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TAMBA - practical preparation for parenthood

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TAMBA - practical preparation for parenthood

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Support for twin families

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Twins UK - dedicated to families with twins, triplets, quads. Specialist products and information helping make life with multiples easier and more enjoyable. Home of Twin Tips

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Mindful Mamma support twin hypnobirthing

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Product Description

This hypnobirthing mp3 Download set will help you prepare for a twin or multiple birth. There are two sets of affirmations, one for pregnancy and birth taken from the book'Mindful Hypnobirthing' by Sophie Fletcher. There is also the popular meadow relaxation recorded for twin birth. Please note, do not listen to them whilst driving.

Track Listing

Guide to using Twin Birth mp3

Pregnancy Affirmation

Birth Affirmations

Preparing for Twin Birth

Meadow Relaxation

Please be aware that if you looking to purchase any of our tracks from outside of the United Kingdom but within the EU you will need to contact us directly.

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Twin Birth Hypnobirthing mp3 Download - Mindful Hypnobirthing

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This hypnobirthing mp3 Download set will help you prepare for a twin or multiple birth. There are two sets of affirmations, one for pregnancy and birth taken from the book'Mindful Hypnobirthing' by Sophie Fletcher. There is also the popular meadow relaxation recorded for twin birth. Please note, do not listen to them whilst driving.

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Premature Birth - Information and Support

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Premature Birth - Information and Support

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one mother's story of her twins' birth

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We are the UK’s leading charity for parents, for your First 1,000 Days - right through your pregnancy, birth and beyond.

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Postnatal Depression - a guide for mothers of multiples

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Postnatal Depression - a guide for mothers of multiples

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Twins and Multiple Birth Association (TAMBA)

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Twins and Multiple Birth Association (TAMBA)

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A resource for information and support, also a great way to meet other parents of twins and multiples

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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an article from the NCT

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to having a single baby.

If the first baby is in a head down position, it's usual to consider having a vaginal delivery. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications.

Your babies' positions may determine whether they should be delivered by caesarean section. If the presenting (first) baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some other conditions might also mean you will need a caesarean section, for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section with twins.

Even if you plan a vaginal delivery, you may end up having an emergency caesarean section. This could be because

the babies become distressed,

the cord prolapses (when the cord falls into the birth canal ahead of the baby),

you have high blood pressure,

the labour is progressing slowly,

an assisted delivery doesn't work.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if the baby becomes distressed. This occurs in less than 5% of situations when twins are born.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba's website if you register.

NHS choices also provide information on delivering twins.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early. People often assume that if you are expecting more than one baby they must be born by caesarean section.

# data[].attributes.body
an article from the NCT

# data[].attributes.attachment_link.readable_text
It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to having a single baby.

If the first baby is in a head down position, it's usual to consider having a vaginal delivery. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications.

Your babies' positions may determine whether they should be delivered by caesarean section. If the presenting (first) baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some other conditions might also mean you will need a caesarean section, for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section with twins.

Even if you plan a vaginal delivery, you may end up having an emergency caesarean section. This could be because

the babies become distressed,

the cord prolapses (when the cord falls into the birth canal ahead of the baby),

you have high blood pressure,

the labour is progressing slowly,

an assisted delivery doesn't work.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if the baby becomes distressed. This occurs in less than 5% of situations when twins are born.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba's website if you register.

NHS choices also provide information on delivering twins.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early. People often assume that if you are expecting more than one baby they must be born by caesarean section.

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Twins, Triplets and More - The First Year

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Twins, Triplets and More - The First Year

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The best available evidence about twin birth

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In this article

Will I have to give birth in hospital if I'm expecting twins or more?

Nearly all women expecting twins or more give birth in a consultant-led hospital unit. Your obstetrician and midwife are likely to advise you that this is the safest place for you to have your babies. However, much depends on your circumstances and how your pregnancy is going.

Your hospital will have worked out its own policy on twin births, taking into consideration national guidelines. These guidelines recommend a planned (elective) birth for twins or more.

A planned birth is one where:

(NCCWCH 2011b, NICE 2011, RCOG 2008)
Hospital is the only place where you can have these types of birth.

A planned birth also means that your obstetrician will recommend a date for your labour to be started or for your babies to be born by c-section. She should discuss the timing of your babies' birth with you early in your third trimester.

Your obstetrician will take into account whether your twins share a placenta (monochorionic) or each one has their own placenta (dichorionic) when recommending a date for them to be born.

National guidelines recommend a planned birth for:

Dichorionic twins from 37 weeks.

