Breastfeeding twins or multiples

Is breastfeeding harder with twins?

Ask anyone who's done it: Breastfeeding twins or higher multiples requires more work – and more dedication – than breastfeeding a single baby. But you can successfully breastfeed more than one baby at a time. It's helpful to plan ahead and get support from your baby's doctor, a lactation consultant, and your family and friends.

The responsibility of feeding more than one can feel overwhelming. You may worry that you won't produce enough milk. Or you may be afraid that nursing twins will take so much time, you'll never get a break. (After all, newborns have tiny tummies that need frequent refilling.)

Once you start, you may feel that your life consists of nothing but feedings and exhaustion. Common problems such as sore or cracked nipples, engorgement, and low milk supply may seem like too much to cope with when you have two or more hungry mouths to feed.

In addition, your babies may be preemies and/or low birth weight, which means they may need a little more time to get the hang of latching, sucking, and swallowing. But breast milk especially benefits premature babies, decreasing the risk of infections such as sepsis and necrotizing enterocolitis (which they're at higher risk for). Even partial breastfeeding is valuable.

Read more about the benefits of breastfeeding.

If your newborns aren't ready to nurse right away, you can hand express and/or pump as soon as you can. Your babies can have your colostrum and breast milk, and you'll be stimulating your milk production. When your twins are ready, they can start breastfeeding.

It's true that moms of singletons are more apt to breastfeed their babies than moms of multiples. But plenty of moms nurse their multiples, even with health conditions. At the time of hospital discharge, one Spanish study of over 32,000 low birth weight infants found that 31 percent of infants who were singletons were exclusively breastfed while 24 percent of multiples were. And thirty three percent of multiples were combination fed compared with 26 percent of singletons.

How often should you breastfeed twins?

At first, newborns need to eat every two to three hours round the clock, adding up to eight to 12 sessions every 24 hours. By one month, they gradually decrease to about seven to nine sessions daily.

You have some options for timing their feedings.

Some moms feed their babies on demand rather than by the clock. In other words, they feed their babies whenever they begin to show signs of hunger. And while it's not impossible to feed two babies at a time, independently, this way, it can feel as if you're doing nothing but feeding nonstop, round the clock.

The American Academy of PediatricsOpens a new window recommends feeding twins at the same time. So if one of your babies wakes to eat or shows signs of hunger, feed them both (waking the other baby, if necessary). This both saves time and is easier to keep track of than nursing them at different times.

Of course, your babies are individuals. One may be more wakeful than the other, or one may be a better nurser. One of your babies may be hungrier than the other, too. Let that baby decide when the next meal is. (It's fine if the other baby doesn't nurse as long.)

You might decide to combine methods, too, such as nursing on demand during the day and keeping to a schedule at night. Or you might feed your babies together during the day and separately at night – or vice versa.

No matter how you decide to handle feedings, don't wait until your babies are very hungry to feed them. It'll be harder to get them to latch and settle in comfortably, and they may swallow more air while nursing if they're gulping, resulting in uncomfortable, gassy babies.

Your healthcare provider will ask you to keep a chart of feeding times, including which baby was on which breast last, how long they nursed, and how many wet and poopy diapers each baby has. It seems like a lot to keep track of, but it'll provide important information early on.

Questions and tips for breastfeeding twins

Knowing the answers to some common questions about breastfeeding multiples ahead of time may help ease your anxiety and prepare you for the job. Here's a look at some common concerns:

How can I nurse two babies at the same time?

While it's challenging at first, you'll soon get the hang of nursing more than one baby.

You'll need something to support your babies while they nurse: Try rolled-up towels or a nursing pillow. You can buy nursing pillows designed specifically for nursing twins. Look for one with large, firm surfaces that will support both of your babies.

If you've had a C-section, a breastfeeding pillow that goes across your abdomen may not be comfortable at first. You can use bed pillows instead (one on each side) until your C-section recovery is further along.

It's a good idea to set up a designated space for breastfeeding that's big enough to comfortably accommodate you all. Keep your breastfeeding pillow there, along with burp cloths, snacks, and water.

Place one twin on each side, using a football hold position (along your side). A football hold works well for nursing twins and is a good place to start, but you can experiment with other breastfeeding positions. Some moms like to hold one twin in a football hold and the other in a traditional cradle hold.

When you're learning, it's helpful to have someone hand you your babies and help you get them in position. Eventually you'll be able to do it on your own. Position and latch one baby, then have the other handed to you to position and latch. Or you might be more comfortable putting both of them in position and then latching one, then the other.

If you don't have help, you can sit on the floor, leaning on something like a wall or furniture, with lots of pillows around you. Lay your babies on a blanket in front of you so you can easily reach them after you put on your nursing pillow or position pillows at your side.

After your babies have nursed, you can burp them one at a time, with one in an infant seat or on a blanket while you burp the other.

Do you produce more milk with twins?

Yes – it's the law of supply and demand. If you breastfeed when your babies want to eat, you can trust your body to supply enough milk. A low milk supply can almost always be corrected by nursing more often. If your babies aren't emptying your breasts (as can be the case with premature babies who have a weak latch or poor suck, for example), you may need to pump.

