The Over Achiever: When one breast produces more than the other

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By: Jacque Ordner BSN, RN, IBCLC 

Have you noticed that one of your breasts seems to consistently produce more milk?  If you’re pumping, this may be even more noticeable.  If your baby nurses, you may have noticed that he or she prefers one side or seems to finish nursing on one side much faster than the other.  Rest assured, this is normal!  One study of exclusively pumping mothers found that in 65.7% of pumping sessions observed, the right breast produced at least slightly more milk.  In another similar study, only 2.6% of the exclusively pumping mothers displayed equal pumping output from both breasts.  

Why does this happen? So, we know it’s normal for one breast to produce more or to have a greater pumping output, but WHY? Breasts aren’t typically symmetrical.  Like many other parts of the human body (eyes, hands, feet, ears, etc.) a degree of asymmetry is normal.  This can mean a difference in the amount of milk making tissue (alveoli) or even in the amount and size of milk ducts.  Many times, mothers can readily observe a difference in the size of their breasts and also notice that one commonly feels “fuller” than the other. Other less common reasons for this discrepancy include previous breast surgery and previous injury or trauma to the breast. Rarely, asymmetry is caused by a disorder known as Poland Syndrome.  This syndrome is evidenced by missing or underdeveloped muscle tissue on only one side of the body and often results in one breast being dramatically smaller and less developed than the other. In general, breast asymmetry is completely normal as is having one breast that produces more milk.  We like to call that breast the Over Achiever. 

We’ve compiled a few tips to help “even out” milk output: 

  • If you’re pumping, consider trying different settings to see if each breast responds differently to certain cycles/vacuums.  Once you determine which settings are best for each breast, determine a plan to incorporate these settings into your typical pump session.  For example, some woman report that one breast responds best to Massage Mode (cycle 70) while the other responds well to an Expression Mode cycle.  Moms often have great success with switching between the two modes like the example below: 

            -5 minutes at cycle 70 

            -5 minutes at cycle 54 

            -5 minutes at cycle 70 

            -5 minutes at cycle 38 

*Remember that higher vacuum doesn’t necessarily mean more milk!  We never recommend increasing the vacuum to an uncomfortable level. 

  • Consider adding more stimulation for the lower producing side. If you’re pumping, this can be as simple as starting or ending the pumping session with just a few extra minutes of single pumping on the lower producing side.  If you’re nursing, consider starting sessions on the lower producing breast or adding a few minutes of single pumping on that side after nursing. 
  • Do YOU have a preference? It’s not uncommon for mom to unknowingly develop a preference for feeding from one side over the other.  We often prefer to keep our dominant hand free, and therefore may feed more often or spend more time on the opposite side.  Keeping a simple log of feeding times for each side can help highlight any preferences you might not have noticed otherwise.  
  • Encourage better nursing and greater pumping output with your hands! If baby tends to stop nursing on the less preferred side sooner, consider incorporating breast compressions while nursing. This can help keep the flow a bit faster and more interesting for baby. It can also make milk removal easier. Similarly, Hands On Pumping is a technique that can help elevate your lower producer to Over Achiever status.  Check out this video from Stanford University: https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html 
  • Add in hand expression. One breast may give less output because it just doesn’t respond to pumping as well as the other.  Hand Expression is a technique that can help increase pumping output not only for the lower producing breast, but even for the Over Achiever breast as well!  A few ways to incorporate hand expression include in between pumping or nursing sessions, following pumping or nursing sessions, or when you’re running short on time and can’t fit a full pumping session in.  Here’s a link for a fantastic resource on the topic: https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html 

Keep in mind that it is normal for one breast to be the over achiever and it’s absolutely ok if you choose to do nothing to even out the supply.  Having a lesser producing breast doesn’t mean there is something wrong, it just means our bodies aren’t perfectly symmetrical! However, if baby consistently fully refuses one breast, if there is a noticeable change in size or shape of only one breast, if there is a lump that doesn’t go away or grows, or if there is a lump that doesn’t move with the breast tissue, reach out to your healthcare provider as soon as possible. Additionally, if baby seems uncomfortable turning toward one breast or always seems to turn his or her head in the same direction, reach out to your pediatrician for further evaluation for conditions such as torticollis.  Should you desire to bring both breasts to Over Achiever status, incorporating the tips above is a great place to start! 

