I have seen only a handful of cases of primary lactation
"failure" (i.e. not a full milk supply) in my very short career (LLLL
since 2002, IBCLC since 2005). In 2 of the cases the mothers were
extremely lean, athletic, and 1 had extremely late onset of menses.
In both of those cases the mothers were able to bring in a full milk
supply by diligent pumping, breastfeeding, and supplementing
judiciously. In another case I am thinking of, the mother elected to
quit after getting very low milk production (<1 oz/session) after 2
weeks of pumping with a Lactina. Most of the other cases I have seen
of low milk production can be attributed to ineffective milk removal
in the early days. There have been times when I've suspected
hypoplasia. If I get the sense that the mother needs to hear
something concrete about why she has constantly had milk supply
issues after doing everything right, then I will share with her that
hypoplasia is a possibility. I will also tell her that it is
difficult to diagnose, and that moms with hypoplasia can sometimes
achieve a full milk supply, and of course that some breastmilk is
absolutely wonderful.
I saw a mom recently who I thought for sure had hypoplasia (widely
spaced breasts, more fatty tissue could be palpated than glandular
tissue, bulbous areolae, minimal breast changes during pregnancy,
history of milk supply problems x 2, no asymmetry though), but she
was able to achieve full milk production after about 4 weeks of
pumping after almost every feeding. I did share with her my thoughts
about hypoplasia, and she was very relieved to hear that (a) her milk
production problems were not her fault, and that (b) she might still
be able to develop a full supply if she maximized the stimulation.
I really dislike the term "insufficient glandular tissue," because it
is so negative, much like "incompetent cervix." I usually explain to
moms that some breasts have more milk-making tissue than others, and
theirs may be on the lower end of the spectrum. It is always
possible to increase the demand on the system and try to increase
supply, and how much we can do that is the question. Some breasts
respond very vigorously and quickly to increased stimulation, others
are a more slow-and-steady increase; and others show just a small
response, which can often be augmented with prescription
galactogogues. We just don't know until we try.
Warmly,
Lynnette Hafken, MA, LLLL, IBCLC
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