Planning Postpartum Help for Twins or More

Two babies, one set of hands at 3 a.m.

When you learn you are having twins, the first question is often how you will manage at night. The short answer is that you will need more hands than you think, and it helps to line them up before the babies arrive.

Timing is part of the reason. The American College of Obstetricians and Gynecologists (ACOG) says the most common complication of a multiple pregnancy is preterm birth, and that more than one half of all twins are born preterm. Triplets and more are almost always born preterm. That means your plan may need to start sooner than your due date, and some of it may happen while one or both babies are still in the hospital.

If your babies spend time in the NICU

ACOG says babies born before 37 weeks may have problems with breathing, eating and staying warm. Some preterm babies need time in a neonatal intensive care unit (NICU). The American Academy of Pediatrics (AAP) notes that you may be ready to go home before your baby is, which can be very hard, and that a baby is usually ready to come home once they are breathing on their own, keeping their body temperature steady, feeding by breast or bottle and gaining weight steadily.

With twins, the babies may come home on different days. That can mean one baby at home and one in the hospital, plus pumping, driving and visiting. Ask the NICU team about visiting rules and what support people are allowed. Our post on NICU levels explains the terms you may hear.

A doula does not take part in NICU medical care. What she can do is practical: help at home with the baby who is there, keep pump parts washed, make sure you eat, and give you time to rest between hospital trips. The AAP also says babies born preterm should be screened in the hospital to make sure they can sit safely in a semi-reclined car seat.

Feeding two babies

The AAP’s golden rule for feeding twins is simple: when one wakes up to eat, both must wake up to eat. The AAP explains that feeding one after the other would leave too few hours in the day. A large U-shaped twin-feeding pillow works for both nursing and bottle-feeding, with each baby in a football hold on one side. You will likely need help positioning both babies at first.

If you had a cesarean birth, the AAP says you may need to wait a week or so before using a twin pillow, because its front edge crosses your healing belly. Bed pillows propped on both sides can work in the meantime. Watch your own posture too, since you may be feeding 8 to 12 times a day.

ACOG says you can breastfeed multiples, though it may take practice, and that lactation help is available at many hospitals and in your community. If you need clinical feeding help, ask your pediatrician about an International Board Certified Lactation Consultant (IBCLC). Our guide to breastfeeding help in NY and CT compares the options.

Safe sleep for two

The AAP notes that twins, triplets and other multiples have higher risks for SIDS, since they may be born early and with low birth weight. Every caregiver in your home needs to follow the same rules:

• The AAP recommends avoiding bed sharing under any circumstances, including with twins and other multiples.
• The NIH Safe to Sleep campaign says twins and higher-order multiples should have separate sleep areas. Plan a crib, bassinet or play yard for each baby.
• Place each baby on their back for every sleep, on a firm, flat surface that meets Consumer Product Safety Commission standards, with a fitted sheet only.
• Share a room with your babies, but not a bed, for at least the first 6 months.
• If a baby falls asleep in a car seat, swing or on a feeding pillow, move them to their own firm, flat sleep space on their back.

Building the help schedule

List every job, then put a name next to each one. Nights, feeds, pumping and bottles, meals, laundry, older children, NICU trips and your own appointments all need an owner. Family and friends can cover some of it. Paid help can fill the gaps you cannot cover.

Nights are often where twin families feel the gap most. Our guide to planning overnight postpartum care walks through matching the night plan to your feeding plan. When you talk to any doula, ask whether she has supported twins before and how she handles two babies waking at once.

With Northeast Doulas, your postpartum doula “will create a customized plan for your family,” and support “can begin as soon as you get home with your new baby.” Overnight support is “our most popular type of post care.” Availability varies, so call early and ask about timing. You can start on our postpartum doula page or contact us.

Your recovery, your mood, and when to get other help

ACOG recommends contact with your obstetric care provider within the first 3 weeks after birth and a full postpartum visit no later than 12 weeks after birth. Put both on the calendar before the babies come, and decide who will watch the twins while you go.

ACOG also says having multiples might increase your risk of postpartum depression. If you have intense feelings of sadness, anxiety or despair that keep you from your daily tasks, talk with your ob-gyn or another member of your care team. A doula may notice that you seem to be struggling and encourage you to call, but she does not screen for or treat depression. For the rest of your plan, see how to make a postpartum plan.