To me, this issue of mammary hypoplasia and full breastfeeding potential is like the issue of infertility.  Should we not have sex if there's a possibility of infertility?  Should we AUTOMATICALLY go to assisted reproduction?  And EVEN IF, there's a positive diagnosis of an issue, how many times have we seen mothers get pregnant, after, despite, therapies and diagnoses?  Infertility is a difficult issue, have been there myself and yet have children.  Yes, the focus on pregnancy sometimes causes strain in the sexual relationship, as much has been written.  The same thing with breastfeeding when adequate breast milk is a goal.  Mothers seek us out as "breastfeeding detectives" and we must share truth with them, but we also must help them to have hope and give them every bit of information and help we can without being Pollyannish.  It's a balance thing - like a mobile - where information, support, technology and redefinition must be adjusted constantly.  That's why the role of lactation consultant is where I've put my efforts for the last 25+ years.  It's not a role for the faint of heart or mind, if it's done well! 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Friday, October 01, 2010 9:38 AM
Subject: Hypoplasia/IGT

Friends,


I must serve, combined between mother baby inpatient and a special care nursery, close to 2000 couplets a year. 3-5% of that figure is @ 60-100. I see a lot of hypoplasia and IGT.


In my experience, often women who have that classic experience of insufficient milk, likely due to IGT/hypoplasia, and tell me the story of their previous experience(s), are angered by what they consider the negligence (their word) of consultants who have worked with them previously and NEVER mentioned a thing. They have asked me questions like, "...don't they teach all of you guys this stuff"?


Here is a story that sticks with me. I once worked with a lovely woman who was on baby #4, and was telling me her story with all 3 previous babies. No lact II, jaundice, dehydration and prolonged excessive weight loss and greatly suffered with postpartum depression. She had class IGT. The lack of glandular tissue made it even difficult to latch her baby because it was as if she had a nipple protruding from a horizontal flat surface with a small amount of upper quadrant tissue, and absolutely none below. She was very informed. And asked me about why small breasted mothers are told they will make plenty of milk, and we discussed the differences between small, developed breasts, and IGT. She had delivered her other 3 not in my area, and had seen hospital and private practice outpatient IBCLC's with #2, and #3 who never said a thing. She asked if I might show her some pictures (she actually saw me charting at the nurses station and came out and asked me about photos)! So I hunted down my Atlas that I donated to my workplace, and we thumbed through it, and she read the captions, some which comment on adequate milk supply in spite of evident  mammary variations, and others which were not as successful. I gave her tons of encouragement and support, and I could tell she was very familiar with the concept that having your baby at your breast is about so much more than food! We discussed what she might consider 'if' she had a similar experience, herbal interventions, Lact-Aid, Rx medications, pump and so forth, talked about what she might do now..... She told me how relieved she was for the information, and how much more confident she felt to mitigate the situation 'if' she experienced this situation again. She felt she had been doing something wrong all this time, or mismanaging breastfeeding.


I realize this is a polarizing issue and I had to reflect long and hard about what approach I would use and feel is best for the mothers I serve. I've concluded, and believe, that we are tasked with finding a compassionate, and supportive way of informing these women while doing our best to make sure that is not all they 'hear' from their consultant. Despite having access to an outpatient breastfeeding clinic that bills insurance in my facility, I cannot guarantee any woman will return for the follow-up we encourage and offer to schedule for them. 


I find that deliberately withholding information from our clients when they have an evident risk factor is limiting their ability to empower themselves simply because we don't feel they will 'appropriately' handle the information. It's up to the client to determine what the appropriate response for them may be, not us. 


Michelle H. Kinne BA IBCLC RLC ICCE CD(DONA) www.CascadePerinatalServices.com








 

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