Importance of breastfeeding for twins
Breast milk is a nutrient-rich food for infants, fulfilling most of the baby’s needs and stimulating appropriate growth & development for the first 6 months. Colostrum(the first yellow or golden milk) is consumed by the infant in the very first days of life. It fights against diseases and aids in the proper digestion of the baby. Repeated skin contact promotes bonding between the baby and the mother. The suckling habit helps in the development of the baby's jaw and teeth. Twins are likely to be born with low birth weights and may require more attention. Breast milk-fed infants show fewer chances of sepsis, diarrhoea, upper respiratory tract infections, and urinary tract infections, and with continuous use, reduced risk of obesity & diabetes. Moreover, formula milk is not easily digested by the baby.,
Benefits of breastfeeding for both mother and babies
Immediate breastfeeding after the birth of the baby induces breast milk production, and persistent suckling avoids engorgement(when milk is not completely removed from the breasts). Breast milk can save money and is often readily available in most places, while formula milk demands call-on-duty and well-sterilized equipment, such as a bottle and boiled water. Exclusive breastfeeding is considered 98% efficient for birth-control measures during the first 6 months if the woman has not started menstruating again. Breastfeeding mothers are less prone to breast cancer and ovarian cancer. Breastfeeding also helps mothers lose postpartum weight.1,3,
Breastfeeding positions for twins
Breastfeeding can be difficult, but utilizing various breastfeeding positions can make this procedure convenient for both mothers and babies. Always maintain healthy postures as this will be a daily chore.
Sit straight and hold one baby in the crook of each arm. Position both babies facing you, with their heads resting on your forearms and their bodies facing your chest. Use pillows or special nursing pillows to support your arms and the babies if required.
Advantages and considerations
This position is the most common and restful hold for mothers and babies. You may need someone’s help with this while adjusting your and your baby's postures. This position is also great if you do not have nursing pillows.3
Position one baby on each side, tucked under your arms like footballs. Support their heads with the palms of your hands, and make sure their bodies are facing your sides. Utilize pillows/ nursing pillows to lift the babies to breast level.
Advantages and considerations
This is useful in the case of mothers who have had C-sections, ladies with big breasts, flat or inverted nipples, and high milk ejection reflexes. This is also helpful with premature babies and babies comfortable with more upright positioning.3
Lie down on your side and position your babies alongside you, one on each side. Ensure their mouths are at breast level. Use your arms to support their heads and bodies, as required.
Advantages and considerations
This can be a comfortable position for nighttime feedings and tired moms. Moreover, it's a more relaxed approach to breastfeeding.3,4
Recline in a semi-reclined position, around 45 degrees, with your back and head propped up slightly. Lay the babies on your chest facing downwards with their bodies on yours. As the baby tries to find the breast, support your baby's head and shoulders, but do not force latching.
Advantages and Considerations
It is a more relaxing baby-led approach; the babies have the opportunity to use their instincts to latch onto the breast and self-regulate their feeds.3
Combination of positions
Alternating between positions for variety and comfort
Mothers can make use of comfortable pillows, nursing pillows, and side blankets depending on their preferred method of feeding, which adds more support and convenience. It is not essential that what works for one mother and her babies will work for others. So, many other combinations of holds can also be applied based on one’s adaptability and comfort.3,4
Tips for successful breastfeeding with twins
Establishing a feeding routine
Establishing a feeding routine for breastfeeding requires careful planning and flexibility to meet their unique needs. At the start, it's important to feed both babies whenever they show hunger signs, stimulating on-demand feeding to establish a good milk supply. In the initial weeks, infants are fed eight to twelve times per day, which can vary in time cycles and other factors. Wait for each infant to show any sign that they are full before stopping the feed. Both babies can be fed simultaneously, and it can save time and result in better bonding. Maintaining a consistent daily schedule with night feedings is necessary to promote natural feeding rhythms and support their growth and development. Shifting the breasts during the sessions can help with equal stimulation. As they grow, monitoring their weight gain and overall health will allow their feeding schedule to meet their evolving requirements.3,5,6
Ensuring proper latch and positioning
A proper latch ensures regular feeding and should feel comfortable to the mother. Sometimes, the baby may not latch properly and may inadvertently cause discomfort or pain to the mother while attempting to suckle, resulting in tender breasts. In such cases, mothers should gently break the suction with clean fingers, take a short break, and then allow the child to try latching again. When the nipples come out of the baby’s mouth, Mothers should check regularly that the nipples are not flat or compressed.3
Seeking support from lactation consultants or support groups
If any problems related to feeding arise, it’s important to contact your healthcare professionals. New mothers can learn essential nursing knowledge from nurses and lactation experts. Additionally, doctors often recommend contacting support groups and breastfeeding peer counsellors for assistance before or after pregnancy.
