Learning to feed
Preterm babies may not have developed the ability to suck, so may need to be fed via a special tube. As the babies develop the ability to suck, the volume of milk given via a tube will be gradually reduced. Initially, most mums start by feeding one baby at a time; this is generally easier as it allows time to learn, and gives one-to-one time with each baby.
When feeding multiples, it is important for you to get help from the neonatal nurses as well as your partner and family and friends, so they can help position the babies, wind, change nappies and give cuddles. You may want to look at our booklet, produced in conjunction with The Twins and Multiple Births Association (Tamba) about multiple births. You can order or download this booklet from the shop
Breastfeeding more than one baby
For very premature or small babies, breast milk is particularly valuable as it boosts the baby’s immune system. It also helps to protect against gastroenteritis and chest infections, as well as supplying the correct mix of fat, protein, carbohydrate, vitamins and minerals. However, in some circumstances, preterm formula may be needed and the staff in the neonatal unit will advise you on this.
If you are expecting more than one baby, you may like to discuss antenatal milk expression with staff. These small quantities of colostrum or early breast milk can then be stored to use in the first few days, so helping to avoid the use of formula milk. You will find hand expressing the colostrum to be more successful than using an electric pump. As lactation establishes, it is advisable to express with a breast pump at least eight times in 24 hours, to establish your milk supply. Staff will advise you on how to do this.
Simultaneous or tandem feeding
Most feeding positions for more than one baby involve being supported by pillows. Some mums find a hard pillow that ties at the back or a sling an advantage. It can be a little daunting at first to hold two babies at once, but staff in the neonatal unit will help with this.
Some parents prefer to time feeds so that they are staggered by a few minutes, waking the less hungry twin after feeding the first. This can allow more individualised attention for each baby and the other baby can be rocked or comforted, if awake.
Breastfeeding more than two
If you have triplets or more, it is still possible for you to breastfeed your babies, but coordination and timing becomes more important. Most mothers of triplets will use a routine and a rota system, feeding one separately after the other two. With quads, this system will be based on the first two babies followed by the last two.
The breast is capable of producing milk on a demand and supply basis, so it can be possible for mothers to feed as many babies as they produce.
Most mothers are able to produce more than enough milk for twins or triplets without any supplementation. For multiple births, you may need to use formula as well, but this will depend on your milk supply, your confidence and the amount of support you have from the people around you.
Routines and on-going feeding
However you feed your babies, most babies will have an established feeding routine when they leave the neonatal unit, which you may choose to follow at home.
You may like to discuss with your paediatricians, neonatal support nurse or health visitor what routine would work best for you and your babies. Remember this will change as they grow and develop. More guidance on how to feed your babies can be provided by a health visitor, a breast feeding counsellor, the National Childbirth Trust (NCT), La Leche League, Tamba, Bliss or the Multiple Births Foundation
Some hospitals have received, or are working towards, the World Heath Organisation (WHO) Baby Friendly award for supporting breastfeeding. To be successful in achieving this award, health professionals must ensure that all pregnant women have information about breastfeeding to enable them to make a choice.
If you choose to formula feed your babies, it is a requirement of the Baby Friendly award that you are taught how to do this safely. Some hospitals with the award may ask you to bring in your chosen formula, but will supply you with sterile bottles and teats.
If you choose to bottle feed, you may still find it comfortable to tandem feed or to use the feeding patterns described.