To parents of twins
A brief guide
My wife and I became parents of identical twin girls just over five months ago. We did not have IVF or another form of assisted reproduction, and twins do not run in either of our families. From pregnancy to birth to today, it's been a huge thrill. Below, I'll recount some of the experiences and tips we've picked up along the way.
When you first find out you are having twins, the experience can be quite overwhelming. Becoming a parent – especially if for the first time – can be daunting and exciting enough. With the prospect of two babies, doubly so.
The first thing you will need to find out, is what type of twins you are having, and, if you want, their genders. The two main types are MCDA (mono-chronionic, di-amniotic), also known as identical twins, and DCDA (di-chronionic, di-amniotic), also known as fraternal twins. The former means that a single egg was fertilised and then split. The embryos will grow in separate amniotic sacs, separated by a membrane, but share a single placenta. The latter means two eggs were fertilised separately, which means two sacs and two placentas.
Fraternal twins, as the name suggests, are really "just" siblings that happen to have the same birth date, and fraternal twins can be as different as any two siblings (although they'll be the same age, obviously). Identical twins share virtually all their DNA and should hence grow at the same rate, are (nearly) always the same sex, and look physically similar, although there will be small differences, and they will likely have different personalities (ours do). One of the strangest things about our (identical) twins is that, save from a birth mark, they look remarkably similar, yet everyone says Hanna looks like my wife and Skye looks like me. I can't really explain that.
With MCDA twins, the hospital will want to monitor the pregnancy every couple of weeks. The big worry is Twin-Twin Transfusion Syndrome (TTTS), a condition where one twin takes a disproportionate amount of the nourishment provided through the placenta, which can lead to a miscarriage. It is thankfully very rare, and can be treated if caught early. Hence, lots of follow-up.
There is also MCMA twins, who share a placenta and an amniotic sac. This is very, very rare, but also very dangerous, and the mother will likely be hospitalised for a long time and constantly monitored.
Once you start telling people (generally after about three months), prepare for two questions:
- Are they identical?
- Do twins run in the family?
The question everyone will be thinking, though is:
- Did you have IVF?
As far as I know, identical twins are accidents of nature (although there are some statistical links to things like the mother's age). Fraternal twins occur when the mother ovulates two eggs at the same time and both happen to be fertilised (by different sperm). This can happen naturally (and is possibly something you can be genetically predisposed to, though again age can be a factor), or through assisted reproduction (not just IVF but also things like ovulation booster shots).
At this point, you'll probably be reading lots about pregnancy. All the usual rules apply: No drinking, smoking, falling over, excessive physical strain, etc. However, with twins, there is one thing you need to get very clear:
Your body is going through something that is was not really designed to do.
You'll have friends who are pregnant with one baby, who'll breeze through pregnancy with a bit of morning sickness in the first trimester and have an altogether great time. You'll have a great time too – pregnancy is a magical experience and something to savour – but the strain on mum's body is immense. You need to plan to take it easy. There is a very real risk of premature delivery or other complications if you don't.
Your second trimester will generally be the easiest. If you plan to do something major like move to a bigger house, do it then. If you plan a 'baby-moon' (you should: you won't have a holiday for a while), do it then too. Some airlines won't even let you fly in the third trimester. But plan a relaxing holiday, not a city trek or something with lots of uncomfortable travel. We opted to travel by train, which was a lot less hassle than flying.
By the third trimester, you should plan to spend most of your time doing not very much. Your body will hurt, and walking will start to become more difficult. Think about how you can avoid a stressful commute if you work (peak hour tube travel is not a great idea), and wear a 'baby on board' button so people know you're pregnant (you can get them from Transport for London, I believe). Others should stand for you. If they don't (on London tubes they often pretend not to see you), give them a kick. You should also expect to be huge. Take lots of pictures. You'll miss the bump when it's gone.