Keep on keeping on, mamas!  We know you’re doing your very best to provide your babies with the best start and we support you! If you have questions about uneven milk supply or any other breastfeeding related topics, we can help! Our International Board Certified Lactation Consultants are available for free consultations at www.spectrababyusa.com/lactationservices.  You can also email us at ibclc@spectrababy.com  Happy pumping! 

References 

Engstrom, J. L., Meier, P. P., Jegier, B., Motykowski, J. E., & Zuleger, J. L. (2007). Comparison of Milk Output from the Right and Left Breasts During Simultaneous Pumping in Mothers of Very Low Birthweight Infants. Breastfeeding Medicine, 2(2), 83-91. doi:10.1089/bfm.2006.0019 

Hill, P. D., Aldag, J. C., Zinaman, M., & Chatterton, R. T. (2007). Comparison of Milk Output Between Breasts in Pump-Dependent Mothers. Journal of Human Lactation, 23(4), 333-337. doi:10.1177/0890334407307575 

 

Bringing Baby Back to the Breast

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Jacque Ordner BSN, RN, IBCLC 

There are scores of reasons why nursing at the breast may have gotten off to a rocky start or, perhaps, didn’t get off to a start at all.  Many mothers desire to bring their babies back to the breast after a period of bottle feeding.  While returning baby to the breast can be emotional, having the right tools, appropriate expectations, and the right support is essential for giving you and baby the best chance of achieving a successful latch. The following tips can help get you started. 

    1. Find a skilled International Board Certified Lactation Consultant.  An experienced IBCLC can help guide you and let you know what interventions to incorporate when.  Don’t be afraid to ask your potential IBCLC if they have experience with exclusive pumping and getting baby back to the breast.  It’s okay to be choosy when lining up your support team! This Find a Lactation Consultant directory can help put you in touch with IBCLCs in your area. 
    2. Consider the age of your baby and the potential reasons latching was difficult. Babies under 4 months of age tend to have a much easier time learning to nurse after a period of bottle feeding.  Older babies have been known to begin latching after having only bottles, but this is less common and often requires considerably more time. In many cases, the initial cause (or causes) of latching difficulty have been eliminated or reduced.  For example, moms and babies often pursue nursing after oral ties have been revised, low milk supply has been increased, baby has been discharged from the NICU, etc.
    3. Skin to skin is powerful! One of the first ways to help ease into latching is to soak up as much skin to skin time as possible.  Skin to skin helps engage baby’s inborn feeding behaviors and reflexes while contributing to a powerful hormone feedback system between mom and baby.  Skin to skin results in the release of Oxytocin, creating a bonded feeling and encouraging mom’s milk to let down.  Many moms and babies find latching success while taking a warm bath skin to skin.  Don’t underestimate the effects of skin to skin! 
    4. Paced Bottle Feeding is key. Many nursing relationships have been halted due to baby’s preference for the faster flow and ease of the bottle.  Paced Bottle Feeding is a technique that helps mimic the slower, less consistent flow of the breast while feeding from a bottle. Check out our blog post for Paced Bottle Feeding tips. Implementing Paced Bottle Feeding can help your baby transition to nursing at the breast by setting the expectation for a realistic flow rather than fast, immediate gratification.   
    5. Keep the experience positive.  Attempting to latch an already ravenous baby is not likely to go well.  In fact, doing so can lead to a negative association with the breast.  Choose a time to offer the breast when baby is calm and not excessively hungry.  Watching for early hunger cues like sucking on hands and fists, smacking lips, sticking out the tongue, rooting, and restlessness can help.  Many moms find great success in offering the breast while baby is sleepy.  If baby becomes upset, stop and comfort baby before attempting to offer the breast again.  It may also be helpful to allow for a small feeding from the bottle before finishing at the breast. This can “take the edge off” of baby’s hunger and help ease tensions.  Skin to skin before offering the breast is another great way to put baby in a calm state. 
    6. Make sure baby is well fed.  Intake from a nursing session can’t be precisely measured as intake from the bottle can.  For this reason, it is especially important to continue supplementing until you are confident baby is nursing successfully.  A well trained IBCLC can help assess baby’s nursing abilities and weight checks and diaper counts can help put mom’s mind at ease. 
    7. Consider the use of nursing tools. Many babies transition back to the breast by use of a nipple shield.  The texture of nipple shield feels similar to that of a bottle nipple, and many reluctant babies are much more likely to take a nipple with a shield over a bare nipple to start.  Squeezing a small amount of breastmilk onto the tip of the shield can also help entice baby to latch. Another tool that can be used with or without a nipple shield is a Supplemental Nursing System (SNS).  An SNS is a tool that helps deliver a supplement of breastmilk or formula via a thin tube placed alongside the nipple and connected to a bottle.  This is especially helpful for moms with low milk supply and for babies who struggle to transfer milk at the breast.Click here for a video demonstration of feeding with an SNS.  *We highly encourage working with and IBCLC if you plan to incorporate a nipple shield or SNS. 

