Breastfeeding and Special Situations

The benefits of breastfeeding for mothers of multiples and their babies are the same as for all mothers and babies — possibly greater, since many multiples are born early. The idea of breastfeeding more than one baby may seem overwhelming at first! But many moms of multiples find breastfeeding easier than other feeding methods, because there is nothing to prepare. Many mothers successfully breastfeed more than one baby even after going back to work.

Being prepared

It will help to learn as much as you can about breastfeeding during your pregnancy. Before the babies are born, you can:

• Take a breastfeeding class
• Find internet and print resources for parents of multiples
• Join a support group for parents of multiples through your doctor, hospital, local breastfeeding center, or La Leche League International
• Let your doctor and family members know that you plan to breastfeed
• Find a lactation consultant who has experience with multiples before your babies are born so that you know where to get help

Many twin and multiple babies are smaller or born premature.

Making enough milk

Most mothers can make plenty of milk for twins. Many mothers exclusively breastfeed or express their milk for triplets or quadruplets. Keep these tips in mind:

• Breastfeeding soon and often after birth is helpful for multiples the same way it is for one baby. The more milk that is removed from your breasts, the more milk your body will make.
• If your babies are born early, double pumping (pumping both breasts at the same time) can help you make more milk.
• The doctor's weight checks can tell you whether your babies are getting enough breastmilk.
• It helps to have each baby feed from both breasts. You can "assign" a breast to each baby for a feeding and switch at the next feeding. Or you can assign a breast to each baby for a day and switch the next day. Switching sides helps keep milk production up if one baby isn't eating as well as the other baby. It also gives babies a different view to stimulate their eyes.

Breastfeeding during your next pregnancy is not usually dangerous to you, your breastfeeding child, or your new developing baby. Your child may decide to wean (stop breastfeeding) on his or her own because of changes in the amount and flavor of your milk. Your doctor also may advise you, or you may want, to wean your baby if:

• You have any problems in your pregnancy, such as uterine pain or bleeding
• You have a history of preterm labor
• Pregnancy hormones make breastfeeding uncomfortable
• Your growing belly makes breastfeeding difficult

Your child will need additional food and drink, especially if he or she stops breastfeeding. You will probably make less milk during pregnancy, especially after your 20th week.

If you keep nursing your child after your baby is born, feed your newborn first to make sure he or she gets the colostrum. Once you are making more milk, you can decide how you can best meet everyone's needs, but stay aware of your new baby's needs for you and your milk.

You may want to ask your partner to help you by taking care of one child while you are breastfeeding. Also, you will need more fluids, healthy foods, and rest, because you are taking care of yourself and two small children.

Yes, but the amount of milk your breasts will make will depend on how your surgery was done, where your incisions were, and the reasons for your surgery. Women who had incisions in the fold under the breast are less likely to have problems making milk than women who had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually are able to breastfeed.

If you ever had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning to have breast surgery, talk with your surgeon about ways he or she can save as much of the breast tissue and milk ducts as possible.

Maybe. Many mothers who adopt can breastfeed their babies with some help. You may need to supplement your breastmilk with donated breastmilk from a milk bank or with infant formula. But some adoptive mothers can breastfeed exclusively, especially if they have been pregnant in the past.

If you plan to adopt and want to breastfeed, talk with your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. Options include:

• Pumping every three hours around the clock for two to three weeks before your baby arrives
• Waiting until the baby arrives and starting to breastfeed
• Using devices such as a supplemental nursing system or a lactation aid. This can help make sure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time.

Maybe. You can try breastfeeding (or returning to breastfeeding) after your baby is older. This process is called relactation. It may take weeks or even longer to get a full supply of milk, so you will need to continue to supplement your baby's diet with formula.

Talk with your doctor and a lactation consultant. They can help you decide the best way to try to rebuild your milk supply. Options include:

• Pumping every three hours to stimulate your milk supply.
• Give your baby skin-to-skin time to encourage the transition from the bottle to the breast.
• Using devices such as a supplemental nursing system or a lactation aid. This can help ensure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time.

If you can't breastfeed and still want to give your baby human milk, you may want to consider a human milk bank. A human milk bank can give you fresh donor human milk if you have a prescription from your doctor. Many steps are taken to make sure the milk is safe.

Some reasons you may want or need a human milk bank include:

You are unable to breastfeed because:

• Your baby was born premature (before 37 weeks of pregnancy)
• Your baby has other health problems
• You take certain medicines that are dangerous for babies and can be passed to your baby in your breastmilk, such as anxiety medicine, birth control with estrogen, or certain migraine medicines
• You have a specific illness (such as HIV or active tuberculosis) that means you should not breastfeed
• You get radiation therapy, though some therapies may mean only a brief pause in breastfeeding

Your baby isn't doing well on formula because of allergies or intolerance

Some mothers give extra breastmilk directly to parents of babies in need. This is called "casual sharing." But this milk has not been tested in a lab like milk at a human milk bank has. The Food and Drug Administration recommends against feeding your baby breastmilk that you get either directly from other women or through the Internet.

You can find a human milk bank through the Human Milk Banking Association of North America (HMBANA). To find out whether your insurance will cover the cost of the milk, call your insurance company or ask your doctor. If your insurance company does not cover the cost of the milk, talk with the milk bank to find out whether payment can be made later on or how to get help with the payments.

References

1. La Leche League. (2015). I would like to resume breastfeeding after an interruption. How do I relactate?

Sources

The Office on Women's Health in the U.S. Department of Health and Human Services

Content last updated on May 25, 2018