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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 

 

5 Quick Tips for Pumping at Work

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by Amanda G.

Pumping at work gets much more manageable once you figure out the logistics and get yourself into a routine.

Here are five quick tips to make pumping at work easier.

  1. Leave an extra set of pump parts at your office.

Trying to leave the house on time and get to work is hard. It’s even harder when you’re trying to get your baby ready too and you need to get your pump bag packed.

A checklist can help you make sure that you have everything you need when you leave the house. But even with a system, there’s a good chance that one day you’re going to be in a hurry and forget something crucial, like breast shields or collection bottles to pump into.

(The first time I forgot my breast shields, in desperation, I actually tried putting my nipple directly into the connector and starting the pump. That was a very bad idea. OUCH!)

In order to avoid having to either go home or try to buy a replacement for whatever it is you forgot, have an extra backup set of pump parts and bottles at work. This way you’ll have peace of mind and be ready for when the inevitable happens.

 

  1. Get a hands-free pumping bra so that you can do other things while you pump.

If you’re pumping two or three times per day at work, that’s a total of 30-45 minutes a day, or about three hours a week, getting a hands-free bra so that you can do other things besides holding your breast shields during the time you spend pumping can be a game changer. This way, while you pump, you can work on a laptop, take notes while you’re on a conference call, or take a break and read a book or magazine.

 

  1. Have as many sets of pump parts as you have pumping sessions in a day.

I used to recommend leaving pump parts in the refrigerator between uses, but the CDC recently issued guidelines stating that pump parts should be washed as soon as possible after each use. (More about the new guidelines here.)

To avoid spending a lot of time washing pump parts – and deal with getting access to a sink, if your lactation room doesn’t have one – bring enough sets of pump parts to get you through a day. Then you can wash them all in one batch, either at home or at the end of the day at work.

 

  1. Carry as little as possible back and forth to work every day.

The more things that you can leave at work (in addition to the extra pump parts mentioned above), the less complicated your mornings will be. So, if you can leave your pump, a hands-free bra, and whatever else you need – breast pads, freezer bags, lanolin – at work, too, then you can travel back and forth with just empty bottles and an ice pack in the morning, and full bottles in the afternoon.

(Obviously, if you need your pump at home, this might not be feasible, but one option is to get an extra manual pump you can use at home when needed.)

 

  1. Make friends with the other pumping moms in your office.

If there are other women using the lactation room at your office, try to get to know them! Having a relationship in place can be really helpful when your boss schedules a meeting and you need to switch your pumping time with someone else.

Did you miss out Live Q&A?  We got you covered!

 

Returning to Work: Planning and Pumping

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by Bonne Dunham, IBCLC

The prospect of returning to work after your baby is born can be a very frightening and overwhelming prospect for some Mothers, but with a little extra planning and knowledge about how to do this, you can smooth out this transition quite a bit.

In case you didn’t already know, there are several benefits to combining work and breastfeeding.  Knowing this might help give you a little bit of extra strength to leap over some of the more common hurdles that women face when re-entering the workforce AND taking care of a baby!  It’s not easy, but you got this!

Here are some benefits of combining work and breastfeeding:

Benefits to Baby:  Making the decision to supply breastmilk to your baby while you are working provides protection from ear infections, respiratory infections, allergies, colds, viruses and diabetes to name a few.

Benefits to Mother: Reduced risk of breast, uterine and ovarian cancer; decreases the risk of osteoporosis and allows for precious time to reconnect with baby.

Benefits to Your Wallet: One-day absences to care for an ill child occur more than twice as frequently for women who formula feed their infants as compared to those who breastfeed. And if you haven’t checked out the cost of formula…it isn’t cheap!

Setting Goals and Planning Ahead Will Reduce Stress

  •    Speaking with your supervisor about your plans for pumping at work BEFORE maternity leave is a great idea. If not before, than as soon as possible.
  •    Locate the lactation room in your workplace; does it have a fridge to store your pumped milk or will you have to bring a small cooler?
  •    Order you pump BEFORE your baby is born and understand how it works. While you are at it, gather your other pumping supplies ahead of time; collection bottles, storage bags and cleaning supplies.
  •    Plan your day: how will pumping fit into your workday? Consider making a mock-up of what your day will look like, from the moment you get up to when you step back through your doors. When and where will you pump? For most moms, pumping every 3 hours or so when separated from baby, for much of the first year, will help to keep your milk supply up and running.

Introduction of Pumping & Bottles

Week 1-4: Avoid pumping. Take this time to be with your baby! Allow the infant to naturally ‘program’ and establish your milk supply.

Week 4-6: Begin pumping once a day for 10-15 minutes and introduce a bottle. Adding this pumping session in during the morning or evening can be the best for when your milk supply is at its peak.

