Nikki Lee Health

Finding Sufficiency: Breastfeeding with Insufficient Glandular Tissue

Diana Cassar-Uhl MPH, IBCLC Praeclarus Press , 2014 228 pages; Paperback; English

URL: http://stores.praeclaruspress.com/finding-sufficiency-breastfeeding-with-insufficient-glandular-tissue/ $18.95 USD

Finding Sufficiency is a compassionate book about a complex, painful and vast topic. It is a delight to read, as Ms Cassar-Uhl writes in a kindly voice as she covers every aspect that a clinician needs to investigate when working with a mother who is dealing with possible insufficient milk supply.

One myth debunked by the author is the commonly held belief that breastfeeding and a full milk supply are possible for every mother, if only she gets the right help and tries hard enough. This belief can create enormous heartache in mothers who are suspecting that their milk making ability is compromised. There are no guarantees in physiology, sometimes things just don’t work the way we want, and lactation is no different. While most women can make enough milk, there are some who cannot, through no fault of their own doing.

Not only are the many factors contributing to the establishment of an adequate milk supply explored, the author is clear about what is relatively certain, and what isn’t. She starts with a foundation of anatomy and physiology, and builds from there, easily bringing the reader along.

Clinicians will find evidence, hypotheses, and suggestions for important questions: Is the milk supply compromised because of a pre-glandular (hormonal) imbalance, or because of insufficient glandular tissue (IGT), or is it a post-glandular challenge, brought about because the baby is unable to transfer milk or the lactation management is poor? Is the milk supply compromised because of one, two or all three of these factors? The author describes respectful and sensitive counseling strategies that will support the mother’s commitment and emotional state, and provides a wealth of references and resources.

One of the highlights of the book is a discussion about the pros and cons of telling or not telling a mother that she may have risks for milk insufficiency. On the con side is the fear that by telling a woman that she may have such a risk, she will be less committed to breastfeeding and that premature weaning will be a self-fulfilling prophecy. On the pro side are the reports by women who say that they wish they had known they had some risk factors before they experienced lactation failure, and that the majority of them would have sustained a commitment to breastfeeding. The author reminds us that we need to take the time to counsel and educate, and to provide encouraging follow-up. A breastfeeding relationship and sufficient milk supply are not mutually exclusive; women can breast nurture with or without making all the milk themselves.

The formatting was annoying; some major points are in grey boxes with white lettering that was difficult to read. This is a mere detail and may be a reflection on the state of my aging eyes. As Kent et al (2006) found that babies remove only about two-thirds of available milk in the breast, I am curious about the evidence behind the statement on page 101, “if you can express more than a few milliliters of milk after breastfeeding, this could also be a sign that your baby isn’t removing milk from your breasts as well as he should.”

This book is a loving support for mothers and a practical guide for practitioners; I would like to see it on a list of required reading for student lactation consultants.

Nikki Lee RN, MS, IBCLC Elkins Park, PA 19027