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Breastfeeding Multiples:
Life in the Twin Zone

Joanie Randle
Athens, Georgia, USA
From: NEW BEGINNINGS, Vol. 13 No. 3, May-June 1996, pp. 68-72

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.

Soon after my husband and I discovered attachment parenting, it was clear to us that our two children were benefiting greatly from all the time and attention. When we discovered during my third pregnancy that I was carrying twins, we knew that attachment parenting would be good for them, too. Although some adjustments were necessary in order to meet the needs of two children born at the same time, our family not only survived the twins' first three years, it thrived.

Attachment parenting usually includes breastfeeding on demand, mother-baby togetherness, natural weaning, and ideas about discipline that rely more on loving guidance than on punishment. Attachment parenting and La Leche League philosophy share the same goal: meet the baby's needs in a responsive and loving manner, because responsive parenting encourages the baby to trust that his needs will be met and to feel that he is worthwhile and lovable. This builds the foundation for high self-esteem and self-confidence later in life. Attachment researchers maintain that an infant who has formed a strong bond with his mother has a secure base from which to explore his world during infancy and toddlerhood. A person who has had a secure attachment to his mother (or mother figure) is more likely to grow up to be an independent, well-adjusted member of society who will be able to form lasting, intimate, and meaningful relationships. Attachment parenting is concerned initially with the mother-baby relationship, and then with the baby's subsequent relationships (father and other family members) during the first few years.

When a family has twins, triplets, or more, the logistics alone may lead some to assume that attachment parenting will not be practical, especially during the first three years. Many mothers, upon learning that they are expecting multiples, presume that exclusive breastfeeding will be too difficult with two or more babies and think of breastfeeding as a short-term option only. In addition, many mothers and fathers may feel overwhelmed at the thought of caring for multiples. They may come to believe that relying on bottles and various other substitutes for mother is the only way to manage.

Although having multiples may present certain challenges for parents, the fact remains that every baby can benefit from attachment parenting. As we and many other families have discovered, it is possible to use attachment parenting with multiples. In his books, Dr. William Sears identifies "tools of attachment" that include: 1) connect early; 2) read and respond to baby's cues; 3) breastfeed; 4) wear your baby; 5) share sleep. Adapting these basics of attachment parenting to fit a family with multiple birth children is not always easy, but it can be done.

Building a Bond with Both Babies

The most efficient way to get attachment parenting off to a good start is to "connect early" by having a positive birth experience. Early interaction with newborns promotes this connection between parent and child. Positive birth experiences seem to enhance early attachment. A mother is better able to interact with her newborn when her birth experience has left her with good feelings about herself. But even when the birth experience is a positive one, some mothers become strongly attached to only one of the babies. This sometimes occurs when the second twin is a surprise, when one baby is separated from the mother due to illness, or when one baby is smaller or in need of special care. The mother may need to make the extra effort to treat the babies equally, but should not be surprised if it takes some time.

In the case of a woman having twins, triplets, or more, other factors also may inhibit this first stage of attachment. Multiple pregnancies are usually classified as "high risk" as soon as the multiple gestation has been discovered. In anticipation of complications, many vigilant obstetricians create an excessive amount of anxiety in the parents, which may become a complication in and of itself. Under these stressful circumstances, a positive birth experience may be hard to realize.

Some complications of pregnancy cannot be controlled or avoided. Surgical birth and prematurity are common complications in women expecting multiples. Taking the time to develop a detailed birth plan that covers all possible scenarios is an excellent way parents can ensure that they will participate as much as possible in the decisions about the birth of their children. In addition, plans should anticipate the possibility that one or both babies will need special attention at birth. It can be upsetting to think about such things in advance. However, being prepared for the unexpected can be very helpful.

Prematurity (delivery prior to 37 weeks gestational age) occurs in approximately fifty percent of multiple births. Depending on how early the babies arrive, they may need extended special care in the hospital. Parents can do many things to connect with their hospitalized infants such as touching, talking, rocking, feeding and holding. One technique is called "kangaroo care." This method encourages skin-to-skin contact between mother and babies (fathers, too) and facilitates the development of premature infants. Infants receiving kangaroo care spend more time in optimal behavioral states such as alert inactivity, deep sleep, and absence of crying. They are able to be moved into open-air cribs sooner, they go home sooner, and they cry less at six months. Kangaroo care also contributes to successful breastfeeding by keeping mother and baby in close contact with one another.

