Yes, You CAN Breastfeed Successfully No Matter How Much Milk You Make

Yesterday, we discussed a somewhat rare condition called Insufficient Glandular Tissue (IGT), in which breasts have inadequate glands (the hardware) needed to make milk.   Click here to read the post and 0ur list of resources.    As breastfeeding advocates, it is extremely important that we educate physicians and healthcare providers, the media, and moms to distinguish between inherent physical conditions like IGT that MAY make it difficult or impossible to produce sufficient breastmilk, and the breastfeeding boobytraps™ that have been sytematically erected so as to interfere with milk supply, so that moms THINK they couldn’t make enough milk, when actually they were managed poorly.    We need to demand that medical schools and associations like the American College of Obstetrics and Gynecology develop curricula, continuing education modules and protocol for diagnosing and managing lactation issues like IGT.   We need to validate and provide resources to the thousands of moms annually that suffer from IGT, can not breastfeed for other reasons or have been booby-trapped, and ENROLL THEM to join us in fighting for the rights of ALL mothers to make informed feeding decisions, achieve their personal breastfeeding goals or have access to donor milk if needed, and make a prepared, positive and empowered transition to motherhood.

Two important things to keep in mind about IGT, as per a comment thread yesterday from Diana West, IBCLC and co-author of Making More Milk: 1) not all women with insufficient glandular tissue have milk supply difficulties; and 2) even if a woman doesn’t have a full milk supply she can still breastfeed successfully!  “Successful breastfeeding” does not depend on the amount of milk!   Click here to read more about the benefits of breastfeeding even when there is little or no breastmilk transfer.

Below is a moving personal story of how one breastfeeding advocate and IBCLC empowered her best friend to make the most out of a nursing relationship, despite the devastating diagnosis of IGT.     

A cup or two, for my best friend

by Diana Cassar-Uhl, IBCLC, La Leche League Leader 

Diana Cassar-Uhl, IBCLC and her daughter

Diana, mom to Anna, Simon, and Gabriella, is an Internationally Board-Certified Lactation Consultant (IBCLC) and La Leche League Leader in Orange County, New York.  On active military duty as a clarinetist in the United States Army, Diana is thrilled for any opportunity to speak and write about breastfeeding to mothers and the healthcare providers who support them, especially in unique or difficult situations.  You can email Diana at

llldianac@gmail.com .

During our junior year of college, my best friend Heather and I would sometimes spend a weekend day at the mall.  While there, we’d get rowdy and extra-giggly when we hit the lingerie section.  We found enormous humor in how different our breasts, and therefore, our bra-shopping headaches were.

“Gimme something bullet-proof,” Heather would say, referring to lots of padding for her 32A’s. 

“Oh, wow!  They’re making them with FIVE hooks and eyes, now … perfect for dates!” I’d respond, disgusted that the only bras they sold for my 34DD’s were obvious companions to 15th-century chastity belts.

“Hey, this one looks like a thimble!” Heather said, holding up a filmy pair of “cups” held together by little more than a few rubber bands.

“Yeah, and this one looks like a yarmulke for a guy with a really, really big head,” I answered, refusing to even touch the giant assemblage of spandex, elastic, and … was that stainless steel?

Heather and I combed through the bras, each of us discouraged by the extremes in our sizes.  If only we were “average,” we could wear cute, lacy things, with or without padding, with or without underwires, in any color of the rainbow.

“I wish I could just give you a cup or two of mine,” I sighed.  That would bring us both to C cups, blissfully slightly larger than average, but well within the norm for bra manufacturers. 

“Yeah, maybe if you can give me one cup for this one, and two for that one, I’d be just right, “ she suggested, as we shrugged off what we had learned in our teen years was normal – that one breast might be slightly larger than the other.  We figured that when one breast was not much bigger than a mosquito bite, it didn’t take much to make the other “slightly larger” than it.

Never did I wish more to give Heather “a cup or two” of my breast tissue than after her first baby was born.  I was already a mother of two breastfed children, at that point both still nursing at 3 -1/2 and almost 2 years old.  I was a La Leche League Leader, with sights on becoming an IBCLC.  Helping mothers and their babies had become a vocation for me.  I loved breastfeeding, and, because she was my best friend, I shared with Heather my feelings about it – including my own frustration when mothers gave up because “it was just too hard.” 

During her pregnancy, Heather came to visit.  We sat and marveled at her fertility chart, showing the cycle that resulted in the miraculous baby growing within her.

“Hmm.  Were your luteal phase temps always so low?  It hardly looks like you ovulated.”  In a normal menstrual cycle, progesterone surges after ovulation, pressing a woman’s basal body temperature higher than it had been during the estrogenic/ovulatory phase, typically the first half of her cycle.  Heather’s temperature didn’t seem to rise significantly, even once the embryo had implanted.

“I always spotted a lot before my period.  I did this time, too, even though I was pregnant,” Heather told me.  I recognized the signs of what was probably a very mild luteal phase defect … obviously mild because she had successfully gotten and stayed pregnant without medical assistance. 

“So, when’s the booby fairy supposed to visit?”  Heather asked me.  She was already well into her second trimester, and hadn’t felt any heat, sensitivity, or growth in her breasts. 

“Ummm … well, mine were like cannonballs by 5 weeks, and they just got hotter and bigger until the ultrasound at 19 weeks, when they finally quit growing!”  I also remembered my nipples being so sensitive, it hurt to wear a shirt without a bra.

I talked to my mom about a week after Heather’s visit.  “Mom, I have a bad feeling about Heather.  I am afraid she’s not going to be able to breastfeed.”

“Why not?  Can’t everybody breastfeed?  She’s healthy, why wouldn’t she be able to?”

I didn’t know the answer, but bad feeling didn’t go away.

Fortuitously, at around the same time Heather was entering her third trimester, I had volunteered to help Diana West, IBCLC, and Lisa Marasco, M.A., IBCLC, by reading and offering suggestions on an early draft of their manuscript for The Breastfeeding Mother’s Guide to Making More Milk.  Diana’s website http://www.lowmilksupply.org/ is a valuable resource for mothers with milk production issues, as is, of course, the book.  I packed a wealth of information about milk production, hormones, anatomy of breasts and babies’ mouths, galactagogues, pumping, and so much more into my brain, but couldn’t shake my feeling about Heather.