Remember that nursing doesn’t have to be “all or nothing”.  Many moms and babies find feedings work best when they do a combination of nursing and bottle feeding.  Many bottle fed babies still like to nurse as much for comfort and closeness as they do for nutrition.  Breastfeeding looks different for different families, and PUMPING IS BREASTFEEDING!  We’re here to support you and offer any help we can as you navigate your breastfeeding journey.  Email us at ibclc@spectrababyusa.com or set up a free consultation with one of our IBCLCs at www.spectrababyusa.com/lactationservices. 

Breastfeeding and Benefits For Mama

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By Melissa Portunato MPH, IBCLC, RLC

You’ve likely heard all the amazing benefits of breastfeeding for your baby and how it can give them the very best start at life. Less risk of allergies, asthma, ear infections, obesity, a strengthened immune system, and so much more. But did you know that the benefits of breastfeeding are not only for your nursling but for you too? Read on to learn more! 

Reduces Risk of Breast and Uterine Cancer 
Breastfeeding can help shed cells with potential DNA damage which can reduce the chances of pre and post menopausal breast cancer. Estrogen can promote cancer cell growth and since breastfeeding delays ovulation this means less lifetime exposure, significantly reducing the risk of ovarian cancer. Studies tell us the longer you breastfeed for, the more protection you will have against both breast and ovarian cancer so nurse on mamas! It’s good for you! 

Less Osteoporosis With Age
Osteoporosis is a disease that weakens the bones and can make fractures sudden and easier to happen. Women are four times more likely to suffer from osteoporosis. By age 50, 1 out of 2 women will break a bone due to the disease. It’s known that while a mother is breastfeeding her bone density will be reduced by up 10% because ovulation is delayed. But when menstruation once again returns, her bones will regain strength. A review of 911 articles relating to breastfeeding and osteoporosis calculated a 0.9% reduction of any fracture from osteoporosis for each month of breastfeeding. More specifically, there is a 1.2% decreased risk of hip fracture for every month of breastfeeding! Breastfeeding can help keep mamas bones healthy and strong! 

Less Chance Type 2  Diabetes
A 30-year study published in 2018 showed the effects breastfeeding can have on diabetes incidence in women of child-bearing age. The study concluded breastfeeding for 1 year can lower your risk of type 2 diabetes from as much as 47%. But how does that all work? Lactation results in lower circulating glucose levels, which in turn lowers insulin secretion. Prolactin (milk making hormone) has also been linked to preserving the function of pancreatic cells. In conclusion, the duration of breastfeeding shows an independent relationship to lower incidence of diabetes, even when other risk factors are considered. 

