Breastfeeding Medicine

Physicians blogging about breastfeeding

When lactation doesn’t work

with 111 comments

As a newly-minted doctor and breastfeeding activist, I used to believe that all mothers could breastfeed. Now, after almost a decade of clinical experience, I know better. Sometimes, breastfeeding physiology just doesn’t work. And frankly, as medical professionals, we handle these situation poorly.

Lactation happens through a choreographed interplay of hormones that build up milk-making machinery during pregnancy and then manufacture milk and deliver it to the baby during feeding. So-called “primary lactation failure,” when a mother’s milk never comes in, may happen because the machinery doesn’t develop , or because the signals to make and move the milk are not in sync or absent altogether.

When a mother’s milk isn’t flowing, physicians should check for any medications that may be interfering with milk production, as well as assess function of the thyroid and pituitary gland, which can be damaged during childbirth after heavy bleeding. Absent milk production can also occur if part of the placenta is left behind at birth. If these tests are all normal, a few drugs can boost the level of prolactin, the milk-making hormone. ABM covers these drugs in our Protocol on Galactogogues.

Often, however, we don’t find an answer. With little knowledge and few treatment options, the physician is typically left telling a mother that she has “lactation failure.” Too often, that diagnosis is followed by some patronizing comment like, “It’s ok — I was formula fed, and I turned out fine.”

Now, I have a question: Why do we accept that malfunction of a major part of reproductive physiology is untreatable, and that the acceptable solution is a synthetic substitute and a pat on the head?

Consider that we spend more than $1 billion a year on Viagra to treat another type of reproductive malfunction. I suspect men with erectile dysfunction would not respond well to being told “We’re sorry, we don’t have a treatment for this important aspect of your reproductive and social well-being. But here’s an artificial substitute.”

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. It seems that, as a nation, we simply don’t consider inability to breastfeed to be an important problem.

Mothers and babies deserve better. First, given the limits of current medical knowledge, we should admit that we should have better answers. And would should honor, not trivialize, her efforts to initiate and sustain breastfeeding. When we tell her, “It’s ok, I was formula fed, and I turned out fine,” we are basically saying that she’s a little crazy to have worked so hard to breastfeed, because it’s really not important, and she shouldn’t worry her pretty little head about it.

Instead, I praise the mother for all the ways she tried to make feeding work. I have even written letters to the baby, documenting for mom how hard she worked to breastfeed. Then, we talk about how breastfeeding is not simply a matter of feeding breast milk. Mom and baby can enjoy much of the bonding and intimacy of breastfeeding with skin-to-skin contact, holding and snuggling her baby, and putting the baby to breast for comfort after feeding.

We also talk about how to respond to strangers who make snide comments to bottle-feeding mothers. I’ve been assailed for nursing in a restaurant, and I was deeply humiliated when a woman stalked up and said, “For future reference, the bathroom is back there!” I can only imagine what a mother who cannot breastfeed — or decides not to — endures when strangers pass judgement on how she is nourishing her baby.

And then there are the policy issues. Physicians and nurses need training to identify moms at risk for lactation failure, provide early help and support, and prevent horror stories of dehydrated infants and devastated mothers. We need more and bigger milk banks to distribute donor human milk. And we need to encourage mothers who couldn’t make milk to transform their feelings of guilt and loss into action by writing letters to demand research funding for this all-too-common problem.

Not all mothers can make milk, but modern medicine has solved more complex problems. What we need is the willpower and resources to determine the causes of lactation failure and develop appropriate treatments so that all mother can reach their breastfeeding goals.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.

Written by astuebe

April 24, 2010 at 4:18 pm

111 Responses

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  1. Well said. There isn’t enough research out there. More research not only for why mother’s don’t make milk, but for the reasons many mothers stop after a couple of weeks/months to learn how we can support them better.

    Michelle

    April 24, 2010 at 4:33 pm

    • Even if a Mom can only partially breastfeed, it should be encouraged.Some Mom have difficulty establishing a full supply and need to supplement. She should be applauded for giving her baby whatever she can.

      Bonnie Yagiela

      April 24, 2010 at 6:18 pm

      • I totally agree! I was feeding my baby 75% breast milk 25% formula and that seemed to work for us! I informed the breast feeding counselor about this and she said I need to be doing 100% and it was not “good enough”. She told me I need to take a natural supplement for breast milk enhancement, so I did. (I wanted to be a 100% mommy not a 75%) Within 48 hours, my left breast went haywire and turned black and as a result I got infection (mastitis). My infection was so bad, I was admitted to hospital and had part of my left breast removed and was attached to a wound vac machine for several weeks. I had to totally stop breastfeeding. It was my first lesson in motherhood. Never let ANYONE make you feel like an inadequate mother when you know in your heart you are doing your best! Yay to this article! and to Bonnie for your comments!

        Denise

        May 31, 2012 at 10:06 pm

      • I’m so sorry to hear what happened to you!! Do you mind sharing what you took that did that to your breast?

        Claire

        June 1, 2012 at 7:15 am

    • And I wonder why the substitute milk that is offered to babies (who’s mothers have worked so hard but are unable to offer their own) isn’t the milk from other human beings.

      Ger

      April 24, 2010 at 6:27 pm

  2. This is an excellent article. I experienced mastitis in the same place in the same breast EIGHT times after 2 months of nursing my daughter. Not one doctor I saw (including an infectious diseases doctor, a breast cancer surgeon, four lactation consultants (including one with an MD), and two OBGYNs) could explain why it continued to happen. They all recommended to put me on a Z-pack for an extended period of time until I could wean my daughter off that breast. I ended up weaning her nearly entirely due to my inability to shake mastitis after being on a Z-pack for 3 months. I tied Lethicin and nearly every homeopathic “cure” on Kellymom’s website. Nothing worked!

    I now only nurse on one side (the un-infected side) but my milk supply has gone down substantially. I am hoping someone out there will find an answer for me because I want to nurse my next child exclusively!

    Stacey

    April 24, 2010 at 5:25 pm

    • Hi Stacey,
      I think it will help you to know that exclusively nursing with one breast is often quite possible. I have a breast damaged from surgery that continued to become infected when I tried to nurse my son – the milk wasn’t able to make it’s way out through the damaged ducts and was causing major issues! After many visits to many doctors (where I was told that my milk supply would decrease if I didn’t keep trying to nurse from that breast, and I’d need to supplement) a La Leche League leader suggested that I just try to nurse with the one breast and see what happened… and it worked! I became pregnant again when my son was 8 months old, and we continued to nurse. And then after my daughter was born, still we continued to nurse! It was a lot to manage at times but my body did compensate.

