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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 4 Jul 2001 09:24:36 -0500
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I empathized with the story of the Korean mom with taut breast tissue and no
appreciable milk.  I have a sweet lady right now with a similar situation.
Pretty normal birth after a very normal pregnancy.  Mom has high, firm,
rather widespaced breast tissue,  long nipples, and unequally distributed
glandular tissue with the inner quadrants very flat compared to the upper,
lower and outer.  Her baby (a 37 weeker, naturally) lost 11% and is very
jaundiced and lethargic.  Mom is a pharmacist, so was happy to try
metaclopramide, and is pumping religiously, but after 5 days of this,
expressible milk is about 6 ml per breast.  Baby sucks nutritively for about
2-3 min. before fussing or falling asleep.   No hx thyroid, no other sx of
Poly Cystic Ovarian Syndrome, no diabetes, no excess bleeding or any other
evidence of retained placenta, perfectly healthy and not stressed or anxious
except about the bfg.  We ran thyroid levels, which I tend to get
discouraged about because they usually come back within normal levels.  I
tell such moms to keep pumping and nursing because of the study Kathleen
Huggins and Binky Petok published in Current Issues in Clinical Lactation
2000 where some of their moms with this type presentation finally brought in
milk out about 4 weeks pp.

Another mom I'm working with has a similarly struggling baby who just had
his tongue tie clipped.  She has only minimal milk but HER breasts palpate
completely normally!  She was in a car wreck and a seat belt bruised one
breast during 4th mo of pregnancy.  That breast isn't producing anything but
drops, although it got engorged briefly just like the other breast.  The
"good" breast only prod. about 28 ml. per pumping.  Baby won't nurse
willingly as mom has flattish nipples.  He will do some sucking with a
nipple shield in place.  Interestingly,  Mom's sister is lactating, and as
an experiment, they put the baby to her breast and he sucked fine!  So the
nipples and the low milk supply are making this baby disinterested, not
nipple confusion, which is what someone made her feel guilty about after
baby's wt loss reached 10% and bili went to 20 and she started
supplementing.

I really struggle about what in the world is going on with these women.  You
can say what you want about women not "believing" in their own body's
ability to lactate, but these women are surprised and very disappointed,
because they fully intended to enjoy breastfeeding and have tried valiantly.
These are not the women who clearly have psychological ambivalence or
extreme social pressures.  I think they clearly have something physical
going on.  We don't really know how to explain what is happening, although
there is one study that Lisa Marasco looked at in her work with PCOS that
talked about using ultrasound to visualize the breast tissue of women with
PCOS.  The researchers found that they could make a good predictive
diagnosis of PCOS working backwards from the view of the inadequately
developed breast tissue. (For the life of me I can't locate my PCOS file at
present, but my recollection is that it was pub. in 1987 or so, and the
words Stein-Leventhal are in the title.  Maybe Lisa can supply the ref.)

These cases speak powerfully to us about the work that still needs to be
done to understand the mechanics of lactation.  I would tell the Korean lady
what I tell my moms: " Evidence suggests more glandular growth with each
pregnancy.  You hopefully will make more milk next time."  Then make sure
she knows to ask for extra help very early.  Her chart should be flagged as
high risk and lots of effort directed toward her.  It may not make it work
any better, but she will feel supported and taken seriously, and not feel as
if she failed to try hard enough.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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