Caring for twins, from breastfeeding to safe sleep

Yes, you can breastfeed twins, and the body can make enough milk for two.^1,2 Twins are more likely than single babies to be born early, so many start life in a neonatal unit.³ With a plan for feeds and sleep, and real help at home, families do manage, and often enjoy it more than they expected.

Are twins more likely to be born premature?

Yes. About 60 in 100 twin pregnancies end in a spontaneous birth before 37 weeks.³

For triplets, about 75 in 100 are born on their own before 35 weeks.³ Babies born early, whether by spontaneous labour or a planned early delivery, are more likely to need a neonatal unit.³

Even when all is well, twins are often delivered before the due date. NICE guidance says planned birth does not seem to raise the risk of serious problems for the babies when it is from 37 weeks for uncomplicated twins with separate placentas, from 36 weeks for twins who share a placenta but have separate sacs, and between 32 and 33+6 weeks for twins who share a single sac.³ So most twins are a little smaller and a little earlier than single babies. Plan to deliver in a hospital with a good neonatal unit.

Can I breastfeed twins?

Yes. Mothers can make enough milk for twins and even triplets.^1,2

In a small study of mothers feeding twins, some made over 1 litre a day from a single breast. One mother fully breastfeeding triplets made about 3 litres a day.¹ The authors concluded that a woman's potential milk supply is higher than the 700 to 800 ml a day often quoted.¹

Full or partial breastfeeding of twins is possible when parents, family and the medical team all pull together.² Even if you combine breast milk with some formula, every feed of breast milk counts.

Why do many mothers of twins stop breastfeeding early?

Breastfeeding rates are lower for twins than for single babies. Prematurity, NICU stays and the work of feeding two can delay the start or lead to stopping early.⁴

A Brazilian study of 128 mothers of twins found that stopping early was linked to lack of support, feeding difficulties, not breastfeeding exclusively, a short breastfeeding time with an earlier baby, and twins born under 2,300 g.⁵ The main reasons mothers gave were feeling they had too little milk, the babies' behaviour, and going back to work.⁵

A Cochrane review looked for trials of breastfeeding support designed for mothers of twins and found none.⁴ So the advice comes from experience: early help, a lactation counsellor, and a family that takes over everything else.

How do I make enough milk for twins?

Feed or express often, from the first hours after birth. In Dr Dutta's experience, milk supply follows demand.

• Start breastfeeding or hand expressing within the first hour if you can.
• If the babies are in the NICU, express often through the day, and at least once at night.
• Feed each baby by her cues, not the clock, in the early weeks.
• In the twin study, mothers at 6 months were feeding on average about 15 times a day in total.¹
• Eat well and drink to thirst. Ask family to bring you water and food during feeds.
• Get help early if feeding hurts or a baby is not gaining.

Avoid adding formula "just to be sure" unless your doctor advises it, as fewer feeds tell your body to make less milk.

How do I tandem feed twins?

Tandem feeding means feeding both babies at the same time, one at each breast. It halves the time spent feeding, which matters a lot by the second week.

Common positions:

• Double rugby (football) hold: each baby lies along your side, under your arm, with feet towards your back. Good after a caesarean.
• Double cradle: babies lie across your front, their bodies crossing.
• Mixed: one in cradle hold, one in rugby hold.

A firm twin feeding pillow or a stack of pillows helps a lot. In the early weeks, ask someone to hand you the second baby once the first is latched. Some mothers tandem feed in the day and feed one at a time at night. Swapping sides between feeds helps keep supply even.

Should I feed my twins at the same time or separately?

Either works. Many families feed together to save time, and feed separately when one baby needs extra help.

A common approach is to wake the second twin when the first wakes to feed, so both stay on a similar pattern. This gives you longer breaks between feeds. If one twin is smaller, born earlier, or a slow feeder, she may need separate, unhurried feeds for a while. Keep a simple chart of feeds and wet nappies for each baby. With two babies, it is very easy to lose track.

Should twins sleep together in the same cot?

