I have to say, I do like the idea of using another term than "insufficient glandular tissue" for moms,
since the term can really polarize the problem in mom's mind. Basically, there is a spectrum of
storage capacity with some women being on the extremely low end. I have not yet met a women
with classical "hypoplasia" who couldn't produce at least some milk.
I think it is important to talk with the mother about what her goals are for breastfeeding when
determining what intervention would be best with her when she has an obvious case of extreme
hypoplasia. I had two mothers with very different goals that had the classical hypoplasic breasts
that took very different routes.
Mom number 1 was a single mother, had insulin resistance, worked in a very high stress male
dominated profession and went through IVF to have her children. The first time around, with no
help whatsoever, she pumped for 12 months and managed to increased her supply from a 10%
supply to a 25% supply. This to her was a marvelous achievement and it was very gratifying to see
the increase in the amount of milk she produced. I saw her with baby #2 who caused her some
pain and fixed the pain. Her baby wasn't a great feeder and she was going back to work so
pumping was clearly going to be a big part of the strategy with her for baby #2.
Mom number 2 had really worked hard with her first and was driven over the edge with biweekly
visits using an SNS and pumping. She really was annoyed that she wasn't told until well into the
process with the SNS that her breasts had a very low storage capacity. She felt she had not had
the chance in the 6 weeks of biweekly visits, obsessively tinkering with tube sizes on the SNS and
pumping to enjoy her first babies early weeks. I was overjoyed that her second was really
fabulous at draining her breasts. Even had I suggested pumping, she would have flatly refused
and ditto with the SNS (or even a Lactaid). So with baby number 2, she was overjoyed to just have
a little help to reposition the latch and no lectures or forceful sales pitches for additional
interventions.
These two women are at opposite ends of the spectrum, but it can be so easy to pitch what we
think is right if we don't spend some time clarifying mom's goals.
Also, I think it is extremely important to help mom understand that breastfeeding does not have
to be "perfect".
As for nature, having worked in many a developing country and raised many animals, I think
nature and natural processes can be incredibly beautiful and incredibly harsh and ugly. Near the
Congo River most of the minerals are washed out of the soil (as is the case in the Midwest of the
US) so iodine levels are very low. On top of this, they eat a bitter form of cassava which needs to
be soaked for 3 days to get the thiocyanate out of the cassava. Even after this process some is left
in the cassava and it is a competitive inhibitor with iodine. So therefore, you have huge rates of
hypothyroidism and goiter from iodine deficiency. This population had a declining population rate
in the 1950s due to many infertility problems. I remember when I took Population Dynamics
classes that they had attributed this to sexually transmitted diseases, but looking back, I think
that the hypothyroidism may have also played a role as well. Both wasting and obesity were highly
prevalent. Young children would die of both marasmus and kwashiorkor and I saw a significant
number of middle aged women who were extremely obese. So, who knows how many mothers
may very well have had a low supply? Of course, this particular culture practiced polygamy and
I"m sure many a baby was swapped to a cowife with higher milk production if there was a
problem.
In addition, I learned there that many natural toxins are extremely harmful as well. Peanut mold,
otherwise known as aflatoxin has been known to increase rates of liver cancer.
Best,
Susan Burger
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