Monochorionic twins from 36 weeks.

Triplets from 35 weeks. Mums expecting triplets will be offered a course of steroids to help their babies' lungs develop before they're born.

It's safest for babies who share a placenta to be born in hospital, where specialist medical care is at hand. And even if your twins have their own placentas, there are still potential risks that could make birth difficult (McAslan Fraser 2012, NCCWCH 2014, NHS 2014).
In any birth of multiples, there's a greater likelihood of heavy bleeding for the mum after the birth (NCCWCH 2014). Newborns often need immediate help after birth too. Just under half of twin babies and nearly all triplets need to spend some time in special care (NHS 2014, Tamba 2012).

All these reasons point to why you're most likely to have your babies in hospital. But, ultimately, the decision is yours. Talk to your midwife or obstetrician about your birth options, in the context of how your pregnancy is going. You could also make an appointment with the head of the labour ward or the supervisor of midwives or midwifery advocate at your hospital to discuss your preferences.

If you opt for a hospital birth, check out these ways to make your room comfortable for labour.

Do I have to have a planned birth with twins?

Despite hospital policies and national guidelines, it's up to you to decide where and when to give birth.

If your twin pregnancy has been without complications, and your babies don't share a placenta, it is possible to wait for your labour to start naturally. This could also open up the option of giving birth at a birth centre or at home. You'll need to plan this well in advance with your obstetrician and midwifery team.

National guidelines recommend planned birth for all twins because, in complicated pregnancies, it reduces the risk of one or both of the babies being stillborn.

However, for uncomplicated twin pregnancies, it's not clear whether planned birth by induction or caesarean is better for mums and babies than waiting for labour to start naturally (Hofmeyr et al 2011, NCCWCH 2011a).

If your babies are healthy and growing well, and you want to wait for labour to start naturally, your obstetrician should support you. It's an individual decision, and some parents consider a wide range of issues when weighing up what to do, including:

how well mum is coping with the pregnancy

how they feel about interventions during labour and birth

how likely it is that a caesarean will be needed

whether opting for a planned birth would affect the mum's chosen place of birth

If you decide against an induction or planned caesarean, you'll need weekly checks with your obstetrician to ensure that you and your babies are healthy.

What are my chances of having a vaginal birth with twins?

If both your twins are growing well and you've had no complications during your pregnancy, you may be able to have a vaginal birth (MBF 2010, RCOG 2008). About four out of 10 twins are born vaginally (NCCWCH 2011a, Redshaw et al 2011).

Some hospitals insist on a mum giving birth by caesarean if she's carrying identical twins who share a placenta (RCOG 2008).

Ask your midwife or obstetrician what your hospital's policy on twin births is, and whether any of the maternity team has experience of vaginal twin births. Ask them to explore thoroughly the risks and benefits of vaginal birth with you (Hofmeyr et al 2011, NCCWCH 2011a), taking into account your circumstances (MBF 2010, RCOG 2008).

The position of the twin that's likely to be born first will have a big influence over the type of birth you have (NCCWCH 2011a, RCOG 2008). If your first twin is in a head-down position, you may be able to have a vaginal birth (NCCWCH 2011a).

It's likely that your second baby can then be born vaginally too. Once your first baby is born, there'll be more space in your womb (uterus). So if your second baby is in a breech position or lying across your cervix, your obstetrician can turn her into a head-down position.

Your obstetrician may move your baby by palpating your belly in a manoeuvre called external cephalic version (ECV). Alternatively, she may be able to insert her hand through your fully open cervix to reach your second baby.

Attempts to turn a second twin are usually successful. In less than five per cent of cases, the second twin needs to be born by caesarean (NHS Choices 2014, NCCWCH 2011a).

What's a vaginal twin birth like?

Because you're giving birth to more than one baby, there'll be more health professionals in the room than there would be for a singleton birth.

The medical team may include two midwives, an obstetrician and, as your babies' birth approaches, two paediatricians and possibly two neonatal unit nurses, one for each baby (McAslan Fraser 2012, NHS 2014).

Your midwife will offer you pain relief such as gas and air and pethidine.

It's likely you'll also be offered an epidural or to have one set up, along with a needle in a vein in your arm (a drip). Having an epidural and a drip set up means you can have your pain relief topped up quickly if you need an assisted birth or a caesarean later on (NHS 2014).

It's worth discussing your pain relief options with your midwife during pregnancy. You can then include your preferences in your birth plan (McAslan Fraser 2012).

Keep in mind that labour and birth are unpredictable, though. Your midwife or doctor may recommend a course of action at any time that isn't what you'd hoped for, but which will always be in the best interests of you and your babies.

