Guest Post: Are we failing those with lactation failure?

FFF Kathleen, over at AMoment2Think, recently emailed me about the “myth” of lactation failure. She made so many excellent points that I felt she’d be far more effective than I at writing a post on the subject. I’m sure this will lead to some hearty debate, so I just want to say in advance – I am so grateful to Kathleen for doing extensive research and putting so much thought into the following post. I agree with her that there is something fishy about the party line here… which is a shame, since I believe that only with acceptance/acknowledgment of the reality of lactation problems, can come the research and assistance so many women need to breastfeed successfully.

***

How many times have you heard this line? “95% of all women can breastfeed” I don’t know about you, but I have heard it more times then I can count.

In my experience, this phrase is used in one of two ways in breastfeeding/formula feeding dialogue.

1)    To support a women to trust her body. Let’s be honest, we aren’t always as in touch or as trusting with our bodies as we could be. And in the stress, anxiety and shock of having a newborn, we sometimes need some encouragement to have confidence in ourselves. In a world where we are accustomed to being able to measure everything, it is a hard adjustment to trust your body to do what it was designed to do. So I am all for the kind, supportive and affirmative use of this phrase with women who want to breastfeed and need to be reminded to trust.

2)    But then there is the other way it is used. You know, that way. Where it is used in a way that is dismissive of a woman’s story or critical of her choices. When it is used to condescend or imply she is ignorant. That is when it is Just. Not. Cool. And this is when I have an issue with it on a number of levels.

I think first, we need to do a quick definition of what ‘can’ versus ‘not physically able’ to breast-feed means. When we are talking ‘not physically able’ what the literature seems to be saying (correct me if I am wrong) is ‘not able to produce enough milk to support a full term infant’ ie: serious supply issue that does not respond to any of the recommended methods to increase supply. Typically, what has happened is something has interfered with the breast tissue to the extent that it can’t do ‘as nature intended’, although I am sure there are other reasons beyond breast tissue. Examples would be PCOS interfering with breast development as explained here or breast augmentation, as explained here.

First, let us accept the premise for now and assume that that number is accurate. If 95% of women are physically able to breastfeed, then there are about 5% of women who are not physically able. Which is a tiny minority, relative to the 95%. But have you ever considered just how many women, per year in US and Canada that is?  Using 2007 numbers, there are around 230 000 women a year* who would fall into the category of not being physically able to breastfeed. That is a lot of women. A lot.

Back to the numbers: 95%. I will admit to not being the best researcher on the block, so if anyone else wants to help me out here, please do so. But I had a heck of a time getting my hands on an explanation of just how we came up with this 95%. What was actually studied? Was this a study of the physical mechanisms of the ability of women to produce breastmilk? Was this a historical study of women’s ability to breastfeed before formula was invented? Was this a study of the ability of women to produce sufficient breastmilk to nourish a full term infant for at least 6 months under ideal circumstances of good support, low stress, a positive birth experience, adequate maternity leave, good nutrition, ect. ect…. Was this a study of ‘given a bit of knowledge and a bit of effort’ 95% of women who wanted to breast feed could, with a low threshold for ‘ideal circumstance’? Because those are all very different things. Particularly when you consider the difference between what could be and what is. If this 95% is based on ideal circumstance, when very few women have the ideal circumstances, then the number isn’t very helpful, now is it? Again, it is all in how you use the phrase. If it is being used in the dismissive ‘you probably didn’t try hard enough’ to breastfeed kind of way or a ‘you’re probably just imagining that you have supply issues’ kind of way, it is just adding insult to injury, as it is likely the issue was/is lack of support, not lack of effort.

I don’t much doubt that from a historical ‘back before there was formula’ perspective that 95% of women were probably able to breastfeed under most circumstances. But I will also recognize that pre-formula:

a) there was much more community and family support with women close at hand who had breastfed before

b) there have always been, formally or informally, wet nurses for women who couldn’t/didn’t choose to breastfed

c) there is some evidence to show the use of other animal milks for infant feeding pre-formula (goat and cow mostly from my understanding)

d) and in tragic circumstances, some babies did not get enough nutrition

I am not saying that with better support it isn’t possible for 95% of women to be able to breastfeed today. I am just saying that we aren’t there. Saying that statistical 95% number doesn’t change the fact that most women do not have access to the support they need.

I will go one step further. I don’t buy the 95% number for a number of different reasons. First off, from an anecdotal stand point, doctors and breastfeeding advocates alike are starting to notice (and talk about) more and more women coming to them with true supply issues. Consider this excerpt from a 2005 publication I found on the Le Leche League website: “When I became a Leader in 1986, true insufficient milk supply was considered a rarity. In recent years, however, there seems to be an increase in genuine lactation failure that has defied explanation.”

The article goes on to talk about the connection between Polycystic Ovary Syndrome and its links with breastfeeding difficulties. Despite the fact that breastfeeding issues were alluded to in the original medical studies on PCOS in 1935, the article says that recent medical literature has focused on the impact of PCOS on fertility and mostly left out the possible impact on breastfeeding. I have heard that more studies have been done since this article was written in 2005, but I can also tell you from personal experience that my many health care providers had NO IDEA about the link between PCOS and breastfeeding difficulties. It was not until I had been seeing a doctor specializing in lactation for over 2 months when she looked back in my chart, saw PCOS, and decided to look it up ‘just in case.’ It was then that she told me that the PCOS might be the reason we couldn’t get my supply up, no matter what we did.

I have seen estimates of anywhere from 5-15% of women are effected by PCOS and up to 30% of women display some symptoms. While the literature on breastfeeding and PCOS is careful to say that not every woman with PCOS will have problems with breastfeeding, the chances that she will is higher then your average women, both because of the hormonal imbalances and the possibility of the breast tissue not developing properly during pregnancy (also due to hormones).