      Ger

      April 24, 2010 at 7:46 pm

      • I do still nurse my 8 month old on the left breast (the un-infected one), but my milk supply dropped radically. I talked to our La Leche League leader as well as 2 lactation consultants in town (1 of whom tandem breastfed two toddlers) and no one had a solution. I tried everything they suggested (for instance, we unclogged a milk duct twice with needle aspiration, and that helped for a few weeks, but then the mastitis came back again). I talked to Jack Newman as well.

        Stacey

        April 26, 2010 at 11:58 am

    • Hi Stacey,
      I am not an expert, but did manage to exclusively nurse my daughter for extended long term nursing…one of the reasons it kept being extended is bc every time I tried to wean I would get the beginnings of mastitis. So, I feel your pain. My only amateur recommendation would be to nurse on demand (vs scheduled) with both breasts, especially the one that gave your trouble with your next baby and make sure you stay ahead of the milk production so you can possibly avoid the clogged ducts all together.
      Blessings!
      Michele

      Michele

      April 24, 2010 at 8:38 pm

      • I nursed on demand as I didn’t go back to work until my daughter was 6 months. Even then, I would run home to nurse my daughter on the days I worked (Tues/Thurs). My babysitter would text me the minute my daughter seemed hungry and I’d come home. But thank you for the tips!

        Stacey

        April 26, 2010 at 11:59 am

    • Stacey,
      here are a few ideas…I’m nursing my 4th right now…

      have you tried the herb fenugreek – you can purchase it at WholeFoods or other healthfood stores. It seems to work GREAT for everyone I know with a low milk supply or for example when you have the flu and your milk almost vanishes.

      Have you been in contact with LaLeche League? They have a lot of helpful advice on breastfeeding – a lot of moms with good practical experience and advice.

      Are you wearing an underwire bra? That is how I got mastitis. (You have probably already been told this but just in case…..)

      Amanda

      April 25, 2010 at 2:22 pm

      • Amanda – Thanks for all the tips. I tried fenugreek, which I got from our local co-op. That didn’t seem to help my milk supply in the one breast. Not sure why.

        I did talk to our La Leche League leader (see above).

        And no, I didn’t wear any underwire bras because 1) none of my old bras fit and 2) my breasts were so huge while nursing that underwire was just plain uncomfortable. I either wore a nursing tank top (way more comfortable, the ones made by La Leche League) or no bra.

        Stacey

        April 26, 2010 at 12:02 pm

    • For anyone who comes across the post and needs mastitis help, I found this article really useful:http://www.theclinics.com/periodicals/atc/article/S1526-9523(07)00345-5/abstract

      I actually contacted the author and flew to California to get a consultation with her. Her clinic was pretty helpful and actually listened to my concerns. I also did a phone consultation with Denise Punger, who is an MD in Florida and a breastfeeding advocate. Her blog can be found here:

      http://www.permissiontomother.com/

      You can tell I wasn’t willing to quit nursing!

      My local hospital pretty much wrote me off, although they did enroll me in a NSF clinical study of recurrent mastitis and took a milk sample from me. The results of the study should be available in the next year, so hopefully I will have some answers from that. The researchers seem to think that there is a particular MRSA-related bacteria that is latent in women who have recurrent mastitis. I was tested for MRSA mastitis (which is a very scary thing), but everything came back negative. Apparently it is very hard to tell is a woman has MRSA mastitis.

      Stacey

      April 26, 2010 at 12:10 pm

      • Stacy–kudos to you for keeping up with nursing! So many women would have quit under the same circumstances. Any breast feeding is better than none. Way to go!!

        Klayre

        April 26, 2010 at 2:18 pm

      • Hi Stacey – BIG kudos to you! You are one dedicated mama! Much admiration to you. One more idea for you that I tried:
        http://www.wishgardenherbs.com/index.php?load=pregnancy&page=index&group_id=7
        (Happy Ducts) and it did wonders for me! If you can’t find it in your area, let me know and I can send some your way.

        Beth

        March 15, 2011 at 11:38 am

    • I admire that you are trying so hard to keep up the breastfeeding. I found a website that I thought might be useful to you. It mentions breastfeeding from the infected breast first, while massaging the breast from the infected area down to the nipple. Also, it mentions rotating between hot and cold packs between feedings. One thing that it did NOT mention, which helped me tremendously when I had mastitis was lying down and breastfeeding “upside down”. Just have your child attach as they normally would while you are both lying down, only have the child’s feet pointing toward your head. This helps by getting the parts of the breasts stimulated where they were not being stimulated before and helping to release the blocked ducts in that way. One more thing that WAS mentioned in the article was that some women find it helpful to place a slice of a raw potato on the infected area. I have used raw potato like this in other instances of infection and it does help very much, by drawing out the infection. The article mentions a few more things also, if you’d like to take a look at it. It is at http://www.associatedcontent.com/article/390192/natural_and_simple_ways_to_cure_mastitis_pg2.html?cat=68

      I wish you all the best!

      Christina

      June 1, 2010 at 2:42 am

    • Hi Stacy,
      I had a clogged duct that almost developed into mastitis. All advices were to keep feeding/pumping on that breast to reduce the clogging and prevent the infection. Nothing seemed to help. After an acupuncture session I asked my acupuncturist if there was anything he could do to help. He prescribed hot ginger compresses and albi plaster with barley powder. Problem solved! Hope that helps…

      Moon

      April 4, 2012 at 10:12 pm

    • Hi Stacey! Really sorry to hear your terrible experience. Usually repeated mastitis happens because it was not treated and healed completely the first time. Actually continuing breastfeeding with the infected breast will draw out the infection. You can take Tylenol or Motrin for the pain, eat lots of garlic, which is nature’s antibiotic. A tea made from chamomile mixed with about 1-2 tablespoons of Organic Apple Cider Vinegar and Manuka Honey will help you heal faster. If you nurse on one side, you will end up with lopsided breasts, so I suggest nurse first on the infected side and then switch to the other side. Also, make sure you are well hydrated, drink plenty of water or coconut water such as Vita Coco. Use hot and cold compresses on the infected breast, massage it as much as possible and wear loose fitting bras & clothes, no underwires. If you need any help, feel free to contact me either on facebook or on my website. http://www.facebook.com/pages/BabyBoobyHelper/301338046597494 or http://babybooby.ourbabychannel.com/ Best of luck to you! Stay strong and kudos to you for being such a good Mommy and giving the best to your baby! *hugs*

      Basia

      April 4, 2012 at 11:56 pm

  3. Great article! Thank you!!!

    Melinda J

    April 24, 2010 at 5:32 pm

  4. Well said! I’m tired of the prevalent attitude of “galactophobia” in our academic and clinical settings.

    Linda Smith

    April 24, 2010 at 5:45 pm

    • I love that word “galactophobia”, Linda! I am not only clapping with my hands…my feet too! Agree 1000%!

