Jay, it sounds like your friend with the twins is doing really well.  What
you describe - mom able to pump 5 oz (150ml) from the left breast, but a lot
less, 2 oz (60ml) from the right, sounds most likely to be just another
variation of normal.  If mom will let down well to the pump on even one
breast, then - unless the other breast has scar-tissue or some other reason
why the nerve pathway might be affected - it is likely that the *let-down*
is not the cause of lower supply on one breast, less glandular
tissue/storage capacity is.  Most breasts produce milk in a 60:40 ratio.
Some moms can produce on a 80:20 ratio, and this can be normal.   If she is
pumping approx 7 oz every 2 - 3 hours this sounds like a really good supply,
and might even be far more than her babies might need for now!

The implications of this uneven production for your twin mom might be that
she could swop breasts between Baby A and Baby B at each consecutive
breastfeed, or she could just expect to top up the baby who has nursed from
the right breast after the baby on the left breast has finished, so that one
baby nurses from the right, but both nurse from the left at each feed. She
could give the smaller/weaker/less competent twin the left breast first
consistently for now, as this breast obviously has a better "flow" and it
may be that if the right breast is drained very well and very consistently
by the bigger twin that things might even out a bit in the future.  As I
have one left-handed twin because I did this though my personal opinion is
that it's important to vary the babies' positions so that they receive
left-right stimulation to eyes/hands.  If she is pumping and giving EBM,
then she can just split the uneven supply between both babies. She could
also breastfeed both simultaneously, pump the fuller breast after feeding
and use the EBM for top-ups for the twin nursed on the less full breast.  It
might take a little planning, and ideally she would need to get a little
ahead with the EBM available, so she could BF, top-up immediately then pump
ready for next time, but this could be streamlined with repetition. Above
all, I would reassure this mom that *this happens* and that it is not
significant.  It's the overall quantity of breastmilk being produced that
she can be pleased with.

Of more concern is the subtly-unsupportive husband.  Lucky she has *you* to
counteract this risk-factor!  Lack of sleep is an occupational hazard with
little twins, and feeding pumped EBM might be quicker at night than
breastfeeding for a while until everyone is more rested. If hubby could be
co-erced into helping then *he* could feed the babies previously pumped EBM
and mom could pump ready for the next feed/night, and they could all go back
to sleep in 30 mins.  Best to them all.

>My friend who just had twins is experiencing a situation that concerns her.
>Her left breast will let-down to the pump just fine and she gets upwards of
>5oz per 2-3 hr pumping and has seen a steady increase in supply in this
>breast since beginning pumping.  The right breast, however, rarely lets-down
>to the pump and she rarely gets more than 2oz per pumping.  There has been
>no increase in supply with this breast since beginning pumping.
>She has had no breast trauma, is on no meds that would affect milk supply.
>Her only factors that I could see that would possibly impact her supplu
>would be stress (subtly unsupportive hubby) and lack of sleep.

Pamela Morrison IBCLC, Zimbabwe
mailto:[log in to unmask]