But you know what really got me when I started to look into this? This article talking about primary lactation failure from a doctors perspective: “This disparity in knowledge and treatment is no accident. If you search the database of federally funded medical research for ‘lactation failure,’ there are only 9 studies listed, compared with 84 for erectile dysfunction.” Yeah, that is not cool. So we say we are for breastfeeding, but we aren’t willing to look into a real and growing issue for thousands and thousands of women every year, that is stopping them from breastfeeding. Huh?

If you have seen my comments on this blog before, I warn you now that I am going to go into my speech about the insanity of how we advocate for breastfeeding in North America. You may have heard this from me before. Why, oh why, do some breastfeeding advocates focus their attention on judging, shaming and scaring women into trying to breastfeed, when they should be focusing on 1) SUPPORT and 2) RESEARCH into the actual reasons that women struggle to breastfeed? It seems pretty clear to me that more women are experiencing supply issues, and yet they are often brushed off with just this “95%” phrase. Rather then dismissing woman’s concerns over supply, why not fight to get research into how to actually over come those challenges? Because the options we have right now are hit and miss, not to mention incredibly time consuming and expensive (pumping, herbal galactogues, prescription medicine).

Dr. Marianne Neifert suggests in this article that about 15% of women experience issues of low supply. While some of this 15% may not respond to treatment, all of the 15% need the support to try. Furthermore, Dr. Neifert also says this, “We now are starting to learn that fatigue and stress and anxiety release hormones that have a negative impact on milk supply, and so the best thing we can do is get somebody a little extra rest and calm them down and reassure them.” Let’s focus on helping those who are committed to being successful first. The best advocacy would be for more women to achieve their breastfeeding goals.

*This 230 000 is a very rough estimation. I found 2007 numbers for babies born and calculated what 5% was. Then I rounded down. Way down. Because, of course, some babies are multiples. That being said, whether the actual number is 250 000 or 200 000 the point remains the same. Its not just 5 women a year and everyone else who claims primary lactation failure is making it up.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


Related Posts Plugin for WordPress, Blogger...

42 thoughts on “Guest Post: Are we failing those with lactation failure?

  1. Given your discussion on how PCOS might affect breastfeeding, I'm wondering if the increase in fertility treatments enabling women who might not have been able to get pregnant otherwise might also contribute to genuine supply problems. That's a study I would love to see!!

  2. I was talking to my mom (LLL leader for years in the '70s and '80s) about some of the things that are making women not able to breastfeed (either fully or partially) now that I've just picked up form listening to people's stories and connecting the dots. She was shocked and horrified at the ways birth has changed (IV fluids causing edema of the breasts) to PCOS issues (probably from plastics in the environment) to stress from no support. And she said, “Wow. It's such a different challenge now to breastfeed than it was 35 years ago.” I just don't understand why people can't see this: We are not the same and we're not being treated the same. So why on earth would our bodies work the same?

    Yes, we're failing all over the place.

  3. Thank you, thank you, thank you, thank you.

    Maybe my supply drop could have been fixed. When my milk vanished after an extremely stressful week spent at a very high altitude (everybody else was sick. I felt fine! Silly me…), I spent a month pumping and nursing and taking supplements under the guidance of a very sweet LC, all to no avail. Maybe if I had all the resources available in the world to help me, we could have brought it back. But that was not my reality.

    “Why, oh why, do some breastfeeding advocates focus their attention on judging, shaming and scaring women into trying to breastfeed, when they should be focusing on 1) SUPPORT and 2) RESEARCH into the actual reasons that women struggle to breastfeed?”

    This says it all, and explains why women who fail to breastfeed are ANGRY, and much less willing to try the second time around. Because formula actually WAS best for my baby at that point. Their smoke and mirrors of fear and shame were shattered, and I no longer believe anything they say.

  4. This is an incredibly interesting (and important!) read. I need to go through and read through some of the research, but right off the bat Kathleen points out (through simple math) something that has long bothered me:
    Even IF it's just 5% of women who CAN'T–that's still a big freaking number. So where's their support?

  5. Anecdotally, I know quite a few women, including me, who have had some undersupply but still produced milk. I feel like that is not addressed enough.

    For me, I made just about enough milk until my daughter reached 3 months and her appetite increased; my supply did not increase to match her appetite. I tried more frequent pumping, massage, and herbs (which gave me clogged ducts, but that's another story).

    In retrospect I probably had a slight under-supply all along. My daughter is now 5 months and is totally formula-fed, since it didn't make sense to me to spend enormous amounts of energy pumping in order to provide about a third of her daily diet, which was the max I was making when I finally stopped BFing/pumping when she was 4 months. And, since switching to formula, she has gained a significant amount of weight– 13% of her body weight from 4 months to 5 months.

    As I said, a lot of people I know have had similar experiences, particularly around the 3-4 month mark, when the baby's appetite increases.

  6. I absolutely agree that 5% is still a large number of women! My milk never came in until I started on domperidone. While domperidone and fenugreek did help to increase my milk supply, it was never enough to keep up with my baby's demand. In the end, the grueling nursing/bottle feeding/pumping schedule was too much for me and I had to give up on breastfeeding and pumping.

    It's strange how breastfeeding classes, books, nurses and lactation consultants either do not mention supply issues at all, or they quote the 95% statistic that makes you feel like low supply is all in your head. Instead of doubting my body, I was doubting my judgment because I knew that my baby's constant screaming was due to hunger, yet I started doubting my own instincts because of this suggestion that supply issues are “very rare”.

