Twins

Although a mother can produce enough milk for more than one baby (Cinar 2016, Flidel 2006), breastfeeding rates in women who deliver more than one child are lower than with a single birth (Whitford 2017, Cinar 2016).

The difficulties of breastfeeding more than one baby and premature weaning are due to added factors such as possible caesarean section, prematurity, low weight and prolonged neonatal admission, difficulties in coordinating the needs of the babies, increased time dedicated to breastfeeding, worry, maternal stress and fatigue, and lack of family and professional support (Mikami 2018, Whitford 2017). In some countries, the shorter duration of breastfeeding in twins is associated with low socioeconomic status and smoking (Ostlund 2010).

The most influential factor in achieving exclusive breastfeeding in twins is maternal self-efficacy, which also increases the mother's confidence in being able to do so. Educating mothers of multiple births in self-efficacy would be an effective undertaking for healthcare personnel and breastfeeding consultants (Anjarwati 2019).

Mothers should know that enough milk can be produced for more than one baby (Leonard 2006). Milk production in these cases can multiply by two or three, reaching more than two litres per day.
A mother with a unilateral mastectomy exclusively breastfed her twins for 3 months and partially for two years (Michaels 2013).
An adoptive mother breastfed her twins through induced lactation (Szucs 2010).

Mothers of twins or multiple births need effective support from healthcare professionals and family members (Leonard 2003). The inverted or "rugby ball" posture can be useful for simultaneous breastfeeding and decrease time spent breastfeeding. Plans for breastfeeding schedules, sleeping hours, and housekeeping that include a partner and other family members are much needed (MBF 2011, Leonard 2006). In cases of prematurity or low weight and neonatal admission, early and frequent expression of milk and skin-to-skin contact (kangaroo-mother method) for as long as possible are essential.

Breastfeeding pillows and expressed milk which is administered by another person can be helpful (MBF 2011).
Partial (mixed) breastfeeding is to be valued because, in the worst case, it is more beneficial than not breastfeeding (Cinar 2013, Flidel 2006).
Alternating the breast between each twin is more advisable than having a breast dedicated to each one, since one breast can produce less milk than the other, either from the outset, or because one of the twins stimulates the breast less (Cinar 2013).

Although there has been much discussion about the lack of evidence of the benefits and risks of prenatal expression of colostrum to administer to the newborn thus avoiding the use of milk formula (East 2014), the benefits are so great when neonatal problems are anticipated (maternal diabetes, planned caesarean section, twins, premature infants, malformations, etc.), which is why it is a practice that is recommended by health institutions and several authors (NHS 2018, Wszolek 2015), and is well tolerated by mothers and improves their self-confidence (Brisbane 2015).

Professional support and breastfeeding education improve the duration of breastfeeding in healthy single-birth full-term newborns. Although there is no good quality evidence on the effectiveness of these actions in mothers of twins or multiple births (Whitford 2017, Mikami 2017), very detailed prenatal education plans and guides are available for families expecting twins (LLL Eu 2018, May 2018, Kuhnly 2015, MBF 2011).

Experienced mothers who have breastfed twins advise expectant mothers of twins that the following are essential: rest and sleep, getting help and support, taking care of themselves, good diet and adequate fluid intake, and avoiding stress (Cinar 2013). It is instructive to read clinical guidelines (LHSC 2017, NMH 2016) and experiences of mothers of multiple babies (ABM 2019, Oliver 2018, ABA 2016, Cárcamo 2016, LLL Int 2015, Somosmúltiples 2013, Gromada 2010).

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