FAQs

FAQ Breastfeeding Multiples

Can I still breastfeed if I’m going to have twins (or more)? Relatives say it will be too hard on me. Friends say I won’t be able to make enough milk. They tell me it’s crazy to even consider it!

Of course, you can still breastfeed! Multiples especially need and deserve breastfeeding and a parent’s milk. When people say it’s impossible to breastfeed multiple babies, it is because they don’t understand how the body makes milk. To answer your questions, let’s look at each one separately:

a) Will breastfeeding multiples be too hard on me?

Breastfeeding should not be more difficult than when you feed two or more babies in some other way. Each of your babies will need you as much as any single-born baby would. An infant’s physical and emotional needs do not change simply because there is more than one of them! It isn’t realistic to think that two, three, four or more times the usual number of babies won’t take extra time and effort! If multiples are more difficult, it is because there are more babies than usual – not because you are breastfeeding.

Actually, many say breastfeeding is much easier than other feeding methods once they and their babies learn to work together as a “feeding team,” because:

• Most breastfeeding parents can feed two at once
• There is nothing to prepare
• Your milk is always at the right temperature, so babies won’t have to wait (and cry) while you to heat their food
• There’s no equipment to clean
• The milk in your breasts has no expiration date – It’s always exactly right!

Breastfeeding “forces” you to hold and interact with your babies, and interaction is how you get to know and form an attachment with each. Breastfeeding gives you an excuse to ask helpers to handle household chores, since only you can breastfeed. Many also say they appreciate the many daily opportunities breastfeeding gives them to sit down and prop their feet!

b) Am I being foolish to think I can breastfeed multiples?

Is it foolish to provide your babies with the disease-fighting properties that are found only in your milk – properties that are likely to save you time and trouble because breastfed babies have fewer infections? Are you nuts if you want your babies to get the “immuno-modulating” factors that jump-start their own immune systems – something available only in your milk now, yet something that may affect their ability to fight illness all their lives? Is it foolish to want to breastfeed because it means your multiples are less likely to pass around colds, bouts of diarrhea, ear infections and other illnesses? Are you nuts if you want to save money on pediatric “sick” visits or medications?

Is it foolish to want to give your babies the only infant food designed especially for them – a food created just for their immature, newborn bodies; the food easiest for their bodies to digest and use; a food containing the perfect amounts of carbohydrates, fats, proteins and other nutrients for their first several months; a hypoallergenic food? Are you foolish to want your babies to have the only infant food that adapts and changes as they grow and develop?

Is it foolish to want the special relationship with each baby that develops from the close contact of breastfeeding? Is it foolish to want to feel the pride of knowing your babies’ weight gains and growth are due, in whole or in part, to your milk?

Is it foolish to want to postpone the return of your menstrual cycle for several months while your body recuperates from multiple pregnancy and birth? Is it foolish to want to burn a significant number of extra calories making double or triple amounts of milk?

Is it foolish to want to decrease your risk of breast, ovarian, uterine and cervical cancers? Is it foolish to lower your risk of developing postmenopausal “metabolic syndrome,” which includes diabetes type 2, high blood pressure and high cholesterol and triglyceride levels, or cardiovascular (heart and blood vessel) diseases?

Is it foolish to want to save hundreds of dollars by not having to purchase a less wholesome infant food/formula(s), feeding equipment, etc.? (The costs of a visit with a lactation consultant* [IBCLC], renting or buying an effective breast pump and any related equipment still saves a considerable amount when compared with the costs of fully formula-feeding multiples. And in some instances, these items are covered by health insurance.) Is it foolish to avoid messy preparation, post-feeding equipment clean up, and the wait while heating something for babies who are hungry NOW? Are you foolish to breastfeed multiples OR are you foolish not to!

