To: Pat Predmore-- Paula Meier has written of her experience with the mother of healthy 34 week quadruplets, whose enthusiasm and personal biology allowed her to breastfeed them all, that is, to provide milk for them all, for over a year, weaning them variously between I think 15 and 20 mos of age. She had enough milk for them all, but "not enough breasts" (mean daily weight gains in the first month were about 1 to 1-3/4 oz/day), so she breastfed and pumped to produce enough milk for all four of them; all of them were fed both at breast as well as expressed milk by bottle except for one that refused the bottle. No artificial milk at all. LJ Mead, R. Chuffo, P. Lawlor-Klean, and P. P. Meier, Breastfeeding success with preterm quadruplets, May/June 1992, JOGNN 21(3):221-227 She started out pumping something like 10 or 12 times a day before the first babies went to breast, I think on day 2. The other two babies were at the breast by 7 days of age. She was nursing upward to 25 or 35 times a day early on. This is not something I would expect anyone to do without both the desire, the enthusiasm, and the household help that this mother had, not to mention professional lactation support, (and a husband into computers to help them track who got how much and who had what output); but I do selectively cite the information to certain mothers of singletons and twins just to let them know that the body can be capable of producing this level of milk. Good info to pass on to health care professionals. I emphasize "**can** be capable," because not everyone can make this much milk, and certainly to do so requires not only the personal biology (the luck of the draw) but also a lot of suckling stimulation, pumping, and yet lots of rest too, which would mostly seem to be contradictory requirments for mothers of multiples. I also have known several mothers of breastfeeding twins, including a pediatrician who's nursing toddlers, and they all think that breastfeeding has to be much easier than bottle feeding, in terms of absence of paraphernalia, having to keep or carry bottles, enough formula on hand, etc. One mother I saw last week couldn't figure out how to nurse one at a time, she was so comfortable with two, but laughed at how awkward she felt trying to hold just one. Most moms however do a combination of nursing one at at time and both. The mother of the quads above actually preferred nursing them separately, because it gave her an opportunity to have individual one to one time with each child, although she certainly nursed more than one at a time often, since she was nursing on cue and not by the clock. Other moms adapt a modified approach, waiting for one to show hunger cues, and then awakening the second. I think the real hurdle with moms of twins is getting thru the first couple weeks/month when it all seems so overwhelming, and, like the primips with singletons, somehow breastfeeding seems like part of that issue, even tho' it's basically more about adjustment to parenting, compounded by twins. Mom's self confidence and self esteem, and ability to adjust to new situations, seems key. Tina Smillie, MD