Breastfeeding twins

Many women who are pregnant with twins worry about their ability to breastfeed once their babies are born. Common concerns relate to not being able to produce sufficient milk, as well as the logistics of handling two breastfeeding babies at the same time. Although the actual mechanics of breastfeeding are the same for one or even two babies, the reality of managing twin feeding can be a challenge.

Successful breastfeeding depends on a simple principle of supply and demand. The more a baby or babies feed, the more milk their mother will produce. But it is important to remember that there is a difference between strong, nutritive sucking which draws the milk from the breast and drains the breast properly and sucking which is less effective. When hungry twins are breastfed as frequently as they demand and they have plenty of opportunity to breastfeed, most mothers are able to produce sufficient breast milk for both their babies to grow and be satisfied.

Being confident is another major factor. When breastfeeding is simply viewed by a mother as the way she is going to feed her twins, then it is normalised and most problems are worked through. It helps to be realistic about the fact that there may be some initial challenges to overcome. But many women don’t have any issues at all; their twins latch on shortly after birth and the whole process is just straightforward and reasonably easy.

Important hormones for breastfeeding

The milk producing hormone prolactin continues to be produced for as long as breastfeeding continues or alternately, for as long as a mother is regularly expressing her breasts. Another hormone which is important in breastfeeding is oxytocin. This allows the milk to be ejected out of the milk ducts when a baby is breastfeeding or a mother is expressing. The presence of oxytocin also means the baby does not have to work so hard to obtain the milk because it then flows more easily into their mouth as they suck.

Common issues with breastfeeding twins

• Prematurity and smallness is more common with twin and multiple births. This means that twins are often a lighter birth weight than singleton babies and are more likely to be sleepy and not as able to suck effectively. Often, mothers need to express their breast milk which is offered to their twins via a feeding tube or bottle.
• If a mother has had a caesarian section delivery then it can be more awkward for her to position herself comfortably when breastfeeding.
• It can take a while for a mother to learn how to attach one baby to each breast at a feed times.
• Deciding what works – as every mother and her twins are unique. For some, synchronising the twins breastfeeds works best and for others, feeding them separately is a more realistic option.
• There may be brief periods of time when a mother’s supply is low and she needs to increase it to meet her babies? nutritional demands.
• Twin breastfeeding can take up many hours of time. It is common for breastfeeding mothers of twins to say they don’t feel as if they are doing any else other than breastfeed, especially in the first few months.
• Twins may not have the same sucking and feeding behaviours. They can display marked differences in their breastfeeding behaviours and this can make the practical aspects of breastfeeding a challenge.

Tips for successfully breastfeeding twins

• During your pregnancy, read as much information as you can on breastfeeding. Books, leaflets, DVDs and classes will help you to build a more comprehensive understanding of what breastfeeding twins involves.
• Try to breastfeed your twins as soon after birth as possible. Colostrum is a powerhouse of antibodies, fat and nutrients which is perfectly designed for newborns.
• If you cannot breastfeed straight away, then try to cuddle your twins and have the opportunity for some one on one, skin to skin contact.
• Alternate each twin with each breast. This will help to equalise your milk production. It is also good for your twins? development as they won’t be lying in the same position every time they feed.
• Make yourself a snack and have a drink of water ready each time you sit down to breastfeed. If you’re endlessly busy, this may be the only chance you have to take a breather and have a meal.
• If you cannot breastfeed your twins then consider expressing and offer your babies expressed colostrum/breast milk.
• Try to stay calm and relaxed. This will make a difference to your breast milk supply and help you to enjoy the process of breastfeeding your twins, rather than viewing it as an ordeal to get through.
• Accept all reasonable offers of help and support. Most people are genuinely keen to offer practical and emotional support for mothers of twins – at least until the novelty has worn off. So get used to people asking you if they can help and be gracious about saying yes. Even if it means having other people in your home, it can and will, make an enormous difference to how you manage, especially in the early days.
• If you don’t have a supportive family or network of friends around you, consider employing some home help. If you can afford it of course. Just getting a cleaner in for a few hours a week and outsourcing household jobs will free you up to concentrate on more important tasks.
• Be organised. This is such an important factor in the overall management of twins, not just for successful breastfeeding. Mothers who are able to sequentially work through tasks, who stay reasonably focused and are good time managers just do get more done and their lives tend to run more smoothly.
• Get as much rest as you can, where and when you can. Don’t be a martyr and keep battling on when you’re clearly exhausted. Rest, sleep and breaks will make a difference to your milk supply, especially for the evening feeds.
• Try to have some time every couple of days just for yourself. A walk around the block, a trip to the shops (alone) to buy some groceries, a hair appointment can all be slotted in with a little planning and babysitting arrangements. You’ll feel better and your body will thank you.
• Become familiar with the changes in your breasts. It can take 3-5 days for milk to “come in” after birth and for the breasts to be producing milk. The more you breastfeed your twins in these early days, the more quickly your breasts will produce milk.
• Try to avoid offering bottles of formula, unless it is really warranted. The more frequently a baby breastfeeds, the more milk a mother produces. Offering bottles can be the start of a weaning process and negatively impact on a mother’s supply.
• It may help for you to breastfeed one twin at a time until you get used to breastfeeding. Although this may be more time consuming, it will give you an opportunity to build your skills in attaching. It will also help with emotional bonding, as you will be able to get to know each individual baby and their own feeding style.
• Make sure your babies are attaching correctly to your nipples and areolas so they do not become tender and traumatised. Ask your midwife, child health nurse and/or lactation consultant to check your breastfeeding attachment. Some early, specific and targeted advice in the early days can really make a difference.
• Investigate your options of hiring or buying a good quality breast pump which has a dual action for expressing both breasts at the same time. Hand expressing can be very laborious and over time, can lead to repetitive strain of the hands and wrists.
• Let your healthcare professionals know that you are keen to breastfeed.
• Be confident, calm and sure that any amount of breast milk will help your twins to grow. Even if you cannot express the full amount of their feeds, combination feeding with expressed breast milk (EBM) as well as formula is another option.
• Go to an ante natal breastfeeding class and talk with other mothers who have breastfed their twins.
• Join the multiple birth association (check contact details below).
• Have a supportive partner and family who are keen to help you.
• Feel confident in making up your own mind about how you want to feed your twins. Some mothers choose not to breastfeed or, are unable to.