*The term “lactation consultant” or “LC” refers to a healthcare professional who is certified by the International Board of Lactation Consultant Examiners (IBLCE) via an independent exam and uses the credential IBCLC (International Board Certified Lactation Consultant) after her/his name. To understand the “alphabet soup” of credentials related to breastfeeding/lactation support, the United States Lactation Consultant’s (USLCA’s) “Who’s Who – An at-a-glance look at lactation support in the United States).” Except for IBCLC, the titles and credentials vary in other countries but are similar.

c) Will I be able to make enough milk?

Two, three or more effectively breastfeeding babies tell one’s body to make a lot more milk, since milk removal drives milk production! Most parents are able to make plenty of milk to fully breastfeed twins, and many fully breastfeed or express their own milk to fully feed triplets or quadruplets. Since you still only have 24 hours in a day, time may be more of a deterrent than your body’s ability to produce enough milk for two or more babies.

At times there are physical or social reasons so that a parent cannot produce enough milk for two or more infants. Still, babies benefit from many of the disease-fighting and other properties found only in human milk. Receiving some breastfeeding or human milk is better than no breastfeeding or human milk!

What can I do to prepare for breastfeeding twins or more?

a) Attend breastfeeding information/support meetings, such as La Leche League (LLL) now. (Other regions/countries may have different breastfeeding-support organizations, and many hospitals also have support meetings.) These meetings provide an opportunity for you to see how breastfeeding works. This is important because many of us grew up without seeing a lot of different parents breastfeed. Most group leaders have helped others to breastfeed twins/multiples (MOT/MOM). Start going to meetings during the second trimester of pregnancy, while you are more comfortable and in case your multiples are born a bit early. If preterm labor or bed rest interferes with meeting attendance, be sure to call and “meet” the group leader, anyway. Then you will feel more comfortable phoning with questions or for encouragement after the babies arrive.

b) Go to a prenatal breastfeeding class. Some organizations even sponsor a multiples-specific class. If possible, take your partner with you. As with breastfeeding-support group meetings, it is a good idea to attend a breastfeeding (and childbirth preparation) class during the second trimester of a multiple pregnancy. These classes teach breastfeeding basics, plus you may have a chance to practice positioning one or two babies for breastfeeding using a doll(s). An instructor can show you positions for feeding two babies at once. (Practicing with dolls to learn how to breastfeed two or more real, moving babies is similar to learning to drive a car by taking a driver’s training simulation! Both give one an idea of the experience, but neither can duplicate the real thing).

c) Get a head start on breastfeeding by reading both general and multiples-specific breastfeeding books, pamphlets, and web sites. A good book should reinforce the basics learned at a breastfeeding class or support group. Mothering Multiples probably has the most extensive multiples-specific breastfeeding information, but basic breastfeeding books will also come in handy. To gain support from your partner, the babies’ grandparents and others, highlight helpful pages so they will read them too.

d) Take a tour of the hospital where you will give birth, and be sure to include a tour of the Neonatal Intensive Care Unit (NICU, often pronounced “nick-you”) – or Special Care Nursery (SCN). (The names for such units may vary in different countries.) Multiples are more likely than a single newborn to spend some time in a NICU or SCN, so a tour can familiarize you with the sights and sounds of the unit if one or more babies requires special care.

e) Talk to a hospital IBCLC (see at the bottom of 1.c) during your tour or call one during your pregnancy. Ask questions about the hospital’s breastfeeding policies*, whether they encourage skin-to-skin contact and breastfeeding within an hour of birth if you and babies are well or expressing milk in the first hour if one or more babies go to a NICU; if full or partial rooming-in (non-separation) of parent and babies is routine; whether high-quality electric breast pumps and good instruction for use are available if needed; what level of support you can expect from NICU staff; and so on.