But when complications require separation from one or more babies, providing expressed breast milk can have a positive effect on bonding. According to Karen Gromada, RN, author of MOTHERING MULTIPLES, a mother who is pumping milk must focus on her infants while pumping at least every three hours to stimulate milk production. She also has the satisfaction of knowing that she's doing something tangible to help her babies survive. "Mothers have told me," Karen said, "that they found pumping milk to be a vital link to their newborns and a way of increasing their confidence in their nurturing abilities at a very stressful time." Some may find that photos, a cassette tape with baby's cries, or an article of their baby's clothing will help get the milk to flow.

Some complications can be avoided with optimal prenatal nutrition. While not a panacea for all complications, a healthful diet is nevertheless of great importance, and is one area where the mother can take full control and responsibility. In her book, Having Twins, Elizabeth Noble states that "studies show that caloric intake in the presence of high protein, more than any other factor, helps avoid low-birthweight babies and infant death." Noble goes on to recommend a specific diet, which generally has resulted in term babies weighing at least seven pounds. This diet recommends eating approximately 4,000 calories a day of foods that are nutritionally dense and high in protein.

While in the hospital, rooming-in with both babies (assuming they are healthy and full-term) will help get breastfeeding off to a good start and promote early attachment. Many hospitals allow mothers and multiples to room-in together if another adult is available to stay with the new mother on a 24-hour basis. This helper can act as mother's advocate, and assist her in positioning babies at the breast and keeping the babies bottle- and pacifier-free. Once discharged from the hospital the real work of attachment parenting on a multiple scale begins.

Become Multilingual

The second tool of attachment identified by Dr. Sears is to "read and respond to your baby's cues." Learning to read the cues and cries of one baby can be baffling. With two or more it can be as though you are trying to learn Greek and Russian simultaneously—it can be done but it will require more time and effort. Keeping mother and babies together as much as possible will facilitate the learning process.

Mother-baby togetherness provides the setting for learning how to read and respond to the different languages of multiple-birth children. If mother and babies do not understand each other the missed cues and the missed learning opportunities spiral downward, producing unhappy, dissatisfied babies, a confused, frustrated and unhappy mother, and general heartache and despair. In many cases the communication problem between mother and babies can be traced to advice that encourages parents to train their babies not to cry, to avoid being manipulated, and to beware the dangers of spoiling. In other cases, unrealistic expectations about completing even simple tasks such as folding laundry or doing the dishes will affect a mother's priorities. Even the most basic household task takes on monumental proportions with multiples in tow, much less the challenge of comforting two or more crying babies. It is during these stressful early days and weeks that many parents throw up their hands in frustration and reach for a bottle, a sitter, and a weekend away.

Mother's physical proximity to her multiples is important not only for establishing a sufficient milk supply but also to ease the transition from life inside the womb to life outside the womb. Lots of body contact is good for babies and can help calm the crying. Studies have shown that babies cry less when they are held more, but more crying and less holding is the typical dilemma in the homes of multiple birth children. Mothers want to hold the babies, but cannot hold both at once, at least not for long periods of time. Baby carriers and slings are useful when the babies are tiny, but can be used with only one baby at a time when they get bigger. This may be useful if one child is high-need and requires more holding time than the other. In this case, many mothers carry one child in a sling or carrier and push the other in a stroller. For mothers of multiples, meeting the needs of their babies may mean choosing to spend more time at home.

The idea of being "on double-duty call" 24 hours a day can be frightening and difficult to come to terms with. A strong support system that includes other mothers of breastfed twins can mean the difference between acknowledging and accepting this challenging stage and resisting the realities that present themselves daily. When Baby A wants to rock and nurse and Baby B wants to be walked, a mother of multiples faces a real dilemma. Each baby wants his needs met right away. Mother wants desperately to meet the needs of both babies, but obviously cannot. Times like these cause even the most dedicated mothers to feel like giving up. Many employ a mother's helper in an effort to avoid this problem. Having another set of arms (father, grandmother, friend) can be just what is needed. Experienced mothers and fathers have found the following tips helpful during the early months when the difficulties associated with parenting multiples revolve around meeting divergent needs:

