FAQs

  1. Can I still breastfeed if I’m going to have twins (or more)?
  2. What can I do to prepare for breastfeeding twins or more?
  3. How do I start breastfeeding after my multiples are born?
  4. What if my babies are born early or can’t breastfeed at first for some reason?
  5. This is starting to sound complicated; isn’t breastfeeding supposed to be natural?
  6. How will I know if each baby is getting enough milk?
  7. How will I know if any of my babies is not breastfeeding “effectively”?
  8. When should I start to breastfeed two babies at once?
  9. Should babies switch breasts or always feed on the same one?
  10. Can I breastfeed if I have to take medications?
  11. Can I breastfeed multiples if I have small breasts? Large breasts?
  12. Can I breastfeed twins (or more) if I wasn’t able or didn’t choose to breastfeed my previous child/children?
  13. Is it fair to my other child/children if I have to spend a lot of time breastfeeding twins (or more)
  14. Will I need a breast pump?
  15. What kind of pump should I get?
  16. Does breastfeeding have to be “all or nothing”?
  17. Can I just pump and give my babies my milk only from a bottle?
  18. Where can I go for help?

1. Can I still breastfeed now that I’ve found out I’m going to have twins (or more)? Relatives say it will be to hard on me. Friends say I won’t be able to make enough milk. They all tell me I am nuts to even consider it!

Of course, you can still breastfeed! Multiples especially need and deserve breastfeeding and their mother’s milk. When people say it’s impossible to breastfeed multiple babies, it is because they don’t understand how a woman’s body makes milk. To answer your questions, let’s look at each one separately:

a) Will breastfeeding multiples be too hard on me? Breastfeeding should not be more difficult than feeding two or more babies in some other way. Each of your babies will need you as much as any single-born baby would. That does not change simply because there is more than one of them! It isn’t realistic to think that two, three, four or more times the usual number of babies won’t take extra time and effort! If multiples are more difficult, it is because there are more babies than usual – not because you are breastfeeding.

Actually, mothers say breastfeeding is much easier than other feeding methods once they and their babies learn to work together as a “feeding team,” because:

  • You can feed two at once
  • There is nothing to prepare
  • Your milk is always at the right temperature, so babies won’t have to wait (and cry) while you to heat their food
  • There’s no equipment to clean
  • The milk in your breasts has no expiration date – It’s always exactly right!

Breastfeeding “forces” you to hold and interact with your babies, and interacting with your babies is how you get to know and form an attachment with each. Breastfeeding gives you an excuse to ask helpers to handle household chores, since only you can breastfeed. Mothers have also said they learned to appreciate the many daily opportunities breastfeeding gave them to sit down and prop their feet!

b) Will I be able to make enough milk? Most mothers are able to make plenty of milk to fully breastfeed twins, and many mothers fully breastfeed or express their own milk to fully feed triplets or quadruplets. Since you still only have 24 hours in a day, time can be more of a deterrent than your body’s ability to produce enough milk for two or more babies.

Milk production is based on a principle of “move it or lose it”! In other words, milk production depends on milk removal (from the breasts). Milk removal occurs when (each) baby effectively breastfeeds, or transfers milk from the breast into his/her mouth and gastro-intestinal (GI) tract with suckling, or when a mother effectively expresses milk by hand or with a breast pump.

Milk removal “tells” the milk-making cells in the breasts to make more milk. Two, three or more effective breastfeeders tell the body to make a lot more milk! (If using an effective breast pump for milk removal, more frequent pumping may be required to produce enough milk for multiples.) If a mother delays, or “puts off,” breastfeeding or a pumping session because she thinks this helps her milk “build up,” she is actually “telling” her breasts’ milk-making cells to slow down and she will soon produce less milk. An excerpt from Mothering Multiples: Breastfeeding and Caring for Twins or More explains how the breasts make milk.

c) Am I nuts to even consider breastfeeding multiples? Are you nuts to want to give your babies the only infant food designed especially for them – a food created just for their immature, newborn bodies; the food easiest for their bodies to digest and use; a food containing the perfect amounts of carbohydrates, fats, proteins and other nutrients for their first several months; a hypoallergic food? Are you nuts if you want your babies to have the only infant food that adapts and changes as they grow and develop?