Baby Sarah was born at term, but a few weeks earlier than anyone expected.  She was tiny, at just over 6 pounds.  She was breech, and born via c-section.  The nurses at the hospital told Heather, once she had recovered enough to be with Sarah and breastfeed her, that she looked like a natural.  “You must’ve read a lot of books, you look like you’ve done this before!”  Heather was so proud of herself and let Sarah breastfeed as much as she seemed to want, which was, as is the case for many newborns, pretty much all the time.

I went to visit Heather and 5-day old baby Sarah when they had settled in at home.  Sarah had lost 10% of her birth weight, which was especially disturbing since she had been born so tiny to begin with.  That 10% of birth weight maximum loss didn’t add up to many ounces of wiggle-room.  Sarah was attached to Heather’s breast for 7 straight hours during my visit.  I watched her nurse and concurred with the nurses from the hospital: Heather was a natural!  Sarah’s latch was great, Heather looked so comfortable and at ease.  She didn’t mind spending all that time in the chair, nursing her baby, especially since her husband was so supportive and her friends were bringing meals for the new family. 

Sarah was latching on well, Heather had no pain, and they were definitely breastfeeding “on demand,” but the first red flag I saw was that, despite being on the breast pretty much non-stop during my visit, Sarah was not swallowing.  I could see that she was sucking, vigorously at times, even, but there was no “kuh” sound to signal that she was swallowing and transferring milk. 

The next red flag presented itself as I asked Heather to switch breasts, in an effort to rouse Sarah a bit and encourage her to feed effectively.  I began teaching Heather about breast compressions, but stopped short when she lifted her tank top, exposing both breasts.  How could I have never noticed her breasts before?  I didn’t want to stare, but what I saw as Heather positioned Sarah onto her other breast was exactly what I had read about and seen in Diana and Lisa’s manuscript and the websites I read for better understanding.  Heather’s nipples were bulbous, much bigger than it seemed the rest of her breast warranted, and her breasts were very widely spaced (more than a hand’s width between them).  I thought back to our summers at college, when we spent days in swimsuits.  Sure, Heather’s breasts were small, but I had never noticed how widely spaced they were, and I guess I never had any reason to look at her nipples back then, nor would I have recognized anything was different. 

I asked Heather if she had felt any sensation of milk coming in, any feelings of fullness at all.

“Well, this one tingles a little bit,” she said, holding the larger of the two, “but just under here, not anywhere else.  Is that normal?”

Is that normal?  My best friend sat breastfeeding her tiny, tiny baby for seven hours, completely unaware that something was terribly wrong.  Could I tell her what I thought?  I had no resources with me to share with her – this wasn’t a breastfeeding help visit, I had driven the 2 hours to her home so that I could spend some time with her, make her some dinner, maybe hold the baby while Heather took a shower or a brief nap.  I remembered how deliriously tired and emotionally overwrought I had felt in those early days.

I took a deep breath.  “I’m not sure if it’s normal, to tell you the truth.  She doesn’t seem to be transferring a whole lot of milk.  Do you have another weight check soon?”  Sarah had been soiling diapers, and I knew that sometimes, after a cesarean delivery or a stressful labor, both of which Heather experienced, a mother’s milk might not come in right away … but here it was the end of the 5th day and still, no milk.  “Make sure you’re staying in close touch with your pediatrician,” I advised her.  “And don’t freak out if she tells you to supplement, because there are ways we can do that and still keep breastfeeding on track.  Call me if you need me.”

I left that evening and cried the entire drive home.  Immediately after I put my children to bed, I started fervently researching.  I asked some more experienced La Leche League Leaders and IBCLC’s to confirm what I suspected: that Heather had mammary hypoplasia/insufficient glandular tissue in her breasts.  I kept in close touch with Heather, and went to visit her two days later.  This time, I brought information for her to read, as well as a big container of fenugreek capsules, 2 pounds of sesame seed candy, and another night’s dinner. Sarah had gained about an ounce since I had shown Heather how to use breast compressions to keep Sarah interested in nursing, but it wasn’t enough and Heather was frustrated.  “I’m nursing her non-stop, but I still don’t feel like my milk came in,” she cried.  “There’s no dripping, nothing.  And when I tried pumping today, I didn’t even get enough in the bottle to coat the bottom.”

I sat for a few hours with Heather while she read, looked at pictures of hypoplastic breasts, and we cried together.  I told her about at-breast supplementers, and assured her that she had done all she could to get breastfeeding off to the best start.  Once she understood that this wasn’t her fault, that she just didn’t have a milk factory, Heather could begin the process of mourning the breastfeeding relationship (see this excellent resource: http://www.mobimotherhood.org/MM/default.aspx ) she had envisioned for herself and her baby during her pregnancy.

But, not so fast!  I asked Heather to get as much information she could from her health care team.  On the plus side, her pediatrician was very breastfeeding-friendly and was conservative when it came to recommending a supplement for Sarah.  The goal was to get Sarah back to her birth weight as soon as possible but not to stop breastfeeding, even if that meant Heather was nursing around the clock.  Sadly, though, no one – not her obstetrician, not the pediatrician, not her midwife, and not even the IBCLC she sought counsel from had ever heard of hypoplastic breasts or insufficient glandular tissue.  My research had indicated that 1 in 1000 mothers might be affected with this condition, but we were both surprised to discover that insufficient glandular tissue is largely unknown in the medical community.

Mother using Lact-Aid supplementer

Heather began supplementing Sarah with any of her own milk she was able to pump (usually 1-2 ounces each day), and with formula, fed through a supplemental nurser, a thin tube attached to a vessel that held the supplement and Heather could wear around her neck, taped to her nipple (see text below for a comparison of the two available on the market).  When Sarah was hungry, Heather would feed her at the breast, which both gave Heather the nipple stimulation she needed to encourage her maximum milk production, and gave Sarah satisfaction at the breast.  Both were vital to ensuring a lasting breastfeeding relationship.

