Rebecca Judd's midwife writes about what the first six weeks with twins is really like.

Midwife Cath has delivered over 10,000 babies throughout her 40-year career. She has worked with hospitals around the nation to develop a model of care for the Maternal and Child Health Service. In 2003 she was awarded the Victorian Premiers Award for her work. She has consulted for many high-profile clients including Rebecca Judd, who is pregnant with twins and due later this year. 

If you have had premature twins, they will have spent their first few weeks in intensive care, and by week four you might only just be welcoming them home.

Multiple births are becoming more common for a whole host of reasons, such as IVF, and having babies after the age of 35 increases the chance of twins. Pregnancy with twins does increase the complications of pregnancy, such as diabetes, pre-eclampsia and premature birth. Pre-eclampsia is a condition peculiar to pregnancy that is diagnosed by: persistent high blood pressure during pregnancy or the post- natal period, evidence of protein in the urine and changes in blood platelets affecting the liver and kidneys.

Twins are hard work and I admire each and every mother and partner who has a multiple birth. It’s often a long and uncomfortable pregnancy and in most cases in 2016 the babies are delivered by caesarean section. It is ideal to maintain the pregnancy for as long as possible, to prevent any issues relating to prematurity. In all pregnancies we care for pregnant women and babies and must keep in mind the health and wellbeing of both. As Emily, one of the mothers of twins I look after, said:

I spent my pregnancy worrying about a whole host of issues, very few of which pertained to actually caring for two newborns. Part of me just assumed everything would come naturally to me, part of me assumed that it couldn’t really be THAT hard. People had twins every day and seemed to survive! Right?

We keep the balance of the mothers’ and babies’ health in the front of our minds at all times. If the mother is unwell with pre-eclampsia and having a multiple birth, for example, and the babies are well but premature, the doctor must decide whether or not to deliver the babies. The only way to ‘cure’ pre-eclampsia is to deliver the baby, or babies, and the placenta: the mother’s body will revert to its non-pregnant state. That is why you will see babies as young as 24–25 weeks born by caesarean section in intensive care units. For Emily:

Recovering from major surgery is no joke! In the first couple of weeks, I struggled moving around. Picking up the babies hurts, walking aches, everything seems painful. My husband is working incredibly hard to feed, change and care for the twins but it really is a two-parent job. Getting the rest I need proves difficult but gradually everything starts to ease. My wound heals well, the bleeding slows down and I’m moving around comfortably.

Ever wonder what a newborn baby is able to see? Technology has the answer. Post continues after video...

As I’ve said, twins are hard work, double the work. You have to be very organised and have not only a supportive and hands-on partner but also help at home from family, friends and, in some cases, hired help such as a nanny. It’s already hard work with one baby and you have to double everything, from prams, baby capsules, cots and bassinets to nappies, wraps, bottles, formula, clothes, and the wet and pooey nappies. It’s full on, so get organised by having a roster of relatives and friends to help you with changing and holding the babies.

Breastfeeding twins is definitely achievable but I strongly suggest you also give the babies formula so you can have your partner, mother, relative or friend feed one of the babies at any one time. It is virtually impossible to sleep when the twins sleep, as in the early days the babies may not sleep at the same time.

Emily and her husband Andrew have very kindly agreed to share their experience of parenting twins:

I was blindly confident about breastfeeding. Why didn’t anyone warn me that it could be really, really tough! I never really entertained the idea that our babies would be formula-fed because I had just assumed that the babies would exit the womb, find their way to my nipples and gracefully attach, gazing at me lovingly as they happily guzzled.

I could not have been more wrong. The twins wouldn’t attach in hospital (at all) and my milk did not come in until after we brought them home. Even then, it wasn’t some wave of breast milk soaking my top like I had heard about. I never really had that ‘full’ feeling to start with and I panicked that I wasn’t going to be able to produce enough milk.

It’s important not to hurry mums who have had twins. I always reassure them that they will breastfeed and the babies will sleep and their life will settle but it takes time and in some cases weeks and weeks of support and guidance. The most important thing is to have the babies feed and gain weight. If the mum needs to express for a few weeks before attaching the babies to the breast, so be it.

Long-term breastfeeding is the goal. Not all babies will attach in the early days, and calm and confident care and planning is what will reassure the overwhelmed new parents.

When we saw Cath, she showed me how to gently attach the babies and it just felt right. She was matter of fact about it and incredibly reassuring (yes, they will be able to breastfeed but you need to be patient and in the meantime, don’t be afraid of formula).

I was beside myself with worry and guilt and felt terrible every time we made up a bottle of formula (this was a million times a day). Gradually it did become easier but it took a lot of perseverance and patience.

I cannot stress enough: parents of twins need help, and a lot of it. If the partner can have four to five weeks off work, that is an added bonus. Remember, not only are the women looking after twins but also they are often recovering from a caesarean section, diabetes and pre-eclampsia.

In many cases twins may be born premature and the mother is often discharged earlier, leaving the babies in the special care nursery to gain weight and learn the two most basic skills of life that a new baby needs—to breathe and to suck. Once home the parents have the added responsibility of frequently visiting the new babies in the hospital and this is particularly hard on the new mother recovering from major abdominal surgery.

Parents of twins are often bleary-eyed, teary and over- whelmed to the max. Parenting in the first six weeks is endless, it’s emotional, it’s rewarding and it’s confronting. You feel guilty as all you have wanted is to have your own baby yet there are times you wish your baby would just stop crying and go to sleep so you can feel better. We all have times when we want to say ‘Please be quiet’, ‘Go to sleep’, ‘You can’t be hungry’, ‘What is wrong with you?’ and ‘I just can’t do this anymore’.

Absolutely nothing feels good at 2 or 3 am with a baby, but there is something deep in our hearts that keeps us going as parents—we put one foot in front of the other, we fall out of bed and dribble while we feed our hungry baby at 2 am. And then, your baby smiles at you, your heart melts and the irritability of sleep deprivation disappears immediately.

As Emily said: Being alone with the twins is a special kind of hell, because I find myself having to triage their cries. Other twin mums say, ‘Oh, you figure stuff out’ and you really do. You have to! I try desperately to get the hang of tandem feeding and can’t seem to master it, breast or bottle. In a pinch though, I can feed them both in their bouncers or propped up on a twin-feeding pillow. I become a pro at feeding one and rocking the other one’s bouncer with my foot. I’m constantly talking to the other twin, begging them to be patient while I feed their brother or sister, thanking my lucky stars that surely this means our babies will grow to be patient adults. They have no choice. I worry about them developing a complex about being neglected. When I’m feeding one and the other one screams at me, I feel like the worst mother in the world. I can’t physically pick up and tend to both babies at once so it’s basically choosing the one who screams the loudest. Cath says we have to ‘learn to like their cry’. When my husband goes back to work and I’m with them all day, it is just non-stop juggling them for hours on end—feeding one, quickly moving to the next, trying to take the ‘edge’ off them so I can go back to the first twin, and so on and so on until they’re both content and happy.

Emily went on to fully breastfeed her twins, giving them one bottle of formula initially after the bath and now as a dream feed. The twins sleep well, play and are happy babies but the work, the hard work, still continues for Emily and Andrew.

This is an edited extract from "The First Six Weeks" by Midwife Cath published by Allen & Unwin, RRP $29.99 available now.