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Friday, January 4, 2013

Not Enough Milk: Insufficient Glandular Tissue and Sheehan's Syndrome

I have had this post in my drafts folder for sometime now.  I came across this Healthland Time article which encouraged me to finally write and finish this post.  This pretty much sums up the problem that breastfeeding faces with the medical community:
That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.” 
While breastfeeding is natural, I do agree that there are some moms who really CANNOT breastfeed.  Before, this wasn't an issue because wet nursing was prevalent.  Don't have enough milk? Send baby to your sister or neighbor.  But now, with our fast paced, urban lives, we often live far from family.  Adding to these factors would the concerns of the medical community on pasteurization plus the influence of formula milk companies that their product is equal to breastmilk.  As a result, more and more moms believe that they really cannot produce breastmilk.

Way back in 1989, the World Health Organization identified specific health factors which may interfere with breastfeeding.  One of those mentioned would be lactation failure.  I believe that true lactation failure does exist and is the condition called hypoplasia or insufficient glandular tissue.  La Leche League recognizes the existence of mammary hypoplasia and identifies several factors to look out for:
What are the visual markers of hypoplastic breasts? In a study of 34 mothers by Kathleen Huggins, et al. (2000), the researchers found a correlation between the following physical characteristics and lower milk output:
  • widely spaced breasts (breasts are more than 1.5 inches apart) 
  • breast asymmetry (one breast is significantly larger than the other) 
  • presence of stretch marks on the breasts, in absence of breast growth, either during puberty or in pregnancy 
  • tubular breast shape ("empty sac" appearance) 
Additional characteristics that may indicate hypoplasia are:
  • disproportionately large or bulbous areolae 
  • absence of breast changes in pregnancy, postpartum, or both 
Hypoplastic breasts may be small or large. It is breast shape, placement, and asymmetry that indicate hypoplasia -- not necessarily size. Normal-sized breasts that are lacking glandular tissue may be made up of fatty tissue that will sufficiently fill a bra cup.
In dealing with IGT, what is important is being able to identify the problem and manage it - without making the mother feel bad for not being able to breastfeed her baby.  This website is quite helpful in providing more information about IGT.

Aside from IGT, postpartum conditions may also lead to failure to produce sufficient breastmilk.  Another mom, Bunny Rufino, shared her inability to produce sufficient milk due to Sheehan's Syndrome.   The US National Library of Medicine defines Sheehan's Syndrome as tissue death in the pituitary gland due to severe bleeding during childbirth.  Among the symptoms of this condition is the inability to breastfeed - breastmilk never comes in.

Bunny shares how she was able to breastfeed her older child for 2 years and so much milk that she ended up donating her breastmilk.  However with her son, her breastmilk is not enough - even after pumping 7x a day. She had a complicated birth - almost dying from massive blood loss.  Her blood was unable to coagulate properly and she had to be transfused with 25 liters of blood. She had to stay in the ICU for 5 days and remained in the hospital for almost 2 weeks.

Upon discharge, Bunny was adamant and really wanted to provide breastmilk to her son so she did research and found out about Sheehan's Syndrome.  She went to her endocrinologist who confirmed that her pituitary gland was damaged by severe hemorrhaging during her son's birth.  This affected her hormones, including prolactin - the hormone released by the pituitary gland that stimulates breast development and milk production.

Despite this condition, Bunny continued to breastfeed and supplemented with donor's milk.  She wanted to share to fellow moms that breastfeeding should not be treated with an all or nothing approach.  She emphasizes that proper support and treatment are necessary, especially from the mom's doctors.  Moms should not be left defeated and guilty that they cannot produce enough milk, when in fact it is not their fault but due to a medical condition.

As emphasized here, even if the mom cannot produce enough breastmilk for her child and needs to supplement, she should still CONTINUE to breastfeed and not stop.  It should be emphasized that any amount of breastmilk she can provide, no matter how little, is better than not providing breastmilk to your child at all.

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