For Sandy, working with the mother of 2 1/2 week old twins and a 16 month old: Just for fun, let's add a few more stresses such as Christmas, etc. This mother is essentially trying to learn how to nurse, as her first experience didn't go very well. We mothers expect so much of ourselves! I would guess that this mother feels really overwhelmed, and with good reason. Is there any way to cut down on all the other demands on her for this next week, so that she can concentrate on nursing and sleeping? Is there a way that she can get full-time help for right now, of a "supportive-of-breastfeeding" type? I would try to help her know that breastfeeding is a learning time for mother and babies, and it may take even 6 weeks to get it all running more smoothly. She should not judge it by this very intense first few weeks, but just take one day at a time. The real delights of nursing twins come after this initial period, if she can make it through this early time. I wonder if she can make a kind of comfortable "nest" area - on her bed, or on the couch,or a big "Lazy-Boy" type of chair, with plenty of pillows, food and fluids for herself handy. This can be her "command center" if it is necessary for her to continue running the household. Then let other people do all the other things that need doing, like meal preparation, laundry, fending off guests, diaper changes, active or outside play for the toddler, etc. She probably also could use help from another adult getting Baby B latched on while Baby A is nursing. Sometimes it works to get the better nurser going first, to stimulate the letdown, then get the second baby on, unless the rush of milk is overwhelming Baby B. It does feel to many mothers like they need 6 hands to do this at first, but as the babies grow, learn to latch on and stay on, gain better coordination and head control, it will get easier. Many mothers find a nursing pillow helps. Others do fine with just plenty of ordinary pillows. Having to pump and/or use a supplementary system can be overwhelming at this stage, so I would try to encourage Baby B at the breast and eliminate all those extras as soon as possible. Some mothers feel most adept using the football (clutch) hold while others hold both babies in cradle holds or one cradle and one clutch hold. Whatever works for her right now. She can gradually learn to try a variety of positions so that she does not get plugged ducts and mastitis. (More common with twins). Have her switch sides so that the better nurser stimulates the milk supply in both breasts. If she has too much milk, she does not have to use both sides for each baby at each feeding, just switch the next feeding. If she feels she can't tackle two at once right now, she may want to try again in a few days when she gets Baby B a little more adept at nursing. Often, identical twins nurse together better than fraternal, and are more likely to have similar sleep-wake cycles. Encourage her to hang loose and see what works best for her, day by day, rather than following someone else's rigid expectations. See if you can help this mother get all the sleep possible, even in small catnaps. For her 16 month old, it may help if she can have 2 dolls or stuffed animals for this little one to cuddle and care for alongside Mom and the 2 babies. Some mothers have found that sitting on the floor to nurse helps a toddler sibling feel closer than when Mom is up on a chair with her arms full of 2 babies and the toddler is down at floor level. (After she feels more adept at nursing). Maybe some favorite lullaby tapes that all can listen to together will help, too. But really, another familiar, caring adult is of top priority to "mother" the whole group right now. I think we must be the only culture that doesn't see this, and that thinks we should do it all by ourselves! Karen Gromada's book, "Mothering Multiples," has many very helpful suggestions and is written in a caring and comforting style. Good luck to her, and keep us posted. Anne Altshuler, RN, MS, IBCLC and LLL Leader of a group for mothers of twins in Madison, WI (I had twins (now age 12) with a 3 year old, a 12 year old and a 14 year old, and wish I could have learned to let go of some of the many things I felt were essential for me to do in those early days!)