Our adventure in tandem nursing

Throughout pregnancy with Joel, I was convinced that Andrew would self-wean from breastfeeding at some point. My milk supply had never been great, but I thought the dwindling in pregnancy would be enough to put him off for good. But as he still wanted it right up until the night Joel was born – I actually had my first contractions whist feeding Andrew before his bedtime – I thought that it showed how breastfeeding wasn’t about the volume of milk for him, but rather the comfort that he gets from cuddling up to me and sucking. Not that I had anything against tandem (two children of different ages simultaneously) feeding, but I was concerned that this wouldn’t be possible for us due to my insufficient glandular (breast) tissue or IGT. However, through my local La Leche League (LLL) group, I found out that it’s not out of the question to tandem feed with IGT – I wrote about this here.

So I set to and read bits from the LLL book Adventures in Tandem Nursing. If Andrew was going to carry on, I needed some info on how to meet the needs of both a baby and a toddler at the same time. This task seemed like something for a super-mum, and I certainly didn’t feel that I was a super-mum, but the book helped me see that it was more normal than I once thought. As Andrew has continued to breastfeed since Joel’s birth, I thought I’d share on here the beginnings of our adventure in tandem nursing, particularly as I have no idea how long this adventure will last. Andrew still seems quite keen at the moment, but you never know how a toddler’s mind can change from one day to the next!

Right up until the night Joel was born, Andrew was still breastfeeding twice a day, once first thing and once before bed, for about 20 minutes on average each time, plus the odd bit here and there in the day if he was upset/tired/grumpy and I needed to calm him down. We were only in the Birth Centre for less than 12 hours, so he only missed the feed first thing in the morning on the day of the birth (which was in the early hours), when Grandma got him up instead of me. The first few mornings and evenings he continued as he had done, but Joel fed first each time and then Andrew fed whilst Daddy held Joel, who slept between feeds anyway, in normal newborn fashion.

Unfortunately we had to go back into hospital when Joel was 3 days old because he had pretty bad jaundice and needed light treatment. So Andrew missed out on the bedtime feed on the one night that we were in, and the morning feed the following morning. Joel responded well to treatment and recovered very quickly, so the doctors were happy that he was well enough to go home on the second evening. The ward staff were very busy though, and asked if we wanted to stay in another night (suggesting that we might like to get onto a 3-hourly feeding routine before we left!), I guess because doing the discharge paperwork would take a while. But I played the toddler card and said that I wanted to get home to put my elder child to bed (I didn’t mention breastfeeding him, but that was part of it). They saw my point and agreed to send the paperwork later in the post. One of the hardest things for me about going back into hospital was leaving and missing Andrew; I was very emotional on the first day and night, partly because it was hard to see Joel on the lights and not be able to cuddle or feed him, but also because I felt bad about not being there for Andrew as I always had been. The hormones probably were also not helping then!

When we got home, Joel was having top-ups via the SNS, and due to his sleepiness from the jaundice he was taking a long time to feed, as he’d feed for a bit, fall asleep, so I had to wake him up and re-latch him, several times over. This meant that more often than not he was feeding at the times when Andrew woke up and went to bed. So what we did was Joel had one side, and after he switched to the other, Andrew fed from the first side. We’ve carried on like this until now. It’s through this arrangement that I’ve ended up having one on each side simultaneously – totally tandem nursing!

My boys and I on our adventure

At nearly 4 weeks into our adventure, I’ve noticed that Andrew’s nursing pattern has changed. He no longer has one main feed at the start of the day and one main feed at the end, but rather lots of smaller ones throughout the day when it’s just the 3 of us together. As I am feeding Joel for quite long stretches (up to an hour) every couple of hours, when that’s happening at home (as opposed to out at a group) and I’m sitting on the sofa, Andrew keeps coming to me and asking for milk – he’ll feed for a few minutes, then go back to watching his DVD or reading a book or playing with toys, and come back to me a bit later for some more, and so it goes on until Joel has finished. Andrew seems less bothered about lots of time with me just before bed than he used to, but overall I reckon on days when it’s just us, he’s feeding for a similar amount of time as before, just in short and sweet stints. When Tom or others are around, he’ll generally have a longer feed again before bed rather than more in the day.

