Many years ago, breast milk was thought to be sterile. While this is far from being the case (it actually contains all manner of germs1), the role it plays in helping keep babies free from harmful disease means it does display some pretty impressive bug-busting capacities.
The immunological components of breast milk help to protect both a mother’s breast and her baby from infection during feeding, as well as aiding the development of the baby’s immune system2. They also have another useful consequence, however: protecting breast milk from disease for some time after it has been expressed, enabling it to be stored. Several studies have examined whether it is safe to keep expressed milk for short periods, and there is general agreement that it can be stored for 8 hours at room temperature (25 degrees C), for three days in the fridge (4 degrees C) and for up to a year in the freezer (-20 degrees C) without any increase in the levels of pathogens (harmful bacteria) it contains3.
Not only does breast milk inhibit the growth of pathogens, however – it actively reduces them. This was convincingly demonstrated in a piece of research examining what happened to milk during short term storage4. Milk was collected from 9 mothers and divided into three samples: the first was analyzed the same day; the second was refrigerated (at 4 to 6 degrees C) for 48 hours; and the third was refrigerated for 72 hours. Each sample was then contaminated with an E.coli solution (the kind of nasty bacteria that dwells in toilets) and left for two hours. When the samples were tested, levels of E.coli had reduced by 80% in both the milk that was fresh and the milk that was 48 hours old. Levels had also diminished in the 3 day-old milk, but only by around 10%, indicating that the antibacterial properties, whilst still present, had started to degrade by this point.
If your baby needs to feed from a bottle or cup, a considerable body of research indicates that it’s safe to give him breast milk that has been stored in the fridge for up to three days, or in the freezer for several months. There is also evidence that if the milk you express does come into contact with germs (keeping pumping equipment sterile in your bag at work isn’t always easy), then the bactericidal components of breast milk should be able to take care of them, providing the milk is under two days old. There may still be potential issues associated with feeding stored, rather than fresh breast milk to your baby: various chemical changes occur in milk once it has left the body, and it’s possible some of these may affect its nutritional value3,5,6. Nevertheless, expressed breast milk remains a healthy alternative to formula, and as a result of its antibacterial qualities, you can rest assured that if your baby can’t feed from you directly, he still has a safe source of food and drink.
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Every new mother has moments of uncertainty. What will life be like when my baby arrives? Will I be able to breastfeed? Those concerns are often magnified for mothers expecting twins, triplets, or more! Even though breasts are designed to “supply” enough milk to meet the “demand” of one or more babies, physical and emotional challenges are common, so it helps to be prepared. Here are 9 tips for breastfeeding multiples from MotheringMultiples author Karen Gromada.
Prepare ahead of time Learn all that you can during pregnancy. Read books and information such as Mothering Multiples: Breastfeeding and Caring for Twins and Moreby Gromada (mother of twins herself). Find other mothers who have breastfed multiples, perhaps through La Leche League, Breastfeeding USA, or similar breastfeeding support groups. Also consider connecting with online groups of women who are breastfeeding multiples, or ask your obstetrician to recommend hospital based breastfeeding support groups. Start attending no later than your second trimester. Multiples have higher odds of being born early, and you’ll want to be prepared if that happens. Studies show that mothers of multiples also benefit from support during the early postpartum period.
Plan for help Knowing how eager family and friends often are to meet newborns, Gromada encourages mothers of multiples to make them “pay some sort of barter system in order to meet the babies.” If it sounds like she’s joking, well she is—and she isn’t. The reality is that parenting one newborn is a lot of work; parenting two, three, or more simultaneously is a lot more work—regardless of how you are feeding them. You’ll need help with laundry, housework, and caring for older siblings. While relatives and friends can’t breastfeed your babies, they can help with diaper changes, holding babies between feedings, bringing meals (in disposable containers), and household chores to ensure that you have the time you need for breastfeeding, expressing milk, and caring for yourself.
Set short- and long-term goals The American Academy of Pediatrics (AAP) and other leading health organizations recommend that babies exclusively breastfeed for the first six months of life, and continue to breastfeed for at least a year. In the first days of mothering multiples, the very act of setting goals may seem to be ambitious, so establish your goals during pregnancy and take them with you to the hospital along with your birth plan. Make a short-term commitment to continue breastfeeding no matter what for some period of time, such as 6–8 weeks. Studies show that simply establishing goals can have a positive impact on breastfeeding duration. Gromada reminds us, “multiples are more likely to be born prematurely or in a stressed condition—even when full term,” and “your milk is especially important for them.”
