Breastfeeding is natural; therefore our bodies function accordingly, right? Our baby nurses. Our baby is satisfied. Our baby gains weight. Mom and baby live happily, nursing and snuggling, all day and night. Well, at least that is what comes to mind when most of us envision breastfeeding.
As I worked my way through my Lactation Educator Certification program, I was amazed at all the issues that can cause problems with breastfeeding. Many women recounted problems such as latch issues, tongue/lip tie, cleft lip/palate, nipple anatomy, to name a few. The availability of resources covering these topics seemed boundless.
One condition that failed to get the same amount of attention was defined as Insufficient Glandular Tissue, (IGT). I was surprised to find that after reading a short paragraph and viewing a few images, that issue was determined to be sufficiently covered. I wondered, was IGT a condition being minimized, or was just not that big of a deal?
It is estimated that between 3-4% of women have IGT. Most women are unaware that they have the condition and are surprised when their infant fails to gain weight. In fact, these infants lose weight at an alarming rate.
Insufficient Gladular Tissue is characterized by widely spaced underdeveloped breasts (hypoplastic). The breasts take on a tube shaped appearance with a gap of an inch and a half or more between them. The breasts do not appear to grow much in pregnancy and do not fill with milk postpartum.
In my lactation studies journey I came across a group of mothers who had IGT. As I listened to their struggles, frustrations and victories, I was in awe of their determination to continue breastfeeding despite their need to supplement with formula and donor breastmilk, constantly pump, and take medications, herbs and teas. These moms were committed and determined to have a breastfeeding relationship with their infants and they were fighting hard. They all desired to breastfeed exclusively, however their bodies just wouldn’t cooperate.
I asked one mom to share her journey to shed more light on IGT and the struggles it brings to the breastfeeding relationship.
Here is Nadia’s story:
“I always knew I would breastfeed my children. I was a breastfed child, though I don’t remember the experience. My younger brother was breastfed, which I also don’t remember. I have dear friends who breastfed their children. I knew that “breast is best”, though I have come to despise that saying. The foundation was already laid for a positive breastfeeding experience and I hadn’t even had to do any work. But I also knew that, though it is a natural thing, breastfeeding does not always come easily.
When I found out I was pregnant and as I prepared for the arrival of our daughter I did massive amounts of research – reading books, talking with friends and family, making several visits to a La Leche League meeting, and surfing the web for resources – in the hopes that forewarned is forearmed. My husband and I planned for a natural, drug-free labor and delivery, which I knew would also be supportive of breastfeeding. I purchased a breast pump in anticipation of pumping so that my husband could feed our daughter bottles. This was especially important to him, as he felt that feeding was the most valuable way of bonding with our daughter. He was a reluctant participant/supporter of the plan to breastfeed.
As we neared our due date, we met one final time with our doula, hired with the knowledge that doula-assisted births typically have fewer interventions. My research had informed me that births with fewer interventions tended to lead to stronger/healthier nursing relationships. We made a birth plan that my husband joked he would tape to his chest once we got to the hospital. We had invited my husband’s sister (who lived with us at the time) and my mother (who flew in from Florida the day before our due date) to be present with us during labor and delivery. I felt ready, at least as much as it is possible to be prepared for an experience one has never had before.
At 2:00 the morning after my due date I woke from a sound sleep to my water breaking. I was not having contractions, so I did not feel especially rushed. I woke my husband, who woke my mom and sister-in-law. Then I took a nice long shower and ate a peanut butter sandwich while the others finished gathering our things together. We arrived at the hospital around 3:30, still no contractions, and I spent 90 minutes or so in triage where they confirmed that I was, in fact, in labor. Once I was transferred to my own room, my family was permitted to join me and we got down to business.
