How to Breast-feed Twins

US News

People assume a lot about you when you're a parent of twins. For example, they assume you used fertility drugs or in vitro fertilization (IVF) to conceive. Or that you delivered via C-section. And of course, that you're formula-feeding your babies. After all--it's impossible to breast-feed twins ... isn't it?

In fact, it is not. While they may not represent the majority, plenty of twin moms do indeed breast-feed. I count myself among this group of self-described stubborn, determined, and persistent women who managed to exclusively breast-feed both their babies until weaning to cow's milk. God gave us two breasts and two babies, after all; the math works out quite elegantly.

To be sure, most moms admit that breast-feeding their twins was hard as hell--at least in the first few months until everyone got the hang of it. There are tears, there is exhaustion, and there are more than a few moments--particularly when hooked up to a double breast pump--where one quite literally feels more bovine than human. But like any labor of love, it's worth the effort--even if it takes the benefit of hindsight (and a full night's sleep) to fully appreciate this fact.

In compiling best practices for expectant twin mamas who plan to give breast-feeding a go, I polled dozens of twin moms who breast-fed their twins exclusively for 6 months or more. I asked them to share the secret(s) of their success and compiled their responses into the following themes.

1. Build your support system (and use it): Lining up your support team in advance is the No. 1 piece of advice from twin moms who breast-fed. Here are the players: your partner, your mother, mother-in-law and/or best friend(s), an international board certified lactation consultant (IBCLC), a pediatrician who supports your goal to breast-feed, a mentor from your local La Leche League chapter, and an online mothers-of-multiples community to whom you can turn for help and support in those early days.

[See Examining Your Pediatrician's Feeding Advice]

Try to meet with a lactation consultant in the hospital, and consult one when you return home if needed; many insurance plans even offer coverage for this. If you plan to hire a baby nurse or nanny, be sure she is experienced in working with breast-fed babies and/or is 100 percent on board with your feeding plan. Before you go on maternity leave, inform your boss or human-resources representative of your plans to breast-feed so they can ready appropriate lactation facilities for you upon your return.

2. Set realistic priorities and expectations: If you plan to breast-feed twins, you have exactly three responsibilities--and three responsibilities only. One: Feed your babies. Two: Eat and drink enough yourself so you can feed your babies. Three: Sleep whenever you are not feeding your babies or yourself so that you have the energy to feed your babies.

This means you'll need to delegate all other household chores to others for a good four months until the demands of breast-feeding wane and your babies feed less frequently and more quickly. Enlist help from grandparents and siblings to vacuum, do the dishes, run loads of laundry, and take care of other children. If you can afford it, hire a housekeeper to clean the bathrooms and kitchen once a week.

[See How to Stop Feeling Selfish About 'Me Time']

Ask friends and relatives to bring meals for you and your family when they come to visit the babies. Before the babies are born, try freezing batches of chilis, stews, and lasagnas to fill gaps in your meal-delivery rotation. (And on the topic of food, many twin moms swear by oatmeal, fenugreek supplements, mother's milk tea, and LOTS of water as crucial to keeping up supply.)

3. Equip yourself for success: Moms agree that a good double breast-feeding pillow is essential--and in a multi-story house, a pillow on every floor is ideal. Using two Boppy pillows as staging areas for babies before and after nursing can also be useful. Most twin moms pump in addition to nursing, and some working moms even keep a second pump at the office to eliminate the need to schlep heavy equipment on their commute.

If pumping, you'll need a hands-free pumping bustier and breast milk storage bags. And don't forget a few tubes of lanolin to soothe your newbie boobies until they adjust to the rigors of feeding two.

If this seems like a heavy up-front investment, bear in mind two things: A year's supply of formula for twins costs at least $2,400 (assume a minimum of $100 per baby, per month); and unlike the cost of breast pumps, pump attachments, and milk storage bags, expenditures on infant formula are not tax deductible.

4. Set (and re-set) short-term goals: Picture it: Two moms are 16 days postpartum, exhausted, and struggling to hit their breast-feeding stride. Mom A has set a goal of exclusive breast-feeding for a full year. Mom B set a goal of exclusive breast-feeding for one month, at which point she'll re-evaluate.