      Virginia

      April 25, 2010 at 12:05 pm

  5. I think that its so sad that other reproductive conditions are treated as the medical issues they are but lactation “failure” is not. I wonder how many diagnoses of thyroid problems are missed because doctors don’t see lactation problems as a symptom.
    I’ve always really liked this article on babyzone: http://www.babyzone.com/baby/feeding_nutrition/breastfeeding/article/breastfeeding-making-it-work about a mom who struggled with supply and, although she had to supplement, she still nursed her baby as much as she could. Too many moms are not given the option to nurse as much as they are able to, but supplement with formula or donor milk as needed.

    Klay

    April 24, 2010 at 5:48 pm

  6. Excellent essay. I have been working with moms for almost 25 years. The most heart-breaking thing I have to deal with is moms who have given it their all, done everything “right” and still don’t make enough milk! But until we say as a nation that close enough is NOT good enough, we will never move beyond this state. We don’t accept that a premature baby’s life is not worth fighting for – why do we accept this? Let’s hope that the scientific community will wake up and give this the attention it deserves!

    Jane

    April 24, 2010 at 6:01 pm

  7. I could not agree more. As an engineer and mother that makes very little milk and has been supplementing at breast for over four months now, I was extremely surprised at how little actual research there has been on this issue. I imagine that there is a physiological reason for the inability to make sufficient milk and that the lack of milk making ability may be an indicator of a larger health issue. In my experience it seems that people tend to accept that some mother’s “just can’t make enough milk” a little to easily. Not only does more research need to be done to determine causes, but also more attention needs to be given to such cases. I also suspect that the number of women that cannot make enough milk has been underestimated due to a variety of reasons and this should also be addressed in order to show the true need to fund such research. The more people affected and the more people that bring up the issue the more likely it is to be funded for research. Thank you for doing your part to bring up the issue of lack of research!

    Nic

    April 24, 2010 at 6:27 pm

  8. So well stated!! As a mother who had milk supply issues but still managed to breastfeed for two years, I really appreciate what you say and the work you are obviously doing. Thank you!!!

    Katie

    April 24, 2010 at 7:52 pm

  9. I would like to pass on the reference book “Making More Milk” by Diana West, BA, IBCLC. There is also a website at http://www.makingmoremilk.com/

    She really breaks down the causes of low milk supply, and how each separate cause requires a different course of action. It doesn’t guarantee a fix, but can help dramatically and is evidence-based. It is a fabulous book.

    Sylva

    April 24, 2010 at 8:01 pm

    • This book is excellent! I think it should be required reading for all lactation consultants.

      Nic

      April 24, 2010 at 11:37 pm

  10. Excellent article….Allison, please continue to influence the medical field with your knowledge and questioning and we will support the research efforts!

    Michele

    April 24, 2010 at 8:43 pm

  11. Wonderful article! I think the first thing we need to look at are some of the things that are taking place in the hospitals immediately after birth. Perfectly healthy babies are being taken away from their mothers moments after birth. They are suctioned, injected, bathed, swaddled and have drops put in their eyes that blur their vision. Mother and baby miss a critical bonding time.

    If the baby is healthy, they should be left alone to have skin-to-skin contact and initiate breastfeeding. Everything else can wait.

    I think medical staff also need to be more educated about breastfeeding. I can’t tell you how many times I’ve heard mothers say the doctor told them to give formula for jaundice, or that they need to supplement in the first couple of days if the milk doesn’t come in. They need to supplement if the baby is big, they need to supplement if the baby is small. They need to supplement if the baby isn’t growing according to a textbook chart designed for formula fed babies.

    Erin

    April 24, 2010 at 9:49 pm

    • Yes, I am soooooo sick and tired of doctorx telling new moms to give formula for jaundice! I grind my teeth and wave my fists! UGH!!!!!!!!!!!!!!!!!

      Virginia

      April 25, 2010 at 12:11 pm

  12. I too had milk problems. I was so determined to breastfeed my daughter that I researched safe natural remedies and found Fenugreek. It did wonders for me! I didn’t mind smelling like maple syrup for a few weeks to get my milk supply up and to nurse my baby was the reward. I recommend Fenugreek to woman now that have lactating problems.

    HeatherK

    April 25, 2010 at 1:39 am

  13. Brilliant connection to the ED research and the lack of research on lactation. I had noticed that the “folk knowledge” on breastfeeding was far superior to anything in the mainstream literature but hadn’t really thought about why it wasn’t taken seriously. I’m so happy that you are working in this field!

    Jennifer

    April 25, 2010 at 6:50 am

  14. Excellent article.

    The comparison with the billions invested in the treatment for erectile disfunction is very appropriate. But I am afraid breastfeeding is just one of all the aspects of the female reproductive cycle that are often treated as “second class”. Female sexual disfunction does not move millions, and the birthing experience is dominated by convenience or cost and not by the needs of women.

    Veronica

    April 25, 2010 at 8:23 am

  15. Please don’t forget the emotions involved. The medical stuff can be explained sometimes, but no one can explain the emotions involved-the grieving process over the lost nursing relationship. I can’t tell you how I cried over the low supply I’ve had and the need to supplement with both of my daughters. I’m sure that the low supply issues contributed heavily to the PPD I experienced after my older daughter’s birth. I take the drugs, I take the herbs, I nurse, I pump, I do it all, but I’m still a supplementing Mama. And I wish someone (other than my favorite LC) would provide the emotional support that says “You’re still doing wonderful things for your baby” instead of “It’s okay to supplement.”

    I wrote about my feelings as a low supply Mom at http://attachmentliving.blogspot.com/2008/08/guest-post-success-or-failure-mom-who.html#links a few years ago. It hurts me terribly to have to supplement…but I have happy, healthy and thriving children, and in the end, they’re probably not going to thank me for the work I did to nurse them.

