April 23rd, 2010

Best Laid Plans: Strategies for Success in Breastfeeding Your Twins

Guest Post by Angela Quinn, a VBAC Mother of twins who were breastfed until 3 years of age.  Angela was recently a guest on my radio show to discuss breastfeeding multiples.  Here she expands on that subject.

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So, you found out that you’re pregnant with twins. You want to breastfeed them, but you’re worried that it will be twice as hard as nursing one baby, and you heard that’s pretty tough as it is, right? Not to worry. I’ll let you in on the Big Secret.

Here it is. The Big Secret is…there is no secret.  It’s not rocket science. I am not Superwoman, able to leap tall buildings in a single, full-breasted bound. There is no magic pill or formula (no pun intended) that makes this work. I firmly believe that nursing twins successfully is a combination of remembering the basic principles of breastfeeding that help ensure success (with one baby, or two, or more!), and adding in a little strategy and modification to help make things a little easier given that you have two little mouths to feed (and only two hands and two breasts).

The rest of this post is geared towards the breastfeeding of nursing full-term or near-term twins (about half of twin pregnancies go 36 weeks or longer). Going into more detail on the unique challenges of breastfeeding a premature baby (or babies) is a topic for another day, but many of these same principles do still apply. I am not presenting myself as the World’s Greatest Expert on nursing multiples. This is just some “been there done that” advice from another mom of twins. Take what works for you and leave the rest behind.

First and foremost, remember these basic concepts:

• Nurse on demand – The concept of supply and demand is not just for economics class. Your body will, with VERY few exceptions, make enough milk if you don’t interrupt this natural feedback mechanism.
• Watch your baby, not the clock – Don’t assume that you always have to nurse for a certain amount of minutes and wait a certain amount of time in between. Look for your baby’s cues that he is hungry, and for his cues that he is done nursing; don’t use the clock as your indicator.
• When in doubt, whip it out – If you even think your baby might want to nurse, offer it. Nursing is hard work, and a baby who is not hungry won’t actively nurse and overeat. But offering frequently and whenever he seems to need it will make sure that you are not missing subtle feeding cues as you and your baby get to know each other and will help to establish a good, strong supply early on.
• What goes in must come out – Our breasts do not come with ounce markers, and most of us do not have access to a medical grade scale on a daily basis. Just be assured that if your baby is peeing and pooping enough (after the first few days: 5-6 wet diapers and 3-4 poopy ones), something’s making that happen. Um, that would be your milk.
• Don’t be a martyr; seek out help and support when you need it – Call in the troops when things get tough. With many things in life, if it just seems too difficult, it probably is. Don’t continue to struggle with an issue – pain, latching, positioning, DOUBT – alone any longer than you have to. Just be sure that you are bringing in only positive influences into this process.

Often, I’ve found that many of the stumbling blocks that mothers have in trying to breastfeed twins are the same ones that singleton mothers encounter. But when things fall apart, the blame is placed on the fact that they were trying to nurse TWINS, not on the true source of the problems. The same errors and misconceptions can undermine any breastfeeding relationship – whether it’s one or two or more. However, because of the balancing-act, survival-mode atmosphere that can quickly consume you once your twins are born, these pitfalls can definitely be a bit easier to fall prey to.

Things to Avoid:

• Sticking to a schedule, no matter what – this violates almost all of the principles above. It is the rare baby that will fit perfectly into the textbook description of the ideal breastfeeding schedule, and your twins are not more likely to thrive on a schedule than a singleton just because they are twins.
• Early introduction of artificial nipples before breastfeeding is well-established – Bottles are not necessary with twins, and, most of the time, it is best to delay the use of any nipples other than your own, at least until breastfeeding is well-established, to avoid potential nipple confusion and bottle preference.
• Too much energy focused on other things – Choose your battles wisely, and decide where you want to concentrate your efforts. Think of breastfeeding as your primary job, and let some other things slide in the beginning if you need to.
• Letting self-doubt drive your behavior – Our bodies were made to do this. I see over and over again that the first step along a path of sabotaging the breastfeeding relationship was just reacting to fear and doubt, with no basis in the reality of the situation.