With twins, there is a lot of preparation to be done. Some parents of single babies just figure it out as they go. With twins, that's not a realistic option. Moreover, after the birth, you will be too exhausted to read, organise, shop, or even think very much. Figure out how you're going to cope now and get everything ready in good time to cover you at least the first three months from birth. Do this early, because twins tend to arrive between 36 and 38 weeks, not 40 weeks as with other babies (more on that below), and sometimes arrive even earlier than that.
This is probably the hardest thing to sort out, but make no mistake:
You will need help once the babies are born
One baby: one pair of hands. Two babies: two pair of hands. It is possible to cope for short stretches of time as one parent, and at different ages, the babies will be easier or harder to deal with. But as a general rule, you should try to have help most of the time for the first month or two, then not be alone with the babies for more than 8-10 hours ever until they are at least 5-6 months.
There are a few reasons for this. One is that feeding two screaming babies at the same time is difficult and takes practice. The other is that calming a fractious baby requires you to lift and cuddle him or her, which again takes two hands. The physical strain in general is big, especially if you've had a c-section. There is a lot of lifting, moving, and rushing around. Also watch out for how you lift and hold the babies, as there is a very real risk of repetitive strain injury and carpal tunnel syndrome in your hands and wrists, which will not help the slightest.
Help can take many forms. Your parents are the cheapest and often the best. Neighbours, friends, other family also work.
Nannies are expensive, but often the only realistic long term option. They come in a few flavours:
- Maternity nurses (also known as night nurses or night nannies), who charge about £150 per night or £10-12 per hour during the day. These are highly qualified and will help you a lot, not just in the time they are there, but also by providing tips and helping to establish the babies on a routine (more on those below). Many parents of twins choose to have a full time (6 nights a week) night nanny for the first 2-6 weeks. This obviously costs a lot of money. However, if you can afford it, it is worth seriously considering. You can find night nurses through agencies or websites like childcare.co.uk. Personal recommendations count for a lot too.
- Daytime nannies. Again, websites like childcare.co.uk, an advert on Gumtree or agencies can find you nannies. Depending on experience, they cost around £8-12 per hour, but you need to withhold and pay income tax on their behalf, too: you effectively become an employer (unless the nanny is self-employed or the agency handles it; see nannytax.co.uk for more details). Even a part time nanny can be a big help, so consider this. Nannies can either live with you or live out. A "sole charge" nanny is one you leave to take care of the babies alone. This will probably not be so relevant in the first few weeks, but if you can build up the trust, it can be great for a nanny to take the babies out in their buggy for a walk (most babies sleep really well in their buggy) to let you sleep as well.
- Mother's helpers. There is a lot of overlap between this and a nanny, but broadly speaking a mother's helper will help mum around the house more, allowing her to focus on the babies.
Other roles like childminders and babysitters don't really apply to very young babies.
In all cases, you need to conduct a search and interview. It is better to do this before birth if you can. Expect to spend some time finding the right candidate, and make sure you check references. It is not very common to find people with twin experience, but this is perhaps not such a big deal: instead, insist on someone with a lot of experience with young babies. You do not want someone who will need to be told in great detail what to do. Finally, if you do get a nanny, make sure you find a person you like. You'll be spending a lot of time with her.
You also need to start planning how dad will help out. In most cases, he will go back to work after a woefully short 2-week paternity leave (there's no double leave for twins). This will be hard for him and for mum. It'll be even more difficult to wake up four or five times a night to feed and then go to work the next day. You should expect this to place a strain on your relationship. Plan ahead now, even though you'll likely throw the plan out after the first week. Also make sure expectations are set appropriately at work. Luckily, most bosses are also parents and will be quite sympathetic. A somewhat more flexible work schedule, no/reduced travel and no expectation of working at home in the evenings (forget about it!) are good places to start.
There's no two ways about it. Having twins is expensive. Accept hand-me-downs and buy second hand where you can. We bought a lot of very high quality clothes, toys and nursery items from second hand markets organised by Mum-to-Mum Net, for example, and found many second-hand items on eBay.
