Dear colleague, As a lactation consultant, I would advice you to continue to put the babies to both breasts regularly. The number of times a baby is put to the breast is more important than the length of each feed when it comes down to stimulating milk production. If no milk is coming out at first, it can be useful to manually express milk from the other breast and give that to the babies by supplementary suckling technique (see IFE Module 2 http://www.ennonline.net/resources/4) from the other breast. That way the babies can drink and stimulate this breast at the same time. Manually expressing milk in between feeds from the other breast will also help to stimulate milk production. Other techniques can be to help the mother relax, encourage her to believe that milk will come out, massage the breast before feeding, apply wet heat to the breast (apply a heated,wet cloth before feeding), drink fennel tea if available, encourage feedings at night. If those are not sufficient in the coming weeks, other, including pharmaceutical, galactogogues can be considered. See the Academy of Breastfeeding Medicin protocol (http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%201st%20Rev.%20Jan%202011.pdf). I hope this helps, best of luck!

Dear colleague, I think you need to address the cultural beliefs surrounding breast feeding practices from this region. The use of only one breast is common practice hence the reason why the breast has never been used and its small size due to non stimulation of the hormones necessary for lactation. I recommend that you include the spouse in your counseling session so as to advocate for complete behavior change to enable them support the nutrition of the newborns. It is possible to still stimulate this breast to produce milk; remember the old story of wet nursing?