While Heather had some feelings that her body had failed her, frustration at the amount of time she had to spend preparing and cleaning the pump and supplementer each day, she realized she was giving Sarah every drop of milk she made, and was a breastfeeding mother despite having insufficient glandular tissue.  Even with daily doses of herbal galactagogues, she never made more than half of what Sarah needed to thrive, but once Sarah started taking solid foods, Heather noticed the amount of formula she needed to give Sarah each day went down.  At the 12-month mark, Heather happily retired “the rig,” her maybe-not-so-affectionate name for the supplementer, except for the last nursing before Sarah went to sleep.  The rest of the day, Sarah was just like any breastfeeding toddler, coming to her mother for “nigh-nighs” when she needed a pick-me-up or a reminder that her mother was close at hand.  Sarah weaned herself shortly after her second birthday.

Heather is expecting her second baby in a few weeks, and she anticipates those early days after his (or her) arrival with some trepidation.  She knows that the work she did to produce milk for Sarah, and the time she spent breastfeeding her, will result in increased milk production this time around, but will she make enough to exclusively breastfeed this baby?  Heather knows her colostrum flows well (colostrum production is not dependent upon presence of glandular tissue) and will be all her baby needs in those first two days of life, but when will she know it is time to begin supplementing?  How much, how soon?  Many babies get enough from their mothers until around 5 weeks, when milk production peaks and the baby needs a full supply to continue gaining weight, according to Breastfeeding Answers Made Simple by Nancy Mohrbacher (page 233).  Until the baby comes and breastfeeding is underway, Heather won’t know how it will all go. 

Heather feels no regret about her breastfeeding experience with Sarah – she knows she did the best she could with the resources and circumstances she was up against, but she also knows that breastfeeding with insufficient glandular tissue requires careful planning, a strategy unique to each mother’s situation, and energy a lot of mothers of newborns might not be able to – or want to muster.  Remembering that breastfeeding and lactation, two terms that are used interchangeably, are not the same thing, and that a mother can breastfeed and confer many of the benefits of doing so whether or not her breasts supply all of the calories and nutrients her growing baby needs, can be encouraging to a mother who is surprised by her own failure to lactate.

I’m an IBCLC myself now, and Heather (as well as another very close friend with hypoplasia) has been my inspiration to not only learn everything I can about insufficient glandular tissue, but to spread the word and reach as many mothers and healthcare professionals as I can.  If you want to know more about mammary hypoplasia/insufficient glandular tissue, or how to support a mother who finds herself struggling with this condition, please refer to this comprehensive article, which first appeared in Leaven, La Leche League International’s Leader publication: http://www.llli.org/llleaderweb/LV/LVIss2-3-2009p4.html

Post-script:  Heather had her baby, another daughter named Abby.  Abby arrived via uncomplicated VBAC after a pleasantly quick labor.  The first few days went well, with Abby getting colostrum and Heather feeling her milk come in … even waking up one morning with dripping milk and a hard spot on her breast!  There were a few days of jaundice (severe enough to require admission back to the hospital for phototherapy) but Abby’s bilirubin came down quickly.  While Heather was disappointed by the need to supplement, she remembered that her number one priority is to feed her baby … and she is thrilled to note that, between offering all of Abby’s feedings at the breast (most with the supplementer) and pumping a few times a day (putting whatever she pumps into the supplementer), Heather is using less formula and producing considerably more milk than she did at this point with Sarah.   While thankful to be feeding Abby at her breast and producing most of what Abby needs to thrive, Heather has her moments of frustration and anger, for example, when the formula she was using for Abby’s supplements was recalled, or when she has to down the herbal preparations that help boost her milk production (“they’re NASTY!” she tells me), or when she just doesn’t feel like pumping – again – after Abby nurses and Sarah, now 4 years old, wants some time with her mother, too.  Some might consider Heather’s efforts to breastfeed, despite having hypoplastic breasts/insufficient glandular tissue, heroic; Heather just says “I’m going to have the feed the kid somehow, I might as well do the best I can to breastfeed her.”

For more resources on Insufficient Glandular Tissue, see our post yesterday (links and resources listed at the end)

—————–

We love this story and applaud Heather and Diana.  However, we couldn’t help but sorrow for all the women who don’t have a best friend like Diana, and whose babies are not getting the help they deserve from our health care system;  from physicians, hospitals and health professionals.   If you suffer from IGT, how were you diagnosed and were you satisfied with the help you got?  How did you cope?



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35 Comments | Last revised on 10/14/2010


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35 Responses to Yes, You CAN Breastfeed Successfully No Matter How Much Milk You Make

  1. I don’t have IGT, but I did have fairly small breasts, not much tissue growth during pregnancy, and mild PCOS. This story rings very, very true for me, thank you so much for it! The first months of my first daughter’s life were extremely challenging, and very similar to the story above (minus the great friend to help diagnose!) . I was just searching and searching for what was wrong — why there was not enough milk, despite me doing everything “right”. Finally got the PCOS diagnosis, and everything clicked into place for me (thanks to Lisa Marasco’s work, which helped me a LOT!). We got through with the help of herbs, domperidone and supplementers (as well as bottle feeding), until she grew out of the need.

    Fast forward two years and I knew I would probably have challenges with TWINS! But I was hopeful, too, knowing so much more about it. For me, the extra tissue that came with my second pregnancy really helped. I still didn’t have enough to exclusively nurse twins, but I had enough for about one baby, which was a lot more than the first time! And I knew the ropes of supplementing, so we did fine. My twins are now still happily nursing at almost 2.5 years old. I am SO glad I had the help of knowledgeable Drs, LCs and LLL leaders to get me to where I am today.! As well as all the online support & info I was able to find. Hooray!

  2. MamaCampbell says:

    I wasn’t diagnosed with IGT until my 2nd daughter (a 33 weeker) was born & I got a lot of help from LCs in the NICU. While I was glad to finally have some answers that I was really doing it right & my breasts just didn’t make enough milk, it was still sad to know that there was a very likely chance I would never EBF my children. I didn’t nurse past 10 weeks with my 2 girls, but have researched the heck out of IGT throughout my last pregnancy & am successfully nursing my 2.5 month old. My mindset has changed (after literally trying every herb, medication, food, power pumping, you name it..) & I know that every drop he gets is one less drop of formula. I had to mourn what I dreamed breastfeeding would be like for me in order to overcome! :o) I am SO encouraged about once they start solids, the formula will probably go down! I never made it that far to try & after hearing her story, I am even more excited to keep going!

