How Do You Make Enough Milk for Two Babies?

At my Richmond Area Mom’s of Multiples (Ramom) meeting the other night, a fellow twin mom said, “I wish someone had told me that I might not produce enough milk.” Statements like this are not uncommon, and we spend a solid portion of every meeting talking about nursing. It’s obviously something that every mother is concerned about. I’m not a lactation consultant, but having nursed my daughter for 15 months and nursing twins for more than three months now, I think there is something I can add to the conversation. Plus people have specifically asked me questions about nursing, and if one person is wondering, chances are a bunch of people are wondering. So here it goes.

“How do you make enough milk for two babies?”

Most of the literature on human lactation will tell you that it’s about supply and demand. The more you nurse/pump, the more milk you will produce. They tell you to let your babies nurse whenever they want to. Don’t give them pacifiers. Let them comfort nurse instead. And if you leave your babies for more than a couple hours, bring your pump so you can express your milk every two to three hours.

Ok supply and demand. Simple and sensible, right? Well the reality is more complicated than that. I'm going to break this problem down into some of it's components.

When Your Milk Comes In

When your babies are born, what you have to offer is colostrum, not milk. If you deliver in a hospital, you'll quickly get sick of all the nurses and doctors asking you if your milk has come in, yet. This early stage of lactation is NOT controlled by supply and demand. Rather it is triggered by the birth of the placenta and is driven by hormones. If a mother chooses not to nurse, her milk will still come in. This is important to know. Usually your milk comes in within a couple of days, but if it takes five days for your milk to come in, that is NOT your fault! 

The Biology of Lactation (Get Ready for Some Jargon!)

Once lactation is established it is driven by supply and demand. Prolactin is the hormone that stimulates milk production. In order to do that, it has to attach to receptor sites on milk-producing cells (lactocytes). When these cells are full, the receptor sites get stretched and misshapen, so prolactin can't attach properly (Read: Full boob = less milk production). So the key to stimulating more milk production is to empty those lactocytes often! 

Frequent and Effective Expression

Nursing often isn't always enough. If you want to boost your milk production, your babies have to be emptying (or almost emptying) your boobs when they nurse. If you've got a singleton, offer both boobs at each feeding. (If you have twins, you're doing that anyway.) You may want to do some breast compression while you're nursing/pumping to increase the milk transfer. If your babies aren't emptying your breasts during a feeding, you may want to pump immediately afterward. 

Storage Capacity 

No, that's not a euphemism for boob size. A large-chested woman can still have a small milk storage capacity. However, a small storage capacity does not mean an inability to effectively nurse. It just means your boobs will get full more often, and therefore you'll have to nurse/pump more often than your large-storage-capacity sisters. If this applies to you and you want to boost your milk supply, you may want to include pumping sessions between feedings.

What You Eat

Some women eat lactogenic foods or take supplements to increase their milk supply. I've never noticed a change in my milk production after eating anything specific, so I can't vouch for this. If it works for you, then great!

Your Support System

For me, this is the key. It's all well and good to say, "Nurse often, and if that's not working, pump more!" But there are only so many hours in the day. While you're glued to the pump, who is going to take care of your toddler and wash all the burp cloths? When my twins were a week old, I posted this as my Facebook status:

Postpartumly crying about how great it is to have my whole family nearby. I spend so much of my day nursing, but I CAN do that right now because my family is taking care of everything else for me. Clean laundry appears in my room and food is brought to my table.

My mom stayed with me for eight weeks! Some new mothers have to go back to work before eight weeks is up. And then they have to find a way to pump and store breastmilk at work! I can't even imagine.

I have so many feels for women who don't produce enough milk. When I think about my ability to feed my babies, I don't feel superior. I feel lucky. I know too many women who did everything right, but the stars just didn't align for them.

Bottom Line: You might not produce enough milk, but lactation is complicated. Please please please don't feel guilty about it.