Many mothers who’ve had challenges with milk supply wonder, “What about next time.. will this happen again? Is there anything I can do now to help with the next baby?” While there are no absolutes, we can tell you that most mothers do make more milk with subsequent babies, though how much more depends on individual circumstances. Having had a previous pregnancy and lactation appears to help because you will likely retain a little of the glandular growth and prolactin receptors, helping the milk-making tissue to be more responsive. The time you’ve spent breastfeeding up to now is laying a foundation for making more milk in the future.

 A Proactive Approach

 Now that you’ve read this book, you have a more complete understanding of what happened or is still happening and what, if anything, can change that path. Working with the advantage of hindsight, you see more of the big picture now, and that puts you in a great position to become proactive. If this baby couldn’t remove milk well, the next baby will be starting fresh with a clean slate. You’ll know what pitfalls to avoid, and if you missed any windows of opportunity, you’ll be ready and waiting for those, as well. Whether you are thinking about another baby or already expecting one, a proactive approach will maximize your chances of making more milk the next time around.

Planning for the Next Pregnancy

Now is the time to explore your options, which vary depending on the cause of the problems For instance, if inverted nipples caused your problems, consider a device such as the Avent Niplette. Or, you might even look into the possibility of nipple release surgery.

 Perhaps you didn’t think you had hormonal problems but are wondering now. Sometimes lactation difficulties are the first obvious clue that something in your body isn’t working right. There are doctors who might tell you, “some mothers just can’t breastfeed,” but that’s like saying, “some mothers just can’t get pregnant.” You deserve to have a health care professional (possibly a reproductive endocrinologist) who will investigate why. Lactation trouble may just be the first symptom of a health problem. These answers are worth pursuing not only for the next baby but for your own long-term health.

 Some intriguing case studies suggest that insufficient glandular tissue may not be a permanent condition in every case. The original researchers of PCOS discovered that some of the young women grew breast tissue where little or none was present once their condition was treated and often went on to breastfeed success fully. Early diagnosis and treatment of PCOS or other hormonal issues, especially during the teen years of critical mammary development for future mothers but also before your next pregnancy, may help minimize problems. Metformin, a diabetes medication that is being used successfully to treat PCOS-related problems in many women, may in some cases correct enough underlying imbalances to allow for better mammary development before and during the next pregnancy. Herbs such as chasteberry and saw palmetto, which are sometimes used as natural treatments for PCOS, have reputations for balancing hormones as well as increasing breast tissue and may be useful between babies.

There are other unconventional ideas for hypoplasia that may be worth exploring as well Some women have experimented with herbs that have “bust-enhancing” reputations, though there is no research to validate whether glandular tissue is truly affected.

 Strategies for a Current Pregnancy

New pregnancies bring new opportunities. Most important is making sure, to the best of your ability, that all of your hormones are functioning properly. Conditions such as thyroid dysfunction should be monitored closely throughout and after pregnancy.

 If you have PCOS, are you currently being treated? Many women have used metformin to help normalize their hormones in order to get pregnant. As mentioned previously, research shows that continuing metformin during pregnancy decreases the risk of miscarriage, gestational diabetes, pregnancy hypertension, remature delivery, and pregnancy complications in general; some of these are also risk factors for delayed lactation. It may also allow for better breast development.

Irene’s low milk supply with her first baby was attributed to insufficient glandular tissue. She had taken progesterone injections during her initial pregnancy for the first trimester and experienced breast changes but reported that her breasts reverted back once the hormone was stopped. After discussing this with her doctor during her second pregnancy, she was placed on a regimen of both oral and injected progesterone that was maintained through eight months, after which she slowly weaned off of them Irene’s breast changes sustained better this time, and she delightedly reported that after the birth of her second baby, her milk came in well and she didn’t need to supplement at all.

 If your progesterone has been low, talk to your doctor about the possibility of supplementation. Progesterone treatment to prevent miscarriage traditionally is discontinued after the first trimester, but for improving glandular growth, therapy through most of the pregnancy may be more effective. Additional progesterone before you conceive also may give your body and breasts a running start.

Some women feel that particular galactogogue herbs have been helpful. Alfalfa during pregnancy and goat’s rue during the last trimester have both been credited by some mothers with boosting breast growth. One mother, pregnant with her seventh child after a lapse of several years, was not experiencing the same breast changes as before. After consultation with her lactation consultant and physician at thirty-six weeks, she started taking goat’s rue and began to experience changes for the first time just a few days later, including leaking colostrum. (As a beneficial side effect her blood sugar levels dropped, and her gestational diabetes resolved.) After a slow start and an additional month of herbs, she was able to exclusively breastfeed. It must be emphasized that these herbal applications are experimental and not backed by research. If you are interested but don’t have expertise in herbs, consult an herbalist, naturopath, or doctor of Chinese medicine for guidance and by all means talk to your pregnancy health care provider before trying anything.

You Never Know

 Angie grew up embarrassed of her small, barely A-sized breasts that she described as looking like “a tennis ball in a tube sock.” She was dismayed when she didn’t experience the pregnancy breast growth she had looked forward to and then, even worse, wasn’t able to produce much milk-just to 4 ounces per day. In addition to nursing, she pumped for a few months with her first child and for more than a year with her next. During that second round, her breasts started filling out and grew multiple cup sizes! With her third baby, she took alfalfa during the end of the pregnancy and additional galactogogues after birth. Her breasts continued to fill out, with normal shape and fullness for the first time in her life. Most amazingly, she made over 70 ounces (2 liters) of milk per day at her high point, much more than her baby needed.

 Chana had asymmetrical breasts with especially severe hypoplasia on her right side and experienced only slight enlargement with no tenderness during pregnancy. She struggled to make milk for her first baby with the aid of domperidone, supplementing at breast for two years so she could have a breastfeeding relationship. With her second pregnancy, Chana again had slight enlargement and no tenderness. But this time she was diagnosed with hypothyroidism and began thyroid replacement therapy. After the birth, she nursed frequently, used breast compressions , kept baby skin to skin, and pumped after every feeding with a hospital-grade pump. During the second week, she began using goat’s rue, domperidone, and Lactation Blend capsules by Vitanica. She ate oatmeal every day and took a daily flaxseed supplement. Within two weeks, she noticed increased veining and enlargement some supplementation was needed at first, she eventually achieved the exclusive breastfeeding relationship she dreamed about. Chana doesn’t attribute her success to any one thing in particular because she believes they all worked synergistically, but she does think that pumping and goat’s rue had the biggest effect for her.

 These intriguing stories suggest that some primary problems can be improved and sometimes even reversed with subsequent babies You never know it’s always worth a try!

Hope Is on the Horizon

Research in other fields may also help future mothers who have insufficient glandular tissue. Breast cancer research on turning cell growth off and on may eventually lead to therapy for completing interrupted mammary gland development. This same research has already led to another breakthrough: the ability to grow completely new breast tissue in a mouse from a single stem cell. Researchers envision the ability to replace tissue damaged from breast surgery but it may eventually be used to help mothers produce more milk as well.1 These and other advances in women’s health have the potential to dramatically increase our milk-making capabilities.

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