  3. Stephanie says:

    Wow, I wonder if I could have this trouble. I am currently trying so hard to nurse my third son. My first two never seemed to have enough milk so I supplemented them from the start and both of them quit nursing at six months. With this baby, I’m trying so hard to nurse exclusively but am taking MANY herbal supplements and pumping multiple times a day. I can relate to not feeling my breasts “tingle” or having much of a let down. I’ve never needed to wear breast shields or anything like that.
    I am so encouraged by this one and glad to hear of someone else out there that may be like me. A mother does feel like her body has let her down when she tries so hard to bf and the baby cries and cries. This has been such a challenge in my home. I’m glad for this article!

  4. Tina says:

    I’m crying as I read this because this is me! This is my story to almost every detail! I’ve never heard of IGT and so it’s nice to know that there’s actually a diagnosis for this. I plan to talk to my doctor about this and hopefully he’s educated on the subject. I can’t thank you enough for this article!!

  5. connor says:

    As a mom w/out an official diagnosis, I cannot say for sure what our problem was, but I can say that after having tried every remedy,herbal supplement, pumping 15 minutes after nursing both sides every two hours, reglan you name it= all I knew was that my baby was falling off the charts. The WIC rep gave me a temporary SNS, & thus began our successful nursing life. I bought the one pictured & that became our normal for 10 mos w/baby #1, 1 year w/ baby #2. I managed about 50% mama’s milk the first round & about 80 the second. I nursed for six years straight b/c of the foundation that wonderful contraption gave us & I am forever grateful for my well informed WIC rep & the SNS.

  6. Sonja says:

    I was in tears reading this post because it describes my experiences with my daughter. My precious Elliana was losing weight even though she was nursing frequently. After my daughter lost 12% of her birth weight (which her pediatrician didn’t notice until my math teacher husband pointed it out at a visit), I went to a lactation consultant. I explained to her that Elli would sometimes nurse for two hours at a time or she’d sleep for six hours straight (at 2 weeks old). The lactation consultant explained that some babies who are not getting enough milk will simply sleep because they lack the energy to do anything else. I was heartbroken and felt like a failure. My LC helped me figure out how to breastfeed and then immediately pump, which I did every 1.5-2 hours for weeks. It was brutal, and with every bottle of formula (organic), I felt like a failure. Eventually, I was able to supply my daughter with breast milk that met about half of her daily need, but I never reached a point where I could rely solely on it. With regard to how I coped with the whole situation: lots and lots of tears. I hope that when I have a second child I will be able to produce enough milk, but if not, I’ll do what Heather did–nurse and pump and try to squeeze in time with my toddler.

  7. artymama says:

    I self diagnosed IGT when my second daughter was 8 months old. I saw the website with photos of IGT breasts and everything made sense. I’ve always had very small breasts and knew they were a different shape to my friends breasts, but I had no idea why. My first daughter was born by cesearean and we had a rocky start to breastfeeding due to an allergic reaction to the painkillers I was on, thrush, bubble palette and dodgy advice from midwives. I assumed all those things contributed to me not having enough milk. I started supplement feeding my daughter at 6 weeks using a bottle after advice from a childhood nurse, she didn’t suggest me seeking the advice of an LC or going to the ABA (Australia’s LLL equivalent). I continued to breastfeed until my dd ‘weaned’ (though now I know it was breast refusal) at 9 months. I researched pregnancy, birth and breastfeeding A LOT after that experience and decided I would have a homebirth next time and that there was no reason I couldn’t breastfeed. I did birth my next daughter at home and truly believed there was nothing wrong with my breasts and absolutely no reason why I couldn’t fully breastfeed. My 2nd daughter was very tiny, cried a lot and had trouble pooing, but I didn’t connect the dots to her hunger. she had the same high pallette my first daughter had and I did struggle with thrush again, this time I even took herbs for milk production and I fed her often but realise now that she was VERY hungry. When she started on solids at 6 months she was a much happier baby. When she was 8 months old I stumbled across the site with pictures of breasts, I couldn’t believe someone had breasts like mine!! I scrolled over the photo and up came the tag ‘hypoplastic tubular breasts’. I clicked the link and couldn’t believe what I was reading, I felt devestated. Everything made sense. I learnt all I could but there wasn’t much info back then, almost 5 years ago. My dd weaned just before her third birthday. Two years ago when I conceived I started looking into it again. I knew my milk production would be higher, but would it be enough to feed my baby? I took herbs in the last trimester of my pregnancy to encourage my glandular tissue growth. When my ds was born (again at home) he fed like a champ. I thought he was very content as he slept alot, so I assumed my milk was going to be enough. Unfortunatley he was still passing urates and hadn’t put on much weight at day 8 (I think it was day 8) and he was only waking for a few seconds of feed before going back to sleep. He was essentially feeding enough to survive…just…but not getting enough to thrive. I tried herbs, pumping (not as much as I would’ve liked due to circumstances) and breast compressions…I tried everything everyone suggested! After much discussion with my good friend, a breastfeeding counsellor who had followed my journey and learnt alot about IGT, I put a call out for expressed breastmilk. My midwife gave me a supplement line and I started my supplement feeding journey. I cried many tears about it, I did feel like my breasts had failed in beauty and function. I’m happy to say my little one is still feeding, he’s 13 months old now. He’s only ever had donor expressed breastmilk apart from one supplement feed of formula and two feeds of raw goats milk. I’ve supplied 2/3-3/4 of his milk needs and now he’s down to one or two supplements per day. I did end up using motillium to help with my supply for a few months but found it didn’t make a big enough difference to continue on it. My heart goes out to all mamas with IGT, but don’t give up hope on breastfeeding, it can be hard but So rewarding.