I was determined to stick to our plan of a natural, drug-free birth. Since I still was not experiencing noticeable contractions I took to walking the hospital halls. My family took turns keeping me company and around lunchtime my husband determined that the contraction that had just had me doubled over gripping the handrail was strong enough that we should head back to our room. Shortly after that our doula arrived and reminded me that laboring on my hands and knees might be more comfortable. So for the next 3-4 hours I was draped over the back of the hospital bed gripping my husband’s hand until it was finally time to push. I do not, honestly, know how long I pushed, but it was not more than 2-3 hours. And then, finally, at 5:58 p.m. on the evening of June 21, the summer solstice, our sweet daughter arrived. Ella Elizabeth was named after two of our grandmothers, one with whom she shares a birthday.
The doula helped me nurse her for the first time within an hour of her birth. She had a great latch, according to the doula and the nurses. Throughout the rest of our 2-day hospital stay Ella continued to nurse well. We almost weren’t released, though, due to her jaundice. She improved enough that they let us go, with the expectation that we would see her pediatrician in two days.
At the appointment Ella had last more weight. It is hard for me to remember the sequence of things in that first few weeks due to my haze of new-parenthood. But all of the following things happened within the first week:
~ Ella continued to lose weight. By the time we started supplementing she had lost more than 10% of her birth weight.
~ She developed crystals in her urine, a sign of dehydration.
~ We saw the pediatrician 4 times in 9 days.
~ My husband accused me of starving our baby.
~ I cried. A lot.
~ My doula came at my heartbroken call at 8:00 p.m. on a Saturday night to hold me and tell me I was a good mother.
~ The pediatrician recommended trying fenugreek to boost my supply.
~ The jaundice stayed around for a while.
~ The pediatrician referred us to a lactation consultant.
The Internationally Board Certified Lactation Consultant came to my home. We did a weighed feeding, she watched me nurse Ella, and she examined my breasts. In a very short time, she diagnosed me with Insufficient Glandular Tissue (IGT). Until that moment I had not heard of IGT. I was aware that some women struggle with breastfeeding. But I had NO IDEA that there were medical conditions that prevented exclusive breastfeeding.
At the suggestion of the IBCLC I started using a supplemental nursing system (SNS) filled with formula or whatever milk I could pump. I pumped with a double electric breast pump after every feeding. I started eating as much oatmeal as I could stomach. And I added a number of herbal galactagogues to my diet – fenugreek, goat’s rue, blessed thistle, brewer’s yeast, flaxseed.
I had the good fortune of being able to stay home with my daughter. Otherwise, I don’t think our breastfeeding relationship would have lasted as long as it did. Every ninety minutes to two hours we would nurse with the SNS and then I would pump. We did this around the clock until Ella was eight weeks old. At that time, she started sleeping around six to seven hours at night. After that, I would wake once for a middle-of-the-night pump.
Sometime around five months after Ella’s birth I got my OB/GYN to write me a prescription for Reglan. I took that in two two-week stretches and saw a small boost in my supply. My doctor would not renew the prescription due to the risks associated with the medication. Fortunately, I never experienced any of the potential negative side effects.
At no time did I ever produce enough milk for my daughter.
At six months on the dot, we started solids with Ella. She LOVED food! We were gifted a baby bullet food system, so I made all of Ella’s purees. That felt so good to me – I was finally able to make sufficient food for her. We continued nursing with the SNS in addition to the solids. The more interested Ella became in food, the less interested she was in nursing. We were down to 2-3 nursing sessions each day (wake-up, nap, and bedtime) as we neared her first birthday.
Two weeks before Ella’s birthday I had an emergency appendectomy. I was in the hospital for two days, apart from her. That was the beginning of the end. Once I got home and had recovered enough to hold and nurse her we only breastfed a few more times. I do not remember our final nursing session. If I had known it was to be our last, I probably would have commemorated it in some way.
Our daughter is now approaching her 4th birthday. She is the light of our lives – happy, kind, bright, energetic, curious, helpful. I look back at the first year of her life and am so proud of the effort I put into our breastfeeding relationship. Nothing about it was easy. But it was so incredibly rewarding.”