Are you nuts to provide your babies with the disease-fighting properties that are found only in your milk – properties that are likely to save you time and trouble because breastfed babies have fewer infections? Are you nuts if you want to breastfeed because it means your multiples are less likely to pass around colds, bouts of diarrhea, ear infections and other illnesses? Are you nuts if you want to save money on pediatric “sick” visits or medications? Are you nuts if you want your babies to get the “immuno-modulating” factors that jump-start their own immune systems – something available only in mom’s milk now, yet something that may affect their ability to fight illness all their lives?

Are you nuts to want the special relationship with each baby that develops from the close contact of breastfeeding? Are you nuts to want to feel the pride of knowing your babies’ weight gains and growth are due, in whole or in part, to you? Are you nuts to want to postpone the return of your menstrual cycle for several months while your body recuperates from multiple pregnancy and birth? Are you nuts to want to decrease your risk of premenopausal breast and ovarian cancers? Are you nuts to want to burn a significant number of extra calories making double or triple amounts of milk?

Are you nuts if you want to save hundreds of dollars a month by not having to purchase a less wholesome infant food/formula(s), feeding equipment, etc.? (Paying a lactation consultant’s* [LC] fees, renting or buying a good pump and the related equipment still saves a considerable amount when compared with the costs of fully formula-feeding multiples.) Are you nuts to avoid messy preparation, post-feeding equipment clean up, and the wait while heating something for babies who are hungry NOW?

Are you nuts if you breastfeed multiples OR are you nuts if you don’t!

*The term “lactation consultant” or “LC” refers to a healthcare professional who is certified by the International Board of Lactation Consultant Examiners (IBLCE) via an independent exam and uses the credential IBCLC (International Board Certified Lactation Consultant) after her/his name.

top^

2. What can I do to prepare for breastfeeding twins or more?

This question should also be divided into several points:

a) Attend La Leche League (LLL) or similar breastfeeding-support meetings. (Certain regions/countries have different “nursing mother” organizations, and many hospitals now have such meetings for mothers.) These meetings provide an opportunity for you to see how breastfeeding works. (This is important because many of us grew up without seeing a lot of different women breastfeed.) Most group leaders have helped other breastfeeding mothers of twins/multiples (MOT/MOM). Start going to meetings during the second trimester of pregnancy, while you are more comfortable and in case your multiples are born a bit early. If preterm labor or bed rest interferes with meeting attendance, be sure to call and “meet” the group leader, anyway. Then you will feel more comfortable phoning her with questions or for encouragement after the babies arrive.

b) Go to a prenatal breastfeeding class. Some organizations even sponsor a multiples-specific class. If possible, take your husband/partner with you. As with breastfeeding-support group meetings, it is a good idea to attend a breastfeeding (and childbirth preparation) class during the second trimester of a multiple pregnancy. These classes teach breastfeeding basics, plus you may have a chance to practice positioning one or two babies for breastfeeding using a doll(s). An instructor can show you positions for feeding two babies at once. (Practicing with dolls to learn how to breastfeed two or more real, moving babies is similar to learning to drive a car by taking a driver’s training simulation! Both give one an idea of what the experience is like, but neither can quite duplicate the real thing.)

c) Get a head start on breastfeeding by reading both general and multiples-specific breastfeeding books, pamphlets, and web sites. A good book should reinforce the basics learned at a breastfeeding class or support group. Mothering Multiples probably has the most extensive multiples-specific breastfeeding information, but basic breastfeeding books will also come in handy. To gain support from your husband/partner, mother or mother-in-law, and others, mark helpful pages so they will read them too.

d) Take a tour of the hospital where you will give birth, and be sure to include a tour of the Neonatal Intensive Care Unit (NICU, often pronounced “nick-you”) – or Special Care Nursery (SCN). Multiples are more likely than a single newborn to spend some time there, so a tour can familiarize you with the NICU sights and sounds if one or more does require special care.

e) Talk to a hospital LC during your tour or call her during your pregnancy. Ask questions about the hospital’s breastfeeding policies, whether they encourage breastfeeding within an hour of birth if mother and babies are well, if full or partial rooming-in (non-separation) of mothers and babies is routine, whether electric breast-pumps are available if needed, what level of support you can expect from NICU staff, and so on.