    From other mothers that I have spoken to about formula feeding, it seems like low supply is usually the reason why breastfeeding didn't work out. I don't think I would have felt so guilty about formula feeding had I known that supply issues DO exist for a lot of women.

  7. Thank you! I'm one of those 5% who had breast reduction surgery and am physically unable to nurse. I was told I'd be fine and to trust my body, which I did, but my breasts filled with milk and not a drop could get out. It is Soooo comforting and empowering to think that there are more than 200,000 of us (though if they have suffered the loss as I have, I wish we could support each other….)

  8. My initial reaction was similar to that of Ginger and others: 5% is a big frickin' number! I think this is illustrative really of the widespread innumeracy that plagues our population. The average person who hears “95%” hears something that is more like what I'd hear if someone said “99.9%”.

    And I mean, according to this article,
    less than one percent of the population is gluten intolerant, but I see gluten-free products everywhere. So if anyone is using this 95% figure to pooh pooh the possibility that someone might not be able to produce enough milk, that is not cool with this lactivist.

    And I absolutely support more research into this area. I don't want to see anyone who is trying to breastfeed fail at it, whether it's because of “booby traps” (which I think also have to be acknowledged as common culprits) or because of true bioligical reasons like those discussed here.

    However, before you get too quick to bristle at lactivists' public health campaigns, you need to remember that despite 5% being a solid number, that's not 5% of all mothers. It would perhaps be 5% of all mothers if all mothers actually tried to breastfeed (though since younger mothers are less likely to try, it would probably be a little less). There are around 30% of mothers who don't even give breastfeeding a shot. And if 5% of the other 70% is significant, this number is roughly ten times as large, which is frickin' huge. So if we lactivists want to make the biggest impact, for now at least it involves aiming our efforts at those who don't even try, don't even have the awareness of breastfeeding and its importance. See what I mean?

  9. I too have wondered about all of this. My mom told me that most women on her side of the family had trouble breastfeeding and did not supply enough, so she was not surprised at all when I was having trouble. Yet all the research says that having a supply issue is very rare. So were all the women in my family just not trying hard enough? I know I tried my ABSOLUTE BEST to breastfeed, and still failed. I'd love to see more research on how rare is it really to have low supply.

  10. @ Moxie, or anyone else who knows: IV fluids cause supply issues? I was pumped full of fluids in an attempt to bring down a fever (cause unknown) during labor. The fever resolved after I delivered, but it was a big problem because it wouldn't come down with fluids or tylenol. There were worries for the baby's safety, health, etc.

    So, you mean, IV fluids could have caused my problems? Does that mean problems immediately after the birth (which I actually didn't have) or problems later (which is when BFing failed for me)?

    Sorry to hijack; I just never heard of this connection before and would love to learn more, especially since we'll try to BF again if/when there is another baby.

    K, I am loving these series of posts! You are taking on the big issues in a smart, helpful way.

  11. Another factor to consider is anemia—many women end up anemic during pregnancy/post partum, and that could affect milk supply too.

    In my case, I'm not sure it would have made a huge difference, but none of my doctors suggested that I stay on iron supps after delivery (a delivery in which I hemorrhaged badly 8hrs later) and I was glad to be done with them, so I stopped taking them. I found out 3mos later that I was anemic. I also had twins and PCOS, so those would also have been factors with my supply issues.

    My point is: doctors, nurses, LCs probably should be telling women to stay on iron supps or start them, after delivery.

  12. I was recently diagnosed with PCOS (like, last week recently) and found out about the connection between PCOS and supply trouble a few months ago when I was sure that my bloodwork was lying and I wasn't fine. Honestly, with all the other crap, the trouble I've had with my cycle for 14 years, the trouble I've had recently working toward trying, and the hate-hate-twisted pride relationship I've had with my breasts, it instantly became this horrible daunting thing. Breastfeeding was always “normal” to me. It's what everyone in my family did. I was told I was weaned “early” because my mother had to start a medication. I knew I'd been deprived. I was weaned at 15 months. Yeah, so deprived. But this was what I have been expecting for years and the one justification for this tortured relationship with my breasts which have always been too large. If they can just be useful, then I've not carried them for no reason. I don't know if I'll be one of the 30% that have trouble (or the 30% with oversupply, which is really my bet), but I'm glad to have found you, FFF, and to know that, in a world of growing lactivism, there might be some support for me.

    As far as lactivism goes, I agree that their intentions (good or not-so-good) would be better served addressing the policy and research issues instead of this “awareness” nonsense. Individualized adopt-a-mom type programs are great, but aside from simply visibly breastfeeding, and normalizing it through action, I don't see anything but viciousness in the “oh you should be breastfeeding” activities.

  13. Low supply runs on my moms side of the family as well. My Oma had it, my mom had it, and I'm not sure how far back that goes. I know I had it. But Hypothyroid also runs on both sides of my family and hypothyroid is often triggered by birth or if it was present before, grows more prominent.

    I think part of the reason that people thought it was rare was because most women in the past didn't seek out LC's or LLL's. If they had good family support they sought them out, otherwise if they encountered difficulties they stopped and found an alternative. It wasn't as big of a deal then as it is now.

  14. I am always interested in hearing about how certain breastfeeding issues seem to run in families. Does anyone know if there have ever been genetic studies on whether low supply can be inherited? I tried looking into it at one point, and just found a bunch of people insisting that it's not, but I don't think I believe that. I mean, I'm not a scientist (although, my husband is), but it just seems like something that could be passed down. Also, if you think about it from an evolutionary standpoint, I suppose low supply would, if not for the advent of formula, be something that would be much rarer, due to natural selection. If the mom with low supply can't nourish her children, then her line would end, thus ending the low supply problem.

