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Friday, April 29, 2011

Breastfeeding Twins

My nieces are twins, my good friend just became an uncle to twins, and another family member is currently pregnant with twins so the topic of breastfeeding twins has come up a lot lately.

My experience with breastfeeding twins is what I witnessed/heard from my sister-in-law, what I've researched about it (alongside breastfeeding in general) over the years, and what I can extrapolate from nursing one baby.

Here is my advice for how to successfully breastfeed twins. This is adapted from the general breastfeeding advice on my breastfeeding page--the parts in italics are where the advice differs from general tips with a singleton. I hope this is helpful!

Breastfeeding Twins

The majority of women have more than enough MILK to exclusively breastfeed twins; what ends up being the scare resources, more often than not, is time, food, and sleep for the Mom.

I firmly believe that breastfeeding is a socialized skill, much like using a fork. We were meant to grow up watching people breastfeed all the time, like using a fork. In this ideal environment, we would learn about breastfeeding by watching our Moms, Aunts, Sisters, and limitless women while out and about in public. However, this is not our environment, so breastfeeding goes from natural and easy to awkward and challenging very quickly.

Here is my advice for having a successful breastfeeding relationship with your twins. These things are in an ideal situation. Sometimes there are emergencies or unforeseen complications, but breastfeeding is resilient enough to work out great even if you can't do all of these things every time.

-If possible, have a natural birth. There is evidence that drugs such as pitocin and the narcotic drugs in an epidural can affect both your milk coming in, and the baby's ability to stimulate the breast early on. Sorry I'm too lazy to look up said evidence and link it but you can look it up yourself and/or use common sense to realize that it is probably true. With this said, a natural birth isn't everyone's first choice for a birth experience and plenty of medicated birth babies have zero issue with breastfeeding. However, I believe a natural birth is a great way to start out a breastfeeding relationship with every advantage on your side.

Some people mistakenly believe that you must have a c-section or an epidural when you are delivering twins. This is not true. As long as one twin is head down and engaged in the birth canal, you should be set to deliver your twins vaginally. Sometimes only one twin can be delivered vaginally but it's still better for that one to have avoided the c-section even if one is necessary for the second twin.

Some hospitals have policies about delivering twins. Fight for your birth rights if having a natural birth is important to you. You are always allowed to deny a medical test or procedure that they are offering.

So even for twins, having a natural birth is a better way to go if you are able to do it!

-Immediately after birthing the first twin, put the baby on your belly/chest, and leave her/him there, skin-to-skin, until you have the other baby. Continue skin-to-skin care then for as long as possible--ideally 1-2 hours or more. You can allow the babies to initiate breastfeeding on their own by crawling to the breast, or you can help them. Keep the babies naked and your chest uncovered, and do this skin-to-skin kangaroo care for at least 1-2 hours after birth.

-My suggestions for a great pattern in which to nurse twins is this: Have one twin on one breast for all feedings and the other twin on the other for an entire week, then switch them. This will ensure that even if one twin is having a needy/fussy day, there will still be plenty of milk there for the other twin. The reason it might be a good idea to switch them weekly is that more often than not, one breast will produce more than the other breast, so this ensures that both twins get a chance at the more productive side.

-The first week should be a "nursing vacation." You, your babies, and ideally your husband, should pretty much stay in bed and be naked together to help the babies bond with both of you and establish proper breastfeeding.

-Expect the babies to pretty much nurse non-stop the first week--this is NORMAL, HEALTHY, and does NOT mean that the babies are not getting enough milk. This first week is CRITICAL in terms of your milk supply coming in well. Some people can take up to a week for the milk to come in. Colostrum is enough for your babies but only if they are able to nurse pretty much constantly. Some babies can go an hour or two between feeds, and most do that at least some of the time, but start out with the expectation that this first week your job is ONLY to nurse the babies. Hence the staying in bed/on the couch.

Even if you don't generally enjoy tandem breastfeeding (feeding both babies at once), you might want to just resign yourself to doing it for this first week or two.

