Insufficient Glandular Tissue and Breastfeeding
We are pleased to bring a guest post to you today from Mellanie Sheppard, IBCLC. Mellanie is an experienced Internationally Board Certified Lactation Consultant who stars in our breastfeeding DVD, “Breastfeeding: the Ultimate MRE.” Mellanie is a wealth of knowledge and we are so excited to have her write about the topic of Insufficient Glandular Tissue (IGT) today.
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We hear it all the time: "97% of women are fully capable of producing enough milk to breastfeed". So who are the 3%? Do they really exist? If you follow any of the breastfeeding support boards online, you see a definite attitude of disbelief anytime a woman says she cannot make enough milk. The conversation usually goes something like this:
NewMom: I am so sad that I have to supplement. I really wanted to exclusively breastfeed. Does anyone know how to get donor milk?
LactivistMom: Don't supplement! You will never make enough if you start supplementing. Only 3% of women can't breastfeed. You just need to take a nursing vacation. Take baby to bed with you and nurse around the clock. Try some fenugreek too. That worked great for me.
NewMom: My baby nurses constantly and is still not gaining weight. We have tried fenugreek and it didn't work.
Every1CanBF: Have you tried More Milk Plus? You should be pumping too. Pump after every feeding and you will have rivers of milk in a few days. Everyone can make enough milk. You just have to work for it.
NewMom: I have been pumping after every feeding for 3 weeks now and I only get drops of milk. My lactation consultant says I might have IGT. Does anyone know anything about this? Where can I get donor milk? It feel so sad every time I have to give my baby formula.
And on and on the conversation goes, with more moms chiming in to tell NewMom that 97% of women can breastfeed and giving her list after list of things to do, all while never answering her original question. Eventually, NewMom moves on, feeling alone, guilty and defeated.
As breastfeeding supporters, we need to understand that the small percentage of women who cannot produce enough milk is real. One of the least understood causes of low - or sometimes no - milk production is breast hypoplasia, also known as insufficient glandular tissue (IGT).
What is IGT? If we liken the lactating breast to a factory, then we could say that, for women with IGT, the workers went on strike before the factory was completely built. This makes it difficult for the factory to bring production up to 100%. She might produce 80% of the milk her baby needs or just 10%. For some, production won't ever get off the ground.
What causes IGT? There are many speculations about the root cause (pesticide exposure during childhood, hormonal imbalance, injury to developing breasts, etc.) Over the years, there is one common thread I have seen with almost every mom with IGT that I have seen - irregular menstrual cycles, especially during the teen years. This makes sense if we know that glandular tissue (the tissue that makes milk) develops with each menstrual cycle and even more develops during pregnancy. So what happens when a young woman only has 3-4 menstrual cycles per year? She gets much less glandular tissue development and may struggle with milk production when she has children. In some women, they report that their breasts were very different from the start - they may be very small or they may be large but look "empty", or maybe one is large and one is small. They may droop excessively or the areolae may be exceptionally large compared to breast size. These are common markers for IGT but do not guarantee that there will be a problem. This site has a great synopsis of what happens in the breast during puberty and pregnancy.
What can you do if you suspect you have IGT? The first thing to do is visit with a knowledgeable lactation consultant (IBCLC). You need someone who is familiar with IGT and knows how to assess for it. If you are pregnant, the lactation consultant can help you with developing a plan so that you know how to recognize whether or not baby is getting enough milk at the breast, how to know if supplementation is necessary, can discuss methods of supplementation if needed (bottle, supplemental nursing system, cup, syringe, etc.), help with deciding on donor breastmilk or formula, and discuss strategies for maximizing milk production.
Being prepared is a big part of the battle. If you have already had your baby and are struggling with milk production, working with a lactation consultant can help you by deciding on herbs or medications to increase milk production, teaching you how to supplement in a way that supports breastfeeding, rather than undermining it, helping you with dietary changes that may improve hormonal issues, etc. If you suspect IGT it is important to know that, even though you may not be able to supply 100% of your babies breastmilk needs, you can still have a breastfeeding relationship. The physical act of nursing and the bond created are just as important as the milk. Breastfeeding is not all or nothing.
Is there support out there for women with low milk supply due to IGT or other issues? Yes! Some of my favorite sources of support are:
You can support a mom with low milk supply with a little compassion and understanding. She is probably working harder than you know and may appreciate just having her struggle acknowledged. She may be grieving the loss of the breastfeeding experience she thought she would have and need to know that someone understands her loss. Show her love and answer her questions without judgement. And most of all, don't make jokes about your oversupply unless you mean to donate milk - in that case, be generous!
For more information on IGT, these resources are excellent:
Mellanie Sheppard, IBCLC is a lactation consultant in private practice with more than 12 years experience working with breastfeeding families. She is an avid proponent of educating expectant families on Mother-Friendly Childbirth and a co-founder and leader of the Tarrant County Birth Network. A leader in her field, Mellanie frequently presents at conferences and events on topics including breastfeeding the special needs infant, the effects of induction of labor on breastfeeding, and how birth and breastfeeding are inter-connected.