The logistics of twins: Part I—Breastfeeding at home

I'll be sharing some of the logistical problems and solutions we've had with twins. I'll be speaking solely from my own experience, without trying to touch on all of the many options available. Please feel free to chime in with your own experiences. This may or may not be a continuing series, so I'm starting with my pet topic.

The challenge of feeding babies like any common mammal

The babies had several advantages when it came to the Battle of the Boob:

1. I've successfully breastfed, without needing to use fancy equipment or formula, two other (singleton) babies.
2. They were born full-term, at good weights, and did not need any sort of interventions (which was achieved partly by believing that twin pregnancy is not high-risk until something actually goes wrong). 
3. Bottlefeeding for reasons other than absolute need is not an option for me.
4. I know  lot about breastfeeding and normal newborn behavior.

I see many of the challenges of breastfeeding twins to be the same as breastfeeding single babies. Those things are mainly having the right support (people experienced with and good at lactation support, as well as support with day-to-day tasks or in-the-moment needs) at the right time and understanding what a normal newborn acts like. The difference with twins is that you're more likely to have to deal with difficult circumstances due to early delivery—babies in NICU, having to pump, underdeveloped suck reflex, etc.—and that you have two babies to contend with. 

Having two babies means that you're dealing with two individual beings. No two babies are exactly alike, even if their genetic makeup is. They will have different personalities; if you're lucky, they'll be personalities that work well with each other and you. Josie seems to be the more dynamic of the two of my babies; she has very definite opinions about things. Ozzie is a bit more laid-back and willing to adapt to what Josie needs.

The early days

Especially in the early days (as of writing this, the babies are almost 14 weeks old), we tandem nursed. I would put both of them on the My Brest Friend Twins Plus pillow and they'd nurse, and sleep, and nurse again. Diapers would get changed on both babies when one would need one, which happened after a dirty diaper or roughly every two hours during the day, and during wakeups at night until they were done having dirty diapers at night, after which time they were outfitted with an enormous, fat, super-absorbent diaper that usually stays on all night. Mostly, I sat on the couch (or bed) and fed babies.

Now, this isn't fun, especially if you have older kids, but after giving birth, a body needs to heal. A woman's two jobs after giving birth are to allow herself to heal and to feed her babies. A baby's job is to eat, poop, and sleep. Other people can take care of running a household. We are blessed with a great community that provided us with meals (using Food Tidings) for six weeks after the babies were born. For me, a person who likes to do things, this lying-in period is sort of like psychological torture, but letting go of the idea that I needed to do things helped immensely. (Even now, I have to stop to remind myself that I do not need to do some things. Almost everything can wait. This is why I have three raised beds full of weeds right now. But, oh, what a splendid weed harvest it will be!

That reminds me of another thing that is important in the early weeks of breastfeeding (and mothering/parenting in general): Telling moms that, yes, it really sucks. You will feel drained and tired and it will be hard. It being hard does not mean you're doing it wrong. And, furthermore, it is okay to think that it sucks and to even say so out loud.

Pumping

Some will insist that you will need to pump in order to have a large enough milk supply. Some will say that sort of thing even if you have just one baby to contend with. But the fact is, unless one or both babies is unable to latch and transfer milk properly (and assuming all of your systems are go), all you need to do in order to have enough milk is to breastfeed on demand. Sometimes the demand is constant (and it's not just about milk, either—here, read this: The Normal Newborn and Why Breastmilk is Not Just Food). 

My advice is to avoid technology until there are problems and, even then, use technology as a second line of defense, not the first. Most breastfeeding problems—assuming they are actual problems, and not just perceived problems—can be fixed by low-tech means alone. Pumps are best used for establishing/keeping milk supply when a baby cannot latch or transfer milk properly or for collecting milk while a mother is away from her baby or needs milk for when she will be away. Pumps are not as efficient as a baby at removing milk; having a baby do the work makes more sense than having a pump do it, especially since adding time to pump and all of the time spent cleaning pump parts will add a significant amount of stress to an already stressful time.

I have a Bailey Medical Nurture III breast pump, which I shall review in detail at some point. I pump while I am away at work and occasionally on mornings/evenings/whenever if I need additional milk. I tend to pump exactly what I "should"; that is, I'll get about 1 ounce per hour that I've not nursed. My left breast consistently produces about double what my right does.

