Breastfeeding twins
by Cordelia Uys, NCT Breastfeeding Counsellor
December 2021
Part 1 - Preparing for breastfeeding twins
Here are some suggestions for how a mother can best prepare herself for breastfeeding twins
Establishing breastfeeding with just one baby can be challenging, it’s therefore not surprising that women expecting twins or triplets can feel daunted. A big obstacle they face is that many health professionals won’t have come across exclusively breastfed twins or triplets, and don’t know it’s possible. However, the vast majority of mothers can make all the milk their baby, or babies, need and can therefore successfully and exclusively breastfeed twins or triplets. Milk production depends entirely on supply and demand: in the early months, milk needs to be removed effectively from both her breasts at least 8 times in 24 hours for a mother’s supply to be established and maintained. By far the most common reason for low milk supply is under-stimulation of a mother’s breasts, either because her babies are not feeding frequently enough or are not removing milk effectively.
Informing yourself as much as possible about breastfeeding before your babies are born can make all the difference.
Do some preparatory reading
Karen Kerkhoff Gromada’s book Mothering Multiples Breastfeeding & Caring for Twins or More is the bible for breastfeeding multiples; it covers everything you might need to know.
Professor Amy Brown’s The Positive Breastfeeding Book, which has a chapter on breastfeeding twins, is comprehensive and easy to read.
See some breastfeeding in the flesh
Spend time with a mother who is successfully breastfeeding twins, or if that’s not possible, a singleton, to see some breastfeeding in action.
Join the Facebook group Breastfeeding Twins and Triplets UK
Kathryn Stagg, the IBCLC lactation consultant and mother of twins who set up and runs Breastfeeding Twins and Triplets UK https://www.facebook.com/groups/460888727398997/?ref=pages_group_cta has done research showing that women who join her group when they’re still pregnant are more likely to successfully breastfeed their twins and triplets.
Find a breastfeeding counsellor or IBCLC lactation consultant
Arrange an antenatal breastfeeding workshop with a BFC or IBCLC who will also be available to support you after your babies are born. She can help you work on good attachment and positioning, which are fundamental to successful breastfeeding. Breastfeeding shouldn’t be painful.
https://lcgb.org/find-an-ibclc/
Antenatal hand expressing and harvesting of colostrum
Women having low risk pregnancies can start harvesting colostrum from 36 weeks. Since twin pregnancies are considered higher risk, it’s important to ask your midwife if it’s safe for you to do this, and if you can start a little earlier. Hand expressing is a very useful skill to learn and having some frozen syringes of colostrum to take into hospital and give your babies, can be very helpful if they’re too sleepy to feed or have low blood sugar. It can also make supplementation with formula less likely to be necessary.
https://www.cordeliauys.co.uk/antenatal-harvesting-of-colostrum
Research where to buy or hire a hospital grade double pump in case you need one after your babies are born
Twins are almost always born early, and even babies born just 2 weeks before their due date aren’t always as efficient at stimulating milk supply as full-termers. Effective and regular removal of milk from both breasts in the first 6 weeks is essential for establishing a good milk supply. The first two weeks are particularly critical.
It’s helpful to know how to get hold of a hospital grade double pump quickly in case your babies are sleepy and not very efficient at transferring milk in the early days. If that’s the case, once your mature milk comes in, you will need to do some pumping after feeds to stimulate your milk production and so you can top your babies up with your breastmilk.
Some women will hire or buy a hospital grade double pump in advance, so they have it ready at home, just in case. A hospital grade double pump is necessary if you need to pump to establish your supply; regular pumps are not powerful enough.
These are the hospital grade double pumps which are available in the UK:
Hiring:
The Ardo Elite or the Carum
The Medela Symphony
Buying:
The Spectra S1
The Baby Buddha
Download a newborn tracking App
This will allow you to keep track of how many feeds each baby is having, and how many wet and dirty nappies they’re producing. Pees and poos are an important way of gauging how breastfeeding is going.
Arrange as much help and support as possible, paid or unpaid, well in advance
When caring for twins, having your partner and at least one additional person around to help with the cleaning, washing, cooking, shopping, nappy changing and settling of babies will be immensely helpful, so that you can focus entirely on breastfeeding. Ideally, this should be someone who is supportive of breastfeeding and with whom you feel comfortable. Remember they’re going to see your breasts a lot. There is also the option of hiring a postnatal doula with experience of twins.
Keep unnecessary visitors to an absolute minimum
Many mothers find that not having any visitors except for ‘helpers’ in the early weeks means they can focus on their babies, and on themselves; that way they don’t even need to get dressed unless they want to. Some mothers enjoy having company, in which case, they should encourage visitors to help with housework, cooking, or looking after an older child.
Fill your cupboards and freezer
Fill your cupboards in advance and prepare or buy lots of meals for your freezer. You won’t believe how hungry and thirsty you will get when breastfeeding in the early weeks. Breastfeeding mothers burn an additional 500 calories a day per baby, so finding time to eat enough can be a struggle.
Maternity bras and comfortable clothing
Before your babies are due, make sure you have bought at least a couple of comfortable maternity bras, as well as lots of tops that allow easy access to your breasts.
https://www.motherandchildhealth.com/breastfeeding/all-about-nursing-bras/
https://www.cordeliauys.co.uk/nursing-bra-recommendations
Part 2 - Getting off to a good start
Immediate skin to skin
Whether you’re having a vaginal or caesarean birth, tell your midwife or obstetrician in advance that you would like to have skin to skin with your babies immediately after birth, if you are all well. Skin to skin will help enormously with breastfeeding and bonding, as well as stabilising their blood sugars, hormone levels, heart rates and body temperatures.
