How to breastfeed Twins?
Breastfeeding twins can be a daunting thought and it takes a little while to get the hang of it so it is best to familiarise yourself with how you are most likely to achieve this before the birth of your twins (or multiples). Once they have arrived there will be so much to think about it that it is best to understand the technicalities beforehand. You can learn about breatsfeeding in multiple ways:
A Tamba webinar https://www.tamba.org.uk/Courses/Expectant-Parents/Breastfeeding
An online class by a Twin specialist provider such as Twin Love Concierge http://twinloveconcierge.com/twin-education-classes/online-breastfeeding-twins-class/
What to expect with breastfeeding?
Nobody really knows what to expect with regards to breastfeeding with the first children. I certainly had absolutely no idea! So here are a few pointers to bear in mind.
How to improve chances of good milk production?
Firstly, milk doesn’t start gushing out the minute the twins are born. It takes time and supply builds up over time through the babies’ suction (or a pump). The first liquid that will come in is ‘the colustrum’, which is incredibly nourishing and full of essential vitamins and antibodies for your babies so be sure not to discard this. It can be recognised by its straw colour compared to the regular breastmilk which is much lighter. It is essential that you start breastfeeding or/and pumping within 24h after giving birth in order to ensure an adequate supply of milk. The longer you wait, the more difficult it will become. Bear in mind that a caesarian section can slow down milk the arrival of milk but persevering is key! I was advised by my lactation consultant to obtain a hospital grade pump immidiately after birth (I request one from the hospital) and start pumping (because my babies went straight to the NICU and was not allowed to hold them straight away). Try and rent a hospital grade pump for after you get home with your babies and use it for the first few weeks to get your supply going. You should pump as well as breastfeed to ensure your supply, every 3h and align to feeding intervals (always pump before feeding, not after for 5-10min). You can then either keep the hospital grade pump and continue to use until you stop breastfeeding (which is what I did) or buy a more portable home pump (the hospital grade pump is so heavy and bulky, you cannot really take it anywhere so you are effectively home bound).
In order to produce good quantities of milk you must drink lots of water!
What happens when the milk starts coming in?
Once the milk does start coming in (it can take up to a week), it often very quickly causes engorgement (usually 2-5 days after delivery). Engorgement happens when the breasts are overfull with milk. Breasts are very swollen, painful, lumpy and hard. You must deal with this quickly to avoid inflammation (mastitis). The best way to do this is to apply warm compresses before feeding (you can buy breast heat pads in various forms or just apply warm wet towels) and massage with warm water shower. You should apply cold compresses after feeding (ice packs). Engorgement usually lasts 48h. If the swelling and pain does not subside after a couple of days, contact your GP.
You will also find that your nipples were initially be very sore from the sucking and will rapidly crack. To avoid this, make sure you cream in your nipples with nipple cream (I used Lansinoh) after every feed. Be sure to wear nursing pads as the nipples will leak regularly throughout the day.
Do not leave too large an interval between emptying your breasts abruptly as this will cause engorgement and potentially mastitis (inflammation of the ducts). Any decrease in frequency should be done gradually
What products do you need for feeding your twins?
A hospital grade pump
Small Baby bottles (Medela or Dr Brown)
Baby teats (slow flow)
Travel breastpump (Medela are best) or a manual breastpump
Twin Breastfeeding pillow (Peanut & Piglet or twins uk)
Nipple cream for cracked nipples (Lansinoh)
Warming tubes for relieving mastitis
Nursing Bras (x2)
Milk storage bags (medela)
Bottle holder for washing up
How to hold Twins while breastfeeding?
You need to find the position that will work best for you and your twins. Try them all out, with some help for positioning preferably while you are still at hospital (it may best to take the twin nursing pillow with you to replicate what you will do at home).
I was not able to tandem breastfeed because one of my twins was not strong enough to suck efficiently. So in the end I breastfed one and bottle fed breastmilk to the other (consecutively to ensure I could bond with both). After 3 months my breastfeeding twin started to refuse the breast and I bottle fed them both with breastmilk in tandem. It was certainly easier but I needed to ensure I had other bonding activities as skin to skin contact is very important for babies.
Advice from a recent twin mum in our club – Frankie Currie’s advice
I am currently exclusively breastfeeding my 11wk old twin girls and it has been a rollercoaster of a ride. Firstly this is not easy, it takes perseverance, compromise, its painful at times, but it’s also really rewarding and above all, although I’ll admit at many points over the last 10 wks it hasn’t felt that way, it is possible. Secondly, I can obviously only recount my own experience which is by no means comprehensive, or the only way or the right way to do things, it is purely what I have experienced. Hopefully it will be useful, I started out with an open mind and the attitude that I would try and breastfeed but if it didn’t work out it wasn’t the end of the world and as long as they are gaining weight and healthy that is the most important thing.
