Mothering Multiples: Breastfeeding and Caring for Twins or More! »

Karen Kerkhoff Gromada, MSN, RN, IBCLC, has transformed this La Leche League International bestseller into a comprehensive collection of wisdom for today's new mothers. She offers invaluable information for parents of multiples with an emphasis on breastfeeding and attachment-style parenting and answers such questions as: What are the risks of a multiple pregnancy? What can a mother do to avoid complications and carry her babies to as close to full-term as possible? How can a mother prepare herself and her family for a multiple birth? Is it possible to breastfeed multiples? What does a mother need to know in order to breastfeed more than one baby? What if the babies are born prematurely? Can they still receive their mother's milk? How can a mother continue meeting her babies' needs if one or more experiences an illness or needs to be hospitalized? Are there ways to cope with breastfeeding challenges in one baby while continuing to nurse another baby? What can a mother do to comfort two or more fussy babies? How can parents of multiples get enough sleep? What kinds of clothing and equipment are needed for multiples? How can a mother adjust to the physical and emotional demands of caring for multiple babies? What about the adjustments needed by the babies' father and any older siblings? Are there ways to manage the household that will help a mother of multiples find some time for herself? What are the challenges of caring for toddler multiples?

Introduction     xi
Acknowledgements     xiii
It's Twins, Triplets, or More     1
Twin Types
Yes, It's Really Twins (or More)
Health Care with Multiples
Multiple Pregnancy as High Risk: Fact and Fiction     7
Maternal Stressors
Infants' Stressors
Think Positive
Improving the Odds
Multiple Pregnancy: Caring for Three, Four, or More before Birth     11
A Good Diet
Nutrition Hints
Taking Charge in Other Ways
What to Do If...     23
Signs to Watch and Report
Fetal Well-Being
Diagnostic Testing during Multiple Pregnancy
Maternal Issues
Preterm Delivery
Getting Ready to Breastfeed Two, Three, or More Newborns     35
Advantage of Breastfeeding Multiples
Breastfeeding Goals
Additional Tools for Mapping Your Route
Getting Ready: Birth Preparation     43
Preparation for Birth
Pregnant Memories
Getting Ready: Preparing for Multiples     51
Pediatric Care
Baby Names x 2, 3, 4 +
Household Help
Employment Issues
Happy Birthday     59
Labor
Vaginal Birth
Surgical (Cesarean) Birth
Hospital Routines and First Stage Interventions
Labor Induction & Augmentation (Acceleration)
Labor Monitoring
Analgesia/Anesthesia
Second Stage Interventions
"Assisted" Vaginal Delivery
Third Stage of Labor
Beginning Breastfeeding     73
During the Hospital Stay
Supplementing or Partial Breastfeeding
Breastfeedingafter Surgical Birth
Other Maternal Conditions Affecting Breastfeeding Initiation
Pain Medication
When One (or More) Cannot Yet Breastfeed
Multiples in the Newborn Intensive Care Unit     85
In the NICU
Parents' Role
When Babies Are Sick
Getting Ready for Discharge
Breastfeeding in the Newborn Intensive Care Unit     95
Your Milk for Your Babies
Expressing Your Milk
Beginning Breastfeeding
Increasing Breastfeeding
Making Up for a Poor Start     115
Keeping Babies Healthy While Increasing Milk Production
For Effective Breastfeeders
When One (or More) Has a Feeding Difficulty
Alternative Feeding Methods
Additional Tips
As Each Baby Improves
Effective Breastfeeding     129
Establishing and Maintaining Lactation
Feeding Behaviors
Typical Feeding Patterns for Effective Breastfeeding
Coordinating Feedings     137
Feeding Rotation
Feeding Routine vs. Schedule
Simultaneous "Twogether" Feedings
Getting Comfortable
Other Hints
Breastfeeding Difficulties in Young Babies     151
Difficulty Latching On or Sucking
Problem-Solving Ideas
Weight Gain Issues
When Mother Has a Breastfeeding Difficulty     161
Sore Nipples
Engorgement
Insufficient Milk Production
Flat or Inverted Nipple(s)
Plugged Ducts and Mastitis
Overabundant Milk Production
Forceful Let-Down/Milk-Ejection Reflex
Maternal Illness
Avoiding Problems During a Hospitalization     185
Exploring Options
Emergency Situations
Full and Partial Breastfeeding     191
Breastfeeding Definitions
Partial Breastfeeding
Full Breastfeeding as a Goal
Partial Breastfeeding as Goal
Human-Milk-Feeding
Breastfeeding Multiples When Mother Is Employed
Lower Milk Production
Breastfeeding Only One
Early Weaning
Enhancing Individuality     209
Attachment to Each Baby
Other Factors
Unit Thinking
Helping the Attachment Process Along
Comforting a Fussy Baby x 1, 2, or More!     219
General Causes
Physical Causes
Survival Tips
The High Need Multiple and Maternal Guilt
Getting Enough Sleep     237
Sleep Deprivation
Encouraging Sleep
Sleep Arrangements
Mother's Sleep Style
Dad's Involvement
What You'll Need     249
Diapers
Clothing or Layette
Breast Pumps
Car Seats
Bedding
Multiple Stroller
Baby Carriers
Other Equipment
Equipment Use vs. Overuse
Getting Out and About     261
Be Prepared for Going Out
Additional Safety Precautions
For Mothers Only: Adjusting to Multiples     267
A New Role
Developing a Routine
The Myth of the SuperMom
Mothers Are Not All the Same
Take Care of Yourself
Self-Esteem Issues
Isolation
Beating the Blues: Postpartum Mood Disorders
Adjusting as a Couple     289
Breastfeeding
Time Together
Older Siblings of Multiples     297
Instant Celebrities
Behavior Problems
Sibling Reactions
Streamlined Housekeeping      305
Meeting Infant Developmental Needs
Household Management
Breastfeeding, Starting Solids, and Weaning     313
Starting Solids
Signs of Readiness
Vitamin and Mineral Supplements
Organizing Mealtime
Meals Are a Social Time
Picky Eaters
Breastfeeding Older Babies and Toddler Multiples
Changing Breastfeeding Patterns
Biting
Nursing Strikes
For Multiples Only
Weaning
Mother-Guided Weaning
Partial Weaning
Abrupt Weaning
Older Babies and Toddlers: Childproofing and Helpful Equipment     337
Safety and Childproofing for Older Babies
Helpful Equipment
Out and About
Childproofing for Very Mobile Toddler Multiples
Basic Childproofing
Indoor Solutions
Multiples' Bedroom
Kitchen
Outdoor Solutions
Parenting Toddler Multiples     357
Multiples' Interactions
Toddlers' Temperaments
Toddler Activity Levels
High Need Flip-Flopping
Discipline of Multiples
Models of Behavior
Strategies That Work
Strategies That Don't Work
Other Toddler Issues
Night Waking
Brief Separations
Potty/Toilet Learning
A Need for Support
Resources     385
Appendix     405
Photo Credits     419
Index     421
About La Leche League     432