Breastfeeding
Key points
- Take advantage of the midwives and nurses on hand while you are still in hospital, for early advice on latching and feeding.
- Whether you choose to tandem feed - feeding two babies at the same time - or feed separately is entirely up to you.
- A supportive partner or close family member is critical to successfully breastfeed multiples, particularly in the early days when you and the babies are all learning together.
- While breastfeeding is often understood as direct latching and feeding by your babies, you may wish (or need) to express breast milk for your babies to drink via a bottle. Information on ‘exclusive expressing’ is below. Our information on Bottle Feeding may also be useful regarding equipment, hygiene and positioning.
Learning to breastfeed multiples
Tandem feeding, with one baby on each breast simultaneously, will save you time - but it is a learned practice. Initially, many breastfeeding parents prefer to feed separately and give each child individual attention. Some parents move to tandem feeding after they and their babies are comfortable breastfeeding, while others continue to feed separately right up until the babies are weaned.
It is useful to know from the outset that tandem feeding at home by yourself can be challenging as it requires a lot of pillows and other supports to position both babies correctly. If you are out and about, tandem feeding is generally not practical. Many parents prefer to tandem breastfeed only if their partner or other support person is at home to help. If you are thinking about tandem feeding, it is a good idea to try the positioning at least once while you are in hospital so that a midwife or nurse is on hand to help you and answer any questions.
Alternating the babies between sides will help you maintain a balanced supply. One option is to alternate sides with each feed, although this can be difficult to track. Another, simpler option is to alternate sides each day.
When feeding triplets or more, a bottle feed of expressed milk can be included in the rotation as a substitute breast.
Equipment and set-up
The following will be extremely helpful when breastfeeding multiples:
- A twin feeding pillow and other pillows to prop the babies up. Feeding pillows are often available to loan or purchase second-hand through your local multiple birth club.
- For those families feeding twins separately, and for higher order multiples: a bouncer or rocker for the baby/ies when it is not their turn to feed.
- A notebook for keeping track of feeds, especially in the early, newborn days
- Lots of snacks and water on hand (something you can eat with one hand/without cutlery)
- Your phone (and charger) on hand before you start each feed
- As much rest as possible
- A determined attitude
- A supportive partner, close family member etc.
Feeding on demand
Multiples can be successfully fed separately on demand. Many parents plan to feed their babies on the same schedule but find that this is not always possible or practical. The time-saving benefits of tandem feeding, or even feeding separately one after the other, will not be realised if your babies have different feeding habits and frequencies.
Feeding on demand does mean the babies may wake at different times (including during the night) and it may feel like you are nearly always feeding a baby or babies. Feeding on demand can feel especially daunting with newborn multiples, who may each need to feed 8-12 times a day. Rest assured that however you choose to feed your multiples, it will become easier over time as you all learn the art of breastfeeding and as your babies grow.
Seeking help
Breastfeeding might not come easily to you or your babies. They might have different birth weights and different challenges with breastfeeding. It is okay to change to bottle feeds if you feel that this is the best option for your personal circumstances. If you choose to keep breastfeeding, remember to take one day at a time, celebrate even the smallest improvements, and seek help when you need it. There are many supports available to help you work through any difficulties.
Lactation consultants can help with all your breastfeeding queries. They are available in all hospital units (including the Neonatal Intensive Care Unit and Special Care Nursery) and privately. The Australian Breastfeeding Association has a wide range of resources online and additional support (including breast pump hire) available to paid members. AMBA, and your local multiple birth club, can also assist with breastfeeding queries, pump hire, and putting you in contact with those who have travelled a similar path.
Exclusive expressing
Exclusive expressing carries its own challenges; learning to pump is an art form similar to, but distinct from, breastfeeding. Be kind to yourself, celebrate the small wins and stay positive as you are learning.
Juggling multiples and expressing can be tricky. A hands-free pumping bra, a good routine and an orderly cleaning/sterilising set-up can address some of the challenges. Once a good routine is established, some families find expressing is a satisfying option when direct latching is not possible.
