Making the Feeding Decision
- Breastfeeding encourages frequent mother-infant interaction with both babies, even with nursing both babies at the same time.
- After breastfeeding is well established (about six weeks after the birth), breastfeeding is easier and more efficient.
- Immunologic properties of human milk are especially beneficial for multiples who may be at high-risk during pregnancy and birth and who tend to share infectious illnesses during infancy. Breastfeeding protects against respiratory and ear infections, as well as diarrhea.
- Breastfeeding helps to contract the uterus. It helps the body return to the pre-pregnancy state more quickly.
- Breastfeeding saves money.
- Breast milk is available immediately.
- The hormone prolactin released during feedings is relaxing to the mother. The hormone oxytocin released during feedings helps the woman to feel good about mothering.
- Breastfeeding helps dental development.
- Human milk is easily digested.
- Human milk provides the best nutrition.
Preparing for Breastfeeding
- Make good nutrition a priority. Adequate weight gain is associated with better outcomes for the infants and the mother.
- Attend a breastfeeding class and childbirth classes early in the pregnancy.
- Read, watch videotapes and talk on the phone to other mothers of multiples.
- Attend a La Leche League meeting.
- Consider applying to the WIC (Women, Infants and Children) program, a supplementary food program, which promotes and supports breastfeeding. Talk to physicians, nurses, and family members about your intention to breastfeed. Find a supportive pediatrician. Line up your sources of support and educate them.
- Attend a Mothers of Multiples club meeting.
- Obtain phone numbers of lactation consultants and breast pump rental depots.
- Plan for full-time help in the home in the early postpartum period and part-time help for several months thereafter.
- Visit the hospital including special care nursery.
- Purchase a couple of well-fitting, comfortable nursing bras.
- Purchase a twin breastfeeding pillow.
Understanding Milk Supply
- Onset of milk production is hormonally driven. The fall in progesterone when the placenta is removed triggers the process.
- Prolactin is released in response to nipple stimulation. It is the key hormone for milk production. Frequent feedings in the early weeks increases milk output because suckling stimulates development of receptors to prolactin in the breast. Simultaneous stimulation by two babies produces a higher prolactin surge.
- Oxytocin is the key hormone for release of milk. Stimulation of the nipple is the most important trigger for the release of oxytocin.
- Continued lactation requires milk production, milk release, and milk removal. Production of milk is more rapid after feedings with a greater degree of milk removal. Effective milk removal is regulated by suck efficiency, frequency of breastfeeding, and length of breastfeeding. Mothers produce more milk during infant appetite spurts and more milk in response to the suckling of multiple babies.
Beginning to Breastfeed
Full-Term Infants
- If babies are full-term and you are in good condition, the start of breastfeeding is the same as for a single infant.
- Limit visitors.
- Eat a nutritious diet and drink plenty of fluids.
- Rest a lot.
- Room-in and offer the breast frequently to both infants with no time limitations.
- Include your partner and other family members so they can learn to support you.
- Learn positioning and latch techniques with each baby separately.
- Prior to leaving the hospital, learn some common simultaneous feeding positions.
- Learn how to tell if the babies are getting enough.
- Keep a diary for each baby, charting times of feedings and wet and dirty diapers.
- Create a breastfeeding station--a comfortable chair with nursing pillow, burp cloth, diapers, drinks and snacks for mom, etc.
- Devise a plan that will accommodate your needs and the needs of each infant.
- Remember the need for household help and emotional support.
One or More Babies in NICU
- Start pumping as soon after delivery as possible.
- Use a piston-type electric automatic breast pump, which pumps both breasts at the same time.
- Obtain a rental pump for use at home.
- Pump seven-to-nine times per 24 hours; one-to-two of the pumpings should be at night.
- Prior to your infant’s discharge, increase to 10-12 pumpings per day.
- Try to see the individuality of each infant’s feeding cues, feeding style and response to being fed.
- Call and visit the NICU frequently.
- After discharge, you can bring the well infant and a caregiver to the hospital so you can breastfeed him/her as needed while visiting the hospitalized baby.
- If one infant is at home, you can nurse that baby, while pumping the other breast. Alternate sides at each feeding. As soon as the condition of the baby in the hospital permits, put him/her to the breast for short periods of time, gradually building to full breastfeeding.
- If one or more babies requires a supplement, consider using a digital electronic scale to determine the amount needed, by doing before and after feeding weights.
- If supplement is needed, consider using a supplemental nutrition system (tube feeding device) at the breast to deliver the supplement. As milk production increases, and/or the infant=s effectiveness of suckling improves, the amount of supplement can be decreased.
Maintaining Lactation at Home
Coordinating Feedings
- Plan I: Alternate infants and breasts at every feeding, so infant A begins on the right breast and infant B on the left breast and at the next feeding infant A begins on the left breast and infant B begins on the right breast.
- Plan II: Alternate infants and breasts every 24 hours. With triplets, alternate breasts every 6-12 hours and rotate infant’s feeding order.
- Plan III: Assign each infant to a specific breast. If this method is chosen, alternate positions.
- Plan IV: Offer the fullest breast to the hungriest infant.
Scheduling Feedings
- Some mothers wake up one multiple either with or shortly after the other awakens.
- Some mothers schedule some feedings and feed on demand other times.
Simultaneous vs. Separate Feedings
- Simultaneous feedings can be more efficient.
- Some mothers prefer separate feedings.
- Infant feeding styles and sleep-wake cycles influence the feasibility of simultaneous feedings.
- Many mothers combine methods.
- It is difficult to manage simultaneous feedings if neither infant latches easily.
- Help may be needed in the beginning.
Positioning for Simultaneous Feedings
- Double cradle or criss-cross hold.
- Double football hold.
- One in football hold and one in cradle hold.
Combining Breast and Bottle
- It is best to wait to introduce bottles until about six weeks postpartum.
- One or two complementary feedings in the evening or at night will usually not affect milk production if the infant is breastfeeding 8-12 times a day.
- Alternating breast and bottle feedings or supplementing after every feeding usually interferes with adequate milk production and with learning to breastfeed.
- Using two feeding methods routinely requires a lot of time and energy and often leads to early weaning.
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