With all this discussion about glandular insufficiency, it has been on my mind 
when working with patients.  I'm working with a particular mom who just isn't 
producing and I'm now wondering if this is her problem.

Baby was born last Wednesday.  She reports feeling like her breasts became 
very full on Saturday, but they have not been full since.  Baby was nursing 
poorly at this time and mom reports that she wasn't feeding him frequently 
enough.  He's now getting supplements in adequate amounts.

Mom came to me on Tuesday.  She rented a pump and began pumping q2 1/2 
to 3 hours but getting only <1oz with each pumping.  Baby will nurse only with 
a shield but a test weight showed an overall 0.4oz wt gain.  Baby has no oral 
problems and sucks like a champ.  Mom reports very irregular menses and very 
little breast changes during pregnancy.  No excessive blood loss, no diabetes 
or thyroid disorder.  Not hirsute.  No s/s retained placenta.  Breasts are 
probably about size C, not tubular or widely spaced, but they do not appear to 
have the fullness of lactating breasts.  Milk does let down easily with 
stimulation but she only produces drops.

Could this be glandular insufficiency, even in the absence of hypoplastic breast 
characteristics?  She does report irregular menses and little to no breast 
changes during pregnancy.  Or could the 3 days of poor, infrequent nursing 
cause milk to decrease that drastically?...   Hmmm.  I've occasionally worked 
with women who, for no apparent reason, just don't produce. 

I would love to hear some input, and thank you in advance!

Julie Conaway, RN, IBCLC

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