Breastfeeding Twins: Getting off to a Good Start.

Tandem nursing.

Tandem nursing twin boys.

You’re expecting twins!  How exciting! After the shock wears off, you may start wondering about how you will breastfeed 2 babies!  No need to worry. With some preparation and lots of support, most mothers of twins have plenty of milk for their babies. Here are a few general tips for ensuring ample milk supply when breastfeeding twins:

  • First of all, don’t listen to anyone who says you won’t be able to do this! If you can make enough milk for one baby you can make enough for two! In fact, the research shows that mothers with twins make MORE than double the amount of milk for one baby and moms of triplets make more than triple. Yes, our bodies over-compensate. Another cool thing. Your breasts know you are carrying twins before they are born and prepare accordingly!
  • Find other moms who are breastfeeding twins and enlist their support. La Leche League may be a good resource to connect with moms of multiples. Many communities have support groups for families with multiples. In Seattle, it’s Seattle Families of Multiples. Get connected while you are pregnant!
  • It would be a good idea to meet with a Board Certified Lactation Consultant (IBCLC) while you’re still pregnant. Especially true if this will be your first experience breastfeeding. She will help you find resources, locate the best breast pump and help you develop a plan for success.
  • Read books about breastfeeding—general books as well as books about twins. One of my favorite twin resources is “Mothering Multiples” by Karen Gromada.
  • Plan on renting a hospital grade pump to use until your milk supply is established. If the babies are born early, or one or both have trouble breastfeeding at first, you will have a machine that can act as a substitute for your babies. Pump as often as your babies eat! Of course, if your babies are both nursing well from birth, you will have no need for a pump. Remember if only one twin is nursing well, you will still need to pump to simulate 2 babies at the breast!
  • Research shows (as well as the experience of my clients) pumping 8x a day will yield the same amount of milk as pumping every 3 hours. So if babies can’t breastfeed yet, give yourself a break and sleep for 4 hours in a row at night. You can pump more often during the day to get in those 8 pumpings!
  • Hire an experienced, trusted lactation consultant (IBCLC) as soon as possible after the babies are born. It’s very important to get things off to a good start. Expect the LC to be supportive of your efforts and positive about your desire to exclusively breastfeed. I recommend asking her about her experience/philosophy before you meet with her. Your local twins group may have some recommendations.
  • Plan on doing nothing but feeding babies, feeding yourself and sleeping for the first 3-6 weeks. (Longer if the babies are premature) You will need help for meals, laundry, cleaning and errands. Let your wonderful helpers do everything non-baby. Your babies need you! Everything will feel much easier and you’ll be able to cope well if you take good care of yourself. Hiring a postpartum doula who is experienced with twins is a great investment!
  • If you’re having trouble with supply or babies aren’t breastfeeding effectively, try pumping for 5-10 minutes immediately after breastfeeding them. This will help you remove any milk they left behind and tell your body to make more milk.
  • Breastfeed simultaneously as much as you can. This tells your body definitively that you have twins and you need to make a lot of milk NOW.
  • Familiarize yourself with lactogenic foods. Milkmakers are one delicious way to help your supply. Foods that are rich in calcium and iron are also supportive. There are a variety of herbs and medications that can help increase your milk production, but please check with your IBCLC for advice!
  • Yes, it’s true that some mothers are not able to make enough milk for their babies. If that is your situation, you can still breastfeed. You can use donor milk or formula for supplementation when necessary.

Note: Many sets twins or triplets were conceived with the help of IVF or some other technology. If you have fertility issues, please be extra cautious the first week or so after the birth of your babies and seek help from an IBCLC immediately after birth.  Some causes of infertility are correlated with low milk supply. If you are prepared, you can avoid unnecessary newborn weight loss.

See also, “Breastfeeding Twins? Yes!”

IGT: Four Stories from Moms Who Have Been There

Nursing with homemade SNS

Nursing with homemade SNS

This post is dedicated to the incredible moms I have met over the years who have IGT.

