Nursing Newborn Twins: How Long Should You Feed?

Breast milk is the best nutrition for newborns, and breastfeeding twins can be challenging for new mothers. Newborn twins may need to be nursed in an incubator and tube-fed expressed breast milk if they are born prematurely, which is common with twins. Even after leaving the hospital, newborn twins need to be breastfed eight to twelve times per day, or about once every two to three hours. This demanding schedule can be managed in several ways, including feeding the twins at the same time or separately, and by bottle-feeding one twin while breastfeeding the other.

Breastfeeding twins: tandem nursing, pumping, and supplementing with formula

Breastfeeding twins can be challenging, but it is possible and can be made easier with the right support and equipment. Here are some tips for tandem nursing, pumping, and supplementing with formula:

Tandem Nursing

Tandem nursing is the practice of breastfeeding two children at the same time. This can be especially useful for twins as it can save time and energy for the parent. Here are some tips for tandem nursing twins:

• Use a twin nursing pillow, such as the Twin Z pillow or the My Brest Friend pillow, to help position and support the babies during feeding.
• Try different positions to find what works best for you and your babies. Some options include the twin football hold (one baby under each arm), the laid-back position (lying back with both babies on your tummy), and the parallel hold (both babies lying across your body in the same direction).
• Consider using a nipple shield if latching is an issue.
• Strip the babies down to their nappies and tickle their backs while nursing to help keep them awake and eating.
• Tandem nurse from the beginning to get them used to it, but be prepared to adapt as they grow and their needs change.
• Watch YouTube videos or work with a lactation consultant to learn more about tandem nursing.

Pumping

Pumping breast milk can be a useful way to establish and maintain milk supply, as well as provide milk for feedings when direct breastfeeding is not possible or desired. Here are some tips for pumping for twins:

• Invest in a good-quality pump, such as a hospital-grade pump or a hands-free pump.
• Consider renting a pump from the hospital if you cannot afford to buy one.
• Pump frequently, especially in the early days, to establish and maintain your supply. Aim for every 2-3 hours, including at least one nighttime pump.
• Power pumping (pumping for 20 minutes, taking a 10-minute break, and repeating) can help increase milk supply.
• Drink plenty of water and eat a healthy, calorie-dense diet to support milk production.
• Consider taking supplements such as moringa, sunflower lecithin, or a probiotic to support milk production and prevent clogged ducts.
• Sanitise pump parts once daily, either by hand or in the dishwasher.
• Use a portable pump, such as the Elvie, for more flexibility and convenience.
• Get support from family or friends to help with bottle-feeding and other tasks while you pump.

Supplementing with Formula

Supplementing with formula can be necessary or preferred for various reasons, such as low milk supply, difficulty with latching, or personal choice. Here are some tips for supplementing with formula:

• Don't feel guilty or like you have failed if you need to supplement with formula. Fed is best, and a happy, non-stressed parent is important for your babies' well-being.
• Be prepared for the possibility of needing formula by having some on hand, especially if your babies are born prematurely or have other health issues.
• If using both breast milk and formula, consider using a Dr. Brown's formula pitcher to mix a day's worth of formula at once and store it in the fridge.
• If your babies are taking cold formula, you may not need to warm it up before feeding, saving time and effort.
• If you are combination feeding, try to give your babies breast milk first and then offer formula to ensure they get some breast milk.
• If you are exclusively formula feeding, consider using ready-to-feed liquid formula or formula powder that can be mixed with cold water to save time and effort.
• If you are combination feeding, aim to give your babies at least some breast milk each day to maintain your supply.
• Seek support from healthcare professionals, such as lactation consultants or early childhood nurses, to help you navigate the challenges of breastfeeding and/or formula feeding.

Establishing a nursing schedule: feeding eight to 12 times per day

Establishing a nursing schedule for newborn twins can be challenging, but it is important to help you and your babies get the rest you need. Here are some tips and suggestions for creating a schedule that includes feeding eight to 12 times per day:

• It is recommended that newborn babies feed at least eight times in a 24-hour period. Newborn twins usually need small, frequent feeds as they cannot stay on the breast for long periods. Aim for eight to 12 feeds per day, spaced evenly throughout the day and night.
• In the early days, you may choose to feed your twins one at a time, especially if you are just learning how to breastfeed. Alternatively, you can try feeding them at the same time, with one twin on each breast. This may require coordination and patience, and it is perfectly fine to switch between these methods to find what works best for you and your babies.
• If you are breastfeeding, it is important to feed from both breasts. Swap your babies from one breast to the other at each feed to help balance your milk production and ensure they get enough milk.
• Burping your babies regularly during feeds is important to prevent them from taking in too much air. Burp them every half ounce or every ounce, depending on their age and comfort level.
• In addition to feeding, your schedule should include time for your babies to be awake and alert. Engage them with interesting shapes, sounds, and toys, or try gentle stimulation like blowing on their face or tickling their cheeks.
• Naps are also an essential part of your twins' schedule. Aim for long, consecutive naps of around two to four hours, swaddled in their cribs. During the night, you can soothe them with a pacifier if they wake up between feeds.
• As your twins grow, gradually increase the amount of milk you offer at each feed. Start with smaller amounts, such as 2-3 ounces, and increase to 4, 5, or 6 ounces as they get older and their appetite increases.
• Keep in mind that every baby is different, and there is no one-size-fits-all schedule. The sample schedule provided by a newborn night nurse in the source material can be a helpful starting point, but you may need to adjust it based on your twins' individual needs and preferences.

