All the recent discussion on inadequate breast tissue came at just the right time for me. I have the mother's permission to share this story. Friday 2/18, I saw a 16 y.o. mother, 5 days postpartum. She had a D&C immediately post partum to stop abnormal bleeding. She came in requesting formula because she was going to wean right away because she didn't think her baby was getting enough "and besides, she was going to go back to school soon, anyway". After discouraging "cold turkey" weaning, I proposed the alternative of maintaining partial breastfeeding during off-school hours. I expected to find her engorged and the baby unable to milk the breast sufficiently. She said the visiting nurse had told her to limit feeding time because "after 20 minutes, the baby was only using her as a pacifier." Planning to assess the breasts and perhaps soften the areola, teach her digital extraction, massage and breast compression etc., I asked her to remove her bra. She simply lifted up her shirt. No bra needed! Imagine my surprise when I saw 2 matched, unengorged tubular breasts with bulbous areolae and a large flat central space on the chest wall between the breasts! I tried to "normalize": my reaction and choose my words wisely, telling her that some mothers need a little closer observation to be sure the baby was getting enough milk. I was secretly relieved that formula coupons had been issued, because, even though I could express a few drops easily, there didn't seem to be much fullness at all. I was wondering whether she might be one of those mothers we had been reading about all week with insufficient glandular tissue. I felt at least, we had provided for rule #1 over the weekend. When I called her Monday, she had taken my suggestion to avoid cold turkey weaning. She was nursing about 5 times a day and giving p.c. feedings of 3 ounces of formula. I helped her understand, on her level, that she could stimulate more milk by nursing 8-12 times a day and reducing the p.c. feedings to 1 1/2 or 2 ounces, at least during her waking hours. I told her that by the time we saw her this Friday, (2/25) we should know better if it was going to work. I called her Thursday to see how things were going. Her reply: " I am leaking a lot now." 3 extra feedings a day, with baby and mother deciding the length of the feeding had done the trick in 72 hours! I made a home visit today to demonstrate the double pump we had origninally decided to arrange when we were thinking of extra stimulation. She was firm, full and leaking. The baby is nursing like a chanp, with audible swallowing and there was definite relief of fullness after nursing. Right after that, she got out 3/4 of an ounce with the pump quite quickly and easily. She lives in the midst of a somewhat chaotic family situation, with responsibility for her younger sibs part of the time. She had sometimes been delaying feeding, hand expressing a few drops for comfort and letting a younger sibling feed ABM because she was involved in trying to get the youngest ones dressed and fed breakfast while her mother was out. I hope I got the message across that she can learn to nurse while supervising her sibs if need be, but that taking care of her own needs for short frequent feedings would benefit her baby more in the long run. I will find out Monday how the photographs turn out. We are going to talk with an ultrasound department about whether U.S. can provide some documentation about the amount and placement of breast tissue. This experience has shown me that appearances can be deceiving, and that encouraging more thorough and frequent milk removal is a good first strategy. Jean ******************************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html