Nursing Twins

My twin girls are now 3 months old and I have been pretty successful at exclusively breastfeeding them and not having to supplement with formula yet. I recently have had some issues trying to keep up my milk supply while feeding them both. I have not been getting enough sleep and eating well and thus my milk supply has suffered. I also believe that the girls hit a growth spurt which meant I needed to nurse more frequently to increase my milk supply.

I thought I would share some pointers to successful breastfeeding twins and maintaining your milk supply that I have recently learned and implemented (and they are working!!!):
1. You must feed at least 7-8 times a day. More frequent nursing helps to drain your breast and stimulate milk production.  My girls are sleeping though the night so this was hard to achieve so what I do is I feed every 3 hours during the day, then cluster feed in the late afternoons and evening, as well as pump right before bed. So here it the feeding schedule: 7am, 10am, 1pm, 4pm, 5:45pm, 7pm, 10pm (pump). This way I can squeeze in 7 nursing/ pumping session in during the day.

2. You must eat well, at least 3.000 calories a day and at least 110g of protein a day. If you are nursing two, you need to stop and take time to feed yourself properly. I know this is easier said then done because you are busy running around the house trying to take care of house hold chores, your twins, and perhaps other children that are still at home. It is important to fuel your body well so have enough nutrition to produce adequate milk for two infants. I have been making a protein shake to have in the later afternoon that has 60g of protein. I also went out and bought some healthy snacks that are high in protein to have on hand to much on throughout the day. Nuts are a really great source of protein and they are quick and easy! I also made sure to have some chicken cooked ahead of time to make sandwiches from lunch. Remember, you are feeding 3 so you need to take in more. If you find it hard to prepare a meal, try to do some precooking ahead of time so all you have to do is grab the meal and go!

3. Drink plenty of water! I make sure to fill up a very large water bottle and carry it around with me at all times. I found that if I did not carry around the water bottle, I did not drink nearly enough. I strive to drink at least 10oz of water after each nursing session and then sip on water in between.

4. Rest, Rest, Rest!!! If you can, makes sure you take some time in the afternoons to rest, even if it is only for 30 minutes. You body does not produce as much milk in the afternoons because of fatigue. If you take time to rest or nap in the afternoons, it will significantly help to boost your milk supply in the later afternoons and evenings. Try to get 8 hours of sleep a night. I know this is hard, but everything I read says that getting proper nighttime sleep is very important to creating a good milk supply.

5. Tandem Nurse. When you tandem nurse, nurse both babies at the same time, you are simulating both breasts. When you stimulate both breasts you actually produce more milk than breastfeeding one breast at time. I am using the Breastfriends Twin Plus nursing pillow to tandem nurse my girls and it is working out great. I love the pillow and highly recommend that you look into buying one if you want to successfully tandem breastfeed. To read more about My Bestfriend’s Twin Plus Nursing Pillow read this: https://blogginaboutbabies.wordpress.com/2010/06/19/my-best-friend-twins-plus-nursing-pillow/

6. Take a supplement with Fenugreek. The supplement that seems to be working really well for me is More Milk Plus by Mother Love. It contains fenugreek and it has been proven to help boost milk supply.

7. Make sure that your twins are taking full feedings. You want to make sure you twins take full feedings and drain your breast adequately after nursing. You will know they took a full feeding if your breast feel softer at the end of the nursing schedule. Make sure to burp your baby and re-latch her after her burping to see if she will nurse some more. The longer your twin nurses at the breast, the more stimulation your breast will receive to make more milk.

8. Feed more frequently during growth spurts. I know that a lot of twin moms feed on a schedule to keep things simple. I feed on a schedule, but if you do this during a growth spurt your babies will be fussy and also not get enough to eat. You also will not be stimulating your supply to increase if you keep to a strict feeding schedule. Growth spurts usually only last a few days or a week at most so it is best to just feed on demand during a growth spurt. Usually once the growth spurt is over, your babies will return to schedule feeding and naps again.

