If a mom I see has significant risk factors for low milk supply, I might 
say it to her like this:

You have a risk factor for possibly having difficulty making enough 
milk. These are the good signs (veining, symmetry, lactogenesis II on 
time, whatever) and this is the risk factor (large intermammary spacing, 
restricted base of the breast (tubular breasts), whatever. Then I tell 
her that we can't predict in advance if she will have difficulty, how we 
can try to maximize supply, and how to know her baby is getting enough milk.

Moms with just obesity or PCOS are not at *high* risk, but may have an 
increased chance of supply problems. In that case I may mention that a 
portion of moms with a history of infertility, thyroid problems, PCOS, 
whatever her condition, may have difficulty with milk production. Then I 
continue as above.

I think this reduces the chance she's going to hear "you can't make 
milk, give up" and increases the chance that she will watch her baby a 
little more closely, which is what we want.

BTW, don't you sometimes wish we could do instant breast transplants 
from people who don't want to bf but have normal breasts to these moms 
who desperately want to and have a physical issue?

I look forward to hearing about other LCs approaches...
Catherine Watson Genna, IBCLC  NYC

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