    I know, for myself, my mom has severely inverted nipples (I'm sure she'd love to know I just put that on the internet), and physically couldn't breastfeed, no matter what. So my brother and I were formula fed. I inherited a single mildly inverted nipple from her, which caused issues for me early on. If nipple type is passed on from mother-daughter, why not milk supply?

  15. @Samantha,

    Wow. That is such an astute observation, and seems so obvious… like you, I'm no evolutionary biologist/anthropologist, but I will certainly find one to pose that question to. It seems odd that no scholarly articles or studies have been published on this, doesn't it? It would answer the question as to why there are more breastfeeding problems these days.

  16. @Samantha

    I don't really know about low supply and genetics in the general sense but PCOS certainly runs in families.

    My paternal grandmother and aunt both had PCOS. Interestingly, both gave birth to several children without any fertility treatment (of course, this was way before fertility treatments were even an option). I'm not sure if either of them breastfed their children.

    I didn't manifest any symptoms of PCOS until I was 32. All of a sudden, my symptoms came on like a ton of bricks. I had to go through one round of fertility medication to get pregnant. I had extremely low milk supply, despite taking Metformin through my whole pregnancy and trying an assortment of strategies after the birth of my twins to boost my supply.

    The literature suggests that PCOS is on the rise – so, one could imagine that there will be more even women with PCOS who will need specialized lactation support if they'd like to breastfeed.

    And I think (I might be wrong about this!) that those numbers mentioned above – that 30% of women with PCOS have low supply, 30% of women with PCOS have oversupply, etc. – I think that is based on a phone survey by Lisa Morasco (a wonderful IBCLC) of 39 women with PCOS. If you google her name, she mentions it in several interviews. There really haven't been any large scale studies on PCOS and breastfeeding – so, we really don't know exactly what those numbers are yet – it could be much higher than 30%. If you are part of any PCOS support groups for new moms, the numbers sure seem higher than 30%.

  17. @Samantha: At the risk of going off the lactivist reservation, it definitely makes sense to me that low supply could be genetic, and thus in an era when formula is available, it can become more prevalent in the gene pool. This is no different from many other genetic issues that, in our primordial state, would be constantly culled from the population and thus kept at a low level. For instance, I wear glasses due to my high astigmatism. This is something that before modern civilisation would have made it harder for me to survive and reproduce.

    Even more stark is the issue of c-sections, which are steadily on the rise. Most people who are into the “crunchy” stuff I am blame this entirely on cultural factors and OBs who are too quick to pull out the scalpel. I think there's some of that, but I think it is increasingly a genetic issue as well. I was born by c-section, as was my sister and our father. Two of my three kids were born by c-section, as were both of my sister's kids. The common denominator: we all have giant noggins, like 99th percentile. The only descendant of my paternal grandfather (with a big cranium himself) who was born vaginally was my eldest son, who would have been sectioned by most doctors and only emerged after six hours of pushing.

    The point is, any evolutionary biologist can tell you that human evolution saw brain (and thus skull) sizes steadily grow, until they reached a limit imposed by the pelvis. But in the age of surgical birth, there is no longer that mechanism to keep cranium size in check, so we shouldn't be surprised to see c-sections become more prevalent, just as I'm sure bad eyesight has since glasses were invented. By the same token, the availability of formula has surely allowed genes for low supply to become more prevalent, and will likely continue to do so.

    So as I say, I differ with many of my crunchy counterparts who insist that everyone should just “trust their body” and everything will work out fine. It's just not always the case.

  18. I know that on my mother's side most of the women who were born after the 1920's breastfed. However, thyroid issues are major in my family and now I have hypothyroid. My aunt who had thyroid cancer and myself were the only ones we knew with the low supply issues.
    @ Samantha, I also have inverted nipples not that I want to say that on the internet either, but it is a very important issue on why women like us have breastfeeding issues. No one I know in my family has this so perhaps it came from my father's maternal side? A study should be done. It would be interesting. Like Alan said, I also wonder about childbirth being inherited too. I was told that like my paternal grandmother I am petite like her and we both went into fast labor giving birth to babies over 8 lbs. We are not obese it just seems to be hereditary for us to labor less than 8 hours and give birth to big babies w/ big heads *LOL*. My paternal aunt and cousin had the same labor too so would be neat to see a study on the childbirth and breastfeeding issues having any hereditary correlation.

  19. Before my own experience of giving birth and having a low milk supply, I was one of those people who believed that there wasn't really any such thing but that the real problem was people not receiving enough support or the right information. I was encouraged to think this way by all the information I was given in pregnancy from books and antenatal and breastfeeding classes. No one ever mentioned there could be supply issues that would not respond to demand. Even the LC I saw while in hospital told me that it would be very unlikely that my supply would not increase if I pumped and used galactogogues. Hence, it was rather a shock for me when I ended up in that situation. In those first few weeks I desperately needed support and the only place that normalised my experience was the internet.

    Helen from New Zealand

  20. I never even thought about births being genetic, but that's a really interesting point! I don't have personal experience with that one. My mom's pregnancies and labors were very typical. Mine wasn't. I had a precipitous labor that only lasted about three hours from first contraction to Gabby's arrival! I don't know anyone in my family who had a fast birth like that, and I'm very petite and fit, so it isn't due to size or health. However, I was told that the gestational diabetes I had was solely due to so many people in my family having type 2 diabetes, so there is that.

  21. I would agree that genetic factors play a role in the causes of low supply. Even if it's not always known, there's always a reason for low supply—could be not enough glandular tissue, hormone imbalance, or other things that can be inherited.

    Also, many human conditions are a combination of a genetic tendency + some external factor that triggers it. An example could be some types of cancer—if you have inherited a genetic mutation, you may be more likely to get a type of cancer, but only if certain conditions are met, like if you smoke or something.

