Thank you for all the wonderful posts on this topic!  Dealing with a sick child
last week put me way behind on all this mail.  I'm glad to put a name to "these
breasts;" hypoplastic describes them well.

Alicia -- Actually, the incidence I see would be at least 1 in 250 (1200
births/year, 62% BF rate so about 750 breastfeeders/year, average of 3 of these
women/year).  It's probably even more common in my population since I don't see
every mom who delivers at my hospital.  Motivated ones can see me for free F/U,
but not everyone is motivated.

Joan -- Thanks for the info that one of your clients was able to produce 40% of
baby's needs by 5 months by persistent pumping.  Most of the mothers I've seen
don't pump more than a week or two.  I've never known how much to be the
cheerleader in these situations because I didn't know what the potential was
likely to be (but it didn't look good).  After reading all the replys I feel
like I've got a better handle on this.

Catherine -- <<Different ethnic groups have different typical breast shapes,
African women might normally have more conical breasts, so beware of
overdiagnosing this problem.>>  I wonder if this is what Chele meant when she
said she had seen breasts like these make milk.  This area is almost exclusively
caucasion, so of course, every time I've seen breasts like these they belong to
white women and they are essentially non-functional.

Jan B. -- I have long suspected, too, that we see an abnormally high proportion
of insufficient milk supply in this country because all kinds of women are
having babies that in 3rd world countries would never have gotten pregnant or
survived the birth.  I wonder whether there aren't some common denominators that
we just don't know about--how about all the women our age that got vaginal
cancer because their mothers took DES during pregnancy?  Perhaps some of what we
see is related to something similar.  When you say there haven't been any
definitive studies in the US on this issue, how about Dr. Neifert's prospective
study of "319 healthy, motivated, primiparous women who were breastfeeding term,
healthy, AGA or LGA infants" reported in Birth 17:1, March 1990?  At 3 weeks,
even using their lower study criteria of 20g/day wt. gain, 10.7% of babies had
"insufficient wt. gain."  I've never taken the time to keep track, but I'll bet
the population I see comes close to this.  Our BF policies are pretty good,
pumping is started early if baby is feeding inadequately, follow-up is free and
fairly available so I see more of a "general population" than somebody at a real
lactation center would, and I still see WAY more mothers with inadequate milk
supply or a marginal milk supply than it seems like I should.

Thanks for all the other replies--they're all going in my file.

Becky Krumwiede
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