I've worked with two mothers with insufficient glandular tissue. The first
mother whom I saw several years ago 0sought help when her baby lost weight
dramatically in the first week. She produced a small amount of milk which did
not increase despite pumping and frequent nursing. However, using the xxx to
supplement the baby at breast, she nursed for almost a year. Before her next
pregnancy she had a sonogram which confirmed that indeed she had minimal
glandular tissue. When her second baby was born, she called me to rent a pump
with the hope of increasing her milk supply but the miracle didn't happen and
she started with the XXX again and continued for a full year. She felt angry
and cheated by her body and it took a long time for her to come to terms with
this. We estimated that she was producing a few ounces of breast milk and she
was comforted that the baby did get something from her.

The second mother, a more recent case, also called because of her baby's
rapid weight loss. It's really hard to tell a mother that she probably won't
make enough milk . This mother also pumped and used the xxx but only for a
few weeks. In both cases the breasts were small and looked somewhat normal -
definitely not the long tubular breasts described in the literature. A key
element of the history was lack of enlargement during pregnancy.

My most fascinating case was a 42 year old first time mother whom I saw on
Day 6 because her 9 lb 4 oz baby wouldn't latch on. Her breasts appeared
flaccid; there was no evidence of milk, and only beads of colostrum. She had
haemmoraged severely after a difficult forceps delivery, during which her
uterus turned inside out (the midwife's words). The placenta broke up and it
required extensive efforts to clear out the  placental fragments. I was on
alert about fragments holding up milk production but was assured by the
midwife and doctor that they got everything out. The mother was given a high
dose of methergine to control the bleeding.  By Day 9 there was still no
milk. The doctor and midwife did not seem to be taking this seriously,
telling the mother to be patient. Day 10, she was tested for prolactin levels
and thyroid function. Sheehan's Syndrome was considered and ruled out. My
theory was that the large amount of prostaglandins the mother was given to
control the bleeding had blocked milk production. The mother was exhausted
and overwhelmed. She had a history of depression, and had been on Pamelor
prior to the pregnancy. Her mother had recently been diagnosed with cancer
and died when the baby was about seven months old. She was at high risk for
postpartum depression and did report feeling very sad in the first few months
but she managed very well without medication. At her third visit with me, as
she started feeling physically better,she learned to use the XXX and we
discussed options in the event that lactation could not be established. ( I
had no idea what the prognosis might be at this stage ).
1. continue with XXX
2. bottlefeed "putting her heart into the bottle".
 The prolactin test came back at 101.1 (WNL for 2 weeks postpartum). Mother
continued sporadically to use xxx and pump, however baby was primarily being
bottle fed.  Syntocinon was tried without success.

 By Day 21 mother was starting to feel much better and was pumping x 3 daily
and getting one and a half ounces per session. I supported whatever effort
she could make. We talked every few days. She continued pumping and
progressed to using the xxx at most feedings.

 On Day 29 she called me in wild excitement to report that one breast was
engorged !

Over the next few weeks she discontinued the XXX and fully breastfed, with
occasional supplementary bottles. Baby was weaned at 9 months. This mother
attended my bi-monthly postpartum support group so I was able to follow her
progress right to the end.

I promise to keep my postings shorter in future !

Beverley Rae, MSW CSW IBCLC
Manhasset, NY