  8. Marie says:

    I cried reading this. Sounds EXACTLY like what I went through. Except for one thing – my breasts are not small. I tried “the rig” and nursed for three months. It’s extremely difficult to use. It needs to suck in air to replace the milk taken from the baby. There is no good way for this to happen. There is a delicate balance between unscrewing the end to let in air and not unscrewing it too much to where the milk leaks out. I have a very helpful suggestion to remedy this frustrating problem which, for me, almost doubled the pain of what I was going through. Have a look at the Playtex VentAir bottles. Model a new SNS after it’s design. It’s venting system is amazing and would work perfectly in an SNS. Having said this I do want to say that even though it was frustrating I am so glad for the current model of the SNS. I grieved very hard for the loss of the breastfeeding experience and bonding that way with my child, and for being able to breastfeed for the betterment of my child, and the SNS helped ease that grief. However, if the venting system were better I would have been able to stick with it longer, and may even still be nursing with it at 19 months. Also, we have since adopted and if the venting system on the SNS were better I’d most likely be using it with my adopted baby too.

  9. Christy says:

    This article applies to women who are breastfeeding after breast reduction surgery as well. We have benefitted so much from Diana West’s books, including Defining Your Own Success and Making More Milk. I had to supplement about 40% of my supply with an at-breast supplementer with my first. I managed a (barely) full supply with my second and am now pregnant with my third. Both times I used herbs but also a medication called domperidone (motillium) which had a huge positive effect on my supply. I wonder if this drug would help mothers with insufficient glandular tissue as well? It’s not sold in the U.S. but is available in Canada, Europe and can be accessed by U.S. moms via overseas pharmacies.
    The physical and emotional toll of working so hard to nurse your baby in the early months is huge, but, like Heather, I experienced the payoff when we crossed the stage into toddler nursing and it no longer mattered how much milk I made, just that I was available. Our babies are so forgiving. And breastfeeding my children to 17 and 29 months respectively despite all odds is one of my proudest achievements. I would encourage all mothers to breastfeed their babies as much as possible, whether it is physical or logistical limits that are placed on them (like going back to work). I know that no matter what, by nursing them I have done all I possibly could to give my babies/toddlers optimal health for a lifetime.

  10. Ilene says:

    Please remember that donor milk is an option. My DIL suffers with IGT and with the help of meds/herbs etc brings in an ALMOST full supply. My grandson still needs between 3-6oz daily of donor milk to gain. He’s almost 6mos and I’m so proud of my DIL for staying with her commitment to breastfeed. I’m angry that she missed much of the new mom bliss the first few weeks as we all worked through what to do to help. My grandson had a tongue tie on top of it that complicated matters further. I’m grateful for good support and resources.

  11. Emily says:

    I was sort of diagnosed with IGT after my babe failed to regain her birth weight. She was 10% below for weeks. I read and re-read my breastfeeding books, feeling confident that I was one of those cases where the baby magically starts gaining weight after a month, and that I shouldn’t freak out and start supplementing. My midwives, IBCLC and post-partum doula had all seen cases of mammary hypoplasia, but their gentle mentions of previous cases didn’t sink in through the post-partum haze. I needed someone to take me by the shoulders and say, “Hey! Your boobs aren’t working! Your baby is starving! DO SOMETHING!”
    I cried gallons of tears over this issue, then eventually came to terms with it. I’m happy to report that I found a better IBCLC at 4 months, who is marvelous with herbs, diet and pumping support. Under her guidance, I’ve experienced significant increases in glandular tissue, even at 9 months! For me the magic herbs were Goat’s Rue, Shatavari and the drug Domperidone.
    So moms, keep nursing, keep working! You can continue to build breast tissue long after they say the window of opportunity has closed. Even if you never make 100% of what your babe needs, your babe will love you and love nursing no matter what. I can’t believe how rewarding my nursing relationship with my daughter is, despite the fact that she also gets donor milk. It’s so worth all of the hard work!

    • Claire says:

      Emily, would you mind sharing the dosages you took to increase your tissue? I’m currently taking Dom & Goats Rue capsules to increase mine but I don’t feel like its working. I’m currently 4 months postpartum.

  12. Elizabeth says:

    Yes, one can get domperidone in the U.S. at compounding pharmacies!

  13. Sara says:

    How I wish I would have had a friend, dr., or lactation consultant like Diana–anyone who would have recognized the signs or done anything to help. It’s SO hard when you know something is wrong with your body, but don’t know what/why.
    I just did a whole series on my blog sharing my story (so similar to Heather’s it’s scary) and am so happy to have found Diana as a result.
    http://www.momendeavors.com/2011/03/when-breastfeeding-doesnt-workpart-1.html
    Please continue these efforts to try to get this information–it would have saved me from some of the terrible anguish I had!! Thank you so much for sharing this.

  14. Eve says:

    I was diagnosed with IGT while in the hospital recovering with my second baby. With my first, I was a very young mother & when I realized my baby was starving, I just defaulted to formula and never looked back. With my second pregnancy, I was so excited to breastfeed and couldn’t wait to start! However, when I saw the lactaction consultant speaking gravely to my doctor & looking back at me, I knew something was wrong. It was similar to a tragedy when they told me I had IGT because of the shape of my breasts and that I would not be able to feed my baby by solely breastfeeding; I would most likely always need to supplement. I did everything I could; pumped with a rented motor-powered pump after every feeding (even middle-of-the-night feedings), took all the herbs, used different supplementers, until I finally gave up when she was 5 months and went solely to formula. With my third baby, I was determined again, only to fail and swith to formula at 4 months. Now I am again pregnant, 10 years after the birth of my last child. I want so badly to be able to breastfeed this baby and am willing again to do anything to be able to.
    The thing that really bothered me is the ignorance of most people of this condition, even some lactation consultatnts. My sister-in-law’s mother is in that field and after all my tears and work and pain of trying, she simply said I didn’t try hard enough. That everyone can produce enough milk if they try. I was amazed that hardly anyone knew about this condition at all, but was thankful there was the one who did & tried to help me as best she could. With only one look, she was able to diagnose me.
    I am praying somehow, this time will be different. So thank you for your encouraging article.

    • Bettina Forbes, CLC says:

      You brave, courageous mama! I am so inspired by your efforts and determination. Please remember that breastfeeding is only part of mothering. You can nurture and nourish your baby at the breast no matter how much milk you make. Your skin, your touch, your love are all powerful immune boosters! :-) Good luck and thank you for your kind words. We believe that every single health professional needs to be made aware of IGT, and that all lactation consultants must demonstrate competency in diagnosing it. We will continue to push for change so that mothers don’t have to suffer unkindness and harassment for not breastfeeding! –Bettina

  15. Kate says:

    Thank you for this article. I’m just coming to terms with my IGT now and I hope that should I have a second baby I won’t have such a heartwrenching time as I did with my daughter.

