Nursing Baby, Baby, and Baby – Breastfeeding Multiple Babies

by Sara Latta

Nursing multiples does have its challenges. First and foremost, it requires dedication and a real desire to provide nourishment.

Susan Kimes was breastfed when she was a baby in the early 1950s, even though bottle-feeding was in vogue and breast-feeding was considered, well, old-fashioned. Years later, she watched her sister breastfeed her children. Kimes had always assumed she would breastfeed her own children as well; to her, it was a natural part of being a woman and a mother.

Giving birth to quadruplets did not change her mind. She remained determined to give breastfeeding a try. “I didn’t go into this thinking I would be their sole source of nutrition,” Kimes points out. “I simply decided that I would nurse them as much as I could, and that bottle-feeding would take up the slack. I would guess that I provided about half their nutrition.” Kimes nursed her babies until they weaned themselves, somewhere between 12 and 18 months of age.

Kime’s experience is proof not only that mothers can nurse their twins, triplets, or quadruplets, but that it can be an intensely rewarding experience. I know, because I nursed my identical twin girls for 17 months.

Multiple Challenges

Nursing multiples does have its challenges. First and foremost, it requires dedication and a real desire to provide nourishment. Katie Wuthnow, who nursed three singletons and is now nursing fraternal twin boys, says, “I breastfeed all my babies because I love it. If your heart’s not in it, don’t breastfeed, because you won’t enjoy it and neither will the babies.”

Support from family, friends, and hospital personnel is also important. If you are pregnant with multiples and planning to breastfeed, inform your obstetrician and the newborn nursery staff in advance. Also find a pediatrician who will support your decision to nurse the babies. A new nursing mother with access to an encouraging and knowledgeable nurse is fortunate indeed. Access to a lactation consultant is a boon as well. Should you encounter nurses who resent deviations in their schedules and view breastfeeding multiples as a nuisance, don’t be swayed! Arm yourself with the facts, and let them know that you feel strongly about breastfeeding.

Your best all-around support person is your partner. Nursing two or more babies several times a night is greatly eased by a partner who is willing to change diapers and rock fussy babies to sleep. While fathers of breastfed singletons sometimes feel excluded from the mother-baby couple, fathers of multiples rarely feel left out.

Breastfeeding multiples is not accomplished with a great deal of modesty, especially with babies who are accustomed to nursing simultaneously. If you are uncomfortable nursing your babies while visiting family or friends, simply excuse yourself and go off to a quiet place to feed your little ones. As time passed, I became more and more comfortable nursing my babies in public – even nursing them simultaneously on an airplane!

Maintaining a Bounteous Milk Supply

Building and maintaining a milk supply for multiples is much the same as it is for singletons: supply follows demand. “Breasts are essentially secretory glands,” explains Sheila Calandro, lactation consultant and childbirth educator at the Carle Clinic Association in Urbana, Illinois. “When baby initially begins to suckle, she gets milk that’s been stored in the milk ducts around the areola. Not much is stored in the ducts, however, and so the suckling stimulates nerve endings in the areola, which send a message to the brain to release the hormones oxytocin and prolactin. Oxytocin causes the milk ducts to contract, which results in milk let-down; and prolactin stimulates the globules in the breast to produce more milk. So, the breasts are actually producing milk while baby nurses. In other words, you cannot ’empty out’ a breast the way you can a bottle. The more your babies nurse, the more milk you will produce.”

In the newborn period, successfully nursing one or several babies requires frequent feeding – 8 to 12 in a 24-hour period, advises Calandro. “Here, dual nursing comes in especially handy,” she adds, “because it saves a considerable amount of time. Dual nursing also stimulates increased prolactin production, which in turn stimulates increased milk production.”

After the first few weeks, babies begin nursing less frequently, and mother’s bodies stop drawing on stored fat for milk production. At this point, the amount of milk you produce becomes directly proportional to the number of calories you ingest. According to Calandro, mothers of breastfeeding twins need to eat a well-balanced, nutritious diet containing at least 3,000 calories a day. Eating enough may be difficult when you can scarcely find time to brush your hair in the morning, much less prepare nutritious snacks and meals. So if friends offer to help – and they will – ask them to bring fruits, vegetables, cheeses, and whole-grain snacks that can be eaten on the spot. Ask for nutritious casseroles, too, and make space in your freezer for storing them.

Rest is essential. And the beauty of breastfeeding is that you can do it while lying dozily on your side. I frequently brought one baby to bed in the middle of the night, fell asleep while nursing, and awakened to my husband handing me another hungry baby to nurse. Moreover, I found that my protective instinct remained alert while I slept; I did not need to worry about rolling over on my baby or letting her fall out of bed. So rest to your heart’s content while breastfeeding, and welcome the sleep that follows.

