Booby Traps Series: Booby Traps for moms of Twins (or more), Part 1

This is the 40th post in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

We are so very pleased to share the first of a two part guest post by Karen Gromada, MSN, RN, IBCLC, FILCA, on Booby Traps for moms of multiples (click here for part II).  Karen is the author of the classic Mothering Multiples, and is recognized as a leading expert on breastfeeding twins (and more).

While a lot has been written about nursing multiples, we haven’t seen a comprehensive explanation of the barriers moms face.  So we think this post will be a classic!

Booby Traps for Mothers of Multiples

Women expecting multiples report a desire to breastfeed at rates as great or greater than
those having a single baby. More than 70% say they plan to breastfeed. And if women find all kinds of Booby Traps hidden along the road when breastfeeding a single newborn, the woman planning to breastfeed two, three or more newborns steps onto a minefield! Here are a few of the typical booby traps mothers of multiples face.

Prenatal Booby Traps

Prenatal Booby Traps include both institutional and cultural ones. Often there is overlap, such as the healthcare professionals, family members, friends, members of a parents of multiples club or total strangers who seem compelled to say, “Breastfeed twins (triplets, quadruplets, etc.)?  That’s a nice idea but…

  • “You’d have to be crazy to do that!”
  • “It will be too hard on you.”
  • “It’s not worth the hassle.”
  • “You can’t make enough milk for two (three, four, etc.) babies.”
  • “You can’t breastfeed twins (or more) exclusively, so why even try?”
  • “You’ll need to supplement or you’ll never get any sleep.”
  •  (Yada, yada ad nauseum!)

These comments are often accompanied by a patronizing rolling or winking of the eyes, giving the impression the person is adding, “Yeah, sure you’ll breastfeed twins (or more), ha, ha.”

Actually, many, and perhaps most, mothers can exclusively breastfeed twins or more whether their breasts are small or large. The issue is often more one of enough hours in the day for cue-based feedings than the body’s ability to produce enough. And there may be a bit more of a learning curve when breastfeeding two or more newborns, especially if they are preterm or small for gestational age but, once working as a breastfeeding team, nothing could be easier, more convenient or more restful. Breastfeeding means spending more time with the babies rather than investing time in shopping/purchasing, cleaning equipment, preparing (sometimes different artificial baby milks for different babies), heating, storing, etc. – and for an inferior product!

When obstetric healthcare providers approach multiple pregnancy as a disease and treat all expectant mothers of multiples in a “one size fits all” manner, it reinforces a notion that one’s body doesn’t work right, especially for women whose multiples are the result of assisted reproductive technology. It also may trigger a cascade of medical interventions that can contribute to a delay in initiating breastfeeding or milk expression with multiple newborns.

Hospital Booby Traps

Hospital Booby Traps occur more often with early breastfeeding because multiples are more likely to be born preterm and small for gestational age. Mothers are somewhat more likely to experience certain complications, such as pregnancy-induced hypertension (PIH, also known as pre-eclampsia) or postpartum hemorrhage. So babies are more likely to require special care and mothers may receive medication or treatments that interfere with early breastfeeding.

However, institutional Booby Traps may also occur as the result of “one size fits all” multiple birth care. More than half of twins and almost 100% of triplets and higher multiples are delivered surgically; some of these deliveries are not related to a complication but are performed electively, “in case a complication develops.” Even in uncomplicated twin or triplet pregnancies, induction or elective cesarean is often “pushed” by late preterm or early term gestation. Then early mother-babies skin contact and breastfeeding (or milk expression) within the first hour get lost – often unnecessarily – within the “drama” of a multiple birth.

Institutional and cultural booby traps bombard the breastfeeding mother of multiples
during early and later postpartum. Mothers report pressure to supplement from postpartum staff or family and friends before they ever leave the hospital – no matter how each baby is breastfeeding. In addition to NICU booby traps already cited, some NICUs still place multiples in different areas rather than close together in the same area. Also, staggered discharge of one baby before the other(s) affects frequency of breastfeeding or pumping for each baby. Poor post-discharge support includes failure to develop realistic plans for continued milk expression and of transition babies to breast once home and coping with the needs of two or more young babies.

The Booby Traps continue when (or once) each baby is breastfeeding well. Feeling exhausted?  Feeling overwhelmed? Having a low-confidence day? Rather than praise the mother for how well she is doing and point out that most of her feelings are related to having more than the usual number of babies, everyone from the pediatrician to family, friends, parents of multiples club members and total strangers rarely hesitate to provide an “out” for the mother of multiples by suggesting she supplement with formula or introduce some early solid food. (A personal “favorite” is the pediatrician who says, “Hey, don’t feel bad. I’ve never had a mother who could exclusively breastfeed twins [or triplets, etc.].” Really? I wonder why this pediatrician doesn’t see exclusively breastfed multiples after voicing that kind of self-fulfilling prophecy concept!)

