From MIDWIFERY MATTERS, Issue No.119
by Melanie Henderson
I had breastfed my first two boys and when I found out that I was expecting twins, I saw no reason to believe anything other than that I would breastfeed these babies. I spent a lot of time during the pregnancy learning about how to hold twins when simultaneously breastfeeding. I even attended a breastfeeding support group where they had dolls which felt like, and flopped like, newborns so I could try some of these holds in preparation for my new babies.
All the information I found seemed to point towards establishing a joint routine, tandem feeding and so on. This made perfect sense. I was told about one mum who demand-fed twins and the person who told me tutted and sighed, saying it was the mum's own fault that she was always tired. I tutted and sighed and agreed, demand-feeding twins would be a recipe for disaster. I felt very prepared and not at all concerned about parenting twins.
However I was a little disheartened in that the only mums I talked to who said they had breastfed twins had usually supplemented with formula, or in one case fed one baby and not the other. I was determined this would not happen to me.
Shortly after my new babies were born I held them both for their first feed. My son Drew latched on perfectly but my daughter Scarlett found it all a bit more difficult. The midwife tried to attach her for me but I was determined to try biological nurturing again as it had worked so well for my other children. So in no uncertain terms I told the midwife to let Scarlett do it herself. Eventually it worked and they both had a good feed.
While in hospital (I stayed for 24 hours) I tended to feed my babies one at a time as I was on a narrow bed and it seemed safest. However, as soon as I got home I started practising my simultaneous feeding holds. They were certainly a lot trickier with real babies but I could just about manage them. Scarlett was still finding feeding quite difficult but I had plenty of milk and could cope with the nipple pain from her poor attachment. I did feel I needed an extra hand and often asked my mum to help me balance the babies.
The community midwife who visited me at home was wonderful. She never once asked to weigh my babies and I was so pleased as I am convinced that Scarlett's poor attachment would have resulted in 'too much' weight loss and therefore recommendations of supplementation and so on. Instead of weighing, the midwife looked at their bright eyes and rosy cheeks, and asked about how many wet and dirty nappies they were giving me!
Getting the twins into a shared routine proved to be a bit of a nightmare. Drew often wanted to sleep for longer periods and if Scarlett was not really hungry or too sleepy she would not open her mouth wide to attach. I found that feeding Scarlett was toe-curling for the first 15 seconds, and uncomfortable for the remainder of the feed.
On around day seven I found a breastfeeding counsellor who had fed twins, without supplementing – finally the guidance I was looking for. She strongly recommended feeding my babies one at a time to allow each one to perfect their own attachment. I was dubious as I felt this would mean my whole day would be spent feeding, but I took her advice and with great success. Scarlett started attaching well and was no longer causing me pain. I did not spend twice as long feeding as a proper attachment meant the feed was completed much more quickly, with each baby more satisfied. My babies also loved the close cuddle they got with each feed and I began to enjoy, rather than dread, feeding time.
On day ten I had my first visit with the health visitor, who asked to weigh the twins. Drew was almost back at his birth weight, but Scarlett, who had weighed 6lb2oz at birth was now only 5lb10oz. I was not too worried, though, as by this point both twins were much better at feeding and I knew time would allow Scarlett to catch up with her brother.
The next night Drew stopped feeding altogether. I blamed myself for giving him a dummy and figured he would wake hungry in an hour or so. However, overnight he continued to refuse feeds and by the morning, when he had refused expressed breast milk from a cup, I took him to see the doctor. My GP sent us straight to hospital, and 12 hours later Drew was transferred to a larger one as he had sepsis and required intensive care. As Scarlett had been suffering from a tiny bit of diarrhoea she was an infection risk and was not allowed in intensive care. I had to choose which twin to stay with. I chose Scarlett as she was still feeding, and Drew was taken away by ambulance with a doctor, a nurse, and a bottle of expressed breast milk.
Although this separation was the worst point of my life to date, if I can be philosophical, I would have to say that the silver lining was that Scarlett had, for the first time, almost 24-hour access to feed, and vast quantities of milk to consume. This gave her the opportunity to become brilliant at feeding. She helped me keep my supply going so Drew could have expressed breast milk and I still had a tiny baby to cuddle and feed when I so desperately needed one.
I visited Drew only for two hours a day, because he was so far from home. On his third day in NICU Scarlett was out of quarantine so I was able to take her to hospital with me and spend a much longer time there. I took her straight over to her brother and told him I was going to feed her, and could he watch so he would remember what to do. Drew took one look at Scarlett and started sucking his fist. The nurse was delighted and said it was the first time he had shown an interest in feeding. So three days after his last feed I put him to the breast and he latched on like a pro and had a fantastic feed.
After eight days in hospital I was able to take Drew home and I have not looked back since. On one or two occasions I tried again to feed simultaneously but it has never worked. Twins or not, my two babies are individuals and follow the same rules as singletons. I have learnt that they need demand feeding, and tandem feeding suits neither them nor me. Sometimes they both want a feed at the same time and in this situation one just has to wait.
The biggest problem with feeding my twins has been other people's attitudes. People stare open-mouthed when they see me feeding, and I know the inevitable, "are you feeding them both yourself?" is coming. I am frequently advised to give them a bottle to give myself a break, and one GP could barely hide her disbelief that I was breastfeeding. I think if I was to give some advice to a new mum of twins it would be to prepare a thick skin, and get on with loving and feeding her babies. It is a very possible, and extremely worthwhile and satisfying, thing to do.
This article was originally published in Midwifery Matters Winter 2008 issue 119
AH updated 22 October 2009