*When told something is “hospital policy,” request a copy of the written policy. Policies are formal documents, which have gone through an extensive approval process. Policies generally include research references and dated management signatures. If there is no formal written document, then it isn’t truly policy.

f) Write down your goal(s) for breastfeeding and go over them with an IBCLC, breastfeeding-support group leader, etc. An IBCLC, lactation counselor/educator or group leader can help you develop a plan for achieving your goals. If you find that any goal does not “fit” with the way your body and babies must “work” together to make enough milk, someone in breastfeeding support can help you revise the goal. Should you face any early breastfeeding-related difficulty, you will feel more confident and able to persist IF you know your goals and have a realistic plan. As extra incentive, include a reward for yourself as you achieve each goal. Also, your plan can be revised as often as needed if the situation changes.

g) Some parents now collect colostrum during the last weeks of pregnancy and store it in sterile, needleless 1 ml syringes in case one/more babies need extra in the days before the volume of milk is available. If interested in “harvesting colostrum” 1-3 times a day, discuss it with your obstetric healthcare provider. Generally, expressing colostrum is not advised before the last several weeks of pregnancy, since it results in a release of oxytocin, which can cause uterine contractions. With multiples you may ask about starting after 35-36 completed weeks of pregnancy if birth is being advised by 36-38 weeks. If birth is scheduled earlier, discuss starting about 4-7 days before the delivery date.  Hand expression tends to work best for obtaining colostrum, as it is a thicker liquid.

h) Write a simple Breastfeeding Plan and ask that it be attached to your and each baby’s hospital chart, so all members of the hospital staff are aware of your initial breastfeeding goal(s) and your preferences for beginning to breastfeed in the hospital. The Birth Plan for Twins and Some Triplets (in Resources: Pregnancy) lists several options that could be included on a breastfeeding plan, and some of the options could also apply to triplet and other higher-order multiple births.

i) Arrange to have a lot of household help when you bring the babies home, so you are free to breastfeed and/or express your milk, and get to know your babies. (The need for household help is due to the number of babies coming home, not because of the way you are feeding them.) Surround yourself with cheerleaders – helpers who support your decision to breastfeed, including your partner, babies’ grandparents, postpartum doula, etc., especially during this early learning period.

j) Make arrangements for a home, office or telehealth visit with an IBCLC after you and the babies have left the hospital. Mothers usually have more specific questions once babies are home, and most new parents appreciate reassurance for babies who are doing well or want early intervention strategies if any is not. There are private practice IBCLCs who make home visits for a fee. And keep the breastfeeding support group leader’s phone number in a handy spot. (Go to Links: IBCLCs for to locate ones in different areas).

How do I start breastfeeding after my multiples are born?

Each healthy, full-term (or close to it) twin or triplet should “cue” to breastfeed within 30 to 60 minutes of birth – the same as for any healthy, term single-born infant. Feeding “cues” are the behaviors babies show when they need to eat. Cues include rooting or seeking the breast with the mouth, making sucking movements with the mouth, bringing hand(s) to face or mouth, whimpering, and crying. Crying is a late feeding cue; it is usually easier for a baby to latch on and begin suckling before reaching this point.

Whether you give birth vaginally or have a surgical cesarean delivery, ask that each newborn be immediately placed on your chest skin-to-skin with you. Your partner could hold one/more skin-to-skin if you are unable to do so initially. If babies are not already skin-to-skin on your chest, have someone, such as a nurse move whichever baby first begins to show feeding cues near the breast to allow that baby to root and latch on. The same is true for the second multiple when he/she demonstrates cues. (For healthy, close to full-term triplet sets, continue by breastfeeding the third when she/he cues.) There should be a nurse or IBCLC available to help you during this “recovery” time or, if you had a birth doula during labor and your babies’ births, she can help you position each newborn for breastfeeding. Ideally, an IBCLC will observe each baby breastfeed before you are all discharged home.

As much as possible, keep both/all healthy babies with you in your hospital room. This is called full or partial “rooming in.” Rooming-in allows you and your babies to remain close, so you start to get to know each of them and learn to “read” their feeding cues!  When rooming-in with multiples, arrange for your husband/partner, and two or three relatives or friends to take turns staying with you at the hospital around the clock so you always have someone to help you with babies.