Here are some of the major things you'll need to consider:
- Cots. You want two separate cots from 3 months or so. For the first 2-3 months they can sleep together. Moses baskets can also work, though again they only last a few months and then you have to buy real cots. Even tiny babies sleep well in baby cots (just put the at the foot of the bed with the right amount of blankets/clothes and on their back to reduce the risk of cot death). Get ones with slatted open sides so the babies can see each other once you separate them. You'll also need cot sheets, blankets and sleeping bags (from 3 months). IKEA make good, cheap cots, though you have a lot of choice. Also check out Mothercare, John Lewis and Mamas and Papas. We were kindly given Stokke Sleepi cots that expand from Moses-basket like size up to baby size and later to a "junior" bed. The advantage of these (apart from the fact that they are very pretty) is that they are on wheels and are small enough to cart in and out of rooms. They spent a lot of time moving between our bedroom and living room in the early weeks.
- Buggy. This is a major purchase. Expect to spend between £600 and £1,200. You have to choose between side-by-side (like the Bugaboo Donkey that we have, or the cheaper Maclaren option, although I'm not convinced that's suitable from birth), front-and-back or over-and-under type arrangements. All twin buggies are too big, really, so you just have to choose whether you want to get stuck sideways or lengthwise. Measure your door. Think about how you will get in and out without leaving one baby outside alone. Make sure your car boot is big enough (or get a bigger car...). Then go and try all the buggies available, several times. Think about whether you need carry cots or not, but remember that infants need to sleep flat for the first three months or so. John Lewis, Mothercare and Mamas and Papas are good places to start.
- Car seats. You'll need two. In fact, the hospital won't let you go home without showing them that you have them. Most people buy Maxi-Cosi – either the Cabriofix or the newer Pebble – which are compatible with a lot of buggies. Consider getting the FamilyFix base which makes it much easier to take it in and out of the car, and see if your buggy has an adapter to let you use it as a frame whilst leaving the babies in their car seats – useful for shopping, say, though not for longer walks in the first few months as they do not lie flat in carseats.
- Bouncers. From about six weeks, you'll be able to put the babies in bouncers (also known as baby chairs). This is a great variation from spending all day on a mat on the floor, and can help free up your hands to do other things. For instance, we tend to bring babies and bouncers to the kitchen when preparing dinner – they are entertained and we have two hands free each. We went for the Baby Björn Babysitter variety which are comfortable, portable and adjustable to various angles. I would highly recommend them.
- Muslin cloth. Baby rule #1: You may think you have enough muslin cloth. You don't. We stopped buying after we amassed about 100 cloths in various sizes. Use for cleaning up all kinds of spills, burping, drying, covering lights to dim them, etc.
- Clothes. You'll need a lot, and they'll grow out of them very quickly. We started with 'tiny baby' size clothes, which lasted about a month. Go for the basics: vests and bodysuits and avoid the temptation to buy expensive cute clothes until they are a bit older.
- Toys. Young babies don't really need a lot of toys, though one or two play gyms (where the baby lies underneath on a mat and looks up at various hanging toys) are a good investment for 2-3 months in. One of the toys we have had the most benefit out of is a set of newborn baby books with high-contrast pattern images and soft crinkly pages. Our girls just love them.
- Bottles and steriliser. More on this in the section on feeding below.
- Bath tubs. We used a foldable "Puj Tub" that goes in the sink for the first month or two, and then bought two small chairs that sit in the bottom of the bathtub and hold the babies secure thereafter. You don't need to bathe newborns very much at all, but from about 6-8 weeks you probably want to start trying to bathe them as part of a bedtime routine.
- Nappies. You will change upwards of 100 nappies a week in the first week weeks. Buy bulk, but not too much as they grow out of these too. We started with Pamper's New Baby range. When changing in the first few months, use lukewarm water and cotton balls only (you'll need a lot of cotton balls). You can move to scent-free wipes after 6-8 weeks.
