Breastfeeding multiple birth infants (MBIs) presents unique challenges that require tailored support and guidance, yet little research has focused on MBIs mothers experiences. This study employed a mixed methods approach and aimed to explore the breastfeeding journey of Australian mothers of MBIs, highlighting the barriers and facilitators they encounter and offering insights into breastfeeding experiences, maternal milk production, and infant milk intake. Data were collected between May and August 2024 via an online survey, which included both quantitative and qualitative components. Quantitative data focused on breastfeeding initiation, duration, and challenges, while qualitative data gathered the experiences, challenges, and support needs of mothers of MBIs. Thematic analysis was used to identify key themes from qualitative responses, and statistical analyses were performed to assess significant differences in breastfeeding outcomes between parity groups. A subset of participants participated in a 24 h milk profile study to measure maternal milk production and infant milk intake. Statistical significance was set at p < 0.05.
Survey data of n = 151 women (n = 80 primiparous, n = 71 multiparous) were available for analysis. This study revealed that, during pregnancy, 87.2% of mothers intended to breastfeed their MBIs. Commercial milk formula was typically introduced during the postnatal hospital stay, and 53.4% reported that they had achieved full breastfeeding during the first six months. The breastfeeding duration of those who had already ceased breastfeeding at the time of survey participation was 5 [3, 9] months. More than half of the infants in the survey were born preterm (58.3%), with NICU admission being the primary reason for the late initiation of breastfeeding. Overall, mothers of MBIs reported latching difficulties (56.0%), low milk supply (49.3%), and sore nipples (46.7%) as major barriers to breastfeeding. Among mothers with preterm infants, the significant barriers to breastfeeding included the need for supplementary feeds (80.2%), latching difficulties (54.9%), and infants’ lack of energy (54.9%). The cost of lactation support did not hinder mothers’ access to breastfeeding support and lactation aids, which likely reflects the higher socioeconomic status of the study sample. Nearly all mothers (98.7%) used electric breast pumps, which were followed by nursing pillows (89.2%) and nipple shields (44.6%) as the most commonly used lactation aids. The primary reason for expressing breast milk was to boost milk supply (68.2%) and to provide expressed breast milk (EBM) to other caregivers in order to feed infants (65.2%).
In the hospital, 71.6% of mothers reported satisfaction with breastfeeding support. However, qualitative data revealed the existence of a dichotomy in care experience, with some mothers receiving excellent hands-on support, while others reported feeling neglected due to busy staff or inconsistent advice. Many mothers reported that existing guidance and hospital support and education were primarily designed for mothers of singleton infants, leaving them unprepared to manage feeding of multiples. Mothers reported that improving breastfeeding outcomes requires specialized guidance, better access to lactation support, and in-home practical support to alleviate the burden of feeding and expressing. They also reported that healthcare professionals should be trained to offer practical, non-judgmental support, helping mothers to navigate the complex challenges of breastfeeding MBIs. This study underscores the need for MBI-specific breastfeeding education and consistent professional support, particularly in the early postpartum period, when establishing a robust milk supply is critical.
The analysis of the 24 h milk profiles in six mothers of twins showed that two mothers fed their twins directly from the breast for all feeds, one breastfed and supplemented with commercial milk formula, and three mothers exclusively expressed and fed both, EBM and commercial milk formula. On average, mothers produced 1403 ± 348 g of milk, with infants consuming on average 679 ± 206 g of mother’s own milk with total infant milk intake being 813 ± 86 g, including commercial infant formula. While some mothers could produce sufficient milk volumes for their infants, maintaining milk supply required a significant time commitment. Mothers +/− other caregivers spent, on average, 5.0 ± 2.2 h feeding and expressing milk. This did not account for time spent cleaning feeding and expressing equipment, which further adds to the time-intensive demands required to feed MBIs.
This study illustrates the significant logistical, physical, and emotional challenges of breastfeeding MBIs. Providing early postpartum support, clinician training, and MBI-specific breastfeeding education and guidelines could help to improve breastfeeding outcomes as well as infant and maternal well-being.
Author Contributions
Conceptualization, M.A.G., Z.G. and D.T.G.; methodology, J.L.M., Z.G. and S.L.P.; formal analysis, M.A.G., Z.G. and S.L.P.; investigation, M.A.G.; resources, D.T.G.; data curation, J.L.M., A.H.W., Z.G. and S.L.P.; writing—original draft preparation, M.A.G.; writing—review and editing, J.L.M., A.H.W., D.J.I., D.T.G., Z.G. and S.L.P.; supervision, D.J.I., D.T.G., S.L.P. and Z.G.; project administration, J.L.M.; funding acquisition, D.T.G. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by unrestricted research grant from Medela AG (Switzerland). The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Human Research Ethics Committee at The University of Western Australia (2024/ET000324, RA/4/20/6134) and conducted in accordance with the relevant guidelines and regulations.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Restrictions apply to the availability of some, or all data generated or analyzed during this study. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.
Acknowledgments
We thank all of the participants for help with this research.
Conflicts of Interest
D.T.G. declares past participation in the Scientific Advisory Board of Medela AG. J.L.M., A.H.W., D.T.G., S.L.P. and Z.G. are supported by an unrestricted research grant from Medela AG, administered by The University of Western Australia. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. All other authors declare no conflicts of interest.
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