Breastfeeding Twins

Key Points:

1. Mothers can indeed produce enough milk for twins, with supply meeting the demand through either tandem feeding or feeding one baby at a time with support.
2. Proper positioning and attachment for tandem feeding can be aided by using a tandem-feeding pillow and various setups to manage both babies comfortably.
3. Implementing a feeding schedule where both twins are fed together can help establish a routine, while expressing milk is often necessary, especially for pre-term twins.
4. While breastfeeding twins may require more effort initially, with the right support and techniques, it becomes easier, allowing for flexibility in feeding positions as the babies grow.

Breastfeeding can be a tough skill to learn, let alone navigating breastfeeding two babies at once. But, with the right support, it’s a challenge that is definitely do-able.

Will I have enough milk for two babies?

When a mum finds out she’s pregnant with twins, her first thought may be ‘will I have enough milk for two babies?’ and the answer is a resounding ‘yes!’. Supply is all about demand, the amount a woman’s baby—or babies—takes is how much her body will make. Some twin mummies have breastfed one baby before, but worry about feeding two — latching just one was hard, is it possible to attach both in tandem-mode? What about having time for their own sleep in between the constant suckling required from newborns to bring in and maintain the milk? This is when at-home help is paramount. The practical help a partner, grandparent or other close friend can give, is a gift like no other. Support with housework, washing, cooking meals, looking after older children or just being an extra pair of hands to hand babies to their mum when she’s sitting down and ready to feed is a huge help.   

How do I position and attach my babies?

Many twins are born early, and many of the challenges faced are to do with their prematurity rather than being multiples, but if they are born 37 weeks or over and are able to room-in with their mum after birth and feed frequently, chances are the milk will come in after about 72 hours, as it does for one baby. Because of the extra stimulation from two babies, the supply should come in in a double lot! If you are comfortable to do so, ask your midwives to help you position and attach your babies to tandem feed, which is feeding two babies at the same time. A purpose-built tandem-feeding pillow is a great asset here, possibly more important than a feeding pillow for a singleton, as the firm surface helps mums to hold and manage their babies as they suckle, adjusting using both hands if necessary. I always encourage my mums to have a stack of cloth nappies or baby wraps to wedge in under their babies’ heads or bodies in case they need to temporarily let go to tend to the other one’s latch. I’ve even seen experienced mums tandem feed and read a book at the same time all while using a twin feeding pillow!

Not all twin mums tandem feed, so it’s OK to learn to feed one at a time if this suits you better and having someone to hold the other bub as they are waiting their turn is super handy. Many mums eventually learn to tandem feed to speed up the process and get more sleep, especially as most newborns take at least an hour to feed at first. With practice, too, women may not always need someone to hold the babies as she gets them ready to feed. I’ve seen some great twin set-ups to physically get babies on the breast without help. One is to sit on a couch with two baby rockers in front of you and lean forward and grab one baby at a time or feed one and rock another with a foot. Another way is to put a bed pillow either side of the mum on the couch, put the babies on the pillows, then sit down, position the breastfeeding pillow on a lap and lift one at a time from the side pillows. It’s OK to pick up a twin ‘cat-style’ by the jumpsuit, too, just do it slowly to accommodate head lag. A third way is to lean each baby over your shoulders, sit down and have your feeding pillow nearby. Lean back to allow gravity to hold babies against you as you let go to grab the pillow, then lower them onto the pillow from there.

Do my twins need a schedule?

As for routines, I usually don’t emphasise scheduled feeds with singletons and encourage demand feeding, so just to feed when baby wakes. However, with twins, many mums find treating them as one baby works well. So if one wakes ready for a feed, they wake the other and always feed together until they fall into this pattern naturally. 

Do I need to express?

Expressing milk for twins is much more commonly required than it is for one baby. With one bub, I encourage mums to wait until they feel their breastfeeding is well established before introducing expressing but with twins, there often isn’t this choice. If the babies are born pre-term and unable to regularly feed from the breast, mums will need to express their colostrum and bring their milk in with hand expressing and usually maintain it with a pump until babies are ready to breastfeed. A double electric pump is the best way to go here – whether it’s a hospital-grade rental at first, or invest in a quality personal-use pump, new mummies need to express as often as one would be breastfeeding, and most newborns feed as frequently as 8-12 times in 24 hours! Once the babies are ready to feed directly, it can still be quite a process to entice them over to breastfeeding, especially if they have needed to use any bottles or other feeding devices before they go to the boob. I would certainly enlist some professional help here — regular sessions with a lactation consultant, or hospital breastfeeding clinic would be ideal. Partners, grandparents or friends, are often a great help ferrying mums to and from appointments or being an extra pair of hands during sessions.

Expressing for twins is a round-the-clock job, even if bubs are in the special care nursery or mum is discharged from hospital before her babies, and needs ongoing support at home to maintain. If your ‘support team’ are up to date on how to store the precious breastmilk (or transport to the hospital) it can help too — milk can stay at room temperature for 6-8 hours under 26˚C, then it needs to be refrigerated (and stay cool with an ice brick if travelling). It can stay in the fridge for 72 hours or in a freezer for up to 3 months, or 6-12 months in a deep freeze. Label breastmilk with the date it was expressed. Milk for feeding can be warmed by sitting in a bowl of hot water until body temperature. Frozen milk can be thawed overnight in a fridge and used within 24 hours.

Breastfeeding challenges

If babies need to be tube fed or bottle fed in hospital, or need top-ups from a cup, syringe, bottle or supply line, this is when the expressed milk is used. Your hospital midwives, special care nurses or lactation consultant will be paramount in making sure mum’s wishes to breastfeed are supported, with the eventual aim to wean off the extra top-up feeds when bub is physically able.

It may take a bit longer to establish breastfeeding with twins, but once you and your babies are managing well, like any skill, it gets easier and easier. Babies get quicker and quicker at feeding, too, so feeding one at a time doesn’t take up as much time as it used to. As a lactation consultant, I form such a strong bond with all my twin mums (they are a determined bunch!) and many come back to me periodically for help with things like managing tandem holds as babies grow and get bigger. As newborns, many mums start out with the double football hold, but as they grow and gain more head control, there’s many holds that can be managed without using a special pillow (some are the V-hold, parallel hold or even double koala hold), which means breastfeeding twins can be managed outside the home environment, at the park, cafes, restaurants, anywhere really! 

Written for Nourish Baby by Simone Casey, ICBLC and volunteer breastfeeding counsellor with the Australian Breastfeeding Association.