Laurie asks if we should voice our concerns to mothers in the first few days if we observe signs of possible hypoplasia.
My immediate reaction is 'NO!' - that is, if you are able to follow her closely enough so that the baby isn't going hungry for days on end. Obviously if the woman herself brings it up you'll need to respond, but at least then you are not the one introducing doubt and uncertainty into the equation. Some babies show signs of intense need already in the first two or three days, and at least in my unit, such babies are likely to be given supplemental feeds. Most babies aren't that desperate for large volumes early on, and if the woman needs all the stimulation the baby can provide, we do her a disservice by supplementing too soon. It's analogous to whether we should tell pregnant women who are five feet tall and wear size 4 shoes that they may have difficulty progressing in labor, esp second stage - I hope we all agree that would be a bad idea. If a problem develops, it will be noticed in plenty of time to deal with it, and there is nothing to be gained by starting her worrying at a time when nobody knows how things will go when labor starts.
I really believe that with the same guidance any new mother should get, about what to expect in the first week or two, including how to tell if baby is feeding effectively and signs that baby is getting enough milk, it is defensible and desirable to watch and wait. Sometimes it will be appropriate to mention your observations and concerns to the woman, but most of the time, not. I think every woman deserves the benefit of the doubt. Any woman starting breastfeeding, esp if it is her first time doing it, needs all the self-confidence she can muster. We don't have to deny reality and pretend that breastfeeding always works perfectly from the first feed, but we also don't have to elaborate on the worst case scenario until we see signs that it is actually developing before us. ALL parents need to know how to tell whether the baby is getting enough nourishment, not just the ones with breasts that alert us to a potential problem.
My other reason for not voicing such concerns unless truly necessary is that before you know it, everyone on your ward will be diagnosing hypoplasia and primary lactation failure on every mother whose baby is a bit unsettled the first few days, especially if she has a visible gap around her cleavage, and you will have even more iatrogenic lactation failure than you want to think about.
If you are not going to be able to follow the mother and child closely enough to ensure that the baby doesn't go hungry for days and days, then I think you can make a case for talking about it, but the conversation is tricky, especially with a woman who has yet to experience breastfeeding as anything other than a way to get food into her child. It's really hard to get across that breastfeeding is much more than that, but IMO it's worth the effort to try anyway!
A lot of this goes for women with previous breast surgery, but they usually ask about it so you end up having the conversation. I think a strategy of watching and waiting, and more liberal use of supplemental milk as needed according to weight loss or discontent in baby, is the best way to support a woman and likely the best way to ensure that her supply is as plentiful as it can be. You don't tell her 'Yes, I thought it might be like this' if it turns out you were right, and you can share with her the reasons you did not give her the full hypoplasia talk on day one.
Rachel Myr
Kristiansand, Norway
"It's hard to predict, and especially about the future."
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