    Erika

    April 25, 2010 at 8:45 am

    • Erika: You have done — and are still doing! – spectacular things for your baby. -Alison

      astuebe

      April 25, 2010 at 9:20 pm

    • Erika, you are doing a wonderful thing for your baby and for yourself. Thank you for your dedication and perseverance! I hope that you can find the space to grieve your loss.

      Erin

      April 26, 2010 at 1:21 am

    • Erika – I know exactly how you feel. I cried and cried as I weaned my daughter from my infected breast (see my post above). I think my family thought I was crazy, but the emotions were very real for me. I still mourn not being able to nurse her exclusively right now. It is so hard.

      Stacey

      April 26, 2010 at 12:12 pm

    • You’re doing a great job! Remember giving a baby any breast milk is still better than none at all. You should be proud of yourself for not giving up!

      Klayre

      April 26, 2010 at 2:20 pm

  16. Thanks so much for this article. I agree 100% that there needs to be more research (and acceptance) into low supply Moms. I remember taking the Breastfeeding class at 32 weeks pregnant and the Lactation consultant telling the class that “Everyone can breastfeed and that every mother makes enough milk to nourish their child.” Well I had a hard time letting those words go when at 10 days old I discovered that my son was losing weight and I was producing practically nothing (I went to an LC for pre feeding and post feeding weigh ins). I tried all the herbal tricks (even domperidone–I refused to take Reglan due to the side effects of depression), his latch was fine, etc…but for whatever reason I could not produce enough milk. Maybe it had to do with the fact that I had Gastric Bypass surgery 3 years earlier or that I have hypothyroidism (which was under control for years due to medication), but for whatever reason I couldn’t keep up with his needs. Not even close. I had somewhat better luck with my 2nd son, but still needed to supplement. I always wished there was more known about low supply, by LCs, Pediatricians, and Obs. So thank you.

    Leigh

    April 25, 2010 at 9:32 am

  17. I don’t think it’s quite fair to compare lactation failures to erectile dysfunction, because the mechanisms are just too different. ED isn’t necessarily a hormonal problem, and Viagra doesn’t treat any underlying causes, just helps increase blood flow and retention (and was discovered by accident during research for a completely unrelated condition). That’s a lot easier than fixing lactation problems, which are often hormonally induced and originate in the brain.

    There actually isn’t much that we can do to re-regulate those hormonal systems, and treatments are usually just “synthetic substitutes” that focus on alleviating the symptoms. How do you treat a patient with central hypothyroidism or hypothalamic amenorrhea? You give her artificial hormones and a pat on the head, because we don’t really know how to kick her brain back into gear and produce them. And if you don’t produce enough prolactin, we don’t have any better idea how to go about fixing that either, other than Reglan or domperidone.

    There’s a lot we don’t know yet about hormone production feedback loops. Until we understand more about how the brain works, it’s not likely that we’ll see a whole lot of advancement in treatment of lactation difficulties.

    Emma B

    April 25, 2010 at 10:44 am

    • well, since we kind of know what we don’t know, we should do more research to discover what we don’t know.

      Virginia

      April 25, 2010 at 12:22 pm

    • Of course, any area of medicine or human physiology deserves more research and breastfeeding mechanisms is one of them. I am not an advocate for breast of formula either way. I do provide information on breast vs formula and the benefits of breastfeeding (breast is best!) to the families i work with, but cannot push a parent to breastfeed over bottle because i am not in their situation.
      I work with preterm infants in an institution that strongly encourages breastfeeding. In respect to the preterm infant, that is the only instance where i would favor breast milk over formula because there are certain disease processes linked to the hyperosmolarity of formula and bm is gentler to digest in these premature guts. i have found that most of the time, mothers are interested in breastfeeding/pumping for their child. the only times a mother chooses formula right off the bat is if they have schedule difficulties (and i have to respect someone who is working to provide for their child because i see many who don’t and just live off our taxes), or if they had previous bad experiences with breastfeeding.
      i have also had mothers that have “lactation failure” and i would never dream of patting them on the head and saying formula is just as good and their child will be just as normal as a formula fed baby. i have no children and have never breastfed, but i have huge empathy for these mothers that come in and try so hard to pump and provide milk. the stress of lactation failure (which we know can be a barrier to milk production in itself) is not what they should be focusing on for a prolonged period of time. as much as i appreciate mothers who try to pump/bf their child, after some attempts to correct (using what we know) i think it is time to move on for the sake of mommy and baby. many of these mothers have sick babies to focus on and when all they can think about is their lack of breastmilk production, i think it becomes a barrier to bonding and supporting their child in other ways. but even mothers of healthy term babies…they should move on to because the guilt associated with being unable to produce milk for their child can also be a barrier to the mother/child relationship.
      lastly, we have on occasion used human milk from a donor bank and observed that the babies fed with this milk DID NOT GROW! not only is donor milk incredibly expensive (around $5 per oz), but by the time it is pastuerized and processed, frozen and shipped, there are not enough nutrients left to help baby grow. we end up having to really fortify this milk with MAN-MADE fortifiers. Donor milk is a good thought (in theory) but in our society, where disease is always a huge risk and concern, it is not likely that donated milk will ever be used without going through these current processes.
      again, i’m not saying i am more of an advocate for bf over formula, but after a certain point, we must all move on for the sake of the family. perhaps we do need more and current research for breastfeeding mechanisms, but with the limited dollars available for research, i am championing for more cancer research…especially because i personally know four people in the last year that have lost their lives to this disease- including my own father. not breasfeeding has never killed anyone.

      jenny

      April 30, 2010 at 2:53 pm

      • Your last comment shocked me a little….not breastfeeding has killed countless babies around the world who’s parents have not had access to clean water and have mixed formula in dirty bottles. There are also many studies that link breastfeeding to decreased cancer risk later in life.

        Rosemarie

        January 30, 2011 at 11:23 pm

  18. My milk supply has been almost nil with both of my babies due to my polycystic ovarian syndrome. With my first baby in 2007 I suggested to my lactation specialist that this might be the case, and she was skeptical. By the time my second was born in 2009, she said that some research had been done which proved that PCOS does affect milk supply. We did everything we could to increase my supply and bemoaned the fact that I had worked so hard to very little result (I used a supplemental nursing system for 8 months with both my babies, pumped 8 times a day for 2 months, took all the herbs and carefully monitored my food and water intake) and couldn’t give her enough milk while my good friend decided she didn’t want to nurse her little guy because it was easier to make a bottle.

