Breastfeeding twins or multiples

Welcoming two or more babies at once is a joy, but can also be challenging – especially when it comes to breastfeeding. But with the right support, breastfeeding twins is possible – read on to find out how

Breastfeeding twins and multiples

There’s lots to consider when expecting multiples, and feeding them will probably be top of your list. The logistics of breastfeeding twins – or more! – may be daunting. But fear not, it can be done and the results will be doubly rewarding.

Like any breastfeeding mum, you need to understand the basics, such as supply and demand, and getting the right position and latch.

Added challenges when breastfeeding multiples include time (or lack of!), sustaining your energy levels and finding the best feeding pattern. Accepting help can make these easier.

How can I prepare for breastfeeding twins?

Getting things ready before birth is key. Even if you’ve breastfed before, take expert advice on twin feeding.

There are dedicated antenatal classes and lactation consultants or breastfeeding specialists who can teach you the basics of nursing twins and answer any questions. Also seek out other mums of multiples and find out about twins’ groups locally and nationally, as these often offer meet-ups, publications, helplines and other valuable support services.

Enlist family and friends ahead of your due date to help around the home. Passing responsibility for any cooking, cleaning and shopping you usually do will allow you to focus on breastfeeding – something Robin, mum of four, Canada, found invaluable: “My mother-in-law stayed with us for the first two months,” she says. “I don’t know what we’d have done without her!”

Manage your expectations, too. Breastfeeding twins will take time to learn, sleep will be rare, and you might be largely housebound initially.

“It’s very full-on at the beginning, so expect life to be feeding, feeding, feeding,” says Helen Turier, who, in addition to being Support Services Manager at the UK’s Twins and Multiple Births Association (Tamba), is a qualified nurse and mum of three children, including twins. “Your breastfeeding journey may be longer, especially if your multiple babies have been in special care.” 

How do I start feeding my twins?

Having skin-to-skin contact with your babies as soon as possible after the birth is the best way to get breastfeeding off to a good start.1 So put this in your birth plan and discuss your intention to breastfeed with your birth partner and healthcare professionals in advance, including considering what will happen if your babies are premature or need to spend time in special care.

Ideally you’ll be breastfeeding as soon as possible after the birth, even if you’ve had a c-section. The healthcare professionals should bring your babies to you and assist with latching. Ask for help if they don’t, and ensure your partner is involved so he or she knows how to support you.

“I think a major reason why I was successful breastfeeding twins, when I had previously struggled with my son, was because I got expert help in hospital during those crucial first days,” says Zoe, mum of three, UK.

Will I produce enough milk for two babies?

Yes. This is because the more your babies feed, the more milk you make. Research shows breastfeeding mums of triplets can produce three litres a day2 – bearing in mind the average male baby drinks 831 ml (29 fl oz) a day.3

Your breasts should make enough colostrum – the nutrient-rich first milk – to feed your newborns for the first two to four days. After that supply and demand starts to come into play.

Follow a baby-led approach. Breastfeed whenever either baby shows early signs of being hungry – such as stirring from sleep, poking their tongue out, turning their head, making cooing noises, or sucking their lips or hands – to help build a sufficient supply.

What I can do to make breastfeeding twins easier?

It will be trial and error for you and your babies – remember they’re also learning. One baby may find feeding easier, need more frequent feeds, or gain weight more quickly, so treat them as individuals. Take expert advice on how to tackle any concerns.

“A midwife friend spent a long time helping with positioning and latching technique, something one of my girls really struggled with initially,” says Anna, mum of two, UK. “In the first month I really needed someone with me when feeding, just to pass me the babies. It’s hard to manage two at once, especially when they’re so tiny.”

Bear in mind that the early weeks are the toughest – it won’t always be this time-consuming and exhausting. And remember that any amount of breast milk has wonderful health benefits for your babies.

If you’re doubting your ability to breastfeed exclusively, or your babies aren’t thriving on your breast milk alone, discuss your feeding options with a healthcare professional, lactation consultant or breastfeeding specialist, and your partner too, so you can make the best choices for your family.

Good attachment and being comfortable are vital. A specifically designed twin breastfeeding pillow can help with positioning and take the strain off your wrists, arms, back and shoulders.

Although you’ll be focusing your energy and attention on your babies, don’t neglect your own nutrition and wellbeing.