Remember to seek support from healthcare professionals, such as your doctor, lactation consultant, or health visitor, if you have any concerns or questions about feeding your newborn twins.

Preparing for premature birth: understanding potential complications and NICU care

Potential Complications

If you're carrying twins, you're at a higher risk for pregnancy complications. The greatest risk is premature birth, which occurs in more than half of all twin pregnancies. Premature birth increases the chances of low birth weight and other health problems for the babies. Other potential complications for the babies include intrauterine growth restriction, amniotic fluid and umbilical cord problems, and birth defects. For mothers, carrying twins increases the risk of gestational hypertension, gestational diabetes, preeclampsia, and other issues.

NICU Care

If your twins are born prematurely, they may need to spend time in a Neonatal Intensive Care Unit (NICU). One out of four twin babies is admitted to the NICU, a rate over five times higher than that of single babies. In the NICU, your babies will receive specialised care to support their breathing, feeding, and overall development. Brigham and Women's Hospital, for example, offers private rooms for twins in their NICU, enabling you to be with your babies 24/7. They also provide expert lactation support to assist with feeding.

Preparing for Premature Birth

• Educate yourself about the risks and complications associated with twin pregnancies.
• Familiarise yourself with the warning signs of preterm labour.
• Ensure proper nutrition and hydration during pregnancy, as twin pregnancies require about 1,000 extra calories daily.
• Take prenatal vitamins with folic acid, ideally starting three months before becoming pregnant.
• Manage stress and anxiety, and seek support if needed.
• Discuss the timing and type of birth with your core team towards the end of your second trimester (between weeks 24 and 28).
• Visit the neonatal unit at your hospital during your pregnancy to familiarise yourself with the environment and ask any questions you may have.

After the Birth

If your twins are born prematurely, they may need to be nursed in incubators and may be surrounded by medical equipment. Even if they are in the NICU, you will still be able to touch them and participate in their care. Hospital staff will show you how to express breast milk for them, which will be fed to them through a thin tube passing through their nose into their stomach. Breast milk is best for premature babies, so breastfeeding is encouraged, but ultimately, how you feed your babies is your choice.

Hospital stay duration: typically two to four days, but varies based on health

The length of your hospital stay after giving birth to twins will depend on the health of the babies and mother at the time of birth. If the twins are born prematurely, they may need to spend some time in the neonatal intensive care unit (NICU). If they are born close to the average birth time for twins, which is 36 weeks, they may not need to spend any time in the NICU and can go home with the mother.

In the ideal scenario, where the twins are born healthy, the length of the hospital stay is often dictated by how long the mother needs to recover. This could be as little as two or three days, or three or four days if the mother has had a c-section. In this case, the twins and mother are discharged at the same time.

On the other hand, if the twins are born prematurely, they may have serious complications that require an extended hospital stay. Twins have been known to stay in the hospital for months to undergo necessary surgeries and to give them time to grow and develop before leaving the NICU.

It's important to discuss potential risks and complications with your doctor during ultrasounds as you get closer to the twins' birth. While packing your bag for the hospital, it's advisable to plan for a stay of three to four days. If the twins need to stay a little longer, the mother can be discharged and then visit the twins as they progress in the NICU.

Post-hospital care: adjusting to life at home with newborn twins

Schedules

The first few weeks and months with newborn twins can be challenging, but creating a schedule can help you survive and establish good sleep habits for your babies. Try to get your twins on the same feeding and sleeping schedule. Feed them at the same time, and if one baby wakes up to eat, wake the other one up too. This will ensure you get some rest between feeds.

Sleep

Sleep training is important for your twins' growth and development, and for your own wellbeing. It can be helpful to establish a bedtime routine, starting at the same time every night, and waking your babies up at the same time every morning so they can learn the difference between night and day. During the day, your twins should take a 2-hour nap every 3 hours. Use white noise machines, create a dark and cosy room, and swaddle your babies for naps and at night.

Shortcuts

Taking care of newborn twins is a lot of work, so it's important to find shortcuts where you can. For example, you can rinse and reuse baby bottles and pump parts throughout the day, and then wash them at the end of the day. You can also prepare lunch for your older children the night before, and prepare bottles in advance.

Set up stations

Feeding and changing nappies will take up a lot of your time, so make your life easier by setting up multiple stations around the house. This way, you won't have to carry your twins up and down the stairs every time they need a nappy change or a feed.

Accept help

Don't be afraid to ask for and accept help from friends and family. Let them hold the babies so you can shower or nap, accept cooked meals, and ask your partner, friend or relative to limit visitors so you don't get too tired.

Join a support group

Being a parent of multiples can be lonely and challenging, so find a support group or club for parents of twins. They will be able to offer you advice and support, and you can ask them for recommendations on twin products.

Frequently asked questions