- Formula. Even if you intend to exclusively breastfeed (more on that below), I think it is wise to have a Plan B. Two babies screaming in hunger that don't latch on the breast creates a lot of tension. We started with SMA and moved onto Aptamil which our babies seem to digest better. We have a lot of friends who prefer Cow & Gate. Whichever brand you go with (they all have the right nutrients and contents, but taste different and seem to digest differently), don't buy too much immediately, as the babies may not like your first attempt. If it's purely for backup purposes, buy the pre made cartons. They're a more expensive, but a lot easier to prepare. Only move to powder if you're going to formula-feed regularly (see below).
One thing to consider is that people will give you a lot of clothes and sometimes toys. Leave the tags on anything you get or buy until you use it – that way you can exchange when they invariably grow out of them before you've used them.
There is no need for baby proofing until the babies start to crawl (which hasn't happened to us yet, though I am terrified of when it does). However, you need to think about your house: where will the babies sleep? where will they play? where will you change them? how will you bathe them? Convenience is a big factor here. You want to avoid having to carry them up and down stairs if you can, for example. Expect your babies to just take over everything (our living room is now 80% play area, our bedroom was an obstacle course of cots and changing table for a long time). It's OK. You won't be doing much that's not baby related for a while anyway.
In the first 2-3 months, you probably want them to sleep in your room, but not in your bed, so you'll need space for at least one cot, ideally two (for when you separate them) in your bedroom. After that, you should put them in a separate room, but use a baby monitor at all times. Twins can generally sleep in the same room, though it's helpful to have the option to separate them (even if one sleeps in the living room, say), if one is unwell and keeps waking the other. That said, twins can often sleep through each other's cries, even if no-one else can.
Reading and learning
You should take a pre-natal class. Your hospital will offer them, but look out for the NCT (National Childcare Trust) ones in your area, which are often considered to be friendlier. We went to a special NCT class for twins, run by a local mum who had five kids, four of which were twins (i.e. two pairs), so she was certainly qualified. To be honest, the contents of the course are secondary to the fact that you'll get to build relationships with several other couples who are having babies at the same time as you. This is really important, as even 1-2 months of difference in baby age can make it difficult to relate or be able to organise things at the same time, and you'll really value the informal support network this provides.
You should be aware, though, that the NCT, like the NHS, has an agenda. They want you to have a natural birth, and they want you to breastfeed. In fact, much of what you read and hear is quite dogmatic and can sometimes feel a bit pushy. Everyone has an opinion on birth and childcare, and they will let you know what it is.
You should also read. Some of the books we read which were helpful were:
- Pregnancy Day by Day. General book about how pregnancy progresses with lots of pictures.
- Pregnancy for Dads. Self-evident content. Funny and quite useful.
- Double Duty. A general book about parenting twins. A bit US-centric, but helpful.
- A Happy House with Contented Twins. Gina Ford for twins. More on this below.
- Healthy Sleep Habits, Happy Twins by Marc Weissbluth. Refreshingly non-dogmatic book about sleep.
- Your Baby Week by Week. Excellent book that can be read after birth (though pre-read the first month or so worth of content). There is also a six-months-to-toddler version.
Finally, speak to your doctor and midwives. You should be seeing them more frequently than other expectant mothers, and they have lots information about the process and about what is happening to your body.
I found this to be one of the most difficult things. You don't strictly need to settle on names until you register the birth (about six weeks after birth), but it becomes a bit impractical to keep referring to them as Twin 1 and Twin 2.
I believe it is important that twins get to develop their own identify. I would pick names that have no obvious theme (like April and June or Holly and Ivy) that will forever make other people think of them and treat them as a pair rather than as individuals. For practical purposes, I'd also avoid having the same first initial.
We used of baby name books, apps and websites, and created a shortlist. We didn't really test them on friends or family, though I know others who have done that and found it useful. I would suggest you don't fully settle on the names until you see the babies in the flesh, though. The names should feel right from the start.
Twins are generally born early. 36 weeks is considered full term for identical twins and 38 weeks is considered full term for fraternal twins. Luckily, the body speeds up the maturation process, and there is generally no problem with delivery around these dates.
That said, many twins arrive even earlier. Of the five couples in our NCT class, only we and one other couple delivered on the planned date, and two of the parents had very traumatic experiences. There is probably nothing you can do to fully prevent premature delivery, but taking it easy during pregnancy is probably a good idea.
