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.
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.