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How Do I Breastfeed Twins?

What are some specific tips for nursing multiples?

Breastfeeding is basically about supply and demand: the more milk you remove from your breasts by nursing or expressing the more milk you make. Early, frequent breastfeeding (or milk expression, if mom or one/more babies are unable to breastfeed) usually ensures an ample supply of milk for two, three, or more babies.

Here are a few tips to help you get ready to breastfeed twins, triplets, or more:

  • Be prepared. Talk with your health care provider about early skin-to-skin contact and how it benefits breastfeeding, as well as “family-centered” or “natural cesarean” options. Surgical (cesarean) birth, preterm delivery, and other conditions that require special care for mothers and/or babies are more common with multiple births than single births. Consider getting a doula; during labor and/or after birth, she can provide much needed support in facilitating skin-to-skin contact, initiating early breastfeeding, or expressing your milk.
  • Learn all you can. Attend childbirth preparation and surgical birth classes early in pregnancy, around your fourth or fifth month. You may also want to schedule an appointment with a lactation consultant before your baby is born. A lactation consultant or other certified breastfeeding professional can demonstrate various positions for feeding multiples. Detailed instructions can also be found in Breastfeeding, A Parent’s Guide.
  • Select a breast pump. Know where to buy or rent a breast pump. Karen Kerkhoff Gromada, lactation consultant and author of Mothering Multiples: Breastfeeding and Caring for Twins or More, strongly recommends the rental of a “hospital-grade” breast pump “until all babies are effectively breastfeeding.” Personal (single-user) breast pumps are “fine” after your breast milk supply is well-established and your babies’ suckling skills are well-developed, but until then, hospital-grade is the way to go. The Affordable Care Act, now requires insurance companies to cover the cost of a breast pump but coverage is variable. Contact your insurance company for details.
  • Get support. Connect with a breastfeeding support group, such as La Leche League or Breastfeeding USA, and begin attending meetings during your pregnancy. Real-world support and advice are likely to help in a way books or online resources cannot.
  • Choose a great pediatrician for your babies. Look for one who is knowledgeable about breastfeeding and has cared for successfully breastfed multiples. Most multiples are born preterm or late preterm, so many of the “normal” breastfeeding expectations, such as how much your baby should eat during a feeding, and how many feedings you can expect in a day, will differ. You will want to have a health care provider who knows what is “normal” for multiples.
  • Enlist help. Ask your partner, a family member, or a friend to stay with you at night while you are in the hospital to provide assistance when you begin to breastfeed your babies. Also, arrange for daily or round-the-clock help from family, friends, or a postpartum doula for several weeks after your babies come home from the hospital. Let others take care of household tasks such as making dinner, folding laundry, and paying bills, so you can focus all your energy on your health (you will need plenty of rest) and your babies.
  • Set a goal. Determine to breastfeed (or express milk) for at least 6–8 weeks after birth, no matter how difficult it may seem. Usually, around the time of the babies’ six-week growth spurt, many mothers find that their milk supply is well-established, and they and their babies have formed a breastfeeding routine.

After your babies are born:

  • Get expressing. If your babies are born preterm or ill, they will need to stay in a neonatal intensive care unit (NICU) after they are born. You will want to begin expressing your milk within 24–48 hours of giving birth. Sooner is better, if your condition allows. In case you are unable to express milk on your own, include in your birth plan to have a nurse, lactation consultant, family member, or friend hand express or help you use a pump. Typically a double-electric hospital-grade pump works best. Begin by pumping both breasts simultaneously, at least 8 times in each 24-hour period, for about 10–15 minutes each time, to help establish a good milk supply. Massaging the breast for several minutes before pumping, as well as during pumping, helps your milk let down. Recent research suggests that initial hand expression of your milk within the first hour followed by pumping with hands-on massage will result in the best possible milk production.
  • Breastfeed and pump at the same time, whenever possible. If one or more effectively breastfeeding babies is discharged before the other(s), breastfeed each baby who is with you 8–12 times in 24 hours. You can pump one breast to provide milk for any multiple(s) not yet breastfeeding while one baby feeds on the other breast. If you don’t think you are ready to coordinate pumping with feeding, pump both breasts immediately after a breastfeeding, or pump in-between feedings. Contrary to common belief, you do not need to wait for your breasts to “refill” before pumping; nor do you need to wait after pumping to feed your baby from the breast. Your breasts are always making milk and are never truly “empty.”
  • Keep a breastfeeding chart. If your newborns are born at term, they will need to feed 8–12 times in a 24-hour period; their stomachs are very small, and frequent feedings cue your body to make enough milk to feed them both. Until you have a good sense of each baby’s breastfeeding style, it may help to keep individual breastfeeding charts that are color-coded for each baby.
  • Keep pumping. Preterm multiples are likely to be discharged from the hospital before they are able to breastfeed well, so you will need to express milk as each baby transitions to the breast at his or her pace. (Usually one is ready before another.) A specially-designed nursing bustier or a modified sports bra can enable you to pump hands-free.
  • Keep support available. Remain in contact with a lactation consultant or other experienced breastfeeding support professional who can help you revise your breastfeeding and milk expression plan as each baby progresses to direct breastfeeding. This person can also provide hands-on assistance with finding breastfeeding positions that are comfortable for you and your babies.
  • Find a position that works for you. semi-reclined position (sometimes called “laid-back” nursing, or “biological nurturing”) may be a good position to start with. Many mothers of twins find that the football hold work wells and enables them to feed both babies simultaneously; mothers who have delivered via cesarean section find that the football hold keeps most of the babies’ weight away from the incision site. Place a pillow across your lap, and lay the babies along your sides so that their heads are positioned at the height of your breasts. (A particular nursing pillow may be helpful but isn’t necessary; bed pillows work just as well.) Wrap your arms around the babies, cradling their heads for support. As they grow, you may consider cradle or cross-cradle positions.
  • Be flexible. Although it may be tempting to hope that your babies are hungry at the same time so that you are not feeding “around the clock,” in reality that may not happen with young babies. It may be that you feed one and then the other each time. Newborn multiples vary! Some do well on 8 feedings every 24 hours while others need 10 or more in order to sustain their rapid early growth. Watch and respond to your babies’ hunger cues. Be assured that, as your babies grow, their feedings will space out.
  • Be sensitive to your babies’ needs. As Gromada explains: “Newborns are immature and need time to transition from womb to world. Each multiple is an immature newborn singleton with as many physical and emotional needs as any singleton, who just happened to arrive with another one, two or more singletons. It’s really not fair to expect multiples to behave differently than any other unique single-born newborn when coming together was not their idea.” Lots of skin-to-skin contact, even when your babies are not breastfeeding, can be comforting and beneficial to you and your babies.

Confidence in both your body’s ability to make enough milk and your babies’ ability to get all they need through breastfeeding will grow as your babies grow.

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