    I am so grateful that there has been enough research done that my PCOS did not prevent me from having children, but have often felt like doctors don’t consider breastfeeding important enough to devote energy to. My doctors were all happy to prescribe Reglan (which I would not take), but would not go any further than that. I tried domperidone with my second baby and found that it did help to double my milk supply so that I could pump almost an ounce of milk after six weeks of taking it. I felt like the effort and expense was worth it, but wish that there was hope that I might be able to exclusively breastfeed my next baby.

    I think that it will take medical professionals deciding that we are not just overly emotional, post-partum crazies when we are distraught over our inability to produce milk. I will continue to make it part of my conversations with my health care professionals (fertility specialist, OB, lactation specialist and MD) in the hopes that if enough of us realize we aren’t being silly and keep talking that sooner or later someone will find some meaningful answers to solve this problem for more women.

    If you have found good treatments for PCOS related milk supply issues, please let me know!

    Kim

    April 25, 2010 at 11:32 am

  19. There is some research into using metformin and other drugs during pregnancy to encourage the proper development of the milk making system in women with PCOS and probably other hormone disorders. There is also some suggestion that it may be useful for some girls during puberty.

    Also keep in mind that you can measure prolactin levels, and that drugs to increase prolactin generally only work in cases of deficiency. There are other hormones involved in milk production and its probably time to look at all of them instead of just prolactin.

    Also I suggest that lactation consultants, doctors, and nursing women make friends with the adult-nursing-relationship community. This group or people know more about inducing lactation without pregnancy than anyone. Sadly, for fear of persecution, this group is very reclusive -they are often called pedophiles, which they are not.

    mystic_eye

    April 25, 2010 at 3:30 pm

    • Another source of information about inducing lactation is the adoption community. Inducing lactation to provide some milk for an adopted infant is becoming more popular.

      Erin

      April 26, 2010 at 1:23 am

  20. In order to further the research along, there needs to be diagnostic tests utilized. We know that in problem pregnancies, sometimes progesterone is low and that is prescribed to improve outcomes. Has anyone looked at correlations between problem pregnancies and hormone levels and lactational outcomes? Some of this is because obstetricians are concerned mostly about what happens below the nipple line and the breasts if there is a problem. Pediatricians are concerned about what’s above the belly button and what’s IN the breast. Lactation Science needs to be a specialty of it’s own with recognition and appropriate coding to identify the issues. When I have sent a mom with low supply for prolactin peak and trough levels, you’d be surprised (or maybe not) when the report comes back as “normal” but the actual results are not at all normal for a breastfeeding mom! And the drugs for treatment such as domperidone are not even legally and widely available in the USA! And is there even any research on developing safe drugs to stimulate prolactin release by the brain? NO! Why don’t pharma companies investigate this? Because, there is more profit in formula! I look forward to the day when lactational dysfunction is treated with the care and concern that any other dysfunction is given. And that mothers are honored as being wonderful moms who provide all the non-nutritional qualities of breastfeeding that cannot be obtained by bottle-feeding whether or not they make a full supply! If we could all realize that mothers are recommended to exclusively breastfeed for 6 months, and after that most children and eventually ALL children will be partially breastfed, and then weaned! This is not to downplay the significance of exclusive breastfeeding, but everything must be held in balance!

    Jane

    April 25, 2010 at 3:41 pm

    • I’ve see an anecdote and a case study where women who had low milk supply with her first child took progesterone during a later pregnancy, experienced breast changes, and was able to exclusively breastfeed that child. I made about 5 ml of milk per feeding with my first child after trying EVERYTHING I could to increase supply. My second pregnancy, I took progesterone because I had very low levels during my luteal phase. This time I’ve been providing more like half of my child’s milk (not sure of the quantities since I haven’t been able to do pre and post feed weights yet – he’s not yet a month old).

      Daemon

      November 4, 2011 at 7:13 am

      • Daemon–I saw that case study as well!! I am hoping that taking progesterone during my next pregnancy will help me.

        Could you give more information on your breastfeeding success after taking progesterone? (although, I realize your baby is still very young) Did you take injections, suppositories or cream? When did you begin the progesterone? Did you take any herbs during your last breastfeeding attempt and/or during this most recent pregnancy?

        After experiencing 2 miscarriages, my 3rd pregnancy was more carefully monitored by my doctor (then I switched to midwifery care). I got a positive pregnancy test at 4w3d pregnant and my progesterone level was 21. Two days later it was still 21. Another 2 days it dropped to 14.9 and I was prescribed a nightly 200mg prometrium suppository (at 5weeks pregnant). My pregnancy proceeded with zero complications.

        My progesterone levels were never checked again. I asked to have them checked but was told that the 200mg would definitely raise the levels.

        I had a planned homebirth–10 hours of labor with 20 minutes of pushing. The only complication was a retained placenta that was removed intact at home with no medication. I gave birth to a very healthy baby girl who had a strong suck and a strong desire to nurse.

        At 3 days postpartum, she had gone 24 hours with only 1 wet diaper. We immediately met with an LC who did a before & after weight check on my left breast. There was no change in weight. At 9 days postpartum, we got a before & after weight check on my right breast. Baby went from 7lbs 2.9oz to 7lbs 3.1oz. The consensus is that I have insufficient glandular tissue. My breasts are not tubular, not widely spaced, I do not have large areolas and they are very similar in size. However, I have never experienced a letdown & did not experience postpartum engorgement.

        My daughter is currently 4 1/2 months old, we are breastfeeding using an SNS. I am still taking Goats Rue & alfalfa in the hopes that this will build more glandular tissue. I have taken many other herbs, Domperidone, pumped, eaten oatmeal, skin to skin & nursing vacations.

        I hope things are going well for you!! I think women with low milk supply can learn alot from each other’s experiences, which is why I briefly described my history. :-)

        Claire

        December 2, 2011 at 12:16 pm

      • I asked my obstetrician about this (and other herbal drugs to boost breast growth) pretty early on for my #2 pregnancy and was given a non committal response along the lines of, hmm it might work, but she never made any attempt to instigate anything. There’s just not a lot of research out there (or the drive/funding for research) is there? anyway a week away from my repeat caesar I am thinking I will do whatever I can but I won’t beat myself up about not being able to fully breastfeed if I can’t.