Breastfeed whenever any baby cues to feed. Very frequent feeding is normal! And the more your babies “ask” to breastfeed, the more milk your breasts will begin to make. Newborns’ tummies are really small, so most will need only colostrum until the volume of your milk “comes in” about 2 to 5 days after birth. Colostrum – the milk in your breasts the first several days – is thicker looking and there is not as much of it. However, not only is it the perfect amount for their very tiny tummies, it is also much higher in disease-fighting properties that coat your babies’ intestinal tracts.

What if my babies are born early or can’t breastfeed at first for some reason?

You would be in good company! Many MOT/MOM have had to express their milk for one or more multiples for varying periods of time before completely transitioning each to the breast. Even when multiples are born at full term, or close to it, the effects of a more stressful pre-birth environment or extra birth interventions may interfere with effective breastfeeding for one or more initially, and it may be necessary to feed them expressed milk in addition to breastfeeding. However, with patience and persistence, you and your babies will get over the early hurdles.

If one/more of your babies’ or your own condition(s) won’t allow for breastfeeding soon after birth, begin expressing colostrum/milk within an hour of the babies’ birth – or as soon after as possible. Most MOT/MOM say they get more milk, and get it faster, when using a high-quality, hospital-type electric breast pump to express (remove) milk on a regular basis. A nurse or other member of the postpartum unit should show you how to use the equipment the first time(s) you pump. If you are taking medicine that makes you feel groggy, you may need an IBCLC, nurse, your partner or relative to pump your breasts for you until you feel more awake and alert.

You’ll want to pump as often as you would expect the babies to breastfeed, so make time for at least 8, and up to 12, pumping sessions (at least 120-140 total minutes of pumping) in every 24 hours. It usually takes about 10 to 20 minutes for a mother to remove most of the milk in her breasts using a high-quality pump. Breast massage and warming the breast shields (flanges) – the pump piece directly applied over the nipples/areolae – just before pumping often helps. (If you don’t have much time, try to massage your breasts for at least a minute or two before pumping. It saves time later!) Hands-on pumping techniques during or at the end of a pumping session have been found to increase the amount of milk. Chart each pumping session, so you can see at a glance the number of time(s) you pumped, how long it took, and how much milk you obtained each day. There are downloadable apps for this or simply make a paper chart.

You may obtain only drops of colostrum during the first few days of pumping. However, the disease-protecting properties in those drops are liquid gold for your babies, and a nurse or IBCLC should know how to draw up even a few drops into a syringe so your babies can receive any available amount. Once the volume of milk “comes in” and with an effective pump and pumping routine, the amount of milk obtained in 24 hours usually increases to more than 23 oz (700 ml/cc).

The increase in milk production may be delayed if you get off to a late start expressing milk, which includes pumping. Some experts think that for a very few new mothers milk production may be affected by certain physical conditions. Be sure to tell an IBCLC and your babies’ pediatric care providers if milk production has not increased by the end of the first week. With few exceptions, milk production will improve with regular and frequent pumping sessions. After asking questions about your pumping routine, an IBCLC or breastfeeding-support group leader may have additional ideas.

Continue to express milk until all babies breastfeed effectively. Since milk production depends on milk removal, you will need an effective breast pump to remove milk when babies are improving but still not quite “there” with effective breastfeeding. As the babies breastfeed better and better, you’ll be able to cut back on, and eventually cut out, the pumping sessions.

This is starting to sound complicated! Isn’t breastfeeding supposed to be natural?

It is natural for pregnancy to prepare your breasts to make milk. It is natural for your breasts to respond to the hormonal changes of birth by making lots of milk within a few days. (It is also natural for milk production to fluctuate based on milk removal.) And it is normal for healthy, full-term babies to have reflexes that help them latch-on to the breast and suckle well.