Provide skin-to-skin care Skin-to-skin care is a key element of the World Health Organization’s (WHO) “First Embrace” campaign for good reason: Skin-to-skin care after birth “transfers warmth, placental blood and protective bacteria, and promotes exclusive breastfeeding.” And the benefits continue in the days and weeks after birth. Babies and mothers experience numerous health benefits when they are in close physical contact. Skin-to-skin contact can be more challenging for mothers with multiple babies. Babies who are healthy and full-term (or close to term) should have skin-to-skin care as soon as possible after birth. Initially, whether you have delivered your babies through vaginal birth or cesarean section, you may want to hold one baby at a time. Enlist your partner or another support person to hold and/or provide skin-to-skin care when you babies are not in your arms. Have a lactation consultant, postpartum nurse, or doula help you position your babies.
Express milk immediately If for any reason one or more of your babies is unable to be with you to breastfeed, initiate milk expression within 1–2 hours of birth. Whether one or more babies are taken to the neonatal intensive care nursery (NICU) or you experience a medical complication, early frequent milk expression speeds the process of obtaining greater volumes of milk. Breastfeeding is a “supply and demand” operation; you want to cue your body about the demand for a supply to meet your babies’ needs as soon as possible. Hand express colostruminto a clean spoon or container the first 1–2 times. Then add a mechanical breast pump. Use a pump at least 8 times per 24 hours—12 times is ideal, although possibly not realistic for every mother—and include hands-on pumping techniquesfor at least 5–6 breast pumping sessions during each 24 hours to maximize milk production.
Have your babies room-in As much as possible, keep your healthy babies with you in your hospital room. This allows you and your babies to remain close, so you can start to get to know your babies and learn to recognize their feeding cues. Keep the hospital bassinets near the head of your bed, so you know when a baby is waking and signaling a readiness to feed. Also, arrange for someone—your partner, relative, and/or other support person—to always be with you at the hospital so that you have an extra pair of hands available to help you with the babies whenever you need it.
Feed one, comfort another Many mothers of multiples do eventually strive to feed their babies simultaneously. (Some refer to this as “tandem feeding,” although that term is typically used to describe the practice of breastfeeding two children of two different ages at the same time.) Wait to try simultaneously feeding two of your babies until at least one of them can latch easily—and in a way that is comfortable for you. But don’t rush the process. While feeding two at once can be a time-saving strategy, it can backfire if introduced too soon. If the babies are not ready for simultaneous feeding, poor latching or feeding behaviors can cause injury to your nipples, or result in one or more of your babies not taking in enough milk. Initially, consider feeding one baby while the others are comforted by the gentle movements of a bouncy seat or a swing.
Position babies well When you do get ready to try simultaneous breastfeeding, consider enlisting the aid of your partner or support person, a lactation consultant, or a knowledgeable postpartum doula. Another set of hands can be helpful until you get the knack of positioning both babies yourself and/or the babies become more deliberate in their own movements. Laid-back breastfeeding (also called “biological nurturing”), a semi-reclined approach described by Dr. Suzanne Colson on her websitecan be a good way to start. Many mothers, especially those who have delivered via cesarean, find that the football hold helps keep most of the babies’ weight away from the incision site. As they grow, you may consider cradle or cross-cradle positions. Gromada provides photos of several positions for simultaneous breastfeeding on her website.
Set realistic expectations Accept that breastfeeding takes a lot of time in the early weeks or months. It is normal for each newborn to need to breastfeed at least 8 times and as many as 12 times in each 24 hours. Expect each baby to have his or her own breastfeeding “style,” but don’t expect two or more babies to synchronize their appetites. For example, one baby may be content with 8 or 9 breastfeeds in 24 hours, while another may need 11 or 12 breastfeeds in the same time period. One may finish feeding in 10–15 minutes, while the other may continue to breastfeed off and on after an initial period of active feeding. It’s helpful to realize that these patterns are normal—and that breastfeeding multiples won’t always be so challenging.