Managing milk supply and demand
A mother’s milk supply increases proportionately to the baby’s needs, and continuous breastfeeding supports its development. Babies can nearly double their weight in just a few months. By monitoring the baby’s weight within three to five days after birth and again at 2to 3 weeks, mothers can gauge the baby’s feeding requirements through regular doctor visits. Other signs of a healthy milk supply include clear and pale yellow urine, regular bowel movements, sleep patterns, periods of wakefulness, and the baby’s satisfaction after feedings. While most mothers can produce ample milk for their baby, if there are concerns about low milk supply, it’s advisable to seek advice from lactation experts.3
Self-care for the mother
This is important for a breastfeeding mother, especially when she has twins. Making sure you’re well-hydrated, eating well, and getting enough rest is really important for both the mom and her overall health. To ease a mother’s workload, it’s great to have support from her from her partner, household help, friends, and family. If needed, it’s a good idea to seek professional help for your well-being.7
Engorgement and blocked ducts
When a mother is not expressing milk regularly, the breast can become swollen, painful, and hard because of milk. This can lead to engorgement and blocked ducts. To prevent this condition, it’s important to breastfeed regularly after giving birth. To manage this:
- Breastfeed on the affected side.
- Avoid using pacifiers
- Gently press the breast or pump a little milk to soften the breast
- Apply a cold compress to reduce swelling or a hot compress to help milk flow more easily
- Breastfeed as frequently as possible.1
Nipple soreness and pain
- Breastfeeding should be frequent
- Ensure a proper latch of the baby
- Avoid using the affected side of the breast; introduce the other breast for feeding.
- Experiment with different feeding positions and improve the baby’s mouth attachment
- Bottle use should be avoided (it causes nipple confusion)1,19
- If you’re experiencing severe difficulties with feeding, contact your doctor, nurse or lactation expert
Low milk supply or oversupply
- Check and improve the baby’s attachment.
- Consider completely stopping the use of formula milk, supplements and bottles.
- Ensure that mothers are maintaining a healthy and balanced diet, including supplements and proper hydration.
- Encourage exclusive breastfeeding
- Promote more frequent demand-feeding
- If you have an oversupply of milk, you can consider pumping it out1,20
Twin-specific challenges and solutions
Breastfeeding can present many challenges for mothers of twins. Both babies require frequent feeding, which can be quite demanding on a mother’s time and energy. Mothers can explore tandem nursing, where they breastfeed two babies simultaneously, using pillows and specially designed aids. Seeking guidance from healthcare professionals and lactation experts is valuable. Low-birthweight babies may require more rounds of frequent feeding sessions. Involving caregivers in feeding can offer mothers much-needed breaks. It’s essential to establish feeding routines that work for both the mothers and babies to ensure the mother's recovery and make breastfeeding more manageable.3,8,21,22
Pumping and storing milk for twins
Introduction to pumping
When a mother needs to be away from her baby for an extended period, she can express and store her breast milk during the times she would normally feed the baby. Storing the milk in clean, sterilized bottles helps maintain a continuous milk supply. This practice is particularly beneficial to working mothers.3,23
Choosing a breast pump
There are manual pumps and electric breast pumps, which mothers can choose according to their convenience.3,24
Tips for efficient pumping
Manual breast pumps are operated by hand and wrist movements to extract milk, while electric breast pumps can be either battery-operated or plugged into an outlet, allowing for quicker pumping of both breasts. Becoming proficient with these pumps may require practice and patience, but mothers typically become skilled with some guidance and time. Always ensure that breast pumps are used in a clean and sterilized manner to prevent any risk of infection for both the mother and baby.3,25
