Tricia’s top ten tips – Breastfeeding Twins

Breastfeeding twins is such a positive achievement for many families. For some, it means overcoming a number of challenges, relevant to many singletons too, yet widely prevalent in this community. There are a number of common contributing factors to breastfeeding twins as follows:

• prematurity (50% born before 36 weeks)
• 70-80% born by c-section
• learning to breastfeed, possibly for the first time, but with two different feeders
• little opportunity to sleep
• establishing milk supply for two babies
• often encouraged to give top-up in the hospital as babies weight loss often more than 10% (due to all of above)

Many of us have managed to overcome these challenges and managed to successfully feed for many months and some years. So here’s my top tips for successfully feeding twins (these should also be used in conjunction with my general top tips for breastfeeding – available from http://nurturemeedinburgh.com/2014/05/19/tricias-top-ten-tips-for-breastfeeding/):

1. Feeding twins is a team effort. Partners and family support is vital. They can focus on general baby care (including skin-to-skin) and ensuring mum has got a steady supply of food and water enabling mum to fully concentrate on feeding. Mum needs lots of positive comments, encouragement and support. This will enable her to keep focussed. Partners can help researching and also can be responsible for drafting in help or taking mum to feeding clinics etc. Consider hiring someone to help you on your return home from hospital for those first few weeks.

2. In those first few days in the hospital, if you are on pain relief medication (such as tramadol or di-hydro-codeine) whilst recovering from a section and/or you have babies born 37/38 weeks or earlier, you might really struggle to have babies awake enough to feed. Carrying out as much skin to skin contact with mum and dad (or partner) and sleeping babies, can really help to overcome this and encourage babies to rouse enough to feed. There is no substitution for patience with this.

3. Top ups. One of the issues many mums have is being able to produce enough colostrum until the milk arrives. Milk usually arrives between days 2-4 (generally on day 4 for sections). However, in the meantime babies are losing weight. Whilst this is normal, if babies lose more than 10% of their body weight a schedule of 3 hourly feeds with babies topped up with expressed colostrum in addition to feeding will be started by the hospital. This whole process can take up to two hours (feed one baby, express, give expressed colostrum/milk/formula and then repeat) leaving very little room to sleep in between the three hour schedule (this really brought me to my knees). In my opinion, this is the biggest challenges for breastfeeding twin mums – it is an exhausting process. It can be difficult then to remove this need for top ups or for mums to believe they can produce enough for a feed. Top ups should be seen (in the majority of cases but not all) as a short term fix until mums are producing enough milk.

4. Building up a milk supply. There is no substitute for a well-attached breastfeeding baby to build up a good milk supply. Encourage frequent feeds (skin-to-skin will help). Let babies feed for as long as they want – the range for new babies can be 20 minutes to 100 minutes – don’t feel you need to remove them after a specific time (unless YOU want to). Middle of the night feeding is essential as this is when your prolactin is highest. If you want to encourage more milk, express for 10 minutes after a feed on each breast. Hire a hospital breast pump or dual pump as they are better and quicker letting you try to rest more in between feeds. There are also supplements such as fenugreek seeds, brewer’s yeast and lots of lovely herbal breastfeeding teas that can help.

5. Learn to feed each baby as an individual. For those first few days, learning how eachsian breastfeeding baby feeds is important. If you are a first time mum, you yourself are also learning about feeding and what is good attachment, how to be comfortable, and getting the babies positioning right. Don’t rush this stage to move onto tandem feeding as if feeding isn’t going well, you might feel that you’re taking a backwards step.

6. Adapted feeding on demand. Whilst with one baby, feeding on demand is essential, with twins it’s also essential that mum can optimise rest time. Therefore, mums should try to feed one baby after the other for the first few days/weeks and then if possible, tandem feed the babies so mum can optimise rest time in between feeds.

7. Tandem feeding. Tandem feeding is the ideal for feeding twins as it means that you can synch up your babies into the same pattern of feeds and sleeps meaning more rest time for mum which is vital. There are a number of positions – available in this handout from the multiple births foundation - http://www.multiplebirths.org.uk/MBFParentsFeedingGuideFINALVERSION.pdf. Many mums find a breastfeeding cushion can really help as it’s tilted meaning babies naturally roll towards you. Popular brands are EZ 2 Nurse Twin feeding pillow or Harmony Duo feeding pillow. Pillows don’t suit every breast shape and size, so bear that in mind that you might need to look at other options. Pillows are definitely suited towards larger breasted woman, whereas smaller breasted woman might prefer other positions. Keep experimenting until you find a position that suits you. For some mums, tandem feeding doesn’t work and you should very much feel that you can choose to feed one at a time. For some, they really enjoy that one to one time.

8. Swapping breasts? For the first few weeks, swapping breasts between feeds is the ideal. You may even want to consider swapping breasts half way through feeds when you’re tandem feeding as it might help if you have a stronger feeder to increase your milk supply. However, you might also decide to eventually allocate one breast to one baby. I eventually did this as I found one preferred one side. It also meant if I wanted to to give an extra in between feed, I could without thinking I was stealing milk from the “other’s” breast. You can end up a bit lop sided (just a little bit!). This is a very individual choice and there isn’t one right answer.

9. Get support – find out what local support there is. In Edinburgh and the Lothians, the Edinburgh and Lothians Twins and Multiples Club have a peer support system where one of our peer supporters will come to see you in your home. In addition, we run a weekly feeding support group (in my home). We also have an active facebook community where mums get lots of support. TAMBA has a breastfeeding information line if you’re in other parts of the UK (http://www.tamba.org.uk/support/Breastfeeding-Peer-Supporter-Scheme). There are lots of places to get help from like local breastfeeding clinics, cafes and the La Leche League branches. The issue that I found with these, is they just weren’t suited as a place to go with two babies and try to sit comfortably with two babies which is why we set up the feeding support in Edinburgh.

1. Look after yourself. It cannot be strongly emphasised enough how important it is to look after yourself. Mums need to be rested, fed and well hydrated. Physical needs such as being able to look after their recovering bodies is vital too – so time to have a bath, shower and feel clean. Self care is essential when caring for newborn twins.

There are so many more things I could go on and on about – I love talking twins and feeding…. but these are the TOP tips…..

I loved feeding my twins (well once we managed to get it established). I fed mine until they were 13 months. I had a number of issues with cracked, blistered, bleeding nipples but so thankful to an NCT counsellor who came to my home and spent time making minor changes to my positioning. And whilst there were so many tears over it, and challenges to overcome, I would love to have that opportunity to have one more middle of the night quiet feed with my two boys. I’m also so sad I have no pictures of me feeding – so advice to any twin mum – get lots of pictures taken of your achievement!!

If you need help with breastfeeding, with any number of babies, NurtureMe offer’s breastfeeding support as well as general postnatal care for those first few weeks helping with each feed. It will help to get breastfeeding off to the best start.

Much love, Tricia xxxxx