Mixed breastfeeding in twins: how to organize to feed two babies

The WHO recommends that babies under six months of age be fed exclusively with breast milk. Mothers who have twins or twins are able to produce milk for both of them, because we know that the greater the stimulation, the greater the milk production; women in these cases can produce… up to 2 liters of milk a day!

However, sometimes exclusive breastfeeding is not possible or the family does not want it, and breastfeeding is combined with the infant formula. This is called mixed breastfeeding.

Why are there fewer rates of exclusive breastfeeding in twins?

We know that women can produce milk for two, even three babies. In fact, the nurses were able to feed three to six babies of different ages. However, multiple-only breastfeeding rates are much lower than when you have only one baby.

In a study conducted in Wales in 2004, breastfeeding initiation rates were 52% for single babies, 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 underweight and many of them will need admission or have other added complications, which can make breastfeeding difficult.

In addition, many of the twins are born by cesarean section, occurring mother-child separation in some cases (unfortunately, since it is possible to make skin to skin during caesarean sections as well) and adding, to the fatigue and stress typical of the postpartum, the discomfort derived from a surgical intervention.

In addition, although there is clear evidence that the higher the demand, the higher the production of milk, 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 a baby is difficult, in the case of having two the problems multiply. The main reasons that lead multiple mothers to combine breastfeeding with infant formula are the perception of inadequate milk production or that babies are not satic, lack of time, medro’s failure of one of the twins or problems in the mother, such as ingurgitation or abscess.

In many cases of twins, mixed breastfeeding leads to prolonging 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 artificial breastfeeding exclusively, 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 a breastfeed for each baby. However, this can be counterproductive because there is usually one baby who breastfeeds better than another, and therefore stimulates milk production more.

If we offer the breasts alternately (each baby takes a different one in each shot), the production of both breasts will be similar and, in addition, the baby who breastfeeds with more difficulty will benefit from the best stimulation performed by his or her sibling.

How to do mixed breastfeeding with twins?

The ways of mixed breastfeeding with twins are very varied and each family can take the way that is most comfortable for it. In most cases, the two twins take mixed breastfeeding, that is, breast milk and infant formula. In these cases we can:

1. Give some complete intake of infant formula and breastfeeding in the rest.

For many authors this is the best option because babies are not used to taking a bottle in all the shots and the mother can rest in the shots in which they take a bottle.

2. In each shot, we breastfeed the one and the other a starter formula bottle. In the next shot, we will change.

This option is good especially if we have help, because while the mother breastfeeds another person can give the bottle to the other twin so that the mother then has more “free” time between shots. However, it is not always easy to achieve the twins’ shots simultaneously.

3. In each shot, give each of the twins a breast and then a bottle.

This option is the least recommended because, on the one hand, it is a great job for the mother. On the other hand, supplementing all intakes, especially if it is done with a bottle, can lead to babies demanding more and more formula and suck less and less, which in the long run leads to less breast milk and finally to weaning.

What to do if one of the babies sucks little or doesn’t get hooked?

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 ensure that both have a similar production of milk.

However, it can also happen that one of the babies does not get hooked. In the same way as when it happens with a single baby, you should consult with an expert breastfeeding professional to discard and/or solve possible problems that lead to the baby not getting hooked.

In these cases, some families decide to breastfeed this formula and the other. Although this decision is up to each family to make it, this baby would be deprived of all the benefits of breast milk.

An alternative can be to give breast milk extracted, so that you can also get this baby who does not get the benefits of breastfeeding. The mother can be removed while breastfeeding the other twin, when the intake is finished or between doses.

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 certainty) of insufficient milk production, the lack of time or the low 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’s point out that the more breast milk our babies receive, the greater benefits (protection against infections, sudden infant death, diabetes and obesity in adulthood…)

To do this, I give you some advice.

– Contact an expert professional in breastfeeding (IBCLC, midwife, pediatrician.

During the first days or weeks you have to try to establish a good production of breast milk. Breastfeeding on demand and at least 8-12 times a day (or extracting every 2-3 hours if babies cannot breastfeed), will help us achieve good milk production and be able to make it more flexible after mixed breastfeeding.

If we take one or two formula shots a day, it is best to do it during the day, especially during the first few weeks. Night intakes are very important to establish a good production of breast milk at the beginning.

– When we give the infant formula, we can do it using an alternative method to the bottle to avoid confusion buttoopy: finger-feeding (finger-yringe), cup or relactator; the latter is ideal if the baby hooks well because it allows to continue stimulating the breast while the baby receives the supplement and also saves us time. If we decide to give the bottle formula, we can do it using the Kassing method.

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