There is always that moment of suspense as a mother is dropping her bra
flaps (drumroll please....). But as someone here said, sometimes you
internally say, "Oh no," and yet things work out. (I personally
launched into breastfeeding my daughter carrying all sorts of red-flags
for milk production, which thankfully I didn't know about at the time.)
Here's some of what I say (much stolen from fine LCs everywhere,
including this list) when suspecting some primary problem with hypoplasia:
""You're probably already suspecting that you're battling with some
unusual problems. And with so many factors in you making and the baby
taking milk, it's sometimes difficult to do the detective work. How a
breast looks doesn't always tell us much -- women are built many
different ways, and breastfeeding tends to work. But there are certain
characteristics, such as this very wide spacing, the lack of roundness
underneath, the unusual shape to the areola and nipple, that are
sometimes associated with a reduced amount of milk-making tissue.It's
not just a matter of small breasts -- this is an unusual situation
called hypoplasia, which is more like an underdevelopment. This is not
a yes/no or black/white situation. You are(generally) already making
some milk, so there is some tissue available. In a world where some
babies never get a *drop* of their mother's milk or a minute at the
breast, you might feel good about whatever this baby is getting."
""At this point, we don't know how productive we can make the available
tissue. As an analogy, if you have a small office, if every person on
staff is working hard, a lot can get done. We can talk about some
strategies. We can maybe explore your health history for clues. We can
work on helping the baby feed more effectively, maybe do some
supplementing at the breast to increase the stimulation, and we can add
a hospital-grade pump, to tell your body that you have twins. There are
some herbal and prescription medications you can discuss with your
doctor, which have a reputation for helping with milk production. It
may take weeks to see how far we can press the system. We're lucky we
have tools for getting milk out of you, and getting milk into the baby,
so he/she will be happy and growing while we figure this out. At this
point we can't predict the outcome. Many women are able to increase
their milk production, though we can't guarantee a complete supply. But
in difficult circumstances, breastfeeding doesn't have to be all or
nothing. Many women find that if they sustain that relationship, even
without the supply they wish they had, they can feel that in the big
picture they gave their baby a lot through breastfeeding -- maybe more
than someone who had a full supply, but stopped at two months".
----------------------------------------
This isn't set in stone. The mother might need time to grapple with the
"diagnosis" before launching into the remedies. The discussion should
be realistic -- a full supply might be impossible. But it's very easy
for a mother to hear, "You don't have the right amount of breast tissue
and you *can't* breastfeed -- end of story," She should feel good that
she's taken active steps and is sitting in a room with a lactation
consultant, when so many people stop breastfeeding in the first week or
two. So it seems that we should move quickly in the more hopeful
approach of what she can do, if the mother is up for it, and battling
for what is possible.
Margaret Wills, LLLL, IBCLC, Maryland
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