In recent decades, multiple births have been increasing in developed countries from a prevalence of 1-2% to a prevalence of 3-4%. This is due to factors such as the increase in maternal age and the use of fertility treatments. Let’s look into the challenges of breastfeeding multiple births.

Context of multiple pregnancies

These pregnancies carry an increased risk of maternal and fetal complications during pregnancy and/or labor:

• Preterm birth is the most frequent complication
• Low birth weight of the newborn
• Placental pathologies and associated complications such as twin-to-twin transfusion syndrome (TTTS) or selective intrauterine growth retardation
• Maternal pathology: increased risk of high blood pressure during pregnancy or gestational diabetes, hyperemesis, or anemia
• Increased risk of hospital admission during pregnancy and after delivery
• Increased risk of obstetric bleeding (metrorrhagia during pregnancy or postpartum hemorrhage due to uterine atony because of more uterine distension)

In addition to this increased risk of complications, which often create worries and fears for the family, some doubts may also arise concerning breastfeeding, since it is challenging for these families: doubts about milk supply, feeding their newborns, organizing the feedings and so on.

Although there is strong evidence about the risks of not breastfeeding, breastfeeding rates in women with multiple births are lower than with single births. In addition, breastfeeding more than one baby may be more difficult because of difficulties associated with childbirth or prematurity.

The healthcare professionals accompanying these triads must be well trained in the physiology of breastfeeding, in addition to knowing the needs of newborns in case of low birth weight or premature birth, and guide the mother on breastfeeding and correct stimulation and extraction of breast milk if necessary.

Multiple pregnancy and lactation

During pregnancy, the mother will be accompanied by information on the mechanism of milk production and, if necessary, and if there is no contraindication, she will be informed of the possibility of prenatal colostrum harvesting.

Suppose hospital admission is required during pregnancy due to any complication (such as threat of premature delivery, control of possible fetal or placental pathologies). In that case, the mother needs to be accompanied by providing information and encouraging her to get all her questions answered.

Birthing should not differ from a singleton pregnancy: a vaginal birth is always preferred. Increased care needs to be given during labor by monitoring both fetal heartbeats continuously and simultaneously.

Immediate postnatal care may differ depending on the type of multiple pregnancy:

• Early clamping of the umbilical cord (with all that this entails) may be required in the case of monochorionic pregnancies in order to protect the second twin from possible acute transfusion phenomena.
• Skin-to-skin contact after birth should be the primary care to be offered to these families, provided that the newborn does not require initial stabilization by a pediatrician for example due to prematurity, risk of loss of fetal well-being during labor, and so on.

Breastfeeding care in the first hours and during the first days should be individualized for each baby. This means it is important to assess the feed separately first and then together to see how the mother is more comfortable breastfeeding them.

Having twins is a challenge and increases the need for support from the people who live with the mother when it comes to breastfeeding. At the same time, the mammary gland, can be very effective when it gets extra stimulation and, if one of the two babies has difficulties, the other may help to get the necessary milk.

 

References

Whitford HM, Wallis SK, Dowswell T, West HM, Renfrew MJ. Breastfeeding education and support for women with twins or higher order multiples. Cochrane Database Syst Rev. 2017 Feb 28;2(2):CD012003. doi: 10.1002/14651858.CD012003.pub2. PMID: 28244065; PMCID: PMC6464508.

Protocol asistencia al embarazo y parto de gestaciones múltiples, BCNatal

Santana DS, Surita FG, Cecatti JG. Multiple Pregnancy: Epidemiology and Association with Maternal and Perinatal Morbidity. Rev Bras Ginecol Obstet. 2018 Sep;40(9):554-562. doi: 10.1055/s-0038-1668117. Epub 2018 Sep 19. PMID: 30231294; PMCID: PMC10316907.