Less Hypertension Decreases Blood Pressure
High blood pressure is often referred to as the silent killer because it can be present with no known symptoms. Alison Stuebe, a lead researcher at the University of North Carolina, Chapel Hill has studied the correlation between high blood pressure and breastfeeding mothers and stated, “Women who never breastfed were more likely to develop hypertension than women who exclusively breastfed their first child for six months or more.” Stuebe and her team analyzed the correlation between breastfeeding and later risk of high blood pressure among  56,000 U.S. women that had at least one baby. Though, the study does not indicate breastfeeding has a direct correlation with healthier blood pressure, it did depict the odds for developing high blood pressure were 22 percent higher for women who did not breastfeed their first child, versus women who exclusively breastfed for six months. The best way to protect yourself is to know the risks associated with high blood pressure and routine monitoring with your medical practitioner. 

In general, experts recommend that mamas and babies breastfeed exclusively for the first six months to receive the optimal benefits, but the longer a mama can breastfeed for the better. Breastfeeding is a mutually exclusive relationship and there is no need to stop if mom and baby are happy and desire to continue. Breastfeeding provides overall health benefits for mom and baby that will last a lifetime. 

Sources:

Lancet 2002 Jul 20;360(9328):187-95. doi: 10.1016/S0140-6736(02)09454-0. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease

Collaborative Group on Hormonal Factors in Breast Cancer, PMID: 12133652 , DOI: 10.1016/S0140-6736(02)09454-0

Gunderson, Erica P., et al. “Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years.” JAMA Internal Medicine, 16 Jan. 2018, pp. 1–10., doi:10.1001/jamainternmed.2017.7978.

Gunderson, Erica P., et al. “Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus.” Annals of Internal Medicine, vol. 163, no. 12, 15 Dec. 2015, pp. 889–898., doi:10.7326/m15-0807.

American Journal of Epidemiology, Volume 174, Issue 10, 15 November 2011, Pages 1147–1158, https://doi.org/10.1093/aje/kwr227 Published: 12 October 2011

https://www.cdc.gov/breastfeeding/data/healthstyles_survey/

https://my.clevelandclinic.org/health/diseases/4443-osteoporosis

https://lacted.org/blog/questions/breastfeeding-osteoporosis-fractures-females/

 

Paced Bottle Feeding

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Jacque Ordner BSN, RN, IBCLC, RLC 

Are you worried your precious little one will grow to prefer the bottle over your breasts?  Are you concerned you might not be able to keep up once baby begins taking bottles regularly while you’re away? Are you exclusively pumping and looking for tips on bottle feeding?  We’ve got you covered with our full guide on Paced Bottle Feeding.  

Research indicates that infants will take more from a bottle than they would when nursing.  This can result in overfeeding, mom losing confidence in her milk supply, and can even contribute to later obesity.  One large study compared formula fed infants (via bottle) and breastfed infants (via direct nursing) and found that the bottle-fed infants consumed 49% more milk at 1 month, 57% more at 3 months, and 71% more at 5 months. In comparison, we know that directly breastfed infants do not increase the volume of breastmilk intake from one to six months of age.  The average daily intake for a breastfed infant from one to six months remains about 25 ounces per day.  

 Why do bottle-fed infants tend to consume more?  

  • The flow from a bottle can often be initiated by gravity alone, triggering innate sucking reflexes present in babies under 4 months old.  In other words, baby will often continue to suck and swallow milk from a bottle long after they’ve reached “fullness”.  In contrast, the flow of milk from the breast requires a coordinated suckle and does not flow consistently.  An infant can pause, breathe, relax, and reassess before initiating additional flow from the breast.  This puts the baby in greater control of the feeding.  
  • Formula fed infants regularly consume more than their breastfed counterparts because more formula is required to meet their nutritional needs.  Formula also does not contain hormones such as leptin and adiponectin which regulate hunger and metabolism.  It’s especially important to keep this in mind if your baby receives breastmilk and formula or if you are tempted to compare your breastmilk fed baby’s intake with that of a formula fed infant.  

 What are the benefits of Paced Bottle Feeding? 

