“Insufficient Glandular Tissue”
The lactation term “Insufficient Glandular Tissue” resonates less than positively with me. As a surgeon, I feel the term lacks precision. I discuss this in more detail on this podcast episode with Margaret Salty, the IBCLC Mentor.
As a feminist, I don’t believe women and their breasts are “insufficient.” Women are trying their hardest to care for themselves and their children in cultures and medical systems that haven’t been built to support them.
The medical system is “insufficient” for failing to provide standardized lactation education to physicians, advanced practice practitioners, nurses, physical therapists, and all other providers who care for lactating women and their children. Political and cultural systems are “insufficient” for failing to provide appropriate perinatal leave. Research funding is “insufficient” for failing to prioritize lactation research and help us better understand why conditions such as hyperlactation (“oversupply”) or hypolactation (“undersupply”) occur, and how we can support women who experience breastfeeding challenges.
Instead, women are told they have “insufficient glandular tissue,” which is a blanket term for a multitude of potential etiologies of low milk production ranging from tubular breast deformity (a congenital condition affecting gland development and breast appearance) to breasts that appear normal but do not make milk in significant quantities. We would not tolerate such a lack of understanding nor a lack of accurate definition for physiology and pathophysiology involving any other human organ.
In medicine, we have developed precise understanding of thyroid disorders, such as hyperthyroid or hypothyroid, as well as ways to treat these conditions effectively. Billions of dollars of research funding has enabled us to develop excellent therapy for diabetes, and surgeons have mastered pancreas transplants. We know how to support an adrenal that is lacking function. We know the body can’t survive without thyroid control, blood glucose control, or cortisol control. Lactation consultants and breastfeeding medicine physicians support postpartum women and children to the best of their abilities. Even still, there are only so many questions we can answer when there’s simply a lack of scientific information to provide.
Other Lactation Language
As we continue to advocate for increased education and understanding of the physiology and pathophysiology of human lactation, I think it is important to reframe our language as well. I refer to “low supply” by its medical name: “hypolactation.” I wonder if we similarly should change “incompetent cervix,” “failure to progress,” and “failed trial of labor” as well as many other terms that somehow suggest women are less than adequate. I also hear lactation language that reflects negatively on babies, such as “nursing strikes” and “sleep regressions.” Often, both of these situations are positive circumstances (for example, a baby is developing curiosity about the world and nursing less during the day and more at night to make up for calories), but moms are led to believe a problem exists with them and their babies.
While some women associate positively with the idea of “breastfeeding goals,” I personally avoid this terminology in my practice. I find the idea of “goals” can set women up for perceived “failure” if they need to supplement or have other breastfeeding challenges. Seeing the “grey” rather than the “black and white” of “meeting goals” versus “not” means we are able to offer individual support to every unique mom, baby, and family circumstance that exists.