f) Write down your goal(s) for breastfeeding and go over them with a LC, breastfeeding-support group leader, etc. If any goal does not “fit” with the way your body and babies must “work” together to make enough milk, a breastfeeding “expert” can help you revise the goal. The LC or group leader can also help you develop a plan for achieving your goals. Should you face any early breastfeeding-related difficulty, you will feel confident and persist IF you know your goals and have a realistic plan. As extra incentive, include a reward for yourself as you achieve each goal. Also, your plan can be revised as often as needed if the situation changes.

g) Write a simple “Breastfeeding Plan” and ask that it be attached to your and each baby’s hospital chart, so all members of the hospital staff are aware of your initial breastfeeding goal(s) and your preferences for beginning to breastfeed in the hospital. The Birth Plan for Twins lists several options that could be included on a breastfeeding plan, and some of its options could also apply to triplet and other higher-order multiple births.

h) Arrange for full-time household help when you bring the babies home, so you are free to breastfeed and get to know your babies. (The need for household help is due to the number of babies coming home, not to the way you are feeding them.) Surround yourself with cheerleaders – helpers who support your decision to breastfeed, including your husband/partner, babies’ grandparents, postpartum doula, etc., especially during this early learning period.

i) Ask how to arrange for a home visit by a RN or LC after you and the babies have left the hospital. Mothers usually have more specific questions once babies have been home a day or two, and most new mothers appreciate reassurance when babies are doing well or quick intervention if any is not. There are private practice LCs who make home visits or see a mother and babies in an office for a fee. And keep the breastfeeding support group leader’s phone number in a handy spot.

top^

3. How do I start breastfeeding after my multiples are born?

Each healthy, full-term (or close to it) twin or triplet should “cue” to breastfeed within 30 to 90 minutes of birth – the same as for any healthy, term single-born infant. Feeding “cues” are the behaviors babies show when they need to eat. Cues include rooting or seeking the breast with the mouth, making sucking movements with the mouth, bringing hand(s) to face or mouth, whimpering, and crying. Crying is a late feeding cue; it is usually easier for a baby to latch on and begin suckling before reaching this point.

Whether you give birth vaginally or have a surgical delivery (cesarean), the best time to start breastfeeding is when one of the babies begins to show interest through feeding cues. Then feed the second multiple when he/she demonstrates cues. (For healthy, close to full-term triplet sets, continue by breastfeeding the third when she/he cues.) There should be a nurse or LC available to help you during this “recovery” time or, if you had a birth doula during labor and your babies’ births, she can help you position each newborn for breastfeeding.

As much as possible, keep both/all healthy babies with you in your hospital room. This is called full or partial “rooming in.” Rooming-in allows you and your babies to remain close, so you start to get to know each of them and learn to “read” their feeding cues! When rooming-in with multiples, arrange for your husband/partner, relatives or friends to take turns staying with you at the hospital around the clock so you always have someone to help you with babies.

Breastfeed whenever any baby cues to feed. Frequent feeding is normal! And the more your babies “ask” to breastfeed, the more milk your breasts will make. Newborns’ tummies are really small, so most will need only colostrum until your milk “comes in” about 2 to 5 days after birth. Colostrum – the milk in your breasts the first several days – is thicker looking and there is not as much of it. However, not only is it the perfect amount for their very tiny tummies, it is also higher in disease-fighting properties that coat your babies’ intestinal tracts.

top^

4. What if my babies are born early or can’t breastfeed at first for some reason?

You would be in good company! Many, and perhaps most, MOT/MOM have had to express their milk for one or more multiples for varying periods of time before transitioning each to the breast. Even when multiples are born at full term, or close to it, the effects of their more stressful pre-birth environment may interfere with effective breastfeeding for one or more, and it may be necessary to feed them some expressed milk in addition to breastfeeding. It may take a bit more patience and persistence, but you and your babies will get over the early hurdles.

If your babies’ or your own condition(s) won’t allow for breastfeeding soon after birth, begin expressing colostrum/milk within hours of the babies’ birth. Most MOM say using a hospital-grade, electric breast pump is the easiest way to express (remove) milk on a regular basis. A LC or nurse should show you how to use the equipment the first time(s) you pump. If you are taking medicine that makes you feel groggy, you may need a LC, nurse or relative to pump your breasts for you until you feel more awake and alert.