        Naomi

        December 4, 2011 at 8:49 pm

  21. [...] When lactation doesn’t work As a newly-minted doctor and breastfeeding activist, I used to believe that all mothers could breastfeed. Now, after [...] [...]

  22. As a midwife of 23 years and a mom who has struggled to have sufficient supply for eleven children over 2 decades I appreciate this column greatly. I know that if it has been such a challenge fo me, with my training and support, how difficult must it be for women without these resources? It wasn’t until my 11th child was a few months old that we found some success–with Domperidone. For teh first time in decades I am anticipating a measure of success with baby number 12 (due in a week) with the help of the medication–but sad that my other children were not able to have the same degree of nourishment at the breast.

    LeeAnne

    April 25, 2010 at 10:40 pm

  23. Hi Alison,

    Do you have stats on the rates of “lactation failure” vs. ED? I’m curious as that could really hammer home the difference in the research funding. Also, what percentage of lactation failure is made up of women with hypoplastic breasts and is that the same as “congenital lack of glandular breast tissue”? Funny, I was just discussing the lack of actual stats on the internet regarding women that are unable to breastfeed. If there are only 9 studies out there, it is no wonder!

    Wendy Armbruster Bell

    April 25, 2010 at 10:50 pm

    • Wendy – it’s actually quite difficult to determine “lactation failure” statistics, in part because it’s such a tough thing to define. We know that many women in the US who quit breastfeeding report low milk supply as an important reason. In many cases, the problem isn’t mom’s biology, but the numerous “booby traps” that undermine moms who want to breastfeed, ranging from breastfeeding-hostile maternity practices to cases of formula shipped to mom’s homes. Other times, a mother perceives a baby’s frequent, but normal, feeding pattern as evidence that she “doesn’t have enough milk.” To get at true biologic lactation failure, we’d have to look at mothers who got optimal support and care from conception onward, and nevertheless were unable to make sufficient milk to feed their babies.

      Nevertheless, we know 4 million women give birth each year in the US, and 75% initiate breastfeeding. That means that even if only 1% of new mothers have biological lactation failure, there are 30,000 women each year who suffer from this condition.

      As for ED — it’s a lot more common, with complete ED affecting 5% of men in their 40s and 15% of men in their 70s, according to the Cleveland Clinic ( http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/erectile-dysfunction/#cesec7 ). That’s likely why pharmaceutical companies devote a lot more bandwidth to drugs for ED than to drugs for lactation failure.

      Personally, I think the discrepency in research priorities has a lot to do with how people feel about male sexual function (“The essence of who a man is! Leave no stone unturned to make sure no man has to suffer without this crucial part of his reproductive health and wellbeing!”) vs. female lactational function (“Ew. Please don’t talk about it. And if it’s not working, just give the baby a bottle and tell mom to get over it.”)

      Whatever the cultural hang-ups involved, it’s bad policy. Untreated ED no doubt affects quality of life. But untreated “LD” not only profoundly affects mom’s quality of life, as many women posting here can attest, but there is also the profound health impact – for mom and baby — of not being able to sustain an exclusive breastfeeding relationship.

      Alison Stuebe

      April 26, 2010 at 1:00 pm

      • As a mom who tried everything to be able to breastfeed- and by everything I mean pumping every three hours with a hospital grade pump, taking Domperidone, reglan, fenugreek, blessed thistle, goat’s rue, and a mother’s milk tincture, seeing the best lactation consultant in town twice and the doctor- I can tell you that a woman not being able to nourish her newborn child is the exact equivalent psychologically to a man’s erectile dysfunction. I have insufficient glandular tissue and even after all of that I could only pump out an ounce over an entire day. When my baby was hungry early and I was in a place where I couldn’t get to a bottle until we got home, I felt so inadequate as a woman and I just cried and cried. That was after I had tried everything and really thought I had dealt with the emotional side of it. This is the first time that particular comparison has been brought to my attention, and I think 30,000 babies getting the best start they can is vastly more important than erectile dysfunction. Although why can’t we solve both?

        Laura

        April 26, 2010 at 3:13 pm

      • Hello Alison,

        I’d be curious to know if you’ve made any headway on this issue in the past two years. I was unable to breastfeed my first daughter (now 23 months) after much MUCH effort. I took herbs, increased water, modified diet, met with the NY Times proclaimed “Guru of Lactation Consultants” spoke with LLL and pumped/bf/and bottle fed at each feeding for weeks. But my daughter was dropping weight very quickly (14 oz in 1.5 days) and I would get less than a tsp. per pumping. The LLL women kept insisting that I wasn’t trying hard enough, that the latch was incorrect, that I just needed to wait. My pediatrician said there was no way I could not supplement. Alas, I was left confused and devastated that I wasn’t able to do what I had planned on my entire pregnancy.

        Now, with my second daughter due in a few months I’m trying to equip myself with as much information as I can. I’d love to try and breastfeed again but wonder if it’s physiologically feasible and what I should do to increase my chances of success. My ob is shockingly dismissive of the issue (as was my last ob) and I can find very minimal information online. I’d love to hear any input that you might have.

        Rebecca

        October 30, 2013 at 4:49 pm

    • This is not anything approaching hard research, but one interesting collection of statistics comes from The Farm community in Tennessee. From the period of 1970-1980, there were 1200 births; the breastfeeding rate for that period was 99.1%. Not coincidentally, the 0.9% not breastfed is identical to “Ladies Who Had Their Babies on The Farm & Left Them” (for adoption). It is not specified in the data, however, what the duration of breastfeeding is measured here. It may purely represent initiation rates. 54.1% of the births were to residents of the community but the remaining 46.9% who were from outside the community would likely have been lost to follow up.

      Also, probably not coincidentally, The Farm’s cesarean birth rate for this period was 1.8%; 98.1% of births were drug- and device-free, including those that transported to a hospital. One can speculate quite a bit about the self-selection involved there, but it’s pretty well established that birth often impacts breastfeeding, and cesarean deliveries often very much so.

      One challenge in doing the necessary hard research about primary lactation failure has to be teasing out the impact of birth and early postpartum breastfeeding management from other more congenital (in the mother) factors. And then there are later factors including mother-baby separation, whether due to medical problems in the neonatal period or to maternal employment. I’ve seen many mothers whose milk supply could not be adequately sustained more than a few months by pumping on a schedule; one has to wonder how many of these mothers would have had different experiences had they been able to avoid separation and to nurse the baby on cue.

