All the recent discussion on inadequate breast tissue came at just the
right time for me. I have the mother's permission to share this story.
Friday 2/18, I saw a 16 y.o. mother, 5 days postpartum. She had a D&C
immediately post partum to stop abnormal bleeding. She came in requesting
formula because she was going to wean right away because she didn't think
her baby was getting enough "and besides, she was going to go back to
school soon, anyway".
After discouraging "cold turkey" weaning, I proposed the alternative of
maintaining partial breastfeeding during off-school hours. I expected to
find her engorged and the baby unable to milk the breast sufficiently.
She said the visiting nurse had told her to limit feeding time because
"after 20 minutes, the baby was only using her as a pacifier."
Planning to assess the breasts and perhaps soften the areola, teach her
digital extraction, massage and breast compression etc., I asked her to
remove her bra. She simply lifted up her shirt. No bra needed! Imagine
my surprise when I saw 2 matched, unengorged tubular breasts with bulbous
areolae and a large flat central space on the chest wall between the
breasts!
I tried to "normalize": my reaction and choose my words wisely, telling
her that some mothers need a little closer observation to be sure the
baby was getting enough milk.
I was secretly relieved that formula coupons had been issued, because,
even though I could express a few drops easily, there didn't seem to be
much fullness at all. I was wondering whether she might be one of those
mothers we had been reading about all week with insufficient glandular
tissue. I felt at least, we had provided for rule #1 over the weekend.
When I called her Monday, she had taken my suggestion to avoid cold
turkey weaning. She was nursing about 5 times a day and giving p.c.
feedings of 3 ounces of formula.
I helped her understand, on her level, that she could stimulate more milk
by nursing 8-12 times a day and reducing the p.c. feedings to 1 1/2 or 2
ounces, at least during her waking hours. I told her that by the time we
saw her this Friday, (2/25) we should know better if it was going to
work.
I called her Thursday to see how things were going. Her reply: " I am
leaking a lot now." 3 extra feedings a day, with baby and mother
deciding the length of the feeding had done the trick in 72 hours!
I made a home visit today to demonstrate the double pump we had
origninally decided to arrange when we were thinking of extra
stimulation. She was firm, full and leaking. The baby is nursing like a
chanp, with audible swallowing and there was definite relief of fullness
after nursing. Right after that, she got out 3/4 of an ounce with the
pump quite quickly and easily.
She lives in the midst of a somewhat chaotic family situation, with
responsibility for her younger sibs part of the time. She had sometimes
been delaying feeding, hand expressing a few drops for comfort and
letting a younger sibling feed ABM because she was involved in trying to
get the youngest ones dressed and fed breakfast while her mother was out.
I hope I got the message across that she can learn to nurse while
supervising her sibs if need be, but that taking care of her own needs
for short frequent feedings would benefit her baby more in the long run.
I will find out Monday how the photographs turn out. We are going to talk
with an ultrasound department about whether U.S. can provide some
documentation about the amount and placement of breast tissue.
This experience has shown me that appearances can be deceiving, and that
encouraging more thorough and frequent milk removal is a good first
strategy.
Jean
********************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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