However, it isn’t all natural. Some of breastfeeding is learned, and many new parents have grown up without ever seeing babies breastfeed. Plus, multiples often come early and aren’t physically ready to latch well or suckle long enough to take in enough milk during a feeding. Give yourself and each baby time to learn how to breastfeed well. 

Expect glitches. Expect it to be hard at times since you have two, three or more times the normal number of babies breastfeeding. Don’t be surprised if breastfeeding gets mixed up with issues that are really more about juggling multiple babies than about the breastfeeding itself. 

As with any new job skill, there is a “learning curve.” It takes time to learn and become adept. Be patient with yourself and with the babies. Give yourself and your babies time, and before long, you will be telling everyone how much easier it is to breastfeed. 

How will I know if each baby is getting enough milk?

Although you don’t have ounce/oz (or milliliter/ml) markings on your breasts, breastfed babies let you know when they are getting enough.  By the end of the first week after birth – or the first week one/more exclusively breastfeeds, each effectively breastfeeding infant will in every 24 hours:

1. Wake on his/her own and cue to feed at least 8 to about 12 times (and 10 times is average) and eagerly breastfeed for about 10 to 30 minutes
2. Soak 6 or more diapers with urine
3. Pass 3 or more stools of at least a credit card in size
4. Gain at least ½ oz (15 gm), but closer to 1 oz (30 gm) is typical.

The information in letters a) through d) are known as “outcomes.” The easiest way to keep track of each baby’s outcomes is to mark outcomes in an app or on a single-sheet, checklist feeding chart. (Since outcomes are slightly different for the first week after birth, you may also want a first-week chart.) Keep each baby’s chart separate, which is possible in certain apps or by copying on different-colored paper for each or writing each baby’s name in large letters at the top of each chart. Make enough copies of each baby’s chart to last a week or two.  (Copying charts may be a good task for the babies’ other parent or another helper).

After 4 to 6 weeks, some fully breastfed babies pass stool less often. Some babies “drop” a breastfeeding after reaching 3 to 6 months. Babies may breastfeed more quickly as they reach the middle of their first year. Your pediatric care provider will be monitoring their individual weight gain and growth patterns. Research has shown that the weight-gain pattern for fully breastfeed babies differs somewhat from formula-fed babies, so be sure the healthcare provider is monitoring their weights on a chart designed for breastfed babies. Growth charts for fully breastfed babies are available at the CDC or WHO web sites.

How will I know if any of my babies is not breastfeeding “effectively”?

Signs that one or more babies may not yet be breastfeeding effectively (not removing milk well from your breasts) include the baby that:

1. Does not wake and cue to feed at least 8 times, or one that usually cues more than 14 times, in 24 hours
2. Has difficulty opening his/her mouth wide and latching deeply back on the areola – well behind the nipple tip
3. Drifts to sleep within a minute or two after latching on and/or does not keep suckling for at least 5 minutes
4. Often takes more than 30 or 40 minutes to feed
5. Frequently is not satisfied after long feedings and acts hungry again in less than 20 to 30 minutes after seeming to finish a feeding
6. Does not produce the wet and dirty diaper, and weight gain outcomes, b) through d), listed in Question 6 by the end of the first 7-10 days postpartum. 

The development of painful or damaged nipples/breasts also is a sign that a baby may not be breastfeeding effectively. Although it may be “normal” for nipples to feel a bit tender during the first week or two of breastfeeding, really painful or damaged nipples are NOT normal! When pain occurs or the nipple looks raw or cracked, consider it a sign that something is not right. Breastfeeding should not be painful. Do NOT ignore painful or damaged nipples/breasts.

If you think something may “wrong” with breastfeeding, trust your instincts. But realize these “signs” do not mean there is a definite problem; they are simply indicators, or “red flags,” that something may not be working as well as it should. A sign means parents should keep a closer eye on the way one or more of the babies breastfeeds. (Here is where those checklist charts come in handy!) Let the babies’ healthcare provider know if you are concerned, since ineffective breastfeeding may mean a baby is not yet able to get all the milk he/she needs when breastfeeding. 

