You're right that a pregnant mother is sensitive and reactive, and can hear any concerns expressed as a firm diagnosis saying she can't breastfeed. But many women want information that they can work with, and a hopeful, knowledgeable person to walk by their side.   So the object is to alert her, to keep her in the game, and to let her get off the ground as fast as possible, to take advantage of perhaps some antentatl hand-expression and lots of removals during the initial calibration.  There's a new book "Finding Sufficiency" by Diana Cassar-Uhl on dealing with the wide spectrum of possible paths that a woman might walk with suspected hyploplasia/IGT.

A long time back I wrote a post on discussing this with the mother already breastfeeding, which is in the archives, but I'll paste it in here again.

Good luck to all
[copied material to follow]
There is always that moment of suspense as a mother is dropping her bra flaps (drumroll please....).  But as someone here said, sometimes you internally say, "Oh no," and yet things work out.  (I personally launched into breastfeeding my daughter carrying all sorts of red-flags for milk production, which thankfully I didn't know about at the time.)

Here's some of what I say (much stolen from fine LCs everywhere, including this list) when suspecting some primary problem with hypoplasia:
""You're probably already suspecting that you're battling with some unusual problems.  And with so many factors in you making and the baby taking milk, it's sometimes difficult to do the detective work.  How a breast looks doesn't always tell us much -- women are built many different ways, and breastfeeding tends to work.  But there are certain characteristics, such as this very wide spacing, the lack of roundness underneath, the unusual shape to the areola and nipple, that are sometimes associated with a reduced amount of milk-making tissue. It's not just a matter of small breasts -- this is an unusual situation called hypoplasia, which is more like an underdevelopment.  This is not a yes/no or black/white situation.  You are(generally) already making some milk, so there is some tissue available.  In a world where some babies never get a *drop* of their mother's milk or a minute at the breast, you might feel good about whatever this baby is getting."

""At this point, we don't know how productive we can make the available tissue.  As an analogy, if you have a small office, if every person on staff is working hard, a lot can get done.  We can talk about some strategies.  We can maybe explore your health history for clues.  We can work on helping the baby feed more effectively, maybe do some supplementing at the breast to increase the stimulation, and we can add a hospital-grade pump, to tell your body that you have twins.  There are some herbal and prescription medications you can discuss with your doctor, which have a reputation for helping with milk production.  It may take weeks to see how far we can press the system.  We're lucky we have tools for getting milk out of you, and getting milk into the baby, so he/she will be happy and growing while we figure this out. At this point we can't predict the outcome.  Many women are able to increase their milk production, though we can't guarantee a complete supply.  But in difficult circumstances, breastfeeding doesn't have to be all or nothing.  Many women find that if they sustain that relationship, even without the supply they wish they had, they can feel that in the big picture they gave their baby a lot through breastfeeding -- maybe more than someone who had a full supply, but stopped at two months".
----------------------------------------
This isn't set in stone.  The mother might need time to grapple with the "diagnosis" before launching into the remedies.  The discussion should be realistic -- a full supply might be impossible.  But it's very easy for a mother to hear, "You don't have the right amount of breast tissue and you *can't* breastfeed -- end of story,"  She should feel good that she's taken active steps and is sitting in a room with a lactation consultant, when so many people stop breastfeeding in the first week or two. So it seems that we should move quickly in the more hopeful approach of what she can do, if the mother is up for it, and battling for what is possible.

Margaret Wills, LLLL, IBCLC, Maryland





> Date:    Mon, 19 Oct 2015 10:00:27 -0800
> From:    Sarah Stevens <[log in to unmask]>
> Subject: genetics of hypoplasia
> 
> Julie was lamenting first seeing mothers with hypoplasia postpartum, when
> she might have been able to take steps in pregnancy to maximize her supply.
> I have worked with one client through all three of her children (and will
> be there for #4, expected next year), who has obvious hypoplasia and a
> severely limited milk supply. I asked her during her second pregnancy if
> she would have preferred to know in advance, with baby #1, that she would
> likely not make a full supply. She told me that she would have been
> crushed, as she always knew she would breastfeed, and that that knowledge
> would have cast a shadow over the entire pregnancy for her.
> 
> That was not the answer that I had expected, as I was also wishing I had
> known in advance so that we could all be a little more prepared. I guess
> sometimes the most practical thing might not be the most helpful thing.
> 
> I have a question, though, for Julie and all of you who do detect
> hypoplasia prior to delivery. How do you bring the subject up with a woman
> who might not suspect that her breasts are anything but normal?  We have so
> much body shame and objectification and anxiety in our culture anyway, I'm
> always concerned about adding breast appearance to the list of things women
> dislike about themselves.
> Cheers,
> Sarah Stevens, IBCLC
> Anchorage, AK
> 
>      

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