There is a woman who is attending my new mothers' drop-in breastfeeding group
at the hospital who has insufficient milk supply.  This is definitely a mother
problem; the baby sucks fine.  She first came when the baby was 3 days old
because of sore nipples.  The next week, at 10 days, it was evident that the
baby was doing very little swallowing.  And test weighing showed an intake of
8cc. after 20 minutes of vigorous sucking on each side.  She had also gone
from 7-14 to 7-2 and was still losing at 10 days.  Her breasts do not have the
typical "insufficient glandular tissue" appearance.  They are nice and round
and equal, although with less veining than you usually see on a fully
lactating woman.  She states that her sister had "no ducts in one breast and
very few in the other", was not clear how that was diagnosed; ended up nursing
with SNS.  Other sister did fine.

Yesterday she came to the group again.  With pumping and supplementing, baby
had gained 5 oz.  in a few days.  She states she is getting around 1 oz. from
one side,  and even with a hospital-grade pump, only gets a few drops from the
other.  The odd thing is that she has an anomaly on one breast - sort of an
extension of her nipple that protrudes from the top of the nipple - more than
a skin tag - which has no openings, so that only the bottom of the nipple has
pores.  That is the breast that is producing the milk.  The other, normal-
appearing breast, produces virtually none.  Yesterday the baby was doing more
swallowing on the good breast, but still not enough - maybe one every 4-5
sucks.

Mom is pumping, supplementing with EBM and ABM via bottle.  Baby continues to
like the breast, nurses well and goes to breast at least 12 times a day.  She
is considering the SNS, but I think is hoping this is more short-term than I
think it's going to be.   She did say her doctor told her she lost a lot of
blood, but didn't know how much.  Will ask him.  No history of thyroid,
medications, breast surgery, etc.  This was not a private consultation, so I
did not do a thorough exam of her breasts, just what I could see.

Has anyone seen a similar situation?  I seem to remember reading here about
ultrasound to visualize extent of ducts.  Is this true?  If in fact she has
very little ductal tissue,  it would be nice to save her the futile effort to
build a supply.  Any input would be welcome.  TIA.  Miriam <[log in to unmask]>