You’ll want to pump as often as you would expect the babies to breastfeed so make time for at least 8, and up to 12, pumping sessions (at least 100 total minutes of pumping) in every 24 hours. It usually takes about 10 to 20 minutes for a mother to remove most of the milk in her breasts using a hospital-grade pump. Mothers often find they obtain more milk if they massage their breasts just before pumping. (If you don’t have much time, at least massage your breasts for a minute or two before pumping. It saves time later!) Mark down every pumping sessions on a checklist chart, so you can see at a glance the time(s) you pumped, how long it took, and how much milk you obtained.

You may obtain only drops during the first few days of pumping. However, the disease-protecting properties in those drops of colostrum are liquid gold for your babies, and a nurse or LC should know how to draw up even a few drops into a syringe so your babies can receive any available amount. Once milk “comes in” and with an effective pump and pumping routine, the amount of milk obtained in 24 hours usually increases to more than 23 oz (700 ml/cc).

The increase in milk production may be delayed if you get off to a late start with pumping. And some experts think that for a very few new mothers milk production may be affected by certain physical conditions. Be sure to tell a LC and your babies’ pediatric care providers if milk production has not increased by the end of the first week. With few exceptions, milk production will improve with regular and frequent pumping sessions. After asking questions about your pumping routine, a LC or breastfeeding-support group leader may have additional ideas.

Continue to express milk until all babies breastfeed effectively. Since milk production depends on milk removal, you will need the pump to remove milk when babies are improving but still not quite “there” with effective breastfeeding. As the babies breastfeed better and better, you’ll be able to cut back on, and eventually cut out, the pumping sessions.

top^

5. This is starting to sound complicated! Isn’t breastfeeding supposed to be natural?

It is natural for pregnancy to prepare your breasts to make milk. It is natural for your breasts to respond to the hormonal changes of birth by making lots of milk within a few days. (It is also natural for milk production to fluctuate based on milk removal.) And it is normal for healthy, full-term babies to have reflexes that help them latch-on to the breast and suckle effectively.

However, a mother must learn how to position and guide each baby to the breast, so babies can use those inborn reflexes and remove the milk naturally occurring within days of birth. If you haven’t seen a lot of babies breastfeed before, give yourself time to learn how to position and guide one or two babies to breast.

Expect glitches. Expect it to be hard at times since you have two, three or more times the normal number of babies breastfeeding. Don’t be surprised if breastfeeding gets mixed up with issues that are really about having multiple babies than about the breastfeeding itself.

As with any new job skill, there is a “learning curve.” It takes time to learn and become adept. Be patient with yourself and with the babies. Give yourself and your babies time and, before long, you will be telling everyone how much easier it is to breastfeed.

top^

6. How will I know if each baby is getting enough milk?

Although you don’t have ounce (or milliliter) markings on your breasts, breastfed babies let you know when they are getting enough. By the end of the first week after birth, each effectively breastfeeding newborn will in 24 hours:

a) Wake on his/her own and cue to feed at least 8 to about 12 times and eagerly breastfeed for about 10 to 30 minutes
b) Soak 6 or more diapers with urine
c) Pass 3 or more stools of at least a USA quarter in quantity and size
d) Gain at least ½ oz (15 mg).

The information in letters a) through d) are known as “outcomes.” The easiest way to keep track of each baby’s outcomes is to mark a single-sheet, checklist feeding chart. (Since outcomes are slightly different for the first week, you may also want a first-week chart.) Keep babies’ charts separate by copying on different-colored paper for each baby’s chart, or write each baby’s name in large letters at the top of each chart. Make enough copies of each baby’s chart to last a week or two. (Copying charts may be a good task for Dad or someone else to do for you.)

