Dear Lactnet,
In response to Barbara Clay Wilson's post today on moms with no milk
production postpartum, this seems to run in cycles with the clientele I work
with (homevisits). In the past three months I have what are, I think, 4
cases of bona fide insufficient glandular tissue with attendant no pregnancy
changes, no marked engorgement and the wide intramammary spacing, lack of
medial tissue, but no asymmetry, and even some stretch marks.
Three of the moms contacted me before delivery because of "no milk" with
siblings. One contacted me from another town. One was referred by her
Ob/Gyn because they thought it was a matter of needing a hospital grade pump.
Because of the article Barbara referred to in the 2000 Clinical Issues In
Lactation "Markers Of Lactation Insufficiency: A Study of 34 Mothers" by
Ellen "Binky" Petok and Kathleen Huggins and having had the ability to pick
their brains at ILCA ( Binky presented on it and it should be on the ILCA
tapes for sale) last year, I felt encouraging them to continue to breastfeed
and pump was a viable option.
One mom elected to use the SNS and has had the highest yield. She is
presently transferring or pumping an average of 2 ounces a session. Baby is
16 weeks now. And get this in Murphy's Law of Lactation: she had a 10 lb
baby, postpartum hemorrhage and rehospitalization, ankyglossia and subsequent
frenotomy, anemia, disc problems and root canal all in the first 2 weeks
postpartum! She has a two year old also! She had done everything she could
to optimize her chances........unmedicated birth, no circ, pumping when baby
was sleepy etc. She is a classic Type 3 in breast anatomy in the
Huggins/Petok article.
The other three moms all continued to pump and breastfeed for at least
3-4 weeks......usually getting less than 10cc a breast. I discussed the
article and other cases I had seen with them all and referred to it as
"breast hypoplasia" rather than insufficient glandular tissue. They all were
very grateful to have current information and know they had done all they
could do to optimize their milk supplies.
Incidentally, I gave a copy of the article to the female Ob/Gyn that
referred one of these moms. She was very interested in the text, table and
graphics.
I could go on and on about these cases but the bottom line is I think it
is a distinct entity that all LCs are bound to run across the longer they
practice. On the other hand, we need to rule out other factors, including
superimposed problems and not jump on the IGT band wagon. Just Tuesday I had
a twin mom rehospitalized at 1 week for retained placenta that was only
getting 20cc after feeds of 38 GA but 4 1/2 lb babes with no engoregement and
no transfer to speak of. I discussed retained placenta at her visit but she
reported no overt symptoms. Sure enough she called the next day from the
hospital where she was having a D & C for fragment removal.
An excerpt from the long distance mom I worked with, not to toot my own
horn, but to emphasis that these moms so need support and validation if they
truly have insufficient glandular tissue........"you are the only LC that
even wanted to wade deeper into lactation, beyond 'latching on'. You'll
never know how much you are appreciated."
Try to lay your hands on the Petok/Huggins article. It is realistic,
current but hopeful to moms that have possible insufficient glandular tissue.
Jan Ellen Brown IBCLC
In Charlotte, NC where I am on a high after just seeing a 26 wk GA former
2.3 lber latch on and transfer 10 ccs after being discharged from NICU
yesterday (twin sister is still there)
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