Breastfeeding twins, how it actually works

The first question I am asked by almost every mother of twins is whether she can possibly make enough milk for two. The answer is yes, and the reason is worth understanding, because it is the thing that will keep you going when someone tells you otherwise.

Milk supply works on removal. The more milk that is taken out, and the more often, the more your body makes. Two babies feeding effectively remove roughly twice as much as one, so your body builds roughly twice the supply. Your breasts are not working to a fixed quota that has to be divided in half.

What is genuinely harder with twins

It is not usually the milk. The difficulties I actually see are:

• Early arrival. Twins are often born before term, and a smaller or earlier baby may be sleepier, tire more quickly at the breast, and take longer to feed effectively.
• Time. Fed separately, two babies feeding eight to twelve times each is most of the day and night.
• A stay on the neonatal unit, sometimes for one baby and not the other, which means expressing, travelling and splitting yourself in two.
• Two different babies. They very often feed differently from each other. One may latch beautifully and the other struggle, and that is normal rather than a sign you are doing something wrong.

Feeding both at once

Learning to feed both together is the single biggest practical change, because it turns two feeds into one. It is worth persevering with even if it feels impossible in week one.

• Double rugby hold. A baby under each arm, bodies tucked along your sides, heads at the front. The most popular, and it keeps their bodies off your abdomen which matters after a caesarean.
• Double cradle, with their bodies crossing over in front of you.
• One of each, with one in a rugby hold and one in a cradle. Useful when one twin needs more help than the other.

A twin feeding pillow makes a real difference and is one of the few pieces of equipment I would recommend buying. In the early days, get someone to hand you the second baby once the first is latched. Latching both by yourself comes later, and it does come.

Getting started when they arrive early

If one or both babies cannot feed at the breast yet:

• Express early and often, ideally within the first hours, and at least eight times in twenty four hours including overnight. Hand expressing gets colostrum out better than a pump in the first days.
• Hire a hospital grade double pump. With twins this is not a luxury, it is the difference between keeping up and not.
• Skin to skin whenever you can, with either baby, including on the unit. It helps your supply as well as them.
• Ask about donor milk if it is available and needed.

There is more in Ways to express milk.

Keeping track without losing your mind

With two babies, feeding fully responsively can mean never sitting down. Most families I work with land somewhere in between.

• Feed both when one wakes. Waking the second baby to feed alongside the first is the most common approach and it protects your sleep more than anything else.
• Swap sides between feeds rather than assigning a breast to each baby, so both breasts get stimulated by both babies and any difference in how well one feeds evens out.
• Keep a simple note of feeds and nappies in the first fortnight. With two it is genuinely hard to remember who did what.
• Accept help with everything that is not feeding. Feeding is the part only you can do. Everything else can be done by someone else.

Mixed feeding is a real option

Some families breastfeed both, some breastfeed one and combination feed the other, some do a mixture that changes week to week. Any milk you give is worth giving, and a plan that keeps you well is better than one that is technically ideal and unsustainable. This is worth saying plainly, because mothers of twins are often made to feel that anything less than exclusive feeding of both is a failure. It is not.

How a consultation helps with twins

Most of the work with twins is practical and needs someone in the room with their hands free. I help you get both babies latched together and find the hold that works for your body and their sizes, which is quicker to do than to read about. We look at each baby separately too, because they are usually not the same, and one of them often has something specific going on that is being missed in the general chaos. Then we build a plan for the day and night that fits the household you actually have, rather than the one in the book. Families often tell me that the appointment where they finally fed both at once was the day it started to feel possible.