Episode 373

Meet the unilateral breastfeeding mother –

The breast is an amazing gland which function is to feed our babies.  When we think about breastfeeding, it is reasonable to make an assumption that we would use both breasts to feed our baby.  And yet, sometimes this is not the case.  There are quite a few reasons why a women would not be able use both her breasts to feed her baby.

1.  The most common reason is that one breast just did not develop and the other did. Perhaps she can even make milk from this side, however, her baby is very frustrated with the very low supply and continually refuses to feed from that side.
2. Recurrent mastitis or chronic plugged ducts on one side. This may cause moms to want to stop breastfeed altogether.  When I explain to them that her breasts are 2 different glands and work separately from each other, I can then explain to her how she can dry up one side and fully breastfeed from the other side.

3. Breast abscess – some moms have had a horrible previous breastfeeding experience.  They really want to breastfeed their  next baby, but say they have ptsd from their previous experience – an awful breast infection that turned into an abscess.  Having needing to go into the hospital and have the abscess drained and needing to care for the resulting with    they just are afraid to even start. I will gently counsel them and offer to help them prevent this from happening again, however, some moms just do not want to even start.  As their LC, I am there to help them meet their goals and I will therefore switch to a plan that will help them build a full supply from their other side.

4. Over the years, I have worked with a few mothers who have Had an accident of some sort which caused major breast trauma which meant she was unable to breastfeed from one breast.  There have been other trauma’s such as car accident or fires that have burnt their breast or nipple tissue.

5. I have also worked with many mothers who have had breast cancer and there is either too much scar tissue for her to breastfeed or she has had 1 breast removed.

The first part of the plan is to educate moms how the breasts work and the importance of getting off to a good breastfeeding start.  This means to be connected with an IBCLC for a prenatal consult and to have an appointment right after the baby is born, so we can rule out any other issues that may cause breastfeeding problems, as well as be sure that position and latch and milk transfer is all optimal.

If there is one breast that does produce a very small volume of milk, she will need to avoid any stimulation and will also  need guidance on how to dry up that side if she is making enough milk that her breast becomes very slightly engorged, clogged ducts, etc.

If there is one breast that has the potential to make a full supply, then we will need to work closely together to avoid her from getting engorged or clogged ducts while she works at drying up that side.  You may wonder why she would need to do that.  Well, the breasts are independent beautiful creatures and just because the mom has decided that she does not want to use that side for breastfeeding, does not mean that it will automatically not produce milk on that side. That side is already  producing milk during the pregnancy.  Once the baby is born and the placenta is out, the hormonal shift is such that it now allows for the milk volume to increase as it is driven by the mothers hormonal system.  In a few Days it shifts to a baby driven supply.  If the milk is not removed by the baby ( or hand or pump) frequently or efficiently, the body will get a strong message that it does not need this milk and will make less and less as long as it is not being stimulated.

From time to time, I have worked with a mom who has changed her mind, once her baby is born.  They just see their breast filling up with milk and while they are afraid of getting another abscess, they start feeling like they can overcome the fear.  Of course, she can do that and then I happily help her with all the tips in my toolbox on how to prevent breast and nipple issues from occurring and how to build up a good supply.  Other times, their own baby makes the choice for them as they are holding them, perhaps burping them from the feed on one side and they are skin to skin and their baby just gravitates to the other breast.

Now, with the mom who has both breasts, but is only feeding from one, the most obvious question I get asked all the time is:  What about being lopsided?  Of course, this is a valid concern, however, I try to help them see that –  A.  they or their partner may be the only person who notices.  B.  If it does bother them they can have a few bras made especially for them so they look the same size on each side.  C.  I am not downplaying or ignoring their concerns, however, I do add to the discussion that there are some moms who have had a breast removed and they do not have a choice at all and that, again, there are things that they can do to “even them out.” so to not let the lopsidedness be a deterrent because it is all figureoutable if they just give it a chance.  Plus, once they are done breastfeeding, both will soon be the same size again.

This was the case with Leanne, who I had the pleasure of getting to know about 4 months ago.  She had major psychological trauma associated with breastfeeding as a result of a left breast trauma.  I did not work with her with her first baby as she lived out of state at the time.  However, she did share with me quite the horrible breastfeeding experience she had and how it resulted in an abscess of her left breast.  Leanne tells me her very personal story and cries when she gets to the part of realizing she had to be hospitalized and separated from her 3 week old baby.  It turns out she had been diagnosed MRSA, which stands for Methicillin-resistant stephylococcus aureus which is a bacterial infection.  Now, not every mom who has a breast abscess needs to be hospitalized, nd not all physicians treat it the same way, however, Leanne had a high fever and she was rating her breast pain as a 10+ and her Dr. recommended an I & D, which is to make an incision in the breast tissue and drain the area.  This means that the area needs regular dressings to be changed and possibly more drainage and she felt it was better to be hospitalized.

Ultimately, this meant being separated from her newborn as they would not allow the newborn to stay with her in the hospital.  I have no problem saying that her case was poorly managed as they did not want her to pump the infected side and pumping the right side meant that she did not have enough milk for her baby, who now needed to have formula and a bottle which her baby had not taken before.