  • Maintain a good attitude. Accept the fact that 99% of your time will be spent mothering the babies. Many mothers report that there are days when they literally have at least one infant in arms from sun-up to sundown. Using a baby sling, in addition to a bouncy chair and/or a battery-operated baby swing, can be helpful on "hold me" days. However, it is easy to fall into the trap of using mechanical mother substitutes more and more often, regardless of how necessary they may be at any given moment.
  • Accept that, for a while, there will be little time left for anything other than the most basic household tasks. This can be terribly frustrating for everyone. Mothers can feel totally inadequate on the housekeeping front and unable to meet the needs of any other family members—"touched out" and tired beyond belief. Fathers may simultaneously feel guilty for being gone all day at work, yet resentful because mother's growing negative balance in her "giving" account is preventing her from meeting his needs. It is important to remember that this will not always be the situation, although it may be a year or two before things change noticeably.
  • Camp out on the floor. Make a baby center with everything you need: water, granola bars, and a basket of fruit; cordless phone; remote control; books, magazines, and videos for mother and older siblings; lots of blankets and pillows; clothing and diaper supplies. During the daylight hours stay on the floor with your babies. Play with older children right next to the baby area. Instead of wearing babies in a baby sling or carrier, sit Indian-style and hold them on your lap, or hold one while the other(s) lies across your lap. Focus on just being with them—not on the fact that you cannot, while holding them, do other chores. Do not expect to get up for anything more than a run to the bathroom!
  • Plan ahead for days when it will be next to impossible to get anything on the table for dinner. Accept that on some days, carry-out or convenience foods will be the best you can do. Days like this usually occur around growth spurt times—or more often if one or more of your multiples is a demanding, high-need baby. A deep freezer can be a lifesaver if it is stocked with emergency meals regularly. Frozen convenience foods (breakfast items, snacks, and dinner entrees) are helpful and should be viewed as "survival" food. Although convenience foods are more expensive, the money saved by breastfeeding multiples makes the higher grocery bill worth it. It is also important to keep quick and nutritious one-handed snacks around for mother to eat.
  • Plan for, accept offers of, and ask for help, especially household help and assistance with errands and shopping. If you are inundated with offers of help in the early weeks, but have things well in hand, be sure and ask for a raincheck—let others know that, although you do not need help at this time, you will certainly need it soon!
  • Learn to manage stress. The stress associated with the birth of multiples is phenomenal. Families with multiple birth children are at greater risk of parental drug and alcohol abuse, divorce, and child abuse. Multiples tend to cry more because their needs cannot consistently be met on demand as easily as with singletons. The increased crying, especially for parents not accustomed to it, is incredibly stressful. Practicing deep breathing exercises or meditating for two quiet minutes when feeling overwrought may help calm you. Remind yourself that you're doing the best that you can. Purchase a yoga video and watch it with your babies. Do anything within reason that will help you avoid falling apart.
  • Shop by phone or by mail as much as possible and have father or a friend grocery shop regularly. Be sure to make your grocery list as detailed as possible with brand name, size, quantity, etc. indicated.
  • Simplify life at every level. Use paper plates and napkins, disposable diapers—anything that makes life easier. Don't feel guilty about not keeping up with the environmentally sensitive standards of living that you may have had with other children. Remember that your time is better spent with your babies, not the washing machine.
  • Keep your sense of humor. Laughing in the face of distress is a great tension breaker. Once, when my twins were about a year old and into everything, my husband came home to find the house more disheveled than normal (and that's saying something!). Before I could apologize for the mess he said that he planned to make us a million dollars by inventing a "New Father Virtual Reality Helmet" that would display a neat home—no toys in sight—complete with "virtual sound" (quiet music), an elegant dinner, and a well rested, amorous wife!

Breastfeeding Multiples

Breastfeeding as part of attachment parenting means much more than simply feeding at the breast. THE WOMANLY ART OF BREASTFEEDING explains that "a nursing mother is physically different from a non-nursing mother. She is in a different hormonal state. She has a high level of prolactin—the 'mothering' hormone...." Prolactin is associated with feelings of calm; it is an antidote to stress. For a mother of breastfeeding multiples this is good news. Surely, breastfeeding two or more babies ensures high levels of prolactin! One new mother of twins commented that she "couldn't survive" without the benefit of extra prolactin.

The problems usually associated with breastfeeding multiples—not enough hands, not enough time, sleep deprivation—actually tend to be problems associated with having multiples rather than true breastfeeding problems. Breastfeeding helps alleviate many. Mothers can nurse lying down and fall asleep with the babies. Breastfed babies cry less when hungry because they do not have to wait for bottles to be prepared. The extra prolactin keeps many mothers on an even keel and helps them to deal with this stressful stage of life. In the early weeks another adult may have to help with positioning babies at the breast when both want to nurse at the same time. As the children get older they will be able to latch on and support themselves with less assistance from mother while nursing. La Leche League's information booklet Breastfeeding Twins, and Karen Gromada's book, Mothering Multiples, are both full of helpful tips. Having a "mentor mother"—either a La Leche League Leader or member who has nursed and parented multiples can be an invaluable source of information and support.