Basic logistics: How we sleep and how we tandem feed

As far as sleeping arrangements go, we have two queen-sized beds on box springs on the floor, which takes up roughly one-half of our bedroom and extends nearly from one wall to the other. The softer mattress, the one we have had for years, is where my husband primarily sleeps (occasionally, a big kid will climb into bed next to him). The firmer mattress is where the babies sleep; for now, they sleep swaddled (using fancy swaddling blankets, since neither of us are good at swaddling) and right next to each other in the middle of this bed. When I tandem feed in bed, I am using a nursing pillow and sitting on the mattress, with my back to the wall; when a baby falls asleep, I can move him/her to the mattress, and if one needs some additional nursing, we can do this side-lying. I sneak away after they fall asleep, and they will sleep for quite a long time (usually five hours, but up to EIGHT—I know, I hate me too!). These days, I often crawl into the softer mattress to go to sleep, and move next to whichever baby needs me as needed at night.

Want to know one of the most challenging things about twins? It's where the heck you put them all. When they were very tiny, I could put them on the couch, parallel to its length, and lift one and then the other onto my nursing pillow. Handy tip: While it is possible to bend over slightly and pick a baby up from a bouncy chair, you can only do that when you have ONE baby unless you are feeling very lucky with balancing babies on your pillow or shoulder. I don't recommend it. Use a middleman, such as the couch or another adult's arms.

Right now, they are too large and too wiggly to lie on the couch together without extreme vigilance. Ozzie can be placed on the couch without much worry, but Josie manages to roll and kick herself into awkward and potentially dangerous situations. My standard approach is to put one, usually Ozzie, on the couch, strap on my nursing pillow, and pick up the other from the playpen or bouncy chair. We settle in, and then I pick up whomever is hanging out on the couch.

Insert specific bulleted lists

Here are some specific bulleted lists about what's gone down at specific times. Any breastfeeding relationship is going to change over time; that's one good reason to stick things out when the going gets tough, because it will change, for better or for worse (but probably better) given enough time.

First eight weeks

• Almost always tandem feeding using a large support pillow, nearly constantly during the day, with naps for the babies happening on my chest.
• Babies would sleep on husband/other adults who were around when I needed a break; occasionally, they napped on their own during the day.
• Babies got a lot of food dropped on their heads. 
• A bedtime routine was established fairly early: Babies diapered, swaddled, nursed on the pillow, and moved to the bed when asleep. 
• When babies woke at night, the husband would change diapers and provide a freshly swaddled baby to me; I would then tandem nurse them, since they usually both woke up during this period.
• For about the first two weeks, my nipples were very sore, and I'd cry with a lot of feeds. I had two babies learning to nurse, not just one, and lots of bad latching happened. The soreness miraculously went away with religious application of Motherlove Nipple Cream over a period of a couple of days.

Eight weeks to twelve weeks

• Maternity leave ended at eight weeks, so things changed a bit; babies began to receive bottles when I was at my part-time job.
• When I was around, still almost always tandem feeding, though when one baby would be content to sit in a bouncy chair (rarely), I took the opportunity to have one-on-one snuggly feeding time with the other.
• The bedtime routine looks similar, though babies no longer wake up at the same time at night as much. On the rare times that happened, tandem feeding happened. On those times I couldn't deal with more tandem feeding (because if you do it all day... guess what!... you don't want to do it all night), my husband would rock, snuggle, shush, or attempt to shove a binky into the mouth of the other. (Neither of them likes pacifiers. *sigh*)

Twelve weeks to now

• Babies are getting a bit more willing to be set down; they've even had a small amount of tummy time (Josie can ROLL already!), so I do much less tandem feeding, because even if I want to sit and nurse babies all day because it's a little bit easier, I have to at least attempt to keep house occasionally. 
• Babies are starting to want to take actual naps. Josie wants these more than Ozzie and will put up quite a fuss if she decides it's naptime, and this fuss can only be fixed by putting her down for a nap. 
• It often happens at night that one baby, usually Ozzie, will be content to be swaddled and simply wait to be fed. I can stroke his/her head (which I think I established as a sleepy cue because I like to sit and stroke their sweet little baby heads as they nurse together) to settle him/her while I'm feeding the other, then flop over to feed that baby. Sometimes I need to go back and forth for a little while before both are settled.

I still feel like I'm nursing a baby almost constantly. The times where both are happy to be on their own are few and far between. I relish them. While tandem nursing is getting more difficult because the pillow seems to be shrinking, I still think it makes a lot more sense than trying to feed them one at a time all of the time, as some people do. By the time you've nursed one baby, then the other, you've got to do it all over again. 

So far the journey has been more enjoyable than not. Seeing sweet little faces smiling sweet little smiles makes up for a whole lot. That said, I'm looking forward to seeing how things change and eagerly awaiting the six-month mark, where I hope the introduction of solid foods means I'm in a bit less constant demand.

FAQ (yes, just the one)

Q: So, do you assign a boob to them for the day, or what?

A: No. They tend to get the same boob at night, since they stay in place and I flip back and forth on either side of them, but during the day I try to switch breasts for each feed. Usually they are content to take only one breast per feed, too, but sometimes one (usually  Josie) will want to switch, so we do.