I agree with Diana that mothers want and need to know so they can receive
information and anticipatory guidance. I've recently worked with a few
mothers, some who've had previous history of lactation insufficiency and they
were relieved to be able to plan ahead, receive information on
galactagogues, donor milk, pumping guidance. Having someone acknowledge that there may
be an issue, listen to their stories, and help them through the grieving
process of past disappointments is different than just saying to them
prenatally that they may not be able to make enough milk for their baby. Ongoing
support and guidance is important before baby arrives and follow-up is a
must after baby is born.
I was surprised recently that a professional said she'd learned from other
lactation professionals that mothers shouldn't be told they may have
IGT/Hypoplasia as it sets them up for failure. Not my experience and I feel
this is unfair to mother and baby who may have been able to receive human milk
and avoid formula, at least in the most crucial early weeks. I've found
Huggins, et al article to be most helpful, as well as Diana's in LLL's
Leaven ( Supporting Mothers with Mammary Hypoplasia, Leaven, Vol 45 No.2-3,
2009, pp.4-14).
Barbara Latterner, BSN, RN, IBCLC
I'm sorry that I can't give you a more comprehensive answer at the moment
because I am under deadline to get my thesis (about the experiences of
mothers with hypoplasia/IGT) submitted in time for me to graduate, but I
wanted to let you know that in our study of mothers with hypoplasia, a very
prevalent theme is that *they wish they had been told* their breasts might
(or might not) show physical characteristics that may (or may not) be
predictive of low milk output in lactation. Less than 1/5 of a
sub-population of the sample (I'm only working with about half of the data
for the thesis so this isn't a complete analysis but the N is sufficient)
indicated that they would only want to be told about the concerning
physical characteristics of their breasts after their breasts didn't want
to make milk -- more than twice that percentage wanted to be told before
pregnancy and about half of the respondents in this sample wanted to know
either during pregnancy or immediately postpartum. The qualitative
responses support these numbers, as well -- these mothers really want to
know what you're seeing and they want to be counseled about why it's
concerning, even if there ends up being no problem with milk production.
For the best evidence we have about the physical markers of mammary
hypoplasia that may be predictive of lactation difficulty/low milk output,
see:
Huggins, K. E., Petok, E. S., & Mireles, O. (2000). Markers of lactation
insufficiency: A study of 34 mothers. *Current Issues in Clinical
Lactation. *Sudbury, MA; Jones & Bartlett, 25-35.
A simple search will take you right to the full text of the paper online.
This blog post by an IGT mom is an excellent gallery of breasts of mothers
who struggled with lactation and offers some insight into how varied their
presentation might be.
http://diaryofalactationfailure.blogspot.com/2011/12/many-faces-well-not-fac
es-of-igt.html
I hope this is useful to you as you support this mother.
--Diana Cassar-Uhl, IBCLC (and hopefully soon-to-be MPH)
New York, U.S.A.
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