Breastfeeding twins: Overcoming challenges, 10 tips for new mothers

In an interview with HT Lifestyle, Dr Vidya V Bhat, Medical Director at RadhaKrishna Multispeciality Hospital in Bengaluru, shared, “In such cases, the primary concern should be ensuring the mother’s optimal nutrition. Typically, we recommend an additional intake of 500 calories, including a focus on calcium-rich and nutritious foods. For twins, an even higher caloric intake might be necessary, often supplemented through diet. Support from the immediate circle around the new mother, both in terms of mental and physical well-being, becomes crucial. The father’s involvement becomes paramount, as he can play a pivotal role in assisting with childcare, particularly considering the mother’s inevitable exhaustion.”

She suggested, “Utilising feeding pillows during breastfeeding is highly advisable to prevent the mother from developing backaches due to prolonged nursing sessions. Additionally, calcium supplements should be considered as part of this process. In cases where the twins are in the Neonatal Intensive Care Unit (NICU), arrangements should be made to deliver the mother’s milk to them, minimizing the need for her to undertake frequent physical trips that could exacerbate her fatigue. In some instances, the mother might face challenges with producing sufficient milk. This might necessitate the inclusion of supplementary diets for the babies. When this occurs, it’s important for the mother to ensure that she breastfeeds both infants equally before offering any supplementary feeds. Equal nutrition for both babies remains a priority. Maintaining proper hygiene and moisturisation before and after breastfeeding is essential. Additionally, addressing any issues such as sore nipples with appropriate medication is crucial for the mother’s comfort and well-being.”

Bringing her expertise to the same, Dr Swathi G Thippeswamy, Women’s Health Physiotherapist and Lactation Consultant at SPARSH Hospital, said, “Assuming everything else is okay and normal, exclusive breastfeeding can be established with twins, along with the mother feeding both the children for long durations, until they grow into toddlers. The second thing with twin feeding is that it is expected that twin mothers should read up about breastfeeding even when they are pregnant so that they can mentally prepare themselves. This will help them understand whether breastfeeding is supposed to be a good journey or happy journey, which it is usually not, because of the societal expectations that the mother must know how to feed. However, these things are not taught to mothers. So expectations need to be set. Feeding is going to take some time, a new mother is going to take some time to learn how to carry the child, hold the child, position herself along with positioning the babies.”

Asserting that it is also important to invest in props, one being the ‘Twin Feeding Pillow’, she said, “It is slightly expensive in India. However, twin feeding pillows are designed so that the mother can place the baby safely just before feeding. When she picks up one baby and puts it on the pillow then picks up the other baby and puts it on the pillow, the babies won’t roll away. The mother can then tandem feed i.e she feeds both babies together. In the early days, from day one of birth to about six months, tandem feeding was encouraged. This is mainly because, when one baby is sucking on one side, the body starts to initiate a ‘Let Down Reflex’ that helps in latching and feeding the other child as well.”

Dr Swathi G Thippeswamy revealed, “Nowadays, doctors help the mother practice Tandem Feeding. In Tandem feeding, the traditional hold method, the cradle method, the cross cradle, etc. do not work. Mothers have to use a position called the ‘Football Hold’ that is going to take some time for her to learn. This is where the support system comes in. The family needs to be able to understand and support the mother. The family person could be the husband, mother, sister, a best friend or caregiver. When breastfeeding is taught to such mothers, the family members must be present as well because they then become appreciative of the efforts involved in feeding the child. They also tend to bond better with the child when they are helping the mother feed the child. So tandem feeding or a feeding pillow and with the family support is absolutely non-negotiable.”

Assuring that lactation consultants will guide them, position them, hold them, show the mother how to hold or place the baby and how to take the baby away from the mother when they have to burp, Dr Swathi G Thippeswamy said, “The other thing that is focused with twin feeding is the mother’s nutrition and hydration. Regardless of whether the mother is a single baby mother or twin baby mother, the mother does not really need to eat for two. However, hydration is of importance. Especially with a twin mother, the stress hormone or the stress factors like, “Oh, I don’t know whether I have enough milk. I don’t know which baby I fed”, and other stressors are quite high. So doctors advise such mothers to keep an account of how many bottles of water she has had. Hydration is mandatory, we tell the mother not to worry about food and water. Someone else is going to take care of it. So, the caregivers are the people who need to be guided and taught to make sure the food is nutritious. It has a variety of colors, mostly greens and all different fruits and vegetables, to make sure the mother has a nutritious diet with no restriction on diet.”

She added, “There is hardly any food that doctors do not recommend eating. We want the mother to eat everything in moderation, moderation is a key. So, this is an important thing for the mother. Now, after the nutrition, the second thing that we ask the mother to do is to maintain a Feed Log. A Feed Log is something very simple to help you keep a track of your things, like a diet chart. But what the Feed Log does is essentially keeps a track of how much feed each child has had. It sometimes gets a little confusing for the mother to remember whether she fed baby one or baby two. So an advice is, one, we want you to put in Tandem Feeding, but the times never usually sync. So if you feed one child at a time, write it down on a piece of paper and that piece of paper is going to be like a chart stuck on the wall that says, “10 a.m. I fed baby one”.”

If you did Tandem Feeding, Dr Swathi G Thippeswamy said, “You will mark the time, and what you did. Did you directly feed the child? In which case you will write DBF, Direct Breast Feed. Sometimes we may ask the mother to invest in a breast pump, a breast pump is a device that will help in collecting milk, pumping it out. However, this needs to be under the guidance of a lactationist and not otherwise. So, what she can do is pump milk and collect it and that pumped milk is called Expressed Breast Milk, EBM. This can be fed to the child by the caregiver using a spoon, an open cup. Bottles are not recommended. These are some of the things that a twin mother needs to do.”

She listed the following tips for new mothers –

• Support system: Create a supporting system in the family. Let’s say the mother must pump and feed. Someone needs to take care of cleaning those pump equipment, cleaning the feeding equipment, sterilizing them, and maintaining sterility. If she’s going for Direct Feeding, then someone needs to get her some food, some snacks, some water. Take the baby to burp when one baby is done, and take the other one to do the same. So, this is a mandatory thing. You need to build that support system. Communicate with the family, tell the family this is what is expected of you people.

It’s not like the mother is trying to give more work or she’s trying to avoid work. Instead, it is a reality of having a set of twins, to create that support system. Involve the family, the husband and caregivers along with it.

• Feeding pillow: Second tip is to invest in a feeding pillow. This is non-negotiable. Invest in a feeding pillow. Yes, it sounds expensive, but that feeding pillow goes a long way.
• Feed log: The third tip is to maintain a feed log so they know whether the baby has had enough food. Let us say one baby did not drink well at the breast. Then you know you are going to top up that baby with Expressed Breast Milk. So, you have a calculated or an aggregate idea of how much the baby has been fed.
• Nutrition and Hydration: The fourth tip is to pay attention to the mother’s nutrition and hydration. Make sure she’s getting good food, a variety of greens, galactagogues or foods that increase milk supply. They need to be included in their diet regularly.
• Find a hobby: Lastly, find a hobby or some other kind of stress buster because the mother needs to be given her me-time as well. A twin mother tends to lose out on sleep. An average twin mother sleeps between one to three hours in the first three to four months of her postpartum life. Thus, it is essential that a twin mother finds a hobby that is going to divert her head away from just the feeding, pumping, diaper changing, putting the baby to bed, to creating a space that says “this is my me time”. This is what is needed for her mental peace because a stressed mother cannot feed a child efficiently. Thus, the mother needs to stay as calm as possible and a twin mother even more.