Storing and managing pumped milk
The expressed milk can be stored in a clean glass, BPA-free plastic bottles, or milk storage bags if you plan to freeze it. Proper refrigeration of storage containers and bags at appropriate temperatures is crucial, and it’s advisable to label the stored milk with the date it was expressed for future feedings. To ensure that older stored milk is used first, you don’t need to warm it, but frozen milk can be thawed under warm running water–never use a microwave. Before feeding, always swirl the milk and check its temperature. Thawed milk should be consumed within 24 hours and should never be refrozen.3,26
Weaning twins from breastfeeding
Introduction to the weaning process
Weaning twins is a gradual process that typically begins around six months of age when solid foods are introduced, gradually replacing some nursing sessions with bottle, sipper, or cup feedings.3,27
Gradual weaning strategies
To ease the transition, provide comfort through cuddling and engage your twins in activities to distract them from breastfeeding. Patience is key, and seeking support if needed can be helpful. Remember, this process varies for each child, depending on their unique needs and traits.3,28
Introducing alternative feeding methods
Gradually introduce bottle, sipper, or cup feedings, starting with slow-flow nipples for bottles and age-appropriate sippy cups with water or expressed breast milk during meals. Begin with age-appropriate solid foods, starting with purees and progressing to mashed and finger foods (using hand blenders and slow cookers). Initially, offer just a few spoonfuls until they become accustomed to it, and encourage self-feeding.3,9,29,30
Breastfeeding twins can be made more convenient and efficient by utilizing different breastfeeding positions, such as the “Football hold” or "Cradle hold”, ensuring both mother and babies are comfortably positioned. The “Tandem nursing” method involves feeding twins simultaneously, even if they are of different ages. Each mother discovers her unique approach by experimenting with holds that work best for her and her children. It’s essential for mothers to prioritise their health and nutrition to ensure proper milk production. If any challenges or problems arise during nursing, don’t hesitate to seek help from family, support networks, healthcare providers, or lactation experts as needed.
- UNICEF. Participant Materials [Internet]. [cited 2023 Jul 23]. Available from: https://www.unicef.org/media/108401/file/Participant%20Materials.pdf
- Flidel-Rimon O. Breastfeeding twins and high multiples. Archives of Disease in Childhood - Fetal and Neonatal Edition [Internet]. 2006 Sep 1;91(5):F377–80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672857/
- Your Guide to Breastfeeding. Learning to Breastfeed: Find out the Best Breastfeeding Hold for Newborns and How It Works. Page 12. Common Questions: Can I Take Medicine While Breastfeeding? Do I Need Birth Control? Find out the Answers to These Questions and More. Learn about the Health Benefits for Mom and Baby! [Internet]. Available from: https://www.uncfsu.edu/assets/Documents/Office%20of%20Legal%20Affairs/Title%20IX/your-guide-to-breastfeeding.pdf
- Breastfeeding Positions [Internet]. www.parentinginottawa.ca. [cited 2023 Jul 25]. Available from: https://www.parentinginottawa.ca/en/breastfeeding/breastfeeding-positions.aspx
- Breastfeeding twins or multiples [Internet]. BabyCenter. [cited 2023 Jul 25]. Available from: https://www.babycenter.com/baby/breastfeeding/breastfeeding-twins-or-multiples_8479
- How to Breastfeed Your Twins [Internet]. What to Expect. Available from: https://www.whattoexpect.com/first-year/breastfeeding-twins
- Twins [Internet]. La Leche League GB. 2016. Available from: https://www.laleche.org.uk/twins/
- Management of breast conditions and other breastfeeding difficulties [Internet]. Nih.gov. World Health Organization; 2009. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148955/
- Weaning twins | twinlifeonline.co.uk [Internet]. twinlifeonline.co.uk. 2013 [cited 2023 Jul 26]. Available from: https://twinlifeonline.co.uk/twins-1st-year/weaning-twins