    The same could be applied to supply issues in some cases—PCOS and Type 2 diabetes seem to have a strong genetic component, but we know that T2 diabetes at least, can sometimes be controlled or avoided by lifestyle choices. Both of those conditions can lead to infertility issues and there now seems to be a correlation between them and supply issues.

    Anyway, with current fertility technology available, more women who would never had had children 30yrs ago have them. If their conditions are linked with low supply, that could contribute to an increase in supply issues among new mothers.

  22. Actually, the 5% number is from Neifert herself. She did a study of women who planned to breastfeed. Fifteen percent of them were unable to breastfeed successfully (i.e. have their babies gain weight adequately on breast milk alone), but in just over two-thirds of these 15% (11% of the whole sample), the lack of success didn't stem from an inherent inability to produce milk but other factors such as a baby's failure to latch on, inverted nipples, etcetera. On the other hand, the other third (4% of the whole sample) couldn't produce milk no matter what the circumstances. Some of these reasons had to do with inadequate glandular tissue or breast surgery, especially reduction but sometimes augmentation as well.

    Regarding infertility, yes, I've heard it said that sometimes women who cannot conceive naturally because of hormonal problems also find it hard to produce enough milk because of the same hormonal conditions. In the past, they simply would have had no chance to demonstrate their milk-producing ability because they wouldn't have the reproductive technologies we now have.

    So as more women have breast surgery and as more women with hormonal problems manage to conceive, the 4% or 5% number may go up.

    Emily

  23. One post then I will scuttle off honest 😉 Don't want to be considered like Alan the Ant!

    The figure quoted is usually 97/98% and I believe ninety-eight percent first-month nursing has been accomplished in Sweden, with 98% upwards in other parts of the world (ie the odd tribe has 99.9!) The biggest thing in Sweden that increased rates was stopping formula in the hospital – perhaps as staff had to help rather than reach for an alternative? My experience from supporting mums is that the vast majority with PCOS breastfeed just fine; however, I have supported cases of assisted conception where the mum has never had milk “come in” – likely linked to why she couldn't conceive naturally. Then again I also know a lot of IVF mums who breastfed just fine, so no hard rules.

    BUT as you say this figure IS under ideal circumstances of good support, low stress, a positive birth experience, adequate maternity leave, good nutrition, etc etc

    It's not a position we are in. Birth and the first few days can have massive impact. For example C-Sections, long births or very fast births can compress the head which can easily interfere with the baby's ability to feed because nerves run through the head. Problems like this are very very VERY rarely picked up by mainstream medical staff – you are looking at a super on the ball lactation consultant.

    Interestingly areas with the least medical intervention, have the highest rates – whereas high tech countries have more women who struggle. But this is very similar for all other mammals.

    AA

  24. I am so interested to hear all these perspectives.

    Maybe a bit of reassurance is in order. I am an IBCLC in private practice, a La Leche League leader,and a breastfeeding coordinator for a WIC program. I breastfed my own five children without real issues.

    In my work I see lots of different kinds of women, different races,ages, socio-economic groups, and various biological issues. I would not dream of doing a consult without a careful history, including the factors mentioned in previous comments of PCOS, thryoid or fertility problems, medications taken, and breast surgeries, all of which can have a signigicant impact on breastfeeding.

    I also start out asking the mom what her goals for breastfeeding are. Many women only want to breastfeed part-time, and that is surely their option. It is my responsibility to help a mom achieve her goals whenever possible, while making sure she is fully informed about all her choices and their ramifications.

    Although I am of course a strong breastfeeding advocate, I also want to be respectful of others' choices, as well as the fact that there are women who are unable to produce a full milk supply. I also have friends who are wonderful mothers with healthy children who made the decision for their own reasons not to breastfeed. Parenting is about more than breastfeeding!

  25. I really respect your website! I'm a speech therapist and lactation consultant who works with premature babies. So basically I am a bottle feeding expert and a breastfeeding expert, if that's an odd world to live in that's me. Anyhow I think it is great the support you show to both the breast and bottle feeder. My philosophy is at the end of the day you need to FEED your baby. I do think breast is best, however I watch alot of mommies do everything in their power to give breast milk or breastfeed and sometimes it is just too much. I believe we need to build up these moms for their commitment to try and reassure them that they have not failed and they did the very best they could given their specific situation. Anyhow thanks for your web site I think you will help many moms.

  26. This is another very good post! I think you are fulfilling a great role by giving such a balanced and responsible viewpoint.

    I second everything that the Armadillo said about failures stemming from hospital policies surrounding birth and add onto that, the lack of education and willful misinformation demonstrated by so many pediatricians. I have spoken to so many women now, who tell me that they were told by their pediatrician, often many years, or decades ago, that they didn't have enough milk. With a little prodding we discover that there was probably no issue and the poor woman has been blaming herself and calling herself a failure for years when it was the doctor who lied to her, not a failure on her part.
    This is a large part of my personal philosophy, which is every woman who even tries to breastfeed is a sucess, period, a hero even! As far as I'm concerned, if you ever put your baby to breast, you breastfed, period. And if something intervened, whether true low supply, or bad medical advice or the effects of bad hospital policy or aggressive formula marketing, then that is an unfortunate circumstance but never a failing on a mom's part!
    I do think that we are seeing a lot more low supply issues, for whatever reason. I think when more women try, but are unsupported of course we are seeing fewer women meeting their goals. As lactivists we need to focus on changing these unsupportive policies, on educating doctors and nurses, on combatting formula marketing but certainly not on individual women. For individuals we need to advocate for them, to get them the support and information they deserve, to donate milk to them and to comfort them if nothing works. I know how much it helps a woman to hear, even years later, that she was NOT a failure bt rather she was failed by those who should have known better but didn't. I know how good it felt to give my friend with PCOS and surgically reduced breasts a nice stash of frozen milk so she had that as backup instead of formula, and how it felt even better to know she hasn't had to use it yet!

