my wits’ end.  I couldn’t understand why I was still in so much pain.  I went to my doctor, who told me that she just couldn’t understand it either.  She said that our latch looked good, so I probably just needed some time to heal up.  She told me to pump and bottle feed the boys for a week to let myself heal.  “No nursing for at least a week!”, she told me.  This didn’t sound quite right to me, but I didn’t know what else to do, so I tried it.  Again, it was a disaster.  My breasts no longer would let down for the pump.  I would pump for 20 minutes and get only an ounce of milk.  Needless to say, my supply plummeted.  We had to supplement the boys with formula, which they again had trouble keeping down.  I went against my doctor’s advice and nursed them once a day, in the evening, just to make sure they would go back to the breast after a week. 

After 4 days, they rejected the breast completely.  Every time I tried to nurse them, they would scream as if they were being terribly hurt.  It was horrible.  They had decided that the bottle was much easier, and they didn’t want to nurse anymore.  I stopped all bottles immediately, and we cup-fed them to make sure they were getting enough to eat.  They still refused the breast, and cried all day and all night.

I was completely at the end of my rope.  Friends and family were telling me to just give up and switch to formula, but I felt like I didn’t know how to be a mom without nursing.  It was so important to me, and I felt like Jonah and Owen really needed it, that I refused to quit.  I cried and cried and spent hours and hours researching on the internet.  Finally, even though we didn’t have the money, I bit the bullet and paid for a private lactation consultant to come out to the house and consult with us. 

She will forever be an angel in my mind.  In the space of about 15 minutes, she had diagnosed and then fixed our latch problem.  I felt so foolish that I had been ‘doing it wrong’ for four months!  As for the nipple confusion, she said to just keep doing what we were doing, and that now that they had a better latch, it would be easier for them to get milk from the breast.  Within a few days, my supply was back up, the boys were nursing like pros, and I was pain-free!  I can’t believe it was so easy after all that pain.  I had been told by two other lactation consultants, my doctor, and the boys’ pediatrician that our latch was very good. 

It was beautiful to nurse without having it make my toes curl in pain!  I was thrilled, but the boys were not happy babies.  They were covered in rashes, and spitting up constantly, and too uncomfortable to sleep, ever.  We were all exhausted, and I did more research.  Although my doctor told me that what I ate wouldn’t affect the boys, I thought that something I ate might be bothering them.  I cut dairy out of my diet for two weeks, and they got much better, and then worse again.  I decided to do the Dr. Sears total elimination diet.

So for two weeks, I ate nothing but rice, millet, summer squash, turkey, sweet potatoes, and pears.  I was ridiculously hungry and lost a twenty pounds, but it helped a lot.  The boys’ rashes disappeared, they stopped spitting up entirely, and they started sleeping longer stretches at night.  They seemed much happier. 

After a couple of months, we figured out that they were reacting to dairy and soy in my diet, which explains why they always had so much trouble with the cows’ milk formula. So now I eat anything but dairy and soy. Now that the boys are a year old, I am able to eat a little bit of cheese once in a while.

One day, when the boys were 7 months old, I noticed that my nipples were getting sore again.  We had started nursing in some new positions, so I just monitored their latches closely, hoping it would go away.  It didn’t, and one day I woke up to find that one of my breasts was red and hot.  I had had this for months before, and I figured it would go away, but later that day I started to feel hot and really tired.  Before long, I had chills and was in really bad shape.  I figured out that I had mastitis, and was put on antibiotics.  Within a day, I was feeling better and I thought that was the end of it.  Unfortunately, I had it again as soon as the antibiotics ran out.  The same thing happened twice more, and I ended up with three courses of antibiotics within 8 weeks.  I was sick from the antibiotics and worried about taking to many meds, especially because I was also on Diflucan so that I wouldn’t get thrush from all of the antibiotics.  The fourth time that I woke up with a red breast, I decided to give it 24 hours and see what happened, as long as I didn’t get a fever.  I kept a heat pad on my breast all day and after every feeding I swabbed my nipple with grapefruit seed extract, let it dry, and applied Bactrim and a clean nursing pad.  After 24 hours, the inflammation was gone!  

Still, five months later, this happens about once a week, but it always goes away with heat and super hygiene.  I had given up on it until recently, when a friend sent me a video about something called inflammatory breast cancer.  I was scared into getting some answers, and will be seeing a breast health specialist this month and getting a mammogram and an ultrasound.  So far, no one has been able to give me any answers, but I’m hopeful that we will figure this out.

Our nursing relationship has been worth every bit of trouble.  It has been amazing to watch my boys grow from two tiny, sick, skinny babies into happy, healthy, chubby mama’s boys.  They will be a year old this month, and they are complete milk monsters.  Their first baby sign was the sign for milk.  They don’t even know what to do with a bottle.  Aside from the disastrous (and, thankfully, occasional) formula, they were exclusively breastfed for 7 months, when they started solid foods. 

I think we have made it this far on sheer determination, but I hope the next year will be easier; my initial goal was a year of nursing, but now I think we’ll do two!

