Breastfeeding one baby can be challenging, and adding another (or two) to the mix brings its own unique set of challenges. For mothers of twins and triplets, support is crucial to ensure they feel confident and capable. It’s also important to note that multiples are often born prematurely, which can add an extra layer of complexity to breastfeeding. This blog will explore strategies to support breastfeeding moms with multiples and provide evidence-based insights.

Multiples Often Come Early

It’s not uncommon for twins and triplets to be born before 37 weeks gestation. In fact, “Twins are usually born around 35 weeks of pregnancy, and triplets are often born even earlier, around 32 weeks” (American College of Obstetricians and Gynecologists, 2019). Prematurity can affect breastfeeding in several ways, including latching difficulties and delayed milk supply. NICU stays are common, which may also impact early breastfeeding experiences.

Establishing Milk Supply

One of the most critical aspects of breastfeeding multiples is ensuring that milk supply is adequate for two or three babies. Since many mothers of multiples experience premature delivery, early and frequent milk expression is vital. “Early initiation of milk expression, ideally within the first hour postpartum, has been associated with increased milk production in mothers of very low birth weight infants” (Parker et al., 2012). Mothers should aim to pump at least 8–12 times in a 24-hour period to establish and maintain their supply.

Hand expression in combination with pumping can also be helpful. “Combining hand expression with electric pumping was found to significantly increase milk production in the first days postpartum for mothers of preterm infants” (Morton et al., 2009). Studies suggest that combining these techniques increases milk output in the early days .

Feeding at the Breast: Positioning and Latching

Positioning is key to making breastfeeding twins or triplets easier. Many mothers find the “football hold” useful, as it allows both babies to latch simultaneously. A twin nursing pillow can provide support and make breastfeeding more comfortable. It’s important to ensure a proper latch to prevent issues like nipple pain and low milk transfer. IBCLCs can offer hands-on assistance to help mothers find the best positions for their babies.

For triplets, tandem feeding two babies at the breast while bottle-feeding or cup-feeding the third with expressed milk is a practical option. Rotating which baby is at the breast can help ensure all three benefit from direct breastfeeding.

Feeding Challenges with Preterm Babies

Prematurity often brings unique feeding challenges. Preterm infants may have a weaker suck, difficulty coordinating sucking, swallowing, and breathing, or may tire easily at the breast. “Preterm infants often exhibit difficulty in coordinating sucking, swallowing, and breathing, which can delay the establishment of successful breastfeeding” (Geddes & Hartmann, 2013). In these cases, moms may need to provide expressed milk via bottles or other alternative feeding methods until their babies are ready for full breastfeeding.

However, skin-to-skin contact (kangaroo care) is incredibly beneficial for preterm infants and can help encourage breastfeeding. “Kangaroo mother care has been shown to significantly reduce morbidity and mortality among low birthweight infants, while also promoting breastfeeding” (Conde-Agudelo et al., 2014). It promotes bonding, regulates the baby’s temperature, and has been shown to increase milk supply.

Managing Time and Fatigue

Breastfeeding multiples is time-intensive. Moms need to balance feeding, pumping, and caring for themselves. Creating a routine can help, as can enlisting support from family, friends, or a postpartum doula. Encouraging mothers to rest when their babies are sleeping, stay hydrated, and eat nutrient-rich meals is important. Fatigue is inevitable, but strategies such as setting up feeding stations with everything within reach can make life a little easier.

Evidence-Based Insights on Breastfeeding Multiples

Studies show that breastfeeding rates among mothers of multiples tend to be lower than those of singleton mothers. According to McAndrew et al. (2012), “Mothers of multiples face additional challenges, such as preterm birth and hospital stays, which can result in lower breastfeeding rates compared to mothers of singletons.” However, with the right support, many mothers are able to successfully breastfeed twins or triplets.

Evidence also suggests that mothers of multiples can produce enough milk for all their babies when breastfeeding or expressing milk frequently. “Frequent breastfeeding or expressing milk is critical for establishing an adequate milk supply, even for mothers of multiples” (Cregan & Hartmann, 1999). Connecting with IBCLCs who specialize in multiples or joining breastfeeding support groups can provide helpful strategies and emotional support.

Breastfeeding twins or triplets may seem daunting, but with the right support and guidance, it is entirely possible. Understanding the challenges that come with prematurity, employing effective feeding techniques, and accessing resources like lactation consultants can help moms navigate this journey successfully. With persistence and encouragement, mothers of multiples can enjoy the many benefits that breastfeeding provides for both them and their babies.

References

• American College of Obstetricians and Gynecologists. (2019). Multiple pregnancy: Twins, triplets, and beyond. ACOG. https://www.acog.org

• Parker, L. A., Sullivan, S., Krueger, C., & Mueller, M. (2012). Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: A pilot study. Journal of Perinatology, 32(3), 205–209. https://doi.org/10.1038/jp.2011.78

• Morton, J., Hall, J. Y., Wong, R. J., Thairu, L., Benitz, W. E., & Rhine, W. D. (2009). Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, 29(11), 757-764. https://doi.org/10.1038/jp.2009.87

• Geddes, D. T., & Hartmann, P. E. (2013). Lactation in mothers of preterm infants. Journal of Mammary Gland Biology and Neoplasia, 18(3-4), 219-226. https://doi.org/10.1007/s10911-013-9290-0

• Conde-Agudelo, A., Belizán, J. M., & Diaz-Rossello, J. (2014). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, 2014(4). https://doi.org/10.1002/14651858.CD002771.pub3

• McAndrew, F., Thompson, J., Fellows, L., Large, A., Speed, M., & Renfrew, M. J. (2012). Infant feeding survey 2010. Health and Social Care Information Centre.

• Cregan, M. D., & Hartmann, P. E. (1999). Computerized breast measurement from real-time ultrasonic images. Journal of Dairy Research, 66(2), 579-589. https://doi.org/10.1017/S0022029999000324