OK, so what’s so special about nursing twins, then? What more do you need to know? Well, there are a few tips that apply to breastfeeding single babies as well but might be a little more critical to remember with twins:

Be willing to respond to your babies as individuals.

Don’t force them into your idea of how things are supposed to go. Information is power, but only if it prepares you to follow your instincts and helps you to weigh your options intelligently. If knowledge leads you to create a mental rule book before you even meet your babies, this no longer facilitates your parenting, it inhibits it. You would never assume that you could make your second child walk or talk at exactly the same time as your first, if she clearly wasn’t ready. As parents, we quickly realize with subsequent children that every child is different with different needs and abilities. So why do we expect our twins to conform to the needs and development of a sibling who just happened to share a womb with them? Sometimes identical twins are very close together in terms of their development patterns, growth spurts, and nutritional needs. But not always. And fraternal twins are no more likely to be alike than any two siblings. So don’t force your twins into a mold. When you don’t respond to your baby, and you instead apply a set of rules or expectations, you interrupt or destroy the natural, symbiotic relationship that is so beautiful about breastfeeding. Our babies tell our bodies what they need, and our bodies respond in kind…if we let them.

Don’t over-plan.

Together or apart? Scheduled or not? Switch or don’t switch sides? Paper or plastic? Twin moms often feel the need to determine everything ahead of time. Rigid schedules are never a good idea with breastfeeding (with any number of babies) for all the reasons above. As far as nursing them together or apart, see how it goes. Twin mothers who respond to their babies as individuals find that this is usually not an all or nothing proposition. My pediatrician, who breastfed her twins for 18 months, advised me to nurse them together while they were little because I wouldn’t be able to do it for long. She said once they got bigger it would be tough. I found the opposite to be true. I breastfed them separately more so in the beginning, enjoying the bonding of holding and nursing one baby at a time, the decreased effort in positioning. As they got older and more able to hold themselves in position, and also make their wishes known (one wanted to nurse when he or she saw the other one nursing), I found that I breastfed them together much more often, well into toddlerhood. The point is, don’t think you have to figure it all out before you even see your babies. Let them lead you and guide you, and they will show you the way. Once you do settle into a pattern and find what works for all three of you, realize that the only sure thing is change. Be willing to adjust and readjust as time goes by.

Accept help when it’s offered, but be clear that feeding is your job.

There are plenty of diapers, meals, loads of laundry, and chores that could use an extra hand. A spouse, partner, mother, sister, friend, etc. can help facilitate your feedings by: comforting the non-nursing twin, handing you the next one (and changing the finished one), helping you position them both, holding an early finisher, burping, etc. Assure visitors that there will be plenty of time for them to hold and snuggle your babies and a bottle in hand is not a prerequisite. Breastfeeding is the one thing that only you can do!

Learn to nurse hands-free!

Breastfeeding in a sling, pouch or wrap is a useful skill to work on for any mother, important for a mother with an infant and an older child (or children), but can be a lifesaver for a mom of twins. Breastfeeding hands-free can make it even easier to respond to your babies’ individual needs. If you can nurse one baby in a sling, you have both hands free to comfort and care for the other one. Nursing in a sling allows you to get in a feeding while doing other things as well, making it more likely that you will nurse on demand rather than postponing or fitting nursing into your schedule.

And a few little things definitely specific to twins:

Count your blessings. I’m not saying this to be trite. There are things that are actually really nice about nursing twins. Your letdown may be stronger and faster (read: shorter, more effective nursing sessions) since you are nursing two. One strong nurser can help a lazier or weaker baby nursing on the other side, and actually help make a more difficult nursing experience for that baby go more smoothly. Your supply is being kept up by two demanding infants, so you are less likely to respond negatively to shifts in nursing patterns (like a nursing strike, illness, teething) that could more drastically impact the milk supply of a singleton mom. And learning to nurse them together, even sometimes, could shorten the time commitment to even less than bottle-feeding. No washing, sterilizing, preparing and feeding bottles for two.