What’s so different about breastfeeding twins?

Put simply, there are two babies instead of one. It can be a challenge to hold, position and breastfeed twins who may be sleepy, small and prone to sucking problems. If you haven’t breastfed before, then this will be a whole new experience for you.

Although breastfeeding is one of the most natural acts in the world, it can also take a while to master. A learned set of skills is necessary in order for breastfeeding to become the relatively easy process it appears to be. What’s most important is that you are comfortable and so are your babies. You may find that you need to change your twin’s feeding positions as they get bigger. Remember to bring your babies to your breasts and not lean over onto them. This will lead to straining your back and is not sustainable in the long term. A variety of pillows with differing thicknesses and densities will make a real difference. But be open to the option of lying down to breastfeed as well. This can be a more comfortable position especially for new mothers who have a caesarian section wound or episiotomy which has not yet healed.

One baby may feed very differently to the other, so you could need to learn alternative ways and strategies to attach each of your twins. One may be hungrier, sleepy, smaller and need more coaxing than the other twin to suck effectively and to stay awake during feeds.

You may also have the experience of one of your twins being well and breastfeeding without any issues and the other twin not doing quite as well. You might need to express milk for one twin and breastfeed the other; alternate breast and bottle feeds, only offer one breastfeed a day and the remainder of the day’s feeds via a bottle; there are all sorts of options when it comes to twin feeding management.

What if I need to express my breast milk?

If your twins were born premature or are unwell, they may need to remain in a special care or neonatal intensive care unit. This could mean you need to express your breast milk and deliver it daily to the hospital. Transporting EBM safety and hygienically can take a bit of organisation but you will soon get into a routine of doing this. Freezing your milk, or alternately, transporting it cold, means you will need to invest in a good quality esky and some freezer bricks. Make sure you label your EBM very clearly and include the date and time that you expressed your milk. The hospital may give you some labels with an identification number, your name and date of birth. Before your twins are fed your EBM, this label is checked against their own, just to make sure that they are receiving your milk.

If you are not able to breastfeed or express sufficient milk yourself for your babies, your twins may still be able to have breast milk which has been donated. Many large maternity hospitals have milk banks of donated breast milk which has been pasteurised and cleared for any contagion risk.

How will I hold both babies to breastfeed them together?

If you are breastfeeding the twins together, you will have options about how to hold them. Football hold involves positioning the babies so their heads are side by side in the middle of your chest and their bodies are lying under your arms. This is the commonly preferred option for breastfeeding twins at the same time. Alternately you may like to position one baby in this football hold and the other across your front in the classic “Madonna” hold. This tends to work more effectively when the babies are still small. Another option is to position your twins so they are both lying across your front and their legs are overlapping. Again, this is ideal for when they are smaller.

Remember

You may need help and support with caring for your twins, but this doesn’t make them any less your own. If you feel your sense of privacy is being invaded, then make some gentle suggestions about having some family time for yourself and your partner to spend alone with your twins. If this is awkward, then ask your partner to do the talking.

Most people are reasonable and their intentions are based on genuine goodwill. But it may be necessary to place some flexible boundaries around what sort of help you want and when. So be clear and communicate what will work best for you and your own little family.

For more help

• Check with your GP and child health nurse.
• Check the Australian Multiple Birth Association
• Check the Australian Breastfeeding Association