I must be in a grumpy mood because I have one of those odd cases right now where I'm annoyed 
because medical research has not focused on helping breastfeeding as much as it should over the 
last 50 years.  Edema that has lasted over a month and a trickle of a supply - so she's hooked up 
with the breastfeeding medicine specialist and I'm hoping that this will turn around.  I'm thinking 
of all the specialized interventions that have been developed in medicine and how ridiculous it is 
that we just throw up our hands at "lactational insufficiency".

The problem with defining lactational insufficiency as rare is that we are professionals who need 
to deal with all conditions.  If we focus on how rare it is, then we are not teaching ourselves how 
to deal with the problem when it does arise or to recognize it.  It builds in a bias of it only occurs 
in less than x% of women so you probably don't have it.  Instead of "well, its an unlikely possibility, 
but lets rule it out so we can move on with all the things that will enable you to enjoy and 
optimize your breastfeeding experience."  

No woman likes to be in that category of "well you have such an odd condition that we can't help 
you."  Even worse, having seen women who were never identified as having insufficient glandular 
tissue when they have been pushed over the edge by lactation consultants that don't recognize the 
condition.  Nothing worse than pumping your brains out for months on end and using the 
supplemental nursing system for months on end under the delusion that the milk supply will get 
up to 100%.  This leaves the mother feeling like she is a total failure because somehow if she 
worked harder or relaxed more the milk would flow.  I can't tell you what a relief it has been for 
some of these women when they understand why they didn't get a full supply and can work out a 
strategy that works for them to enjoy the breastfeeding.   I'm feeling a little peavish about this 
right now because I had my third woman in a month pop into support group using an SNS for over 
six weeks under the care of a lactation consultant and the baby is mostly taking formula and mom 
is still thinking that the supply will improve if she keeps doing the same thing.  The latest of these 
was only pumping 1x/day and the baby took 0.2 oz from the breast and the rest from the small 
tube.  Clearly, in her case, the SNS was NOT stimulating the supply.  

We should all know what insufficient glandular tissue looks like and feels like.  We should all know 
that there are some borderline cases where moms really have to work harder than the average 
mom at frequent feeding with an efficiently feeding baby or a little pumping for the inefficient 
baby or the supply dips.  Anytime mom is using a feeding device at the breast, we should all be 
monitoring what is going on with the supply so it doesn't plateau and/or measuring whether the 
device really is stimulating supply rather than assuming it is stimulating supply.  We should all be 
ready to encounter odd cases that don't exist in the literature to document these and help these 
women as best we can.   As more women try to breastfeed, more of these cases will pop up.  They 
deserve our help no less than the moms who have straightforward problems and a full capacity to 
produce milk.

Best, Susan Burger

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