It is also a good idea to contact an IBCLC or a breastfeeding-support-group leader when ineffective breastfeeding is suspected. They can often help by suggesting minor adjustments to breastfeeding that “fix” the problem. Sometimes additional intervention is needed, and they will have some helpful ideas. Still, ineffective breastfeeding is usually a short-term issue,especially when one seeks help early.

When should I start to breastfeed two babies at once?

The answer is “it depends”! Both the nursing parent and each baby play a role in the simultaneous, often referred to as *tandem, feeding decision. Some mothers want the closeness of individual feedings and never breastfeed two babies together. Others always breastfeed simultaneously and do so from the day their babies are born. Many find simultaneous feedings more difficult to manage in the early days or weeks after birth, but later they rarely breastfeed any other way; others find simultaneous breastfeeding easier initially, yet they stop as babies get larger and heavier. Some older infant or toddler multiples won’t begin to feed until they hear/feel another multiple at the other breast; others become too distracted when another multiple is at breast.

There is no rush to start simultaneous breastfeeding with two babies at once. It is probably best to wait until you feel sure that at least one baby is latching on and suckling well, which means at least one is able to breastfeed effectively. So feed your babies one at a time until a LC, nurse or pediatrician can watch each one breastfeed. Although simultaneous feeding can save time, it will not save you time or trouble if one or more babies have difficulty latching or suckling, which may result in one or more babies not getting enough milk and you developing sore or damaged nipples. If you or your babies aren’t ready to breastfeed together, don’t worry. You’ll get there.

Go to Simultaneous Feeding Positions for ideas on positioning and using different kinds of pillows. A special breastfeeding pillow is not always a necessity; many mothers find bed or sofa pillows easier to work with and less expensive. Other mothers swear by a special nursing pillow – initially and/or long term. If using a nursing pillow, it should have a wide top “shelf” area that goes all the way around your abdomen. Contoured nursing pillows rarely provide the room or support needed for feeding two at once. Mothers often recommend the EZ-2-Nurse and Womb Mate pillows designed for feeding two babies at once.

*Tandem feeding is often used by parents of multiples for feeding two of their babies at the same time, but it is also used by parents who breastfeed children of different ages, such as a newborn and a toddler or preschooler even when the different-age children nurse separately. To avoid confusion, the word “simultaneous” is used here to refer to feeding two babies at the same time.

Should babies switch breasts or always feed on the same one?

Again, the answer is “it depends,” and almost anything can work as long as each baby breastfeeds effectively and each breast produces milk well. However, most mothers switch babies and breasts, because breasts are less likely to look or feel lopsided. And, if one baby ever can’t or won’t breastfeed for a few days for some reason, switching ensures that the second multiple breastfeeds (and removes milk) from both breasts until the other baby is back to breast. 

To simplify the process, many mothers switch breasts only every 24 hours – baby A breastfeeds only on the right breast and baby B only on the left for today, but tomorrow baby A breastfeeds only on the left and baby B only on the right. This switching routine can also be used for quadruplets. For odd-numbered multiple sets, baby A may breastfeed only on the right breast, baby B only on the left and baby C on both breasts for several hours and then switch. (Some mothers rotate who gets which breast[s] with every feeding).

Sometimes one multiple seems to “prefer,” or feeds much better on, a particular breast. Occasionally, switching breasts seems to contribute to digestive upset for one/more multiple, and “assigning” each a particular breast for all feedings alleviates the symptoms of discomfort. It usually works better if assigning a particular breast is the babies’ decision rather than having mom assign each baby a breast arbitrarily. Preference, or the need to assign for digestive reasons, tends to occur more often when multiples have very different styles of behavior, including feeding behavior.

Can I breastfeed if I have to take medications? 