Breastfeeding Support Booby Traps

On the other side of the booby trap coin is the breastfeeding advocate who fails to recognize that breastfeeding (or breastmilk-feeding) two, three or more the usual number of babies is not the same as breastfeeding a single baby. Mothers will tell you that breastfeeding multiples is more than the mechanics of latch or observing for signs of effective milk transfer during suckling. It’s also the logistics of juggling more than one newborn when two (or more) are crying at the same time! It’s the exhaustion of week after week of no more than an hour or two of uninterrupted sleep. It’s a feeling of being overwhelmed when giving more than 100% yet feeling as if no one’s needs are being met.

Mothers of multiples report they’ve been told by lactation consultants or counselors and peer supporters or leaders who have never breastfeed multiples themselves that “You may not have enough milk for two (three, more) unless you…

  • “Always breastfeed two at once.”
  • “Always assign each a particular breast,” or “Never assign each a particular breast!”
  • “Pump after every feeding (even when babies are term and breastfeeding well).”
  • “Pump every 2 hours for 20 minutes (for preterm multiples).”
  • “Sure, a nice personal double pump is as good as a hospital-grade rental pump once your milk ‘comes in.’”
  • “Use a tube at breast (finger-feed, syringe-feed, etc.) for any supplements. If you give a bottle, the babies will get nipple confused and then have trouble latching.”

How demoralizing! Many of these “rules” don’t take into account the research evidence about milk production nor do they acknowledge the physical and emotional toll of caring for multiple (often preterm) newborns and figuring out the differences in their individual needs. Mothers of multiples need strategies for breastfeeding and expressing milk that are based in their current reality. Whether for physical or psychosocial reasons, some mothers may also need strategies for offering occasional or regular supplements of mom’s milk, or possibly artificial infant milk, if they are to continue to breastfeed (or pump). Also, different strategies work for different breastfeeding “teams” – there is no one way to breastfeed multiples.

This concludes the first part in this two-part post on Booby Traps for Moms of Multiples.

In the second part of this post, Karen will discuss Peer Booby Traps, how Moms Booby Trap themselves, and her best advice for How Moms of Multiples can Avoid the Booby Traps.  

Are you a mom of multiples?  Did you experience any of these Booby Traps?  What made a difference for you in breastfeeding your babies?

*Image credit:  International Symbol for Breastfeeding, modified for twins tandem nursing by Robby Poore. 

14 thoughts on “Booby Traps Series: Booby Traps for moms of Twins (or more), Part 1

  1. Thank you for this! I look forward to the next part! I’m pregnant with twins living overseas, with my primary voice of support back in the US. The twins are my first children, which is scary enough. Adding on the, “breastfeeding? Really?” has made things even more frightening. I have (and am reading) Karen’s book, and getting as much education as I can before they arrive. But the post today was great for validation that these are traps and not to fall in.


  2. I breastfed my twins exclusively until they weaned on their own. It was one of my life’s greatest achievements, since I heard every last of of these booby traps numerous times! Nursing twins is WAY easier than washing all those bottles 🙂 And the bonding has paid off, they are now 4 healthy little sweethearts.


  3. I nursed my year old throughout my pregnancy with twins and now am nursing 3 so I agree, it absolutely can be done! Great article, thank you!


  4. I exclusively breastfed my at term twins (which I delivered via c-section) for the first 6 months, and then continued until they were 19 months old. I am happy to say that with great support from my husband we never bought formula. I did get a lot of people who seemed to think I was nuts as my twins latched on to bloody nipples in the first few weeks. Balancing two is just not going to provide for a perfect latch every time. I stuck with it. Having achieved extended breastfeeding is the single hardest thing I have done over college and grad school. I totally feel like Superwoman. I lost all my baby weight in 7 weeks. It saved us so much money. Also…my kids RARELY get sick.


  5. Fantastic article! As a fairly fledgling IBCLC I need to learn more about supporting mothers of multiples. Good to see the booby traps that we can fall into. My best teacher so far is the mother of my daughter’s friends…she breastfed the twins without a hitch and didn’t pay attention to those booby traps!


  6. Just want to throw my story out there for any multiple mother who is reading this. My twins were born at 36 weeks (vaginally) and were in the NICU for 12 days and 18 days. I was able to pump to establish my supply and after a small learning curve when they came home, I am now EBFing them! Get informed, line a up a lactation consultant who is experienced with multiples and tell yourself that you CAN do it! I agree, it is WAY easier than washing bottles!


