Breastfeeding for the first time can be a challenge with a singleton but the thought of breastfeeding more than one baby is definitely daunting. I breastfed my eldest for 9 months and when my twins were born I knew that if I could feed them myself, even for a short time, I’d be giving my babies the best possible start in life.

Why Should You Breastfeed Your Baby – What are the Benefits?

Breast milk is the ideal food for newborns as it contains:

• All the energy, protein, fat, sugar, vitamins, minerals and fluids they need during their first 4 to 6 months of life
• Amino acids in the right quantity and ratio for human infants
• Antibodies, immune cells, plus natural antibacterial and antiviral substances to help protect against disease
• Essential fatty acids that are vital for the development of a baby’s eyes and brain
• Growth factors that influence how a baby matures

Breastfeeding has also been shown to reduce the risk of a number of medical conditions, including:

• Sudden infant death syndrome
• Infections such as colds, bronchitis, diarrhea, meningitis
• Allergies such as asthma and eczema
• Middle ear problems
• Obesity in later life

Other benefits include promoting a warm, cosy environment for bonding, and new findings that for the mother, breastfeeding may reduce the risk of future health conditions such as rheumatoid arthritis and cancers of the breast, ovary and womb.

Breast Milk and Essential Fatty Acids

During the first year of life, a baby’s brain almost triples in weight to 1000g. Around a fifth of this weight is made up of long-chain essential fatty acids that help form communication channels between brain cells.

Because of this rapid growth, 60% of the calories your baby needs during their first year of life are used for their nervous system to develop. Much of this energy comes from the fat present in human milk or infant formulas.

The essential fatty acids found in human milk include a substance known as DHA (docosahexaenoic acid).

This is especially important during the first few months after life, as babies are unable to make their own DHA (from another essential fatty acid, linolenic acid) until they are four to six months old.

The DHA content of your breast milk is significantly higher than that of cows’ milk, and depends upon the quality of your diet, and the amount of oily fish (e.g. salmon, mackerel, sardines, herrings) nuts, seeds, whole grains, pasture-reared meats and dark green, leafy vegetables you eat.

As many as 80% of pregnant women are deficient in dietary essential fatty acids. This can result in levels of DHA in breast milk that are 20 times lower than in women who regularly eat oily fish or who take DHA supplements.

It’s therefore a good idea to take a DHA supplement especially formulated for pregnancy and breastfeeding. The DHA in supplements can be derived from omega-3 fish oils, but vegetarian forms are also available as even fish DHA is originally derived from marine algae lower down the food chain.

Good DHA intakes help to significantly increase the level of DHA in human breast milk and, in turn, increases the blood levels of DHA in breast-fed babies by up to 40%. Taking supplements can therefore enrich your baby’s supply of DHA to ensure his brain cells have all the essential fatty acids they need for optimum development.

While breast milk is the food of choice for your baby, formulas containing long-chain polyunsaturated fats (known as LCPs) are the next best option available to mothers who are unable or unwilling to breast feed.

If you are able to breastfeed your baby – even twins or more – it is one of the most rewarding experiences.

Even if you decide that formula-feeding is best for you and your family, it’s worth trying to breastfeed during at least the first few weeks so your babies get some of the protective benefits of milk, including the immune cells and antibodies that help them fight infections.

Getting Started

Breast fed babies are usually put to the breast soon after birth. Suckling helps to stimulate milk production so milk comes in between the second and sixth day. In the meantime, your babies will receive a small amount of a rich, creamy milk called colostrum.

With twins, some mothers find it easy to have one on each side at the same time. This didn’t work for me as when one slipped off or pinched a nipple, I didn’t have a spare hand to latch them back on correctly. I found it easier to feed them one after the other, with the first baby staying on just one boob.

This is something you need to experiment with to find what works for you. I’d collect the milk that leaked from the other side in a sterile container and freeze it. When the first baby was done, I’d hand him or her (I had a boy and girl) over to my other half, or granny, and then feed the other on the unused boob.

With each feed, I would alternate which baby and boob started first, as this seemed to work best at first. Then we realised that the boy would scream until he would feed, while the girl waited patiently and we went with the easier option of sorting him first while my little girl got plenty of attention and cuddles as she waited. Boys, eh?

During the first few days, while waiting for your milk to come in, twin babies may need supplementary feeds – especially if they were premature or of low birth weight. You midwife and doctors will advise if this is necessary.