The big decision you have to make is whether you want a natural birth or a caesarian section. If you go to the NCT classes, they will push you towards a natural birth. Your doctor may push you towards a c-section. Most twin parents we know have had c-sections. With DCDA twins you'll have a choice provided both babies end up head-down. With MCDA twins you still have a choice, but the hospital's advocacy a c-section will be a lot stronger as the risks are greater.
The reason your hospital wants you to have a planned c-section is that twin births are inherently more risky than a single birth (twice as risky, if you think about it). A planned c-section gives the hospital much more control, and you'll give birth surrounded by multiple doctors and midwives. The timing of this is important, however. You want to wait as long as possible to give your babies the greatest chance of maturing, but not so late that any complications arise or that you go into labour. At this point, you'll have what is (somewhat alarmingly) called an emergency c-section, which is the same thing, just rushed and under more stress (although it may not really be an emergency - it often takes a few hours or even a full day from when the need for one is identified to when it is performed).
You will hear a lot about how natural birth is better: establishing breastfeeding is supposedly easier, some theorise that you'll bond with your baby better after going through the pain of natural birth, and your body will recover quicker. The latter is certainly true - a c-section is major surgery under partial anaesthetic and takes its toll on you. Expect to be mostly bed-bound for a week or so, and to stay in hospital for several nights after the birth.
Whether the other benefits really matter, I don't know. We had a c-section and it was the right choice for us. Speak to your doctor and listen to your instincts. Try not to over-dramatise the impact of the babies coming out a day or two earlier than they would have naturally or play the statistics game. And above all, don't for a second feel any guilt, regardless of your method of delivery. Birth is a big deal, but it's only the first fraction of their lives: it's what comes after that matters.
If you do have a planned c-section, it is a little odd to wake up really early one morning, going to the hospital, and being able to count down the minutes until you will become a parent of two (more?) children. Quite surreal, in fact. The procedure itself is also very strange to be part of. To you, this is the biggest day of your lives so far. To the seemingly hundreds of people who are there (two surgeons, an anaesthetist, five or six nurses and midwives, and probably a paediatrician), this is routine. Everything is very procedural.
You may make a birth plan (a written guide to how you want the birth to take place). For a c-section, this is less relevant. You may ask for things like immediate skin-to-skin contact and for the umbilical chords to be left to pulsate for a while to supply a burst of antibodies, both of which supposedly good for the babies. You should discuss this with the surgeon, who will come see you prior to delivery. However, the only thing that really matters is the safe delivery of your babies, and you will probably find the hospital reluctant to deviate too much from their well-rehearsed procedures. That's probably best.
Once you have given birth, plan to stay in the hospital for a while. There is no rush to go home, and you'll come to appreciate the midwives (who'll appreciate you – twins are special even to them) giving you tips, reassurance and helping with the practicalities of taking care of two babies. We stayed for three or four nights, partly because the babies were slightly jaundiced and needed monitoring, partly because we were overwhelmed and needed the support. Note that dad can't stay overnight and whilst visiting hours are quite generous, they never quite seem enough. The nights can be quite lonely and exhausting for mum, especially when the babies need feeding every hour. My tip: Befriend the midwife on duty.
After the birth, you need to go home. This is logistically quite nerve-wracking. I don't think I've ever driven so carefully in my life, or been so scared. Make sure everything at home is ready. You'll miss the support of the midwives once you're there.
After the birth, there are two support systems in place: You'll be visited by a community midwife a few times to check on the babies and mum. After about a week, the health visitors will take over. They'll come to visit sometimes, and you will take your babies to their clinic to get weighed every couple of weeks. The health visitors are a fountain of information and you can call them if you have any questions. We probably called or saw them once a week if not more in the early weeks.
Finally, a tip: If your twins look very similar, leave the little tags they get on their ankles in the hospital on for a week or so until you are comfortable telling them apart. I don't think you'll ever truly mix them up, but the fear of doing so made me paranoid for the first week. It's not as if they'd ever be able to set the record straight if we got them wrong and never realised.
