Last update Dec. 2, 2020

Twins

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

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).


See below the information of this related product:

  • Premature Infant ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Anjarwati N, Waluyanti FT, Rachmawati IN. Exclusive Breastfeeding for Twin Babies and Its Influencing Factors: A Study in East Java, Indonesia. Compr Child Adolesc Nurs. 2019;42(sup1):261-266. Abstract
  2. ABM - Association of Breastfeeding Mothers. Breastfeeding twins. 2019 Full text (link to original source)
  3. NHS. Royal Berkshire. Expressing colostrum in pregnancy. Brochure. 2018 Full text (link to original source) Full text (in our servers)
  4. Mayo Clinic. Lactancia de gemelos: cómo organizarse al alimentar. Atención al paciente e información sobre salud. 2018 Full text (link to original source) Full text (in our servers)
  5. Mikami FCF, Francisco RPV, Rodrigues A, Hernandez WR, Zugaib M, de Lourdes Brizot M. Breastfeeding Twins: Factors Related to Weaning. J Hum Lact. 2018 Nov;34(4):749-759. Abstract
  6. Oliver Diana. El desafío de la lactancia materna en tándem. El País, 08.01.2018. 2018 Full text (link to original source) Full text (in our servers)
  7. La Liga de la Leche de Euskadi. Ideas para amamantar gemelos. 2018 Full text (link to original source)
  8. Mayo Clinica. Breast-feeding twins: Making feedings manageable. Patient Care & Health Info. 2018 Full text (link to original source) Full text (in our servers)
  9. Mikami FC, de Lourdes Brizot M, Tase TH, Saccuman E, Vieira Francisco RP, Zugaib M. Effect of Prenatal Counseling on Breastfeeding Rates in Mothers of Twins. J Obstet Gynecol Neonatal Nurs. 2017 Mar - Apr;46(2):229-237. Abstract
  10. LHSC - London Health Sciences Center. Breastfeeding multiples. Patient Information. 2017 Full text (in our servers)
  11. Whitford HM, Wallis SK, Dowswell T, West HM, Renfrew MJ. Breastfeeding education and support for women with twins or higher order multiples. Cochrane Database Syst Rev. 2017 Feb 28;2:CD012003. Abstract
  12. ABA - Australian Breastfeeding Association. Breastfeeding twins. 2016 Full text (link to original source)
  13. Cárcamo Gema. Lactancia materna con gemelos o más múltiples. LactApp 2016 Full text (link to original source)
  14. NMH - Northwestern Memorial HealthCare. Breas eeding Multiple Babies. 2016 Full text (link to original source) Full text (in our servers)
  15. NMH - Northwestern Memorial HealthCare. Cómo Amamantar a Bebés Múltiples. 2016 Full text (link to original source) Full text (in our servers)
  16. Cinar N, Kose D, Alvur M, Dogu O. Mothers' Attitudes Toward Feeding Twin Babies in the First Six Months of Life: A Sample From Sakarya, Turkey. Iran J Pediatr. 2016 Jun 14;26(5):e5413. Abstract Full text (link to original source)
  17. Brisbane JM, Giglia RC. Experiences of expressing and storing colostrum antenatally: A qualitative study of mothers in regional Western Australia. J Child Health Care. 2015 Abstract
  18. Kuhnly JE, Juliano M, McLarney PS. The Development and Implementation of a Prenatal Education Program for Expectant Parents of Multiples. J Perinat Educ. 2015;24(2):110-8. Abstract
  19. LLL Int. La Leche League International. Gemelos: ¿Doble Problema? 2015 Full text (link to original source)
  20. Wszolek K. Hand expressing in pregnancy and colostrum harvesting—preparation for successful breastfeeding? British Journal of Midwifery 2015 23:4, 268-274 2015 Abstract
  21. East CE, Dolan WJ, Forster DA. Extracción prenatal de leche materna por pacientes con diabetes para mejorar los resultados del lactante. Cochrane Database Syst. 2014 Full text (link to original source) Full text (in our servers)
  22. East CE, Dolan WJ, Forster DA. Antenatal breast milk expression by women with diabetes for improving infant outcomes. Cochrane Database Syst Rev. 2014 Abstract
  23. Somos Múltiples. 21 consejos para una lactancia feliz con gemelos o mellizos. Blog 2013 Full text (link to original source)
  24. Michaels AM, Wanner H. Breastfeeding twins after mastectomy. J Hum Lact. 2013 Feb;29(1):20-2. Abstract
  25. Cinar ND, Alvur TM, Kose D, Nemut T. Breastfeeding twins: a qualitative study. J Health Popul Nutr. 2013 Dec;31(4):504-9. Abstract Full text (link to original source)
  26. MBF. Multiple Births Foundation. Guidance for Health Professionals on Feeding Twins, Triplets and Higher Order Multiples. 2011 Full text (link to original source) Full text (in our servers)
  27. MBF. Multiple Births Foundation. Feeding twins, triplets and more. A booklet for parents with advice and information. 2011 Full text (link to original source) Full text (in our servers)
  28. Gromada Karen. Mellizos. Ilca´s Inside Track. 2010 Full text (in our servers)
  29. Ostlund A, Nordström M, Dykes F, Flacking R. Breastfeeding in preterm and term twins--maternal factors associated with early cessation: a population-based study. J Hum Lact. 2010 Aug;26(3):235-41; quiz 327-9. Abstract
  30. Szucs KA, Axline SE, Rosenman MB. Induced lactation and exclusive breast milk feeding of adopted premature twins. J Hum Lact. 2010 Aug;26(3):309-13. Abstract
  31. HWA - Healthy Western Australia, Department of Health. More about breastfeeding. Health Pamphlet 2009 Full text (link to original source) Full text (in our servers)
  32. Leonard LG, Denton J. Preparation for parenting multiple birth children. Early Hum Dev. 2006 Jun;82(6):371-8. Epub 2006 May 3. Review. Abstract Full text (link to original source) Full text (in our servers)
  33. Flidel-Rimon O, Shinwell ES. Breast feeding twins and high multiples. Arch Dis Child Fetal Neonatal Ed. 2006 Sep;91(5):F377-80. Review. Abstract Full text (link to original source)
  34. Leonard LG. Breastfeeding rights of multiple birth families and guidelines for health professionals. Twin Res. 2003 Feb;6(1):34-45. Abstract Full text (link to original source) Full text (in our servers)

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