When Chama asked me to write this post, in her text, she wrote “low glandular tissue.” For several hours I have been reflecting on how differently that sits with me than what is commonly referred to as insufficient glandular tissue or IGT. There is something about being diagnosed with something that actually has the word “insufficient” that can feel impossible to process.
I knew for many years prior to giving birth that I had some of the physical markers of breast hypoplasia which sometimes (but not always) correlates to low glandular tissue and supply issues. Breast hypoplasia has nothing to do with breast size, but with the amount of glandular tissue vs. fatty tissue.
Around 60% of women with markers of breast hypoplasia can still produce a full milk supply. IGT is a diagnosis of exclusion, meaning, all other factors for low supply need to be ruled out first.
The first moment of confirming low supply will always stay with me. The florescent lights, the tone in the lactation consultant’s voice, the hot redness of my crying baby’s body on the scale, my tears that wouldn’t stop coming, and the responsiveness of a best friend who texted back immediately “of course, how much do you need?” Yes, she would give us a few bags of breast milk. My baby was hungry and it was day ten postpartum.
Causes of low milk supply can be broken down into pre-glandular (like a hormonal imbalance from a retained placenta or postpartum thyroiditis for example), glandular (IGT) or post-glandular (transfer issues, tongue ties). Often times when there is low glandular tissue that impacts supply, there can also be other pre or post-glandular tissue factors that also impact milk production.
Some studies show that low glandular tissue can be impacted by genetics, Mother’s exposure to particular toxins in utero, a hormonal disruption during puberty, or it can occur after a prior breast reduction surgery. IGT is often seen in combination with PCOS (poly-cystic ovarian syndrome), but sometimes it is not. Often women with PCOS have an abundant milk supply. Every situation is different, and recommendations for galactagogues or medications have to be specifically tailored to suspected underlying causes. The book Making More Milk by Lisa Morasco and Diana West, the second edition, synthesizes all the recent research as well as a full breakdown of herbal galatagogues and when they might be helpful.
One spring day, I took a walk in the hot sun with my first baby, Rosie, my husband and a few of our friends. I ate ice cream at Hickory Nut Gap farm, put my feet in the cold creek, and felt like myself for the first time in weeks. At that point, I was pumping once in the evening because my daughter was sleeping a longer stretch at night. To my great shock, I pumped almost twice what I normally did. It was still not close to what I would have needed to have a fully supply. It was then that I fully realized the role that my nervous system and my emotional health played in not only milk production, but efficient let-down. The stress hormone, cortisol, actually inhibits the let-down reflex. For me, this actually meant caring less about how much milk I was making and instead caring more about my emotional health, my relationship with my daughter, and embracing the moments of joy in my mothering. This movement towards letting down, and letting go, opened up more space for me to enjoy breastfeeding. My small supply would ebb and flow, and each time it did, I had to continually return to a self-acceptance that was very hard won. After beginning to see infant craniosacral clients again a few months after giving birth, I gave myself permission to take an extended leave of absence from supporting other breastfeeding dyads, to commit to my own healing first. When I returned to seeing clients again, I was able to be present with less bias, more presence and more compassion.
After giving birth to my second baby, Zev, my mantra was “radical kindness towards myself.” I wish this mantra could be with every woman who has struggled with low supply, is diagnosed with IGT or suspects it, or has a baby that won’t latch, or any other breastfeeding struggle. Breastfeeding struggles and our mental health are intimately woven together. We can’t tend to one without tending to the other.
Taking Care of Yourself or Someone Love with Low Glandular Tissue
If you or someone you love is struggling with low milk supply and known or suspected low glandular tissue, here are some helpful tips:
All the postpartum support! Help around the house, food, time to shower, take a walk, nap, etc. Create space, even small windows of time, that you can tend to yourself and your needs.
- Work with trusted professionals including lactation consultants who are well versed in this specialty as well any adjunct therapies that support your mental and emotional health. Clover Heart Concepts was and is very helpful in my journey.
- There can be a tendency for some providers and friends to not believe that low supply exists because sometimes new mothers can feel that there is a supply issue when there isn’t. As an example, cluster feeding can be a normal newborn behavior. Sometimes it’s hard to discern what is going on in the early weeks. If you are questioning whether your friend truly has low supply or if it could easily be “fixed,” please refrain from offering advice before you hear her whole story. Please also get permission first before offering advice or remedies.
- Hearing that someone has low supply is not an invitation to talk about how difficult it is to have an oversupply. You would be surprised by how common this response is! It’s not appropriate to say something like “well at least you aren’t leaking everywhere.”
- Unconditional, unbiased support is what is needed. I will never forget when a friend looked at me while I was pumping, and literally only getting drops, “you know, you don’t have to do this. It’s your choice. You are an amazing Mom either way.”
- Triple feeding (breastfeeding, bottle feeding, pumping) can sometimes have big pay off when pumping increases supply. No one wants to believe that pumping 8-10 times a day will not increase supply. I’m here to tell you that, sometimes, it doesn’t. The amount that you pump is not equal to your worth as a parent. Say it again. Set a time limit to trying, “I will commit to pumping for x amount of days and then reassess.” Or, if you don’t want to try or are physically or emotionally not able to pump around the clock, then don’t. It’s ok to make that choice.
- Contact naps, comfort nursing, and nursing to sleep were all so helpful for me. Both my babies loved this and the bonding time was so important for my mental health. Breastfeeding is about so much more than milk transfer. The amount of milk you have, in no way, correlates with the amount of love or the depth of your bond with your baby.
- Unconditionally support your friends when they call it. Some women with low supply need to shift to exclusive bottle feeding to protect their mental health. Ultimately, this is what is best for not only her, but her baby and her family. Continuing to breastfeed with low supply takes ongoing attention and management. I was highly privileged with my daughter, and am currently privileged with my son to have the time and energy to breastfeed and supplement. Some women exclusively pump and supplement. Whatever the variation, please, honor and respect these parents unconditionally! All these decisions are made with love and with careful thought.
Having low glandular tissue, for me, has meant that I am even more deeply woven into my community of other parents. My babies have abundantly received donor milk and formula when needed. Low glandular tissue continues to teach me that I cannot do this alone. I cannot raise my babies in isolation. I have needed so much help. I have, miraculously, received help and let that help and support in.
There is a myth out there that with the right social support and breastfeeding support, that all women can exclusively breastfeed. This myth is harmful and it is not true. Yes, most women can. Sometimes, we can’t.
There is nothing that is insufficient about a woman with low glandular tissue other than the insufficiency of an ableist medical culture.
We all deserve providers who are willing to help us both uncover any co-occurring issues and root causes as well as, most importantly, uphold a culture of honoring our wholeness and strength.