Most medications are considered compatible with breastfeeding. Such medication may pass into milk in extremely small quantities or may pass through baby’s GI tract without much being absorbed into the baby’s system, and so on.  Even when there is concern about a medication, such as when there is limited research about how a particular medication passes into mothers’ milk or how it is absorbed, it may be possible to watch babies for side effects.  Only a few medications, or types of medication, are considered as completely unsafe or incompatible with breastfeeding, and compatible alternative medications often are available. It is usually possible to treat a mother’s health condition and continue breastfeeding.

When there is concern about a medication that your healthcare provider prescribes, it is important to weigh the well-known, long-term benefits of your milk and any known or theoretical side effect(s) of a medication with the risks of infant formula. Talk to your prescribing care provider, your babies’ pediatric care provider, and an IBCLC or breastfeeding-support-leader to find information and arrive at a solution that meets both your needs and those of your babies. 

Can I breastfeed multiples if I have small breasts? Large breasts?

Breast size is NOT a good predictor of how well or how much milk a woman can produce. “Working” breasts and nipples-areola come in all shapes and sizes. Many small-breasted women have fully breastfed twins and triplets as have women with larger or pendulous breasts. An IBCLC or nurse should be able to offer suggestions if your anatomy is not an exact or easy “fit” for positioning or latching your babies!

Can I breastfeed twins (or more) if I wasn’t able, or didn’t choose, to breastfeed my previous child/children? 

Of course, you can. Many women have breastfed multiples after formula-feeding a previous child. Actually, these mothers often become the biggest cheerleaders for breastfeeding once they learn they have nothing to buy, clean, prepare, heat, etc.! Although previous experience may add a bit of confidence initially, it definitely is not a requirement when it comes to breastfeeding these babies. You will gain confidence as you and your babies learn to work together.

Only a few mothers are not “able” to breastfeed. If you were told this or thought you weren’t able to breastfeed a previous baby, go over your breastfeeding history with an IBCLC or an experienced breastfeeding-support leader. In the meantime, your breasts are “preparing” to produce milk for these babies, as they would during any singleton pregnancy.  If you previously gave birth when medication was given to “dry up” a mother’s milk, don’t worry. The medication will have no effect on breastfeeding after this pregnancy. 

Is it fair to my other child/children if I have to spend a lot of time breastfeeding twins (or more)?

Your role in the early development of each multiple is just as crucial as it was with their older brother(s) or sister(s). Your older single-born child/children had you and your milk all to himself/herself for months to years, but your multiples will never have you to themselves; they must always share you with others. Also, multiples are more likely to be born prematurely, or in a stressed condition even when full term, so your milk is especially important for them. Perhaps the question should be, is it “fair” to deprive this little duo, trio, quartet, etc. of your milk and as much time in your arms as possible simply because you have an older child?

This is not to imply that an older child does not still need your love and attention or that the older child is not going face an adjustment period, but he/she is older developmentally than the multiple siblings and better able to let others help care for him/her. There is a chapter devoted to this topic in Mothering Multiples and in Keys to Parenting Multiples. 

Will I need a breast pump?

This is another “it depends” answer. If multiples are born near full term and breastfeed effectively, there is no need to express milk. Manual (hand) expression or an effective, hand-held pump usually suffices if you want milk for an occasional “relief” bottle. However, because multiples are more likely to be preterm or sick at birth, even when close to full term, effective breastfeeding is more likely to be an issue initially. Then the use of a high-quality, hospital-type electric breast pump with a double accessories “kit,” which allows you to pump both breasts at once, is usually the most efficient and effective way to remove milk. If returning to paid employment, or you regularly complement (top off) or supplement direct breastfeeding with mother’s own milk from an infant feeding-bottle, you are likely to find the use of a self-cycling, double electric breast pump the most efficient and effective method for maintaining milk production.      

What kind of pump should I get?

