The thought of breastfeeding just one baby can be daunting enough, yet when you have two at once it can be a terrifying prospect, not only terms of positioning, winding and soreness, but also in terms of milk supply….  Here, author and breastfeeding specialist for The Baby Show, Clare Byam-Cook, offers her advice on common questions from mums of twins

In terms of latching techniques, how do you go about this when teaching your twins to feed? Is it best individually or separately?

I always recommend that a mother starts off by feeding her babies individually so she can establish whether each baby is able to latch on easily and feed effectively and also to learn roughly how long each baby takes to get a full feed.  If both babies feed well she can then graduate to the more complicated process of feeding them simultaneously. But if one or both babies is not very good at feeding, it is better to continue feeding them individually so that she can ensure each baby gets a proper feed.

With latching techniques aside, in general is it typical for mothers with twins to breastfeed both at the same time or separately?

I don’t think one can generalise on this. Mothers for whom breastfeeding is working really well can usually establish simultaneous feeding within a week or so of the birth, for others it takes several weeks and some mothers never manage to do it. The main factor is whether the mother has plenty of milk that flows quickly and whether both babies feed effectively – and this is more down to luck than time and effort by the mother.

Going off this last question, how typical is it for twins to feel the need to feed at the same time?

Unfortunately, I don’t think twins ever feel the need to feed at the same time! They are individuals with different feeding and sleeping patterns and will want to feed as soon as they are hungry, regardless of whether their sibling is still asleep/not hungry. Having said this, it is usually possible to get them to feed at the same time by waking one twin slightly earlier in order to fit in with the feeding requirements of the other. This can be done without causing any stress to the baby as most babies thrive on having a fairly regular feeding and sleeping routine.

What can you use if you want to breastfeed your babies at the same time?

There are special feeding pillows designed to be used with twins but you can also use ordinary bed pillows. Either way, you need each breast to be supported by a pillow on which to lay the baby and feed using the ‘rugby’ hold. Some mothers eventually manage to feed without needing to use pillows at all – but they are very skilful!

How long does breastfeeding normally take?

There is no simple answer to this. It all depends on how much milk the mother has, how quickly it flows and how well the baby sucks – and there are huge variations on this. Some mothers have such a fast flow that their baby can feed as quickly from her breast as he does from a bottle, which is roughly 10 to 20 minutes. At the other end of the scale, others have a very slow flow which means that their baby may need to suck for as long as an hour in order to get a full feed. For these mothers, breast-feeding twins is clearly going to be more difficult than for the lucky mothers who have a very fast flow of milk. So, each mother has to learn how long it takes her baby to get a full meal that lasts him roughly 3 to 4 hours, rather than a snack that only lasts him an hour or so. She does this by timing the length of each feed and then seeing how well her baby settles and how long it is before he gets hungry again. Gradually a pattern should emerge and the mother will learn how long each baby needs to spend at the breast to get a full feed.

How often should you be breastfeeding? 

In the early weeks most babies need to feed roughly every 3 to 4 hours, which means approximately 6 to 9 feeds during a 24-hour period. Some babies will need to feed slightly more frequently than this but the main aim is to get the babies into a good routine that involves proper meals rather than lots of little snacks.

Can breastfeeding twins result in even more soreness/tenderness of the breasts?

My firm view is that sore nipples are not part and parcel breast-feeding, so it shouldn’t make any difference whether the mother is feeding one baby or two. If the baby latches on correctly, feeding should be pain-free right from the outset. If a mother is experiencing pain she needs to get professional advice to check that her latch is correct and to exclude thrush, which is a common cause of sore nipples.

How much more milk does your body produce during this time? Is it also possible to not produce enough milk for both children?

In theory, breasts work on a supply and demand basis, which means the more a baby (or babies) demands, the more milk they will produce. But in reality many mothers find that they don’t have enough milk for one baby, let alone two – even when they are feeding correctly and eating a healthy diet. I therefore take the view that a mother should not feel guilty if she needs to top up some or all of her feeds with formula milk if she has been unable to establish an adequate milk supply for the needs of her babies. I think that the most important thing is to have healthy and happy babies who are getting enough milk to settle well after feeds and gain the correct amount of weight.

What do you feel mothers need to know about diet, nutrition, etc. post-pregnancy when they’re feeding twins?

The most important thing is to maintain a healthy and balanced diet, that is rich in iron and calcium. It is safe to eat anything when you’re breastfeeding but some babies may become windy or colicky if you eat foods that don’t agree with them. If you notice that any food disagrees with your baby, it’s best to omit that food from your diet for the duration of breastfeeding. If your milk supply is low you should try slightly increasing your calorie intake and also make sure that you are drinking plenty of fluids. Some mothers also find that drinking fennel tea or taking fenugreek tablets can help improve milk supply.

How do you know if your baby has a good latch?

If your baby is latched on correctly he should have his mouth wide open, his lips curled back and he should do deep rhythmic sucks rather than short, shallow ‘dummy’ type sucking. Feeding should be pain-free and you should not feel or see any pulling of the breast as he sucks.

Can you discuss how different it is to breastfeed twins if they are born prematurely? (e.g. is your milk different, is there more time required?)

When twins are born prematurely it should have no effect on the milk supply, which will normally be the same as it would be at full-term. However, babies that are born very early will often feed less effectively than an older full-term baby, which means that feeds may take longer. The mother may also need to give top-up bottles after some or all of the feeds until they are strong enough to manage exclusive breastfeeding.

Can you explain what the pros and cons might be of breastfeeding simultaneously vs breastfeeding one baby at a time (e.g. the letdown reflex, more or less time for the mother to rest, etc.) 

The main advantage to breastfeeding the babies simultaneously is that it allows their mother to have uninterrupted time between feeds for her to sleep, eat and generally relax. For these reasons, feeding simultaneously is the ideal way to feed if all is going well. But many mothers find that in the early weeks the babies may not feed very efficiently, she may not have enough milk and/or it might be hard to persuade both babies to feed at the same time, especially if one is bigger than the other and doesn’t want to feed as frequently as his smaller sibling. Any of these factors can mean that it might be better for everyone (mother and her babies) to feed them separately, so each baby has her full attention for the duration of the feed. And if her milk supply is low, it can be a good idea to give one baby a breastfeed using both breasts while his sibling is being given the entire feed from a bottle. She can then reverse the process at the next feed so each baby gets a turn at the breast.

In this video, a breastfeeding support specialist gives practical advice on how to breastfeed twins, and a mother of twins describes her experience.