For more information on breastfeeding twins and multiples, read the book: Oh Yes You Can Breastfeed Twins and The Nursing Mothers Companion
If you are having supply issues, please read the following posts:
How To Increase Low Milk Supply
Milk Supply & Breastfeeding During Menstruation

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Baby Wise: Sleep Training

FACT #1: Establish a good schedule (eat, wake, sleep)

If this is the only thing you take from baby wise, then great! Babies thrive from consistence. If you are constantly changing up the schedule and routine daily, your child will have a more difficult time achieving good nighttime sleep. Every day should have consistency with a wake up time that is the same every day (our’s is 7am) and a bedtime that is the same every day (our’s is 7pm now). In between the start and close of each day, your child will cycle through several eat, wake, sleep cycles. This trains you child to not become dependent on nursing or bottle feeding to fall asleep. And beleive it or not, this helps with nighttime sleep too. If you babies wakes in the middle of the night, she may be able to put herself back to sleep if she is not dependent on nursing or bottle feeding to fall asleep. For more on eat, wake, sleep cycles see my post entitled “Infant & Baby Schedules”  https://blogginaboutbabies.wordpress.com/2009/04/16/infant-schedules/

FACT #2: Keep Sleep Props to a minimum

Baby Wise urges parents to stay away from sleep props such as nursing or rocking baby to sleep or sleeping with your baby in a shared bed. There is nothing wrong with any of these sleep props. There are many parents who do this with their children and it works for their family. But if you are attempting to use parent-directed feeding and Baby Wise, these sleep props will hinder your progress. The goal of Baby Wise is to help teach children how to fall asleep on their own without someone’s help. Having said that, I will say that I believe it is okay to rock your baby to the point of drowsiness before laying her in her crib. Just don’t allow them to fall sleep in your arms.  For more on putting your baby to bed drowsy but awake see my post “Put Your Baby To Bed Drowsy But Awake” https://blogginaboutbabies.wordpress.com/2009/04/09/put-baby-to-bed-drowsy-but-awake/

FACT #3: Some crying will happen (Cry-It-Out)

If you are using Baby Wise, then they recommend putting your baby in his own crib awake. Some babies will fuss or cry in their crib before falling asleep. Baby Wise suggests allowing your baby to cry for up to 15 minutes. If your child is still crying after 15 minutes, go in a check on him. You might want to pat him on the back or hold him in your arms for a little.  Then leave the room and try again. Every baby is different, if I showed my face even after 15 minutes my son would cry longer and harder.  I had to learn that when we where in the heat of sleep training (Cry-It-Out), I had to just leave him be. We had a video monitor so we could make sure he was okay. Thankfully, the hard nights really only lasted for 3-5 days, maybe 7 days at the most.  We started putting my son to bed awake by drowsy when he was 4/5 weeks old at night. At first he would cried for 20 minutes before falling asleep, but it did not take long (maybe 4-5 days) and his crying diminished. I believe by the time he was  3 months old, he rarely cried going to sleep at night. If he did cry, it was because he was overstimulated and needs to blow off steam.

FACT #4: Some babies make noise, fuss, or cry during sleep transitions (so don’t rush in)

Babies sleep cycle are about every 45-50 minutes. During this transition from one sleep sleep cycle to the next, your baby may partially arouse and make noise, fuss, move around, or even cry. As hard as it is, don’t rush into their room to check on them. Give them a few minutes to settle. “Sometimes you may think your baby is waking up when she’s actually going though a phase of light slumber. She could be squirming, startling, fussing, or even crying- and still be asleep. Or she may be awake by on the verge of drifting off again if left alone. Don’t make the mistake of trying to comfort her during these moments; you’ll only awaken her further and delay her going back to sleep. Instead, if you let her fuss and even cry for a few minutes, she’ll learn to get herself to sleep without relying on you (BW p. 146)” My son use to wake from his naps in between sleep cycles (45 minute intruder) and would cry for 5-15 minutes when he was 2-4 months old. I learned to leave him alone or he would never complete a full nap and be cranky. For more on baby’s sleep cycle read my post entitled “Infant Sleep Cycles” https://blogginaboutbabies.wordpress.com/2009/04/13/infant-sleep-cycles/

Important Reminders

• Don’t start sleep training during a growth spurt, illness, or during a hectic time of year with lots of disruptions  https://blogginaboutbabies.wordpress.com/2009/04/08/choosing-the-right-time-sleep-training/
• It is never to late to start sleep training. It does not matter if your child is 2 days old or 12 months old. It is just easier to start when you baby is young because habits have not been formed yet.
• Be consistent- if are going to use the Cry-It-Out method then stick to it. Don’t let your child cry it out for 3 nights, but on the 4 night rock him to sleep or nurse him to sleep. You are going to send mixed messages to your baby. He will not learn what is expected of him.  https://blogginaboutbabies.wordpress.com/2009/04/08/consistency-sleep-training/
• Put them to bed before they are overtired or overstimulate. If you put them to bed to late, often babies will have more difficulty falling asleep and will cry longer and harder. https://blogginaboutbabies.wordpress.com/2009/04/23/sleep-windows-get-them-to-bed-before-its-too-late/
• Keep a consistent bedtime routine and time, as well as a consistent wake up routine and time https://blogginaboutbabies.wordpress.com/2009/04/08/bedtime-routine/ and https://blogginaboutbabies.wordpress.com/2009/04/24/dramatic-wake-up/
• Don’t Set unrealistic expectations. See my post about how many hours a baby should sleep at night without a feeding https://blogginaboutbabies.wordpress.com/2009/04/08/sleep-requirements-for-infants/
• Make sure that your child has a good sleep environment https://blogginaboutbabies.wordpress.com/2009/04/27/create-a-good-sleep-environment/