  7. Great article. My twins were born at 32wks by emergency c-section. I had all the complications mentioned–severe pre-eclampsia, retained placental product and postpartum hemorrhage. I was separated from my babies for 3 days, but I started pumping as soon as I could sit up in bed, and they were on exclusive breastmilk from day 2 of their lives. I had a hospital LC tell me I would “never make enough milk for two” unless I learned to use the hospital electric pump, which never worked for me (I pumped with a manual. The entire time they nursed). My twins nursed exclusively for 4 months and continued until they self-weaned at 19 months. As a peer mentor and soon-to-be CLC, I have met MANY twin moms who bf, some exclusive, some with a little supplementation, some for a short time, some for over a year, some primarily pumping. It is fantastic to read this information in print and I love the way you put it that moms of multiples “need strategies…based on their current realities.” I recently had a new twin mom tell me, “Thanks. I just needed a reminder to take care of myself better so that I can take care of my kids.” Looking forward to the second part of this article!


  8. I highly recommend a bfing
    pillow called “My Breastfriend” it’s made specifically for twins! My daughter has HUGE success EBFing her twins that were born at 29 weeks by using it!!!


  9. Thanks for this. I’m still feeding both at one year and have dropped 3 stone in weight! The worst periods were the first couple of weeks when hospital midwives etc were telling me to give formula top ups as expressing would be too much work… and then at about five months just before they started weaning… but you can get through it and now its my few minutes at the beginning and end of the day when I get a hug with my girlies… and my excuse for that chocolate bar!!!


  10. Those “rules” for breastfeeding multiples are scary. It make sense why a lot of Moms of Multiples don’t even attempt to breastfeed or quit early because inaccurate information. Good thing is that there isn’t “one way” to feed twins or more…and I know because over the past 17 months of breastfeeding twins I’ve done it at least 2 dozen different ways, lol!


  11. When I was in hospital I decided to make it my goal to establish tandem breastfeeding while I had the help. After helping me get the babies to latch on, one of the midwives called in another to look at me and said ‘look it can be done’! That showed me how unusual I was, before then I’d assumed it was quite normal!!
    A health visitor weighed my ebf babies when they were 4 months old and saw that they were going up the growth curves. Minutes later when I asked for her advice about why they get upset in the evenings, she had the audacity to question my milk supply!!!
    Even well meaning friends and family have been amazed I’ve ‘been able’ to ebf twins, even though I’ve already ebf 2 other babies already.


  12. My twins will be 4 months this Saturday and I am still breastfeeding (even though I had to go back to work at 3 months)/ breastmilk feeding exclusively. I had a lot of support from my husband, mother and initially some of the nurses at the hospital, but also a lot of discouragement from some individuals! The peadiatrician insisted on supplement feeding on the first day for my older twin to get his glucose levels up, but as soon as I was informed that his glucose levels have picked up sufficiently, I insisted that my babies were only to be breastfed by myself and under no circumstances to be supplemented with formula. One of the night nurses kept on saying that it would be my fault if my children could not go home with me from hospital as I refused any supplementing. Unfortunately this woman had to “help” me with breastfeeding during the night and somewhere during the morning hours I could not bear her negativety and stopped asking for help… It was a nightmare and both of my little boys were crying and I battled as both were hungry at the same time and I could not cope on my own… I was sooo relieved to be able to go home that next morning! With my husbands help and a lot of practice I learned to tandem feed while being alone with the twins and things just got easier as they got older…. I am so thankful for being able to breastfeed! My worry is that so many mothers give up breastfeeding because of one or two nurses that might be against it in hospital. I was determined to breastfeed and even I was unsettled by all the negative comments from others! At the end it IS possible to breastfeed twins! 🙂


  13. I think the biggest issue parents of multiples face today is carrying babies to “term” with the recent push to designate term for multiples as 37 or even 36 weeks. My twins are 24 years old and to be perfectly honest, I never faced a single one of these booby traps. My doctors were completely supportive and encouraging. I carried my babies to 39 weeks and went into labor spontaneously. I was still breastfeeding my 23 month old when they were born, but she soon weaned. I was blessed with tons of help from my friends and family. Because my babies were full term and were allowed to come in their own timing, we avoided issues of immaturity, undeveloped reflexes, NICU time, and so much more. Of course, much of this was completely outside of our control and we were very blessed with healthy babies, but my doula clients have had to fight and beg to hold their babies inside past that 36-37 week mark. While the challenges presented to breastfeeding were not insurmountable, I can’t help but wonder if they would have existed at all if the babies were allowed to choose their own birth date.


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