Who's more likely to press on? Mom B, of course! She's already more than halfway to her goal. Mom A, on the other hand, can't see any light at the end of her tunnel, and says to herself: Well, if I know I won't be able to make it all the way, why bother torturing myself at all?

Twin moms who succeed with breast-feeding for the long haul tend to take it a day--or a week--at a time. Once they make it to a month, they challenge themselves to six weeks. At six weeks, they're already halfway to three months, so they keep on going. By the third or fourth month, it's already become so much easier that many figure they might as well go for six. Then solid foods arrive and the demand for milk gradually declines, making it easier still--so why not just push forward? And so on?

5. Don't let naysayers or self-doubt undermine your commitment: From the hospital nurse who insists you'll sleep more if you formula-feed (not true, according to research) to your own mother who argues that "you turned out OK" despite not being breast-fed, pressure to supplement with formula can be pervasive.

Like all new moms learning how to breast-feed, you will doubt whether your babies "are getting enough" and convince yourself that their constant hunger is a sure sign that your supply isn't sufficient. You will read books intended for formula-feeding moms and feel insecure that your kids aren't on a schedule, aren't sleeping through the night by six weeks, and can't possibly be drinking X ounces per day like the book insists they should.

This is when your support system comes in handy, and you must remind yourself that weight gain--NOT ounces--is the best indicator of whether babies are getting enough. What gave me the confidence to avoid topping off feeds with formula was a visit from my lactation consultant; she weighed my babies before and after a feed to determine how many ounces they drank and assured me it was sufficient.

Soon after, I actually bought a pediatric scale so I could track my kids' weekly weights to ensure they were gaining at the appropriate pace. Overkill? Perhaps. But the info was what I needed to put my self-doubt to rest. Before long, my scrawny little newborns filled out into chunky infants with rubber-band wrists, and it seemed inconceivable that I ever doubted my milk supply.

6. Feed them on the same schedule: Unless you literally want to be breast-feeding 24 hours a day, most moms agree that when one newborn wakes to feed, you'll want to wake the second as well. Sleepy newborns can take a solid 45 minutes to nurse--and often demand to be fed every one and a half to two hours in the early weeks.

Unless you're feeding them at the same time, this leaves little time for you to sleep, pump, eat, drink, and shower every so often. Some moms tandem nurse (see below), and some moms nurse one while bottle-feeding the other expressed breast milk. Some moms do a combo, like nursing during the day and then letting dad bottle-feed simultaneously overnight so mom can sleep a bit--waking every three to four hours to pump.

On a related note, many advised building up a freezer stash of expressed breast milk in the early days to enable more flexibility with feeding arrangements, particularly if you're planning to go back to work. All agreed that whatever system works best for you is the best system.

[See Work, Life, and the Attempt to Do it All]

7. Practice tandem feeding: Even if you choose not to tandem feed all the time, learning how to do it can be the difference between success and failure according to the twin mamasphere.

Some moms used books like Mothering Multiples and The Womanly Art of Breastfeeding to learn the tandem nursing positions. Others watched YouTube videos. Many practiced when husbands or mothers were around to help them position babies until they got the hang of doing it solo.

8. Enlist your babies' help to overcome breast-feeding obstacles: All nursing moms run into a common set of challenges from time to time, but twin moms in the know use their babies to troubleshoot. A strong nurser can prime a breast for a weaker or impatient nurser--getting the milk to "let down" for his sibling before being switched to the second breast.

Likewise, a strong nurser can help unplug a plugged duct like a little Hoover. Concerned about supply issues? Practice "kangaroo care," a technique of using skin-to-skin contact with your babies to help stimulate milk supply while providing precious bonding time and much-needed rest for all.

9. Stay positive: As stressed and tired as you may find yourself, look down at your beautiful babies while they are nursing or snuggled in your arms drinking bottles of the liquid gold you made for them. Instead of beating yourself up about not being back at the gym yet while your friends who have singletons are already signed up for a triathalon, remind yourself that it would take four hours at the gym to burn the 1,000 to 1,200 calories you're torching each day just by making milk for two.

[See Myths and Facts: Exercising While Pregnant]

Celebrate your breast-feeding triumphs as often as you complain about the tribulations, and remind yourself daily that, as one mom eloquently put it: "Our bodies are designed to nurse as many babies as we birth."

Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.

Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.

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