Breastfeeding twins – getting off to a good start despite hypoplasia

I’m sat here typing one handed on my phone as I breastfeed a twin. Sometimes I feed them individually, sometimes in tandem with my trusty preloved Peanut and Piglet tandem feeding pillow – it depends who is awake when. They’re currently 3 weeks old, and compared to the first few weeks of my singleton boys’ lives, feeding is going extremely well. This is partly due to the fact that I know so much more about breastfeeding and about my condition called breast hypoplasia (underdeveloped breasts) and consequent IGT (insufficient glandular tissue), and partly because the twins have fed brilliantly right from the start, with no issues such as low blood sugar or jaundice to contend with.

I was expecting them to be lower birth weights and therefore potentially need a bit of special care where it may have been suggested to top up with formula if they struggled to maintain their body temperature and/or blood glucose levels. But I managed to produce enough colostrum during our 3-day-2-night stay in hospital to sustain them. It helped too that I had managed to express several 1ml syringes worth of colostrum antenatally, so I gave them these in hospital as well as feeding them regularly. As I wrote in the twins’ birth story, I was impressed at the huge amount of uninterrupted skin to skin time and therefore chance to freely feed that we had for about the first 10 hours of their lives outside the womb – I’m sure that this really helped us get off to a good start with breastfeeding.


When they were first weighed on day 3 at home by the community midwives, Naomi had lost 10% of her birth weight and Samuel had lost 7%. These were both still within acceptable limits, and the midwives were happy that they looked well and that we knew what we were doing in terms of looking at nappy output etc. to see if they were getting enough and topping up with the SNS (supplemental nursing system) as necessary, after I explained our history with feeding the boys. My milk came in on day 3, which is earlier than I was thinking it might do after an elective c-section, which meant I didn’t go into spontaneous labour and therefore didn’t get to go through the hormonal process that occurs for this. My hypoplasia means I don’t really get a huge full feeling when my milk comes in after birth, but I could feel some firmness and could hand express milk that looked mature and white instead of the yellowy colostrum that it had been.

I decided that we needed to start some small top ups with the SNS on day 3, because I didn’t feel that my milk was enough to satisfy them, and nappy output started to dip a little, though soon picked up again. Even with some small top ups, their poo still looked breastfed by day 5 – yellow, loose and seedy rather than pasty like formula fed poo. In fact it still does at nearly 4 weeks old, so I’m assuming that they are getting a decent amount of milk from me – probably around half breast milk and half formula based on formula amounts taken by the average baby as well as the look of their poo! This is not bad going considering there are two of them. They were and still are soaking through a good amount of cloth nappies too.

By day 5 at their next weigh in, both had put on a good amount of weight in 2 days, so this was a great reassurance that we were going in the right direction. The next weigh in was at 13 days, and they had continued to feed well with the SNS in that time. Samuel had gone well beyond his birth weight, and Naomi was only about 80g off it, which the midwives were very happy with. They couldn’t discharge us just yet due to this 80g, but when they came back to weigh them at 21 days old, both had put on a great amount, were well over birth weight, and were starting to look like they’re following a line on the graph. I can’t quite believe how little an issue weight gain has been, after all the struggles we went through with Andrew after his dehydration in the first week and with Joel for his jaundice and related sleepiness in the first month or so. It’s such a relief to not have the battle with health professionals over the dreaded growth charts. And these are twins! And I have low milk supply!!


The only slight issue that we have encountered is tongue tie. But again this hasn’t impacted on us nearly as much as before, because this time it has been dealt with much more quickly and less stressfully than with Andrew’s. The midwife who did the twins’ health check 24 hours after birth in the paediatric clinic at the hospital picked up on the fact that both had posterior tongue ties when she looked in their mouths. I had noticed Naomi’s myself, now I know what I’m looking for, when she was placed on my chest straight after birth, screaming her head off in my face! The midwife was very helpful and straight away told us how to get a referral to the nearest NHS tongue tie clinic at the hospital in Dudley. It was all done quickly and electronically – Tom filled in an online form, I got a quick phone interview and then an appointment through by email for when they were 24 days old.

With the help of my mum, we went to the appointment on Friday. It was such an amazing clinic, run by a midwife who clearly was an expert in tongue ties and passionate about breastfeeding. She assessed them thoroughly with a points-based system, and agreed that their posterior ties meant they weren’t maximising the amount of breast milk they could get out of me, and the fact we have to top up anyway due to the hypoplasia is masking this in terms of their weight gain being ok so far. I’ve not had any real pain whilst feeding, but I have felt that their latches were fairly shallow, and that tandem feeding them in particular was less comfortable than individual feeding. And I’d never had any real pain with Andrew before he had his snipped, but noticed the difference afterwards with a deeper latch.

So we went ahead with the snips, and both fed well from me straight afterwards. There were a few more tears from Naomi than from Samuel, who wasn’t crying at all by the time he was handed back to me. Both were mainly before they were even cut due to the fingers they had firmly holding them in their mouths, but they calmed down whilst feeding and went back to sleep after the feed. I have noticed how much wider their mouths open and therefore the deeper latches they now get, plus tandem feeding has become more comfortable.

As well as the midwife who runs the Dudley clinic, there was another one there who is currently shadowing her with the view to setting up her own NHS clinic in Bolton. It’s so good to see that this is being taken seriously by certain professionals within the NHS. I’m so glad we didn’t have to pay for a private lactation consultant to do the assessment and snip this time like we had done with the boys (Joel didn’t need his snipped).

Both of the midwives were very much in awe of me persevering with feeding like I do, despite the fact I’ll never be able to exclusively breastfeed, and thought I deserved a medal for feeding twins entirely at the breast using a supplementer. For me this was lovely to get recognition for my determination, and a reminder of why I do this despite all odds, something I don’t think of often enough myself. Most midwives I have seen at hospital and in the community haven’t had a clue what an SNS and hypoplasia even are when I’ve explained my breastfeeding story, so it was great to be able to talk about these things with professionals who are experts in lactation and know what I mean.


So this brings us to where we are now. We’ve been handed over to the health visitor, who said they only need to be weighed once a month now unless I have concerns about their feeding. Having the ball in my court like this, being trusted on feeding and no pressure for weekly weigh ins is such a world of difference from the stress that we felt before with the boys. I’m genuinely enjoying this breastfeeding journey a lot more already, and we’re not even at a month old yet – it took a good few months to get to this before with both boys.

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2 thoughts on “Breastfeeding twins – getting off to a good start despite hypoplasia”

  1. You are amazing Ruth and it’s inspiring to read y9ur blog. The little guys look so well. I had opposite issue to you, trying to feed a preterm baby when my areola was bigger than Sam’s head. Took 7 weeks of sheer stubbornness on my part but then we were set for over a year!
    Just so glad this is such an edifying experience for you with all the additional challenges you are dealing with.
    Sending love to you all. Dee xxx

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