Hi! My name is Cindy Miller. I am a LLL Leader and Doula in Minnetonka,
MN, USA.  I have a friend, who is also one of my LLL Group Moms and a
doula client, who will be having her second child in Feb/March. She
breastfed her first child for 22 months. Her 3 1/2 yo daughter was born
naturally, 41 weeks, meconium, but didn't get to even try bfing until
approx. 4 hours postpartum.  She wasn't allowed to hold her daughter
for almost 2 hours.  Her daughter did not latch on for the first 24 hours,
she'd start sucking and then cry. She had a successful feed after 24 hours,
on the right breast. The left nipple was flat.  Due to her own lack of
knowledge as a first-time mom, significant lack of bf support from husband
and family members, and inadequate bf management (infrequent nursing,
lack of rest, poor latch-on and positioning, medical advice to suppliment
with ABM), she ended up supplementing ABM, max 12 oz/day thru the
first year. She never successfully bf on the left breast: the nipple was
flat, her daughter mostly refused the left, and when pumping it only
produced about 1/4 of the milk that the right side produced.

Because she supplemented for the first year, my client retains a feeling of
having an inadequate milk supply, even with two breasts.

Their breastfeeding relationship was interrupted a year and a half ago
when my client was diagnosed with breast cancer of the left breast.  She
chose a lumpectomy over mastectomy, followed by chemo and then radiation
therapies.  Her surgery report mentions removal of the lump and nearby
"sub-areolar tissue", but it is unknown how much glandular tissue was
removed and how many ducts from other areas were damaged.

Her primary concern, something she hopes to have some control over, is
to get her breastfeeding relationship off to a good start immediately
after her birth this time, and to be able to exclusively breastfeed this
time.  To that end she has educated herself regarding lactation.  She is
a very active LLL Group Mom. She is extremely well-informed, not to mention
courageous <smile>.

This time around, we are planning on giving her a lot of emotional and
physical support. I'll be there to suport her in having a natural birth,
and to help her in immediately bfing.  When she returns home, we plan on
having her stay in bed, do nothing but eat, sleep, and have frequent
nursings, etc.  I'm not an LC, but one of our Group Leaders is an IBCLC,
so we are not concerned too much about establishing a breastfeeding
relationship.  However, my friend/client is concerned about whether she
will be able to exclusively bf, as she wishes, with only one breast.
This is even more of a concern because she has very skeptical family
members (including her husband) and we are trying to arm ourselves with
as much supporting evidence as possible in advance.

To summarize, our questions are these:

1)  After lumpectomy, chemo, and radiation therapy, can she expect anything
at all from that side? Since the lumpectomy scar goes partway up the areola
might that side be too uncomfortable to use, even if an adequate latch-on
and supply is achieved?

2) Could her daughter's inability to latch on and suck for the first
24 hours after birth have been the result of an oral aversion due to the
deep suctioning at birth?  Could the 4 hours between birth and first
attempt at bfing have significanlty effected her milk coming in (it was late),
or contributed to her "low supply" problem? Can she expect to exclusively
breastfeed with only one breast?

3) What iatrogenic, real, or perceived problems could occur in a hospital
setting that would prevent her from bfing immediately after birth?  Are
they frequent, often, rare, etc?

4) Is her situation analogous to a situation where a mother with previous
milk supply trouble bfing baby #1 finds out that baby #2 is twins and wonders
if she will have sufficient supply for those twins?  This is her metaphor
for her own situation.  Is there a "feel" for what percentage of women
would be unable to exclusively bf twins?  Is it appropriate to relate such
numbers to my client? She is interested in these numbers as ammunition to
support her in doing whatever it takes to bf her new child.

Thanks In Advance!

Cindy Miller, LLL Leader, Doula, CBE trainee
Minnetonka, MN, USA