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Baby Wise & Breastfeeding

I have used many of the baby wise principals with my son. I have followed a lot of the advice they have given about feeding schedules. They have worked really well so far. I exclusively breastfeed Cooper until he was almost 5 months old. My son is now 7 months old and I am still breastfeeding and have not lost my milk supply. I should also add that Cooper has always been in the 50 %ile for weight and 90-95 %ile for height.

Common Issues with Baby Wise and Breastfeeding

I have hear the common issues that people have when it comes to babywise- “you can decrease you milk supply or lose it all together if you follow babywise and your child may have failure to thrive. After following a feeding schedule that is similar to the one they suggest in baby wise, I can understand why that might happen. People misinterpret how to implement baby wise while they are breast feeding which results in low milk supply (or loose ability to nurse) and children who fail to thrive. I wanted to give some helpful suggestions to make sure this does not happen to you!

Don’t feed by the clock- this type of feeding schedule is not baby wise. Baby wise is a parent-directed feeding schedule. This type of feeding schedule has designated feeding times, but also allows for some variation due to child’s hunger. For instants, let’s say you’re feeding schedule looked something like this- 7am, 10am, 1pm, 4pm, 7pm, 10pm. If you child is suppose to eat at 10am but is crying and fussy at 9:50 should you make them wait an additional 10 minutes to eat- no, that is hyper scheduling! The schedule serves as a guide line for when to feed and how to schedule naps. It helps you as a parent know when to expect your child to be hungry. This was great when my son was a newborn. I knew if he was crying around a scheduled feeding time he was most likely hungry.  But if he was crying and he had just eaten a hour prior, he most likely was not hungry and perhaps he was tired or had gas. Babywise gave this diagram to help drive home the point to not feed only by the clock:

Hunger Cue + Clock + Parent Assessment = Feeding Time

Feed More Frequently During Growth Spurts- During a growth spurt, you will need to feed your baby more frequently if you are nursing. This will help stimulate your breasts to start producing more milk. If you fail to follow your child’s hunger cues, you could damage your milk supply. The result is less milk and a fussy, underfeed baby. If you were feeding on a 3- hour schedule, consider moving back to a 2.5 hour schedule to fit in an extra feeding. Remember to follow your child’s hunger cue’s and feed your baby when she is hungry. Growth spurts really don’t last longer than a few days, a week at most. Yes your schedule will be a little messed up for a few days. Don’t fear, after the growth spurt is over, you little one will return to the previous schedule fairly easy.

Add a feeding- Once your child is on a 4-hour schedule, that means you will only need to feed your little one 4 times a day. Your schedule might look like this- 7am, 11am, 3pm, 7pm. For some breastfeeding mom’s 4 feedings is not enough. Baby wise recognizes this and writes, “Your baby will maintain four to six liquid feeding in a 24- hour period, three of which will be supplemented by babyfood.” Some moms can nurse 4 times and maintain milk supply but others cannot. If you are on a 4 hour schedule, how do you fit in the 6 feedings to maintain milk supply? You can add the late night feeding (dreamfeed), this is the feeding you usually give to your child after they have been asleep around 10/11pm before you go to sleep. You could also try cluster feeding in the evening since your milk supply is lower at night any way. Your schedule might look like this- 7am, 11am, 3pm, 5pm, 7pm, with an optional late night feeding at 10/11pm. Once your baby is older and will stay awake longer, they may not be on a perfect 4 hour eat, wake, sleep cycle. NOTE: if you see your milk supply dipping, just add an additional feeding.  Shorten the length between feeding to accomplish this.