The stories below are as uniquely individual as the mothers who wrote them. Even so, they do have many elements in common. All of these moms were very committed to breastfeeding. None of these moms were screened for possible IGT prenatally or early enough postpartum to avoid severe infant weight loss. All of these babies lost a significant amount of weight—a weight loss that was completely avoidable. All of the mothers put an extreme amount of effort into producing enough milk for their babies. All of these mothers have felt guilt and remorse—even though none of this was their fault. All of the mothers received inappropriate advice from the professionals they trusted to help them with a very basic function—feeding their babies. These mothers have no reason to feel shame. It is our system that has let them down. Continue reading

Low Milk Supply: Could it be IGT?

Baby and mom breastfeeding with IGT

Baby and mom breastfeeding with IGT

Your breast anatomy was determined even before you were born. During the early months of fetal development, breast buds are formed. If the breast buds do not develop properly in utero, development in puberty may not occur normally. Breasts may develop minimally or not at all. And future milk making ability may be compromised. Continue reading

Thankful for Breastfeeding

Thankful for baby bliss.

Thankful for baby bliss.

Recently a client sent me a nice note with a generous check. She had been feeling gratitude for the help she received to breastfeed her son. There were multiple lactation consultations in her home, a frenotomy (the procedure to release a tongue tie) and body work for baby. There were many up-front costs–some of which were not covered by insurance. Here’s what she wrote: Continue reading

Choosing and Preparing Formula for your Newborn

DSCN1955You may be wondering… why is a lactation consultant writing about formula? Because in my world of breastfeeding difficulties including chronic low milk supply, mothers often find they need to supplement breastfeeding with another source of nutrition. Sometimes that’s donor milk from another mother, sometimes banked human milk. But most often it is commercially available formula.

All formulas are not created equal. There are pros and cons to various brands. There are milk-based formulas, soy formulas, organic, non-organic and special formulas. But the most important distinction in my mind is liquid vs powder. Why is this so important?

It turns out that powdered infant formula (PIF) is not sterile. The manufacturing process does not allow for elimination of all germs. In addition, preparation of the product in the home can lead to further contamination. The most concerning bacteria found in PIF is called Cronobacter bacteria.

Cronobacter bacteria is an organism that thrives in dry conditions and it’s very prevalent. The bacteria is found in dry herbs and spices, herbal teas, dry milk manufacturing facilities and household vacuum cleaners. It has also been found in waste water. It can thrive on plastics, rubber and silicone bottle nipples. Clearly it is difficult to avoid this little beast.

Becoming sick from Cronobacter is a rare event, but it can be deadly in young infants. Premature babies and infants younger than 2 months are most vulnerable to Cronobacter illness. Cronobacter illness can lead to blood infections or meningitis. According to The Center for Disease Control (CDC) there are about 4-6 reported cases of Cronobacter illness in infants per year, but it may be under-reported. Recently more awareness has led to higher reported numbers. There were 13 known cases in 2011.

Breastfeeding is the best protection against Cronobacter infection. If possible, provide your baby with breast milk—especially for the first 2 months. “Almost no cases of Cronobacter infection have been reported among infants who were being exclusively breastfed.” (Center for Disease Control and Prevention website).

If your baby uses formula, choose formula that is sold as a liquid. Liquid formula is sterile so is less likely to transmit the bacteria. This is especially important for very young or premature babies.

If you choose to use powdered formula, please do so safely with good hygiene in mind.

  • Always wash your hands prior to preparing formula.
  • Use clean tongs to fish the scoop out of the container. Wash the scoop after every use.
  • Clean bottles in hot dishwasher or hot soapy water plus sterilization.
  • Use only clean work surfaces when preparing the bottles.
  • Use hot water to prepare the powdered formula—at least 158 degrees F(70 degrees C) This temperature is necessary to kill the bacteria. Cool to room temperature before feeding to baby by placing closed bottle in ice bath.
  • If you make the formula ahead of time, refrigerate it immediately and use it within 24 hours.

The Center for Disease Control and Prevention: has more information on this topic. The World Health Organization (WHO) has created a PDF in several different languages that includes guidelines regarding formula and breastfeeding.