You could describe a lot of breastfeeding moms as determined. But moms who nurse twins or preterm babies? Hey, they are definitely determined. No doubt about it, nursing twins or preemie babies has a lot of challenges, but research shows more and more parents of these extra-small newborns are deciding to give breastfeeding a try.
“You and your babies are unique, and you have your own set of circumstances and your own breastfeeding goals,” says JonaRose Feinberg, an International Board Certified Lactation Consultant (IBCLC) who writes about twin parenthood at Twins in Mind in Seattle, Washington. “There isn’t just one way of breastfeeding and ‘success’ will look different to different families. Some families may work toward exclusive breastfeeding; some will work toward partial breastfeeding combined with pumping. There is no single ‘right’ way.”
Read on to discover some of the common issues that come with breastfeeding twins or a preterm baby and possible solutions.
Many twins are born early. Twins born at 34-36 weeks are called “late preterm” twins, and while they may be similar in size to a full-term baby, they sometimes find it harder to breastfeed at first because they tire easily and their sucking reflex isn’t as well developed. As with a full-term newborn, early skin-to-skin contact and frequent breastfeeding can help get the milk supply established. After each baby has breastfed, consider using a pump to express the rest of the milk in your breasts, which you can freeze and store for use later. Pumping also helps keep your milk supply up.
Breastfeeding both babies at the same time?? While this may sound daunting it may be the best solution. “It’s sometimes really helpful to feed them at the same time—for example, one baby may be a stronger breastfeeder and help stimulate the milk flow for the other. It’s also a big time-saving measure! If you have a supportive nurse or IBCLC in the hospital, this can be a great time to experiment with tandem feeding because the extra hands can be really helpful while you’re learning,” says Feinberg, who breastfed her own twins and is the editor at Breastfeeding Twins.
However, she adds, if the babies are still learning to latch and feed effectively, it may make more sense to feed them separately at first. The football or clutch hold works well for many moms of twins, she says. “In the early days it really helps to be able to focus on each baby and be sure they’re latching well, and the football hold gives mom a good view of what’s going on with the latch. Once she’s ready to tandem feed, it’s easy to add a second baby in the double football position. This is also a good position if mom has had a Caesarean birth, because it helps keep the babies off her incision.”
Lara Wellman of Ottawa, Ontario, who blogs at Gliding through Motherhood and Kids in the Capital found that in the early days, her babies found comfort in having their twin nearby. “When I first got home from the hospital and tried to breastfeed, my son wouldn’t latch on, although he had been breastfeeding fine at the hospital. I decided to try to tandem breastfeed and it seemed the combination of having his sister start the process and being nestled in together with her calmed him enough to get him latched on and successfully breastfeed. It was a beautiful moment!”
To help deal with the extra time that it takes to feed twins, create a ‘breastfeeding nest” with your breastfeeding pillow, other support pillows, and whatever else you need to be comfortable while breastfeeding, says Feinberg. “Stock a basket with snacks, water, your phone, the TV remote, and anything else you might need for an extended feeding session.”
Breastfeeding twins requires lots of support. Wellman shares some other twin tips: see a IBCLC before the babies are born to discuss strategies; bring your breast pump to the hospital so you can use it right away; arrange for cooking and cleaning support at home (“When you’re breastfeeding twins you’re hungry…VERY VERY hungry”); and have a family member or mother’s helper with you every day during the first few months. “My twins were born full term, had no health issues and latched without difficulty. My milk was in before I left the hospital,” says Wellman. “With all those things in my favour, breastfeeding twins was still hard. I topped up a small bottle [of formula] a day for about two and a half months and I was OK with that. If you breastfeed twins then I think you are awesome. It’s a big commitment, but well worth it.”
Preterm babies—born as early as 22 weeks gestation—have a wide range of issues, from respiratory and gastrointestinal complications to low birth weight and the overall pain, stress and fatigue for both mom and baby due to a difficult pregnancy or delivery. That means there isn’t any one-size-fits-all recommendation when it comes to breastfeeding and taking in breast milk through a feeding tube or bottle. There are some overall ideas to keep in mind though.
“In general, late preterm infants are sleepier and have less stamina than full term babies, and they may have more difficulty with latch, suck, and swallow,” says Feinberg. “This means they tend to need to be awakened for their feedings and kept awake to complete the feeding, and they sometimes have trouble maintaining their latch due to their size—small babies with small mouths can seem really out of proportion to lactating breasts!”
Before 34 weeks, most babies are not developed enough to be able to coordinate their sucking, swallowing and breathing, so if you want your baby to have breast milk, you need to pump every three hours for about 15-20 minutes at a time, to establish and maintain your milk supply. In a study published in the medical journal Pediatrics, moms of babies born on average at 28 weeks who had the most success transitioning from taking in expressed breast milk to breastfeeding did three key things: (1) they started trying to pump milk within six hours of giving birth, (2) they did “kangaroo care” (frequent skin on skin contact with the baby), and (3) they expressed milk more than five times a day. Other studies show that simultaneous pumping—that is, a hospital-grade double breast pump that can express milk from both breasts at the same time—is a great way to improve milk production because it increases the “milk making” hormone prolactin, plus, of course, it cuts pumping time in half.
“Oh, the pumping!” says Jess Threlkeld of San Diego, who blogs at Team Threlkeld. Her daughter Bree was born eight weeks early. “Make it fun by listening to calming music, watching a funny show, or reading a good book. The hardest time to pump is in the middle of the night, but if it is something that you can commit to, it will make a huge difference in keeping your supply going.” When her baby transitioned from tube feeding to breastfeeding, she used a breast shield (also known as a nipple shield), a soft silicon cover over the breast that often helps babies who are used to a bottle or feeding tube to latch. “With the help of my incredible lactation consultant and the shield, we were able to get a good, strong latch. We often joked that I needed my shield as I raised my fist in the air like a superhero!” she says.
“The NICU tends to be very numbers-based, weighing and monitoring babies’ intake and output regularly,” notes Feinberg. “As families transition to care at home, it can be difficult to let go of that constant monitoring. Each family should consult with their own health care provider, but in general, you’ll know the babies are ready to start cutting out the supplements [formula] when they are able to latch comfortably, actively transfer milk, and end the feeding satisfied.”
Threlkeld, who blogged about her experience in the NICU points out that stress can affect your milk supply. “The NICU is a very stressful environment,” she says. “I made a goal to walk around outside for 10 minutes every day and just breathe. I journaled and found funny shows to watch. Find a nurse that you connect with, a friend, or your spouse, and find something to laugh at. And eat and drink regularly!”
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Dr. Cindy-Lee Dennis is a Professor at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and holds a Canada Research Chair in Perinatal Community Health.