Weeks 6 and Beyond: Pump daily to store your milk or to have ready for your workday.

Milk Storage Strategies…The best tip I ever received!

The freshest is the bestest! Ok, bestest is not really a word, but I bet you get the picture: Always try to give your baby the freshest milk you have on hand, it will be highest in nutritive quality and deliver the most health benefits. Think “first in, first out”.

However, it’s also a good idea to rotate your frozen stash a bit too. Here is a way to do that: On Sunday night, take a days’ worth of frozen milk out of the freezer to thaw overnight in the fridge to feed baby on Monday. The milk you pump for Monday while at work will feed baby on Tuesday; Tuesdays’ pumped milk feeds baby on Wednesday, etc. No need to freeze this milk in-between, just keep it cool in the fridge.

Remember: Take a deep breath, take care of yourself too, and ask others for help. Leave us a comment about how you returned to work while breastfeeding and pumping.

Working and Pumping: The Struggle is Real

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What To Know When Returning to Work

Well, it’s sadly that time, when you are headed back to work after maternity leave.  Hopefully, your employer offers that necessary benefit. The baby honeymoon is over and now you have some big decisions to make regarding childcare and feeding.  If you’ve been breastfeeding up to this point, there is a good chance you’ll want to continue providing baby with your milk. After all, it is recommended to breastfeed exclusively for 6 months if possible, to get the continued benefits such as less frequent illness.  Before your actual return, try to be as prepared as possible. Make sure you know your workplace rights; have all the gear you need and have at least a general plan for how you will feasibly pump enough to keep up your supply for baby. Here are the basics to get you started:

Protection under federal and state laws

In 2010, the Affordable Care Act was signed into law with provisions related to nursing mothers and pumping at work. The guidelines include employees that are not exempt under section 7 of the law.  This includes most hourly paid employees. The law specifically calls for providing a nursing mother unpaid (unless all employees are paid for their breaks) reasonable breaks with a private room for nursing that isn’t a bathroom.  If your employer is smaller than 50 employees, they may be exempt from this law if it causes them “undue hardship.”  For full details check out these great resources here and here.  If you aren’t covered under the ACA, make sure to check your state laws.  Twenty-eight of fifty states have some kind of provision related to breastfeeding.

Planning and educating yourself

First, figure out what laws you are specifically covered by depending on your employment from the resources above.  If you aren’t sure, talk to your boss, human resources, or a workplace lawyer so you can start making a game plan.

Next, equipping yourself with all the essentials for successful workplace pumping is key.  To maintain a good milk supply it is important to have access to the best possible pump. For time management and optimal pumping, look into getting a double, electric breast pump that is hospital strength.  Under the ACA, it is also required that your health insurance provide you with a pump (either a rental or single user depending on the model). There are several pump options available and companies that will do all the footwork for you to get you the pump you need with little hassle.  Spectra Baby USA is one of these companies with the added bonus of great customer service and lactations consultants on hand as needed.  Check out their page for a comparison chart of different pumps to find the best option for you and you can also check their insurance lookup tool that locates a DME (Durable Medical Equipment) company that will work with your insurance policy to get you a breast pump covered by your plan.

Lastly, consider any accessories to purchase to make your life easier as a pumping mom.  This includes items like a pumping bra, sterilizing tools, nipple cream, adequate collection bottles, freezer bags, and insulated tote to be able to get your milk safely to and from work.  Having the right gear will keep you organized and efficient!

When and how to pump: finding a schedule

In general, you want to pump in a way that would mimic your baby’s current feeding schedule.  This generally means that a mom will have to pump every 3-4 hours. For a full-time employee that should be 2-3 times depending on lunch breaks and commute time.  How you want to schedule these into your day is completely dependent on what works in your day. Regardless, make sure that you try to actually schedule these times into your calendar to remind yourself and your co-workers.  It’s easy to forget or skip a pumping session if you don’t make it a priority and this can negatively impact your supply. If you are short on time one day, don’t stress and just try to get in as many short sessions as you can to keep the supply signal going to your breasts.

The last big consideration is your milk supply as your switch from breastfeeding to the use of a pump.  Your baby is much better at extracting milk from your breast than a machine, so if you have trouble initially with the amount you are pumping don’t be discouraged.  Keep these basic tips in mind: keep hydrated, eat healthily and frequently, stimulate an adequate let down with massage, heat or thinking of your baby (even look at a picture!), stay relaxed and comfortable and make sure you have the right size breast shield.

With the right preparation, you will manage the transition into a work-family balance well.  You rock mama! Keep up the good work providing liquid gold for your child while crushing those career goals.

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