>> I will have to think more about your approach Cathy. Perhaps my own fear
of power of suggestion is interfering with my approach.
Augmentation issues are something I do discuss if I know during pregnancy
since mothers are already aware of the possible complications. It seems so
much easier if there is already an awareness that complications may occur
and I am not the first person telling them.  I don't always see mothers
during pregnancy so have not had to face the situation often.  It is hard
enough when I am sure there is a problem.  Once I am seeing a mother for
supply issues I do exactly as you describe.<<

I've lost count of the mothers for whom I have been the first person to tell
them about their risk factors and who have said to me, "why didn't anyone
else tell me? Why didn't my doctor say anything? Why didn't the nurse or the
LC at the hospital say anything?"  I realize that to some mothers this may
not be what they want to hear, but how we deliver it is important, too. I've
gotten good at keeping things upbeat-- cautiously optimistic. I just did a
prenatal consult with a mom who had breast reduction surgery. Cannot express
a drop of colostrum so far with 5 weeks to go. Some breast changes. 1000g
removed from each breast. Nipples painful all the time. I gave her the
straight shot-- some women deliver enough milk from the start, more women in
your situation may struggle, and a few deliver very little. I explained the
basic strategy of super-charging what tissue she had left, and the limiting
factor of ductile connections. I encouraged her to take all the
breastfeeding classes available, feed often, and told her to watch the baby
carefully. If anyone becomes concerned about baby's intake, don't be afraid
to supplement if it seems necessary and do call me right away, etc. 

Most especially for the mother with infertility issues, they think that
having that baby is the last hurdle and rarely suspect that breastfeeding
could become an issue. It is a double shock and betrayal, then, when their
body does not do what they expect. (BTW-- I've heard people suggest that
these women don't produce as much because they don't expect to, but it's
really the opposite; they expect to make milk and are shocked if they don't)
They deserve to know if they have any red flags and what to watch for and
where they can go if they have any doubts.  

With hormonal conditions, a really nice, positive approach is to let them
know of the risk factor but then let them know what they can do to minimize
it. The woman with thyroid issues can be counseled on having her thyroid
hormone closely monitored the first few months; the mother with PCOS can be
encouraged to stay on or get back on her glucophage to optimize her hormones
for making milk. Information is empowering.

~Lisa Marasco 

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