How to Breastfeed Twins

Breastfeeding twins might seem like a very daunting task but it is  possible, whether you persevere to exclusively breastfeed or try combination feeding. Difficulties associated with the birth or premature delivery can make breastfeeding twins/multiples more challenging. Exclusive breastfeeding is the ideal for both you and your twins, but this may not be possible for all mothers even if they plan on breastfeeding, for various reasons. 

The World Health Organisation recommends exclusive breastfeeding for the first six months; however, parents of twins/multiples may want to try combination/mixed feeding where you alternate formula and breastfeeding/breast milk. This allows your twins to get the benefits of breastfeeding and gives your partner the chance to be more involved in the feeding process. It does, however, require a lot of time and physical effort. If you are struggling with feeding two or more babies, even with combination feeding, and you want to retain your sanity, you may need to consider weaning one twin off the breast (perhaps temporarily) before the recommended  six month timeframe.   

There are several things to bear in mind about breastfeeding multiples, including:

Multiples are more likely to be born prematurely

Irrespective of whether you are planning on breastfeeding your twins or not, they will likely be born prematurely. You should bear in mind that there are extra benefits to breastfeeding premature babies. Premature babies have an immature gut, and breastmilk is easier for them to tolerate and digest. As premature babies are more vulnerable to infections, the proteins and antibodies in breastmilk are a great way of  protecting against harmful bacteria.

 If your babies are born very prematurely or have health issues, they may not be able to feed from your breast to start with. Instead you may choose to  express your breast milk, which you can do as soon as  your babies are born. Aim to express at least eight times a day to start with; this will help establish your milk supply and the expressed milk can be frozen for you to give to your babies later. Then you can start breastfeeding your twins from the breast when they are ready.

 In the first few days, it is easier to express your milk by hand. You will likely only express a few drops at a time, but with frequent hand expression, this will increase. You can store it in a small sterilised container or syringe in the fridge for up to five days (below 4oC) or frozen for up to 6 months. You can try using a breast pump when you are expressing more milk. 

Exclusively breastfeeding multiples

Introducing skin-to-skin contact as soon as possible after the birth of your twins is the best way to get breastfeeding off to a good start. Mothers of twins can produce enough breast milk to feed twins, as the more your babies feed, the more milk you produce. However, a frequent reason for stopping breastfeed twins is a perceived lack of milk supply. The reasons for low milk supply are usually treatable and no different from breastfeeding singletons, and worried mothers should not hesitate to seek help. Speak to your doctor or your midwife about local lactation consultants, ideally with experience in breastfeeding multiples as early as possible. A lactation specialist is best placed to identify any issues you have with breastfeeding and find reasonable solutions.

 Important considerations when planning to exclusively breastfeed twins include:

• Get family and friends to help with feeding. They can help by handing you the babies if you are recovering from a caesarean section or other delivery-related complications. They may also be able to help you  with the positioning of the babies during feeding..
• Allow plenty of time to dedicate to breastfeeding in the first few weeks and let other family members take over the housework and cooking so you can breastfeed and rest between feeds when possible.
• It can be useful to express breastmilk, so others can help with feeding. After the first few days you can express using a breast pump. Hospital grade, double electric pumps are recommended for twin moms, as they stimulate more milk production in both breasts and reduce the pumping time.   

 Some mothers prefer to feed their twins simultaneously, others  prefer separate feeding. You may find it easier to start feeding one twin at a time on the breast and then, as you get more confident with your babies feeding patterns, switch to  feeding both simultaneously. Breastfeeding pillows for twins can be very helpful. These can help you to breastfeed your twins simultaneously, ensuring comfortable positioning of both babies and maximal skin-to-skin contact.

 In general, it is considered a good idea to alternate breasts when feeding your twins in case one breast produces more milk than the other. Also, in the early days after birth, it is important to try to feed your twins from alternate breasts, especially if one twin is a weaker feeder. This breastfeeding practice allows equal stimulation from both babies and helps build an even supply on both sides.  

Combination/mixed feeding multiples

If you are losing confidence in your ability to breastfeed exclusively, or one or both of your twins are not thriving on your breast milk alone, you may consider combination/mixed feeding, where you combine breastfeeding with some formula feeds. Any breast milk is better than none at all. You should discuss your feeding options with your partner and lactation consultant if possible, so you can make the best choice, especially if you had been planning on exclusively breastfeeding. Ideally, before switching to combination feeding, you should first try establishing your breastmilk supply, by breastfeeding or expressing 8-12 times in 24 hours during the first few weeks.

 One option could be to combination feed one twin, especially if this twin has feeding or  latching difficulties. This allows you to focus on exclusively breastfeeding the other twin and increasing your milk supply. When this twin is confidently exclusively breastfeeding, then the formula feeds can be reduced for the other twin, and you may find that you can exclusively breastfeed both. It is also best to continue breastfeeding both twins at night, as this is when the mother’s hormones are at a higher level for breastmilk production. This helps maintain your supply of breastmilk.

 Combination feeding both twins can take up a lot of time, but does allow your partner or someone else to help more with the feeding. It is considered better to substitute a single feed with formula, rather than supplementing or ‘topping-up’ breastfeeds. There are a number of  milk preparation machines available for accurately preparing formula feeds. These can save a lot of time and help make combination feeding possible, and aid you in persevering to get breastmilk for your children.   

 Sources: 

•       “Feeding twins and multiples”, NHS, 12 August 2019, https://www.nhs.uk/conditions/pregnancy-and-baby/feeding-multiples/
•       “Breastfeeding your premature baby”, NHS, 10 October 2019, https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-premature-baby/
•       “Guidance for Health Professionals on Feeding Twins, Triplets and Higher Order Multiples”, The Multiple Births Foundation, 2011, http://www.multiplebirths.org.uk/MBF_Professionals_Final.pdf
•       “Mixed feeding”,Twins Trust, 2020, https://twinstrust.org/let-us-help/parenting/under-1s/feeding/mixed-feeding.html
• “Breast-feeding twins: Making feedings manageable” Mayo Clinic, 01 April 2020, https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breastfeeding-twins/art-20044417