It's a good idea to alternate breasts with every feeding, especially if one twin is a stronger feeder. If it's hard to keep track of who was on each breast last, try alternating breasts every 24 hours instead of after each feeding. Switching back and forth regularly helps produce equal amounts of milk in both breasts and lessens the chance of clogged milk ducts. Alternating breasts also helps your babies' eyes get equal exercise and stimulation.

How do I know if my babies are getting enough to eat?

Lactation consultants and doctors can tell whether your babies are getting enough milk by how much weight they gain. Newborns normally lose 5 to 10 percent of their birth weight before regaining it by the time they're 2 weeks old. They should start gaining half an ounce to an ounce a day by the fifth day after birth. Have your pediatrician check your babies' weight if you're concerned.

There are other ways to gauge if your babies are getting enough milk. Signs that all's well:

• Your babies eat at least every two to three hours or at least eight times a day for the first two to three weeks.
• They have one or two bowel movements daily on the first two days and at least two on days three and four. By the time they're a week old, they should have at least 3 to 4 loose, yellow stools daily. (Your babies may poop after every feeding as your milk production increases.)
• They're gaining about 6 to 8 ounces a week for the first four months and 4 to 6 ounces weekly from 4 to 7 months.
• They wet 2 to 3 diapers daily in their first few days and at least six diapers a day after the first 4 to 5 days (after your milk comes in). The urine should be pale yellow or almost colorless.
• You can hear your babies swallowing while nursing.
• Your breasts feel softer after nursing.
• Your babies seem satisfied for one to three hours between feedings.

How do I keep my milk supply up with twins?

Here are some breastfeeding tips to help ensure you'll have plenty of milk for your twins:

• If you're supplementing your babies' feedings with formula, nurse them first. The more you breastfeed, the more your body will receive signals to produce more milk.
• If you're pumping, opt for a double electric pump, which will make shorter and easier work than a manual or hand pump. Make sure your pump is working properly and that your flanges are the right size. A lactation consultant can help.
• Stay hydrated. Nursing may make you very thirsty. Make it a habit to drink water whenever you breastfeed, and keep an eye on your urine. If it's dark yellow, you're probably not drinking enough water. Eight to 12 glasses each day is a good goal.
• Try to reduce stress. Experts continue to study the effect of stress on breast milk production, but we do know that stress can affect your milk flow. You may want to focus on relaxing during breastfeeding sessions (play quiet music or practice deep breathing, for example), and get some fresh air and gentle exercise each day – whatever helps you reduce your feelings of stress.
• Sleep when you can. Sleep deprivation with newborns is a given, but do your best to take naps and ask for help so you can catch up a bit.
• Make sure your babies are latching and feeding well. This may be an issue if they were born prematurely. Preemies sometimes take some time learning to eat effectively.
• Talk with your healthcare provider if you think you're not producing enough milk for your babies. There are health factors that may play a role in milk production, such as having a C-section, previous breast surgery, blood loss, or thyroid issues.
• Eat well. For each baby, your body needs about an additional 330 calories daily for the first six months of nursing and 400 calories daily for six through 12 months of breastfeeding. Continue taking your prenatal vitamin. The Centers for Disease Control and PreventionOpens a new window (CDC) offers helpful nutrition advice for breastfeeding mothers.

If you're not producing enough milk for both babies, it's fine to breastfeed one and formula feed the other at one feeding and then switch off at the next. You might try pumping between nursing sessions to stimulate your milk supply further, if you like.

Breastfeeding Problem Solver

Find solutions to a variety of breastfeeding challenges, including nipple pain, low milk supply, and more.

Do I ever get a break?

No doubt about it, breastfeeding twins is time consuming. It's a big commitment and likely your most important job right now.

But you don't have to be on the job at all times. In fact, you shouldn't be. Sleep when the babies sleep, if you can. Ask for help when you're feeling frazzled, beginning with your partner. Let them take over while you take off, even if it's for only 15 or 20 minutes. Get out of hearing range of the babies by going for a walk, taking a hot bath, or napping in another room.

Once your feeding routine is well established, enjoy a night out with your partner or a friend. (Learn how to pump your milk and teach your baby to drink from a bottle so you can spend more than an hour or two away from home.)

Where to get help with breastfeeding twins

If possible, get support teams in place before your babies are born.

• Make sure you'll have the help of a lactation consultant at the hospital right after the birth to help you get started nursing.
• Find a healthcare provider who encourages breastfeeding and supports your ideas about childcare.
• Join a Mother of Twins clubOpens a new window.
• Visit the La Leche LeagueOpens a new window website, which offers online support groups and a tool for finding a La Leche League leader or group near you.
• Talk to family members, friends, and neighbors to see if they can help with cooking, cleaning, and shopping after the birth. Above all, don't try to be Supermom and go it alone. With twins and multiples, even more so than with a single baby, you'll need – and deserve – all the help you can get.

Learn more:

• Tips for a healthy breastfeeding diet
• Signs you're having twins or multiples
• How to prepare for breastfeeding