Barbara Wilson Clay's case reminds me of a mother and baby I met several
years ago. She was G12P11, well over 250 pounds, no endocrine problems.
She had nursed 6 babies without problem, lost 100# between babies 6 and
7, then had difficulty with poor supply and FTT with the next 5 babies.On
exam her breasts were pendulous...extending to her navel. The areola was
4" in diameter, and I could not express milk till my fingers were nearly
at the perimiter of the areola. Diane Wiessinger and I discussed this at
length and wondered if the lactiferous sinuses had "stretched" or
elongated beyond the normal range of the infant mouth, so the the baby
never exerted compression pressure on the sinuses, never draining the
breast well, decreasing the supply.  The mother attempted some positional
changes (the footbal gave the baby the best attachment. But things has
progressed to such a severe state by the time she was seen that she moved
on to formula rather soon. She wondered if her weight loss between babier
6 and 7 would have been responsible...I doubted that as fat pads would
have depleted, not mammary tissue. I did not have any "evidence" of the
stretching to share...it is just how it seemed.  A year later at a
conference in Philadelphia, a similar case was presented...G5P6 and 5 and
6 never gained well, even though 1-4 did well. With #6 SNS used for 6
weeks until baby's mouth grew enough to reach the sinuses.  This was all
very fascinating to me and I would like some additional thoughts on this.
Please comment, Barbara, TIA, Anne Andrianos, MSN, IBCLC