My perspective is that I don't want to plant any seeds of doubt. I think most moms have enough of those. If I am concerned and it's early days I just give very thorough education on "This is when your milk should come in, this is signs of good milk transfer and adequate milk intake. You should get a weight check by this date."

I saw a mom very recently and took one look at her tubular breasts with those bulbous areola and thought, uhoh. They had been supplementing tons and it would have been tempting to keep that up. Surprisingly, the baby had good milk transfer in my office so I recommended breastfeeding, pumping and supplementing after breastfeeding with pumped milk and only formula if necessary. She left my office and a couple days later returned for a weight check. She had supplemented only with expressed breastmilk and weight gain had been good so we went the next step and she just breastfed. Weight gain was great. I hate to think what could have happened if I had said, "Your breasts may not make enough milk."  The shape was a red flag for sure, but it turned out a false one.

Andrea Tran RN, IBCLC
Boulder/Erie, CO


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