I confess I may not have read all the posts about this case, so if I missed something - please no
flames.

I think there is a very different way that one could look at this situation.

First, I have worked very closely with clients who have seen the breastfeeding medicine specialist
that this mother saw.  From seeing how the breastfeeding medicine handles her cases, I have to
say she leaves no stone unturned when it comes to helping mother's increase their supply.  I also
trust that this mother got the best support possible and put in a good effort at all the measures at
her disposal to increase the supply.  I've seen some pretty tricky cases of low supply with this
specialist, so I have developed a huge amount of trust and respect for her methods.

Second, we have to remember that there are very different perspectives on the use of tubes at the
breast depending upon what the primary problem is.  For an adoptive mother, this can be an
opportunity to develop that closeness that she may have felt she missed by not going through the
birthing process.  It is s symbol of hope that she will be able to develop a milk supply - despite
not having the hormonal changes of pregnancy to help the process along.  In this regard, an
increase in supply is looked upon as a huge acheivement.  For some mothers who have had a
breast reduction and come to terms with the breast reduction - it may also be seen as a symbol of
hope - a way of keeping baby at the breast and possibly increasing supply as well.  The opposite
may be true of a mother who expected to have a full supply.  The SNS or Lactaid is a constant
reminder of the fact that the breasts are not producing enough milk.

I'm thinking that the mother of twins may be having a similar response to a woman I saw who had
the classic tubular breasts with clearcut insufficient glandular tissue.  With her first baby, the
lactation consultant didn't tell the mother she had insufficient glandular tissue. She pumped her
brains out & used the SNS in the futile hope that she would get a good supply.  These two devices
- the pump and the SNS became symbols of her failure to produce enough milk to satisfy her
baby.  If I remember correctly, her OB was the one who noticed the lack of glandular tissue & clued
her in to the fact that she would never produce enough.  I saw her with baby number 2.  He had a
wondeful suck.  Really drained her breasts well - which was about 1 ounce.  So, we normalized
things by letting him stay on the breast for as long as he wanted and then letting him finish with a
bottle.  He really liked the breast & was strong and vigorous enough to let her know when he
needed more.  This approach enabled the mother and her son to ENJOY breastfeeding in a way she
had never been able to with her first.  I saw no reason to tamper with an efficient baby and
interfere with this mother's opportunity to enjoy the breastfeeding relationship with her son.  And
had I thought she needed to pump and use the SNS or Lactaid, I'm sure she would have shown me
the door.  We worked on latch and breast compressions instead.

So, while one could think it would be weird for a mom to not want her baby associating the breast
with food - it could be taken in an entirely different light.  This mom might have dissociated
breastfeeding from our PRODUCTION ORIENTED society.  In other words, what she may have really
been telling Ayelet was that she didn't want to focus on the PRODUCTION end of the spectrum, but
rather wanted to focus on the BONDING end of the spectrum.  Seen in this light - it can actually be
viewed as something very positive.  This mother ENJOYED having her baby at the breast.

Given the entire picture of this mother's situation of having twins, of really wanting the bonding,
of having really worked hard at the supply end with a breastfeeding medicine specialist, she may
actually have made some pragmatic decisions that make sense in view of her goals. While I'm sure
that some women would opt for the Lactaid or SNS, these are difficult devices to get used to and
with another baby, it may very well be too much for this particular mother.  Since I'm not a mother
of multiples, I cannot speak to the challenges of trying to do this with 2 babies, but it seems
challenging enough with one baby unless mom is highly motivated.

She may be mourning the loss of closeness as her baby has shifted to a new phase and begun to
get frustrated with the low supply.  So, I would suggest adding in other activities to replicate the
bonding she obviously felt during the nursing such as infant massage - which would be good for
both babies.

Best regards, Susan Burger, MHS, PhD, IBCLC

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