One of the top 3 concerns I hear as a lactation professional specializing in multiples is that a mother’s breastmilk supply just isn’t enough for her babies. Research tells us that about 35% of mothers cite insufficient milk supply as the reason they wean, yet only about 5% of women are physiologically unable to produce breastmilk (Gatti, 2008). While factors such as endocrine disorders, previous breast surgeries or insufficient glandular tissue CAN reduce supply potential – more commonly over supplementing, bottle preference, skipped feedings, or rigid scheduling is to blame. The trick is to know what puts your milk supply at risk and avoid those practices if possible, which is certainly easier said than done while navigating new twin parenthood and all that entails. Below you will find the most common situations that lead parents of twins, ages 0-3 months, to be concerned their breastmilk supply, and an explanation of what might be going on instead.

“My breastfed babies want to nurse every two hours, while my friend’s formula fed twins eat every three hours. My babies must not be getting enough milk to keep them satisfied.”

Most mothers who come to me with this concern assume low supply is to blame, that their babies just aren’t getting enough milk to sustain them for longer. My first response is always to ask mom about diaper counts and weight gain. A baby up until 6 weeks old should have on average 6+ wet diapers and 4+ bowel movements (size of a quarter or larger) per day. Once a baby is a little older, expect bowel movements to slow down a bit, (sometimes a lot) depending on the baby. Weight gain in another primary indicator, so if your pediatrician is happy with baby’s weight gain (typically about 6oz per week) then you know they are getting enough milk.  Commonly I hear that the baby does not seem satisfied after a feeding and that they are eating “all the time”, making a mom feel that they are never filling baby’s tummy. Additionally, many multiples spend time in the NICU, where the 3 hour schedule reigns supreme. Parents will naturally expect that to continue once babies are home, but if they are spending more time nursing on demand, rather than at prescribed times and amounts like in the NICU, you can expect more frequent feedings. When my 30 weekers first came home after 7 weeks in the hospital, I became very stressed when a nursing session didn’t keep them full for 3 hours like with previous schedule. The big difference is that after a weighted feed at the breast, they were bottle fed or tube fed the remaining milliliters of their “prescribed feed”, formulated with accelerated weight gain in mind. Unfortunately,  NICU schedules do not set breastfeeding parents of preemies up with realistic expectations of feeding on demand once they are home.

It is important to understand “typical” breastfed infant feeding patterns – once this is looked at, many times the worry of low supply is alleviated. Most newborns breastfeed an average of 10 times per day, with a general range of 8-12 feedings per 24 hours. At the breast, the average 0-6 week old feeding takes 30-45 minutes. Yes, it will feel like a lot over those first few weeks, and at times overwhelming – but baby’s efficiency speeds up dramatically over those first few months! Before you know it, feedings will be more like 10-15 minutes but still average every 2-3 hours during the day. It is easy to compare this frequent feeding schedule with a friend’s every-3-hour formula-fed baby and think they aren’t getting enough breastmilk… But breastmilk is more quickly digested than formula, and the feeding patterns just can’t be compared.

“All of a sudden, my babies are very fussy and feeding non-stop – I must be ‘drying up’”.

Two words for this – growth spurt! According to kellymom.com (one of my favorite breastfeeding resources!), babies typically go through growth spurts at 7-10 days old, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months. During those times, baby might be showing hunger cues much more often than they normally do – it might even feel like they go through hours where they nurse non-stop! They do need more milk during those times to help fuel growth, but all the increased demand will naturally increase your supply. It won’t happen immediately, but if you hang in there for a few days, you should see things even out within a week or so. Try your best NOT to offer formula in situations like this if you can avoid it, since that will do nothing for increasing your supply. Instead tell yourself this is temporary and push through that quick – but challenging – phase. Supply regulation also happens between 6-12 weeks postpartum, which will cause your breasts to leak less, feel softer even when “full”, and even pump a bit less. These are not signs your milk has decreased, but instead that your body is responding to the demand your babies have placed on it more accurately – rather than the surplus you may have had in the beginning.

