I agree with Karleen. Celina, you say that "Moms don't get set up for failure by being given information if it is given factually." A UK study which looked at short and inverted nipples found that simply inviting women who intended to breastfeed to join a study of whether treatments like shells influenced breastfeeding success meant that a significant proportion of the women didn't even try to breastfeed. (That was the only significant result of the study, to discourage mothers from trying.)  Unless women have become much more confident since then, I think we are setting them up for failure by identifying possible problems with their breasts during pregnancy. And having seen the huge variety of breast shape and sizes across the planet, in books like Ploss and Bartel's 1935 3 vols  Woman; an Historical, Gynaecological and Anthropological Compendium.I have never been convinced that there is anything at all predictive about any particular breast structure. You wouldn't believe the breast tissue visible in some nomadic women who all breastfeed : just little nubs of glands on a bony chest. I'm not sure that western views of the normal breast isn't influenced by affluence and the breast fetish culture of Hollywood et al. Storage capacity will influence feeding frequency but not necessarily breastfeeding success. But even storage capacity can't be totally predicted by looking at breasts.

I tell pregnant mothers that lactation is a fundamental survival survival mechanism, that only interference in its basic mechanisms causes it to fail, that Nature is economical and wouldn't  allow a pregnancy to go to term if the child was to be starved to death because the mother's body physically couldn't feed it, that breastfeeding problems have causes that can be identified, and almost all can be managed successfully if they get help early.  I make sure they understand what's needed to get off to a good start, and will be assertive if being subjected to interference in those basic lactation mechanisms. And I'm around and pro-active in the first few weeks as they get supply into balance. A few phone calls and visits then saves hassles later. The old 30day babymoon was a very good idea... 
Maureen Minchin




> Date:    Thu, 18 Apr 2013 11:44:48 +1000
> From:    Karleen Gribble <[log in to unmask]>
> Subject: Re: IGT/ hypoplasia
> 
> But Celina, by definition the two women that were able to make enough milk did not have IGT. It's 30-80% of women who believe that they are not able to make enough milk for their babies. It seems that being female is a risk factor for making insufficient milk. I have seen LCs speak about risk factors such as having PCOS and being adoptive mothers as being predictive of a woman's ability to make enough milk for their baby when they are no such thing. We really don't know beforehand who is going to have problems and who is not. So much depends not just on the mother but on her baby and how they interact with one another. We should be looking at each individual situation. I have seen adoptive mothers have a terrible time stopping supplementing, not because they don't have enough milk but because they were counselled to be "realistic" about their ability to make milk. It does have an impact. Having a crystal ball would be lovely. It would be great to be able to predict who will have problems making enough milk but we just can't.
> Karleen Gribble
> Australia
> On 18/04/2013, at 10:29 AM, Celina Dykstra wrote:
> 
>> widely spaced breasts and breast development during pregnancy. For some reason 5 clients last year had IGT/Hypoplasia. Of those 5 I have met 2 mothers with widely spaced breasts, somewhat tubular shaped breasts, bulbous areolas, one with a 2 bra cup size growth during pregnancy and the other with a 1 cup size development. Both are producing enough. Both have tt'd babies, one had a revision of the anterior tie, who is doing great with breastfeeding, great milk supply - just had to adjust the angle of the latch.. cross cradle did not work as her nipple points to her elbow. The other chose not to go for further assessment after being told by an ENT that there are no restrictions (baby coming on and off frequently, clicking, spilling when bottle feeding, etc and a thick fleshy maxillary frenum wrapping right under the gum into the palate).. This mom is barely producing enough. I did give her information about both frenums and IGT. She is well armed with info and if things need looking at again, she won't be blindsided. 
>> 
>> For me, it is a matter of saying - "this is what I see, this may or may not make a difference, these are things to watch for, lets work on these things first and see what effect that has on breastfeeding". Every mom I have met with IGT says she wished her care providers, IBCLC, midwives etc would have told her right off the bat that they suspected IGT. Instead they jumped through a bunch of hoops doing x, y and z, when it was w all along.. and yes, we do have to address all the aspects. 
>> 
>> IMHO all women should have their breasts assessed during pregnancy and be given all the information. It would be like finding a lump in my breast which may or may not be cancer and not telling me what was found because I might lose hope. Moms don't get set up for failure by being given information if it is given factually. They get set up for failure by not being given the full assessment. 
>> 
>> It is a testament to our caring that none of us takes how to impart this information lightly. If there are any IGT or possible IGT moms on this board, what would you would prefer?
>> 
>> Celina Dykstra, IBCLC, LLLL
>> 


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