  16. Carol says:

    I also self-diagnosed about a year ago. My son, now 7, lost from 8 lb 2oz to 6lb 15oz or a little less (15% loss). I had a friend who was an OB nurse and a former LC. She came over at one week, and said, “God just told me to come over since I saw him two days ago. We have to get some milk in him.” She showed me how to syringe feed. She didn’t seem to know what was up with my breasts, but just said he looked too small, and was sleeping too much. She also noticed he was not “gulping” anything down. I had NO breast size increase during pg with him, wore my same bras the whole time. After syringe feeding and using a breast shield (I also had flat nipples) until he was 9 weeks old, he just latched one afternoon and nursed without the shield from then on. Once he started solids at 7 months, he slowly gave up his afternoon supplement of formula. He nursed until 16 months and would have gone til 18 or so months. I hurried him a little, but he had already weaned to just night-night and sometimes a 5 am feeding.

    Then, 2.5 yrs later, I had another baby. With that pg, my breasts grew and got fuller (from A/B-ish to D!!!). This baby nursed from day one like a little champ (for 15 min per breast whereas my son had to stay on for 45 per side and still got next to nothing). She weighed 9lb 13oz at birth, so had a little more to play with. She lost to 8lb 10oz (12% loss). Had she not nursed as efficiently as she did, she probably would have needed to supplement, too. However, she did fine, started gaining back, and nursed until she was 22 months old. She self-weaned, and I would have nursed longer knowing that she was the baby for us.

    I hope my story helps someone to see some of the red flags. I look at pictures of my little boy, and am sad at how little and hungry I let him get not knowing that I had IGT. Looking back, one nurse practitioner said off-handedly in college during a pap, “You have some underdeveloped breast tissue in this breast, so it may affect you when/if you nurse children. It probably explains your uneven sizes.” I waved her off and didn’t think anything more about til 20 yrs later! At 21, I just wasn’t interested if it didn’t affect me right then.

  17. Maria says:

    I self diagnosed IGT while pregnant with #4. I was never successful at bfing, and wanted to try harder. I stumbled upon a link on the Internet, and one article led to another, and a lightbulb went off. It was heartbreaking to know why I had never been able to produce more than a few drops of milk, and with 4 young children it was simply out of the question to sit and nurse all day long. I ended up formula feeding after what colostrum I had was gone. I would have loved to breast feed, but I don’t feel that my connection to them was harmed in any way by bottle feeding.

  18. Amanda says:

    I can’t help but cry reading this. I was blessed with an amazing LC with my daughter & she is the one who “diagnosed” me with type 2 (hypoblastic) breasts. It was so hard to let go of the idea that I could exclusively breastfeed. I went through so much trying to provide fully for my daughter. I took supplements & even went in Reglan. Now I’m 4 months with #2 and seeing no breast changes once again. It’s heart breaking because people say, “Oh, every woman can breast feed you just have to keep after it.” I plan on checking out our local LLL since I have moved 2 hrs from where DD was born. I already feel like I’m mourning the loss of being able to exclusively nurse this child too. I’m still praying that I can by some miracle fully provide nourishment for this miracle inside of me. I just don’t know if I have the energy or the heart to go through this all again. I will definetly give it my all (I can’t just not try) but its so hard to go thru this when NO ONE knows how to help. :’(

    • Bettina Forbes, CLC says:

      Hang in there babe. We hear you and feel your sorrow. Remember that your babies are lucky to have you, an amazing mother who cares so deeply, and that love is all powerful!! We hope you will become an advocate for affordable donor milk and milk sharing. Sending you hugs and best wishes!

  19. Carlie says:

    I was diagnosed with hypoplastic/tubular breasts in 2003 – when I went for a consultation for a breast augmentation. I did opt for surgery (minor adjustment!) just to have a more “normal” look. I had no idea that hypoplastic breasts meant anything beyond appearance-related factors. In March of 2011 I gave birth to my first (biological) son and was thrilled that he latched on so quickly – I was so happy to breastfeed. He was a peaceful, content baby until Day 3 when my milk “came in”. I knew it was not coming in like it had for my friends and when my son stopped being content and seemed to need to eat all the time (not like him in first 3 days), I knew something was up – I just had no idea it was as bad as it was. After taking supplements, pumping, diet changes, etc….I gave my son formula for a whole day and pumped to see what I would produce. In 24 hours, only 3.5 oz. I scoured the internet for help and finally stumbled on something that mentioned hypoplastic breasts related to difficulties with breastfeeding. I thought “I have those!” The pieces all started fitting together. Heartbreaking is such an understatement. My son and I have experienced many sweet bottle-feeding moments and he is a bright, beautiful, healthy, tall, intelligent toddler. I know he wasn’t stunted by this experience, but I still feel we were so robbed. I’m expecting again now and the grief is so present again. I really could relate to sweet Amanda – I share her pain and am sorry she’s going through it! Thank you for sharing this information so that we can educate women about the realities of this concern – while still encouraging women not to give up too quickly. I would still put in every ounce (no pun intendeD) of effort again to try.

  20. Lisa C says:

    Thanks for the great article! I was blindsided by low milk supply when my son hadn’t gained anything by 12 days old. I started on a regimen of breastfeeding, then supplementing with formula, then pumping, taking tincture & teas, as well as Domperidone. I tracked my pumping output & formula usage, his weight & how many feedings, etc, etc for months. My husband wasn’t working at the time, so I had two sets of hands 24/7 with everything. We went to LCs, midwives, LLL meetings, workshops & weekly appointments with a doctor at a specialized breastfeeding clinic. I don’t remember anyone mentioning IGT.

    After a few months of struggle, I resigned myself to making about 80-85% of what my son needed & started easing off all the herbs & eventually the Dom & pumping. Once my son started eating solids, he started gaining tons of weight, so we gradually cut out the supplement & just breastfed, which was really awesome. He was nearly self-weaned when I decided to stop breastfeeding in January this year. He was two & a half & I was pregnant again & SORE.