This set in motion a whole care plan and a major change in her breastfeeding life.  One that she was not prepared for and one that she did not receive the proper guidance for. Leanne became quite depressed at only seeing her baby once a day for about an hour. Once home after 4 day stay, her baby was not so thrilled with latching on anymore and she had a difficult time getting her back to the breast.  Her left breast was still leaking some milk, but the supply had dropped quite a bit and the dressings were in the way of her being able to latch her baby on to that side.  Leanne followed her Drs. instructions and accepted the fact that she could not breastfeed from her left side.

Leanne was determined and as she told me – naively stubborn as she just continued to offer the right side and eventually her baby was EBF from just one breast.  Now, pregnant again and due in about 6 weeks, she sat in my office, with her 3 year old playing blocks on the floor by our feet.  Tears flowed easily down her cheek as she relayed this story to me. She told me that she was in the “I want to, but I am afraid to” place.  She really wanted to breastfeed from both sides, but was, in her words “deathly afraid to.”  She talked a lot about all of the “what ifs.”

My role was to listen to her tell her story, ask her what it is that she wanted, and to come up with a plan to meet her goals.  She just could not make up her mind. The first thing I did was tell her that she did not need to make up her mind right now.  I suggested – what if I could give her some options, she could choose what she felt most comfortable with and we could go from there. She liked this idea and after some discussion, Leanne basically felt comfortable having decided a few things.

The very first one was for her just to know – that she did not have to make a decision at the moment.  This really freed her up emotionally as this had been weighing heavily on her mind.  The second is that she felt a huge load lifted emotionally just to know that she had made the connection with me and did not have to scrounge around last minute searching for someone to help once her baby was born.

Other decision she made:

She would wait until the baby was born and see if she felt a strong pull one way or the other. – to breastfeed from both sides OR to only feed from one side and get on a care plan to dry up the other side.   If she knew which way she was going to go, we would follow a care plan to meet those goals.

If she still was unsure, she would remove the milk with hand expression, at least until the time she felt this is what she wanted to do.

I had explained to her that, as long as she removed the milk on a regular basis, she could take the time to decide if she wanted to breastfeed from one or both sides.

If she decided she wanted to use both sides, we would concentrating on good position and latch.

If she decided not to use the other side, I would help her manage drying up from this side.

But if she did not remove the milk at all, she may wind up getting engorged and increase he risk factor for clogged ducts, which unresolved might lead to an infection or an abscess.

In other words, she understood that the worst thing for her to do, was to just leave her breast alone and only feed from the right.

The plan we came up with was for me to see her as soon after the birth as possible  This way, we could rule out any risk factors for potential latch issues on the right side and we could make sure that her baby was latching on well.  Since moms are more likely to get an abscess from nipple damage in the early days of breastfeeding, this was very important. At that time, I could go into greater detail about all that she needed to know.

In the end, about a week before her baby was born, she called me up and said she definitely wanted to breastfeed from both sides.  She had some help with her midwives right after the birth and I was able to be at her home within 12 hours of her being discharged from the birthing center where she gave birth.  By the time our consult was over, she was latching her baby on really well to both sides and was feeling pretty confident.  A day  later, she told me she had a meltdown, woke up from a nap in a swear, the fears overwhelmed her and she switched from breastfeeding from the left side to hand expressing.  She did this for another few days and said she kept trying to get the  nerve up to breastfeed her newborn from the left side.  While she was in the business of thinking about it, her baby led the way.  Leanne said that she swore he kept gravitating to that side and at one point she lifted her shirt, she was braless, held him on her chest and he just bobbled his was onto the left breast and she said – Okay then….   after that things went rather smoothly.

Probably the most difficult of times for me is when the mom has had a breast removed because she had cancer.  The choice to breastfeed from both sides has been taken away from her.  With the proper help and a good positive attitude, she can make plenty of milk from the one side and they can be a happy breastfeeding pair.  Sharon is one such mom and I helped her with her first 2 and I recently found out that she had baby #3 and never even called me for help ahead of time like she had done.  I saw a post on Facebook, congratulated her and she sent me a private message back saying:  I hope you are not insulted, but I didn’t need your help anymore.  I got it all figured out!  Of course, I am very happy for her and glad that she did not need me anymore!

This message is for anyone listening who for some reason finds themselves in the position of having one breast to feed your baby – do not despair!  We have ways of helping you through this.  Perhaps you will use an SNS, perhaps you will make a partial supply.  Please also know that There are many mothers who have provided a full supply for their baby from just one breast!  Please don’t keep all your fears bottled up inside.  There are many ways in which we can help you.  All you need to do is reach out to an experienced IBCLC  who will help guide you through the process.

As you so often hear me say:  Don’t let this show, The All About Breastfeeding show, the place where you get really great breastfeeding information, all for free, don’t let the AAB show be your best kept secret.  Why not take a moment and share this show with some of your pregnant and new mothering friends.  Also, don’t forget to go to aabreastfeeding.com/breastfeedingclass to learn how you can register for The AAB online class where you can become a student of mine and I can help guide you through the early days of breastfeeding.

I leave you today with this quote from the novel, PS, I love you by author Cecelia Ahern

Shoot for the moon, even if you fail, you’ll land among the stars”