If there are multiple signs, I may talk about "some women having a
smaller milk factory", then talk about all the things we can do to help
the factory maximize it's output, including early manual expression in
addition to early  and frequent bf. If there is clear hypoplasia (very
large intramammary space and high inframammary fold with cyllindrical
breasts with large areolas), I will share the information with her that
she may have less milk making tissue than typically found, and share the
Huggins, Petok and Mireles study from 2000 that showed that even moms
with the most severe hypoplasia increased their milk production over the
first 6 weeks postpartum with lots of stimulation. This is important for
us to remember too, that we can't always predict by looking at the
breasts how they will do, and that there is hope.

I also focus on the relationship aspects of breastfeeding, and share
options for supplementing at the breast to maintain the bf relationship
and maximize milk production.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 5/24/2015 9:47 PM, Melinda wrote:
> This is such a touchy diagnosis. I'd like to know how you consultants bring up the issue upon meeting a woman with IGT. How to balance an honest assessment with encouragement but no unrealistic expectations, and respect their desire to breastfeed?
> Melinda Harris-Moulton
> IBCLC FNP
> Olympia, WA
>
> Sent from my iPad
>
>> On May 22, 2015, at 5:26 AM, SUBSCRIBE LACTNET Jacalyn <[log in to unmask]> wrote:
>>
>> I just had a Mom with this.  I would be interested in more information as well
>> So far for the Mom I had, at first weight check post discharge the baby's weight was stable. (not >10%)
>>
>> During her hospital stay, I did discuss with her the potential for inadequate supply but to continue frequent feedings.  She did immediate skin to skin and spent much of first 24hrs skin to skin.  She did have breast changes with pregnancy, so remaining hopeful for her.   She was surprised...shows the lack of breast assessment prenatally :(   Fortunately she attended the prenatal BF class and knew skin to skin, early feedings, feed on demand.
>>
>> I would encourage this mom- skin to skin, frequent feedings, pumping early if poor feeds.
>> Hopefully, one of the LC experts will provide us both more information :)
>>
>> I referred to  Breastfeeding and Human Lactation 4th edition - Riordan & Wambach and Breastfeeding Atlas 5th edition- Wilson-Clay & Hoover.  sorry not good at actual links.
>>
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