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Dr. Bill and Martha Answer:
How will I get sleep while breastfeeding triplets?

Question:
I've been reading The Baby Book with great interest, particularly the information about twins. I'm expecting triplets at year-end. How do you suggest I balance the need for sleep with the babies' breastfeeding needs? I had intended to pump as well as feed at breast, so that another person could feed the babies at night. If it takes 60 to 90 minutes to feed the babies every two to three hours, I won't be able to get more than 30 to 60 minutes of sleep at a time if I exclusively feed at breast. Do you have any suggestions or experience in applying attachment parenting techniques to high order multiples? Also, I'm wondering how I can use babywearing with my babies (one at a time, I suspect).

 Answer:
Congratulations on expecting triplets! You have been triply blessed, yet it's important to avoid being triply tired. As mothers will tell you, one baby is tiring enough, three babies -- wow! At present we have five sets of triplets in our pediatric practice, most of whom have at least been partially breastfed. The first piece of advice we have for you is put a big sign on your refrigerator that says: "Remember, what my babies need is a happy, rested mother." It's very easy to give, give, give to your babies until you get so gived out that the whole family is burned out. Be assured that during that first six months you will spend most of your time feeding and holding your babies. For this reason, it's important to get help that frees you up from all non-baby-tending chores and activities that drain your energy away from your babies, yourself, and your relationship with your husband.

Speaking of husbands, with multiples, dads must get involved. It's a necessity. As one father of twins said to us, "Our babies have two mothers. She's the milk mother and I'm the hairy mother." Your husband can be wearing one or two infants in slings while you are feeding one or two.

Breastfeeding is even more important for multiples, since they will undoubtedly be born pre-term. By a marvelous adaptation of nature, mothers of multiples produce milk that is higher in the nutrients that pre-term babies need. Consider your milk as medicine. Since your babies may be too weak to suck efficiently in the early days or weeks, line up a lactation consultant now and be ready to start pumping as soon as your babies are born.

Also, be sure you tell the neonatologists and nurses that you plan to breastfeed and would like your babies to be given your pumped breastmilk as soon as possible, preferably by a nursing supplementer (called a supplementary nursing system or SNS) or by syringe. Try to avoid rubber nipples as much as possible, since pre-term babies are particularly susceptible to nipple confusion.

One of the newest ways of caring for pre-term babies is a custom called "kangaroo care." Newborn nurseries that are up-to-date on the latest techniques will encourage this. Kangaroo care means that after your infants are in the "growing stage" and off oxygen or intravenous attachments, spend many hours a day holding them skin-to-skin against your breasts, rocking in a rocking chair, or wearing them around the nursery in a sling. Recent studies have shown that pre-terms given kangaroo care gain weight faster and leave the hospital sooner.

Three babies in your bed may be a bit awkward for you to begin with, yet it's important to have all three of your infants sleep close to one another. They will sleep better that way, since they have been "womb mates" for many months. You might try extending your bed with a large crib attached alongside your bed. These are known as bedside cosleepers. One of the perks of having pre-term babies is you get a chance to see them grow the final month or two outside the womb. Yet, that's exactly what attachment parenting is in those early months -- an outside womb. Lots of skin-to-skin contact, frequent feedings, and wearing them in slings is just the extra womb they need to grow.