Getting Started Breastfeeding Twins

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Breastfeeding-TwinsCan I make enough milk for twins?

You have two breasts and two babies – you should be able to make plenty of milk!  First, carrying twins you will have more placental tissue than with one baby.  Thus, your body is already preparing to make more milk to feed your babies.  Then, as your body makes milk according to how much is needed.  With two babies nursing, your body gets the message

to make more milk, and will do so.  If you will give attention in the early days to establishing a strong milk supply, and don’t supplement your babies, you will have plenty of milk to nurse twins.  In fact, mothers who later have a singleton, after previously nursing twins will not produce double the milk for their singleton.  Milk production strictly depends on milk removal.  One baby removes the milk he needs, and the body will replenish that supply.  Twins remove twice the milk, and the body replenishes that amount, and so on.

Though, in general, a woman’s body is fully able to make milk to support twins (or even triplets or more!) there are circumstances where there could be a low milk supply.

Can I produce enough milk for triplets or more?

iStock_000020866394XSmallMany mothers have successfully, exclusively nursed triplets and even quadruplets!  Of course finding the time to do this can be challenging.  With higher order multiples, it is such a unique situation and what works for one mother and her circumstances may not work for another.  However you feed your babies, it is going to be important to have help from family and friends, especially during the first year of life.

How can I get breastfeeding twins off to a good start? 

The best way to bond with your baby and get breastfeeding off to a good start is to have plenty of skin-to-skin time immediately following birth (or as close as possible thereafter).  You cannot spend too long cuddling with your babies in skin-to-skin time.  Not only does it have many health advantages to both mother and baby (including regulating body temperature and love hormones) but it helps to increase a mother’s milk supply and impact breastfeeding positively.  If this is not possible, or if your babies are not nursing well, you will need to be expressing your milk routinely to build your supply.  See milk expression for further information.  Your goal will be for your body to produce 750 ml of milk for each baby by Day 10.  Once you are expressing this quantity you can tailor how often and for how long you’re express to your individual body.  Make sure to consult a lactation consultant.

What if my twins are born early?

Most twins are born preterm today.  Though some may only be slightly early – between 36-38 weeks – others can be much earlier.  If your babies are born early and are in the NICU, you will need to follow strict measures pumping or expressing often to ensure your body makes enough milk to feed your babies once they are out of the NICU and eating more.  Read here for information on feeding your preterm baby.  Also, talk with your NICU about Kangaroo Mother Care for caring for and nursing your preterm babies.

What if my babies are sleepy and don’t wake to nurse?

Even if your babies are only slightly early, it is still important to watch them closely to ensure they are latching well and nursing effectively.  It is common for babies born close to term to sleep more often.  In order to protect your milk supply, as well as to ensure adequate growth, you will most likely need to wake your babies up to feed them.  They need to eat a minimum of 8-10 times every 24 hours.  While a clock is the not the most effective judge of eating a good meal at the breast, it is also important to note that a new baby needs time to eat well and if he is nursing for just a couple minutes and falling back asleep he is probably not eating as much as he needs – both for his growth and your milk supply.  In this case, diligently work to wake him and feed him.  If he is not nursing well, make sure you hand express or pump your milk to build your supply.  You can offer this milk to him in a cup or syringe as an “appetizer” to help him have the energy to nurse more effectively and take his “meal” at the breast.

What if one baby nurses well and the other doesn’t?

This is one of the challenges of nursing twins.  It is usually not feasible to nurse one while pumping for the other.  Therefore, you may need to alternate feedings whereby you nurse both at the breast for one feeding and then the next feeding you express and give this milk to your babies in a cup, syringe, or bottle.  Alternatively, if you have a lot of extra milk expressed you could nurse one baby while feeding this already-expressed milk to the other.  After nursing you will need to pump so that your body will continue to make an adequate milk supply for two babies.

Part of feeding twins is making sure you don’t get so tired and run down you don’t want to continue breastfeeding.  Therefore, if it means you express and give milk to both babies (even though one could’ve nursed) that is okay!  Perhaps you work diligently to get both latched at the breast during the day and then bottle-feed your expressed milk at night.  Though you will need to make sure to pump, you may be able to get more rest if you have help giving the bottles at night – especially if they are small and feeds take awhile.  You will need to evaluate your situation but make sure to take care of yourself too.  Accept all offers of help – this is not the time to make sure your house is perfectly clean and gourmet meals are on the table!

How do I know if my babies are getting enough milk?

What goes in must come out – so it is important to watch for adequate wet and dirty diapers.  When you are tired and taking care of multiple babies, it is easy to lose track of which baby did what so make sure to write down on separate charts for both babies what their diaper output has been.

Should I nurse them at the same time?

Many twin moms find that nursing their babies together saves time.  However, there can be a big learning curve in the beginning.  It is helpful to work one-on-one with each baby in the beginning to make sure he is able to latch and suckle effectively, then tackle nursing both babies at the same time.  Nursing them together has the added benefit of increasing your milk supply as well as the babies suckling and producing milk let-downs for one another.  It is still important to remember that each baby is an individual with unique needs and may need to nurse at different times than the other, too.

How do I know which baby to feed on which side?

You can either assign a breast to each baby or switch which side the babies nurse from.  Keeping the babies on their own side has the advantage of making milk specific to that baby (though the babies will probably be sharing the same germs anyway as they will be in close contact) and containing something like a thrush infection should that ever occur.  Switching sides has the advantages of eye stimulation and development and making sure each baby is adequately fed as it is very common for one breast to produce more milk than the other.  Or, if one baby eats more than the other, it keeps you from looking lop-sided in size!

If you choose to switch breasts, you can either switch at each feed, or switch each day keeping one baby on each side for 24 hours before switching.  There is no one right way so just find what works best for you and go with it!

What positions work for feeding twins?

The short answer is, “any that are comfortable for you and your babies!”  There is no right or wrong position to nurse your twins.  That said, you want to make sure you are comfortable and propping many pillows around you to help support your babies can make nursing easier.  See this page for pictures and ideas for positions.

Breastfeeding twins is so much work!

Yes, nursing twins is a lot of work.  You will probably look back on their first year of life and think all you ever did was nurse babies.  But, feeding twins, no matter how you choose to do it, is work.  Imagine if you bottle-fed your babies – mixing the formula, cleaning and sterilizing bottles, as well as trying to hold them both while taking their bottles. . . not to mention the cost of buying the formula.  From this perspective, breastfeeding twins seems quite easy compared to the alternative!

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