Mammary Mania: Podcast approaches lactation science as the science it should be

I just listened to a podcast of a fascinating interview about breastmilk, courtesy of Skeptically Speaking. Interviewer Desiree Schell spoke with Dr. Katie Hinde, an Assistant Professor of Human Evolutionary Biology and the Director of the Comparative Lactation Laboratory at Harvard University. The newest of my internet crushes, Hinde offers a unique perspective on the science behind breastmilk with a level of sensitivity and realism that is unparalleled, as far as I’m concerned.
Take a listen for yourself – it’s well worth the 15 minutes. But in case you just want the Cliff’s Notes, here are the FFF-related highlights:
  • Hinde points out that while there is a good deal of lactation research going on in the world, much of it is agenda-driven. The science is mainly coming from three areas: breast cancer research (which tends to focus on rats, who have similar mammary development to humans), the dairy industry (fixated on how to maximize milk production in cows) and from the infant feeding world (looking at tiny humans and their mothers).  Within the last category, Hinde notes that both sides have clear agendas – one is trying to increase formula sales, and the other has “anti-formula aspects, that no matter what, breast is best.”  “Both ends of these spectrums are limiting,” she says. (To which I say, word. WORD.)
  • Research has shown that milk varies dramatically between women. Some mothers make high fat, low sugar milk; some have more cortisol (a beneficial hormone) in their milk; and so forth. Hinde explains that our milk is affected by what we’ve eaten and been exposed to for years prior to pregnancy and actual lactation, and that these lifestyle factors may create these differences in milk. Even the lactation process can vary across populations – Hinde notes that in America, studies have shown that many women do not have “copious milk production” until 72 hours postpartum, whereas in the less-developed world, the average time is much shorter. Considering doctors often step in at that 72-hour mark and recommend formula supplementation due to fears of dehydration or neonatal weight loss,  it would be highly beneficial to find out why this delay occurs. Hinde questions why there hasn’t been more research on these differences in lactation process and milk constituents among women.
  • While Hinde speaks about the power of breastmilk (and gives a really interesting explanation of just why breastmilk is so miraculous, absent of the usual hyperbole and backed by actual science), she also acknowledges that the decision to breastfeed is not made in a vacuum. And in what is probably one of the bravest statements I’ve ever heard made in a public forum about these issues, she argues that by finding out more about breastmilk, we can then create a better formula. “This is an important goal,” she states, because if women are unable to lactate, or have contraindications like HIV, “we need to make sure that the intervention (formula) is as representative as it can be for what (babies would be) getting from their mothers.” Now, obviously Hinde would argue that breastmilk is a superior nutritional choice, but the fact that she acknowledges the reality that some women are going to need formula, and that we owe these women and their children a better product…. well, let’s just say it made me tear up.
  • On the topic of breastfeeding support, Hinde muses that there is this idea that because lactation has evolved over millions of years, it should be effortless and natural. But “so is sex”, she says, and a lot of us aren’t so great at that to begin with, either. She suggests that by openly discussing the physiological problems so many mothers face when attempting to breastfeed, we could actually increase the amount of women successfully meeting their breastfeeding goals, because we would feel less overwhelmed and lost when these issues arise. (I like to think all of your FFF Friday stories are doing this, in some small way; that they not only make formula feeding moms feel more empowered, but also help women dealing with breastfeeding challenges find answers, solace, and community, as well.)

Dr. Hinde is exactly what is needed in the world of lactation science – a true scientist, able to approach her research with nuance and a wider perspective.  Check out her blog, Mammals Suck…Milk and take a listen to the Skeptically Speaking podcast (Schell, the interviewer, is also pretty darn rad, and manages to guide a potentially science-y interview into a very accessible and entertaining listening experience) to gain a far more thorough understanding of mother’s milk that makes you think instead of wanting to hurl your computer at the wall.
Speaking of thinking, this interview made me ponder about the types of studies that would be truly helpful for infant feeding research. How about a large study examining differences in children of non-breastfeeding mothers, randomly and blindly assigned only expressed donor breastmilk from bottles or a DHA/ARA containing, partially hydrolyzed formula (since this type seems to be the one that fares best in the studies which have been done), essentially ruling out all confounding factors? Or, what if we did intensive interviews and examinations with women who suffer from insufficient milk or delayed milk production, compared to controls that have no problems? Looked into their social, emotional and physical histories, and tried to find a common thread. I’d also love to see studies of breastmilk composition from women on severe elimination diets compared to those with healthy diets. And the list goes on…
So, let’s play scientist. What types of studies would you like to see in the field of lactation science? What do you think would actually help women to breastfeed, or to make formula a better substance?