Linnea Mead, a lecturer in the Department of Maternal-Child Nursing at the University of Illinois College of Nursing and a specialist in breastfeeding multiples, suggests keeping track of when each baby eats, has a wet diaper, and has a stool. “A log of some sort is a good idea for twins,” she says,” and almost essential for triplets and quadruplets.” When the babies are very small, they may not wake up to nurse as often as they ought to, and it is all too easy, especially at 3 am, to forget which baby you nursed just the hour before.

If you can afford to hire someone to help, or if your insurance company will pay for it, by all means do it! An uninterrupted nap or two a couple of times a week can make a big difference. Kimes suggests hiring nighttime help: “We had a nurse’s aide who came in during the day; and at night, my husband and I were essentially on our own with the four babies. Since I was breastfeeding them and he had to go to work in the mornings, I did most of the caretaking at night, getting by on two or three hours of sleep. Looking back, I would have managed better had I accepted the help of friends during the day and relied on the aide to care for the babies at night while I slept.”

Nursing Premies

Many multiples are premature and require an initial stay in an intensive care nursery. Here, if they are too weak to suckle at the breast, they are given tube feedings. The heartening news is that the tubes can be filled with mother’s milk.

To provide your babies with breast-milk while they are being tube-fed, simply pump your breasts, preferably with a dual electric pump. These may be rented from a hospital or medical supply store, and the cost is often covered by insurance. Calandro’s advice is to pump often – every two or three hours during the day, and once in the middle of the night. The milk can be refrigerated up to 48 hours, or stored in the freezer for about six months.

While pumping, do try breastfeeding – as soon as you possibly can. Paula Meier, assistant professor and coordinator in graduate perinatal nursing at the University of Illinois at Chicago, has found that infants generally considered too small to nurse (those weighing 1,200 to 1,300 grams [slightly less than 3 pounds] or of 32 weeks gestational age) can in fact do so. Moreover, they are better able to coordinate their sucking and breathing while breastfeeding than while bottle-feeding. In addition, whereas babies’ blood oxygen levels tend to vary during bottle-feeding, they remain steady during breastfeeding(1). “Breastfeeding is less stressful for premature babies, because they are able to control the process,” explains Rebecca Chuffo, a perinatal clinical nurse specialist at Copley Memorial Hospital in Aurora, Illinois. “We like to wean the babies from tube feedings directly to breastfeeding.”

Be sure to discuss any concerns you might have with a lactation consultant or others knowledgeable in breastfeeding premies. Some mothers, for example, worry that their nipples might be too large for their tiny babies. Rarely is this true. In Meier’s experience, most premature babies are able to get their mouths around a portion of the areola, which is sufficient to stimulate the let-down of milk.

The intensive care nursery stage of life can be difficult and discouraging for a woman determined to breastfeed her babies. Yet, it is a worthy struggle, resulting in the best sustenance possible for the little ones. Premature babies need the benefits of breastmilk even more than full-term babies do. Their more immature immune systems render them highly vulnerable to infection and in great need of the infection-fighting antibodies available only in mother’s milk. Studies have in fact shown that premature infants receiving breast-milk develop significantly fewer infections than those receiving formula. Furthermore, a premature baby’s less developed digestive system requires highly absorbable nutrients. “Breastmilk is less of a load on the infant’s digestive system,” says Chuffo, “because human proteins are more easily digestible than cow or other proteins found in formulas.”

Not surprisingly, the milk of mothers who birth their babies prematurely differs from that of full-term mothers. As Calandro points out, the proteins and nutrients are more highly concentrated, and thus ideally suited to the premature infant who is unable to hold a large volume of milk. “Breastmilk is perfectly capable of meeting the needs of the premature infant,” she notes.

Weaning the babies from tube feedings or bottle-feedings to breast-feeding is a gradual process. The best way to begin is to nurse each baby once a day, while continuing to pump your breasts. Little by little, replace the tube and bottle-feedings with the breast. When the babies are nursing for every feeding, it is time to stop pumping.

How do you know if you are producing enough milk for your babies? If you can hear them swallowing while nursing and if you can feel your milk letting down, chances are that your milk supply is keeping up with their demands. If the babies are gaining weight and, in every 24-hour period, nursing at least eight times and wetting six to eight diapers, you can feel confident that your milk supply is adequate. Should your confidence waver, consider regular weight checks for a period of time.

Two at Once?