Although I was fit and healthy, being a 38 year old first time mum having twins, I had some difficulties in the pregnancy. I was nauseous for nearly five months, frequently had high blood pressure, put on 22kg and was the size of a house. But the babies were healthy and I would merrily have carried them to term until the doctor discovered that I had ‘placenta praevia’. This is where the placenta, or in my case, placentas, are so low that they are blocking the babies’ exit. If I had gone into labour naturally, we would all probably have ruptured and died so the doctor rightly decided I needed to have an early caesarean to avoid this, and I was booked in at 37 weeks.

Because of where the placenta was, he would also have to cut through it to get to the babies, in a very very fast procedure, so I had to have a general anaesthetic instead of a routine epidural. I also had the very bad luck of having a severe post-partum haemorrhage, losing over two litres of blood, and in quite a scary hospital room emergency scene, with ten doctors rushing into the room, being pumped full of several different drugs to stop the bleeding and eventually having to have an extremely painful ‘manual evacuation’ which involved the doctor brutally pushing on my newly stitched wound to try to empty the uterus of blood so that it could clamp down and stop the bleeding. This is apparently rare, happening to women only a few times in our city each year, and had I not been in a hospital, I would probably not be here today, so I still feel very lucky.

So instead of my blissful and effortless breastfeeding expectations, I was a weak wreck recovering from a major trauma with two premature tube-fed babies in the special care nursery, drowsy from the general anaesthetic they got.

My hospital days were a weary blur of expressing every three hours, resting, and trying to get my sleepy little girls to feed, with little success, but we still tried at every feed before filling their tummies with formula via the tube. I began expressing on my second day and was very proud of my few millilitres of colostrum that I got each time. But after a fortnight in the nursery, I was advised that I should teach the babies to drink from bottles so that I could take them home, and we did.

Our next three months was an unhappy quest to get the girls to breastfeed. My body was desperately trying to replace the blood I’d lost, because despite two blood transfusions I was still only at half my red blood cell count. So its priority was not to make milk. I was physically exhausted because of this, and also the regime of expressing every three hours, including through the night. Nearly every health professional I saw during this time gave me a brochure on post-natal depression, and I had to keep telling them that I wasn’t depressed, I was just exhausted and a little frustrated. Through all this, my little girls were happy, healthy, growing well and just adorable, and I loved them dearly.

It would have been easier to just give up but I knew that breastmilk was so important for their brain and immune development, and I hoped that by keeping up the expressing I would slowly build up my very tiny supply. I also knew that I needed to have milk if I was ever going to get them to take the breast, which we were still trying continuously. I was very proud of the 30 or 40 millilitres I could give each of them each feed, topped up straight afterward with formula, a small percentage compared with what most healthy women can express, and it took me fifteen minutes at the pump to get even that.

During this three months we tried umpteen lactation consultants, the community maternal health nurses and day stay sessions, lots of friends with breastfeeding experience, visits from Australian Breastfeeding Association counsellors, baths, supply lines, nipple shields, massage, fenugreek, waiting for their mouths to grow a bit bigger (I had large nipples according to one consultant), offering the breast before, during and after formula feeds, and heat packs. Sarah did suckle for a few minutes a few times but we could not get her to do it again. And Emma always cried and cried. Without the support of my husband and our parents, especially my mum who came and helped me every weekday afternoon for a few hours, I don’t think I would have been able to cope at all.

I kept hoping that if I could only get them to suckle, then they would stimulate me to make all the milk they needed and then we could get rid of all the work involved in feeding twins formula (that’s washing, filling, heating sixteen bottles each day, plus another ten or so with the precious expressed breastmilk), not to mention getting up three times a night to trudge to the kitchen and wait for the water to boil and then the bottles to heat up while a hungry bub screams in the background, rather than just attaching to the breast. So together with knowing the benefits for the babies, I was motivated to continue trying. Like all expressing women, I became best friends with my wheezy electric pump, and quite fond of early morning radio while expressing at 2 or 3am. Let me tell you, the shows are quite different at that time of day. It’s amazing who’s still awake then.

It was finally at a five day stay at our local breastfeeding stay-in centre, when the girls were three and a half months old, that I was advised to give up trying, give up the night expressing to get more rest, and just express lots during the day to get some breastmilk for the girls’ health. My brain was very much relieved but I was heartbroken.

Because I wasn’t expressing during the night anymore, my supply slowly dropped over the next few moths until I was extracting only a teaspoonful each time, but it was the most amazing creamy yellow milk, looking just like colostrum again. So what one of the lovely nurses at my five day stay had told me was right, that my body knew it was still providing milk for my babies, and although it couldn’t manage much volume of milk, it was packing all of the goodness, vitamins and brain chemicals into the small amount I was expressing.

I was sad again on the day I finally ran dry, when my twin girls were five and a half months old, and I gave them their last few drops of breastmilk, scraped out of the pump bottle with my finger and popped into their mouths. I still feel sad that I couldn’t feed normally, but nonetheless extremely proud that I got them both five months’ worth of breastmilk anyway.

Funnily enough, they’re now both cheerful three year olds who are obsessed with breastfeeding their teddies, copying the other nursing mums that we see each day. If only they’d been that interested in breasts when they were little.