  • Paced Bottle Feeding allows infants to develop and practice their innate feeding cues and skills rather than only responding to the consistent flow of the bottle over which they have no control.  This is especially important for newborns (particularly pre-term newborns) who require supplementation early.  Allowing newborns to develop natural feeding cues and skills can be instrumental in helping them return to the breast or to transition from breast to bottle and back.   
  • Babies often develop a preference for the fast and continuous flow from the bottle. In the past, this might have been labeled as “nipple confusion”, but we now call it flow preference.  We now know that when baby prefers the bottle over the breast, it’s almost always due to the preference and ease associated with the faster flow of the bottle.  Babies are smart, and once they learn that they don’t have to wait for milk from the bottle they may start to refuse or become frustrated at the breast. Paced Bottle Feeding helps to mimic the slower and non-continuous flow of milk that occurs during nursing.  
  • Paced bottle feeding allows time for baby’s satiation signals to be recognized.  Most of us know the experience of scarfing down a big holiday meal in 10 minutes or less only to realize we’re painfully full.  Similarly, a baby can often take copious amounts from the bottle, due to its rapid and persistent flow, before the brain has had a chance to realize the belly is full.  This can lead to a gassy, fussy, spitty baby. Over time, baby’s tummy can come to expect those large feeds even if the volume isn’t necessary for baby’s complete nutrition.  Additionally, the same large study mentioned above found that caregivers often encourage baby to finish a bottle even when they’re displaying signs of satiety. Caregiver pressure to empty the bottle is another contributing factor to overfeeding. This can also lead mom to believe her supply is inadequate when baby is actually being overfed. 

 What are the principles of Paced Bottle Feeding? 

  • Feed on demand following baby’s hunger cues (rooting, sucking on fists, smacking lips, restlessness, etc.) Remember crying is a LATE sign of hunger.  
  • Choose a slow flow nipple.  Not all slow flow nipples are as slow as they claim.  Click HERE for to check the flow rate of many popular brands.  
  • Feed baby in a nearly upright position. 
  • Allow baby to “latch” onto the nipple rather than inserting it into his or her mouth. 
  • Hold the bottle parallel to the ground so that milk just enters the nipple. 
  • Provide frequent breaks by tipping the bottom of bottle down or completely removing the nipple from baby’s mouth. This is especially important if baby begins to gulp. Watch baby’s cues! 
  • Switch sides halfway through the feeding to mimic a nursing session. This also provides cross-connectivity in the brain. 
  •  Feedings should take 15-30 minutes.  
  • Don’t force baby to finish the bottle.  Allow baby to determine when he or she is full rather than encouraging them to finish a specific amount.  

*These techniques are appropriate for babies under 6 months of age.  

Click HERE for a video demonstration of Paced Bottle Feeding. 

Paced Bottle Feeding helps protect the nursing relationship, reduces the risk of overfeeding, and gives baby control of their feedings.  Have concerns about bottle feeding?  We can help!  Our Board Certified Lactation Consultants can develop a plan to help you introduce or manage bottle feeding.  Click HERE to schedule your free virtual consultation or email us at ibclc@spectrababyusa.com.  We’re here to support you! 

References 

 Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity–a systematic review. International Journal of Obesity and Related Metabolic Disorders, 28(10), 1247-1256. 

 Dewey, K. G. (2009). Infant feeding and growth. In G. Goldberg, A. Prentice, P. A., S. Filteau & K. Simondon (Eds.), Breast-Feeding: Early influences on later health (pp. 57-66). New York, NY: Springer. 

Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. (2004). Feeding effects on growth during infancy. Journal of Pediatrics, 145(5), 600-605. 

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395. 

Li, R., Fein, S. B., & Grummer-Strawn, L. M. (2008). Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants’ risk for excess weight at late infancy. Pediatrics, 122 Suppl 2, S77-84. 

Doneray, H., Orbak, Z., & Yildiz, L. (2009). The relationship between breast milk leptin and neonatal weight gain. Acta Paediatrica, 98(4), 643-647.

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