A Narrative Review of Strategies to Optimize Breastfeeding Among Mothers of Twins

The global incidence of twin births has substantially increased in recent decades. Twin pregnancies are inherently associated with higher obstetric risks, often resulting in preterm birth and low birth weight, both of which frequently necessitate neonatal intensive care (NICU) interventions. Such interventions can significantly disrupt early breastfeeding practices, contributing to lower exclusive breastfeeding (EBF) rates in twins as compared to singletons. This review examines the factors affecting optimal breastfeeding among twins and strategies for optimization. An extensive literature search was conducted across several databases focusing on breastfeeding twins and related factors. A total of 256 studies on breastfeeding among twins were identified. Additionally, relevant reviews, guidelines, and support materials from twin associations and organizations were examined to identify factors affecting optimal breastfeeding and to highlight strategies for enhancing breastfeeding success. Studies highlight factors affecting optimal breastfeeding among twins, including low milk supply, fatigue, lack of knowledge, anxiety, stress, limited support, breastfeeding reluctance, breast problems, maternal illness, twin prematurity, and NICU admission. Suggested strategies to optimize breastfeeding outcomes include educational support, expressing breastmilk for preterm twins, establishing routines, correct techniques, varied positions, comfort devices, family support, using resources from twin associations, community engagement, and promoting early initiation and EBF. Although factors affecting breastfeeding among twins have been studied, few studies provide strong evidence or statistically determine these issues, and also, interventions are not tailored to individual needs. Studies focusing on personalized interventions are needed to improve breastfeeding outcomes for mothers of twins.