FSP posted last year about how her love for data had driven her, during gestational diabetes, to collect extra blood glucose data from herself and graph it. Inspired by her example, today I present Dr Jekyll's Milk Pumping Data for November.
Methods
I was away from Small for ~9.5 hrs, 5 days a week. During that time, Small was exclusively fed expressed breastmilk. I initially pumped three times a day, around 9 am, noon, and 3 pm, reducing to twice a day towards the end of the month. Pumping duration of each epoch was typically 30-40 minutes, corresponding with (a) the time required to drain most available milk; (b) the time required to obtain enough milk to make the hassle worthwhile; and (c) the maximum time I was willing to spend, or rather longer. The pump used was a secondhand Medela Freestyle.
On weekends, Small was fed ad libitum direct from the source. Due to the effects of indoor lighting and winter in the northern hemisphere, he was kept on a 14:10 light:dark cycle.
Results
Asymmetry of production
Despite no obvious size disparity, Righty consistently delivered more product than Lefty. Across all observations (n = 50), Righty matched or outpaced Lefty (Fig. 1).
Fig. 1: Righty delivers the goods better than Lefty. R-squared ofbest-fit line, 0.59. Dashed line represents unity.
Effect of time on output
We had hypothesized that production would peak early in the week, due to the extra stimulation on the weekend. Surprisingly, there was no significant within-week effect (Fig. 2), although the relatively low N at this point may have limited statistical power.

Fig. 2: We'll see what effect restarting Monday lab meetings
will have. Error bars represent SEM.
will have. Error bars represent SEM.
It is well-established that milk production decreases in the afternoon relative to the morning. Our data were consistent with this finding (Fig. 3), although the fucking ANOVA is only 0.07.
Fig. 3: I went ahead and ran the T-tests anyhow. Morning > afternoon,p = 0.045. But the midday versus afternoon is only p = 0.09.
Disregarding the ANOVA made me feel naughty.
Pumping is less effective than slurping
As has been seen previously, a pump is not as efficient at milk extraction as a baby. However, thanks to diligent monitoring, the deficit held steady at an average of 1 oz/day (Fig. 4). The total deficit over the period under study was -16.6 oz, which was compensated for by previously frozen supplies. It is worth noting that an additional 12.2 oz was pumped outside of work (data not shown), reducing the month's net deficit to -4.4 oz.
Discussion
Pumping wouldn't suck so much if it were consistently possible to work during sessions. Frequently, though, working reduces output. So we'll see how long I keep this up.
Also, carting one's own bodily fluids around in lab is really weird. But the prospect of writing this post was oddly motivational.
Happy Thanksgiving, Americans.

42 comments:
A few thoughts:
1. This may be the most fucking awesome post I have ever read.
2. due to the extra stimulation on the weekend. This means, ah, stimulation due to breast feeding, right?
3. I apologise if this a naive question, but does Fig 4 display amounts fed direct from the source? If so, how do you measure that?
4. (Again perhaps a naive question, but I really have no experience about this.) I wonder if there is temporal autocorrelation in the data? e.g., Is it harder to produce the day after a particularly productive day?
Awesome post! Thank you for the detailed analysis!
These kinds of stats make a pumping PhD smile. I only wish I used all the mental energy I put into pumping to benefit the greater scientific community!
Further questions: did the difference between righty and lefty increase over time?
Also, would Figure 3 be more significant if a rank sum test was used instead of a T?
This might be one of the best blog posts I've read all year!
I can support your findings that either Lefty or Righty will produce more than its counterpart. Beautiful data!
I found that pumped amounts decreased with increased work. Decreased production correlated well with decreased food consumption by myself.
You amaze me that you were able to return to work so quickly and maintain a pumping schedule.
Standing ovations. Best post I've read in a long time. Thank you!
Ditto what Charles said in point 1 and 3.
And people wonder what the benefits of a scientific education are?
ANOVA is the wrong way to analyse that data as there is no way one can assume independence of the data from one person repeatedly measured across many days. You'll be needing a really cool mixed model, I reckon.
-antipodean
I think this is the most amazing post I have ever read. Good work, DrJMH!
What, you didn't weigh the baby before and after nursing sessions to quantify at-the-source consumption? ;)
Seriously, I've heard of people doing this. Crazy.
I am absolutely appalled by this post. I found it disgusting and frankly unacceptable.
