Twin pregnancies

What are some of the challenges of having twins?

Breastfeeding offers many benefits to mothers, their babies, and their families. Families with twins do not have to buy infant formula for two babies and are less likely to have two sick babies at the same time. Caring for twins has challenges. There’s an extra baby to look after, and twins tend to be premature, which increases the risk of health and breastfeeding problems. Mothers of twins are more likely to have complications in pregnancy and labour, which can reduce the amount of milk they make. To stay healthy and breastfeed, mothers need to make sure they eat and drink enough and have a balanced diet. They benefit from information from knowledgeable health-care providers and good support from those around them. The good news is that as the twins grow, breastfeeding will take less and less time.

A) Health challenges of mothers and twins

Twice the work and half the rest time: That’s what some mothers say about mothering twins. To add to the stress, mothers may:

Mothers of twins are also more likely to have complications in pregnancy and labour, including:

These complications may reduce the amount of milk mothers can make, increase the risk of mother-baby separation, and delay the first feed. There are also challenges when positioning babies and dealing with feeding times and breastfeeding triplets even more so. Not surprisingly, mothers of twins tend to wean earlier than mothers of single babies (Mikami 2018; Porta 2019). 

The good news is that as the twins grow, breastfeeding takes less and less time and offers many benefits for mothers and families. In particular, they can avoid the cost of buying infant formula for two babies.

B) Making milk and staying healthy

Mothers who breastfeed multiple babies need to make sure they eat enough. In addition to meeting her own needs, a mother needs about 700 calories a day to make 800 millilitres (27 U.S. fluid ounces) of breast milk. This is the average amount of milk needed each day by one baby from one to six months after delivery. Having two babies means an extra 1,400 calories. That’s a lot of food!

Mothers should eat a balanced diet that includes all food groups and not shy away from rich foods. They should consider taking vitamin D and calcium if their diet does not provide appropriate amounts.  

Mothers should weigh themselves regularly and ensure that they are not losing weight too quickly. Breastfeeding mothers with normal weight loss will lose half of their baby weight by 6 weeks after delivery and return to their pre-pregnant weight by 6 to 12 months after delivery. Mothers who lose excess weight should discuss this with their health-care providers.

Mothers of twins also need extra liquids to make the milk they need and should not allow themselves to be thirsty. Breastfeeding mothers will roughly need an additional 700 ml (24 oz) of liquid to make 800 ml (27 oz) of breast milk and double this amount to breastfeed twins as breast milk is about 87% water.

C) Support

Support is critical for breastfeeding success. Mothers should ensure they are getting:

Support can be practical or emotional (Cinar 2013; Flidel‐Rimon 2006).

Mothers can ask friends and family to help with food (cooking; getting groceries, etc.), housekeeping, caring for the twins while mothers have a nap, and looking after other children.

They can see if there is a local twin and triplet club where they can meet other mothers in the same situation. This can also be a source for obtaining second-hand items.

Many mothers of twins feel isolated because getting out is a lot of work and may like to join an online support group. 

D) Time challenges

Life is more complicated when there are two babies to care for and even more so if there are older children in the home.

Breastfeeding may be faster if the babies breastfeed together.

Mothers should sleep when they can, delegate as many tasks as possible, ask for support, and watch for signs of stress.

E) Twins are unique

Twins, even identical ones, may be very different. They often have unique:

  • Health challenges.
  • Breastfeeding abilities.
  • Personalities.

It may be hard not to compare the two and expect one to be as capable as the other. The differences can be frustrating for parents. It can be helpful to remember that twins are two separate individuals and will progress in their own way.

References

Cinar ND, Alvur TM, Kose D, et al. Breastfeeding twins: a qualitative study. Journal of Health, Population, and Nutrition. 2013;31(4):504-509
 
Flidel‐Rimon O, Shinwell ES. Breast feeding twins and high multiples. Arch Dis Child Fetal Neonatal Ed. 2006 Sep;91(5):F377-80

Mikami FCF, Francisco RPV, Rodrigues A, et al. Breastfeeding Twins: Factors Related to Weaning. J Hum Lact. 2018 Apr 1:890334418767382

Monvillers S, Tchaconas A, Li R, Adesman A, et al. Characteristics of and Sources of Support for Women Who Breastfed Multiples for More than 12 Months. Breastfeed Med. 2020 Apr;15(4):213-223

Porta R, Capdevila E, Botet F, et al. Breastfeeding Disparities between Multiples and Singletons by NICU Discharge. Nutrients 2019; 9(12)