-For at least the first six weeks, breastfeeding twins is (at least) a three person 24-hour a day job:
+The Mom should (for most of the day and night) be comfortably arranged on a couch or bed, with pillows set up so that when a twin is hungry, it is brought to the Mom's breast, arranged on the pillow, and allowed to nurse. In this way the Mom can nurse both babies at once on demand, even with twins.
+The Dad should be on diaper and baby comfort duty. Besides feedings, Dad should be the primary caretaker of the babies. He will do most diaper changes, clothes changes, will bring twins to and from Mom, will rock to sleep, etc.
+And there should be a third person, a family member or friend (or many in turn), with you 24/7 to take care of cooking and feeding both parents, doing all the laundry, and for back-up baby care.

-After the first week, continue to nurse the babies on demand--nurse at the first sign of hunger--rooting (chewing/sucking on hands, clothing, etc), open "searching" mouth, agitated movements, etc. During the day try to nurse at least every 2 hours. This will help the babies sleep longer at night if they are fed more often during the day.

-Expect the babies to be fussy and cluster nurse (feed very often/constantly), usually in the evening and during growth spurts. You will probably at some point feel like you are "out of milk" and that the babies seems hungry and unsatisfied. As long as this only happens for a day or two at a time (growth spurts), and/or during one part of the day, it is totally normal and DOES NOT MEAN the babies are overly hungry, starving, or that you need to supplement with f0rmula. Supplementing during times like these can be very dangerous and lead to a permanent (and spiraling) supply dip.

This cluster nursing usually lasts for the first 6-12 weeks.

-After the first six weeks, breastfeeding twins (just like with singletons) will become easier. By 6 weeks, the babies will usually be going at least two hours between feeds and sleeping longer stretches at night. Breastfeeding will become more routine and each nursing session will shorter. At this point it might be possible to only have two full-time adults taking care of: the twins, the Mom, and the house. ;-)

-Have CONFIDENCE in breastfeeding. It is difficult at times, but it really is perfect food for your babies, and a perfect "system" for Mom. There is no reason to question whether your babies are eating enough unless they aren't gaining weight. Otherwise, feed your babies at your breasts, watch the milk dribble from their chins, and KNOW that they will eat as much as they needs to eat, and your breasts will make it for him. Supply and demand. It's that simple, especially if you can do all of the things above.

-After the first 3 months, it can become REALLY easy. Most babies drop to 5-10 minute feedings every 2-3 hours and many are sleeping through the night, or only waking once or twice to nurse (again usually only for 5-10 mins). There is no warming bottles, mixing f0rmula, wondering if the baby ate enough or if you need more--you don't even have to get out of bed all night long! It is true that it can be challenging and demanding in the early days, but it totally pays off in the long run!

By 3/4 months, an energetic Mom (even an exclusively breastfeeding one) can probably handle her twins on her own with just a few hours of help (including a baby break) per week. As long as she has lots of snacks and isn't expected to do much else besides take care of the babies and feed herself. ;-)

-All problems can be solved. Seriously. Of course with twins more often than with singletons, supplementation with f0rmula or donor milk can be required, but this should not be seen as a failure. The goal should be to continue to provide as much breast milk as possible for as long as possible, and success shouldn't be judged on exclusively breastfeeding.

If you are pregnant with twins and would like to breastfeed, definitely get both Breastfeeding Made Simple (which I recommend to all pregnant ladies), and also Adventures in Tandem Nursing. This is an entire book about breastfeeding two: twins, while pregnant, an infant and a toddler, etc. There are personalized stories, photos and descriptions of good tandem positions, and general advice.

Generally, understand that exclusively breastfeeding twins is POSSIBLE most of the time--it is more normal than not for a Mom to have more than enough milk to feed two babies. What is going to make it really happen though is having the right help and support in the beginning. The Mom needs to be waited on hand and foot and should NOT be the primary caretaker of the babies. Her only job should be to breastfeed (for at least 6 weeks)--this approach will make success easier. With the appropriate support, even a Mom of twins can have a wonderful breastfeeding relationship with her babies!


EricaG said...

I'm so glad that you share positive breastfeeding info on your blog. I would add...get connected with other moms who breastfeed and other moms of multiples. I met a mom of twins at an La Leche League conference a few years ago, and she was such an inspiration even though I do not have twiins myself.

justadrienne said...

Great advice Erica! I might add that (and to the general page) along with "make sure you see a LC before leaving the hospital"--that's an important one, definitely!

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