Breastfeeding twins

How do I breastfeed twins?

Breastfeeding twins can be a challenge, but many mothers are successful. The chances are better when the babies are healthy and not too premature. Many mothers use a large, comfortable chair or a sofa (couch) with good back support if they are using the cross-cradle or under-arm hold. With a laid-back hold, you need to be semi-reclined. Either way, you need a safe place on either side to set down or scoop up one baby without disturbing the other. Ideally mothers breastfeed both babies at the same time as it is time-effective, and a stronger twin can help a weaker one by stimulating more and stronger let-downs. Some mothers can only feed one baby at a time, especially if the babies are premature and have trouble latching or sucking. With premature twins, supplementing is often necessary.

A) Breastfeeding twins

Twins breastfeeding in the under-arm hold. This family needed two pillows for enough support to allow the mother to relax in the under-arm hold.

Many mothers of twins worry about not being able to make enough milk, but we have cared for many mothers who had no difficulty. The chance of exclusive breastfeeding is higher when the babies are healthy and are not born premature.

Babies born at 39 weeks or later are often able to breastfeed from birth without extra support. Early-term and premature babies can have significant breastfeeding challenges.

Breastfeeding abilities can vary greatly between twin babies. It is important to accept these differences and resist comparing the two.

B) Getting ready to breastfeed

Twins breastfeeding in under-arm hold and interacting with their mother and sibling. Photo by Sarah Pflug from Burst.

Create a breastfeeding area in your home.

1) Chair

Some mothers use a large, comfortable chair that gives good back support if they are using a cradlecross-cradle, or under-arm hold.

To breastfeed with a laid-back hold, you need to be semi-reclined. This can be done in a reclining chair or using pillows to support your back on a flatter surface. You may need extra support for your arms or the babies.

2) A place for each baby

Make sure you have a safe place to set each baby down within arm’s reach on either side of you. That way you can scoop up or set down one twin without disturbing the other’s breastfeeding.

3) Twin breastfeeding pillows 

There are several advantages to breastfeeding both babies at the same time. This is called tandem breastfeeding.

Twin breastfeeding pillows can be very useful when tandem breastfeeding in the under-arm hold. A “log” made of a rolled towel fastened with elastics or string (twine) can be used as extra support under your wrists.  

4) Have liquids at hand

Many mothers have sudden thirst with the let-down and this sensation can be greater when breastfeeding twins. It may help to keep water or other drinks nearby.

C) Breastfeeding one baby at a time

Some mothers of twins, especially premature twins, find that breastfeeding one baby at a time is easier until the babies are stronger and can tandem breastfeed effectively. Some are able to tandem breastfeed if they have help latching the babies. It can take time to figure things out.

D) Consider breastfeeding both babies together

When babies are young, they spend much of their time feeding. Breastfeeding the babies together is much quicker than feeding one at a time. Another benefit is that a stronger twin can help a weaker one by stimulating more and stronger let-downs.  

Some twins are always hungry at the same time and others rarely are. As a result, some mothers always tandem breastfeed and others do it for some feeds and not for others.

Same-sex and same-sized twins are more likely to feed at the same time. Having babies who are hungry at the same time helps if you want to tandem breastfeed and feeding one after the other is a bit more stressful as one baby has to wait and can become upset.

E) How to breastfeed two babies at the same time

Use the under-arm or laid-back holds to tandem breastfeed. Don’t be afraid to experiment. Just make sure that you and the babies are comfortable and the babies are well positioned at the breast.

Tandem feeds are done as follows:

Start when both babies show hunger signs.

  1. Latch the baby who has more latching problems.
  2. Latch the other baby.
  3. Leave both babies on the breast until they are done breastfeeding.
  4. Unlatch them if they have not let go on their own.
  5. If the babies are still hungry, move each to the other breast.
  6. Repeat steps 1 to 4. 
  7. If the babies show hunger signs or have not breastfed effectively:
    1. Supplement them with extra milk.
    2. Express after feeds to maintain your milk supply and to obtain milk for supplementing at the next feed.

As with single babies, twins should be offered both breasts at each feeding if they are interested. At the start of a feeding, for each baby, change the starting breast from the previous feeding. Beyond that, twins breastfeed and behave just like singletons.

F) Supplementing

Twins may not need supplementing if they:

  • Are born healthy.
  • Are born close to full-term.
  • Can breastfeed effectively.
  • Show clear signs of getting enough milk.

However, twins are often premature and have major breastfeeding challenges, so supplementing and expressing may be necessary after breastfeeding. It will be temporary if the babies learn to breastfeed over time. 

It is also possible that you may not have enough milk for both babies. In this case, they will need to be breastfeed and supplemented with extra milk after feeds for the entire duration of breastfeeding.

G) Expressing

Expressing can be critical for establishing and maintaining a milk supply and providing breast milk for premature twins. Mothers need to express until the babies are strong enough to breastfeed well and are 42 to 44 weeks of age after conception.

Expressing can also be used to store milk for “daddy bottles” to allow mothers to get a little more sleep one to two times each week. While there are risks with skipping feeds without pumping and sleeping instead, some mothers find that the occasional break is essential, given how busy it can be to care for two babies. Ideally breaks should be limited to the occasional five hour period.