When you tell people with children that you are expecting twins, they will tell you, rather smugly, to get all the sleep you can get now, because you won't get it later. Irritating as this will be to hear, it is true. Sortof. I actually think you should do as much of what you enjoy doing (so long as it is not too strenuous) whilst you have fewer responsibilities.
Sleep will become a big issue in your day to day life. You will not have enough of it. It is quite incredible how much we need sleep and how we are affected by sleep deprivation. Mum will run on hormones for the first 3-4 months, which will help, but not enough. I think my wife Googled the question "when will babies sleep through the night" (which means, you put them to bed at 7pm, wake them at 10pm or so for a quick feed, and then they sleep until 7am) every night for about six weeks. "Do they sleep through the night yet" will be the first question you ask other parents (even if they have only one baby – baby in the singular will not make much sense to you).
There are two philosophies of baby sleep: baby-led and routine-led. The former means you feed and put to bed the baby when he or she gives sign (baby signs are hard to read initially, of course) and never wake a sleeping baby. The latter means you try to structure their day by putting them to sleep and feeding at regular times.
For twins, I maintain that being entirely baby-led is suicide. I have heard of parents being hospitalised from sleep deprivation.
Consider this: In the first few weeks, a feed can take an hour and each baby needs a feed roughly every three hours. If you have twins and you're breastfeeding, and your twins are out of sync by 90 minutes, mum will have no more than 30 minutes rest. Ever. Twenty-four hours a day. This is no way to live.
Secondly, sleep and self-setting are skills and something babies need to be taught, as is the difference between night and day. Good quality sleep is very important for infant development.
Finally, if you're so sleep deprived you make mistakes (e.g. feed one baby twice and not the other), you're no good to them.
To some (and the NHS) being routine-led is akin to baby torture. The problem is that most of the routine literature is incredibly prescriptive. The main proponent is Gina Ford (who, famously, has no children of her own, though she worked as a maternity nurse for many years), and her books have schedules in them down to 15-minute intervals. Babies are nowhere near that predictable, and it can be quite daunting to figure out what to do when the routine goes wrong.
That said, I recommend reading Gina Ford and the book by Marc Weissbluth. You should try to understand the principles behind the routines, and apply them in your own way. It will not work well in the first few weeks, but it will pay off and it will give you something to hang your day on. A map, even if an imperfect one, to help you structure your day will be very useful. The point is not to let your babies go hungry (never do that!) or to keep them awake so they become over-tired (a recipe for disaster), but rather to teach them how to eat and sleep well by giving some consistency and encouraging sensible habits.
The first 1-2 weeks are actually quite easy, as the babies will generally just sleep and wake for feedings. They'll also sleep through virtually anything, so you can put their cot in the living room and have people around to visit. However, the next few weeks are much harder, because they'll be very unpredictable and give you no other sign than a cry that something is wrong.
When babies cry and there's no obvious physical discomfort, it's usually hunger. If it's not, check their nappies. If they're dry, make sure they're not too hot or cold. Very young babies don't get lonely or scared, though in time that may be a reason too. The Week by Week book is a great guide to when you will start seeing changes in behaviour like this.
Finally, with twins, there is one golden rule: Synchronise. If one baby wakes up and can't be settled down again, wake the other. If one goes to bed, put the other down too. Keeping them in sync is the only way you'll manage to properly look after both and still function. Start early and be consistent is my advice.
We started with routines for real about 4-6 weeks. They started working for us from 8-10 weeks, probably.
A few more tips:
- Sleep when they sleep. You need to take care of yourself as well, which means you need to eat properly (particularly important if breastfeeding) and rest. You do not need to vacuum the house.
- Get help with the basic domestics and try to find healthy food that you can prepare quickly and easily.
- Learn how to swaddle your babies. For the first month or two, this can greatly help their sleep. There is a video (and book) called The Happiest Baby on the Block, which describes a too-good-to-be-true (but still useful) technique for calming babies under three months.