Each baby should sleep on her back on a firm, flat surface, in your room but not in your bed.⁶ Sharing a cot in the early weeks is allowed in UK safe sleep advice, with precautions.⁷

The Lullaby Trust says newborn twins can share a cot if they are placed on their backs, either head to head with feet at opposite ends, or side by side with feet at the foot of the cot. Once either baby can roll, they need separate sleep spaces.⁷

A Cochrane review of co-bedding preterm twins in hospital nurseries found too little evidence to say whether it helps or harms.⁸ My advice is simple: if space allows, use two cots side by side in your room. Twins who are small or premature are at higher risk of sudden infant death, so follow every safe sleep step carefully.⁷

What safe sleep rules matter most for twins?

The same rules as for any baby, applied to each baby, every sleep.^6,7

• Always on the back⁶
• Firm, flat, non-tilted mattress⁶
• No pillows, bumpers, soft toys or heavy quilts⁶
• Room sharing without bed sharing⁶
• Avoid overheating, a real risk in the Kolkata summer⁶
• No smoking near the babies⁶

Tired parents of twins often fall asleep while feeding on a sofa or bed. If you feel drowsy during a night feed, put the baby down in her cot first.

What is corrected age for twins?

Corrected age is your babies' age counted from their due date instead of their birth date. Use it to judge milestones in the first 2 years if they were born early.⁹

To work it out, take their age in weeks since birth and subtract the number of weeks they were born early.⁹ For example, twins born at 32 weeks are 8 weeks early. At 4 months after birth, their corrected age is 2 months, and you should expect the skills of a 2-month-old.⁹

Relatives may worry that your 4-month-olds are not rolling. Using corrected age stops needless worry. Vaccines, though, are given by actual age from birth, not corrected age.

Why is one twin smaller or slower than the other?

Twins often differ in size at birth, and they develop at their own pace, just like any two siblings.

One twin may have had a smaller share of the placenta, or may have been born more unwell. A smaller twin often catches up in the first year or two. Compare each child with her own growth chart, not with her twin. If one twin is falling further behind in weight or skills, see your doctor rather than waiting.

How do I raise twins as individuals?

Call each twin by name, give each some one-to-one time, and let their personalities show. They are two children who happen to share a birthday.

• Avoid always calling them "the twins".
• Dress them differently sometimes, so others learn to tell them apart.
• Give each a few toys and clothes of her own.
• Spend a short time alone with each one, even a walk to the shop.
• Do not compare them aloud: "Your sister already ate hers."

Later, think about each child's needs when deciding on school classes, rather than following a fixed rule.

How can I get help at home with twins?

Ask for help before the babies come, and be specific about what you need. Mothers of twins are more likely to become depressed.¹⁰ Practical help eases the load.

A US study found mothers of twins and other multiples had 43% higher odds of moderate to severe depressive symptoms 9 months after birth than mothers of single babies.¹⁰ Few mothers with these symptoms had talked to a health professional.¹⁰

Ideas that work:

• Give each helper a job: one grandparent for cooking, one for night nappies.
• If you can afford it, hire a trained helper or a night nurse for the first months.
• Keep supplies in two stations so you are not walking up and down stairs.
• Say yes to offers of food and laundry, and no to long visits.
• Join a parents of twins group online.

How do I manage the logistics of twins?

Simplify everything you can, and keep a written routine on the wall so any helper can follow it.

• Use a feeding and nappy chart, with a different colour pen for each baby.
• Buy two car seats, two cots, and one double pram. Other items can often be shared.
• Bathe the babies on alternate days, or one in the morning and one at night.
• Book clinic visits for both at once, and bring a second adult.
• Keep a small bag ready with nappies, clothes and feeds for two.

When should I call a doctor about my twins?

Call your doctor or go to hospital if either baby:

• Is not feeding well, or has fewer wet nappies than usual
• Has a temperature of 38 degrees C or more under 3 months of age¹¹
• Is very sleepy, floppy, or hard to wake for feeds
• Breathes fast, grunts, or has pauses in breathing
• Turns yellow, especially on the arms and legs, or in the first 24 hours
• Is losing weight or falling behind her twin

Also see a doctor if you or your partner feel low, hopeless or unable to cope for more than 2 weeks.