Don’t automatically assume that nursing two babies always takes twice as long or is twice as difficult as nursing one. My own experience is only that, my own experience, but I was fully prepared to sit my butt on the couch and not get up for at least 6 months, assuming that nursing my twins would be as difficult and time-consuming as nursing my first baby TIMES TWO! My first nursling was a high-needs baby. He nursed frequently and for a long time (usually 45 minutes per feeding, minimum, and about every hour and half). When I imagined nursing my twins, I doubled the time commitment in my head and steeled myself for a Herculean effort. Imagine my surprise when my twins took up less time nursing than my singleton and I got more total sleep. Not only did I not double my time and effort, it was pretty much cut in half! They were closer to average in that huge range of normal that a baby’s nursing pattern can fall into, and even with nursing them together only sometimes, my total nursing time did not even come close to my time spent nursing my first. I’m sure this is a combination of all three babies’ varied needs and personalities, as well as my experience level the second time around. But the point is – don’t assume that all mothers with single babies are having an easier time of it.

Switch sides periodically. The recommendation in most cases is that a mother let the baby finish nursing on one side, then offer the other. This ensures the transfer of the hind milk and also affords the baby the opportunity to “top it off” if needed with the other side. However, with twins, it may be easier to pick a side and a twin and stick with that, for a day, or a week, or a block of time, whatever works for you. In this way, you ensure that differing nursing patterns (either daily or longer term) are allowed to develop naturally. For example, if one baby snacked at a feeding and the other pigged out, and then you switched at the next feeding, the snacker would then get the relatively empty breast at the next feeding instead of the fuller one. So why not just assign one breast to one baby at all times and keep it simple? Well, you could do this, but it comes with drawbacks as well. Nursing on only one side, for singletons too, has been shown to impact brain development. When a baby is nursing, they see the world through one eye, and it’s good to switch this up. Also, switching the baby/breast combo can help to keep your supply similar in both breasts. Along the same lines, if you have a lower producing side (most women have a slight difference in milk output between breasts), you don’t stick one twin with that side. Also, by switching it up, a stronger nurser can make up for a more lackadaisical or weaker nurser by helping both breasts to stay emptied and stimulated (which is what drives milk production).

Encourage coordinated nursing patterns, if you want to. Although forcing a predetermined feeding schedule on a nursing baby can cause lots of problems, there is nothing wrong with encouraging your twins to find their way into a similar schedule if you want to nurse them together most of the time, and if their individual needs allow this to work. One way to get them into a more similar routine is by offering the second twin the breast when you nurse the first, or right after (depending on if you are breastfeeding simultaneously or separately). The second twin may not nurse, may just snack, or may do a full feeding. But you have a chance at getting some portion of a feeding in, which increases the chances that they’ll both want to nurse again around the same time.

Be creative. It may be really worth the extra effort to learn all of the various different breastfeeding positions – football hold, cross cradle hold, shifted cradle hold, side-lying, etc. This gives you more flexibility and options. It’s also even more important to position furniture and pillows to make yourself comfortable for the long haul because it may be harder to adjust mid-feed if both of your hands are full. So spend the time prepping your environment ahead of time.

Long hair can be hazardous to your health. OK, not really, but short hair or a ponytail is a very helpful. You’ll see when you try extracting your hair from two clutching fists while trying to keep them both latched and nursing.

Go with the flow. Your breasts may get really used to both letting down strongly at the same time. Keep a cloth diaper or burp cloth handy if you are only nursing one to catch any overflow.

Lose the muumuu. Slightly more fitted tops are a little easier to manage than loose, billowy ones, or just go topless while you’re breastfeeding. You may not have an extra hand to hold back and control your clothing. Slightly fitted tank tops with shelf bras are great. And, when you are home and don’t care how funny it looks, a length-wise folded cloth diaper can lay right in that shelf instead of breast pads.

So there you have it. My advice to you, mother-to-mother, to hopefully help you get on the right track with breastfeeding your twins. Find your own way and experiment with different ideas to see what works best for your family. Trust in yourself and your body and believe that you can do this.

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Angela is a soon-to-be mother of 4.  She is a La Leche League leader, an ICAN member, and is currently working full-time in the clinical research field.  In her spare time (ha!), she enjoys marathon running, free-lance writing, and helping other mothers explore instinctive parenting through breastfeeding, co-sleeping, baby-wearing and cloth diapering.

(Please note that the views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any of the above mentioned organizations .)

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