It’s great that Andrew wants to, and feels that he can ask to, feed when I’m feeding Joel, because I feel bad about the fact that I’m spending less time focussed on Andrew these days, though I know that this is an inevitable part of having a second child, and at least by letting Andrew in on our milky cuddles, he knows that I’m still there for him too, whenever he needs me. I think this is important for him and means a lot to him – to know that I haven’t forgotten about him. When my 2 boys are nursing at the same time, I look down at them and think what a lovely way it is for them to bond; Andrew is very affectionate towards Joel when they’re nursing together, and often strokes his head and comes off and kisses him.

Overall I’d say that tandem nursing is so far a very positive experience. I do have to say though that I still have the feeling like I did in pregnancy that feeding Andrew is less pleasurable for me than it once was. It’s hard for me to put into words what I feel – it’s not painful or annoying, it’s just a strange feeling that having him suck from me is not the same as Joel sucking. Maybe it’s his size, maybe it’s because he moves around and therefore his latch sometimes leaves a lot to be desired (although at least I can ask him to come off and do it better!) I thought this feeling was mainly to do with feeding during pregnancy, but obviously it’s not the case now. Apparently this happens to other mums who nurse toddlers though, so I’m not alone. But I always said I would let him choose when he wants to stop, so I’m happy to carry on, despite the strange feeling, until that might be – I’ll let you know when I see any signs of him giving up completely.

2 weeks old: jaundice and getting breastfeeding off to a good start

2 weeks ago about now we were not long home after a less than 12-hour stay at the local Birth Centre. Time has flown by, although strangely it doesn’t seem to me to have gone as fast as Andrew’s first 2 weeks did. For Tom, though, it has gone faster, and this afternoon is his first afternoon back at work – handily his first day back is a Tuesday and he only works a half day, so we are being broken in gently to his return to work. Andrew is napping, so I won’t notice Tom’s absence fully until tomorrow, when I’ll have to ‘go solo’ with 2 little ones all day – eek!

Andrew dishing out one of his lovely kisses when he fist met Joel....

So what’s happened already in 2 weeks since Joel’s birth? Well we had a trip back into hospital when he was 3 days old, because he was quite highly jaundiced. As we’d had to do this with Andrew too at 6 days old, though his problem was dehydration not jaundice, we kind of knew what to expect and were not quite so shocked. One of the hardest parts for me going back in was being away from Andrew for 2 days and one night (except a couple of visits to the ward), but I knew it was the best place for Joel to be and I couldn’t be there for both my boys at the same time. I also felt better this time knowing that his jaundice was nothing to do with my milk supply (which the dehydration had been) – it would have happened regardless of how he’d been fed.

We didn’t know it at the time, but apparently they take jaundice very seriously in Cambridgeshire these days, as there have been a couple of cases that were missed early and the babies developed serious complications from it. Jaundice is caused by a build-up of a substance called bilirubin in the body which is deposited in tissues such as the skin, gums and whites of the eyes and gives them a yellowish colour. In a newborn it is as a result of many red blood cells being broken down in one go – the baby needed these extra cells in the womb as there was less oxygen available than in the real world, and after birth the extra ones are broken down and excreted from the body. If a baby’s liver can’t do this fast enough (because it’s still not mature enough), the bilirubin level can get very high, and if it gets too high this can lead to it being deposited in the brain tissue and causing complications like deafness and cerebral palsy.

