Kathryn Stagg, IBCLC, is a UK-based Lactation Consultant certified by the International Board of Lactation Consultant Examiners. Her philosophy, as she puts it, “empowers and enables mums to fulfill and surpass their breastfeeding goals with factual, evidence based information and emotional support. With these tools, women are amazing and can overcome unimaginable difficulties.”
Thirteen years ago, Kathryn received such great breastfeeding support after welcoming her twins, she decided to become an IBCLC. She now runs a website and Facebook page dedicated to helping nursing mothers of multiples.
In my own work as a postpartum doula, I’ve seen many well-prepared mothers of twins struggle with breastfeeding for various reasons. Many of the available breastfeeding books are written from the perspective of nursing a singleton, and it can take more effort to find resources focused on breastfeeding multiples.
It’s rare to encounter a Lactation Consultant who also successfully breastfed her own twins. I interviewed Kathryn so she can share her first hand knowledge and advice about breastfeeding twins.
Q: I have worked with moms of twins who compare their breastfeeding experience to what they’ve read in general breastfeeding books or what they’ve witnessed with friends who have one baby. How is breastfeeding twins different from breastfeeding a singleton?
A: The actual act of breastfeeding is the same, no matter how many babies you have. The latch still has to be the same, and in order to make enough milk it is important for the babies to remove the milk frequently and effectively, just as it is with one baby. The main difference is that there are two babies! But also twin babies tend to be smaller and are often born early, not normally born after 38 weeks and often before. This impacts how easily they will be able to breastfeed, and can make the early days quite challenging, as they can be sleepy and difficult to wake for feeds.
Q: What are the time demands to exclusively breastfeed twins?
A: Basically expect to spend the first 6 to 8 weeks breastfeeding a lot. If mom prefers to breastfeed separately, breastfeeding can be pretty time consuming until the babies become more efficient later. If moms can manage to get tandem feeding going this helps massively as it can halve the time it takes! Once the babies become more efficient when they’re a few months old, breastfeeding can be really quick.
Q: What gear is “must have” for breastfeeding twins?
A: A twin breastfeeding cushion can be a really useful tool to tandem feed. They are designed specifically so that you can breastfeed both babies in football hold and if they are the correct height and set up properly, it should mean you can feed hands-free. But they are not essential. Moms can tandem feed in a more laid back position without any cushions, or can just use standard cushions or pillows from the bed or couch.
Q: How can a mother breastfeed twins when they don’t have someone there to help set them up… can you walk us through the step by step logistics of getting into the chair, putting on the pillow and getting situated with both infants?
A: Collect everything around you that you need, drink, snacks, remote, phone, feeding cushion. Place babies on bed or couch next to you ensuring that babies cannot roll off. Get seated and comfortable and put the feeding cushion in position. Grasp baby’s sleepsuit under the chin to ensure babies don’t roll off and scoop baby up on to the feeding cushion. Baby shouldn’t roll off as feeding cushion is sloped towards mum. Then reach over and do the same with the second baby. Then latch first baby, and then second. You may find latching the more difficult feeder first works better so you can concentrate and use two hands. Once you have finished you can sit the baby up on your shoulder whilst the other finishes off. They may want seconds after a burp, so re-latch the babies if necessary.
Q: I have seen mothers struggle with tandem feedings, especially in the early days. Many are also pumping to bolster their milk supply or “top-up” a baby who is having difficulty feeding efficiently at the breast or is sleepy due to being born early. What can a twin mom realistically expect from her nursing experience? Is it possible to exclusively breastfeed twins?
A: YES! I have myself and have supported many moms over the years to fully breastfeed their twins. The more frequently you remove the milk from the breast, the more milk you make. A twin mom’s breasts get twice the stimulation of those of a singleton mom, and so make twice as much milk.
Q: How do you recommend balancing breastfeeding and pumping milk? One common routine I see is nursing babies at the breast first, and then offering a bottle, followed by soothing and settling babies, then pumping while the babies sleep. This can be a time consuming process that can make getting sleep elusive. Is this practice sustainable? What is your best advice for a twin mother who finds herself in this situation?
A: This is a short-term transition in my experience. Once babies are feeding efficiently mom can work to reduce the top ups and move towards exclusive breastfeeding, which most find much easier. If mom needs to use some bottles, then doing some whole feeds and breastfeeding on demand in between can work well. During this period it is incredibly important that she has help and support. There needs to be someone available if possible to mother the mother so the mother can mother the babies.
Q: I’ve noticed some twin mothers experience a reduction in the quantity of milk they’re able to pump in a day because they are breastfeeding two babies. When this happens, they often jump to the conclusion they’ll never get their supply back up. When a twin mom notices a dip in her pumping output, does it mean her supply is going down permanently?