After 4 to 6 weeks, some fully breastfed babies pass stool less often. Some babies “drop” a breastfeeding after reaching 3 to 6 months. Babies may breastfeed more quickly as they reach the middle of their first year. Your pediatric care provider will be monitoring their individual weight gain and growth patterns. Research has shown that the weight-gain pattern for fully breastfeed babies differs somewhat from formula-fed babies, so be sure the healthcare provider is monitoring their weights on a chart designed for breastfed babies. Growth charts for fully breastfed babies are available at the CDC web site.

top^

7. How will I know if any of my babies is not breastfeeding “effectively”?

Signs that one or more babies may not yet be breastfeeding effectively – not removing milk well from your breasts – include the baby that:

a) Does not wake and cue to feed at least 8 times, or one that usually cues more than 14 times, in 24 hours

b) Has difficulty opening his/her mouth wide and latching deeply back on the areola – well behind the nipple tip

c) Drifts to sleep within a minute or two after latching on and/or does not keep suckling for at least 5 minutes

d) Often takes more than 30 or 40 minutes to feed

e) Frequently is not satisfied after long feedings and acts hungry again in less than 20 to 30 minutes after seeming to finish a feeding

f) Does not produce the wet and dirty diaper, and weight gain outcomes, b) through d), listed in Question 6 by the end of the first 7-10 days postpartum.

The development of painful or damaged nipples/breasts also is a sign that a baby may not be breastfeeding effectively. Although it may be “normal” for nipples to feel a bit tender during the first week or two of breastfeeding, really painful or damaged nipples are NOT normal! When pain occurs or the nipple looks raw or cracked, consider it a sign that something is not right. Breastfeeding should not be painful. Do NOT ignore painful or damaged nipples/breasts.

If you think something may “wrong” with breastfeeding, trust your instincts. But realize these “signs” do not mean there is a definite problem; they are simply indicators, or “red flags,” that something may not be working as well as it should. A sign means parents should keep a closer eye on the way one or more babies breastfeeds. (Here is where those checklist charts come in handy!) Let the babies’ healthcare provider know if you are concerned, since ineffective breastfeeding may mean a baby is not yet able to get all the milk he/she needs via direct breastfeeding.

It’s also a good idea to contact a LC or a breastfeeding-support-group leader when ineffective breastfeeding is suspected. Often a LC or support leader can help a mother make minor adjustments to breastfeeding that “fix” the problem. Sometimes additional intervention is needed, and they will have some helpful ideas. Still, ineffective breastfeeding is usually a short-term issue, especially when a mother seeks help early.

top^

8. When should I start to breastfeed two babies at once?

The answer is “it depends”! Both mother and each baby play a role in the simultaneous feeding decision. Some mothers want the closeness of individual feedings and never breastfeed two babies together. Others always breastfeed simultaneously and do so from the day their babies are born. Many mothers find simultaneous feedings difficult to manage in the early days or weeks after birth, but later they rarely breastfeed any other way; other mothers find simultaneous breastfeeding easier initially, yet they stop as babies get larger and heavier. Some older infant or toddler multiples won’t begin to feed until they hear/feel another multiple at the other breast; others become too distracted when another multiple is at breast.

There is no rush to start simultaneous breastfeedings with two babies at once. It is probably best to wait until you feel sure that at least one baby is latching on and suckling well, which means at least one is able to breastfeed effectively. So feed your babies one at a time until a LC, nurse or pediatrician can watch each one breastfeed. Although simultaneous feeding can save time, it will not save you time or trouble if one or more babies have difficulty latching or suckling, which may result in one or more babies not getting enough milk and you developing sore or damaged nipples. If you or your babies aren’t ready to breastfeed together, don’t worry. You’ll get there.

Go to Simultaneous Feeding Positions for ideas on positioning and using different kinds of pillows. A special breastfeeding pillow is not always a necessity; many mothers find bed or sofa pillows easier to work with and less expensive. Other mothers swear by a special nursing pillow – initially and/or long term. If using a nursing pillow, it should have a wide top “shelf” area that goes all the way around your abdomen. Contoured nursing pillows rarely provide the room or support needed for feeding two at once. Mothers often recommend the EZ-2-Nurse and Womb Mate pillows designed for feeding two babies at once.

top^

9. Should babies switch breasts or always feed on the same one?

Again, the answer is “it depends,” and almost anything can work. However, most mothers switch babies and breasts, because breasts are less likely to look or feel lopsided. Switching may also provide babies with optimal eye stimulation. And, if one baby ever can’t or won’t breastfeed for a few days for some reason, switching ensures that the second multiple breastfeeds (and removes milk) from both breasts until the other baby is back to breast.

To simplify the process, many mothers switch breasts only every 24 hours – baby A breastfeeds only on the right breast and baby B only on the left for today, but tomorrow baby A breastfeeds only on the left and baby B only on the right. This switching routine can also be used for quadruplets. For odd-numbered multiple sets, baby A may breastfeed only on the right breast, baby B only on the left and baby C on both breasts for several hours and then switch. (Some mothers rotate who gets which breast[s] with every feeding.)

