BreastFeeding Twins

Today many women decide to breastfeed twins for a variety of reasons. Benefits of breastfeeding include:

Breast milk is the best food for any baby, especially for preemies and small babies, which many twins are.
Breast milk is much healthier for a baby than formula.
It is easier and quicker to breastfeed two hungry babies than to prepare formula for town hungry babies. Some mothers have estimated that they have saved over 300 hours the first year by breastfeeding their twins.
Formula feeding costs for twins are doubled – breastfeeding is free.
It is easier to pack your babies and go out – no need to prepare bottles ahead of time. Mothers of twins have enough to carry without having to lug bottles and bottle warmers.
Nursing helps your uterus contract and your body to get back into pre-pregnancy shape faster.

Preparing to Breastfeed Twins

Many women exclusively breastfeed their twins. Unfortunately, most people have no idea that this is even possible. However, the female body is well equipped to nurse two children. What you will need, as in any nursing situation, is patience and determination. Support from family members and others close to you is also important. It can be very helpful to do a little advance planning.

Choosing a Doctor

Select your baby’s doctor carefully. Try to find someone who will support your decision to breastfeed and will not recommend supplementing either of your babies’ diets with formula unless it is necessary. Sometimes prematurely and poor weight gain are factors facing twins. It will be an additional benefit if you have a pediatrician who understands the importance of breastfeeding in these situations. Interview potential pediatricians either in person or by phone to find out their positions on breastfeeding twins. Some questions to consider include:

What are your views on nursing (in general)?
What are your views on nursing twins?
Do you believe twins can be exclusively breastfed:
If one or both of my babies are in the Neonatal Intensive Care Unit (NICU) after they are born, what is your normal routine for handling breastfeeding?
What are your thoughts on the common practice of using bottles in hospitals? If I do not want any bottles used at all, can you make the hospital staff aware of my desire?
How do you usually handle weight gain problems with exclusively breastfed infants?
If my babies need supplements, what do you normally recommend (expressed breast milk? Formula? What kind?)? How would you advise me to feed supplements (time of day, method of feeding such as a supplemental nursing system, cup, eyedropper or bottle)?

You should also talk with your obstetrician and make sure he or she is aware of your decision to breastfeed. You need to discuss topics such as:

Medication during delivery and possible effects on breastfeeding.
Medication after birth (especially if you have a cesarean) and possible effects on breastfeeding
Contraceptives and possible effects on breastfeeding.
Making sure medication to dry up your milk will not be ordered.
Your desire to breastfeed both of your twins as soon as possible after delivery.
Having both your babies with you as often as possible while you are in the hospital so that you can nurse on demand. You may also want to discuss this with your pediatrician.
Evaluate your breasts to see if you have flat or inverted nipples.

Preparing for the Babies

Because twins are usually high-risk babies and are often born early, and because you may be put on bed rest for part of your pregnancy, you may want to take your hospital tour, childbirth and childcare classes early. Try to discuss your breastfeeding decision with the instructors and hospital staff at this time. They may offer some helpful ideas.

Nursing Mothers, Inc. offers free classes on breastfeeding each month. These classes inform you about breastfeeding basics, what to expect, and help prepare you to begin breastfeeding. Nursing Mothers also offers pumps for medical need, a bra bank, and monthly meetings in your area. These meetings provide a great forum for meeting other nursing mothers and asking any questions you may have. A Nursing Mother's counselor can help you prepare for any special situations you may encounter, such as prematurely and low birth weight, when your babies are born.

First State Mothers of Multiples is a support group for twins, triples, etc… They offer a nursing pillow bank and monthly meetings. They also schedule special events and opportunities to meet other parents of twins.

Recognizing that many twins are born prematurely and may have to spend time in the NICU, try to visit this facility during your pregnancy if possible. If your hospital won’t allow this, a different hospital may allow you to visit. This pre-delivery visit can prepare you for what may be in store for all of you. Try to speak with a staff neonatologist and several of the NICU nurses to discuss breastfeeding attitudes and policies on the unit. Ask if the hospital offer the use of a breast pump. The best type of pump for mothers of twins is one that will “double pump” (allow you to pump both breast at the same time). Nursing Mothers also ahs information on collecting and storing breast milk.

Getting Started with Twins

Breastfeeding twins is not only possible, it is the preferred feeding method for all babies. Breastfeeding is rewarding and healthy for both you and your babies. Getting off to a good start in the hospital can really build your confidence and your milk supply. This is a time for you and your babies to get acquainted. Don’t’ be discouraged if one or both of the twins doesn’t nurse well the first few times. You and your babies will soon earn each other’s needs. Your Nursing Mothers counselor will help you develop a healthy nursing relationship and answer any questions you may have.

Nurse as soon after the babies are boon as possible. Because you have twins, the delivery room will probably be very busy. Talk to your doctor and the nurses about your desire to nurse so they will understand your need to have your babies with you as soon as possible.

If neither of your babies is in NICU, it is best to avoid giving any bottles for at least six weeks. This will prevent nipple confusion and help your milk supply adjust to the proper supply level.

Nurse both babies every time. This method will stimulate your milk supply best. Advice used to suggest that you nurse only one baby each time, giving the other a bottle of formula and alternating babies with each feeding. We now know this method of feeding will lead to milk supply problems because your body will be fooled into producing milk for only one baby.

Your babies should gain about one pound a month. Many doctors use growth charts based on formula-fed babies. Breastfed babies typically grow a little more slowly, so bear that in mind when you refer to growth charts.

