Mothers with Multiples
The "supply and demand" production principle of lactation is a compensatory mechanism, which ensures the availability of adequate amounts of human milk, no matter how many infants are breastfeeding. A lack of time for the increased number of breastfeedings, physical and emotional difficulties associated with caring for more than one infant, and a lack of available professional support generally are greater hindrances than an inability on the part of the mother's body to produce milk for all infants.
Multiples born prematurely are at greatest risk for under consumption (Geraghty, 2004). The physiologic and behavioral differences of preterm infants mean that breastfeeding strategies commonly used for term, healthy infants, in particular, unmonitored "demand" feedings, may not be appropriate for preterm infants, because of the risk for dehydration and slow weight gain (Meier, 1996).
Promoting adequate milk production for multiples, especially preterm infants, can be accomplished more reliably, if known stimulants to milk production are initiated early in the first postpartum day. Protect mothers from unnecessary interruptions, and offer physical assistance with feedings on a regular basis.
- Explain to mothers the importance of protecting herself from unnecessary interruptions and investing her energies in these first few days in building up her milk supply.
- Avoid or minimize maternal-infants and infant-infant separations.
- Provide parents with a chart and teach them how to keep a daily record of milk intake, wet diapers, bowel movements, etc. (see Appendix C).
- Provide greater assistance with positioning and attachment, recommending feeding each infant separately, until both mother and infant have achieved some level of breastfeeding competency. (Some parents find it helpful to have a partner hand-express or pump the other breast, while one twin is nursing. This volume can then be fed to the second twin (see Appendix G). If twins nurse well, teach the partner how to get the second infant attached after the first has started to feed.
- Alternate breasts between twins, to balance milk volumes. One baby may have a more vigorous sucking style, promoting increased production on both sides, and making it easier for the less vigorous infant.
- Recommend back-to-back feedings, 10-12 /day in the first 3 days to accelerate the learning process and lactogenesis (increase in milk production). This upfront investment will make it easier for a mother after discharge. “Recovering”, by separating the mother and infants in the hospital, increases her post discharge workload, when less help may be available.
- For preterm babies, pump after each nursing to ensure maximum emptying.
- Once babies learn how to breastfeed, around the third week, bottles of expressed milk can be introduced for convenience, without the same risk of interfering with breastfeeding.
- Test weighing may be useful, especially for mothers with preterm twins (See Appendix D).
The most important thing you can do these first few days is to signal your breasts to make enough milk for triplets instead of twins. The more milk you have, the easier your life will be at home with twins. So, ask for lots of help with positioning the babies and expressing milk.
Your babies’ different nursing styles can be used to your advantage. The more vigorous, wakeful baby should set the pace. Then you can wake up the sleepier baby after her (his) sib has finished or once the first baby is started nursing well. Alternate breasts between twins, so both breasts get the loud and clear order for the “double latte”.
You can nurse both babies at the same time after each has learned how to latch on, and stay on, by him(her)self. Or, once you get one baby started, (Dad, Grandma, etc.) can help the second baby get started. We want you eventually to be able to nurse them at the same time to save yourself a lot of time.
Figure out all the things you do not absolutely have to do, and let your partner do them, like diapering or keeping the feeding record, or protecting you from unnecessary interruptions or phone calls. Tuck your babies in on each side of you and learn how to say, “later, but not now…I’m in the middle of things.” Your job right now is just to feed the babies and take care of yourself.
Babies At Risk
- C-section Mothers
- Mothers with multiples
- Infants who have not latched-on or nursed effectively for 12 hours
- Mothers of NICU or PSCN infants
- Infants supplemented more than once in 24 hours
- Infants < 38 weeks or less than 6 pounds
- Infant with loss of 10% birth weight
- Mothers with breast surgery
- Mothers with a history of breastfeeding failure
- Antepartum mothers at risk of preterm delivery