Alesha,
When did the abm supplementation begin?  How frequently were the twins
breastfed?  Did you examine the mother's breasts for signs of
lactogenesis such as increased veining?  What shape were the breasts?
        Estrogen is sometimes used to induce breast development in induced
lactation.  It is possible that this 41 yr old primip on long term
hormone replacement had the breast development occur then, as can
sometimes happen with moms on combination oral contraceptives.  On the
other hand, if the breasts are clearly abnormal (asymmetrical, narrow in
diameter at the base and tubular in shape, with undeveloped nipples and
areolae), it could be a case of glandular agenesis- the mom never
developed glandular tissue in her breasts as a fetus herself.  In this
case the prognosis for a full milk supply is poor.  But this is
uncommon.  It is more common that a self fulfilling prophecy occurs when
a mom has an unusual situation - fear that her situation will prevent
adequate milk production leads to early supplementation of the
infant(s), which reduces demand, which reduces supply.  If this was the
situation, the fix is to increase demand again (pump and breastfeed more
often) while carefully monitoring the babies for voids, stools and
activity level as the abm is withdrawn.
--
Catherine Watson Genna, IBCLC  NYC  mailto:[log in to unmask]