    I still don’t know if I have IGT–if I do, it’s mild–or if it was latch issues that we didn’t sort out soon enough or if he may have had a slight tongue tie or if it was hormonal or maybe a combination… This pregnancy I’ve been researching a lot & setting up a plan of herbs to take, starting to pump right away, possibly setting up potential milk donors, etc. I feel optimistic that I might be able to produce enough–just that extra 15-20% is all I ask!–but still a little anxious. I’m not sure I’ll be able to keep up with constant pumping, washing, sterilizing, herb regimen, etc with less help (my husband won’t be off more than a few weeks) & a three-year-old around too.

    It is really great to have articles like this around to just get the idea out there that it’s NOT one or the other, breastfeeding OR formula. While I’m frustrated that I could never exclusively breastfeed my son, I am very proud to have exceeded my breastfeeding goals. I couldn’t have done that without the support I received in ‘mostly breastfeeding’ my son. Thanks again, Diana, for the story.

  21. Katerina says:

    I live in Russia and IGT theme is not widely known here. My story is the same as described in the article.
    I don`t know the reason for my condition but it is IGT. My breasts look normal apart from being small but the space between is at about 5 cm. Neither had I breast change during pregnancy nor after delivery. Doctors never asked about breasts and I even didn’t suspect I might have any problems. My mother breastfed successfully. I had a perfect pregnancy and natural birth.
    It took me 3 (!) weeks to figure out with that I don`t produce enough milk. I was lucky to find a lactation consultant who finally suggested it’s a find out I could barely produce 8 ounces of milk per 24 hours.
    What I want to stress out is that I was blind to understand what`s going on for 3 weeks because of the message: «Everybody can breastfeed». My son would have not been starving for 3 weeks if I was fully informed that in fact not everybody could breastfeed and that depending on some markers investigation should start ASAP. When I told my pediatrician that baby doesn’t gain (I rented scales after suspicion came for the first time) reassured me and said he will start to gain after mature milk will arrive.
    I started to supplement using SNS at 3 weeks.

    • Bettina Forbes, CLC says:

      Thank you for sharing your story! We are working hard to educate the masses, and especially doctors, that not all mothers can make enough milk. Kudos to you for finding a lactation consultant and continuing to feed your baby at the breast. You are doing a GREAT job!

  22. JK says:

    Just went to LC today and I’m 36 weeks…Had problems BF my first with no change in breast tissue, not engorgement, barely an ounce or two when pumping. Tried fenugreek, reglan, etc, with no luck. I suspected breast Hypoplasia and indeed I do have mild hypoplastic breasts. We are going to do everything we can this time to produce as much milk as possible and I will give my baby whatever I can again even If I have to supplement. SHe suggested the medela SNS feeder to use when needing to supplement. MY LC was fantastic, so glad I saw her and go an actual diagnosis!

  23. Megan Orsi says:

    Tears were flowing while reading this article, as well as the comments. As I sit here, pumping at work – .75 ounces from one breast, .25 ounces from the other.

    I was never officially diagnosed, and I don’t have any visual symptoms of hypoplasia, I do have rather small breasts. While I did experience engorgement and I do leak every once in a while, my breasts show very little growth during pregnancy, pumping results in no more than 1.5 ounces, per session, at best, and my son continually lost weight, despite feeding on demand.

    I’ve tried the tea, the cookies, the herbs, 3 liters of water a day, leafy greens, the oatmeal and I’m currently pumping every 2-2.5 hours at work, with breast compressions. NOTHING seems to help.

    It’s so frustrating to know that your body has failed you – and there’s nothing you can do to change it. You know, if I were bad at cooking, with some practice, I could get better. But, no matter how much effort I put forth into breastfeeding, it won’t change the fact that my body has failed me.

    I have not yet figured out how to get over the disappointment and devastation of not being able to be the sole milk provider for my boys. I often find myself hoping and maybe even partially believing, that I’ll have some sort of milk miracle, and I’ll one day be blessed with an abundance of milk.

    Ladies, thank you so much for sharing your stories in the comments. It’s made me feel better knowing I’m not the only one.

    PS: My 2nd son, Orion, is a little over 8 weeks. We had to supplement to get him back to his birth weight, which he hadn’t regained by the two-week marker. I’ve returned back to work and he gets mostly formula due to the fact I’m unable to pump more than a bottle and a half of what he would eat during the day. That equates to about 6 or so ounces of milk pumped, PER DAY. We still breastfeed whenever we can but it’s almost always followed by a bottle of formula. We’re working on finding a breastmilk donor.

    • Jennifer b says:

      I feel your pain. I don’t know if this is what I have, but it seems like it. I’ve also tried everything I could with very little increase. I saw a LC early on who encouraged me to supplement until we figured it out. Thank goodness he did. This is so much work that I find myself battling the decision on giving up each day. My baby is 5 months. Happy and growing. She no longer loves the breast during the day but does at night. So I don’t sleep much. She’s up every 1.5 hr to eat. 5 months with barely any sleep, but the thought of giving up breaks my heart. Nowi just thank God very time I breast feed that I am able to at all. The added stress of mspi and extremely expensive formula make me thank God that the special formula exists to feed my baby. It’s been very challenging, but this too shall pass. Big hug to all the moms endlessly listening to the breast pump, feeding their babies fighting back tears for our failure to ebf, and loving our babies 100% successfully through it all.

    • Kirstin says:

      Megan, love, I was only able to pump 2 oz per day. And that was with my second child. I’m so sorry, and do I ever understand. On one of the IGT blogs (there are blogs now! When my daughter was born in 2009, there was NOTHING. The nurse midwives had no idea what was going on with me. When my son was born in 2013, it was a completely different experience.), the mother said that with her third child, she defied the midwives and the LCs and gave a bottle *before* breastfeeding, switching to breast about 3/4 way through the feeding. At the time of writing, she had breastfed this baby for 9 months, whereas she had only been able to go 3-4 months with her previous two kids, because this baby didn’t hate her boobs (since he didn’t only see them when he was starving). Genius. I don’t think I’ll have a third kid, but if I do, this is the way to go.