How could you possibly conduct post-hoc t-tests knowing that the ANOVA had not reached significance?
It's this quite of attitude that is causing the demise of society ... and global warming. I am shocked.
Mmmmmmmmmmmm. Science.
Reviewer Comments: The author has conducted a limited investigation into the mechanics of breast pumping. Reviewer H has already raised concerns about statistical significance. The present reviewer would like to add that the comparison of breast pump vs baby mouth could be strengthened by additional experiments, possibly involving a second feeding subject.
Reviewer Recommendation: Further Experiments Needed
Awesome post! I totally did the same thing with LittleJane1. In my case, Righty outperformed Lefty, and was the preferred side for straight from the source meals.
LittleJane2 will not drink from a bottle or cup, so I mostly pump to maintain supply (and not leak) so don't track it.
Excellent synopsis, and some noble efforts on the statistical analysis. I am really surprised at the large value of the y-intercept in Figure 1 (given that there is no size disparity). Also, the fact that the slope is greater than 1 is very interesting.
Good job. :)
Good to know my science society appreciates geeked out pumpery.
Fig 4 is the qty of milk Small drank from bottles during the day while I was gone.
Anon at 3:29 am : FUCKING REVIEWER 3!
Will try to follow up some of your questions....
I am concerned that the authors have overinterpreted the data on Fig. 4 in their caption "Small is an eating machine". In this reviewer's lab, consumption peaks at ~34oz/day. However, this discrepancy may be due to exclusively feeding breast milk vs. supplementing with formula. More Experiments Must Be Done.
I've similarly dorked out on graphing my commute time, how it varies vs. day of the week, time of departure from my house, and which of two paths I take in.
Preliminary data indicate that there is a trend toward longest commutes on Tuesdays and Thursdays, with shorter commutes on Monday/Wednesday/Friday, independent of route taken or time of departure. There is also an inverse correlation between time of departure and total commute time, significant to p < 0.03 (n = 35). Additional data suggest that the standard deviation of travel time is much greater on Route 1 than Route 2, but further study will be required to establish a definite correlation.
Technician, D.G. "Commute Time: A Multivariate Analysis" J. Nerdy Stats, 1(1); 1-3. Nov 2009.
Becca, are our labs comparing over the same time period? This graph only represents 9.5 hrs of the day.
But sheesh, 34 oz?! You got yourself a Grendel!
And Charles Q2, YES. There is precious little waking time for other options. Alas.
"We had hypothesized that production would peak early in the week... Surprisingly, there was no significant within-week effect..."
Did you use some sort of nurture trick to hide the decline?
LOVED this. Especially the Bruce Hood Comment. I'm trying to get Hub to graph our daycare-reported naptimes over that last month...
Thank you, DJ&MH.
I have a better understanding of what it's about after reading your post.
This is awesome.
I'm 8 weeks into my second round of feeding a baby. I was nowhere near as thorough with my data collection first time around as you have been here, but can definitely report that asymmetric output is reproduced here, too. Interestingly, it is similarly asymmetric under my repeat conditions, 2.5 years later.
I pumped at work until my first was about 17 months old (its a long story). The pumping routine gets easier, and I was weirdly conflicted about quitting (another long story).
Some tips that you may already know to handle the inevitable drops in supply: eat lots of protein (those lovely fat stores built up during pregnancy are no help with producing this component of breastmilk!), drink lots of water. Sometimes, I had to add a pumping session before bed to get the supply and the frozen stocks back up, but I only had to do that intermittently. I also took the herb fenugreek from time to time. You have to take enough to smell like maple syrup.
All in all, I thought it was well worth the hassle. I can't really put my reasons for that into words, though.
@Betsy- people weigh before and after feedings if there is a concern about whether the baby is getting enough food. It is often the only way to satisfy worried pediatricians and/or parents if the baby is not growing at the "normal" rate of an ounce per day.
Actually using a GLS with day included as a random variable(if using R to carry out the analysis) may allow you to incorporate any possible autocorrelation.
Haven't laughed so much at science thank you for confirming my beliefs that us sciency folk are fucking hilarious!
I hadn't realized that women took fenugreek to increase milk production, so I did a search for data. There are lots of anecdotes, and articles in 'believer' journals (e.g. Complementary Therapies in Nursing and Midwifery), but I couldn't find any data.