Continued skin to skin
Continuing to keep your babies close and doing skin to skin with them as much as possible in the early weeks will be good for your milk supply and will be enjoyable for all of you. Skin to skin with fathers also aids bonding and calms babies.
If your babies are taking the breast
As mentioned in Part 1, when babies are born even just a couple of weeks early, they can be quite sleepy, and might not be as efficient at removing milk as is necessary to transfer milk effectively and properly establish a mother’s milk supply. It’s imperative to get qualified breastfeeding support from an IBCLC lactation consultant or breastfeeding counsellor as soon as possible, so they can observe your babies at the breast and ensure they are transferring milk effectively. Here’s a video showing twin baby Alison drinking really well at the breast at 37 weeks and 3 days (with many thanks to Alison’s mother Amy Clayton):
https://www.youtube.com/watch?v=13gkFmBfX_U
If your babies are premature, not well enough to breastfeed or sleepy and not yet able to remove milk efficiently
You will need to hand express your colostrum from as soon as possible after your babies are born, ideally within two hours, and no later than 6 hours. Until your milk comes in, continue hand expressing at least 8 to 10 times in 24 hours, for roughly 10 minutes on each breast. Very frequent stimulation is crucial in these early days.
Once your mature milk comes in, move to double pumping for approximately 20 to 30 minutes, a minimum of 8-10 times in 24 hours, including once between 2am and 4am, because that’s when prolactin, the hormone that makes milk, is at its highest levels in your body.
If you can establish your milk supply by double pumping, you can then gradually move to breastfeeding once your babies are ready. Again, this is best done with the support of an IBCLC lactation consultant or breastfeeding counsellor.
Paced bottle feeding
If you, or anyone else, is topping your babies up with breastmilk or formula, it is essential to practise paced bottle feeding. The traditional way of bottle feeding delivers milk very fast and often results in babies rejecting the breast, due to a slower flow.
Rather than holding your baby in a reclined position, hold them upright and close to your body, and hold the bottle horizontal with the floor. The teat should only be half full of milk. Pause every 30 seconds or so by pulling the bottle down to vertical. Bring the bottle back up to horizontal once the baby starts to suck again. Stop feeding as soon as your baby no longer sucks/seems interested.
https://www.youtube.com/watch?v=wumI31Oyc8k
Positions for breastfeeding
Breastfeeding comes naturally to babies, but for mothers it’s a skill they need to master. After a while, muscle memory kicks in and it becomes easy, but in the early days, learning to latch a baby can be quite difficult and dispiriting. Be kind and patient with yourself.
Here are a couple of really helpful videos showing various positions for breastfeeding twins:
https://www.facebook.com/reel/267826532816987
https://www.instagram.com/reel/C6NyIBcgMh_/?igsh=bmpjOXRmZHN4N2Zw
Also see photos below.
To tandem or not to tandem feed?
Most mothers of twins prefer to wait until they feel confident feeding their babies individually, and at least one of them is nursing well, before attempting to tandem feed. Some mothers decide to continue feeding their babies singly, either occasionally or all the time, because they enjoy focusing on one baby at a time. However, tandem feeding saves time and removing milk from both breasts simultaneously is excellent for a mother’s milk supply.
Here’s an article on tandem feeding from the Facebook group ‘Breastfeeding Twins and Triplets UK’:
https://breastfeedingtwinsandtriplets.co.uk/2018/01/31/tandem-feeding-twins/
There are a number of positions that work well for tandem feeding. Please see the photos below. A pillow specially designed for breastfeeding twins can be very helpful.
Here’s an article from the Facebook group ‘Breastfeeding Twins and Triplets UK’ on choosing a breastfeeding pillow:
https://breastfeedingtwinsandtriplets.co.uk/2017/10/27/twin-breastfeeding-pillows/
Mastering positions in which you can feed both babies while lying down in bed will allow you to get rest during the day, and more sleep at night. For one example, please see the photo at the top of this article.
Have plenty of food and drink at arms’ reach
Whatever position you are using, make sure you have plenty of food and drink (straws can be very useful) within reach, as well as your phone, the remote control, a book and whatever else will help keep you entertained for the many hours that you will be feeding your babies in the early months.
Breastfeed responsively – mostly
Responsive feeding, i.e. feeding a baby as soon as they show signs of hunger, is what allows mothers to establish exactly the right milk supply. However, when breastfeeding twins, most mothers choose to synchronise feeding, so will feed both babies whenever one is hungry, especially at night.
Which breast?
Some mothers assign a breast to each baby and always feed that baby on the same side. However, women don’t always produce the same amount of milk on each side, and one baby might be a more efficient feeder than the other, so it can be helpful to regularly change the breast each baby is getting, to make sure both breasts are getting equal stimulation, and so that one baby isn’t always getting the less generous breast. Sometimes mothers will alternate at each feed, but it tends to be easier to alternate every 24 hours.
Combination feeding
Breastfeeding twins isn’t all or nothing; any breastfeeding is beneficial. If you are combination feeding, speak to a BFC or IBCLC about how to protect your milk supply.
In conclusion
Establishing breastfeeding twins is undoubtedly extremely hard work. It takes an iron will to persevere in the early weeks; but many twin mums say that once established, breastfeeding twins is much easier and more enjoyable than bottle feeding.
With thanks to Amy Clayton and her babies Alison and Toby
Amy with babies Alison and Toby
Amy with babies Alison and Toby
Amy with babies Alison and Toby