Factors associated with failure of exclusive breastfeeding among mothers of twins in Saudi Arabia

Objective: To assess prevalence of exclusive breastfeeding practices and risk factors for failure to fulfill exclusive breastfeeding for twins delivered in Saudi Arabia. Methods: Following a comparative case-control study design in Saudi Arabia, this study comprised 178 mothers who delivered twins and 122 mothers who delivered singleton babies. The researcher developed a self-administered questionnaire in simple Arabic language. The questionnaire included questions regarding personal characteristics of the mothers, breastfeeding practices of the baby, and questions about mothers' confidence toward their ability to exclusively breastfeed their babies. Results: Caesarian delivery was significantly more among mothers of twins than mothers of singleton babies (79.5% and 35.4%, respectively, p<0.001). Admission to neonatal intensive care units was significantly more among twin babies than singleton babies (60.7% and 18.5%, respectively, p<0.001). Number of children (5 or more) was significantly more among mothers with twins than those with singletons (16.4% and 4.5%, respectively, p<0.001). Mothers in both study groups did not differ significantly according to their employment status, residence, and family monthly income. Significantly less twin, than singleton babies started breastfeeding during the first 6 hours after birth (48.4% and 73%, respectively, p<0.001). There were significantly less twin than singleton babies who were exclusivelybreastfed (46.7%and 79.2%, respectively, p<0.001). Exclusive breastfeeding was significantly more practiced by mothers whose children were not admitted to neonatal intensive care units (NICU) than those whose children were admitted to NICU (64.6% and 35.1%, respectively, p=0.001). Exclusive breastfeeding was also significantly more practiced by mothers whose children started breastfeeding within the first 6 hours than those who started breastfeeding after 6 hours (p=0.009). Mothers of twin babies were significantly less confident than mothers of singleton babies regarding being able to exclusively breastfeed their babies (p<0.001 for all statements of confidence). Conclusions: Twins usually start their first breastfeeding later than singleton babies, and also tend to achieve exclusive breastfeeding less than singleton babies. Exclusive breastfeeding is less practiced by mothers whose children are admitted to NICU and whose children did not start breastfeeding within the first 6 hours. Mothers of twin babies are less confident than those of singleton babies regarding being able to exclusively breastfeed their babies. Rooming-in of mothers with their babies should be allowed at NICU.