I prefer not to set limits -- in my own mind, or for
the mother.  The fact that she is producing milk at
all in this stressful and compromised position is
itself encouraging.  I find it more helpful to take it
one day at a time, and to have an ongoing discussion
about expectations and what she will find rewarding
about a breastfeeding relationship.

I like to take the tactic that the bfar mom will
follow the path of any other mom in terms of baby's
expectations/needs/normal nursing patterns.  We layer
the extra effort and challenge to bfar over "the
norm."  The challenge with this case is the baby is 2
months early, with all that that means.  Prematurity
is now this baby’s “norm,” not a reason to change
feeding and mothering plans.  The breastfeeding
relationship need not be limited by the quantity of
milk.  I've seen a number of partially breastfeeding
mothers stop cold after a "frank" talk with a
well-meaning breastfeeding advocate.  Milk is an
emotional secretion, and our honest belief in women’s
bodies and in breastfeeding can be every bit as
important as pumping rituals and galactagogues.

I've learned to stop predicting which mother will
"succeed" in terms of milk quantity, breastfeeding
duration, or sheer joy of knowing her child at the
breast.

Many mothers are immensely rewarded nursing with
assists -- tubes, donor milk, aim, etc.  I think
mothers find their own turning points.  I've noticed a
pivotal question is "have I given it all I have to
give" which varies for each mother.  Countless mothers
have said to me "if I quit now I'll always wonder,
what if I'd given it one more day/week/et."

And sometimes I wonder if we all try as hard when we
know the woman has had a reduction (or other
challenge).  Is it a little too easy to give up at the
first sign of trouble?  How differently would we
approach the same woman and milk supply if there had
been no reduction?  Spotting zebras shouldn't mean we
stop expecting horses.

Hopefully this mother is enjoying skin-to-skin, family
support and more to inspire milk and mothering.

I've seen enough bfar successes to feel honest hope
with each new case.  One woman I worked with was told
she could not breastfeed after her reduction as a
teenage (she believed the nipple was removed from the
pedicle though she did not have the surgical report
and was out of contact with the surgeon).  As a
result, she did not consider breastfeeding when she
gave birth to her first child in her early twenties.
Lying in her hospital bed bottle feeding her second
child, the mother was amazed to find herself leaking
milk.  She called me to ask "Can I make milk?" so I
asked "Are you making milk?" and she said "Yes, I am!"
 She began nursing aided initially by an SNS and soon
discarded the tube to exclusively breastfeed.  I
mention this story because the mother found such
success out of improbable circumstances.

The issue facing most bfar moms is reminiscent of the
issue facing many adoptive moms:  Why do I want to
breastfeed? What does it mean to nurse my baby?  How
will I define my own success?

I'd love to have a bfar booklet for expectant mothers
similar to the one LLLI publishes for adoptive moms
discussing issues of decisionmaking (re bf), maybe
written by Diana West.  (Diana's book has gotten rave
review from mothers I see, particularly one mom who
called me at 2 months to ask if I could direct her to
a milk bank, she had so much...)

The issue intrigues me as it is as much about the
experience of breastfeeding, of mothering, as it is
about the mechanics of lactation.


Susan Johnson  MFA, IBCLC
Salt Lake City


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