Ann writes
<Mothers
who themserlves were premature may not have had the maternal hormonal
input
to develop themammary breast bud infastructure.>

The eversion of the nipple happens near term and beyond (after separated
from placental hormones.) partly as a function of the proliferation of
the underlying connective tissue. The primary mammary bud and the
secondary budding occur before the middle of pregnancy, but there is
still yet the canalization of the secondary sprouts that must occur after
mid-pregnancy. One reference gives a vague attribution to the hormonal
milieu as trigger for this process. Perhaps it may be connected to the
development of receptor sites. In the male rat, the hormonal milieu
actually stops mammary development much more auickly and markedly than in
males of other species if I remember correctly. 


One of the criteria for assessing gestational age accurately is the
general size/degree of externally observed development of the breast bud.
I have mused before about whether taking a more thorough history of the
mother's own birth statistics and pregnancy course as a fetus/premature
might be a clue at least in the degree of nipple eversion. Since the
development of LLL, we have several generations of mothers with more
specific awareness of their breasts and the breasts of their daughters
and granddaughters who could give very good histories. 

There have been several cases on LN recently that surmised that perhaps
some mothers have blind ducts (never canalized), even though the end buds
may continue to develop and produce milk. Could it be possible that some
moms have some of their ducts patent and others never got canalized??
This would certainly impact the occurrence of engorgement and adequacy of
milk transfer. I have some preliminary references to look up someday on
canalization, but have still not been able to trace information as yet.
There is so much yet to learn about the early development of the breast,
and ultrasound is becoming more sophisticated all the time, though there
would certainly be ethical issues involved in its use for such research.
It would be a fertile field for a research project to include a thorough
history of the mother's own fetal days /gestational age at birth as part
of her lactation progress, comparing that with moms who were born full
term. Would make a great master's degree project or doctoral thesis, I
bet!

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

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