Sometimes one multiple seems to “prefer,” or feeds much better on, a particular breast. Occasionally, switching breasts seems to contribute to digestive upset for one multiple, and “assigning” each a particular breast for all feedings alleviates the symptoms of discomfort. It usually works better if assigning a particular breast is the babies’ decision rather than having mom assign each baby a breast arbitrarily. Preference, or the need to assign for digestive reasons, tends to occur more often when multiples are fraternal, or dizygotic, and have very different styles of behavior, including feeding behavior.

top^

10. Can I breastfeed if I have to take medications?

Many medications are considered compatible with breastfeeding. Such medication may pass into milk in extremelysmall quantities or may pass through baby’s GI tract without much being absorbed into the baby’s system, and so on. Even when there is concern about a medication, such as when there is limited research about how a particular medication passes into mothers’ milk or how it is absorbed, it may be possible to watch babies for side effects. Only a few medications, or types of medication, are considered as completely unsafe or incompatible with breastfeeding, and compatible alternative medications often are available. It is usually possible to treat a mother’s health condition and continue breastfeeding.

When there is concern about a medication that your healthcare provider prescribes, it is important to weigh the well-known, long-term benefits of your milk and any known or theoretical side effect(s) of a medication with the risks of infant formula. Talk to your prescribing care provider, your babies’ pediatric care provider, and a lactation consultant to find information and arrive at a solution that meets both your needs and those of your babies.

top^

11. Can I breastfeed multiples if I have small breasts? Large breasts?

Breast size is NOT a good predictor of how well or how much milk a woman can produce. “Working” breasts and nipples-areola come in all shapes and sizes. Many small-breasted women have fully breastfed twins and triplets as have women with larger or pendulous breasts. A LC or nurse should be able to offer suggestions if your anatomy is not an exact or easy “fit” for positioning or latching your babies!

top^

12. Can I breastfeed twins (or more) if I wasn’t able, or didn’t choose, to breastfeed my previous child/children?

Of course, you can. Many women have breastfed multiples after formula-feeding a previous child. Actually, these mothers often become the biggest cheerleaders for breastfeeding once they learn they have nothing to buy, clean, prepare, heat, etc.! Although previous experience may add a bit of confidence initially, it definitely is not a requirement when it comes to breastfeeding these babies, and you will gain confidence as you and your babies learn to work together.

Only a few mothers are not “able” to breastfeed. If you were told this or thought you weren’t able to breastfeed a previous baby, go over your breastfeeding history with a LC or an experienced breastfeeding-support leader. In the meantime, your breasts are “preparing” to produce milk for these babies, as they would during any singleton pregnancy. If you previously gave birth when medication was given to “dry up” a mother’s milk, don’t worry. The medication will have no effect on breastfeeding after this pregnancy.

top^

13. Is it fair to my other child/children if I have to spend a lot of time breastfeeding twins (or more)?

Your role in the early development of each multiple is just as crucial as it was with their older brother(s) or sister(s). Your older single-born child/children had you and your milk all to himself/herself for months to years, but your multiples will never have Mom to themselves; they must always share you with others. Also, multiples are more likely to be born prematurely or in a stressed condition – even when full term – so your milk is especially important for them. Perhaps the question should be, is it “fair” to deprive this little duo, trio, quartet, etc. of your milk and as much time in your arms as possible simply because you have an older child?

This is not to imply that an older child does not still need your love and attention or that the older child is not going face an adjustment period, but he/she is older developmentally than the multiple siblings and better able to let others help care for him/her. There is a chapter devoted to this topic in Mothering Multiples and in Keys to Parenting Multiples.

top^

14. Will I need a breast pump?

This is another “it depends” answer. If multiples are born near full term and breastfeed effectively, there is no need to express milk. Manual (hand) expression or an effective, hand-held pump usually suffices if you want milk for an occasional “relief” bottle. However, because multiples are more likely to be preterm or sick at birth, even when close to full term, effective breastfeeding is more likely to be an issue initially. Then the use of a hospital-grade, electric breast pump with a double “kit,” which allows you to pump both breasts at once, is usually the most efficient and effective way to remove milk. A mother that is returning to paid employment, or one who regularly complements (tops off) or supplements direct breastfeeding with mother’s own milk from a bottle is also likely to find the use of a self-cycling, electric breast pump the most efficient and effective method for maintaining milk production.