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.

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24 thoughts on “Mammary Mania: Podcast approaches lactation science as the science it should be

  1. I think studies looking at mechanisms of action in women with no or low supply. Sure, some women have IGT or hypoplastic breasts–but why? Is there anything that could be done to prevent that, or if not, can we figure out exactly what is going on and perphaps someday be able to offer…if not a cure…something that would address the problem at its core? And of course those women who currently have no explanation for low/no supply–is there something about their milk ducts? About their hormone levels? In science things don't “just happen”—there is always a reason, even if we can't figure out what it is.

    Genetics probably factors in, in some (possibly many or most) cases and so far, we don't have the technology to decide which genes people are born with. However, we do have technology to observe gene expression and would a gene signature study help in this area? The populations of women who have no/low supply are probably heterogeneous, but there may be a limited number of subtypes, and if a woman could have a small blood test, and be classified into a subtype, then we may be able to predict which women will have a problem, and even know the nature of that problem. Someday, even if we can't fix a given person's mutated genes, maybe we can offer personalized medicine like what is being done in cancer trials lately. If Woman A has no supply, but she has a specific gene mutation that interferes with proper duct development (just as an example), perhaps some therapy could be found to reverse or mitigate that, and she could be treated during pregnancy and go on to nurse, or at least nurse more than she would have been able to naturally.

  2. Amy- excellent ideas! I have a feeling it is something either environmental or genetic, and I'd assume it would be easier to rule out the genetic factors. I wonder if the delay in copious milk production that Hinde mentions is related to whatever is causing low milk supply in general…

  3. Thank you so much for the kind words about the interview. Dr. Hinde was a great guest, and we're glad the discussion struck this chord. That's exactly what we were going for. =)

  4. Ok, I'm going to cheat a bit and re-quote myself from 'The Conflict' post: “I'd like to see a study, hell, I'll even take a survey of first time mothers and their experiences in breastfeeding over the AAP recommended six month period of time. Break it down by, exclusive breastfeed, breastfeeding and pumping, combo feeding and finally, introduction of formula. When did these women have to go back to work? Who decided to stay home? How long were their breastfeeding sessions? What kind of problems did they encounter and when (while in the hospital or after discharge?)?”

    Ideally, this would be a long-term clinical outcomes study like 'The Asheville Project' (from their website: The Asheville Project® began in 1996…to provide education and personal oversight for employees with chronic health problems such as diabetes, asthma, hypertension, and high cholesterol. (E)mployees with these conditions were provided with intensive education through the Mission-St. Joseph’s Diabetes and Health Education Center. Patients were then teamed with community pharmacists who made sure they were using their medications correctly.)

    So, instead of pharmacists, pair mothers with lactation consultants/researchers. This pairing, ideally, would start before birth and continue until the mother/child were no longer nursing/bottle feeding. The lactation consultant(s) would be paired with the mother prior to birth and available immediately after delivery, weekly for the first month, bi-weekly during the second and monthly until the child weans. Time from delivery to arrival of supply should be noted in addition to the normal factors like infant weight gain or loss. Feeding support and information should be given in a 'preference neutral' environment to evaluate when and why mother decides to abandon breastfeeding. Mother and child should be evaluated for the full range of breastfeeding obstacle (tongue tie, inverted nipples, poor latch, intolerance of milk). The mothers age, weight, household income, maternity leave and return to work should all be notated, as should when or if a child is placed in daycare, home daycare, care of a relative (full time and part time).

    Because we are dealing with so many variables (societal, physical, emotional, financial) that have gone under researched, that type of information, (especially when relating to issues such a FMLA and breastfeeding friendly work practices) could be pivotal in helping to improve policy and/or set more realistic nationwide breastfeeding goals.

  5. Does eating oatmeal really increase supply? Also, I'd like to see some research into helping women breastfeed after scheduled cesarean. Is there any way to bring the milk in quicker?

    Brilliant link by the way; I've just added the site to my blogroll 😀

  6. Can I also add that I was just THRILLED that Dr. Hinde brought up the topic of wet nurses? It was fascinating to hear that a wet nurse's children faced higher mortality rates than the children of the the higher born. I'm really interested in historical aspects of breastfeeding as it is often as 'all women are able to breastfeed, it's what we are biologically supposed to do' is used as a rallying cry with seeming no consideration to historical rates of infant mortality. Her comment actually opened a whole area that I had not considered; the infringement of the health of poor children to feed the wealthy.

