It can be disappointing to some, and devastating to others, when breastfeeding doesn't go as planned. In the quest to provide better support and education to new mothers, many breastfeeding advocates understandibly focus on the goal of success, especially with a healthy baby that seems to be nursing well. After all, most breastfeeding obstacles are temporary and brief. For a small minority of women, however, there are obstacles that no amount of time or effort can overcome.

Insufficient glandular tissue, or IGT, is a rarely-discussed condition in which a mother has underdeveloped glands that are thus less capable of producing milk. While many women with this condition also have small breasts, it is important to note that breast size in and of itself is not an indication of IGT, and that most women with small breasts produce sufficient milk. Rather, IGT is most noted by breast hypoplasia (asymmetry or underdevlopment that can be evaluated by a physician), and many women diagnosed with IGT later report little or no breast change during pregnancy and lactation. Photographic record documenting breast hypoplasia often displays visually obvious underdevelopment in one or both breasts, but variations in breast shape can vary dramatically from woman to woman, and the condition is not always visually obvious.

The good news is most women with IGT can successfully nurse, though in most cases, supplementation is required. Some women experience only delayed lactation, and with sufficient stimulation and temporary supplementation can later go on to exclusively breastfeed. In a few extremely rare cases, a mother with must use formula exclusively.

Here are a few tips if you suspect you might have IGT:

If you are still pregnant, prepare yourself emotionally, and inform your doctor of your concerns. One of the biggest difficulties for women with IGT is the disappointment experienced during the postpartum rush of emotions. Many women experience feelings of anger, guilt, or inadequacy, especially with the lack of information about IGT. The more you can prepare yourself, the better off you are.

If your baby is already born - don't panic. Remember that most problems with breastfeeding, even those related to poor weight gain, can be resolved and are not, in fact, IGT. Contact a lactation consultant to evaluate the possibilities and get advice as to how to maximize your potential for milk production.

Keep a detailed feeding and diaper log. This information will be valuable to you and your child's caregivers in order to evaluate when and if supplementation is needed.

Always remain in contact with your child's pediatrician.

Discuss your concerns about possibly having IGT with your OB-GYN and/or lactation consultant. Many women who are diagnosed with IGT report that no one discussed the issue with them prenatally.

If you advised to supplement with formula, do so with confidence. While formula is second-best to breastmilk, it is a nutritious alternative that babies not only survive on, but thrive on.

Most babies can adapt to feeding at both the breast and the bottle, especially after the first few weeks. If you are concerned about nipple confusion in a newborn, there are many ways to supplement besides the bottle, including a dropper or SNS (supplemental nursing system.)

If you wish to continue breastfeeding, remember to always nurse first and thoroughly before providing your baby with a supplemental bottle. Some physicians may also advise using a hospital grade electric pump to pump following each feeding, to assure the breasts have been thoroughly drained. As long as nursing sessions are as frequent and thorough as a woman without IGT, you will maximize your milk production.

Finally, if you do have IGT, stay calm and move forward. Whatever you decide, it is important for a mother to feel confident and positive about her circumstances and her feeding choices. Many mothers with IGT go on to have successful and fulfilling breastfeeding relationships. Breastfeeding with IGT does have its own challenges, however, as you cannot enjoy the full advantages of either breastfeeding or bottlefeeding, and there may be a range of physical and emotional burdens that only you can assess. If you find supplementing is too impractical for your circumstances and choose to bottlefeed exclusively, do so liberated from any feelings of inadequacy or guilt. As a whole woman and a whole family with diverse circumstances and needs, only you can decide on a practical feeding plan for your baby that not only nourishes your child, but creates a family situation that is calm, balanced, and content. Your baby's greatest need isn't just breastmilk, it's you.