      Penny in TX

      February 23, 2011 at 10:32 pm

  24. [...] 29 April 2010 All moms — those who breastfeed and those who do not — deserve our support. [...]

  25. Thank you for this post. I struggled with my milk with both of my children, despite doing everything “right,” from pregnancy to birth to postpartum. I held my baby immediately after birth (before delivering placenta), skin to skin, where he stayed for hours. I delivered with no drugs and a midwife, in a birth center. They made sure nursing was going well, baby’s latch looked good, etc.

    My milk just came in slowly and poorly, and by day 10, my first baby was dehydrated, screaming nonstop, etc. A visit to an LC revealed that he was getting less than a tenth of an ounce of milk after nursing both sides for 45 minutes.

    Many, many months later, after having tried everything (including domperidone), I resigned myself to long term supplementation and better luck next time.

    Next time was no better.

    I was fortunate during this time of my life to befriend the late (and incredible) lactation expert Mary Rose Tully from UNC. She worked with me and both of my children to get the best nursing relationship possible, and she gently nudged me to find a balance between working nonstop to extract every possible drop of milk from my body… and having the time and emotional energy to mother my children. She let me know, again and again, that mothers should not have to go to extraordinary lengths to breastfeed their children, and that it was best that I do what was reasonable rather than what was heroic. She helped me let go of my hurt after well-meaning friends from LLL continued to downplay my body’s failures, and gave me permission to be angry about falling into the category of women for whom there are no easy answers. The medical world needs more people like her, and I am so sad that she is gone.

    Rebecca

    April 29, 2010 at 2:43 pm

    • Rebecca –

      Thank you so much for tellikng your story. We don’t know why some mothers struggle so much to make milk, even when we do everything right. In the research arena, there’s a lot of work to be done.

      I also tremendously appreciated your comments about Mary Rose. I took my current job at UNC in large part so that I could work w/ her. In January, I told her we were all going to get bumper stickers and bracelets and pens that said, “WWMRD” — What would Mary Rose Do? Her willingness to go anywhere, at any time, to help mothers and babies was extraordinary. She also understood, as you describe so beautifully, that feeding a baby breastmilk is part, not all, of the nursing relationship,

      Your story reminds me why I miss her so very, very much.

      -Alison

      astuebe

      April 30, 2010 at 7:04 am

  26. Yes, yes, and one more time YES!

    Finally! I am so happy that you are talking about this. I’ve been saying for so long that we need to focus more on the very real problem of lactation issues in Western society. Let’s concentrate our research on THIS instead of finding more evidence that breastfeeding is superior to formula feeding. I think we all agree that breastfeeding is the optimum way to feed our kids – but it would be nice to help women do so rather than make feel guilty or depressed when it isn’t working out correctly.

    Fearless Formula Feeder

    April 30, 2010 at 5:12 pm

    • Absolutely. One of the most ridiculous things we are forced to do is to defend breastfeeding as “normal” or ” superior”. Do we do that about sexuality? No we treat it. Accepting Alternatives is just a way of admitting defeat or lack of interest in tackling the problem on a later scale. Sometimes we can’t fix the problem with an individual but if we just sweep it under the rug it will never be important enough to be solved!

      Jane

      April 30, 2010 at 5:35 pm

    • Except that the expectation is that lactation will fail, that very few people ever succeed and certainly not long term. Often the only thing that keeps people going is the the mounting evidence that artificial milk does not the optimal provide nutrition AND can be detrimental. I also posit that lactation fails at a much higher rate here in the US than in countries where breast feeding is the norm. Of course we need more research into how and why a normal biological function fails but we also have to recognize that most of the time that failure come from a lack of support and education not from purely and unexplainable or untreatable issues.

      I had serious supply issues and had to supplement for several months before I could build a full supply. Most people around me expected failure and spent more time reassuring me that formula was “just as good” instead of trying to figure out how to make it work. Our babies had been adopted so I started out with a real disadvantage but I had the advantage of having a great grand mother, grand mother and great aunts who remembered a time when what is known now as “re-lactation” was just what was done out of necessity in a world without a viable alternative to human milk. With their encouragement and the help of an International board Certified LC, herbs and a Dr who understood how to use Domperidome. Besides the hurtle of having to build supply from scratch I also had to deal with mundane issues that ending the nursing relationships of lots of people I know. We had thrush, I had one with a bubble palate, one with a weak suck, one with tongue thrust. I had a formidable team and managed to nurse both kids all the way through toddlerhood. I don’t think that most women don’t have that and while research is absolutely vital we should not miss the fact that far more lactation failure could be avoided with what we already know, by giving moms the education and support to keep going thru adversity.

      lisanvenice

      April 5, 2012 at 11:47 am

  27. Any suggestions on who we should be writing to get someone to take on this kind of research? Because I will write 1000 letters if someone would start studying this.

    Like an other commenter, I think, among other things, my PCOS played a role in my inability to make enough milk for my daughter. It wasn’t until I had been doing everything I possibly could for 3 1/2 months that my lactation doctor looked at my chart again and had the thought that PCOS might be contributing to my issues. If some research was done between now and when I have a second child, maybe I would have a fighting chance at breastfeeding my next child (if I am lucky enough to have an other).

    Thank you for this article to get the conversation started.

    amoment2think

    April 30, 2010 at 8:49 pm

  28. Weichert C (Paediatrics 56;9871975) wrote:
    “….a functional castration of women has occurred. They have aquiesced to a combination of forces, medical and cultural, which have eventuated in the use of the breast as the primary sex symbol and yardstick of feminine desirability, divorced from its nurturing role. Women in a critical period of their life cycle have become divorced from themselves and from their ability to confirm their identity fundamentally. In this instance, the degree of concern of the medical profession might be described as inversely proportional to the dimension of the problem, To draw an analogy, would the professional distance of physicians be maintained were it routinely recommended that all insemination be accomplished artificially? Would anybody suggest, seriously, that males abstain from intercourse, bind themselves, take drugs to relieve congestion, or be mechanically relieved routinely, and that it would be as good?
    The apparant absurdity of the analogy goes to the heart of the problem. If one sees lactation as part of the psychosexual continuum in women, the analogy can be taken seriously.”

    Nan Jolly

    May 2, 2010 at 12:16 pm

    • Thanks for this quote. My first breastfeeding relationship failed (booby-trapped “just one bottle won’t hurt” and the supplementation spiral after a supply dip) and my second has gone well. However, very few people realize that while we shouldn’t worry about making mom’s feel guilty about choosing formula, we *should* worry about making moms feel guilty who genuinely couldn’t breastfeed, and that there is a real feeling of inadequacy behind it.