During labour, expect to have your babies monitored with electronic fetal monitors (EFM) (NHS 2014). This is standard practice for multiple births.

Your midwife will strap a belt with sensors attached to wires around your belly. The sensors pick up your babies' heartbeats and the intensity and frequency of your contractions. You will need to have two belts to pick up each twin's heartbeat.

Once your waters have broken, your midwife may ask your permission to attach a wire to the top of your first twin's head. At this stage, your baby's head will be showing through your widening cervix (McAslan Fraser 2012, NHS 2014). The wire is called a fetal scalp electrode, and it's a clearer way to measure your baby's heartbeat.

When you're ready to push, your obstetrician may ask to move you to the operating theatre (McAslan Fraser 2012), in case you need an assisted birth. Some hospitals have a policy of carrying out assisted births in a theatre setting (McAslan Fraser 2012, NCCWCH 2011b). You'll also be in the right place in the unlikely event you need a c-section to give birth to one or both of your babies.

Once your first baby is born vaginally, your midwife or doctor will check the position of your second twin by:

feeling your tummy

asking your permission to do a vaginal examination

carrying out an ultrasound scan (McAslan Fraser 2012)

If your second baby is in a good position to be born, your midwife or obstetrician will break the waters surrounding him. Your second baby is likely to be born very soon after your first, because your cervix is already fully open (dilated) (McAslan Fraser 2012, NHS 2014).
If your contractions stop after your first twin is born, your midwife will add hormones to the drip to restart them (McAslan Fraser 2012, NHS 2014).

Once you've given birth to your babies, you'll deliver the placenta or placentas. This is the third stage of labour. Your midwife will recommend that you have a managed third stage, when delivery of the placenta or placentas is helped along with a injection that helps your womb to contract strongly.

Your midwife will give you this by an injection in your thigh or via an intravenous drip, soon after you've given birth to your second baby. The hormone helps to protect you against heavy bleeding. There's an increased risk of bleeding when the placenta is larger, and because your womb has been stretched by two babies (McAslan Fraser 2012, NHS 2014).

It should still be possible to have delayed clamping of each umbilical cord, whether your babies are born vaginally or by caesarean. Delayed cord clamping means that your babies can benefit from the extra blood that pulsates from the placenta (Liu et al 2017, Ruangkit et al 2015). Ask your midwife or doctor if this is supported at your maternity unit and add it to your birth plan if you want to ensure it happens.

Why might I have to give birth by c-section with twins?

Your babies will have to be born by caesarean if the placenta or one of the placentas is covering the opening to your cervix ( placenta praevia) (NCCWCH 2011a). Placenta praevia is case where a vaginal birth is not possible.

In addition, you may be advised to have a planned caesarean if:

You've had a caesarean before (McAslan Fraser 2012, NCCWCH 2011, RCOG 2015).

You've had a difficult or complicated birth before (McAslan Fraser 2012).

You've had a complication during your pregnancy, such as one or both of your twins are not growing as well as expected (MBF 2010).

Your twins share a placenta and an amniotic sac (monochorionic monoamniotic). A caesarean is recommended because of the risk of your babies' umbilical cords becoming tangled during vaginal birth (MBF 2010, RCOG 2008).

You may go into labour, but still need to have an unplanned caesarean if:

There is a complication with your labour, such as your twins moving into an awkward position (McAslan Fraser 2012).

One or both of your babies have become distressed during labour (McAslan Fraser 2012).

Your labour is slowing down (McAslan Fraser 2012, NCCWCH 2011a).

You have high blood pressure or pre-eclampsia that doesn't respond to treatment (McAslan Fraser 2012).

The cord falls through your cervix ahead of your baby or babies (prolapse) (McAslan Fraser 2012, NHS Choices 2014).

What can I do to avoid a caesarean?

Try to stay as fit and healthy as you can during pregnancy, as this will help you to cope with labour when the time comes (NHS 2015). Try to stick to a gentle exercise programme throughout your pregnancy.

Be as active during labour as possible. Keeping mobile may improve your chances of avoiding a caesarean (Lawrence et al 2013).

However, this may be a challenge in a twin birth, as fetal monitoring can restrict you physically. Some hospitals have mobile monitors that allow you to move around freely.

Having a birth partner to give you continuous support while you're in labour may reduce your chances of having an unplanned caesarean (NCCWCH 2011a). You'll need good, solid support from the moment your labour starts. You could ask your partner, a friend, a relative, or a doula to take the role.