      I can’t help you with the grief and disappointment (I know how demoralizing this experience is), but be strong knowing that you are giving your baby what he needs. You are feeding him and loving him, and he will be just fine. Truly. And now for a little catharsis, here’s a post I found on what NOT to say to an IGT mom: http://diaryofalactationfailure.blogspot.com/2014/02/guest-post-what-not-to-say.html#comment-form

  24. Lauren says:

    I could have written this myself. As im sitting here in bed feeding my precious 3wk old baby boy via sns line, again searching desperately for answers, the tears began to flow. I have been through this all before when my daughter was born and not once was IGT mentioned to me, despite me being a perfect fit for such diagnosis. I honestly feel like I am grieving. I want so much to feed my children at every should be able to, but I can’t produce the milk despite everything I try. It truly is heart breaking for me.

    • cris says:

      Hi!!! How are you Lauren? I hope you’re doing good. I just wanna share my experience with you. I just gave birth last Dec.to my second daughter, So my baby is now 4mos.old. I’m “ebf” exclusive breastfeeding mom. i joined a group on Facebook for Asean that helps or encourage moms to breastfeed their baby as much/ or often as possible. We have the term “unlilacth” unlimited latching. And you shouldn’t stress yourself that might affect the milk production. I learned and still learning a lot from that group. I hope these info can help you. Cause I feel bad also on what happened from my 1st daughter who is 5 yrs old now. Maybe lack of experience or information about breastfeeding when I got sick (flu) after 2mos. of breastfeeding I stopped and switch to formula. which I found out now that you can still breastfeed your baby even if you’re sick. Not having enough knowledge about breastfeeding that time, I was so upset or stress cause I was sick and I couldn’t pick up my baby, that contributed to my milk production from low to nothing at all. If i only knew that the baby is gonna be okay to breastfeed, i still breastfeed her. I hope these info or my experienced can help u. Please don’t stress yourself, im just trying to help.

  25. Rebecca says:

    Have you heard of motherlove’s “more milk with goats rue?” The goats rue stimulates breast tissue growth and can be taken while nursing, but not while pregnant if I’m remembering correctly. Look it up, it might help her to be able to develop more tissue and then nurse more fully.

  26. Heather says:

    Thank is beautiful.

  27. Helen says:

    Hi there – I wish I could be as well adjusted as some of these beautiful mothers. I am the mummy to 3 boys. My first is 5 year old now, I had an induced labour which ended in an emergency C section. I was devastated and struggled so much with the loss of that normal birth. Everything went well till the last minute. With my first I felt that the ONLY thing that went right was the breastfeeding!!!!! He was hungry and fed a lot but in the early weeks grew crazy amounts. He cried a lot and was very unsettled. He growth settled to less than average per week after 6 weeks but no-one was worried and neither was I. We fed exclusively till we mutually ended at 13.5 months. In the early days I would often have breasts so full they were sore and I would have to hand express to get him to latch.
    With my second I was advised to seek a specialist and had an elective c section which was a very difficult and much anguished decision after lots of advice and discussions. I never dreamed I would have problems feeding subsequent children. Everyone said things were easier a second time around and everything would work better and I too grew up with an idea that ‘everyone can breastfed’, those that can’t don’t try hard enough. Although I respected that breastfeeding is extremely hard work.
    My second was very jaundice and sleepy. The postnatal midwife have no idea about feeding. So his weight gains weren’t that great and she suggested formula and I said no there must be something we can do. She suggested breastfeeding tea, occasional expressing and there was no need to see an LC and it’s ok to let him sleep for 6 hours (!!) and I was so sore and sleep deprived I didn’t question these suggestions. When he got to his 6 week check the team were horrified and I saw an LC and started domperidone and expressed several times a day but his weight gains never really picked up and I couldn’t really every express a lot. Until he started sleeping through at 4-5 months and I would express a full feeds worth AFTER feeding him. So I wasn’t really sure what went wrong but thought we got off on a bad start and wouldn’t let that happen again.
    So with my 3rd I had an antenatal LC I employed. I still have not recovered from her analysis. She diagnosed me with mild hypoplasia but said given all went well with my first we should be fine for my 3rd but that we would put a good plan in place to ensure this. So I started domperidone straight after birth and took fenugreek. But his weight gain was still pretty average and then was not good at all weeks 3-4. I couldn’t understand and still can’t why not. He is 10 months old now and I am still burning with anger and frustration and rage and so annoyed. I tried goats rue, we move from single expressing to double expressing. I feel psychologically broken by it all. Despite all this his weight gain and my supply have still be very mediocre. She can’t explain why (except maybe early regression to menopause – but I am only 34 and have no early menopause in the family and am already ovulating again). Every time I feed him I feel inadequate, I feel ridiculous that I can’t supply food for my child. I resigned myself to needing formula but couldn’t because my mother-in-law is so anti it and my husband was unable to support this decision. My mother was too but she saw how hard I was trying with little improvement, she saw how crying and hungry my little boy was and she said to me ‘you’ve given it a 1000%, no other mother would have done this, give him some formula top-ups and move on’. The two things holding me back were 1) the uncertainty of what would happen to my supply/fear it would further decrease and disappear because he would prefer formula/fast flow and I would be tempted to give up and wean it was all just so hard 2) I was already double feeding with feeding at breast and pumping so I had no energy to introduce another complication ie supplementing at this point. My mother-in-law is not aware of my diagnosis and would make very unhelpful comments like how she didn’t understand because it’s just supply and demand after all anyone can do it (she belonged to LLL in her day) and how I only pumped to get time out for myself (how awful given how much I hated it). And no she never came over to give us a rest/break or help at all in those first 6 weeks. So I also felt like if I gave him formula I could never go to her house till he was weaned or have her at mine while he was feeding because of the judgement that I felt from her and her daughters.
    It is all still very raw and painful. I have always wanted 4 children but I am not sure if I can put myself through it again. I realise now my breasts didn’t really change much with pregnancy but can’t understand why it has got harder not easier as most woman find. I think if I did have a 4th child it may be easier to just formula feed after colostrum but I know I don’t really want that. It just hurts so much to even have to think about this. No sure I can risk my mental health again :-(

    • Bettina Forbes, CLC says:

      Helen, my heart aches for you. I am so sorry that you faced so many challenges, that you got so little empathy, understanding and support. Just know that you are a hero to us!! A mother who is that determined is a great mother no matter how she feeds her baby. Wishing I could give you a hug. Hoping you find peace and acceptance and healing. You deserve it! –Bettina, BfB Co-Founder

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