I tell moms to breastfeeed on one breast and pump the other at only one  
feeding...the morning one is usually the easiest, but any time will do.  To  
finish feeding on the side they pumped, and to switch the sides every day so  both 
sides can respond to the extra removal.   
 
I am having a very hard time understanding why pumping extra milk is an  
issue.  I fed twins, one each breast so how can it mean less milk will  be 
available if you pump one side and nurse the other?  This topic is  always coming 
back to Hartman's research, and I am always thinking the same  thing....these 
women were NOT trying to increase their milk supply.  What  if they were?  What 
if they were feeding and pumping and feeding and  pumping, would not the supply 
increase?  Why is it that we have now decided  that what a mother makes is a 
constant unchangeable amount?  And, in terms  of exact numbers is that even 
what the research showed?  Maybe there were  variations of a small amount, but 
not enough to be considered 'statistically  significant', but still it was 
there.
 
And, as long as I am thinking of this, I will add that I am fairly sure  
consumption increases and/or varies also.  Sure, growth caloric needs slow  down, 
but how about caloric needs for activity?  I have yet to have 5 month  old 
that is not busy moving.  What about the older baby crawling and  walking?  My 
babes walked by 8 months and only a couple were even tasting  food then.  I do 
not think my supply dropped.  How long was the study  continued? What is done 
through the first two years?  If not, how do we  know for sure that breast milk 
was not available in a varying quantity after the  6 months?  Maybe it 
changed a bit when solids first started, but then  rebounded for those picky eater 
days.  I know my 1 year olds would  sometimes refuse to eat anything at all!  
Thank goodness they had my  milk.
 
I  think that we are talking about different issues when we talk  about 
ability to produce milk as needed rather pumped or removed by  the baby.  Some 
women schedule feeds around the clock, others don't  schedule and instead follow 
baby's cues.  This means that some women are  consistently aiming to feed 'x' 
number of times per day and others are feeding  ad lib with the baby's whim and 
desire.  Would not that make a difference  too?  If a mom is consistently 
expressing 2 ounces a feeding, why would her  body not simply make 2 more ounces 
a feeding if she were always allowing her  baby to nurse without the clock 
driving his feedings?  And, actually, even  if she was watching her clock, it 
still seems to me her body would simply make  the milk removed.  It seems to me 
that the idea of milk removal is the  driving force for milk production would 
apply.
 
Breastmilk continues to have more calories than solids and definitely is  the 
superior source of nutrients.  I do realize that mothers replace  
breastfeeding with solids, but that is not what is supposed to  happen.  Also, as along 
we use the bottle feeding as the norm to mimic we  are going to miss the whole 
picture.  Moms who bottle feed add to the  bottle, remove a bottle, etc.  
Sure, if they feed the baby two jars of food  they are likely to not give them 
that feeding's bottle.  BUT, with a  mother who is breastfeeding by the 'nursing' 
definition (which means as needed  and for more than food) and only offers 
foods after nursing and is not aiming to  eliminate breastfeeds I do not think 
we will see the drop in supply.
 
I appreciate Hartman's research, but what he was looking at is not what we  
are talking about when it comes to increasing supply.  I would like to see  the 
same research being done for women who were actively trying to increase  
their supply for their 2 or 4 or 6 month old.  I still think if at 2 months  women 
no longer have the ability to increase their supply then we are all  wasting 
our time working on this issue with slow weight gain.  Might as  well say 
'well, you have set your production and now must just use an  alternative to 
breast milk' and that is not what we are doing.  

I  do not think Hartman's research meant for the assumption to be that what a 
 mother makes cannot change.  And, I am even less sure that it applies to  
all women in general.  I accept it is what he saw with the women he worked  
with, but I think we have more to do before we assume that all women everywhere  
reach a certain volume and are unable to increase it.  The same is true I  
think about starting solids.  There are still babies who do not start  solids at 6 
months and even more who when they do start solids are not taking  more than 
an experimental taste and yet they continue to grow and be  active.  And, the 
caloric needs for growth in the earliest months when all  the baby really does 
is eat and sleep cannot be that much more than the needs of  a child who is 
growing more slowly, but sleeping much less and much more  active.  Even using 
an older child or the adult as measurement---those of  us who are very active 
can continue to consume calories and not get to be the  size of the barn door, 
but for those like me who consume more calories than we  are using we do in 
fact continue to grow...just not in height and  head circumference.  
 
This is just one of those evidence based topics that I think is still  
missing all the evidence and that some of the evidence is interpreted  differently 
from one professional to another.  If we used the evidence to  mean milk 
production is established by 2 months, then it makes perfect sense to  have mothers 
pumping and stockpiling for separation needs because that will  simply set the 
production level at a higher amount.  And, it would make  sense to start that 
by the 2-4 week mark.  Thinking of the overproduction  of the early weeks as 
the body is establishing need would be ideal for pumping  and would tell the 
body the need is great.  Isn't that what happens when  mothers have twins and 
are exclusively breastfeeding? Every time I think of this  I think of all the 
women nursing on only one breast out of necessity and all the  mothers of 
multiples.  No one is telling them they cannot make enough  milk.  Why is 
expressing any different?
 
Of all the changes in lactation information I have had to absorb, this  is 
the hardest information for me to accept as the new absolute.  I still  hear the 
mantra, the milk in the breast was not put there to stay, the more you  take 
out the more you make...or something simlar.  Are we now adding to it  with 
"in a set amount that you cannot change". 
 
I really like reading Linda Smith's comment on her web site that  people get 
PhDs studying this. At least I don't feel totally ignorant for  not being able 
to 'get it' completely.  Haha.
 
Best,
Pam MazzellaDiBosco, IBCLC, RLC who is going to be sure to delay solids  just 
to watch intake after 6 months....not a biggie as I do not feed my babies  
until closer to 9 months anyway. 
 
 

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