I want to second Lisa Marasco's observations in her post about women who are
able to conceive and deliver babies, but have what appear to be primary
insufficiencies.  Kathleen Huggins and Ellen Petok have done a nice job of
beginning an exploration of breast configurations that may signal glandular
deficits.  And I, like Lisa, see a fair amount of women who present with low
milk supplies that appear to result from subtle hormonal imbalances.  I see
some of these women very early in lactation -- some are 2nd time clients to
whom I've suggested early, early intervention to protect their lactation
based on past problems.    This is the nature of priv. pract:  you see the
problems.

There have been 4 women in my practice within the past month who have
histories remarkable for testosterone elevation, androgen imbalance,
polycystic ovarian syndrome, hypothyroidism, or other such past diagnoses.
One made literally no milk; the others made reduced supplies.  Babies were
poor gainers, needed supplements, and one mom had the mysterious deep breast
pain that I speculated may have had a mechanical component of baby sucking
too aggressively to obtain slowly flowing milk.

Where is the evidence that we are the only mammals that have these problems?
I don't believe that.  I've raised animals for years, and have had cats and
seen dogs who didn't have healthy litters or sufficient milk.  In dairy
herds and breeding populations such animals are culled (killed) so that is
why you don't hear about them.  While childbirth and lactation are robust
and stable systems, they are not going to work perfectly all the time.  In
fact, the history of maternal and infant mortality (even today in areas
where money limits access to interventions) suggests staggering numbers of
dyads that didn't (don't) make it.  Pointless and stupid and dangerous
interventions are bad.  Providing appropriate care to reduce problems and
increase positive outcomes is good.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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