I have this mom's permission to share her case.

<I have GREAT news!  . . . . . .  (her baby daughter)  had her 2 months
check up today.  The thrush is gone after going on diflucan for 2 weeks.
Also, she weighs 12 lbs 12 oz!!!!!  All on my milk!  I can't believe it.  I
never knew breastfeeding could be this great.  It was so much work with . .
. . . . (her second son) having to pump all the time and then still mix some
formula and having to wash all the bottles and equipment.

I love being able to take her out all day and not having to worry about how
many bottles I'll need and how I'm going to wash them or heat them.

Thank you again for all your help and encouragement.  I don't think I'd be
where I am now without it.>

She originally sought me out before planning to conceive their second child.
Her problem that bothered her most was the terrible pain she experienced
with her nipples with the first child. She had given up direct breastfeeding
and had pumped for 3 months. I cannot remember whether she was able to pump
all his milk or not. She learned of my interest in nipple pain through
colleagues who are LLLL's. I remember examining her nipples, and just to be
on the safe side, referring her to a dermatologist to be sure there were no
skin or hypersensitivity issues. Her fear of nipple pain made her flinch
easily and her situation almost reminded me of a degree of PTSD from the
first experience. She came across as somewhat unassertive and lacking in
general confidence, but highly motivated to mother her children the best way
she could find, especially desirous of breastfeeding them. She never
indicated any memories of past abuse when I mentioned the general subject
and how it could affect some mothers.


When she was 7-8 months along with the second pregnancy, I gave her a
private class imparting all the insights I thought might help.
I explained my concerns about the importance of areolar pliability and the
relationship with overhydration, and gave her encouragement to negotiate
with her OB not to have IV's or induction, etc. She went on to give birth
without any interventions whatsoever, other than a needle in place in her
hand in case an emergency arose. Her husband called me in the a.m. when the
baby was just 6 hours old, and already she was experiencing excruciating
nipple pain at latch. The birth had been rapid, and after a long period of
observing them nurse, I tested his mouth with my finger, and found a
"clamper". I made a home visit at 5 days, at which time, at least with moms
who have had IV's, I would have expected her to have some degree of
swelling, but I observed no increase in size. She alluded to some swelling
the day before, but the thing that struck me, and was the greatest learning
experience for me, was that when I saw her nursing in her home, she had no
bra on.


Bingo! No connection with the original concern of nipple pain, but there,
staring me in the face was a fully 2 inch wide space between her breasts! I
had always before just had her drop her bra flaps, during the pre-pregnancy
exam, the 8 month exam/private class session and observing the hospital
nursing at 6 hours. I had always before failed to look at the totally bare
breasts, and finally saw them just by chance! Shame on me! The divider strip
with the hook loops that had lain loosely between the breasts when the flaps
were down had completely obscured and camouflaged the two inch flat space
between the breasts from my view!



The latching pain and clamping continued to bring major pain. I don't
remember that surface damage was a particular problem, and not wanting to
continue and risk possible development of Raynaud's, I suggested
cranio-sacral therapy from a local osteopath. Indeed it was my first
experience observing how well this worked to change the baby's jaw action.



However, the weight gain was inadequate. I called the wide spacing to her
attention and gave her one possibility: my theory that when she was a fetus
inside her mom, the full number of secondary buds off her primary buds
may have failed to develop, and limited the subsequent number of ducts that
developed, and therefore, during adolescence and pregnancy, the number of
lobules that were able to develop on the limited number of ducts had
resulted in a smaller number of total lobules than most moms have, and
therefore less glandular tissue. She was actually relieved to hear my
theory, and was then happy to pump avidly and supplement with AIM as needed
for weight gain. The main thing she was happy to do was to use a home-made
(a la Jack Newman) supplementer at breast, and the baby always got most all
his milk nutrition at breast. She continued lots of pumping, and I can't
remember, but I don't think there were any galactogogues used. She continued
frequent pumping and using supplementation at breast till she chose to wean
at 18 months, and while enjoying being able to view herself as a nursing
mother, felt the process was very laborious for her. She quietly but
faithfully continued to attend LLL meetings all along.


Shortly after they conceived their third child, she contacted me to notify
me that she was experiencing really obvious breast enlargement from early in
the first trimester, and I helped her to understand that for one thing, each
weaning is a little like the leaves falling in autumn, and each new
pregnancy has a new placenta, and therefore, conceivably, a different amount
of hormonal stimulation to stimulate the few remaining alveoli and the
regrowth of new alveoli. I remember some article that made a point of giving
encouragement to moms in second pregnancies to breastfeed even if there had
been inadequate milk supply with the first baby, so I told her to keep on
observing, and once again explain to her OB how much it meant to her to
avoid interventions at birth, etc.


Once again, she had a completely natural, but rapid labor and birth, a
clamper of a little nurser, and they arranged to get craniosacral therapy on
their way home from the hospital. She was definitely aware of much more
fullness, knew how to handle it, got weight checks at her pediatrician's
office and went on to the happy experience reported above. I had assured her
that while there were still many unknowns to be researched in the general
public, I felt there was a good chance that her regular pumping and
supplementing at the breast with the second baby may have somehow improved
her chances of producing more milk with this third baby. At any rate, I
complimented her heartily and told her that my hat has been off to her with
all the effort she herself put into her mothering, and I have noticed her
self image and confidence in her mothering have seemed to benefit with this
success as well.


I too hope lots more research gets done. The number of secondary buds
sprouting off the primary ectodermal breast bud and/or canalization may be
limited by something in the food supply or medicines, particularly hormonal
BC, in several generations, or environmental contaminants???


In particular, I think it might be important in our history taking to find
out if the particular mother was born before term, because, although
sprouting of the secondary buds and their subsequent canalization into ducts
takes place in early and mid pregnancy, the completion of nipple-areolar
development and nipple eversion normally takes place between about 36-44
weeks from conception. Who knows whether this process is strictly a
genetically programmed process or whether it is supposed to be
partially effected by the influence of the mother's hormonal milieu? The
little girl born before term has less time for her nipples to be influenced
by her mother's placental hormones.


So much more to learn about this fascinating subject!


Jean
**********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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