If one or both of your babies experience a weight gain problem, ask yourself the following questions:

Is letdown occurring?
Am I nursing frequently enough?
Are the babies positioned and latching on properly?

If the babies have a weak suck, they may not be stimulating your breasts enough to produce an adequate milk supply. You may need to pump after nursing or use a supplemental nursing system until the babies’ suck is stronger. If you and your doctor decide to supplement, you may consider suing a supplemental nursing system to stimulate your breasts to produce more, thereby avoiding the problems that a bottle may cause.

Nursing “Schedules” and Positions

You may choose between simultaneous or separate feedings. The babies’ temperaments may also be a consideration in your nursing patters. Separate feedings can accommodate the individuality of each baby. Babies with different birth weights have different needs, so it may be unrealistic to expect them to be hungry at the same time. Newborns usually want to nurse every 1 ½ to 3 hours (measured from the start of one feeding to the start of the next). You may choose to use a pacifier (one of your fingers, well cleaned, would be the best choice – it will help reduce the potential confusion of a rubber nipple) to calm one while nursing the other if you choose to nurse them separately.

Simultaneous nursing means nursing both babies at the same time. This is a time-saver and enhances your milk supply. For these reasons, many mothers choose this method. Initially, you will may need help getting one latched on and then the other. But soon this will become second nature. Try various positions to find out what is comfortable for you (see the accompanying illustrations). A nursing pillow supports the babies’ heads while they nurse together. Many mothers like this because it frees their hands. First State Mothers of Multiples makes these pillows available.

First, get comfortable with your arms supported by pillows or an armchair. Your feed should be elevated on a footstool. Next, help one baby to start nursing. Then, either request help with the second baby, or position the second baby close to you before you start (on your legs, next to you on the sofa, or in an infant seat) so you can pick up the second baby while continuing to nurse the first. Remember, by the time the twins are about three months old, positioning will be easier because they can support the weight of their heads.

Many mothers discover after the first several weeks that they use a combination of separate and simultaneous feedings to meet the twins’ needs.

Demand feeding is optimal for all breastfeeding babies, but may be modified for twins. This is the first-come-both-served method. When one baby gets hungry, nurse both of them. Sometimes this means waking one up. You may choose to feed both on their own demand schedules. This will meet each baby’s individual need. Allow them to finish nursing at their own pace. Babies have different sucking abilities. One baby may finish quickly while the other may take longer. It can take up to 5 minutes for letdown to occur, so average nursing time will probably be between 10 and 20 minutes. However, there is no need to time your feedings.

When feeding young babies, burp them often and then resume nursing. When one baby is finished nursing, you may lay her across your knees on her stomach and pat her to burp while you continue nursing the other.

Mothers of single babies usually offer both breasts at each feeding and alternate the starting side. Twin moms have different ways of doing this. Some mothers assign a baby his own breast. When doing this, it is important to remember to empty both breasts each time you nurse - either with simultaneous nursing or by pumping the side not nursed. This will help prevent breast infections. Other mothers alternate the babies and breasts each day, while some alternate babies and breasts each feeding. Some moms just decide not to keep track of who got which breast last time, etc. Every mom does it differently -- there is no “right” or “wrong” way to do it. Usually though, each baby nurses from one side at each feeding, rather than offering the other breast as well.

Growth spurts often occur during the first year of life. Your babies may not experience spurts at the same time. Nursing frequency may increase through the week at this time. This is normal. If breastfeeding remains exclusive, your milk supply will increase to meet the growing needs of your babies, and the frequency of nursing will again subside. Keep in mind that supplemental bottles tend to lead to further supplementing and eventual weaning.

Milk production works on a supply and demand system. This means the more milk the babies take from your breasts, the more milk your breasts will produce. After your milk supply is well established, around 4 to 6 weeks post-partum, an occasional supplemental bottle when you are away can be given without compromising your milk supply. However, because of the large supply of milk you have to feed twins, it is particularly important for your own comfort to pump missed feedings to avoid fullness.

To keep a good supply of milk, your body needs food, drink and rest. It is important to eat a well-balanced diet. Most health care providers recommend you continue taking prenatal vitamins after birth. You will need approximately 1000 extra calories per day to nurse twins. Drink to satisfy your thirst. Avoid caffeine and alcohol. Try to schedule rest periods for yourself, even if it means a messy house. Neglecting any of these three important elements of your own care can result in a diminished milk supply.

You will find as you talk with different people, including health care providers, and as you read different books, that there are many different and conflicting ideas on breastfeeding twins. The most important thing to remember is to do what you believe is best for you and your babies. Everyone’s situation is unique, and what works for one mother may not work for another.

Making Life Easier with Twins

Accept all the help you can with the household, meals, groceries, etc…
Sleep while nursing
Nap whenever the babies nap
Use a stroller in the house to move the babies form room to room
Set up an extra changing area near the living space of the house
Have the babies sleep together when they are very young – they often like the warmth and companionship
Set up a nursing station with reading material, TV, lighting, comfortable chair, pillow and whatever else you would like to feel pampered
Don’t expect to get all the things done that you used to – try to tolerate dust, unmade beds and dirty dishes
When nursing in public, a baby sling or one baby in the cradle hold and one in the football hold can be more discreet
Dressing them differently helps t avoid the curiosity of strangers and may help you get your business done faster
Run errands alone when a babysitter is available
Above all, take care of yourself!