It depends on why you use a pump. Not all pumps are created equal. A pump that may be great for pumping a few times a day once lactation (milk production) is well established, may not be a good choice for someone who needs a pump to establish good milk production for preterm or sick newborns during the early weeks of the postpartum period. A pump that works well to provide the occasional “relief” feeding may not be at all what is needed for frequent milk expression at one’s workplace. Some electric breast pump brands or models are more effective than others due to the size and strength of a pump’s motor; check the instruction manual and warranty for how long it is expected to work and under what conditions. Also, consider the source of the pump and whether other products they sell could undermine breastfeeding. Before renting or purchasing a breast pump, discuss the pros and cons of specific pumps with an IBCLC or a breastfeeding-support leader and check online reviews.

Does breastfeeding have to be “all or nothing” or can I partially breastfeed?

Sure, you can partially breastfeed if that works better in your situation. Different MOT/MOM coordinate partial breastfeed in different ways. For many, partial breastfeeding includes direct breastfeeding, plus occasional or daily feedings of mother’s expressed breast milk (EBM) via a feeding-bottle or other feeding device. Others breastfeed but offer infant formula as either an occasional or daily substitute(s) after breastfeeding first (complement/top off) or instead of a breastfeeding (supplement).

Partial breastfeeding is definitely better than no breastfeeding at all! One study found the amount of breastfeeding (or human milk) babies received, and the incidence of ear infection and diarrhea formed an inverse proportion. This means the more mothers’ milk these babies received, the less episodes of illness reported; the less mothers’ milk they received, the more episodes of illness reported. 

No use beating around the bush – exclusive/full breastfeeding, followed by human-milk-feeding, is BEST for babies. Still, your milk in any amount is much better for your babies than formula alone, and your babies benefit highly when your milk is part of their diet. Partial breastfeeding IS worth it for all of you. Talk to an IBCLC or breastfeeding support leader to develop a partial breastfeeding routine that is likely to maintain adequate milk production.

Can I just pump and give my babies my milk only from a bottle?

Of course, you can do that, and a growing number of MOT/MOM are doing just that. You may hear this option referred to as human-milk-feeding or breast-milk-feeding. Many fully provide their babies with their milk for several months and continue to partially human-milk-feed as solid foods are introduced. If two or more babies have a lot of difficulty learning to breastfeed, usually after being born early, MOT/MOM sometimes choose this option for the short or long term. MOM have directly breastfed one (or two) and human-milk-fed one that continued to have difficulty transitioning to direct breastfeeding or had a condition interfering with direct breastfeeding, such as a cleft palate, Down syndrome, etc. (However, many babies with Down syndrome breastfeed very well!) Some simply decide not to breastfeed directly, yet they want their multiples to have the benefits of their own milk. And there are MOT/MOM whose babies moved to direct breastfeeding after weeks or months of human-milk-feeding. The pumping option leaves all breastfeeding options open.

In general, expressed human milk retains the nutritional and immunological benefits of direct breastfeeding, although cooling and reheating expressed milk affects few of its properties. Also, we know a mother’s milk adapts over time as her babies grow and change, but we don’t know exactly how or why. So, we don’t know if this adaptation is affected, or to what degree, by direct breastfeeding versus long-term pumping. To summarize, although direct breastfeeding is best, human-milk-feeding your milk beats any and all other alternatives! And, as long as you pump and human-milk-feed your babies, you leave the door open to direct breastfeeding if you or your babies later change your minds.

Where can I go for help? 

Check the information you received when you were discharged from the hospital. Often hospitals provide a discharge booklet containing local resource numbers, such as their in-hospital LCs, community private practice LCs, LLL or other breastfeeding-support group leaders, etc. If you did not receive this information, contact the hospital where you gave birth. You may also go LLL’s web site and search for local leaders by country and then by smaller areas at La Leche League International. (There are also other breastfeeding information and support organizations in different countries) To find a lactation consultant anywhere in the world, go to the International Lactation Consultant Association.  (Again, there are other IBCLC organizations with “find help” in different countries).  

Help is available!