    but the other factor that I think is contributing to low supply which hasn't been mentioned is pollution. the chemicals floating around in our air and water, the fertilisers and pesticides in our food. the pharmaceuticals flushed down our sewers and through our livestock, all of this affects our fertility and our milk supply. Look at BPA, we're taking it out of our baby bottles, but moms still are exposed. it's an endocrine disruptor, and lactation is an endocrine function! even overpopulation must be affecting this. animals in crowded circumstances have decreased fertility, why wouldn't milk b affected too?

    there's so much that gets in the way of motherhood in our world. and that's not even taking the patriarchy into account! so, is it 1% or 3? 4? 5? you're right, it doesn't matter. we need to focus on being there for those women, however many there are! whether it's supporting her in making breastfeeding work, or providing milk by donation or cross-nursing, help is the only thing that's helpful :)

  27. Hi
    one thing i would like to add (as a BF advocate who actually had to use formula on day 4 when my son was very sleepy and dropped over 10% birthweight. he went on to recover well and BF for two years, but it took a long time to get it right) is this:
    there is very little paid research into breastfeeding, because no-one wants to pay for it. most of the research into lactation is done by formula companies so they can imitate human milk more closely and make a killing on it.
    If you feel strongly about this issue write to federal government about it, cos most other BF advocates don't have the money or resources to do the research – it needs to be coming from impartial sources. You mentioned 30 studies on erectile dysfunction – thats the big pharma companies making a market for viagra….
    I applaud your blog as a rational look at the debate, but please remember, that while formula was medically necessary for you, me and many other women, for many many more it has become a lifestyle choice because multi-national companies make big bucks out of undermining women's superior biology. The world health organisation recommends formula as the 4th best method of feeding a baby (1st is bf weith mother, 2nd is mothers milk by bottle, 3rd is donor human milk, then formula). If the money spent on researching to sell more formula was spent on making milk banks available at every hospital, your child and my child could have been spared the use of formula, and we needn't be having this debate!

  28. @ceba

    (I am the author of this guest post, so I thought I should respond).

    I understand and can appreciate what you are saying. I have no doubt the reason there are so many studies for erectile dysfunction and not for lactation failure is 100% about money. I am not naive to that.

    That being said I have to disagree with you on a number of points.

    First off, there is research money being spent on breastfeeding- I just think it is being spent in the wrong place. Studies are done regularly trying to show the benefits of breastfeeding and the harms of formula feeding- which seems to me to be aimed at getting more fuel for the PR battle, rather then really helping women. It is generally agreed upon that breast is the ideal food for babies. Not every women may have this information, but I don't think we need more studies to 'prove' it. That money could be better spent finding out why so many women struggle to achieve their breastfeeding goals.

    Secondly, there is a market out there for pharmaceuticals related to breastfeeding. I was on major doses of domperidone for the better part of 4 months, a drug designed reduce vomiting, which just happens to increase lactation. I was also prescribed (experimentally) a drug for diabetes near the end of my breastfeeding ordeal which was rumored to help women like me with PCOS with lactation. With the push to get women to breastfeed big pharma could probably find a way to spend some money on drugs safe for breastfeeding not only for lactation, but also for other medicial issues where our current drugs are not safe for breastfeeding. I am not a fan of big pharma, I am just trying to make a point.

    Lastly, I totally disagree that BF advocates don't have the resources or the money to push the government to do some research into lactation failure. It seems to me there are some pretty strong and successful breastfeeding advocates out there who seem pretty influential if you ask me. (Look at PHD in Parentings recent post re: Babble and Similac. Though they haven't publically admitted their fault it appears the Similac ads are off the Babble's Breastfeedings guides page. http://www.phdinparenting.com/2010/09/03/similac-and-babble-team-up-to-dupe-breastfeeding-moms/).

    What I am saying is that government is often moved by lobby groups and special interest. To say it has to be us 'impartial' formula feeders who ask the gov to spend some $ on research is absurd. Why don't we do it together? If all the breastfeeding advocates and all the women pissed that they couldn't breastfeed partially because no money is spent on studying lactation failure got together and lobbyed the government, I suspect it would do a lot of good. More good anyway then this back and forth battle we spend some much time with each other on.

    Why not work together? Why not advocate for something that would make a big difference to women already committed to breastfeeding?

  29. Kathleen – have you ever read the polics of breastfeeding? WELL worth a read when writing/reading about this subject if not.

    QUOTE Studies are done regularly trying to show the benefits of breastfeeding and the harms of formula feeding- which seems to me to be aimed at getting more fuel for the PR battle END

    Are they? Isn't it just that studies are done (often by AF companies trying to improve the substitute) and the outcome is that AF fare worse – fuel for PR battle? intersting, do you have a study(ies) in mind you are refering to? Who is the PR of breastfeeding? In the UK the government spend 17p per baby born promoting breastfeeding, compared to over £20 from the formula companies, so certainly not them it would seem….

    QUOTE That money could be better spent finding out why so many women struggle to achieve their breastfeeding goals.

    Again the Politics of Breastfeeding explores this in some detail.

