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.
Page last edited Sun Oct 14 09:29:27 UTC 2007.
