I'm working with a mom of twins who has a very different milk production from
her right breast than from her left breast.  The baby girls are now a month
old. The pediatrician recommended that the mom call me when the babies were a
week and a half old and showed poor weight gain. When I saw them, one girl
seemed to have a dysfunctional suck. With test weighing, her intake was 12
grams (right breast). The other's intake was 22 grams (left breast). After
feedings, they were supplemented with formula. The mother had not
supplemented in the hospital, but the pediatrician told her to give water
because "they looked a little jaundiced". The mother felt that this had
changed the way they fed.

The girls are usually breastfed simultaneously, and alternate breasts. I
showed the mother how to do suck training and provided supplies for cup
feeding. The next week, the suck looked pretty good. Test weighing showed
that this baby's intake was better, but the other girl only ate 12 grams
(right breast).  I loaned her an electric breastpump set up for double
pumping. The latest test weighing shows 12 grams for the baby nursing on the
right breast and 40 grams for the baby taking the left breast. The mom's
breasts don't look or feel really different, and it is equally easy to hand
express milk. I tell moms that "no one is exactly the same on both sides",
but it never occurred to me that there could be so much difference. Even
though the mom is supplementing with bottles of formula (for time and
convenience), I would expect her milk production to increase.

This mom's diet and fluid intake is good. She has some help from family and
friends, but is still tired. She notices that whichever girl nurses on the
left breast seems to take less formula. She has stopped pumping due to the
time required. The family seems happy.

The breastfeeding initiation rate is approximately 40% at our hospital. Over
the past two years, 50 to 70 moms a month begin breastfeeding. I am budgeted
8 hours a week for LC duties. The rest of the time, I am a mother-baby (&/or
GYN surgery) staff nurse. (Of course, I am consulted whenever I am at the
hospital, or answer my telephone at home.) I have to accept my limitations. I
try to improve skills of other nurses. I've been following this family by
calling them two or three times a week (and providing my home telephone
number), talking with the pediatrician and the home visit nurse.

I'd appreciate ideas from fellow Lactnetters ideas about what to look for and
what interventions to try in a case like this.

Becky Engel, RN, IBCLC
Athens, GA