Jay asks:

<Quick question - does anyone have any experience with a mom with breast
hypoplasia taking domperidone and having it help the milk production at all?
I am working with a young mom who is really struggling with the fact that
her breasts simply will not produce a full supply of milk for her baby.



Baby breastfeeds very well, mom is taking More Milk Special Blend and is
supplementing at breast with an SNS.  She is currently doing pre/post
weights for 48-72 hours to determine where her actual supply is due to baby
gaining slowly (about 4oz per week is all - baby is currently 11wks old and
is doing fine otherwise) so that she knows how much more ABM to supplement
with.   However, mom is very interested in trying Domperidone to see if it
will also help to augment her supply even more so she can use less ABM (she
hates the stuff!).>

A question arises in my mind regarding our choosing to use the word
"hypoplasia". I would hate to see it become "routinely used" in a
careless/thoughtless manner, particularly by LC's and other
lactation/maternity workers, as well as possibly, by physicians such as
Ped's, OB's and FP's. In other words, "Are we watching our language???"


I think it might be helpful to consider: "On what basis(es) are we using the
word?? Simply on the struggle to produce an adequate supply??? On visual or
palpable cues?? What psychological effect might this have on a particular
mother??? How might we express this possibility in order to avoid
potential undermining her self-image and confidence???"  There is enough
"medicalizing" as is, and I admit to the general tendency from the
perspective of a nurse-LC. I continue to try to improve my ability and
deliberate effort to reflect back what I perceive to be a mother's feelings,
and to find ways to affirm each and every mother I see in some genuine way.
This means my facial expressions, body language and comments about
her overall basic importance to her baby, her obvious positive motivations,
efforts, challenges, and very real successes thus far, at whatever stage of
motherhood I meet her. Grandmothers included!

A quick google search brought up:

<Hypoplasia From Wikipedia, the free encyclopedia
*Hypoplasia* is an incomplete or arrested development of an organ or a part.
. . . It is descriptive of many medical
conditions<http://en.wikipedia.org/wiki/Medical_condition>such as:

   - Underdeveloped breasts <http://en.wikipedia.org/wiki/Breasts> during
   puberty <http://en.wikipedia.org/wiki/Puberty>. . . . . . .

The physical changes of puberty in girls

Breast development

The first physical sign of puberty in girls is usually a firm, tender lump
under the center of the areola(e) <http://en.wikipedia.org/wiki/Areola> of
one or both breasts <http://en.wikipedia.org/wiki/Breast>, occurring on
average at about 10 years of age. This is referred to as
thelarche<http://en.wikipedia.org/wiki/Thelarche>
. By the widely used Tanner
staging<http://en.wikipedia.org/wiki/Tanner_stages>of puberty, this is
stage 2 of breast development (stage 1 is a flat,
prepubertal breast). Within 6-12 months, the swelling has clearly begun in
both sides, softened, and can be felt and seen extending beyond the edges of
the areolae. This is stage 3 of breast development. By another 12 months
(stage 4), the breasts are approaching mature size and shape, with areolae
and papillae <http://en.wikipedia.org/wiki/Papilla> forming a secondary
mound. In most young women, this mound disappears into the contour of the
mature breast (stage 5), although there is so much variation in sizes and
shapes of adult breasts that distinguishing advanced stages is of little
clinical value. . . . . .>



Tanner staging seems a fertile subject for further reading.



In addition, my own reading on the embryological development of the breast
leads me to further conclusions that some "hypoplasia" (and
conversely, "relative hyperplasia", in those mothers who happen
to experience oversupply problems) may be based on development during
embryonic and fetal life. This would give puberty much less parenchyma upon
which to focus further pubertal development through the Tanner stages. If,
during a girl's own development within her own mother's uterus, a limited
number of secondary sprouts descend into the mesenchyme, then
theoretically, a limited number of future main ducts and therefore, lobes
will develop. (A completely different question may be whether all the
secondary sprouts completely canalize in later fetal life.)

I have thus far avoided the word "hypoplasia" so as not to give the illusion
of my being able to give a medical diagnosis (long before the recent scope
of practice discussion.) When I noted "visual red flags", I just gave
several moms a very simple description (e.g. a plant establishing roots) of
the normal fetal developmental process, and what differences I saw in a
particular mom. In retrospect, I can remember at least two in particular
that I completely missed and naively continued routine encouragement, having
not yet read about the Tanner stages. However, the approach of explaining
development was most comforting to at least one mom, allowing her to
supplement as needed without fears that she simply wasn't doing "enough" to
produce a full supply, despite pumping and galactogogues. (This mother's
case is described somewhere in recent archives, reporting her amazement at
having developed a very full supply with a subsequent baby, apparently as a
result of her patient and consistent efforts for 18 months with the previous
child, or perhaps in part due to a new and very healthy placenta. I am
relatively sure she would be willing to correspond (briefly, with 3 children
under 6) with the mother in question, if that would be helpful.)

To my knowledge, I have seen one article from the Ukraine which quantifies
the increase in the amount of glandular tissue versus decreased % of other
types of tissue in each trimester. I have also found of value the reference
(which I can't recall right now) that gives diagrams of the countours that
can serve as "visual red flags". But other than that, I would like to know
if there is any actual well-documented research on the normal appearing
breast, in regard to when and if the term "hypoplasia" might actually apply,
since evidence under the microscope during reproductive life seems very hard
to come by.

Curious minds want to know;-)



Jean

******************

K. Jean Cotterman RNC, IBCLC

Dayton, OH USA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html