PTP:

I once was consulted by a mom between pregnancies to discover if there were any obvious reason for the extreme nipple pain she had experienced with her first child. She had switched to pumping early on and continued bottlefeeding EBM for at least 3 months if I remember correctly.

In retrospect, I admit that I concentrated mainly on assessing the nipples, their protractility, etc. etc. and even went so far as to refer her to a dermatologist just to be sure. She soon conceived their next child. She had an unmedicated birth with a rather rapid delivery, and I came to the hospital before he was 5 hours old. Same pain. Suck assessment made my finger hurt, and I went with her for her baby's craniosacral adjustment after a few days home from the hospital. Just one adjustment fixed the tonic bite and the nipple pain problem. I made a home visit on day 5.

Duh! This was the first time I had seen her with no bra on at all! The center panel of her nursing bra, which I had failed to suggest she remove at past assessments, had been hiding the fact that there was hypoplasia in the inner lower (and perhaps the upper?) quadrants of each breast! I found out in time to be able to explain it to her, explain the need for extra pumping and to suggest that an inexpensive homemade supplementer could be made a la Jack Newman (from a sterile tube I bought from my veterinarian). She supplemented ad lib either with her pumped EBM or sometimes with ABM. She continued this labor of love, which included lots of pumping and nursing to begin each feeding, then judicious use of the supplementer when necessary till he was 18 months old. She felt very gratified that she had been able to provide so much of his milk. (She also became a faithful attendee at her local LLL meetings for years.)

The following year, she called me when she was 3 months pregnant with her 3rd child to report that she had been experiencing marked breast changes she had never noticed with either of her other 2 pregnancies. (She also called after birth to tell me they had once again had a rapid birth, and knew to go for a craniosacral treatment for the baby on the way home from the hospital.) I did not see her personally with this child and so cannot testify as to the possible comparison of the inner quadrants of her breasts that I had belatedly noted with the second child once I just HAPPENED to see her with the bra completely off! That was at least a great, but humbling learning experience for me, as I found something completely unrelated to her original reason for consulting me, and have tried never to fail to see the entire breast bared for an assessment since.

She went on to exclusively breastfeed that 3rd child without supplementer or supplementation and no pumping except for her own convenience at times, till the child weaned spontaneously at over two and half years old!! 

My supposition was that the extra stimulation of pumping and supplementing at the breast had exposed her breast tissue, (of which?? how many?? quadrants) to much more prolactin than the first nursing experience, and perhaps somehow created more prolactin binding sites.

That's not research, but it was an amazing experience for that mother and me, and her babies. I will try to contact her soon and ask if she can remember any comparative differences in the inner breast quadrants with the last pregnancy.

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH

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