  7. I would love to see more science behind the big myths. I'm not incredibly science-y — I mean, I just used the word “science-y” — but I feel like breastfeeding can only benefit from knowing fact from fiction.

    That's the best I've got, lol.

  8. Why is it that there always have to be a STORY behind not able to breastfeed? I did it out of choice with both of my children I stopped breastfeedign after 10 and 8 weeks respectively. Just because I found it too tiereing for me.

  9. The higher mortality rate was explained by conditions those wet nurses and their children lived in. I remember Joan Wolf in her book “Is breast best?” talking about it – facinating!

  10. While I agree with you…no woman needs to find reasons that meet everyone's approval, knowing the facts behind the stories could someday lead to more information. I think many women here came here under the impression that they were the only ones dealing with XYZ, and as it turns out, there are many women who have difficulty with BFing. Of course there are a variety of reasons, but the ones that aren't based on choice (meaning the mother WANTS to BF and can't) might be lead to a solution to at least some of the common problems.

    Like you, stopping BFing (pumping) after 4wk wasn't a big deal to me, and luckily, no one has ever given me crap about it. But it is no one's business why you or I stopped. But, for a woman who wants to BF and then later learns she has IGT, if she heard the stories (hopefully fact-filled) about women with IGT, it may have saved her a lot of grief. That's where I see the stories as helpful.

    Though I may have misunderstood you…by story, did you mean why women always feel they have to explain why they aren't BF, and defend their decisions? In that case, I agree wholeheartedly….everyone has to make decisions based on their situations and family/friends/neighbors get no say in this particular one.

  11. Where do I begin? I think before researchers will get serious about looking into lactation issues they need to have a reason to. At the moment there is a made up number of anywhere between 1% and 15% of women who physically can't breastfeed, (which is usually used to dismiss women who can't breastfeed “but only 3% of all women can't breastfeed – it's such a small number, surely you must be able to if you have the right support” etc) but only 2 very small studies that I have ever been able to find that indicated any sort of figure. I think once they had a better idea of how many women can not physically breastfeed (which I think would be closer to 15% than the 1%) then they may sit up and take notice.
    There have been a handful of studies into issues like IGT, which is not good enough. I did read somewhere a case study of a women with IGT with no milk supply receiving progesterone shoots who went on to increase her supply. It seems to me that they may have touched on a missing link – but then did nothing about it. Why not? They can spend money on yet another stupid study (such as 'which mother's are more protective of their babies' using video games to come to conclusions) yet they can't spend time helping women who want to breastfeed to have a chance? And that goes for lots of medical complications that may preclude exclusive breastfeeding such as PCOS, D-Mer, breast surgeries, Primary Lactation Failure (medical term – not one that I would use) etc. How do we help these women achieve their breastfeeding goals (whatever they maybe) When it comes to male reproductive issues (such as erection issues) the government and health departments have no problems spending millions of dollars coming up with a solution. Yet a women with IGT and limited or no milk supply (if she is luck enough to be diagnosed and doesn't just find out she has it somewhere on the internet) is told that there isn't much info on it and sent on her merry way. That's just wrong.

    I would like to see alot more research put into mental health issues (such as PND) and connections with the pressure to breastfeed.

    Then there is really basic bottle feeding health and safety issues such as the temp of the water that should be used to reconstitute formula, how long formula and expressed milk can be safely fed to baby once offered the first time, if bottle sterilization is even needed anymore, if, with fluoride being added to many mains water supplies it should also be added to formula, and many other 'small issues' which are so important to babies health that just don't have enough research behind it and health care professionals can not agree on.

    The study I would like to see the most is one that gives bottle feeding parents all the support and information they need without pressure or judgement including things such as support groups of other bottle feeding parents, inhome bottle preparation and storage demonstrations and guidance, emotional support where needed, telephone help lines for questions bottle feeding parents may have and whatever else helps parents feel confident and fearless bottle feeders with all the information to make their feeding experience healthy and enjoyable and then compare then with the normal (basically non-existent) support that bottle feeding parents receive normally and look at the difference it makes to the health and well being of the child.

    I could probably go on for ages but I will leave it at that for now 😉

  12. Oh I agree, and I think FFF's regular readers around here would too. However, when you wanted to BF and found that you couldn't, running into the usual lactivist line that only X% of women can't breastfeed is so unhelpful as to be bad medicine. IMO, unethical medicine is worthy of correcting.

