What is insufficient glandular tissue?
Basically, it is when a woman does not have enough milk-making (glandular) tissue in her breasts. She may produce little milk, and some women don’t produce any. Her breasts may be any size as the breast also contains fatty tissue and may be comprised of mostly fatty tissue (small breasts may also have plenty of milk-making tissue). There are certain characteristics that may indicate IGT, such as tubular shape breasts, stretch marks without much growth, widely spaced breasts, breast asymmetry, and little or no growth during either puberty or pregnancy. However, many women have some of these characteristics and have no problems breastfeeding; therefore, a woman will not be diagnosed with IGT until she has difficulty producing milk. For me, I had never heard of it until we met with a lactation consultant after almost a month.
Additionally, many medical professionals, including lactation consultants, are not well-versed in IGT and so fail to identify it. If you have PCOS (a hormonal syndrome), little or no breast growth during pregnancy, or any of the symptoms mentioned above, I encourage you to look into IGT during pregnancy and prepare yourself for the possibility – I would have mother’s milk tea and a good breast pump on hand. Remember, though, that most women with PCOS have sufficient or even abundant milk supply, and the other symptoms do not indicate IGT on their own. You won’t know for sure until you do not produce enough milk. I also encourage all women to see a lactation consultant in the first week after birth, as it is extremely helpful to identify and troubleshoot any problems early. I wish I had seen one sooner.
If you do have IGT, the hardest part is actually the emotional component. I have found it really helpful to have a plan on how to continue (this will be different for each person depending on your goals), have a support system, including a supportive lactation consultant, and to be nice to yourself. It is easy to feel like something is wrong with you – it’s important to remember that it’s not your fault and you are not alone.
For more information on IGT, I found the following articles really helpful.
Once I established that I really do have low supply that is likely caused by IGT, I was able to take steps to increase my milk supply and give Tiny One as much breast milk as I can. (This made me feel so much better!)
Increasing Milk Supply
Milk supply is a supply and demand situation – the more milk is demanded, the more will be made. Ideally, the baby would demand exactly what you need; however, you might have a sleepy baby (like Tiny One) and if they are not getting much, they probably won’t keep sucking effectively. (Would you do the work if you weren’t getting anything?) So somehow we need to increase the demand. The best way to do this is through pumping. I try to pump after each feeding to make sure the breasts have been drained, and will pump at other times too, if she has not eaten in a little while. Ideally, I would be pumping 8-10 times a day, but – especially with Mr. S back at work – I usually only get in 6-7 sessions a day. Anything you can do will help. Our lactation consultant recommended considering a hospital grade pump, since the better pumps remove milk more efficiently. For now, we are happy with the Medela Pump In Style.
Another way to increase demand is to use an at-breast supplementer to give the baby formula or pumped breast milk while at the breast. This encourages them to suck more vigorously, which stimulates milk production, and gives them the supplement without the bottle. As our lactation consultant says, it is a “fiddly device,” but it can be helpful if you have the patience for it. I try to use it at least once every weekday, although it does not always happen since I don’t want to take the time to set it up when I have a very hungry baby!
Galactagogues are herbs and medications that help increase milk supply. I have been drinking a mother’s milk tea, which is a combination of herbs including fennel, fenugreek, nettles, raspberry leaf, catnip and more. I also take extra capsules of fenugreek and fennel. I found that my milk supply did increase after I started taking the fenugreek capsules. There are also certain medications that have the side effect of increased milk supply, which you can talk to your doctor or midwife about. I prefer to use herbs.
Common Herbs to Increase Milk Supply
- Blessed Thistle
- Red Clover Blossoms
- Marshmallow (helps enhance other galactagogues)
- Fennel (helps with let-down)
*Some of these herbs should not be taken if you are pregnant, including fenugreek, fennel and blessed thistle. Always check the safety of any herbs you take during pregnancy.
Certain foods are also thought to help increase milk supply, including oatmeal, seeds (especially pumpkin, sunflower, and sesame), chicken and seaweed soup, barley, rice, and chickpeas. I have been eating a bowl of oatmeal for breakfast every morning and also try to incorporate oats into my day through granola, granola bars, and lactation cookies. (I am still playing with lactation cookie recipes to make them less sweet – hopefully, I will find a recipe I really like so I can share it with you!)
Increasing Milk-Making Tissue
Many moms trying to increase their supply have adequate glandular tissue, so they will not need to worry about this, but it can really help women with IGT. The drug metformin, which is used to treat diabetes and is at times prescribed for PCOS, has been prescribed to help increase glandular tissue. The herb goat’s rue has a similar effect. The Ayruvedic herb shatavari helps promote deep vitality and immunity and may also increase glandular tissue. Chaste tree (also known as vitex) is another herb that may help with IGT, likely because if its effect on hormonal imbalances, including those associated with PCOS. Saw palmetto is another herb that may be given for hormonal imbalance and may help increase milk production. Herbs that act on hormones can also decrease milk supply depending on the hormonal situation, so it is important to be careful with them. Personally, I have found goat’s rue to be effective.
If you know you have insufficient glandular tissue before or while pregnant (which unfortunately is usually only for subsequent pregnancies) there may be some things you can do to promote tissue growth during pregnancy, such as supplement progesterone. Unfortunately, there is not a lot of information on this, and you should always check with your doctor before taking anything during pregnancy.
Avoid things that can decrease supply
This seems obvious, but many women don’t know or just don’t think about things that can decrease supply. The herbs sage, parsley, oregano and mint may all decrease milk supply, although you would probably have to eat a lot of them to make much of a difference. I am not cooking with them right now and would probably not order an item at a restaurant that had one in the name or description, but if they throw a little bit in it’s ok. Cigarettes are a no-go for many health reasons, but they are also bad for milk production. Caffeine and alcohol are both ok in moderation, but caffeine is dehydrating and alcohol in excess can disrupt balance of lactation hormones. I am avoiding both for the time being. You should also look into any medication, first to see if it is compatible with breastfeeding generally, and then whether it will affect milk production.
This is an ongoing journey for us. I don’t know if I will ever be able to exclusively breastfeed Tiny One, but the more I can give her, the better.
The Breastfeeding Mother’s Guide to Making More Milk, by Diana West: This book is a fabulous resource for trying to increase milk supply, especially since many breastfeeding resources don’t address low supply.
Breast Pump – I use the Medela Pump In Style (electric double pump). It is a little pricey, and there are cheaper options, but having a good double pump is essential if you will be pumping many times a day.
Hands-free Pumping Bra – if you are pumping with any regularity, this is really helpful. I went several weeks without it, and wish I had purchased it sooner. I have the Simple Wishes Hands Free Bra, since that is what our lactation consultant carried.
Supplementer – there are two commercial supplementers available in the US: Medela Supplemental Nursing System or Lact-Aid. We use a “rigged up” version from our LC, using a feeding tube and a disposable bottle top (see photo above).
If you want to make your own Mother’s Milk Tea, I like to get my herbs from Mountain Rose Herbals.