I have been thinking about this alot. I can readily identify breast
hypoplasia, even before examining or palpating a mother's breasts -- I
can see it thru her hospital gown!
I can see the breasts are very wide apart, small, conical and/or tubular
and usually have what I call a bulbous areola. Once palpated, the
breasts feel quite flaccid with a concentration of a small amount of
firmer knotty glandular tissue in and near the areolar region.
Unfortunately I see this fairly often. I hope you know that I don't give
the mother any clue that this is a concern, unless she has a history of
prior lactation issues when I get a history from her. Since we have a
free followup clinic here, I can feel pretty good that we will be
assessing both mother and infant within a day or two of hospital
discharge, so I feel I have that safety net.
Here is my concern: many of these dyads show signs and symptoms of
insufficient milk even on day one. Trust me, I do believe that well
babies don't need large amounts of milk the first day or two, but they
do need some. These babies are often very unhappy and begin to look
jaundiced and dry pretty quickly, with scant urine output. I don't think
I am imagining this. If the baby seems content and all the indicators
are ok (wet and dirty), things can wait. But a mother this week was
really concerned and saying she felt the baby was not getting anything
(less than 24 hrs old) and even with expressing (started towards end of
first 24 hr period) only a drop or two was able to be expressed (hand +
pump). This was a well baby who initiated bf in delivery room and was
exlusively bf. It also often happens that the baby has a difficult time
latching onto this flaccid bulbous areola and none or very rare swallows
are noted when baby does breastfeed. This was the case here too.
My usual approach is a wait and see (because one never knows, mom may
make tons of milk, right?), and optimize the usual good bf practices.
But I was also concerned about the baby getting very very little, though
trying not to let on. Even reading Making More Milk by West and Marasco,
in the chapter on galactagogues, it says, "In most cases, it's wise to
give your body at least 4 to 7 days after birth to try and do its job
before intervening." p. 168. I would generally agree with this.
What I am wondering is this: is it wrong to know that the baby is not
receiving milk (or only scant) and wants more, but to wait to intervene
with pumping, galactagogues, and supplementing? The baby is the more
vulnerable party to be sure. I am talking about on day one. I cannot
think of one case where I was concerned about the hypoplasia, and the
mother went on to make plenty of milk. I feel I am able to identify
these cases quite readily. I may go back through my files to verify my
perceptions. Your thoughts and opinions please.
Laurie Wheeler RN MN IBCLC
Mississippi USA
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