First of all....yes I've read the entire article.  I was glad that my
journal arrived in time!

I think I agree with Nikki here.  So many of my clients are insecure as it
is, that I'm not sure I'd *tell* a woman that the shape, size, or growth of
her particular breasts may pose a problem for her ability to produce milk.
What would happen, IMO, is that she would then *expect* not to produce
sufficiently.  Self-fulfilling prophecy.

How would I use, then, my assessment of her hypoplasia?  I would DEFINITELY
follow her up closely, teach signs of breastfeeding inadequacy, cue-based
feeding, etc.  If/when a supply problem became evident to me, I would tell
her.

OTOH, women are entitled to frank information about their own bodies, are
they not?  As I sit here, I can construct an argument in favor of telling
her my concerns from the start, rather than NOT telling her and therefore by
extension treating her as if she can't handle knowing the truth about her
own body.  It angers me when people use "not making a woman feel guilty" as
an excuse for withholding the frank truth about the advantages of
breastfeeding/disadvantages of artificial feeding.  Operating from a
perspective that women can't handle making their own decisions unless
they're "protected" from the truth really bothers me.

Yet here I sit, potentially not wanting to tell women that I think they're
hypoplastic ::::grin:::  Interesting.  Definitely food for thought.

My main thought after I finished reading this article was how much I'd love
to see further study of hypoplasia, with a control group, as described in
the Limitations section.  Perhaps if we *did* have further study of
hypoplasia, I would feel more comfortable with telling a client of her
potential problem.....
Regina Roig Lane BS IBCLC for Miami-Dade County WIC

> -----Original Message-----
>
>     My first question is about management. I don't know if I would ever
> tell
> a new mother that the shape or size or growth of her breasts may pose a
> problem to her lactation. As Derrick Jelliffe has said, "Breastfeeding is
> a
> confidence game". I would be loathe to do anything that would plant a seed
> of
> doubt in a new mother's mind. The optimum situation would be for all
> mothers
> to have frequent follow-ups in the first two weeks of lactation, no matter
> what their status; and, for all mothers be taught about cue-based feeding,
> the need for close and intimate contact with their newborns, and signs of
> breastfeeding adequacy.
>

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