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Archived Comments for: Overabundant milk supply: an alternative way to intervene by full drainage and block feeding

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  1. Outstanding article will be cited often

    Kermaline Cotterman, WIC Volunteer, Author, ILCA member

    12 October 2007

    The author is to be complimented on her article, both for the well-referenced physiological insights which explain how and why the method works, and the case studies which illustrate how the method needs to be explained and followed up carefully in order to tailor it to the individual mother/baby dyad involved.

    This article has great potential to add to the practice insights for clinical lactation specialists and the very vital lay breastfeeding support communities, but especially for the general pediatrician, family practitioner, emergency room physician, public health and pediatric nurses, and the educational formation of future practitioners in these and other disciplines.

    This will result in a more comfortable and satisfactory experience for many mothers and babies, whose example and testimony to friends and relatives does so much to positively (or negatively) influence the feeding choices of future mothers.

    I echo the author's conclusion: "More research will need to be done to understand why some women will easily produce much more milk than needed and why for some it is so hard to regulate milk production to meet the needs of their children."

    I suggest that the disciplines of embryology, by investigating initial breast development, and those of pathology and radiology, by investigating both breast disease and lactation, have much more yet to contribute to a better understanding of the number of main ducts, lobes and potential for alveolar development during various stages in life. It may yet require the examination of hundreds, perhaps thousands more breasts at multiple life/reproductive stages before such variations in anatomy can be fully understood.

    Although there may be no definitive histological or radiological proof thus far, I suggest that the number of lobes in one or both breasts of some women may actually be the potential histological "normal" of 15-20 sometimes described in the past. This might help explain those mothers at risk for oversupply, as well as those historically able to wet-nurse multiple infants, produce adequately for their own twins, triplets or more, or easily tandem nurse an infant plus one or more older siblings.

    I base my hypothesis on my understanding of the embryonic development of the human breast. When the primary bud reaches the stage of "sprouting" secondary buds and their subsequent invasion into the mesenchyme,

    * individual genetic programming may, or may not, allow the full number to "sprout", successfully develop and canalize.

    * This then might account for individual breasts having differing numbers of main ducts, each of which is destined to further develop its own separate lobe at thelarche.

    * This would then account for potential of the individual breast to develop correspondingly fewer or more lobules/alveoli during pregnancy.

    * This might easily explain some of the visible variations in breast development and/or sufficient versus insufficient glandular tissue.

    * Accurate external assessment by simple inspection or palpation is hampered by the presence of adipose cells within the connective tissue.

    If the concept is accurate that each main duct has the potential to form a temporary "milk lake", the original genetic programming may set the stage for the discomfort of hypergalactia when identical management patterns are used for all mothers during the initiation of lactation. This article provides much food for further thought.

    K. Jean Cotterman RNC-E, IBCLC

    Dayton, Ohio USA

    Hughes ESR. The Development of the Mammary Gland, Annals of the Royal College of Surgeons, Oct. 25, 1949 pp. 99-119.

    Knight CH, Peaker M, Development of the Mammary Gland, J Reprod Fert (1982), 65, 521-536.

    O’Rahilly KR, Muller F, Human Embryology & Teratolology, Third edition, 2000, Wiley-Liss Inc., New York.

    Russo J, Russo IH, Development of the Human Mammary Gland in: The Mammary Gland, Development, Regulation, and Function ed. by Neville MC, Daniels CW 1987 Plenum Press, NY. pp 67-93.

    Competing interests