Strategies to Support Sustained Breastfeeding of Late Preterm Multiple Birth Infants

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

Background

Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins.

Methods

A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis.

Results

All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding.

Conclusions

Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00507-3.

Twin Births in Medicaid: Prevalence, Outcomes, Utilization, and Cost in Four States, 2014-2015

OBJECTIVES

Twin births have increased in prevalence. Twin births are more likely to have poorer outcomes than singleton births and are more costly. However, although Medicaid paid for approximately half of U.S. births in 2016, little is known specifically about the incidence of twin births and related costs for Medicaid beneficiaries. This paper seeks to expand the knowledge of twin births covered by Medicaid.

METHODS

We obtained data for singleton (N = 115,568) and twin (N = 3775) Medicaid-covered births in selected geographic areas of four states in 2014 and 2015. States provided linked birth certificates to Medicaid claims data for mothers and infants. We compared health care utilization and Medicaid costs for twins to singletons in the same geographic areas.

RESULTS

The prevalence of Medicaid twins in the selected areas of these four states was 3.2% of births, identical to the rate of twins nationwide. Two thirds of Medicaid twins were born preterm, and average gestational age was 34.8 weeks. Mothers of twins had higher rates of C-Sect. (73.6% vs. 32.0% for singletons) and of neonatal intensive care use (45.2% vs. 11.1%). The average length of delivery stay for twins was 12.3 days, vs. 4.1, and the rate of hospital readmissions was almost twice as high. The total cost for mother and infant over the prenatal, delivery, and post-natal period for a pair of twins was $48,479, over two and a half times as high as for singleton births ($18,032). However, when considering the average cost of a single twin vs. a singleton birth, the cost differential is less ($24,239 vs. $18,032, or a ratio of 1.34).

CONCLUSIONS

Medicaid twins are a fragile population with poorer outcomes and higher service use than singleton infants. Twins contribute substantially to the Medicaid cost of maternity and newborn care. A variety of strategies can be used to improve twin outcomes and reduce costs.