The WHO recommends that babies under six months be exclusively breastfed. Mothers who have twins or fraternal twins are capable of producing milk for both of them , since we know that the greater the stimulation, the greater the production of milk; women in these cases can produce… up to 2 liters of milk a day!
However, sometimes exclusive breastfeeding is not possible or is not desired by the family, and breastfeeding is combined with infant formula . This is called mixed breastfeeding .
Why are there lower rates of exclusive breastfeeding in twins?
We know that women can produce milk for two, even three babies. In fact, wet nurses were capable of feeding three to six babies of different ages. However, exclusive breastfeeding rates in multiples are much lower than when having only one baby .
In a 2004 study in Wales, breastfeeding initiation rates were 52% for singletons, 40% for twins, and only 15% for triplets.
This is due to several reasons. On the one hand, approximately half of these babies are born premature or with low birth weight and many of these will require admission or will have other complications, which can make breastfeeding difficult.
In addition, many of the twins are born by caesarean section , with mother-child separation occurring in some cases (unfortunately, it is possible to perform skin-to-skin during caesarean sections as well) and adding, to the fatigue and stress typical of postpartum, the discomfort derived from an intervention surgical.
Furthermore, although there is clear evidence that the higher the demand, the higher the milk production, many women and families believe that breastfeeding two babies exclusively is not possible.
The reasons that lead to mixed breastfeeding in twins
If in many cases exclusive breastfeeding with one baby is difficult, in the case of having two the problems are multiplied. The main reasons that lead mothers of multiples to combine breastfeeding with infant formula are the perception of inadequate milk production or that the babies are not satisfied, lack of time, the failure of one of the twins to thrive or problems in the mother , such as engorgement or abscess.
In many cases of twins, mixed breastfeeding leads to longer breastfeeding (mothers have more time, it gives them the impression that their children eat better…). Mixed breastfeeding is always better and has more benefits than exclusively artificial feeding, so mixed breastfeeding can be a good alternative in some cases.
One breast for each baby or both breasts for both?
Some professionals recommend that we reserve one breast for each baby. However, this can be counterproductive because there is usually a baby that sucks better than another, and therefore stimulates more milk production.
If we offer the breasts alternately (each baby takes a different one at each feeding), the production of both breasts will be similar and, in addition, the baby who sucks with more difficulty will benefit from the better stimulation that his sibling does.
How to do a mixed breastfeeding with twins?
The forms of mixed breastfeeding with twins are very varied and each family can adopt the form that is most comfortable for them. In most cases, the two twins take mixed feeding, that is, breast milk and infant formula. In these cases we can:
1. Give some full intake of infant formula and breastfeeding in the rest.
For many authors, this is the best option because babies do not get used to taking a bottle at every feeding and the mother can rest during the feedings in which they take a bottle.
2. At each feeding, we give one the breast and the other a bottle of starter formula. On the next take, we switch.
This option is especially good if we have help, because while the mother is breastfeeding another person can give the bottle to the other twin so that later the mother has more “free” time between feedings. However, it is not always easy to achieve simultaneous shots of the twins.
3. At each feeding, give each of the twins the breast and then the bottle.
This option is the least recommended because, on the one hand, it involves a lot of work for the mother. On the other hand, supplementing all feedings, especially if it is done with a bottle, can lead to babies demanding more and more formula and suckling less and less, which in the long run leads to producing less breast milk and finally to weaning.
What to do if one of the babies suckles poorly or does not latch on?
As we have mentioned, it is very common for one of the babies to suck better than another. If we alternate the breasts , and offer each time a different breast to each baby, we will achieve that both have a similar production of milk.
However, it can also happen that one of the babies fails to latch on. In the same way as when it happens with a single baby, it would be necessary to consult an expert breastfeeding professional to rule out and/or solve possible problems that lead to not latching on to the baby.
In these cases, some families decide to give this one formula and the other breastfeeding . Although this decision is up to each family to make, this baby would be deprived of all the benefits of breast milk.
An alternative may be to give expressed breast milk , so that this baby who is not hooked also gets the benefits of breastfeeding. The mother can be expressed while nursing the other twin, at the end of the feed, or between feeds.
How to make mixed breastfeeding in twins a success?
As we have seen, the main reasons that lead to mixed breastfeeding in twins is the feeling (or the certainty) of insufficient milk production, lack of time or poor weight gain of one of the twins.
The success of mixed breastfeeding, for me, would be to solve these problems and maintain it for as long as possible . Let us remember that the greater the amount of breast milk that our babies receive, the greater the benefits (protection against infections, sudden infant death, diabetes and obesity in adulthood…)
For this, I give you some advice.
– Contact a professional expert in breastfeeding (IBCLC, midwife, pediatrician.
– During the first days or weeks you should try to establish a good production of breast milk . Breastfeeding on demand and at least 8-12 times a day (or expressing every 2-3 hours if babies can’t breastfeed), will help us achieve good milk production and be more flexible after mixed breastfeeding.
– If we give one or two feedings of formula per day, it is best that they be during the day, especially during the first weeks. Night feedings are very important to establish a good production of breast milk at the beginning.
– When we give infant formula, we can do so using an alternative method to the bottle to avoid teat-nipple confusion : finger-feeding (finger-syringe), cup or relactator; the latter is ideal if the baby latches on well because it allows the breast to continue to be stimulated while the baby receives the supplement and also saves us time. If we decide to give the formula in a bottle, we can do it using the Kassing method.
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