Krista’s story: Breastfeeding Premature Twins

Krista’s story: Breastfeeding Premature Twins

When we learned that Krista Gray had breastfed premature twin boys, we were intrigued. When we also learned she had given birth in Egypt, far away from extended family and supports, we knew this was a story we had to hear.  Thank you, Krista, for sharing your incredible story with us. We admire your strength and determination!


I was living overseas with my husband and 20-month old daughter when we found out I was pregnant with twins.  I went through so many emotions in those early days –shock, excitement, joy – and then one evening I was struck with fear when I realized I was going to birth twins. I began to research and learn everything I could about twin pregnancy and birth.


My doctor in Egypt was very uncomfortable with my desire for a natural twin birth and began pressuring me to schedule a C-section from early-on.  As my uneventful pregnancy progressed, and the boys enjoyed staying in their breech position, we bought plane tickets to return to the states where I had found a doctor who was comfortable with giving me the opportunity to try to birth them naturally, even while breech. (I know these doctors are rare!  I searched for someone who would let me attempt a vaginal delivery yet also birth in a hospital and out of three states I could only find one doctor!)


Fast forward to 32 weeks, 3 days in my pregnancy.  I was still walking 2 miles daily, up and down playing with my toddler, and feeling great (besides, of course, having a whale of a tummy).  I was packing, because we were flying home in 4 days to wait on our twins’ arrival.  I woke up that morning to feeling slight contractions, which, after getting up, promptly became intense, all-consuming, and coming right on top of one another.


My husband called our doctor and we went to the hospital – and found I was already dilated 8 cm.  I ended up having an emergency C-section with general anesthesia. Neither preemie twins nor a C-section had ever been in my plans for their birth but now I found myself not only with both of these, but also living abroad without the support of family and with a 2 ½ year old daughter.


I was determined to breastfeed.  Exclusively.  And, since the birth didn’t go at all as I had hoped, I think this made me even more determined to succeed at my breastfeeding goals.


When I woke up from surgery one of the first thoughts I had was that I needed to start pumping.  My boys were in the NICU and I was in pain from surgery (and refusing pain meds as I didn’t know if they would harm my milk) so I didn’t even get to see them until they were 12 hours old.  But I lay in bed and began to pump.  Every three hours I pumped with a double-sided electric pump and I began to get that incredible first milk: colostrum.


When I talked to their neonatologist the following day, who was cautiously supportive of my desire to breastfeed, he said I could go ahead and get started trying.  As soon as they were able to coordinate sucking-swallowing-breathing at the same time and were putting on weight I could bring them home.


The first time I held my boys or tried nursing them was 26 hours after their birth (that’s a long time as research shows so many benefits to kangaroo mother care from as soon after birth as possible).  Though they could suck-swallow-breathe for short durations, they were unable to nurse fully at the breast and were losing weight.  I was concerned about “nipple confusion” so started giving my colostrum in a syringe. After a few days we switched to giving my milk in bottles as it was easier – and exhaustion was already setting in.


We decided to bring our boys home when they were six days old – they could not yet regulate their own body temperature and it was a struggle to get them to take enough milk at each feed to begin to put on weight – but, with the conditions of the hospital, we felt this was a better option.


I do not regret this decision, but I can say it was A LOT of hard, hard work caring for these two, both-under-four-pound-babies, at home, with a toddler, in a foreign country, with little help/support.  Sometimes I think back to these days and wonder how we survived!


The following two months were a blur of sleepless nights as I settled into a routine of feeding them every three hours around the clock.  Each feed would typically take 1 ½ – 2 hours so there was usually just one hour before starting the routine all over again, 24/7.  I started off giving them expressed milk in a bottle as an “appetizer,” then nursed at the breast, then finished them with the bottle when they got too tired to nurse.  When they were done eating I would pump and then clean/sterilize the pump and bottles.


I had a digital scale that I weighed them on every few days at first, but I mostly just went with my maternal instinct, watching wet/dirty diapers, developmental milestones, and growing out of clothes as indicators for growth.


About a month into this routine (when they were still 4 weeks premature) I decided to try to transition them to the breast exclusively.  I arranged help with my daughter and planned to nurse them around-the-clock but not offer any bottles or pump (I was so tired of both pumping and bottles!).


After three days (and a terrible bout with mastitis) I found that one of my boys was thriving at the breast but the other was still not strong enough to nurse and began losing weight.  Since the logistics of pumping did not allow me to pump one side and nurse on the other (I was converting my 110 volt pump and had to have it plugged in on the kitchen counter) I continued pumping and giving bottles to both babies until they were around 40 weeks gestation.  At this point, they really were like newborns and both could nurse at the breast without needing supplemental bottles to gain weight.


There were still occasions over the next several weeks where I had to pump at times (mostly because I had built up such a supply that I had to slowly reduce it as I was prone to plugged ducts).  The day I packed up my pump was one of the happiest days ever.  I later counted the stored milk in my freezer (the excess I had pumped to build my supply when they were so small and still eating tiny amounts) and I had more than 13 gallons!




I learned a lot through this experience – mostly by trial and error.  There were no lactation consultants in Egypt and my husband and I had very limited support – just the precious visits from our family as they coordinated trips to help out during those first couple of months.




If I were counseling a mom today in my situation, I would share the following (in no particular order):


  • You can do it.  Determination can overcome most every obstacle.


  • Remember the goal and just take it one day at a time – don’t worry about tomorrow.


  • Your babies are premature; don’t expect them to act like full-term babies.  But, probably around the 40-week mark you will notice a maturity and ability to breastfeed more successfully.


  • Get support.  Find a breastfeeding support group and get involved while you are pregnant.  Gather supportive friends and family around you.  (Even without support, you can do it – remember the first point – but seriously, find support.  You need to be able to talk with other mothers who have been there and made it through.)


  • Be diligent to build your supply from the beginning.


  • Take care of yourself and get some rest. (I was so concerned with supply, even once my supply was really strong, that I was scared to drop even one pumping session.  Had I done this and just had my husband do one feed, I could have gotten so much more sleep.  I seriously cannot tell you how sleep deprived I was at this time – and when you are sleep deprived you are more likely to give up.)


  • Don’t fortify your milk just because they are small if this isn’t what you want to do.  There are different classifications of preterm and, typically, if a baby weighs more than 1.5 kg he can meet his nutritional needs on breast milk alone. Talk with a lactation consultant and make sure you understand the pros and cons of supplementation so you can make an informed decision.

(Editor’s note: We recommend that you discuss fortification of breastmilk with  your healthcare provider. Practices vary between hospitals.) 


  • Practice as much skin-to-skin time as possible.  I had heard about Kangaroo Mother Care (skin-to-skin for preemies) but I didn’t really know what it meant.  This, more than anything else, would be the one thing I’d like to go back and change.  I would’ve held them skin-to-skin so much more often if I had known the amazing benefits.



Krista Gray is an International Board Certified Lactation Consultant (IBCLC), La Leche League Leader, and mother of four breastfed children, including preemie twins. She spontaneously went into labor with her twins two months early while living with her husband and daughter in Egypt.  Sheer determination helped her persevere to go on to nurse them until they self-weaned at 2 ½ years.  At Nursing Nurture Krista shares research-based information and experience to help moms in their breastfeeding journeys.  You can also connect with Krista on Twitter {@nursingnurture} and on Facebook {}.



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