Have a look at this infographic, which summarises the risks and benefits of giving birth by caesarean section if you're expecting twins.

References

Hofmeyr GJ, Barrett JF, Crowther CA. 2011. . Planned caesarean section for women with a twin pregnancy. Cochrane Database of Systematic Reviews (12): CD006553. onlinelibrary.wiley.com [Accessed October 2015]

MBF. 2010. Monochorionic twins: information for parents when twins share one placenta. Multiple Births Foundation. www.multiplebirths.org.uk [Accessed May 2016]

Lawrence A, Lewis L, Hofmeyr GJ, et al. 2013. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews (10): CD003934 onlinelibrary.wiley.com [Accessed May 2016]

Liu et al. 2017. Use of delayed cord clamping in preterm dichorionic twin gestations. Obstet & Gynecol 129

McAslan Fraser E. 2012. Expecting twins, triplets or more: the healthy multiple pregnancy guide. Tamba (Twins & Multiple Births Assocation). www.tamba.org.uk [Accessed May 2016]

NCCWCH. 2011a. Caesarean section. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed May 2016]

NCCWCH. 2011b. Multiple pregnancy: the management of twin and triplet pregnancy in the antenatal period. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed May 2016]

NCCWCH. 2014. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.uk [Accessed May 2016]

NHS. 2014. Giving birth to twins or more. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2016]

NHS. 2015. Exercise in pregnancy. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2016]

NICE. 2011. Information for the public: antenatal care for women who are pregnant with twins or triplets. National Institute for Health and Clinical Excellence. www.nice.org.uk [Accessed May 2016]

RCOG. 2008. Management of monochorionic twin pregnancy. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 51. www.rcog.org.uk [Accessed May 2016]

RCOG. 2015. Birth after previous caesarean. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 45. www.rcog.org.uk [Accessed October 2015]

Redshaw M, Henderson J, Kurinczuk JJ. 2011. Maternity care for women having a multiple birth. Oxford: NPEU. www.npeu.ox.ac.uk [Accessed May 2016]

Ruangkit C, Moroney V, Viswanathan S, et al. 2015. Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - a quality improvement study. J Neonatal Perinatal Med 8(4):393-402.

Tamba. 2012. Tamba twins & multiples healthcare survey: making progress. Twins and Multiple Births Association. www.tamba.org.uk [Accessed May 2016]

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In this article Nearly all women expecting twins or more give birth in a consultant-led hospital unit. Your obstetrician and midwife are likely to advise you that this is the safest place for you to have your babies. However, much depends on your circumstances and how your pregnancy is going.

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Sprogcast is a podcast about pregnancy, birth and parenting by midwife Mark Harris and Childbirth Educator Karen Hall, this one features independent midwife Virginia Howes talking about risks and possibilities for normality when giving birth to twins and doula Mars Lord discussing her experiences as a mother of twins and specialist twin doula

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Sprogcast - Episode 11 - Twins (March 2016) by Pinter & Martin

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Hosted by Karen Hall and Mark Harris, with midwife Virginia Howes and doula Mars Lord

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs.

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TAMBA - the healthy multiple pregnancy guide

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TAMBA - the healthy multiple pregnancy guide

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Royal College of Obstetricians and Gynaecologists - Multiple Pregnancy

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Royal College of Obstetricians and Gynaecologists - Multiple Pregnancy

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Royal College of Obstetricians & Gynaecologists

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Published: 16/11/2016

This information is for you if you know you are carrying more than one baby. It may also be helpful if you are a partner, relative or friend of someone in this situation. It focuses mainly on twins but it is relevant to any pregnancy where more than one baby is expected. It tells you about:

the different types of multiple pregnancy

what it means for you and your babies

the care you will receive while you are pregnant

the options for birth so that you can make an informed choice

where to find further advice and support

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Multiple pregnancy: having more than one baby

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Published: 16/11/2016 This information is for you if you know you are carrying more than one baby. It may also be helpful if you are a partner, relative or friend of someone in this situation. It focuses mainly on twins but it is relevant to any pregnancy where more than one baby is expected.

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Expressing Milk Before Your Babies Arrive

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Expressing Milk Before Your Babies Arrive

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Some mothers, including those expecting twins, may find it helpful to express colostrum before their babies are born. This helpful article from the Association of Breastfeeding Mothers explains why and how.

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts.

Mothers are normally advised to wait until around 36 weeks before starting antenatal expression. Mums who are having multiple births may sometimes start sooner as giving birth earlier is more likely.
Why do it?
For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

Colostrum contains vital immunological properties and helps to colonise the baby's gut with healthy bacteria that protect against allergy and disease.

It also contains the perfect balance of proteins, fats and micronutrients needed for human babies as well as acting as a laxative to help the passing of the first tarry meconium stools.

Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and therefore may require supplementary feeds.

These include babies:

whose mother had diabetes in pregnancy or who has a history of diabetes.

with a cleft lip or palate identified during pregnancy.

with congenital conditions e.g. Down syndrome or cardiac complications.

diagnosed with intrauterine growth restriction.

whose mother is taking beta blockers to control high blood pressure.

who are twins or triplets.

Where there is a family history of cow's milk protein sensitivity or type 1 diabetes, families may be particularly keen to avoid the use of early formula supplementation.

Some women may need to consider supplementing feeds from an early stage if there are concerns over their ability to make and/or secrete milk.

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

It is important for a mother to discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies, or have a surgical stitch, for example.

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect. A pump at this stage is likely to be more uncomfortable than gentle hands. Try hand expressing for a few minutes, 2 or 3 times a day.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth. Your health care provider may be able to supply you with sterile syringes.
How to hand express:

Always wash your hands before expressing.

Applying a warm compress to your breast or expressing after a warm bath or shower can help the flow of colostrum.

Get yourself comfortable. Perhaps seated and leaning slightly forward but find what works best for you.

Start with a gentle breast massage, stroking from the back of your breast towards the nipple to encourage the let-down reflex.

Put your thumb above the nipple and your first few fingers below the nipple. You will be cupping the breast in a 'C' shape.

With your thumb and fingers, feel a few centimetres back from the nipple.

Press back towards your chest, then compress (press your fingers together), and release.

Repeat this process, building up a rhythm. Press, compress, release.

It may be useful to look online for videos of hand expression techniques.

Colostrum should start to arrive drop by drop. Initially it may just be a glisten on the end of your nipple, and it may take a few days of practice before drops appear.

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe). If nothing happens, adjust your finger position slightly to find the spot that works for you. Try not to pinch your nipple or slide your fingers uncomfortably over the skin.

Rotate the position of your fingers and thumb around the areola (imagine a clock face) and repeat the expressing process to stimulate and remove colostrum from different parts of your breast.

Express each breast twice during each session.

Colostrum can vary in appearance. Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner. Expressing colostrum antenatally will not decrease or increase your milk supply after baby is born.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

At the end of the collecting day, the colostrum can be frozen - place the syringe into a zip-lock bag before putting into the freezer. Label the syringe and bag (separately) with the date and time of when you expressed.

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.
Is it safe?
The oxytocin hormone released when expressing, stimulates the uterus. Opinions differ on whether expressing colostrum antenatally is likely to induce labour. Those who advocate it do not believe that expressing would constitute sufficient stimulation to start labour. Sex while pregnant and breastfeeding through pregnancy both release oxytocin and both are generally considered safe while pregnant. If you experience any cramping in your uterus however, you should stop expressing and discuss your choice with your healthcare provider.
Transporting your frozen colostrum
You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

It's a good idea to mention your colostrum stores on your birth plan and make sure staff are aware in advance of your wishes in certain situations. The hospital may have access to a freezer for storage once you arrive.

After the birth, breastfeeding should usually be unrestricted. Ideally, a baby should feed successfully at the breast and the antenatally expressed colostrum would remain unused.

If your baby is experiencing difficulties with breastfeeding at this time, you may be encouraged to express some fresh colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you in preference to using any formula.

If harvested colostrum ends up being 'wasted' because you are able to establish early exclusive breastfeeding, this is a cause for celebration rather than commiseration!

The process of antenatal expressing however, gives you a back-up if things don't go to plan which many families find reassuring. You'll also start your breastfeeding with a good sense of how to hand express and confidence about how your breasts work.

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Expressing your milk before your baby arrives - ABM

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts. Mothers are normally advised to wait until around 36 weeks before starting antenatal expression.

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Parents.com partnered with the American Institute of Ultrasound Medicine (AIUM) to create this unique peak into a baby's development inside the womb. These images reveal all the intricate details of a baby's growth -- from a collection of cells to a full-term newborn. While most women may only receive one or two ultrasounds during pregnancy, which is normal, this slideshow of the 3rd trimester of pregnancy gives you a look at each week of development.

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Twin Fetal Development: A Closer Look at Your Developing Babies

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Parents.com partnered with the American Institute of Ultrasound Medicine (AIUM) to create this unique peak into a baby's development inside the womb. These images reveal all the intricate details of a baby's growth -- from a collection of cells to a full-term newborn.