Chanita,

Those are lucky new moms of twins who have you there assisting them as they
get started!  You raise some thoughtful questions.

With brand new twins, most mothers feel compelled to keep charts of who ate
where, when, for how long, etc.  After they become more experienced and can
see the babies growing and thriving, this need for documentation gives way
to "whoever is yelling loudest gets the fuller side," and it doesn't seem
to matter as much.  The mother lets go of the fear that she might
accidentally nurse one baby twice and the other not at all.  This is just
part of the process of learning to cope with the very intense first weeks
of mothering two babies.

In the beginning, it is often easier for the mother to nurse one baby at a
time.  As babies grow and gain head control, learn to latch on and suck, it
will be easier to do both together.  Also, babies will express their own
preferences to nurse separately or together. Often, identical twins have
more similar waking and sleeping patterns and are more likely to want to
nurse at the same time.  Fraternal twins may or may not.  Mothers have to
see what works for them.  If they are expending more energy trying to get
the babies to adopt similar schedules, (such as spending fruitless time
trying to wake a sound-asleep baby up to nurse in the middle of the night,
just because the other baby is up) it may be wiser to try to respond
separately to each baby's individual cues. It is a given that more
household and support help is needed at home, something that today's
"supermoms" have a hard time believing when they are pregnant, and
accepting once the babies have arrived.

For separate feedings, usually it works well to nurse hungry Baby A on one
side, finishing off on the second breast if desired, as we would do with
any baby.  Then Baby B awakes and gets that second breast first, finishing
off on the breast that Baby A got first. The next feeding, Baby B could go
first but I think it doesn't really matter too much.  Both are getting the
option of both sides each time if they wish.  Soon the mother will be able
to listen to the baby and respond appropriately to each baby's cues. And to
find what is possible and workable for her.

I like to encourage mothers to give each baby a chance to nurse from each
breast rather than assigning the left side to one baby and the right side
to the other.  I think it's important that each baby get a chance to gaze
up at mom's face from both directions, exercising the eye and facial
muscles on both sides.  I also like mothers to get comfortable varying the
nursing positions - although most moms seem to prefer one position in the
beginning.  As they begin to feel more adept, they can add others.  I see a
lot of mothers who use the twin nursing pillow and the football (clutch)
hold for nursing the twins simultaneously at first. It's nice if the nurses
in the hospital can help the mother try  simultaneous nursing at least once
with some help, before going home.  By 5 months or so the pillows are being
discarded and the babies are nursing comfortably almost anywhere - chair,
sofa, bed, floor, etc. and in many different positions.

A helpful resource is "Mothering Multiples: Breastfeeding and Caring for
Twins" by Karen Gromada (available from LLLI), although I would like to see
it updated with new pictures (pumps, strollers).  Also look at the section
on multiples in "The Breastfeeding Answer Book" (1997) by Nancy Mohrbacher
and Julie Stock. Do you refer parents to Twin Services in your area? (P.O.
Box 10066, Berkeley, CA 94709, (510)524-0863).  They have helpful handouts
on getting organized, getting help, and other aspects of parenting twins.
However, their breastfeeding handout is not as useful as it could be.

Recently I've seen several mothers who started out with preemies, pumping
religiously, and building a big oversupply by the time the babies were a
few months old.  It's very hard for them to let go of pumping when it is no
longer needed.  There is a fear that somehow they will run out of milk.
Decreasing and then eliminating the pumping has solved the problem in these
cases, and also afforded these mothers more time to sleep and to enjoy
their babies.

The  La Leche League group I run is all mothers of twins.  What really
helps is for the mother of 2 month olds to see how the mothers of 4 months
olds have survived and are now finding so much pleasure in their happy,
responsive nursing babies.

Anne Altshuler, RN, MS, IBCLC and LLL leader in snowy Madison, WI
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