As one of the poster women of small breasted women being able to 
breastfeed I thought I'd chime in on this one :-)

I am glad no one predicted my ability to breastfeed based on the *look* 
of my breasts prior to or during my first pregnancy...
I had my first baby at twenty, and for the previous fifteen years I had 
been a serious athlete...training 2-4 hours a day 6 days a week...

The second edition of Wilson-Clay and Hoover's breastfeeding atlas has 
a picture of an adoptive mom using an SNS and labeled with the words 
"underdeveloped breasts" underneath...figure 162....

That's pretty much how my breasts looked at twenty when I had almost no 
body fat to speak of...
and I went on to nurse six babies without supplementation...

But if someone had planted the seeds of doubt in my mind based on my 
breast size I probably would have formula-fed all six of them because 
like all mothers I had difficulties nursing my first child because 
well-intentioned pediatricians and grandmothers where trying to force a 
bottle-feeding schedule on us...

The woman in figure 162 had not gone through a pregnancy and birth...
so there is no reason to surmise that she has *underdeveloped breasts* 
(whatever that means) for her state in life-
not pregnant not lactating-
and no one should predict based on the look of her breasts that she 
would not be able to lactate if she ever were to conceive and give 
birth...

I also want to add that I abruptly weaned my first child at nine months 
(out of ignorance) and I down regulated so quickly that within 3 days 
my breasts returned to their pre-pregnancy appearance...so I shudder to 
think that some women who have down regulated are being *diagnosed* 
with insufficient glandular tissue...

I tend to think that insufficient glandular tissue could probably only 
be definitively diagnosed by a pathologist during a post-mortem....
and we probably don't yet know the lower limit of glandular tissue that 
can sustain an infant...
Small or flaccid breasts could merely be an indication of down 
regulation, or hormonal or neuroendocrine problems not insufficient 
glandular tissue...even mothers with tubular breasts often have no 
problems breastfeeding...the look of a breast may give us a lead but 
ultimately we have to rely on what the breast does in response to 
various interventions not the *look* of it...

I once helped a mom *diagnosed* with *insufficient glandular tissue* 
and indeed at two weeks postpartum she had small flaccid breasts and 
had never experienced the milk coming in...she followed a modified 
protocol for inducing lactation and at twenty-one days postpartum milk 
appeared... a month later she was breastfeeding without supplementation 
and nursed her daughter for two years...

So I for one am glad that breast exam and prophesy about milk 
production where never part of my prenatal care ;-)

Jen O'Quinn IBCLC

On Tuesday, August 9, 2005, at 04:42  PM, vicki hayes RN wrote:

> It bothers me that thorough breast exam and discussion of breastfeeding
> apparently weren't part of routine prenatal care. Not that it would 
> have
> changed her inability to produce the milk but at least she wouldn't 
> have
> been shocked a few days postpartum.
>

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