Feeding Frenzy: Breastfeeding Multiples

Breastfeeding in itself is a home run of accomplishment. Breastfeeding twins and beyond is a whole other ballgame. If you’re expecting a handful of babies, chances are you have questions: How do I do this? How do I keep up with milk supply needs? How do I create a feeding schedule?

Barbara Carr, MD, neonatologist and medical director at Pediatrix Medical Group of Kansas, took on all of our questions and concerns to help fellow moms of breastfed babies feel more informed and confident for the task at hand. Read on for her expert insight.

1| Does a mother make more milk upfront when she has birthed more than one child?

Not necessarily. Milk supply really runs on a demand and supply basis, just like with a single child. The greater the demand, the greater the supply to a point. Mothers of multiples do produce more milk over time, but it is related to demand. Rest assured you should be able to make enough milk if you continue to feed on demand.

2| Is it better to feed one baby at a time or aim to feed together on both breasts?

Either approach is OK and really depends on the woman and her comfort level. If she’s an experienced breastfeeding mom, she may be quite comfortable doing tandem nursing, while a woman breastfeeding for the first time may want to ensure that she and each baby has the hang of it before starting tandem feeding. It’s a good idea for mothers to try and be familiar with different positions beforehand as well, such as the football hold or cradle hold, and feel comfortable using a breastfeeding pillow. Regardless of nursing babies one at a time or together, I would recommend mom of twins alternate breasts to ensure similar stimulation of both breasts, as babies may feed differently.

3| Does a mom of multiples need to pump to help maintain milk supply?

During the early days this may be helpful depending on how effectively the babies are nursing. Using a breast pump after nursing is one strategy to increase milk supply if you are concerned that your supply is inadequate for feeding twins or more. Using hand expression in the first few days (different than massage!) can help to bring milk in, and in mothers of premature babies, it’s has been shown to increase milk supply as much as 50 percent at eight or nine weeks postpartum.

4| Do you have any tips for scheduling so many feedings and finding a rhythm?

I think the most important thing is to give yourself some grace and accept help with meals, laundry, cleaning, whatever from your partner, a parent or caregiver. When nursing is first getting established (especially during periods of cluster feeding), you’re sleep deprived, tired and your body is still adjusting. We are all hesitant to accept help but how many of us wouldn’t hesitate to offer to our friends and family (especially if they were breastfeeding two or more babies)? Accept that help. As the infants mature, they will find their own rhythm, and what will feel like a constant cycle of feeding, changing, napping will settle in as the first year progresses.

When it comes to creating a feeding schedule versus going off of cue, given time, babies will establish their own schedule. Early on, the frequent feedings (cluster feeds) are normal and assist with establishing milk production. If over the first month babies aren’t settling in, women may wish to establish more of a schedule. This may also be a good time to book an appointment with a lactation consultant or connect with a local la leche league chapter for additional support from moms in your same situation.

5| Is it normal for babies to have different feeding needs for more or less milk, or will they mostly mirror each other?

Babies may feed differently and at different frequencies—they are different little people! All babies should nurse eight to 10 times per day when they start breastfeeding and will settle usually into about eight times per day over time.

To accommodate these evolving needs, moms should ensure that they are eating a healthy diet, staying hydrated and resting as they are able. She will need to monitor for any changes in her breasts that would suggest she is developing mastitis or a plugged duct (swelling, pain, fever). She may be thirstier and hungrier, particularly during periods of growth spurts where babies may be nursing more frequently.

6| How can mothers of twins or more look after themselves?

Rest, eat well and stay hydrated. Accept help and give yourself grace. Don’t smoke (for you and your babies’ sakes!). Pay attention to medication use; common things like allergy medications may reduce your supply.

Mothers may need to take in an extra 500 calories per baby per day—just make sure it’s nutritionally sound. Baseline caloric needs will vary between mothers based on their level of fitness and activity. Dieting while breastfeeding is not recommended. Mothers who are vegetarian should consult with their pediatrician regarding vitamin and mineral supplements as milk content can be altered. The American Dietetic Association recommends vitamin B12 supplementation during pregnancy and while breastfeeding for mothers who eat vegan or vegetarian diets. Women do need increased water intake while nursing but in general should drink to thirst. I’d recommend keeping water handy as we often get busy and forget to drink and ignore those thirst cues.

7| Can mom wean one baby while continuing to nurse her other child?

Yes, involving dad or a partner in this is helpful as babies have a very good sense of smell and recognize maternal scent and the scent of breast milk. Having a partner bottle feed at mealtimes will help the baby to focus on alternate forms of feedings.

8| When should supplementation with formula or donated breast milk be considered?

Supplementation may be needed for a variety of reasons and typically is related to hydration and caloric needs. Keep watch on your baby’s urine output (are they having six to eight wet diapers per day?) and stooling pattern/consistency (has the stool changed from the early dark tarry stools to seedy yellow as opposed to hard or pellets?). If these things are OK, then likely your baby is also doing OK.

Setting up weight checks in your doctor’s office or via a lactation support group in the first weeks is important to ensure that your babies are gaining weight adequately and to assess their hydration status. Moms should supplement if their babies aren’t urinating regularly by three to five days of life or if they aren’t growing appropriately. Women should use donor milk that has been appropriately screened and processed via an established milk bank rather than purchasing milk off the internet or even using milk that belongs to a friend or family member. If this isn’t available, using formula is considered the next safest option.