breast feeding twins or triplets

Last reviewed 04/2023

• human breast milk is the best nutrition for human infants
  • advantages over the milk of other species, such as cows, include both a reduced risk for infections, allergies and chronic diseases, together with the full nutritional requirements for growth and development
• breast-feeding is as important for multiples as for singletons
• prematurity and low or very low birth weight are associated with multiple pregnancies and breastfeeding helps in decreasing the incidence of postnatal complications like recurrent episodes of sepsis, necrotising enterocolitis and retinopathy of prematurity in these babies (2)
• there is evidence that, multiples receive less breast-feeding than singletons. Common reasons for not breast-feeding multiples include:
  • fear of not fulfilling the infants needs
  • difficulty of coping with the demands on the mother's time
  • also, many multiples are delivered prematurely and by Caesarean section - in this situation, maternal pain and discomfort together with anxiety over the infants? condition are not conducive to successful breast-feeding
• during breast feeding - the mother needs to add calories to her daily diet
  • recommended to add approximately 500-600 kcal/day for each infant - therefore, between eating, nursing and sleeping, life is very busy for the mother of multiples
  • there is evidence that, with appropriate nutrition, one mother can nourish more than one infant
    • simultaneous breast-feeding can save much time
    • mothers should be informed that the volume and the content of breast milk is adequate to feed multiple infants and the more they nurse, the more adequate the milk supply will be (2)
    • also combined efforts of parents, close family, friends and the medical team can help to make either full or partial breast-feeding of multiples possible

Note that , when breast-feeding is not possible, health care workers need to carefully avoid judgmental approaches that may induce feelings of guilt.

Advice on how to manage breastfeeding multiples (2):

• adequate rest - although the life may be very busy for the mother of multiples, getting sufficient rest is important in maintaining exclusive breastfeeding
  
  
• nutrition of the mother
  • according to current recommendations a breastfeeding mother should have at least 2100-2500 kJ (500-600 kcal) per baby per day
  • a well balanced diet should be taken with protein 20% of total calories, carbohydrates 40%, and fat 40%
  • increase in fluid intake
    
    
• advise that smoking is detrimental for breast feeding (decreases prolactin) (1)
  
  
• avoid wearing a tight bra or a sling pressing on the breasts, taking allergy drugs, and sleeping prone (1)
  
  
• timing of breastfeeding:
  • breastfeeding twins can be done
    • simultaneously - saves time and also the more vigorous baby on one side may stimulate the let down reflex of the other twin
    • separately on an individual demand schedule
    • separately on a modified demand schedule - one infant is fed on demand and then the other immediately afterwards
  • the most common practice initially is to breast feed each baby separately and once the mother and the infants adapt to the situation, mothers can soon choose their preferred schedule (2)
    
    
• sides - alternate breasts when breast feeding twins in order to make certain that each breast receives balanced stimulation from each baby and that the amount of milk produced is same for each baby (2)
  
  
• positions for simultaneous breast feeding - there are 3 commonly used positions:
  • "double football" position - an infants body is placed under each of mother's arms while the head is supported in each of the mother's hands (or on a pillow), preferred position in most mothers initially until they gather more experience
  • "double cradle" - each infant is held in a cradle position and the two infants cross on the mother's abdomen, often done when the mother is more experienced and the infants have better head control
  • combination of cradle with football - one infant is held in the cradle position and the other infant in the football position (2)

Note that feeding multiples is a difficult and stressful task hence should be approached with appropriate sensitivity and understanding. It is important to understand that even partial breastfeeding may be beneficial (1).

Reference:

• (1) Semin Neonatol. 2002 Jun;7(3):231-9
• (2) Flidel-Rimon O, Shinwell ES. Breast feeding twins and high multiples. Arch Dis Child Fetal Neonatal Ed. 2006;91(5):F377-80