- Install blackout curtains in their room. Between two and six months, they will sleep better when it is pitch black. Try to avoid too much light for night time feedings as well, as this may stimulate them too much.
- Learn their sleep signs (the Weissbluth book is very good for this). The last thing you want is two overtired babies.
- Take them out for a walk in the afternoon. This helps you and them get fresh air, and they not only nap well in in the buggy, but sleep better if they've had some air and natural light prior to going to bed.
If sleep is your number one concern, feeding will be second. The big choice is whether you breastfeed, whether you do so exclusively, and for how long.
The ideal is to exclusively breastfeed for six months before you start weaning onto solids. Breastfeeding is free (formula costs about £10 per tin, which nowadays lasts us less than a week), easier (no bottles to sterilise or water to boil and cool down), and healthier (babies get lots of useful antibodies).
However: for many mothers breastfeeding is incredibly hard.
It always struck me how strange it is that something so vital to the survival of our species is so difficult. But it is. For babies to latch onto the breast correctly and eat properly without falling asleep requires a complex dance between mother and child. It takes time a lot of frustration to get right.
If you intend to exclusively breastfeed, you need to do so right from the start. We always gave a formula top-up (on hospital advice). Gradually, the top-up became bigger than the breastfeed and the babies stopped taking the breast altogether (bottles are easier to eat from). We expressed for a while and did a mixture of breast milk and formula, and now do formula exclusively. I think this is similar to most twin parents we know.
The breastfeeding brigade will make you feel guilty for doing this. Don't. As with many things baby-related, it's easy to get hung up on things that in the grand scheme of things are not so important. Are your babies healthy? Do they put on weight regularly? Good. Move on.
Breastfeeding twins brings particular challenges. First, mum's breasts will be able to produce enough milk (note: cup size has no bearing on milk production, though some women seem to produce milk more easily than others), as her body responds to the demands of the babies. The more they suck, the more she makes. However, it's a gradual process, and you may need to see your babies hungry or frustrated for a few feeds before production goes up enough in the early weeks. Expect to do very little other than breastfeeding in the first week or so to really get started, and expect some discomfort.
Second, you will probably want to parallelise the feeding so that it takes half as long, helps to synchronise the babies, and is more equitable. Give one breast to each baby and switch between feedings (but not during, as both babies need to reach the richer hind milk that only comes after a while, but not necessarily at the same time in each breast). The biggest challenge is how to hold them. We used a twin breastfeeding pillow – a monstrosity made in China called My Brest Friend – which was pretty good, coupled with a raft of other pillows and devices. Sitting in bed seemed to work best. Getting a baby with no neck control to lie correctly and latch on properly is hard, though, and you'll find it easier to start by doing them one by one across the body. Take off their clothes so their skin touches yours to make it easier. And practice. Lots. We got help in the hospital before we left to get the basic technique, and then spent a lot of frustrated days and nights trying to make it all work.
If and when you bottle feed, there are some advantages to that too. It is often easier and faster to feed from a bottle, and dad and others can help out more easily. It is also less straining on mum's body. For bottle feeding you have two choices: expressed breast milk or formula.
If you choose to express, buy an electric breast pump (one of the weirder things I have ever owned for sure). We know a mother who basically fed exclusive expressed breast milk for three months. She had one baby. The time it takes to express and then feed probably makes this unrealistic for most twin parents, but one or two expressions a day for mixed feeding can be viable.
Formula can be made from powder or served from pre-made cartons. Cartons are not economically viable in the long run, but great for emergencies or travel. You should always have some. Powder milk has to be prepared by boiling and then cooling down water to the right temperature. This can take a while (up to 30 minutes if air cooling, though you can pour the water into a bottle and stand the bottle in some cold water to speed up the process; ditto in hot water to heat if the milk is too cold – we found this easier and less fiddly than an electric bottle heater).
