When the “Milk Fairy” doesn’t come; Having Insufficient Glandular Tissue

on March 25, 2014 in Breastfeeding, Insufficient Glandular Tissue

The number one reason mothers give for abandoning breastfeeding is the belief that they do not have enough milk.  And some mothers do not have enough milk, but typically this is due to early mismanagement of nursing often in the first days and weeks of the baby’s life. Infrequent feeding, poor latch techniques, or the late onset of milk production can all lead to low milk supply, to mention a few.

But another cause of low milk supply is having insufficient glandular tissue.  Mothers with insufficient glandular tissue lack the milk making tissue necessary to produce a plentiful milk supply.  I estimate that between 3-4 % of women have this cruel condition.  And many times, a mother has no idea about having insufficient glandular tissue and assumes that nursing is going well until her newborn experiences an excessive weight loss, more than 10% or her baby fails to gain weight as expected, an ounce a day from 5 days of age, and fails to re-gain their birth weight by 10-14 days of age.  And many health care providers, Obstetricians, midwives, Pediatricians, and hospital staff do not recognize this condition.

Women with insufficient glandular tissue have widely spaced “hypoplastic” or underdeveloped breasts that are more tubular in shape, than round, with a flat space of about 1-½ inches or more between their breasts.  This is very different than simply having small breasts.  Mothers with breast hypoplasia have breasts that grow very little during pregnancy, if at all,  and on the third to fourth day post partum; their breasts do not fill with milk.

In 1999, two co-workers and myself set out to identify the markers of insufficient glandular tissue.  We learned a great deal and our article was accepted for publication in 2000 a lactation journal.  We learned that there are different severities of this condition.  In addition to having little breast growth during pregnancy, we also found that the majority of mothers also had one breast that was significantly larger than the other.  Most also had stretch marks on their breasts despite their lack of growth.  And the larger the flat space in between the breasts, the more severe the condition.  We ultimately described four types of hypoplasia, with Type 1 being the least severe and Type 4 being the most severe.  The article can be read at http://www.sonic.net/~mollyf/igt/

We worked with 34 women who we suspected of having breast hypoplasia for a 6 week period or longer.   We had each mother pump after every nursing and use fenugreek capsules; 3 caps taken three times a day.  This was done to try and stimulate more milk production.  Many of the mothers who had a mild case of hypoplasia achieved normal milk production by 6 weeks post partum.  None of the mothers with Type 4 hypoplasia achieved adequate production.

We also discovered that some mothers, who had a history of having breast implants, actually had the surgery to improve the size and shape of their breasts due to breast hypoplasia.  So whenever mothers have had breast augmentation and their infants fail to gain weight well, we ask about the appearance of their breasts prior to having the surgery.

We saw some mothers again, years later, with a subsequent baby. Surprisingly, we did find that these mothers produced more milk with additional babies than with their first born.

As time went on, we added other therapies to help these mothers produce more milk.  Specifically, we added Domperidone to their post feeding pumpings and use of fenugreek capsules.  While initially there was some hesitancy about using Domperidone, it didn’t make sense that it would help.  We believed the breast tissue itself would not be stimulated by using this medication because it is used to increase prolactin, the milk making hormone.  But after some trials, we found that mothers did get a boost in their overall production by adding Domperidone to the other measures already in place.  Now, we routinely use Motherlove’s More Milk Special Blend, a combination of fenugreek, blessed thistle, nettle and fennel and Goat’s Rue and Domperidone.  Domperidone is not available in the U.S. but must be either made up in a compounding pharmacy or ordered from another country.  I have found that Domperidone can be safely ordered in Vanuatu less expensively at Inhousedrugstore.biz.  They offer 3 different brands from 3 drug companies each with different pricing and arrives to the U.S. in 10-14 days after ordering.  The typical starting dose is 30 milligrams three times a day.

Some mothers chose to supplement their babies using various methods.  Some use bottles while others chose to use a nursing supplementer system, like the one offered by Medela, a pump manufacturer. A supplementer with its thin, soft tubing attached to a bottle-like container of formula, allows the baby to be fed supplemental formula while nursing at the breast.  This may be the best way to supplement if the baby fusses at the breast or simply drifts off to sleep like when a pacifier is used.

Mothers often wonder why they have this unhappy breast condition.  We don’t have many answers about this.  We did have some mothers who had close relatives, like their mothers with the same condition.  None of the mothers we worked with had any issues with infertility.  A few of the mothers had a certain body type with broad shoulders and not much of a defined waistline.

We do encourage mothers to give breastfeeding a good six-week trial.  Many babies enjoy nursing even when the supply is low.  And getting some or most of their milk at the breast is certainly worthwhile for both mother and baby.

There is a website for mothers with Insufficient Glandular Tissue at http://www.noteveryonecanbreastfeed.com which has some valuable information and referrals to other sites.