It’s normal for a new born baby to lose up to 10% of his or her birth weight during the first few days, which is worrying if you are not warned it will happen. If the baby was of low weight at birth, however, even this normal weight loss may not be a good idea. If you are concerned about whether your babies are getting enough feed, always seek advice from your doctor or midwife.

After these first few difficult days, and after your baby learns to latch on properly, you will usually make enough milk for your babies – even twins – as the more they suckle, the more milk you will produce. By the time I felt ready to stop exclusive breastfeeding after four months, I still had enough frozen milk collected to continue feeding for another few weeks – all neatly racked up and labelled (by my hubby!) in the freezer.

Latching On

To breastfeed successfully, a baby needs to latch on to the breast properly. Here are some tips:

• The nipple needs to be drawn deeply into your baby’s mouth so the teat forms from both nipple and breast tissue. This stops sucking causing nipple friction which will quickly lead to soreness.
• If your nipples are large, make sure your baby’s mouth is gaping wide before you let her latch on, otherwise she won’t draw breast tissue into her mouth as well. If your nipples are small, or retracted, your baby will still be able to mould them into a good shape as long as she gets a good mouthful of breast tissue, too.
• When your baby is well latched on, her lower jaw will be well down over the darker skin round your nipple, and her chin pressed firmly against your breast rather than tilting away. Her lips will be rolled back rather than pouting and her ears may waggle as she sucks strongly.
• Milk is stimulated by your baby’s jaws – not her lips – pressing down on your breast milk sacs and this is only possible if she’s properly latched on.

I fed my babies on demand rather than to a strict schedule, and let them suckle as often and as long as they wanted. Don’t despair if breastfeeding seems difficult at first. It’s a new skill that mother and babies each have to learn.

With patience and perseverance, a baby will usually learn to breastfeed efficiently.

Ask for help if you need it from your midwife or a breastfeeding counsellor. With my first baby, I found attending a neonatal breastfeeding session with other new mums invaluable.

Your Diet When Breastfeeding

While breastfeeding exclusively, a woman feeding just one baby needs an extra 500 to 600 kcals per day more energy from her diet than women who are not breastfeeding – so when feeding more than one baby your needs are likely to be even higher.

Your need for many vitamins and minerals also increase. Aim to:

• Eat a good, healthy, varied diet
• Listen to your body and eat according to your appetite
• If you are hungry, have a healthy snack such as fresh fruit or yoghurt
• Drink plenty of fluids
• Eat more fish – especially oily fish (such as sardines, mackerel, herring, or salmon) as these contain essential fatty acids (e.g. DHA) needed for your baby’s brain and eye development.
• Take a vitamin and mineral supplement especially formulated for breastfeeding

Should You Drink Alcohol?

Alcohol passes into breast milk and can affect the taste of your milk. Babies seem to want less milk when their mother has been drinking alcohol. It can also make them sleep more frequently, for shorter lengths of time, as well as making them irritable. Ideally, avoid it altogether.

If you choose to drink alcohol when you are breastfeeding, aim to have only a little and drink plenty of water to dilute its effects and ensure you don’t become dehydrated.

Who Should Not Breastfeed?

Some women may be advised to avoid breastfeeding for their own health, or to minimise risks of passing on certain infections to their baby. You can find more information about this here: Centers for Disease Control and Prevention.

Always follow the advice of your healthcare team.

If breastfeeding is not something you are able or willing to do, for whatever reason, don’t feel guilty. You know what’s best for your individual circumstances. Formula milk is now sophisticated and can meet all the nutritional needs of your babies, although they do not provide all the immune benefits supplied by breast milk.

About the Author

Dr. Sarah Brewer

Dr Sarah Brewer MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, FRSM qualified from Cambridge University with degrees in Natural Sciences, Medicine and Surgery. After working in general practice and realising that many illnesses have a dietary basis, she gained a Master’s degree in nutritional medicine from the University of Surrey. As well as being a licensed doctor, Sarah is now also a Registered Nutritionist, a Registered Nutritional Therapist and an award winning health writer. She is the author of over 60 popular self-help books, and has Nutritional Medicine blog at DrSarahBrewer.com. Follow her nutrition and recipe tweets @DrSarahB and her general health and fitness tweets @DrSarahBHealthy.

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