Hi, everyone--it's been awhile since I've visited, but I have a question.   I
did a consultation a few weeks back for a woman whose son, age 3 weeks, 3
days, was persistently feeding, crying after feeds--just not doing well.   She
opens her shirt and has (in my opinion) insufficient breast tissue.   They were
really classic in their look, wide-spaced, very flaccid, sort of a bulbous
areolae, etc.   They felt like they were "empty," and hand expression yielded
some immediate watery milk, but you could just tell that these breasts drained
very immediately and then didn't do a whole lot in terms of volume.  The baby
got on and after lots of nursing, breast compression, switch-nursing, the whole
gamut, he took in 1.4 oz total (I do test weighs).   He eventually fell asleep
at the last breast because there was virtually no flow, but when we took him
off to get a final weight, he was screaming in hunger, sucking at his fists,
etc.   She said that that was typical, so she's just doing marathon feeding
sessions.   Now here's the problem:   his weight gain had been okay.   He was
born at 6.09, had a 4th-day discharge weight of 6.01, on day 7 was 6.05, and at 3
weeks was 7.04.   And I weighed him naked on that day, which was day 24 at
7.08.   I should mention that even though the numbers were okay, he looked thin
and not so great--kind of like he had been fed a skim-milk diet.   My area of
interest is low supply, so I know my way around low-supply breasts and I also
have certainly seen what I like to refer to as the "insulin-resistent" breasts
carry a baby a certain amount (i.e. the babies limp along gaining
less-than-ideal weight but gaining weight nonetheless, and still having adequate diapers,
but fussy behavior after feeds), but the thing is that I usually see
everything fall apart so much earlier than three weeks of age.   I think there may be
a chance that I intercepted this dyad just as it was all crumbling, but of
course this woman---who, I should add, had never pumped nor supplemented,
ever---didn't want to use formula at all and decided that before she began pumping
after feeds (as I suggested), she wanted to ask her pediatrician if she should
do so (!).   So I've not been able to follow her up, but can anyone share
experiences with me about seeing what you could swear on your life were
low-supply/low-tissue breasts, but the woman went on to nurse fine?   It's one of those
situations where I will be SHOCKED if this woman supports the baby on those
breasts--they not only had the look, but had the feel as well--very, very
flaccid. Oh, and some other possibly pertinent history: her periods had been regular,
no fertility problems, some skin tag growth, very heavy, longish periods,
though.   Also had a history of miscarriages.   Anyhow, any input would be
great...

Heather Kelly, MA, IBCLC
NYC, NY

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