>Maria is interested in BF, but knows
>her chances of supplying a complete milk supply for baby due in the summer
are
>slim.

Not necessarily.

Tina, I had a client who had similar surgery, 19 years before her baby was
born.  She called me when she was about 5 months pregnant to ask if she
could breastfeed her baby.  I told her that I didn't know, but that I
recommended that she assume that she could, until she found out otherwise.

I have two posts on this case but, this morning, I can't find them. When I
do I"ll send them to you.

My client did have milk, dripping from the re-channeled milk ducts, through
her re-connected nipples. Everywhere she turned, people kept telling her 1)
that she wouldn't make milk, 2) that she would be horrible engorged,
because 3) her milk would not be able to get out.  When she did have milk,
the doubters said that she would not produce enough for her baby.

She had a lot of milk, but she doubted her supply and began supplementing
because her baby was fussy--hungry, of course.  There were ample wet
diapers and stools, baby was gaining fine, but the doubts were there.  So
she supplemented until baby showed severe allergy to the abm.  Then she
returned to pumping, and built up her supply.  She had had enough all along.

She knows that with the next baby, she will not be undermined by the doubts
of others in the restorative power of the body. One day when I was there,
she was pumping and getting sprays from each breast until her husband made
a derisive comment.  The milk stopped instantly and didn't resume at that
pumping.

I was the only person in her life who continued to leave the outcome open
to all possibility.  I encourage you to share this story with your client
as "one" story of breast reduction and later lactation.  If she doubts her
supply, it will most likely be less.  Don't be afraid that if she believes
that she can make enough milk for her baby, that her disappointment will be
too great to overcome if that is not the case.  Greater would be the
disappointment if she didn't go into it with all of her heart and mind and
body, then found out later that she might have been one who had
fully-recovered breasts.

Remember Willy Shake said, "Tis better to have loved and lost, than never
to have loved at all."

And my favorite Bro. David quote, "We must always choost between risk and
risk."

You asked:
>Should she allow baby to suckle at "naked" breast first and then add
>the feeder?  Would baby just get frustrated if no milk is immediately
>available?

Definitely have baby feed long and often at the breast.  I recently had an
adoptive mom whose baby happily fed for 50 minutes just after the birth,
and continued to feed with relish for almost 48 hours, before mom began to
supplement. She is now happily feeding with a supplementer and is
definitely getting some breastmilk. The more she sees herself as a "normal"
mother, the more her body (and her mind) will respond as if she is.

I hope that you can be her voice of hope.  I disagree with the caution of,
"Don't get your hopes up."  "Up" is where hopes should be.

Patricia Gima, IBCLC
Milwaukee


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