January 20, 2020
Mothers with multiple infants are often able to completely nurse their infants without supplementation. It is reasonable to encourage mothers with multiples to hand express colostrum after feedings in the first few days. This sends a strong signal to the breasts to maximize milk production. It is often easier for mother and newborns to nurse one at a time in the early days. As the mother becomes more comfortable with positioning and latching her newborns, she can work on her tandem nursing skills, meaning nursing two infants at the same time. Special pillows made to support twins help immensely with positioning and maternal comfort. Mother should be encouraged to arrange for extra help at home, as she will be working full time to breastfeed and/or express milk for her infants.
If the infants are born prematurely, a mother who is mostly or exclusively pumping should be encouraged to gradually increase her supply to the peak volume that the infants will eventually need (~25-30 oz per infant) in the first 4 weeks after delivery, even if the infants taking less volume at that point. It is more difficult to increase her production if she waits until her premature infants are ingesting that volume.