    It's not all about women failing at their goals though either is it? Even if you tell mums ah we can help, all you need to do is XYZ, a mum can easily say actually she doesn't feel the effort is worth it and she has decided to bottle feed. Women DO feel substitutes are a “nearly as good choice” – despite the mountains of overwhelming evidence demonstrating outcomes are less favourable (as you yourself mentioned above) they want their husband to share feeding or as a UK baby magazine recently phraaed it “she just couldn't be fagged”. People don't really relate to studies and the implications to themselves, otherwise all the studies already done would impact. So um it wouldn't seem to be that good a PR move if that was indeed the motive as you suggest.

    QUOTE That money could be better spent finding out why so many women struggle to achieve their breastfeeding goals.

    But it is as well? we know how intricately linked birth and the first hour and day are – we know this doesn't happen as it should for most mothers. We know the impact of this on feeding. We also know so many Western parenting practices interfere with lactation – when they are removed rates soar. We have so many logical evidence based reasons for why lactation isn't working, why start working on obscure theories for potentially a miniscule percentage of the population when we know why masses of mothers are failing??

    QUOTE What I am saying is that government is often moved by lobby groups and special interest.

    It's all about the money as the book I mentioned above discusses. This is an interesting US example of “PR”:
    http://www.truth-out.org/112908E

    When free formula is removed from hospitals, that alone causes initiation and early rates to massively increase – why would this be if it was down to broken mothers?

  30. @Armadillo-
    One thing that frustrates me is that a lot of the claims you are making have been further discussed on this blog, and yet, we seem to rehash them every time someone comes on to “argue” the point. I'm sorry you feel that health problems are a “minuscule” population. We've expounded on that before that even a small percentage translates into hundreds of thousands of women, at minimum. And I'm sorry but I have MANY CHOICE WORDS for anyone who would call many of the women who frequent this board “BROKEN.”

  31. @Armadillo,

    I think part of the reason some women choose formula over breastfeeding despite the numerous studies showing more favorable outcomes in breastfed kids is that anyone who has taken college-level statistics or read any of the great pop science books about how medical studies work and how they are misinterpreted in the media (I highly recommend “Bad Science” by your countryman Ben Goldacre, or “Denialism” by Michael Spector, or “Damned Lies and Statistic” by Joel Best) can figure out that these outcomes are far from black and white. These studies are SO rife with confounding factors, which is not the fault of the researchers, but they do need to clarify these restrictions in their reporting of the studies, which many don't take the time to do. Even in the studies which claim to “control” for a variety of these factors, there is a clear difference between women who breastfeed and women who do not, and it's not easily quantifiable. And even if we were to forget all of that, when you look at the actual numbers – not the misleading memes that get spread through social media – there may be statistically significant advantages to breastfeeding, but in most cases, they are nominal. (The diabetes study I recently discussed is an example of where this is NOT the case; I do think that there was a true statistical advantage to breastfeeding in this case, so if you are at high risk of diabetes, breastfeeding might be a good way to cut that risk. However, choosing to have no kids is almost as good a risk-cutter, and should we be encouraging women to give up their dreams of motherhood in order to prevent a disease they most likely won't get if they don't have a family history, eat and exercise well?)

    Regardless, everyone is entitled to their own interpretations of data such as this, because it is not “hard science”. There have been some studies on the actual properties of breastmilk, and those are far more encouraging. But other than that, we are dealing with mostly observational studies, and things get a bit tricky. I am not saying breastmilk isn't better, because I believe in most cases it is (but not all, and I need to make that clear, because there are exceptions to every rule, both in nature and society), but the question is HOW much better. Better enough to justify the pressure on women in affluent, western nations with good healthcare and clean water? Or to call a woman “broken” b/c she comes up against numerous challenges, both physical and societal? I don't think so, and I think many of my readers feel the same way. This sort of debate tends to get nowhere on this blog, b/c it comes down to debating larger issues of good study methodologies, publication bias, gender equality, history, anthropology… and while these discussions are interesting, I think we all need to be in the right mindset to have them correctly, and there tends to be so much passion and heartache surrounding infant feeding that I doubt a rational debate can really ever happen.

  32. Sorry, just reread that comment and saw that it could be construed as insulting. I actually think the debate on this blog is exceptionally rational and mature, and I'm constantly heartened by my readers' ability to conduct themselves with class (on both sides of the debate). I just meant that this major arc of “formula is harmful” can get very heated, and I've seen on other blogs lately that even if you're discussing something off topic, it always comes back to that. Seems to be a futile debate for that reason. That's all I meant. This blog is full of people who see formula as a lifesaver, so I'm not sure its the right place to start rehashing something we have already dealt with in other posts, as Brooke mentioned.

  33. Hi — I really enjoy reading the discussion here. I'm a breastfeeding and natural parenting advocate, but I understand the many reasons women choose formula, and also the guilt that can come with it.

    I agree with the posters who think there is a connection with our birth experiences and difficulty breastfeeding. One of my friends had a lot of trouble nursing and supplemented with formula until her son was a year old. When I talked to my midwife about her experience, the first thing she asked about was her birth experience. The stress that many women feel during births that didn't go the way they expected or planned can impact initial milk supply, which can impact on-going supply.

    It's a difficult issue to bridge, but I'm glad I found this blog because I hope it helps me understand all mamas better and perhaps bridge the gap between formula feeders and breastfeeders. We're all doing the best we can for ourselves and our babies.

    Cheers,
    Suchada

  34. @Armadillo

    You and I have already hashed this out on your blog before; I really think you and I are in a 'agree to disagree' kinda place. The bottom line is that based on what I know, my experiences and the people I have spoken to I believe women stop or don't start breastfeed due to lack of support (be that medical, emotional, financial, ect). Period. You believe that women don't breastfeed because they don't want to put the effort in and don't believe breastfeeding is significantly better. That may be true for some, but I believe them to be the minority.