Bottles also need to be washed and sterilised before each use. This can take a lot of time and is not something you want to do whilst the babies are hungry. We decided to buy enough bottles to cover a full day's feedings, which meant we ended up with 16 (we now do only 5 feeds a day, thankfully, but at that time we did 8). Also, buy a tabletop steriliser, not a microwave one (too small and fiddly). Finally, make sure you have the right teats: teats have different flow rates and too fast a flow causes excess leakage and sputtering, unhappy babies. Too slow flow causes frustration and may mean they fall asleep before finishing the feed. Start with "newborn flow" (1 hole) and move to "slow flow" (2 holes) after about 4-6 weeks. We have gone with the Philips Avent range bottles and steriliser.
To be able to make up bottles quickly, we keep a clean, sterile jar of cooled, boiled water that we make twice per day. We also have a set of Tommy Tippie milk powder dispensers that we pre-fill with the right amount of formula for each feeding every night, at the same time that we wash and sterilise the next day's bottles. Making a bottle then becomes a matter of pouring the right amount of water into a bottle and pouring in the powder. We prepare the water part for two or three feeds at a time, and tip the powder in at the last minute. Once the milk has been prepared, it will last about 2 hours before it has to be thrown out.
With bottles made, you then need to feed. Again, you want to parallelise. With two pairs of hands, this is relatively easy. Hold the baby, put on a bib or place muslin cloth under his or her chin (there will be spillage), and encourage him or her to eat. This does sometimes take a bit of coaxing and timing is important, but you will learn your babies' signs soon enough. You tend to become adept at anything you do 8 times a day.
With one pair of hands, you can prop the babies up on on pillows, put them in their bouncers (tip: we use the lowest angle on the Baby Björn bouncers and use the toy attachment as an arm rest), or lie them flat on a play mat. The latter is surprisingly efficient. You then have one hand for each bottle. This does take some getting used to. Timing is important: the babies should be hungry, but not yet so hungry they become fractious. You may need to start with them one by one to take the edge off, and then parallelise for the remainder of the feed.
This can be quite hard, because you will in effect need to choose which baby is most needy of your attention to tackle first, and you may have to accept that the other baby will cry for a while. This sounds sensible in theory, but in practice is is incredibly difficult to listen to your own baby crying. Strength of conviction that you are doing the right thing is very important (the same thing applies when you are sleep training using "controlled crying" – again see the Weissbluth book). You also need to stay calm and positive. Babies sense your nervousness and get very nervous in return, which just doesn't help. The thing to remember is that even if a feeding goes a bit wrong, there won't be any lasting damage. The only time you need to start worrying is if, after a week or so, you go for a weighing and they are not putting on weight. If in doubt, call the health visitors.
It is difficult to give advice to other parents without sounding negative. There are a myriad of pitfalls and challenges. With twins even more so. Whenever I received this kind of advice before our girls were born, I always suspected other parents were trying to tell me they regretted having kids, but were too afraid to admit it to themselves.
However, what they were doing – and what I am doing – was to try to prepare me so that I could better enjoy what is probably the most profound thing that will ever happen to anyone. It is at once so common and so special that it is hard to describe. The challenges are many and specific, so I can enumerate them and try to prepare you. The upside is really only one: they are your babies. Having twins is also incredibly special, and is something not many people will get to experience.
These days, if I wake them from a nap, they slowly rub their eyes and stretch. Then they open their eyes and see me above their cots. And they show me the most amazing, unadulterated and unconstrained smiles. Both of their faces literally glow with pure joy. They are so happy to see me – me. They love me so unconditionally they start to giggle. They love being alive. Even the tiniest things excite them.
There's just no way to prepare you for how good that feels. I've literally shed tears when they achieve something that, really, is not all that impressive, like rolling over after having tried for three days. My wife puts them to bed, exhausted and sick of baby duty, only to spend the next hour looking at baby pictures on her phone.
In fact, if there is one final piece of advice I can give you, take lots and lots of pictures every single day. They grow so fast you won't even know what hit you. You'll miss their tiny, fragile bodies when they are plump and active. If you're ever without them for more than a day, you'll literally see the difference. It's a magical experience, and I wouldn't change it for the world.