Joel’s bilirubin level wasn’t allowed to get that high, as he was treated with phototherapy and food. Phototherapy is basically like a sun bed that he lay on with blue lights underneath him and blue lights over the top of him. The light helps to break down the bilirubin so it can be excreted. He lay there with no clothes on, except he had to wear a cute little eye patch to stop the lights damaging his eyes – he hated it though and kept pulling it off whenever he woke up! Initially he was allowed to feed on demand from me and therefore spend some time away from the lights, but then his bilirubin level increased again and the doctors decided that he needed to be constantly on the lights, so they fitted a naso-gastric tube and fed him vast amounts of formula through it. Having milk is also effective in treating jaundice, because it makes baby poo it out and that’s how the bilirubin is excreted; breast milk is more effective than formula at this, but at 3 days old, even if I was normal and didn’t have insufficient glandular breast tissue to exclusively breastfeed a baby, my milk wouldn’t have already ‘come in’ and be there in vast quantities. (You know you’re a parent when you don’t bat an eyelid at writing the word ‘poo’ in a blog post!)

The good thing is that Joel responded well to the lights and milk treatment and after 12 hours on the lights he was allowed to breastfeed on demand again and was well enough to get out of hospital after just one overnight stay. I think it helped our case when I explained to the doctors that I was willing to supplement with formula given my previous breastfeeding experience. Plus they saw me using the SNS (supplemental nursing system) that I’d taken in with us in case we needed it, and could see that Joel was feeding well with it.

.... and another at home with Granny 🙂

The hardest thing since coming out of hospital the second time has been how sleepy Joel is. This is a common side effect of jaundice, and I’ve been told that jaundiced babies sometimes take a few weeks to really wake up. But even before we went back into hospital, Joel seemed like a much more chilled out baby than Andrew was, so it could partly just be his personality too. You might be wondering why sleepy means hard?! Surely that’s a good thing, right?! Well not if you want to establish a good breast milk supply and in particular if you have supply issues anyway like I do. I’m having to wake him up for feeds, especially overnight when it’s the best time to stimulate my supply when the hormone prolactin is highest. I’m often feeding him in just his nappy so he’s nice and cool so less likely to drift off to sleep, and he’s next to my skin to help stimulate milk production. I also find myself tickling his feet and changing his nappy during feeds to try and wake him up. This is such a culture shock for me having fed Andrew as a baby who was always so active, awake and keen to tell me when he was hungry.

But he’s already showing a few signs of being less sleepy and I feel like I have much more knowledge and support with breastfeeding this time, so I’m working hard doing everything I can to get things off to a good start. I’m expressing after feeds (though not getting loads out, as I’ve never managed to get loads out with a breast pump – by hand I get more), taking a herbal supplement that is supposed to boost milk supply, eating lots of oats (porridge, flapjacks etc.), drinking fennel tea, resting when I can and, of course, using the SNS to top Joel up with formula so that he gets as much from me as possible. All this effort seemed worth it this morning when he was weighed and his weight had gone up to beyond his birth weight! Hooray! This means a lot to me because Andrew took ages to put weight on in the early weeks and weight was a constant worry for us.

Talking of Andrew, I can’t leave him out of this post. He has been a star in welcoming his little brother to our family. He’s been dishing out lots of kisses of his own accord to Joel (and us) and has carried on as normal being his happy little self, except he doesn’t seem so little any more! As I’ve spent much of the last 2 weeks holding Joel, whenever I have held Andrew for a moment, he feels and looks absolutely massive to me. Of course so far Andrew has had at least Tom around and often another person or more as we’ve had lots of help from family visiting, so the real test of how he copes with having to share my attention will come in the next week. But I’m optimistic from the signs so far.

It’s been nice to sit and write something (the skill of one-handed typing whilst feeding is like riding a bike – never forgotten), though I feel that my head is still quite all over the place and this post is more muddled in thought than usual. I thought it would be good to share our experience of jaundice, as it’s something I’d heard of but didn’t realise was so common and often required such hardcore treatment – about 60% of babies get it, and I can’t help but wonder how many mums of jaundiced babies end up giving up breastfeeding because their supply never really gets going before the formula is introduced and baby is so sleepy that they don’t feed enough. I did also write Joel’s birth story 2 days afterwards so I didn’t forget anything, but it’s still in rather note form and needs some editing to make it publishable; I’ll post it when I get round to it. Anyway, I’d better get back to some more resting on the sofa whilst Andrew is napping and Joel is feeding 🙂

A bit red faced - matches his tomato babygro! I think he's going to be a blond boy like his daddy was.