Kristin Cavuto, New Jersey, USA
When a brand-new parent is “born”, along with a baby, they often have many fears. One of the major fears of the breast and chestfeeding parent is that they won’t make enough milk for their baby. As Leaders, we often reassure parents that with proper management their milk supply will likely be just fine. For the vast majority, this is true! They get into the groove, they learn how to live in the rhythm of a nursing family, and all is well. However, for some birthing and nursing parents, there are medical reasons for low supply. Insufficient glandular tissue (IGT) is one of them.
IGT is a disorder in which the milk-making tissue of the breast does not develop as expected, either in utero, during puberty, and/or during pregnancy. It is caused by a variety of factors, including endocrine disorders during any of those life stages. The mother with IGT will often (but not always!) have a physical presentation characterized by a wide space between the breasts on the chest wall, tubular shaped breasts with bulbous areolae, and a lack of breast growth during pregnancy. Sometimes this “IGT look” is obvious, and sometimes it is more subtle, with clues being the wide spacing and the lack of growth. Sometimes a parent has had breast augmentation to normalize the look of the chest; this can be a clue that there may be IGT.
A nursing parent with IGT will often not know that they have it, leading to the diagnosis being made when lactation fails. With IGT, colostrum changes to mature milk, but then the volume does not increase as it should. The baby, if not supplemented, will fail to gain appropriately, and will have scant diaper output. The unsupplemented baby of a mother with IGT will quickly become failure-to-thrive and is in danger of permanent damage and even death.
All is not lost for this nursing relationship! A parent with IGT who wants to nurse their baby can still do so. They can use an at-breast supplementer to give their baby donated human milk or formula at the breast. The Womanly Art of Breastfeeding has instructions for making a homemade supplementer on pages 422-423. With this type of device, the parent and baby will be able to enjoy nursing together while baby stimulates what milk supply is present and gains the oral, ocular, and emotional benefits of feeding at the breast. Excessive pumping is not generally recommended for parents with IGT, as it is both ineffective and disheartening. For some families, letting go of nursing attempts and learning to bottle feed with love is the best answer.
Leaders can support a mother with IGT by acknowledging that the breast, like any other organ, sometimes does not work as expected. They can provide a warm and welcoming meeting space for parents as they accept their condition and learn to feed their baby with confidence, no matter the method. Leaders can also refer to an experienced International Board Certified Lactation Consultant (IBCLC) so that parents with IGT can learn to supplement at the breast if desired, explore the medical reasons for their low milk supply and plan for the next baby. A parent with IGT can have a satisfying nursing relationship!
Editor’s note: the author would like readers to know that she originally wrote this article using fully gender neutral language which was changed during the editing process in accordance with LLLI policy. For more information see Cultural Sensitivity in Publications, August 2020.
Resources for Leaders
What Does a Breastfeeding Mother Look Like? Kellymom. 2018 https://kellymom.com/bf/normal/picture-of-success/
Hypoplasia/Insufficient Glandular Tissue. Kellymom. 2018 https://kellymom.com/bf/got-milk/supply-worries/insufficient-glandular-tissue/
Finding Sufficiency: Breastfeeding with Insufficient Glandular Tissue https://stores.praeclaruspress.com/finding-sufficiency-breastfeeding-with-insufficient-glandular-tissue/
In Praise of At-Breast Supplementers. LLLGB. 2016 https://www.laleche.org.uk/in-praise-of-at-breast-supplementers/
Kristin Cavuto is a Licensed Clinical Social Worker and IBCLC in private practice in central New Jersey, USA. Her practice specialties are low supply, maternal and infant mental health, and the intersection of ethnicity, sexual orientation, and gender in the care of the new family. She has been an LLL Leader since 2008. Kristin is the mother of two children who nursed full-term despite maternal IGT, and who are now 15 and 12.