Pump: Once your little one is sleeping through the night and no longer taking the late night feeding (dreamfeed) you may only be breastfeeding 4 times a day. I tried doing that, but my milk supply started to dip. I added a 5 feeding, but I pump this feeding right before I go to sleep between 10/11pm. I save the milk that I pump and use it in his cereal for the next day. Once I added the 5 feeding back with pumping, I was able to maintain a healthy milk supply.

Here is what my feeding schedule looks like with my 7 month old currently:

• 7am Breastfeed/ breakfast
• 10am nap (1.5 hours)
• 11:30 breastfeed/ lunch
• 2:30 nap (1.5 hours)
• 4:00 breastfeed
• 6:00 Dinner
  
• 7:00 Breastfeed
• 10/11:00 Pump (save breast milk for cereal next day)

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Baby & Infant Daily Schedules

There are two books that I highly recommend you read if you have a small infant: Babywise and The Baby Whisperer Solves All Your Problems. These two books have been a huge resource to me, especially when Cooper was under 4 months old. I have turned through the pages of these two books plenty of times. Both books talk about a daily schedule that follows a very simple pattern it looks something like this:

1. Eat
2. Awake/ Play
3. Sleep
4. Repeat (eat, play, sleep)

This pattern is important to follow because your baby does not learn to depend on eating (nursing/bottle) to fall asleep.

Be careful not to hyper schedule- be flexible

Depending on how old your baby is will determine how long each cycle (eat, play, sleep) will be. Your baby is not a robot and each cycle may vary by a few minutes each day. It is important not to hyper schedule and only feed the baby by the clock. Also keep in mind that at different parts of the day, your baby will be able to go longer between feeds than other times of the day. My son was only able to go 2.5 hours in the morning between feeds when he was under 3 months old. The rest of the schedule he was able to go 3 hours between each feed. Be flexible. Find out what works for your child and build your schedule around that.

Schedules Change

Schedules are constantly changing based on the developing needs of your child. Keep that in mind too! What worked last week might not work this week. Consider changing the amount of time your child stays awake if you child is having trouble napping by either decreasing or increasing his awake time.

What happens to the schedule when your baby has a growth spurt?

When a baby is in the middle of a growth spurt, if you are nursing, you must increase the number of times you feed your baby. This will only last a few days and you can go back to your normal schedule. If you are bottle feeding during a growth spurt, you can just increase the amount of formula in each bottle.

What determines the length of each cycle?

1. Eating: this depends on how long your baby takes to eat (nurse/bottle). Newborns can take 20-45 minutes to nurse. As babies get older they get more efficient at eating. My son is now 6.5 months old and he nurses for 5 minutes on each side for a total of 10 minutes. When he was a newborn he was a fast eater, only nursing for a total of 15-20 minutes. Each baby is different and some take longer than others.
2. Awake/ Play: this will depend on two factors- how old your baby is and how long it takes them to nurse. If your baby takes a long time to nurse then he will not have a lot of time left over to play. Below are some recommended awake times for each baby. Not all babies are the same. Some babies need shorter awake time while other may need longer. Remember to include how long your baby east when calculating awake time. As your baby gets older, wake times could vary. They tend to stay awake for a shorter time in the morning, longer in the afternoon, and even longer in the evening. See my post entitled 2-3-4 Nap Schedule for more on this: https://blogginaboutbabies.wordpress.com/2009/05/13/2-3-4-nap-schedule-for-older-babies/
   Newborn 50-60 mins
   1 month 60 mins-hour and 15
   2 months 1 hour and 15 – 20 mins
   3 months 1 hour and 20 – 30 mins
   4 months 1 hour and 45 – 2 hours
   5 months 2 hours – 2.25 hours
   Late 5 months/early 6 months 2.25-2.5 hours
   6.5 – 7 months 2.75-3 hours. Some are getting more.
   8 – 10 months 3 – 4 hours. Some are getting more.
   11 – 12 months 3.5 -4.5 hours. Some are getting more if moved early to 1 nap
3. Sleep (naps): this depends on how long your baby can stay awake and how long they can go in between feedings. Below is a the number of naps that each baby should take each day (this could vary). See my post Infant Sleep Requirements which gives more information about how long each nap should be.
   Newborn- 1 month 3-4 naps
   2- 3 months 3-4 naps
   3 months 3 naps
   4-5 months 2-3 naps
   6- 8 months 2-3  naps
   9- 18 months 2 naps
   18+ months 1 naps

I typed the schedules that I kept with my son every month. They have changed quite a bit as he has grown. https://blogginaboutbabies.wordpress.com/2009/05/13/infant-schedules-by-month/

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