Breastfeeding a full-term healthy baby is physically and mentally exhausting for most of us, so how do mothers of multiples succeed? Information, support, and a plan are essential when breastfeeding twins or triplets.
Multiples are often born prematurely or small for gestational age so receiving human milk is especially important for them because it reduces the risk of infection and incidence of necrotizing enterocolitis (inflammation of the intestine) while supporting growth and cognitive development. Despite this, research shows that mothers of multiples are less likely to breastfeed or breast milk feed and when they do, it is for shorter periods of time than other mothers.
So, what are some of the breastfeeding challenges that mothers of multiples face?
- Twin and triplet mothers are more likely to have high risk pregnancies, surgical births, and health complications from conditions such as hypertension and gestational diabetes.
- Premature birth, before 28 weeks, may prevent adequate breast development to support full lactation.
- Initiation of breastfeeding is often delayed due to mother’s or infants’ health status.
- Preterm and small infants have less stamina, smaller mouths, and are often unable to seal to the breast and suckle effectively.
- Sleepiness, disinterest in feeding, and indistinct feeding cues make it more difficult to know when infants are ready to feed.
- Greater weight loss increases likelihood of dehydration, jaundice, and the need for supplemental feeds.
- Maternal exertion is increased due to caring for multiple babies.
- Mother’s fatigue is intensified by ongoing efforts to breastfeed and express breast milk.
- Concerns about inadequate milk supply may lead to reduced confidence
Tips to help you get off to a good start
Skin to skin as soon as possible…… if possible
Place your babies’ skin to skin, also called “kangaroo care”, on your chest after delivery if possible. This helps them to transition to extra-uterine life, reduces risks of hypothermia and hypoglycemia, and stimulates their newborn reflexes. If you are unable to do skin to skin, or need extra help, you can have your significant other, or a family member, place babies’ skin to skin with them instead. Immediate skin to skin after delivery is associated with increased breastfeeding success.
Pump early and often
If your babies are separated from you because of prematurity or medical issues, start pumping as soon as possible. Double pump with a hospital-grade electric breast pump, and express at least 8 times per 24 hours, including pumping during the night. Start “kangaroo care” with your babies as soon as their conditions allow.
Even if your babies are able to partially suckle at breast, still do some hand expression and breast pumping for extra stimulation. Continue 6-8 pumping sessions per 24 hours, if possible. We call this insurance pumping.
Massage your breasts and do hand expression before you pump. Use hands-on pumping techniques where you alternate among pumping, breast massage, breast compression, and hand expression. These techniques combined with double pumping, using a hospital-grade pump, will increase levels of fat as well as volume of milk.
Thoroughly drain breasts
Pump or hand express after breastfeeding to thoroughly drain breasts and obtain hind milk for supplementation.
Boost your milk supply by “Power Pumping”
“Power-Pumping” is super stimulation for milk production. It consists of short frequent pumping phases with brief pauses in between and is usually done over an hour. It imitates your babies’ cluster feeding patterns causing higher prolactin levels which in turn increases milk production and collection. There are various methods of “power pumping” and they can be adapted according to personal need.
Short frequent feeds
Start with short frequent breastfeeds, as these will be more manageable for you and less tiring for your babies.
Sequential feeding at first – Simultaneous feeding later
Feed each baby separately at first while you are becoming accustomed to positioning and supporting them at the breast. This is especially important if your babies are premature or small for gestational age.
Later, when you become more proficient at breastfeeding, you can try to feed your babies together with one baby at each breast. This simultaneous method of breastfeeding will save you more time. Use the football hold and a twin nursing pillow for better support and increased comfort.
Switch babies midway
It is common for one baby to be larger and stronger than the other(s) so they suckle and stimulate more effectively. Be sure to switch your babies over midway through simultaneous breastfeeding so that your breasts are equally stimulated and emptied.
Get organized before you deliver. Stock your cupboards with nutritious nonperishable foods and freeze a variety of meals ahead of time. Make a list of friends and family members who are willing to help you with household tasks. Set up a station for breastfeeding and infant care. Keep breastfeeding and baby care supplies in close proximity. Use a comfortable recliner or rocker chair for breastfeeding put up your feet and relax. Take every opportunity to rest.
Tactics for Triplets
Rotating Babies: Place babies A & B at breast simultaneously, then let baby C breastfeed from both breasts. At next feed, place babies B & C at breast simultaneously, then let baby A breastfeed from both. At next feed, place babies C & A at breast simultaneously, then let baby B breastfeed from both.
Or, alternatively, feed A & B at breast simultaneously then C gets previously expressed breast milk, donor milk, or formula by bottle rotating as previous plan.
Weekly Weight Checks
Follow up with your Pediatrician and Lactation Consultant for weekly weight checks, at least until infants reach 40-42 weeks gestation, or weigh 7 Ibs (about 3200 grams). Some mothers also rent an electronic baby scale to use at home.
Discuss dietary needs with a nutrition coach. Caring for multiple infants is physically and emotionally demanding. Energy expenditure is high due to physical exertion and calories needed for milk production. Many mothers become protein and calorie deficient. Dietary counseling can help to identify specific needs and outline a plan for optimal nutrition. Recommended daily intake of vitamins and minerals can, in most cases, be obtained by nutritious food choices but vitamin and mineral supplements may be necessary. Vitamin B12 is particularly important for mothers who follow a vegan diet.
Donor Human Milk
Infants receiving intensive care, due to prematurity, may be prescribed donor human milk. You may be eligible to receive donor milk from Human Milk Banking Association of North America. There is no charge for milk, but recipients are required to cover the cost of processing and shipping. For more information, go to their website at https://www.hmbana.org/
The decision to breastfeed multiples may seem daunting but many mothers are able to enjoy a rewarding breastfeeding or breast milk feeding experience. Expectations need to be practical and realistic. Prenatal education, home visit(s), and ongoing follow up by an International Board-Certified Lactation Consultant (IBCLC) are invaluable for mothers who are navigating the process of breastfeeding twins or triplets.
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