In terms of equipment, you will require all the bottle feeding equipment listed here plus a breast pump. There are many on the market, and your body may respond differently (in terms of supply) to different brands. In general, a double electric hospital grade pump is an expensive option but offers the most efficient and effective way to pump. You may be able to hire one through your local multiple births club on a short- or long-term basis.
Anything you store your expressed breastmilk in should be food-grade and BPA free. Expressed milk can be stored for up to 8 hours at room temperature (26°C or lower, and noting once a feed has commenced any remaining milk should be discarded after an hour), 72 hours at the back of the fridge, three months in the freezer section of a fridge (i.e. with a separate door) or twelve months in a deep freezer.
The Australian Breastfeeding Association offers a range of resources on expressing and storing breastmilk for your babies.
Bottle feeding
Key points
- Some women choose not to breastfeed; for others, breastfeeding may not be possible. Whatever your circumstances, it is okay to bottle feed your babies. Only you can decide what is right for you and your family.
- Bottle feeding multiples involves a lot of equipment, cleaning and preparation. However, it can truly be a ‘team effort’ with both parents, and extended family members, able to actively participate in feeding the babies.
- This page provides information on formula feeding via bottles. Information on expressing breastmilk for your babies to drink via bottles is available under Breastfeeding.
Equipment
You will need many bottles to feed multiples, but it is not worthwhile stocking up on a particular brand of bottle (and teats) until you know which one is right for your babies. There may need to be some trial and error - contact your maternal and child health nurse if you are having trouble finding the right bottles. And remember, each of your babies may end up preferring a different brand and shape of bottle and teat. When selecting teats, trial bigger or smaller holes until you find the right flow; there is no scientific evidence that babies need different teat sizes or shapes as they grow, or that one teat shape is better than another.
For cleaning, a bottle brush and a teat cleaning brush will make your job easier. You won’t necessarily need specialised equipment to sterilise your bottles and teats; this can be done by boiling them in a pot of water on the stove. However, other options include using a microwave steriliser, electric steam or UV steriliser, or soaking your equipment in a sterilising solution.
Formula
Choosing the right formula for your babies can be confusing as there are so many brands on the market. There are many different varieties catering for various food intolerances or allergies (which should be discussed with a doctor and/or dietitian) and some with thickener which can assist babies with reflux. Some formulas have lower levels of iron which can be suitable for full-term babies, but not for premature babies. Always consult your GP, paediatrician, or maternal and child health nurse to confirm the right formula for your babies’ needs.
Preparing bottles and positioning the babies
Formula should be prepared according to the instructions on the tin, using pre-boiled water that has been allowed to cool. Bottles of pre-prepared formula can be stored in the fridge for up to 24 hours. A labelling system can be helpful to record when each bottle was prepared; if you are unsure of the elapsed time it is safest to discard the contents.
To warm bottles, you can purchase a bottle warmer, or place the bottle in a jug of very hot or just-boiled water. Check the temperature of the formula regularly to avoid overheating. Never warm bottles in the microwave or on the stove. Shake the bottle and test the temperature before giving it to your baby; the formula should be the same temperature as the inside of your wrist.
When it is time to feed your babies, a special feeding pillow can help to prop them up safely. Rockers or bouncers can be helpful too, once your babies are a little older. Feeding higher order multiples simultaneously can be achieved by propping two babies against your tummy, lying in your lap; this can allow you to hold two bottles in one hand and feed a third baby propped in a feeding pillow or bouncer beside you.
There are also some things to avoid:
- Never leave a feeding baby unattended
- Do not lay the babies flat on their backs
- Avoid bottle propping (using pillows or other items, instead of your hands, to hold the bottles).
Hygiene
Clean hands and a hygienic work station are essential for every feed that is prepared. All equipment must be cleaned and sterilised between feeds.
Do not reheat half empty bottles of formula, and discard any formula that has not been consumed within an hour of the feed beginning.