top^

15. What kind of pump should I get?

It depends on why you use a pump. Not all pumps are created equal. A pump that may be great for maintaining milk production after lactation is well established, may not be a good choice if establishing milk production for preterm or sick newborns during the immediate postpartum period. A pump that works well to provide the occasional “relief” feeding may not be at all what is needed for frequent milk expression at one’s workplace. Also, whether a mother’s needs are for a small hand-held manual model or a self-cycling electric, some pumps are more effective than others. Before renting or purchasing a breast pump, discuss the pros and cons of specific pumps with a LC or a breastfeeding-support leader. Then, consider the source of the pump. When a manufacturer’s primary products are breast pumps, a company may have more incentive to make effective pumps than a company producing breast pumps as a sideline or one that is associated with an infant formula company.

top^

16. Does breastfeeding have to be “all or nothing” or can I partially breastfeed?

Sure, you can partially breastfeed if that is what works in your situation. Different MOM coordinate partial breastfeed in different ways. For many MOM, partial breastfeeding includes direct breastfeeding, plus occasional or daily feedings of mother’s expressed breast milk (EBM) via a bottle or other feeding device. Other MOM breastfeed but offer infant formula as either an occasional or daily substitute(s) after breastfeeding first or instead of a breastfeeding.
Partial breastfeeding is definitely better than no breastfeeding at all! One study found the amount of breastfeeding (or human milk) babies received, and the incidence of ear infection and diarrhea formed an inverse proportion. This means the more mothers’ milk these babies received, the less episodes of illness reported; the less mothers’ milk they received, the more episodes of illness reported.

No use beating around the bush – exclusive/full breastfeeding, followed by human-milk-feeding, is BEST for babies. Still, your milk in any amount is much better for your babies than formula alone, and your babies benefit highly when your milk is part of their diet. Partial breastfeeding IS worth it for all of you. Talk to a LC or breastfeeding support leader to develop a partial breastfeeding routine that is likely to maintain adequate milk production.

top^

17. Can I just pump and give my babies my milk only from a bottle?

Of course, you can do that, and a growing number of MOM are doing just that. You may hear this option referred to as human-milk-feeding or breast-milk-feeding. Many MOM fully provide for their babies with their milk for several months and continue to partially human-milk-feed as solid foods are introduced. If two or more babies have a lot of difficulty learning to breastfeed, usually after being born very early, MOM sometimes choose this option for the short or long term. MOM have directly breastfed one (or two) and human-milk-fed one that continued to have difficulty transitioning to direct breastfeeding or had a condition interfering with direct breastfeeding, such as a cleft palate, Down syndrome, etc. (However, many babies with Down syndrome breastfeed very well!) Some mothers simply decide not to breastfeed directly, yet they want their multiples to have the benefits of their own milk. And there are MOM whose babies moved to direct breastfeeding after weeks or months of human-milk-feeding. This option leaves all breastfeeding options open.

In general, expressed human milk retains the nutritional and immunological benefits of direct breastfeeding, although cooling and reheating expressed milk slightly affects a few of its properties. Also, we know a mother’s milk adapts over time as her babies grow and change, but we don’t know exactly how or why. So, we don’t know if this adaptation is affected in any way by direct breastfeeding versus long-term pumping. To summarize, although direct breastfeeding is best, human-milk-feeding your milk beats any and all other alternatives! And, as long as you pump and human-milk-feed your babies, you leave the door open to direct breastfeeding if you or your babies later change your minds.

top^

18. Where can I go for help?

Check the information you received when you were discharged from the hospital. Often hospitals provide a discharge booklet containing local resource numbers, such as their in-hospital LCs, community private practice LCs, LLL or other breastfeeding-support group leaders, etc. If you did not receive this information, contact the hospital where you gave birth. You may also go LLL’s web site and search for local leaders by country and then by smaller areas at La Leche League International. To find a lactation consultant anywhere in the world, go to the International Lactation Consultant Association or the International Board of Lactation Consultant Examiners. Help is available!