Dear Friends:
    Thank you Jeanne, for a fine abstract.
    This is an interesting article about the relationship between breast
appearance and milk production. The majority of women with some breast
hypoplasia and an intramammary distance of 1.5 inches or more had some degree
of primary milk insufficiency. These women can be identified in the prenatal
or early postpartum period.
    My first question is about management. I don't know if I would ever tell
a new mother that the shape or size or growth of her breasts may pose a
problem to her lactation. As Derrick Jelliffe has said, "Breastfeeding is a
confidence game". I would be loathe to do anything that would plant a seed of
doubt in a new mother's mind. The optimum situation would be for all mothers
to have frequent follow-ups in the first two weeks of lactation, no matter
what their status; and, for all mothers be taught about cue-based feeding,
the need for close and intimate contact with their newborns, and signs of
breastfeeding adequacy.
    My second question is about the statement "failure of the newborn to
stool at least twice every 24 hours." We all have lots of experience in this
realm, and know that the literature is deficient on this point. I would
prefer for women to be taught about the whole picture of appropriate newborn
behaviors: peeing, waking to feed, waking to look around, smiling, passing
flatus or stool, and clearing the meconium by day 4-5.
Nikki Lee RN, MSN, Mother of 2, IBCLC, CSTP, CIMI
Elkins Park (a suburb of Philadelphia, Pennsylvania,  northeastern USA)

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