A: No, you can boost it back up by pumping more frequently for a few days, or by power pumping once a day. Or if the babies are feeding well, you can just breastfeed and you don’t need to pump at all and you’ll make the perfect amount of milk for their needs.
Q: Under what conditions would you suggest pumping exclusively and bottle-feeding?
A: Only if the babies can’t latch. Or if mom has a specific reason why she does not want to directly breastfeed. Pumping and bottle feeding is much harder work and maintaining milk supply via the pump is much more difficult than if you’re directly feeding the babies. Pumps are less efficient than babies at removing the milk and so it is more difficult to fully drain the breast with a pump.
Q: For mothers who have to supplement, is there a formula you recommend?
A: I won’t recommend a certain brand of formula. This goes against the WHO code of marketing of breast milk substitutes to which I must adhere as an IBCLC.
Q: In California, where I am, donor milk is available for purchase from the milk bank with a prescription from your pediatrician. The milk bank does give priority to hospital NICU’s and there are periodic shortages. We also have online groups where mothers do peer to peer milk sharing. What are your thoughts on donor milk or milk bank for moms who have to supplement?
A: Donor milk – absolutely fantastic if you have a local milk bank that you can use, here in the UK it is really only available for very sick or very early babies unfortunately.
Peer to peer donation is more risky but can be very useful. Better to use milk from someone you know personally if possible. Screen for disease/meds. Self-pasteurize if you’re unsure.
Q: Do you have any special advice for mothers who have given birth to premature twins?
A: It’s a long road to exclusive breastfeeding when you start with babies in the Neonatal Intensive Care Unit (NICU). But many moms do manage it. It’s so important to establish your supply early, so pumping 8-10 times in 24 hours is a must. As soon as babies are well enough, lots of skin to skin or kangaroo care is incredibly beneficial for babies but also for mom’s milk supply. Babies are usually able to begin trying to breastfeed from around 33 weeks gestation, but they are normally nearer due date before they are strong enough to fully breastfeed. So, many moms are discharged from hospital breastfeeding, topping up and pumping.
Q: Preemies often come home fairly familiar with being bottle-fed. I’ve known families with twins discharged with human milk fortifier, as well as the recommendation by the neonatologist to do one high calorie formula bottle per day. How can mothers of premature twins balance their doctor’s medical advice and/or prescription with their desire to breastfeed?
A: Ah in the UK it’s unusual to be discharged using fortifier. Normally it’s just used in the Neonatal Intensive Care Unit (NICU). Supplementing can be used alongside breastfeeding very successfully (as long as there is actually a medical need, often it’s not necessary once babies are feeding effectively and frequently once past their due date). The important thing with supplementing is to make sure you don’t increase formula and not increase breastfeeding during growth spurts, as then milk supply will just not keep up. Keeping a set time for formula and breastfeeding on demand the rest of the time usually works ok. Also babies are often able to come off supplemental feeds at some point, it’s temporary whilst they’re learning to feed well. It doesn’t have to be forever. (Check out “Dropping Top Ups Gradually”)
Q: What about sleep expectations for breastfed twins, can families schedule them? Will mom sleep?
A: Sleep is a difficult one. I think there’s two ways of tackling it. Either wake second baby and tandem feed so you can maximize the gap between. Or feed one at a time lying down and sleep whilst you feed (observing safe cosleeping guidelines of course). Some mums manage to tandem feed lying down too, which is quite a skill, and one I never mastered myself unfortunately! A loose routine can help a bit. But it’s important not to be too strict. Following the hungriest baby and tandem feeding both is one way mums find helps them.
Thanks, Kathryn, for taking the time to do this interview and sharing your valuable advice.
According to the National Center for Health Statistics, between 1980 and 2009, the number of twin births increased more than 75%. In 2016, in the USA alone, there were 131,723 twin births. More than 50% of which are born prematurely according to The American College of Obstetricians and Gynecologists. With the increase in twin births, it is my hope, we will continue seeing breastfeeding support and guidance specifically for families with twins and multiples. In the meantime, here is the advice I share most often with families expecting twins:
1. Make contact with at least one Lactation Consultant who is experienced with mothers breastfeeding multiples, someone you can call for in-home support after you’re home with your babies.
2. Join a twin mom breastfeeding group, either local or online, so you can receive peer support and encouragement on your breastfeeding journey.
3. Plan to have extra help available in the early days so you can focus 100% of your time and energy on feeding your babies and recovering from childbirth. Have friends and family to help with meals. Find a housekeeper to assist with laundry and keeping your environment organized and serene. Consider a postpartum doula to assist with newborn care, especially if you’re pumping to boost or maintain a supply.
For families who would like more information about postpartum care and planning, or have questions specific to your personal situation, please contact me here.