This mom seems to be describing what we would see with hypoplasia. I
have seen this, and when the mother says 'my milk came in' it really
is a very slight fullness of the breasts but not the usual onset of
*copious* milk production. To her she feels her milk is in. Typically
the breasts feel very soft and flaccid on first days, and only some
firmness more around the areolar region.

What I would recommend for this mother would be prenatal breast
expression at around 38 wks. May not get any colostrum, but might help
stimulate? Donor milk or formula ready if needed for infant signs of
hunger, no voiding or stooling, no swallows, etc. even in the face of
good lactation help and very frequent breastfeeding. I would recommend
if the need for that occurs, that mom use with a lactation aid at
breast. Immediate start of galactagogues on day of birth, if not
sooner, if it is safe during pregnancy.

This may sound fatalistic, but unfortunately I have seen quite a few
cases. Typically the mom reports infrequent voiding, pink or orange
color of the urine, and no stooling for couple days or scant stools
that remain meconium.
If this lactation goes well, then she can disregard these interventions.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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