The most promising article looks to be this review (http://informahealthcare.com/doi/abs/10.1080/15228940802142852); its Google Scholar tag-line says "... Pregnancy & Lactation Literature review reveals no reliable human data or systematic study of fenugreek during pregnancy or lactation..." . Unofrtunately it's pay-to-read even via my UBC account.
Pretty funny- and I have to wonder, is this really not documented anywhere? Maybe you and the 2-3 commenters who also participated should write it up as a letter to some not-too-stuck-up journal and suggest it warrants further study. Although, you'd have to add a discussion section explaining the functional significance of asymmetry in this case (?). Does one arm get more tired-? Are there any other side-effects of asymmetric feeding?
IT'S ALWAYS THE FUCKING THIRD REVIEWER!!!
@Rosie Redfield- I'm not aware of any data on fenugreek, but it is a fairy wide-spread practice. I wouldn't be surprised if it is a placebo effect- milk production is decreased by stress, and watching your supply drop is pretty stressful. Regardless, it is an herb used in cooking, so its a fairly safe thing to try.
People also try dark beer to increase milk production, and there's no data to support that, either. But at least its fun to take.
There is a real lack of data on a lot of things quite important to the nursing mom, actually. I tried to base my decision about whether to avoid common allergens (like peanuts) on data, and was thwarted by sparse and contradictory studies.
Totally awesome. I will do my best to add supporting data for this study when we get to that point in a few months.
Small is NOT an eating machine. Small, and other versions of Small, can accurately be portrayed as a special purpose learning organism. Eating is a necessary function of energy regulation.
I suggest not only weighing Small, but measuring output. Remaining energy can be directly measured with calorimetry and the use of fecal cups. It may then be compared to energy input and the discrepancy investigated.
I took fenugreek with LittleJane#1 (had major supply issues, and milk didn't fully come in for almost 2 weeks after a long labor followed by a c-section!). I can say that for me, it worked. Can't say whether it was a placebo effect, but I can see the results in my pumping data. I would go on for 2-3 weeks, increase supply, then go off until supply dropped too much. Then back on for another 2-3 weeks. You need to take A LOT of pills (as Cloud said, you need to smell like maple syrup). I took 3-4 pills 3 times a day.
Blessed thistle (another recommended galactogogue) didn't work for me, either alone or in combo with fenugreek. Domperidone works too, but it is illegal in the US.
Thankfully, LittleJane#2 didn't have to deal with supply issues.
Awesome post. As a fellow pumping PhD, my #1 correlation was how much water I drank that day. I had asymmetry too, right > left until masitis on the right, then it switched to left > right.
These are some seriously impressive reviews. I am going back to my stats immediately. Also, to the diaper bin, thanks Jay!
All you people are sick as hell, and this is why you are My People.
Funniest part of the whole post:
"...the fucking ANOVA was only 0.07."
This post is AWESOME! Had to laugh at the lefty vs righty. Mine exhibit the same behavior. I originally thought it was due to mastitis in lefty about 3 yrs ago with my first but I am learning that this is a pretty common phenomenon!
People also try dark beer to increase milk production, and there's no data to support that, either. But at least its fun to take.
In the 19th C Mrs Beeton recommended nursing mothers drink porter, or a mixture of porter and stout.
Fascinating.
I expect a larger sample size than 1 is needed to see if there is any correlation between the productive output of Righty/Lefty and the handedness of mother, baby or, possibly, father.
Volume-wise my #1 correlation was room temperature. When it was hot I produced more and more liquidy milk. Volume, of course, not being all there is to breast-milk.
I just started reading blogs from fellow '(gorgeous) ladies of science' and am entranced by their insightfulness and hillarity. Am an amateur self-experimenter (at least, one who will never pass up a chance to use available equipment to measure her own blood glucose/hormones/etc.). Also happen to have done a few studies on lactation energetics during my PhD. Anonymous (January 23, 2010 5:20 PM), I am please to see your observations conform to my expectations re: the effects of temperature.
This reviewer finds that the author's conclusion, "Small is an eating machine", is an under-interpretation of the data and is beside the point. The subject apparently spends all his time in either of two states: "Pumped" or "Drunk". Thus, "Small is a Party Animal" is the significant finding, and the manuscript should be rewritten to emphasize that fact.
I subscribed to your blog because of this post. Not only are you brilliant and hilarious, but you're a total nerd too. Congratulations! P.S. In my case, lefty was always the winner.
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