Bethan, mum of two, UK, advises: “Try to sleep when you can. Do online grocery shopping and book delivery for when you have a friend or partner there. Prepare a big bottle of water and drink every time you feed. And ask someone to take your babies out afterwards so you can rest.”

What if my twins are unable to breastfeed?

Should one or both babies need to stay in hospital for a time, or arrive prematurely, feeding directly from the breast can still be possible, but it may not be established until later. If either baby can’t latch, you can express in the meantime. This will help initiate and build your milk supply and enable your newborns to have all the benefits of your breast milk, whether it’s fed to them from a syringe, feeding tube or another method with the support of a healthcare professional. You’ll need to pump as often as a newborn would normally breastfeed, which means every two to three hours, for at least the first month or so.4

“My twin girls came at week 30 by caesarean and were in the neonatal intensive care unit for many weeks,” remembers Monika, mum of three, Switzerland. “They couldn’t breastfeed until 34 or 35 weeks. So for the first month I was pumping every day, at least eight times a day. This felt like the most important thing I could do for them.”

You may have one baby who’s strong enough to feed from the breast, while the other still needs expressed milk. In this situation, mums often find it’s easiest to pump for the weaker twin while breastfeeding the stronger one.

Breast milk is proven to lower the risk of some serious health problems that premature babies are more prone to, including necrotising enterocolitis (NEC) and sepsis.5 So if your multiples are able to take some of your expressed breast milk, you can take comfort knowing you’re giving them the best start.

Should I feed my twins together or separately?

Each method has its merits. You might feed individually while you sort out the basics, then move to time-saving tandem breastfeeding (nursing both babies together).

There are various twin breastfeeding positions you can try, such as the double rugby ball (with a baby under each arm), the parallel hold (with your babies lying across your body in the same direction), or the laid-back position (with both babies lying on your tummy). Ask a lactation consultant or breastfeeding specialist to show you how to do these. You may find one suits you better, or that different positions work in different situations.

“I found it easier to feed my twins simultaneously,” says Zoe, mum of three, UK. “I did the same at night. If one baby woke for a feed, my husband would wake the other.”

Alternatively, you may prefer to feed each baby on demand or to wake the second to feed after the first one has finished. Or you might mix and match.

While tandem feeding in public might be tricky, you can buy special covers to help make you feel less self-conscious.

“Tandem feeding is not for everyone though. Often once one baby had latched on, the other would fall off,” recalls Robin, mum of four, Canada. “I ended up being a sweaty, frustrated mess. I switched to feeding them one after the other, sacrificing time but saving my sanity.”

When it comes to choosing which breast to feed each baby with, some mums allocate a breast to each twin. However, it’s a good idea to alternate in case one breast produces more milk than the other. This can be an issue in the early days, especially if one baby is a weaker feeder. Alternating breasts would allow the stronger feeder to stimulate milk production for the weaker feeder and help build an even supply on both sides.  

I’m struggling with breastfeeding multiples: What should I do?

Don’t be afraid to ask loved ones to look after you so you can look after your babies. “Coping well can mean saying no to things you can’t manage,” advises Bethan, mum of two, UK.

Seek professional and emotional support, no matter what stage you’re at in your breastfeeding journey.

“I lost my confidence at six weeks in,” recalls Billie, mum of four, UK. “I called a helpline and went to a breastfeeding group where I got suggestions for better positioning. I never looked back.”

Crucially, don’t be too hard on yourself if you have down days. Breastfeeding multiples can feel like an overwhelming responsibility at times.

“Breastfeeding one baby takes a lot longer than you think to master. Perseverance pays off,” says Olivia, mum of four, Australia. “Breastfeeding two is a whole new level of patience. But it’s so worth it.” 

References

1 Crenshaw JT. Healthy birth practice# 6: Keep mother and baby together – it’s best for mother, baby, and breastfeeding. J Perinat Educ. 2014;23(4):211.

2 Flidel-Rimon O, Shinwell ES. Breast feeding twins and high multiples. Arch Dis Child Fetal Neonatal Edn. 2006;91(5):F377-F380.

3 Kent JC et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 2006;117(3):e387-395.

4 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet Gynecol Neonatal Nurs. 2012;41(1):114-121.

5 Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60(1):189-207.