I have worked with a number of breastfeeding twins in the hospital and
have followed a number of them for at least a while after discharge.
The mother of one set of twins I worked with now works on our postpartum
unit.  It used to be couplet care, but we have gone back to "traditional
care" at that hospital.

None of the mothers I have worked with have mentioned out of the
ordinary change in breast size.  Others are probably better able to
answer this question than I, especially those who sell bras.

A nursing pillow for twins is a great help.  It should be wide all the
way around so there is room for both babies to lie on it at once.
However, this will only work if mom has a comfortable place to nurse the
twins that will accommodate the width of the pillow.

The breasts can be supported by rolled wash cloths, cloth diapers,
receiving blankets, etc.--whatever will support the breast without
interfering with positioning the babies at breast.

The most important thing is for the mother to have help.  In the
hospital she will need help positioning the babies, especially if she
wants to nurse both at once.  I like to have mom do this at least once
in the hospital with my help so she knows how it works.  Double football
usually is easiest for most moms.   She will need help at
home--preferably for at least the first 3 months.  Talk to her, her
husband, her friends and family, and the hospital social worker if she
hasn't yet arranged for this.  Someone will need to fix meals, clean the
house, and assist in caring for older siblings, as well as helping with
the babies.

At the beginning, mom will probably need help latching the babies if she
plans to nurse both at once.  When one baby can self-attach, she can
attach the one who needs help and then latch the other.  Otherwise, the
helper can comfort one baby if necessary while she feeds the other.
Help her develop a routine.  Modified scheduling often becomes essential
to allow the mother to get some rest.  She can try waking the second
baby when the first awakens or as soon as she finishes feeding him.  The
second twin to feed is likely to get more attention, since mom will be
in a hurry to feed the second and may spend less time with the first.
She should therefore develop some sort of plan so one twin isn't always
first.

If the babies require supplementation (due to prematurity, for example)
help mom develop a routine, such as:
Every 3 hours (or sooner if baby is hungry) mom nurses one baby, then a
helper supplements while mom nurses #2.
Mom pumps while #2 is being supplemented.
Mom takes care of personal needs and RESTS!
I worked with one mom who wanted to do everything for her babies and
entertained visitors all day (a big part of the problem, but she
wouldn't listen initially).  Babies were breastfed immediately, but by
24 hours of age were nursing very poorly and had to be supplemented.  We
initially tried a supplementer, but this was too overwhelming, and mom
soon chose to bottlefeed the supplements.  Mom did insurance pumping
beginning after the first feeding and continuing after each feeding.  By
the end of day 3 the amount she pumped had decreased to only a few
milliliters per pumping.  With the above program her milk production
rapidly and steadily improved until she was able to fully breastfeed by
about 10 days postpartum.

Record keeping is essential.  If you have feeding and elimination logs,
give her a number of copies for each baby.  She may find it helpful to
continue record keeping for much longer than a singleton mom.  One
mother of 9-month old triplets reported she was still keeping records.

Would recommend Karen Gromada's book, but understand it is currently out
of print.  The Joy of Twins and Other Multiple Births has a lot of good
suggestions for positioning; unfortunately, some of the basic
breastfeeding info is inaccurate.  LLLI has a nice pamplet on the
subject.

Well, this is much longer than I intended.  Hope it helps.

You probably didn't need half of it.  If you remember the basics, and if
you and the mother use your own experiences and common sense, you'll do
find.  Twins are a lot of fun.

Two more suggestions:  keep the babies in the same crib, beginning in
the hospital, and always call the babies by their names.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA