Can I produce enough milk for more than one baby?
Yes you can. Breastmilk production is based on a system of supply and demand. The more you nurse, the more milk will be produced. In addition, it is known that mothers of multiples produce significantly more milk than mothers of singletons. A study published in the British Journal of Nutrition in 1986 indicates that during the first four months of life a mother of one infant produces 600-800 ml of breastmilk per day, while a mother of twins is thought to produce 1000-2000 ml in the same time period. (Saint,L, et al. BJ Nutr; 1986; 56:49-58.) There are rare instances where you might not produce enough milk, but if you nurse early and frequently, avoid supplementation if possible and follow the basic guidelines for establishing and maintaining a good milk supply you shouldn't have a problem. If you do think your babies aren't getting enough, you need to get help. Fast.

My doctor told me that I am at high risk for premature delivery. Since my babies will likely be in the NICU for awhile, I should probably just plan to formula feed them right?
Absolutely not! If your babies are premature, it is crucial that they recieve your milk. Your body makes the perfect preterm milk that your babies need. You are the only one who can give this to your babies and any extra effort it takes on your part will benefit your babies in many ways.

• No formula can possibly mimic this special preterm milk that your body is producing.
  
  
• Preterm milk provides more protein, energy, calcium and several vital minerals than full term breastmilk.
  
  
• When infants are born prematurely, they often miss out on the usual placental transfer of calcium, iron, and immunoglobulins that occurs in the third trimester. Your breastmilk is the only way for your baby to get the immunoglobulins that she needs to help her fight off illness and infections.
  
  
• More information on this topic, including the numerous benefits for your baby and yourself, is available in the Breastfeeding the Premature Infant section.

How in the world will I be able to feed two babies or even 3 or 4? I only have one lap and 2 hands!
Well, chances are you might need some help figuring out how to do this. Once you have learned some basic positions and feel comfortable with them it will come naturally. Obviously, you can only hold two babies at once, but beyond that basic limitation, the options are almost endless! You might find that a nursing pillow designed for twins is essential.

Here are several options:

• Both babies in football/clutch hold
  
  
• One baby in the football hold and one in the cradle hold
  
  
• A parallel hold with the babies angled in the same direction, the first in a cradle hold and the second resting her head on the first's legs for support
  
  
• A criss-cross hold involves each baby being in the cradle position with their legs crossing over one another.
  
  
• You will quickly discover which positions work best for you and you may even develop your own unique position!

Got it. But who gets which side and when?
I'm not going to lie. If you have twins, this really isn't too difficult but if you have more than two it can be a bit of a juggling act! Let's say you have two babies to feed.

• Each baby can have his or her own special side. A couple of advantages to this system are that it's easier for you to keep track of and each breast will produce the exact amount of milk that each baby needs. One disadvantage is that you may have slightly lopsided breasts if the babies don't feed equally. Most women have slightly lopsided breasts anyway, so don't worry too much about this!
  
  
• If you alternate breasts, your milk supply will be more even. If you have one baby that is a more vigorous feeder, she will help maintain an adequate supply in both breasts. Vision development may be slightly enhanced when your infants are switched from side to side. Lastly, If you are having a problem with sore nipples and it is being aggravated by the nursing style of one of your babies, alternating breasts for feedings may allow more healing time in between the feedings of your "heartier" nurser.
  
  
• You can feed both babies at once, or seperately. If you feed them together, it cuts down on the amount of time you will spend nursing. This is especially nice at night. When one baby wakes up to nurse, you may want to consider waking the other to try and encourage them both into a similar schedule. Some mothers prefer feeding seperately. At nighttime, when one baby wakes to nurse your partner can rouse the other baby for a diaper change if needed. When you are ready to switch babies, the fed baby can then be burped and changed.
  
  
• The most important thing to remember about feeding positions and schedules for multiples is do what works for you.

• You may need a more rigid schedule overall for triplets and quads. You probably aren't going to feed your triplets or quads one at a time on a regular basis - it is extremely time consuming! Even when you feed in pairs, you will be spending a lot of time nursing them. Remember though that formula feeding is time consuming too....the purchasing and preparation of formula, bottles to fill and wash and you still need to hold your babies to bottle feed them....babies should not be left to feed themselves. (Though you may need to prop a bottle occasionally if you are alternating breast and bottle feeds this should not be done on a regular basis) So don't let the time factor prevent you from nursing!
  
  
• Let's say you have triplets. We'll name them babies A, B and C. For the first feeding of the day: A and B nurse together first and C finishes off both sides. Feeding number two: A and C take the first round and then B gets her turn. For the third feeding, babies B and C would go first, followed by A. This would alternate throughout the day so that each baby gets equal amounts of breastmilk and time at the breast.
  
  
• Another option would be for the third baby to take a feeding of expressed milk or formula. Some moms consider a rotating formula feed to be more feasible than exclusive breastfeeding, but please be aware that this can reduce your milk supply. You will only produce enough to feed three if you are nursing three! Again, do what works for you.
  
  
• Quads are actually a bit easier to coordinate feedings for, because you can keep them paired up for feedings. Let's toss baby D into the scenario above and see what happens. First babies A and B can nurse, followed by babies C and D. The next feeding, C and D get the first turn followed by A and B. Much simpler!

Let's talk about me.....for example, how much do I need to eat and drink?

• The main problem in this area will be finding, and taking, the time to eat well. Hopefully, you will have some help around the house so that you can focus on taking care of yourself and nursing your babies.
  
  
• Once you have lost your initial pregnancy weight, your weight loss/gain will usually indicate if you are eating enough. Eat to satisfy your hunger and focus on nutritious foods. If excess weight loss is a problem, try to eat foods that are dense in nutrition and calories. Make sure you eat something for breakfast, even it's just a protein drink or a double helping of Instant Breakfast. Even mothers of one baby who skip breakfast will all of a sudden realize (sometime past noon!) that they haven't eaten a bite all day. Keep a supply of nibbles close to you at all times. Veggies and a yogurt based dip, cheese and crackers, sliced fruit, try apples with peanut butter for extra calories. Consider preparing a snack tray or some sandwiches before you go to bed so they are ready for the next day.
  
  
• Just as with one baby you should drink to thirst. Make sure that every time you sit down to nurse that you have a large cup of water beside you. If you are drinking enough, your urine should be pale. If your urine is sparse and dark, you are not drinking enough fluids.

How can I make more time in the day?

• While you can't actually turn a 24 hour day into a 36 hour day, there are ways to squeak out more time in the day for feeding your babies and taking care of you. You need to nurse your babies. You need food, rest and more rest. You don't need to clean house.....for awhile anyway!
  
  
• Especially if you have triplets or quads you will likely need help at home. Not everyone can afford to hire help so consider the following free resources. If you have extended family close by, they can be a wonderful resource. Close friends and neighbors can also provide invaluable assistance. When people want to know what they can do to help, be specific! They probably really want to help and let's face it, you can't do everything by yourself! People can take turns dropping off an oven ready casserole. They can go grocery shopping, clean the house, do laundry, etc. Don't forget members of your church community if you attend one, someone might even be willing to coordinate a small army of volunteers.
  
  
• For relatively inexpensive help, you could hire a teenager to be a "mother's helper" for a couple hours each afternoon. Also, if your budget allows it hire a professional house cleaner once a week. Think of it this way, by breastfeeding your babies you are saving a huge amount of money. Use some of it to make your life easier. Eat. Nap when your babies nap. Tuck them into bed with you if you can. Learn how to nurse lying down. Your chances of being successful at breastfeeding your multiples are greater if you aren't exhausted, stressed out and too busy to eat and sleep.
  
  
• Some other ways that you can save time during the day and make your life a bit easier include always feeding two babies at once, keeping a feeding chart that enables you to see who ate what and when at a simple glance, getting creative about diaper and clothing changes (consider several portable containers with diaper stuff and clothing changes to be placed strategically around the house), learning how to carry two of your babies at once in slings and above all, learning how to relax your standards. Decide what you can "let slide" and focus on yourself and your babies. The benefits of loving, breastfeeding and nurturing your babies will last forever. The benefits of a sparkling toilet and streak-free windows might provide immediate aesthetic rewards but aren't very valuable in the long run. Plan on having a slightly messy but love-filled house for a while...say 18 years or so? *grin*

Where can I find more help and support?

• In terms of breastfeeding, try the La Leche League. They have lots of information on their website and attending meetings will provide you with mother-to-mother support and lots of encouragment. For other issues specific to multiples, try support groups like Mothers of Multiples and Mothers of Twins. There are also support groups available for online interaction.