The start – c-section/colostrum. No one told me that after my c-s it might delay my milk coming in, so only after 6 days did it finally make an appearance. In the mean time in hindsight we should have been topping the girls up with formula, but had no idea what we were doing, and as a result the smaller twin lost 16% of her body weight and we were admitted back into hospital. I felt like a failure, convinced I wasn’t going to be able to breastfeed, questioning how do you know if you have enough milk?, how do you know they are getting enough? Etc. Trust your instincts if you are unsure, try topping them up to make sure they have enough. From this point forward I started using a hospital grade pump and I can’t recommend starting pumping as early as possible to build up your supply. If your serious about bf get as gd a pump as you can afford, I hired the hospital grade medela. I tried hand expressing colostrum but this didn’t work for me.
Get advice from as many qualified professionals as possible while in hospital, not all of it will be useful but once you leave hosp it is much more difficult to find that help. Ask questions. I found midwives etc more than willing to help.
Once the little one had lost lots of weight and had been topped up with formula she stopped breast feeding almost altogether (abt 10 days old) at this point I seriously considered just going down the bottle route but I didn’t want to give up, also the other one loved breastfeeding and I didn’t want to feed them both differently. The midwife gave me the number of the local breastfeeding support group (Barnet breastfeeding helpline) who have regular drop ins for advice etc however being a mum of twins and having a c-section meant getting out to one of these was not possible so they sent a breast feeding consultant out too me the same day (for free). She was brilliant and within 10 mins her guidance had the little one feeding again on the breast. So whether it’s a problem with latch, nipple pain, or just wanting to check everything is going well, anything at all, seek help immediately, there is lots out there – Local breast feeding helpline; start4life helpline; national breastfeeding helpline; nct helpline; la leche helpline, local breastfeeding drop in clinics etc.
Formula – We combination fed for abt 7 wks, babies need to be a certain size before they have the strength to suck and therefore feed properly, our attitude was as long as babies are putting on weight that’s the most important thing. Combination feeding has not affected their latch or ability to breastfeed.
Supply – once your milk comes in it is really important to pump/feed regularly (roughly every 3 hours) to build up a gd supply. Also make sure you eat well, drink plenty of fluids and rest when you can. I noticed these things really affected my supply.
Blocked ducts/mastitis – once your supply is gd these then become a problem. It’s obvious but try to avoid this, it is incredibly painful and a bugger to get rid of. It is also more common when feeding multiples. Warning signs to watch out for:
If an area of your breast still feels hard after feeding; any pain or tenderness on breast; any hot areas on breast. I found it useful to adopt these preventative measures:
- Never skip feeds
- Empty breasts at each feed
- Vary the position you feed babies in
- Switch babies between breasts at alternate feeds
- Massage breasts before and after feeding
- Warm breasts prior to feed to encourage let down (use warm flannel/linsonah pads/warm shower)
- For clearing a duct I found useful:
- Ibuprofen – so you can bear to feed/massage the affected breast
- Shower head (warm water) pressed on affected area
- Warm flannel/linsonah breast heat pad applied for 30 mins prior to feeding
- Position baby’s chin facing blockage for feeding
- It may take a number of attempts (often over a few days) to clear but keep at it.
- Other advice:
- Use nipple cream regularly to begin with.
If it’s painful stop immediately. In the first few days of feeding I had a bad latch once that was painful to feed, I kept going and after only that one feed I ended up with a bloody and cracked nipple. I didn’t do that again and if I experienced any pain I stopped immediately, unlatched the baby and started again.
Feed regularly and when your due a feed but not feeding then pump.
Best time to pump and feed to increase supply is in the morning. Pump before feeding if your tandem feeding or alternatively during feeding if your feeding one at a time, I was told by the amazing breastfeeding lady not to pump after feeding.
We never experienced any nipple confusion, not that it doesn’t happen, but the girls switched easily between breast and bottle.
Tandem feeding cushion – there are a few out there (essential for the first 3 months). I did a lot of research and eventually got the peanut and piglet as I am taller and this had greater cushion height so that they were at the right height for feeding and easier on the neck and back. There are others out there – harmony duo; twin z; my Brest friend; cuddles collection.
Pump – I found both a hand pump (if you want to leave the house for more than a couple of hours and aren’t going to breast feed while you are out to relieve pressure and avoid blocked ducts) and an electric pump (to build supply) essential.
Something to encourage let down prior to feeding/pumping in the early days i found useful whether it be a nappy soaked in warm water, a quick hot shower or the lansinah heat pads I mentioned before.