Melinda asks how to discuss the difficult toic of insufficient glandular
tisse (IGT) with a women ... to "balance an honest assessment with
encouragement but no unrealistic expectations, and respect their desire to
breastfeed."

I am not being flip when say your answer is right there, in your question.
It's all about parent-centered care ... so a good clinician will "balance
an honest assessment with encouragement but no unrealistic expectations,
and respect their desire to breastfeed."

Parents are smart, and by-and-large want to do right by their children,
nomatter their circumstances. Information never hurt anyone.  I think we
often fall into a trap, in maternal-child heatlh, of assuming new parents
are frail and unable to "handle" distressing or difficult news.  To which I
politely say: Bull hockey. We should not be gate-keepers of information,
and the families we work with don't want us to.

When I have such a conversation, I start out with positive affirmation,
validating the family by pointing out all the things that are working WELL:
the way the parent holds the baby, the way the baby calms when latching on,
suggesting tweaks to improve comfort -- whatever.  While the feed is
happening I will drop in some relevant Qs about the history of breast
development, onset of menses, fertility issues (if any) and breast surgery
(if any).  The answers there may help me to affirm and validate more, or I
will mentally note the increased risks.  But with a nursing babe-in-arms,
the mood in the room is markedly calmer.

And then I just explain what I see, why IGT is a marker **to really watch
supply** (since I am seeing most of these parents in the immediate
post-partum period, in the hospital).  I arm the IGT family with
information about what to look for and why, so they know when to call an
IBCLC or their primary healthcare provider. I tell them that IGT is a
*risk* for low supply, but not a certainty ... but I stress (rather firmly)
that they should absolutely positively respect "that little voice" in their
parental head that suspects on Day 4 or 6 or 7 that something isn't going
right ...so they pick up the phone Right Then to have the baby and the
lactation re-evaluated.

The result is that the family feels *empowered* with information about what
is working well now, what to look for to ensure everything continues to go
well, and what to do if they suspect things are not going well.

--
Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA

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