So up until this point, I have referred to our daughters collectively, i.e. “the twins” or “the girls.” However, each has definitely asserted her own personality, and I know there will be many times when I will need to refer to them individually as in this post. Since I don’t want to use real names nor refer to them as “Baby A” and “Baby B” (or other monikers with an inherent order), I will therefore be referring to them as Pretzel and Peanut. Why? Because both their real names start with M, so my family has been calling them the M&M twins. And because I can.

A few hours after the twins were born, a lactation consultant brought us a single sheet of paper labelled “Feeding Plan” at the top. This plan instructed us that 8-12 times a day, we were to wake the girls (if they were still sleeping), try to feed them at the breast for 10-15 minutes (or until they became frustrated), supplement with pumped breastmilk/donated breastmilk/formula, and then pump for 15 minutes. The lactation consultant explained to me that because the girls were a bit premature (35 weeks, 6 days), they would likely be “lazy nursers” and might not get enough calories from the breast to make up for the calories they would lose nursing. Since they were also on the small side, the supplements would help make sure they grew appropriately.

I was certainly disappointed with this. I had planned to exclusively breastfeed as everything I had read suggested that it should be possible for just about every mother of twins. But, as my husband reminded me, “fed is best.” The lactation consultants also assured me that by pumping, I would help establish my supply and by letting the girls try nursing, I could help them learn how to do so. Essentially, supplementing would not last forever. Wanting more details, I asked how just about every doctor, nurse, and lactation consultant I saw how long it would last. I never really got a straight (or honestly even consistent) answer—most seemed to indicate that I would “know” when they were ready because they would be latching well and refuse the supplement after eating from the breast. A couple people also mentioned that once they were gaining weight well, that was a good time to start weaning them. The only time period I heard was “probably around two weeks or so.”

It definitely was not two weeks. They also never refused the supplement—in fact, Peanut would happily suck down any amount of milk you gave her in a bottle, even if there was not room in her stomach (we learned that the hard way). So we ended up needing to help them along with the weaning. Since I was not able to find a good guide on the internet of how to do this, I thought I would share what we did for any of you looking to wean your babies off a supplement. As a disclaimer, please don’t start weaning without the okay from your pediatrician. You want to make sure your babies are gaining weight well before you attempt any of this. Ideally, you would also check their weight every few days during the process to make sure they continue to gain well—our doctor offered to let us bring them in to weigh on their scale whenever we wanted.

1. Start by reducing the total amount of supplement for the entire day by 1 oz (we chose two feedings and reduced each by 0.5oz). You might be able to go a bit higher than this, but I would be careful. After talking with the lactation consultant and pediatrician, I got very gung ho about weaning off the supplement and reduced all their supplements down to about 1.5oz. It. . . did not go well. They wanted to nurse pretty much continuously that day and fussed a good portion of the night until we finally gave in and gave them more formula in a bottle.
2. Wait three days. Most of what I read suggested this is about how long it takes babies to get used to a new thing, and that certainly seemed true for our girls. By waiting some time before cutting out more of the supplement, you teach them to nurse more at the breast and let your breasts adjust to the increased demand.
3. Repeat. I chose to continue to reduce the same two supplements until they were eliminated and then move on to other supplements, but you could change supplements with each round so they all stay about the same if you prefer.
4. If at any point, they do not take the full amount of a supplement or spit up more than normal, reduce that supplement the next day even if it’s not one of the ones you were planning to reduce. This was the one exception we made to the 1 oz rule. We would reduce by either the amount they did not take or about half an ounce (if we were reducing due to excessive spit up).
   1. This is definitely more complicated with twins. You can certainly reduce the supplement for just one if only one seems to need less, but I found it impossible to remember when I was desperately trying to make bottles for screaming babies. Instead, I would only reduce if both met the above criteria at a given feeding—which did actually happen a couple times.
5. Continue this process until you are no longer supplementing (or are at the desired level of supplementation). We started by eliminating the daytime supplements because we knew my mother was leaving and it was very hard to manage the full process (breastfeed, supplement, pump) on my own. We then eliminated all of the nighttime supplements except the one right before bed. They still get 2oz then and will probably always get that. I consider it less of a supplement and more of a shifting of my larger supply in the morning to a time when I have less in the evening.

Once again, I want to reiterate that this should only be done with your doctors’ approval. Chances are that if you started them on a supplement when you were planning to exclusively breastfeed, you did it for a reason, likely because a healthcare professional told you to do so. However, there is a flip side to that coin as well. Make sure you advocate for your own desires and fully understand why you are being advised to supplement. If anything seems weird, seek a second opinion. Most doctors these days are fully supportive of exclusive breastfeeding, but we did see one older pediatrician when the girls were three days old (fortunately not our normal doctor) who told us not to let them attempt nursing for more than “a minute or two at most.” This was in direct conflict with the 10-15 minutes the hospital had told us we could do and seemed suspicious, especially because they were no longer losing weight at that point (all babies lose some weight when they’re first born but it should turn around by 3-4 days or so). I talked to our normal doctor after that, and he assured me that as long as no one was getting frustrated, I could let them nurse as long as they wanted since they were gaining well.

Another thing I wish I had known from the beginning is just how hard this process would be and how long it would take to wean them off the supplement. If I had known, I may have talked with the lactation consultant and doctor to come up with a plan that involved less supplement after each feeding so it would not take as long to wean. As it was, we were giving 3 ounces 8 times a day before we began weaning which was honestly probably a little excessive (though they did gain weight very well).

I will conclude by saying that this definitely was not easy. There were times when they seemed to be constantly hungry, and there was a week or two when I basically just set up shop in the recliner with my breastfeeding pillow and nursed them for five hours straight. On those nights, it would have been easier to give a bottle but I knew that if I did, I would then have that many more ounces to try and wean them off later. But it definitely took a lot of determination and we did not even wean them all the way and probably never will since the two ounces before bedtime seems to help them settle down to sleep. Which brings me to the biggest lesson I learned in all of this—it’s okay to feed some (or all) formula to you babies. It’s not going to harm them later in life or give them a lower IQ or anything like that (there was actually a very interesting Freakonomics podcast on that recently). As one of my friends put it, no matter what you do as a parent, you’re going to get judged. So do what works for you and what makes sense for your family. If you’re bound and determined to exclusively breastfeed because of the formula expense or just because you feel that it helps you bond with your baby, more power to you. But if you have found your baby sleeps longer with a couple ounces of formula supplement in the evening and you need that sleep, go ahead and give that and don’t feel guilty. In the end, you love your child and that’s what matters.