Logic tells us that because we have two breasts, we are equipped to nurse two babies at once. The logistics are not that easy, though – at least not at the outset. If at all possible, arrange to have someone (your husband, or a relative, or hired help) around during the first few weeks to help you position the babies for simultaneous on-demand nursing. While most mothers of breastfed multiples agree that nursing one baby at a time is most enjoyable, they also acknowledge the need to nurse both babies at once, especially in the early weeks. Nursing one baby while listening to the other one wail with hunger is not at all enjoyable.

While your babies are still small, you may find it easiest to hold them both in the cradle position – that is, across your lap. For me, holding one in the cradle position and the other in the football position (nearly parallel with my side, with feet extended back, and face facing mine) worked best. This way, I was able to position both infants without assistance. I sat on a sofa with a low arm (a pillow placed lengthwise at your side will also do) and positioned the first baby in a cradle hold. Letting the arm of the sofa support baby’s head, I would reach over for the second baby, who’d be waiting, none too patiently, on a pillow placed lengthwise at my other side.

As my twins got a little older, the cradle nurser began kicking the football nurser in the face, so I terminated the cradle position and nursed them both football-style. For added solace, I sometimes kept a pillow on my lap to form a resting place for their heads. While they snoozed on the pillow, my hands were free, and I could eat, read, or talk on the phone. Amy Bernard, mother of fraternal boys, used “pillowtime” for clipping her babies’ fingernails. Pillows – lots of them – are perfect accessories to simultaneous nursing. And although special nursing pillows are available, the generic variety work just fine.

Who goes first? One guideline, says Calandro, is to begin by positioning the baby who needs the most help latching on, and to follow up with the more skilled baby. On the other hand, she notes, you may want to start with the stronger vigorously at one breast will stimulate milk let-down in the other breast, and thus provide the weaker baby with a ready meal.

Should the babies be switched from one breast to the other with each nursing session? It’s a matter of personal choice, Calandro explains, adding, “I think it’s a good idea to get them accustomed to nursing on both sides, so they don’t develop a preference for one side or another…. If one baby is hungrier than the other, you may end up with lopsided breasts.”

Simultaneous breastfeeding does not always arise naturally, and yet it is the key to synchronized scheduling, which permits more rest for mom. To establish synchronization, follow the cues of the hungriest baby. When this infant calls for milk, you may have to wake the other infant to nurse, in which case you could try a diaper change or some gentle toe-tickling. Some babies strongly resist any attempt to synchronize their schedules. One twin may have a smaller appetite than the other, or may simply dislike simultaneous nursing, preferring mom’s full attention! Similarly, some mothers are uncomfortable pressing for conformity to a schedule. Kimes, for one, chose to breastfeed her quadruplets on demand.

Choose whatever approach is best for you and your babies. If you decide on simultaneous nursing, be sure to catch a few winks when the babies do. If you decide to nurse one-on-one, keep soft toys on hand for the nonnursing baby to play with or look at. The more occupied the nonnurser is, the more attention you can give to the babe in arms.

A Multitude of Rewards

Breastfeeding multiples offers a host of rewards. Some are measurable. After the first week or two, for instance, I never had to spend time preparing a refrigerator full of bottles. Nor did I have to spend money purchasing huge amounts of formula – a formidable expense when it comes to multiples. The local WIC program, which provides low-income mothers with 26 ounces of formula a day, spends about $65 a month per child, according to Les Hitchens, director of nutrition at the Champaign-Urbana Public Health District. This translates into $1,560 a year to feed twins!

Other benefits are less tangible. For many mothers, breastfeeding helps alleviate the feelings of helplessness that come with leaving their premature babies in the neonatal intensive care unit for a time. “I knew deep down that they were not getting that much milk from me at first,” says Bernard, whose boys spent a week in the hospital. “Still, I felt that I was doing something important to help get them home as soon as possible.” In my case, I sensed a smoothing over of the inevitable conflicts between my girls when the three of us settled down for a quiet time of nursing. The stolen toys were forgotten, and the girls would fall asleep holding hands as I nursed them.

“The pace of having four infants the same age is so great that I don’t think I would have been able to sit so quietly and be with each of my children so intensely if I had bottlefed them,” says Kimes. “Not that you can’t nurture your babies while bottle-feeding – but with this many children, it’s just too tempting to do a lot of bottle propping. Throughout my pregnancy, I had a hard time envisioning my babies, seeing myself holding them and loving them. We had tried so long to conceive, and I had such a high-risk pregnancy, that I could think of myself only as an incubator. By nursing my babies, I got to hold them in a way I never allowed myself when they were inside my body. Nursing them healed that wound.”

Notes

(1.) P.P. Meier, “Bottle and Breastfeeding: Effects on Transcuntaneous Oxygen Pressure and Temperature in Preterm Infants,” Nursing Research 37 (1988): 36-42.

COPYRIGHT 1992 Mothering Magazine
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