Co-Family Sleeping

Co-family sleeping ensures that parents learn the very subtle cues of their babies, and it also makes breastfeeding easier. Babies do not have to get into a full-blown crying fit before mother is awakened and there to breastfeed. Some families find that mother sleeping in a double (or larger) bed with the babies on either side of her works out well with twins; if father is disturbed easily by the nighttime sounds of babies he may want to sleep elsewhere for a while. Other options include babies in bed with both parents; babies sharing a crib next to the parents' bed; babies in another room, in crib(s), with a bed in the room for mother so she can lie down and nurse during the night.

A mother breastfeeding multiples will almost always find it easier to sleep with the babies routinely, at least for a while. When one baby is up every hour to hour-and-a half, it would be impossible for mother to get any rest at all if she spent half the night walking up and down the hall to get to each baby. With infants in bed with her, she can nurse one baby first and continue until he's finished (or until the other baby awakens). Then she can simply roll over, nursing the second baby until the first awakens again, and so forth. If babies awaken together, mother can nurse them simultaneously in a semi-sitting position without having to awaken for more than a few minutes to get them latched on. Some mothers report actually getting a whole night's rest without getting out of bed using this method. Triplets and higher order multiples will necessitate the help of father or another adult so the baby not on the breast can be held, rocked, and soothed until mother has an available breast for him.

Multiple Years of Parenting Multiples

One of the most common misconceptions about parenting multiple-birth children is that after they become mobile things will get easier. The second and third year in the "twin zone" can be even more demanding. During the first year, mothers spend most of their time holding and caring for the babies. The next few years are spent chasing, childproofing, and refereeing. It almost seems as though for every hour a mother nurses her infants there will be five hours spent as traffic controller, safety inspector, and arbitrator.

When my own twins (now three years old) were babies, people kept telling me to "wait till they are one-year-old—things will be so much easier." They were wrong; things have remained intense, though the cause of the intensity has changed. Mothering multiple toddlers is an ongoing physical and intellectual marathon. The tag-team duo of "Seek and Destroy" makes childproofing a never-ending battle. Employing the principles of loving guidance on two nonreasoning people is a diplomatic exercise on the level of international peacekeeping and treaty negotiation. Sometimes I wax nostalgic and wish that my twins were four months old again: they would stay where I put them; they would not say "no"; and I would be able to sit down with them, relax, and nurse several times a day.

The first year was so emotionally intense that I cannot remember the twins' babyhood except for snatches of foggy sound bites (a case of acute, prolactin-induced amnesia?). All of a sudden my babies are almost weaned, toilet-trained, and awake all day. When my first child was born, it took about six months before I felt I had hit my stride as a parent. With my second, it took about three months to adjust to life with two children. With the twins, three years after their birth, I finally feel like I'm coming out of the daze. Mothering multiples is demanding and difficult, but has also been one of the most rewarding experiences I've ever had.

REFERENCES

Bell, Steven. Long-Term Effects of Responsive Parenting. Work in progress, Mount Berry College, Mount Berry GA.

Bowlby, John. A Secure Base. Basic Books, Inc. New York NY 1988.

Brewer, T. Metabolic Toxemia of Late Pregnancy. Keats Publishing Co. New Canaan CT, 1995.

Fleming, M. BREASTFEEDING TWINS, Reprint #52. La Leche League International, Schaumburg, IL, 1991.

Gromada, K. MOTHERING MULTIPLES. La Leche League International. Schaumburg IL, 1985.

Grunberg, R. Breastfeeding Triplets. NEW BEGINNINGS, Vol. 9, No. 5, September/October, 1992. La Leche League International. Schaumburg IL.

Karen, R. Becoming Attached. Warner Books. New York NY, 1994.

La Leche League International. THE WOMANLY ART OF BREASTFEEDING. Schaumburg IL 1991.

Leach, P. "Motherhood or Career." Empathic Parenting, Vol. 17, Issue 3, Summer, 1994.

Noble, E. Having Twins (2nd Ed.). Houghton Mifflin Company Boston MA, 1991.

Sears, W. THE FUSSY BABY. La Leche League International, Schaumburg IL, 1985.

Creative Parenting. Dodd, Mead and Co. New York NY, 1987.

The Baby Book. Little Brown & Co. New York NY 1993.

"Kangaroo Care and Breastfeeding for Preterm Infants," BREASTFEEDING ABSTRACTS, Vol. 9, No. 2, November, 1989. La Leche League International. Schaumburg IL.

Last updated Tuesday, October 3, 2006 by njb.
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