Another explanation for this worry is the lovely “witching hour” phenomenon – for hours each night, your baby is fussy and cluster feeds until bed time, leaving you beyond exhausted. When you have not one, but TWO (or more) babies going through this at the same time, it can make us desperate for a reason so that we can alleviate the struggle. Many moms will assume they are still hungry after a feeding and question their supply as a possible cause, when in actuality this is a very normal developmental stage for an infant to go through. Evening fussiness and cluster feeding tends to build in intensity until about 10-12 weeks, and then improve dramatically between 3-4 months of age. Researchers credit a baby’s immature nervous system as the root of the phenomenon. Try other comfort measures if you need a break from the constant nursing such as bouncing and walking, babywearing, playing white noise, ect – but again, try to resist giving supplements if you can.

“I offered my baby 4 ounces of formula after a nursing session where they didn’t seem satisfied. The baby drank it so fast, I must be starving them!”

One of baby’s favorite soothing mechanisms is to suck, so it is no surprise that a baby would happily pacify and drink what is in a bottle offered to them. In the lactation world, we refer to the act of a baby moving milk from a breast or a device (such as a bottle) into their mouths and then down to their stomachs as “transferring” milk. Transferring milk from a bottle is much, MUCH easier than the work a baby has to put in at the breast. A baby has to wait for the milk ejection reflex, or letdown, before the milk flows consistently for a period of time. After that initial letdown of milk subsides, baby then has to work pretty hard to transfer the milk and finish the feeding. Compared to a bottle where the milk flow is faster and much more consistent, breastfeeding is tough work for tiny babies.  {As a side note, paced bottle feeding techniques should always be used with breastfed babies to cut down on bottle preference for these reasons.} It is easy to see how a baby being bottle-fed could over eat and also drink a large quantity at a very fast rate. Think of it this way – if someone gave us a large milkshake on a hot day, would we only drink exactly what we “need”? Chances are, the cool drink would be refreshing and soothing (like the act of sucking is for a fussy baby), and we would likely finish it. Offering a breastfed baby a bottle is often just like that.

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If you need to supplement after a breastfeeding session for growth reasons – or even for sanity’s sake – start very small. Babies only need 1-1.5oz of breastmilk per hour, so try limiting to that amount and see if it can hold them over until their next session at the breast. If the bottle contains more than this, it will put off that next session – as well as the frequent emptying of the breast that your body needs to keep up supply. Without a full explanation (that’s a whole other blog post!) the more you supplement, the less milk you will make, so try to use VERY sparingly and offer the breast more frequently instead.

Breastfeeding multiples (and breastfeeding in general!) can often be as much of a mental challenge as it is a physical one. Society doesn’t do a great job of teaching us as women to be confident and trust our bodies, and I truly believe supply concerns can often be traced back to that. Your body will do it’s absolute best to make enough milk if you are emptying your breasts frequently and thoroughly. If baby is growing well and giving you enough wet and dirty diapers, trust that things are going great! And even if you are doing all the “right” things, but still can’t get by without a little help, know that any amount of breastmilk is a gift. This season of frequent, lengthy feedings will soon pass, and will be so happy and proud that you stuck it out. You got this, Mama!

About the author

Lindsay Castiglione, LC is TLC’s Connecticut Associate and the mother of two sets of twins, an identical 8 year old boy set, and a 6 year old boy/girl set. She was born and raised in Cape Cod, MA, and married a Submariner in the U.S. Navy for 10 years, so now home is where the Navy takes them. She has her B.S. in Social Work, and focused on helping support parents of young children before starting her own family. Breastfeeding was very different for each set, but equally as important, and her varied experiences motivated her to become a Certified Lactation Counselor in 2015. You can contact her at lindsay@twinloveconcierge.com for more information on our Connecticut services, Online Expecting Twins Classes or Online Breastfeeding Twins Class details.