    We also live in two very different places. I gave birth in a 'baby friendly' hospital, with free access to lactation consultants, pressure from the nurses to breastfeed, a full years maternity leave and a local breastfeeding rate of 90+% at birth and just below 50% at 6 months. Where I live women want to breastfeed but struggle to keep going. I don't know anyone who 'couldn't be fagged' to breastfeed or who didn't hear the message that formula isn't as good as breast milk. From what I understand, where you live the situation is very different. I understand that the UK looks more the US when it comes to breastfeeding rates and the practice of formula sampling. So it makes sense that we are coming from very different perspectives.

    I can certainly accept and agree that formula samples and advertising need to be taken out of hospitals. I am all for that. I agree, it does help the initiation rates to rise. But to keep women breastfeeding… to me that comes down to recognizing that we need to really support women, hear their stories and be willing to put our money and collective voice where our mouth is. Supply issues are real and they are growing. You can disagree with me all you want, but I truly believe that. We are not just 'broken' women. Why not help women who want to succeed?

    Also, thanks for the book recommendation. I will let you know what I think if ever get a chance to read it.

  35. @ Brooke – the thing with a blog is people can visit and comment without having read the entire blog already!

    I'm unsure what “claims” you feel I have made? I do believe women with true health reasons for failed lactation are a very small minority of women, that's my opinion and I don't believe I was rude in presenting it? I don't see the point spending money researching this until we have helped the millions of women who COULD lactate fine.

    When reading FFF's story of why lactation didn't work out last week, one can head into theories of amazing nature, but ultimately there were several very obvious reasons jumping out – why the need to head into obscure land and act as though women are broken (was what I meant by that comment!)

    @FFF do studies show “more favourable outcome” for breastfed kids? if it's the milk they were intended to drink, surely the breastfed outcome is the bog standard one?

    I also think we spend our lives discussing things upside down – yes you can choose to pick over studies (and yes media portrayals versus fact can be very different) but then why are we trying to prove milk of our own species is “best”?? As you point out, proving something without all doubt is almost impossible with reserch – we can only ever look at highly probables.

    If we take breastfeeding as standard, lets start looking for the proof that what is sold as an alternative gives an outcome as good – then we can get onto “bad science”. There are at least a hundred constituents in breastmilk that formula companies can't copy – what is the impact of this? Instead of looking at “how much better” breastmilk is, or the outcomes associated with it, shouldn't we actually be checking if not having these constituents makes children less healthy – and if so how much less healthy?

    QUOTE FFF Or to call a woman “broken” b/c she comes up against numerous challenges, both physical and societal

    I didn't call woman broken – I should perhaps have used “” because it's what I felt the OP was suggesting and my view is it's nothing to do with the ability to lactate for the vast majority of mothers. I am more than aware of the challenges women face – lactation is HARD in current society. I just don't see we are at a place for 99% of women where there is nothing but a medical explanation for this.

  36. 1- Brooke, many women with PCOS, including myself, get pregnant spontaneously without any medical help (but are unable to breastfeed).
    2- Women with PCOS are not the only ones who get lactation failure (lovely phrase btw). Try women with tuberous breasts, women with diabetes, women who suffered a severe blood loss, women with a hypothyroidy etc etc. That's why the number of 5 percent is a blatant LIE. BF proponents just won't let facts rain on their parade, and on their mantra that everyone can breastfeed. Up to 10 percent of women of reproductive age have PCOS, and then there are all other conditions susceptible of causing insufficient milk supply, either primarily or secondarily.

  37. I found the link to this in the comments of an article I was reading about the increase of SIDS in formula fed babies and how they should inform people despite it causing guilt. The article had me in tears as I have tried so so hard to breastfeed everything but medication I absolutely wanted this. The “support” at the hospital was hit or miss a couple nurses genuinely wanted to help but didn’t know enough on the subject they gave it their all anyway, the lactation consultant was a joke I didn’t know any better I’m the first in my family to breastfeed as far back as well we know and she was my first baby. I was absolutely committed to it till i was home from the hospital with an inconsolable newborn who hadn’t had a wet diaper in 24 hours. She and I had been through hell leading up to the emergency csection that brought her I to this world and I was so scared I was repeatedly told by the LC at the hospital she will figure it out but she wasn’t and that’s all the help she had to give that and to force the screaming baby to stay on my boob while desperately trying to pull away. I broke at that point I broke and I gave her formula we went out with a newborn and me recovering from surgery and we got our formula knowledge from a lady at babies are us for the first time and we brought it home and I cried as I fed her I felt like I had failed I felt like I was loosing my mind and I was worthless. Then when she had at her fill she quietly drifted to sleep the most peaceful sleep and she slept in her bassinet for more the a couple minutes for the first time since the day she was born when she wouldn’t wake for anything. Then I cried again I cried because my baby was starving and I felt both good because she wasn’t inconsolable finally and cried from sadness that it had come to this. I kept trying I pumped I went to breastfeeding groups I tried foods, teas, and pumping I tried a sheild I went to weighed feedings saw multiple lactation consultants I still get 10-15ml a day with a pump my daughter’s latch still isn’t right and I recently gave up I just wanted to be happy my daughter is 2 months old and i was stressed and frustrated constantly I didn’t have the time to sit back and really enjoy her and I felt it was time I quit. I completely quit though the truth is even if she isn’t latched right even if she doesn’t get anything I still try to nurse her now and then and I’m considering asking my doctor for medicine to make me lactate since it all I haven’t tried. I didn’t have the support, I was exhausted and terrified and had just nearly lost my daughter and underwent surgery. I’ve never been through so much in my life and if things were different I think we could have done this. I think I needed her to make the milk come in and we didn’t get the help we needed from the beginning.

Leave a Reply

Your email address will not be published. Required fields are marked *