    One thing I'd like to see studied is something on women who choose not to breastfeed from the start, and those who choose not to breastfeed at some point. I see a lot of lactivists who admit that breastfeeding isn't possible for everyone, who then go on to say they reserve the right to condemn, criticize, and judge those who “choose not to breastfeed.” Well, what does that really mean?

    FFF does a tremendous service to those lactivists willing to listen that infant feeding is, for so many women, not just a matter of capricious whim, but rather, it is an issue that women think quite seriously about. The stories she features put the humanity in the situations that are so often dismissed on lactivist forums and blogs as statistics attributable to simple formula bags passed out in hospitals. These stories are a wealth of information about how breastfeeding promotion is often so wrong-footed, and provide plenty of examples of why, more than insisting on increasing breastfeeding rates, we must instead be insisting on proper health care for all women and children, no matter what methods they end up using to get food into babies' stomachs. If more people who promote breastfeeding as best would kindly listen to her–and to all of us–they would find more and better ways to encourage breastfeeding among those who can/should/want to, while at the same time helping the mommy wars to stop. But why do we have to rely on these stories in order to prove that a family's choice in infant feeding should be respected? I believe the answer is in what Hinde says about research being agenda-driven.

    There was a very informal poll at the Bottle Babies FB page asking people about choosing not to breastfeed. Very, very few who answered said they chose not to breastfeed from the start because they didn't want to. Just about every response had some kind of medical or life situation behind it–in other words, good reasons. Not excuses. Now, like I said, it's an informal poll. But why do we only have informal polls about these sorts of things?

    I would love to see a non-agenda-driven study that really looked at reasons not to breastfeed. I suspect it would really lay it out to lactivists of all stripes that the decision not to breastfeed (whether from the start or after) is not one borne of laziness, selfishness, or lack of education–or, if it ends up being in part due to lack of education, it's because the very people who are supposed to educate are too agenda-driven themselves to meet women and children where they are instead of where ideology dictates they should be. It's often one of necessity–whether that necessity is lack of sleep (so often ignored as a serious medical issue), the need to take medications, or a lack of glandular tissue.

  13. I would like to see a study done on ways to control the hormonal side effects of breastfeeding. We all know that low estrogen is part of the game, but my estrogen was very low. I had a number of side effects (I'll spare from here, but lets say I have a newfound empathy for menopausal women), but the main one being hot flashes. I clocked it, and I would have as much as 8-12 hotflashes a day, sometimes in the middle of breastfeeding. I contacted teh hospital LCs, 2 private LCs and all of them told me that they'd never heard of such a problem. When I did some reading the only thing I could find was: “increase foreplay.” snort. My OB prescribed some estrace for me, that helped subside some of the more embarassing issues, but it didn't stop the hotflashes. I decided at 9.5 weeks in that I needed my sanity.

    I'm 27 years old, healthy and I just know I can't be the only one who experienced this! We have viagra for men, why can't we solve a hormonal breastfeeding problem?

    I'd also like to see more studies and support on how to coach women who had c-sections, but someone else wrote about that earlier in the comment section and worded it perfectly.

  14. To be quite honest, I haven't looked this up to see if this is a common problem or if it's just my picky kid, but I'd like to see a study done on the reasons why babies just refuse to nurse. I swear my first daughter refused to nurse because she didn't like the taste, but is there something different I could have/should have done to alleviate the issue? I gave up after 2 days since she wasn't having enough wet diapers and by enough I mean she had maybe 3 and they had the brick red crystals in them. She took the Enfamil formula like a champ and to this day is the pickiest child I have run into.

  15. Dear FFF, Thank you so much for posting the interview and appreciating the key take away points. I had no idea until recently that such perspectives were so rare- or rather- so rarely communicated to the public!

    Your hypothesized studies in the comments section above are fantastic and I am happy to say a number are actively being investigated. When results are available I will make sure to work on disseminating them beyond academia with the help of FFF and the larger mothering community.

    I don't tend to write about my own research as much on Mammals Suck… Milk!, but a fellow blogger wrote a post summarizing a lot of the findings coming out of the Comparative Lactation Lab that talk specifically about differences between humans and non-human primates and among mothers within the monkey species I study:

    Rhesus macaques are a useful model for understanding the underlying physiology of lactation biology in a way that's useful for humans- dilute milk, long period of infancy, complex social behavior and cognitive development, and usually a single infant (but occasionally twins!).

    Results from rhesus can provide insight into the biology, but we still need systematic research projects with women who struggle with numerous challenges and barriers that don't face monkeys; cultural pressures, careers, fast food, politics, etc etc. The list goes on… and on. As every reader of these blogs is greatly away.

    Thank you again,

    Katie Hinde

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