      Rebecca

      May 5, 2010 at 1:26 pm

  29. [...] when lactation doesn’t work? That’s another blog post, but we still need to watch our language. If we talk about breastfeeding benefits, then [...]

  30. Tears streaming down my face as I read this article. SHE GETS ME! I work as a clinical nurse with premature babies and I was also of the opinion that pretty much almost everyone could breastfeed or express enough milk if they just tried hard enough.
    I have a very tuberous L breast, mildly on the right, and when I was pregnant I asked my obstetrician if it would be a problem, she wasn’t really interested. LCs at my work were supportive and said it was possible to sustain a baby on one side. Just having passed the 6 months mark I have made it! But not without sheer determination, tears, topups, drugs, extra pumping and just the thought that I’ll try to get to the “next month”.
    I no longer feed on the L as he attaches poorly, gets frustrated and I only get <10mL off that side anyway. My breasts differ by about 3 cupsizes, bringing with it all the feelings of hideousness as my R breast is ridiculously huge; an issue I had surgery for to correct 7 years ago and had finally felt normal in that area!
    Tuberous breasts are surprisingly common, as are difficulties in maintaining adequate lactation in this instance, yet nothing is being done to discover why breasts are developing this way. Is it a symptom of our environment and a form of toxicity to some chemical?
    Finally, "making more milk" by west and marasco is a wonderful book and I strongly recommend LCs read this to give an insight into these populations struggling with poor supply.
    Thankyou again, Alison!

    Naomi

    January 30, 2011 at 9:15 pm

  31. Thankyou Alison
    thankyou

    I am crying as I type.

    I have failed to fully breastfeed both (?all)of my babies and there is not one person who can tell me why. It hurts, and I have been saying for so long that it isn’t fair that when I go to the medical profession and say “my breasts don’t work” that there is no information, research, answers or treatment. I know that if a man went to his Dr and said my male member doesn’t work he’d come out with a minimum of 2 scripts, a specialist referral, counselling and a bunch of research and resources to arm himself with.

    It’s not fair. It has to change. Now.

    In the meantime, I must keep myself sane by knowing that I fought every single day to partially breastfeed my children for 2years each. That may be all the breastfeeding success I see in this lifetime and I pray that my daughter does not experience it in her turn. She deserves better – we all do.

    mum22

    January 31, 2011 at 9:19 am

  32. great article, thanks. what is not mentioned at all in the article are the things that happen during labor. I am wondering if you are familiar with the book “Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby continuum” by Mary Kroeger,CNM? There is little research because the money is in the formula industry and there is no pharma answer, right? follow the money!

    Judith

    March 1, 2011 at 7:11 pm

  33. I had tears in my eyes reading these posts. I am a LC, mother and grandmother. On a personal level I have had BF failures and successes and the same goes for my professional life.
    One thing I can say is that science doesn’t have all the answers and probably never will. You are mostly right in saying Obs are not interested in BF and Paeds only slightly more, but we are working on this.
    I see women who don’t care about their babies and anything will do, usually the basis being they have not been adequately mothered themselves or drug and food addiction prevails.
    Then I see women who do not have confidence in BF because they have never seen a woman BF, and there significant role models do not have confidence.
    With the advent of BFHI Accreditation at my place of work I am seeing more and more women successfully BF for longer periods of time because they have been supported and given information.
    We also have introduced the midwifery model of care for high risk groups of women. This is an amazing program and these mothers are blossoming with increased self esteem and knowledge. This has made a major impact on our ceasarean section rates.
    Rarely I see women who have hypoplasia of the breast tissue, which is usually related to PCOS.
    Lactation will still be achieved, but perhaps not at a level to sustain a baby, as there are not enough lactocytes which are the cells which produce milk.
    I have known women who use a supplementer whilst breastfeeding for over two years, and I regard these women as remarkable.
    Perhaps stem cell research may help in the future?
    Breastfeeding is very important and any amount of breast milk is better than none. These mothers need to grieve this loss, but it is important to keep thing in perspective and balance. Seek advice take advice and do the best you possibly can.
    The old adage dont stress about the things we cant change prevails at this point as there is no cure and you have a baby to love and care for.
    If women feel strong enough about this issue it is time to write some letters and get some research going in this area. You cant leave this issue to other people or organisations. Action and power starts with you!!

    Lori Turner

    March 10, 2011 at 9:03 pm

  34. Great article. I didn’t have time to read through all the comments, so this may have been brought up already. I think there has been research on the link between the kind of birth one has and ones ability to breastfeed. This can’t be denied. I’m not saying that by having an intervention free, drug free labor and birth will solve all cases, but I bet you it would significantly reduce the incidence of “breastfeeding failure”. And no drugs are required!

    Kristin

    March 11, 2011 at 8:58 pm

  35. [...] blog. This week Dr. Alison Stuebe wondered why there isn’t more research being done on why some moms don’t make milk and how that problem can be solved.  We’ve solved much more difficult medical problems, why [...]

  36. Thank you thank you thank you for writing this. I tried everything for the first 7 weeks of my baby’s life to feed but had every problem imaginable. I only had 4 days in the 7 weeks when I was not on flucloxacillin for mastitis; a golf-ball size galactocel in my right breast; chronic over-supply with milk backed up to my elbows with very poor drainage; and nipples so ripped that the cracks were 4mm deep and 4mm wide all the way around both nipples–which were wobbling and just hanging on by a threat. Still the lactation consultant condescendingly just said “if she’s latched on right it won’t hurt”. I spent almost $3000 on surgery and lactation consultants but to no avail. I have very flat nipples and fair skin with red hair which (apparently) produces paper-thin skin which rips very easily. I dreaded feeding my baby and was in tears for every feed due to the pain which was worse than labour. I tried and I tried but nothing worked. The breastfeeding “Nazis” just made it worse. Going to formula was the best thing I ever did.

    Emma

    May 21, 2011 at 4:56 pm

  37. Fantastic article! How can we help?

    Shonda

    May 22, 2011 at 12:41 pm

  38. We do need more research into the medical conditions that preclude breastfeeding. It’s refreshing to see someone acknowledge that such conditions exist–many lactivists plug their ears and scream “BOOBY TRAP” at the top of their lungs over and over again to avoid acknowledging that many women just. cannot. breastfeed. Just getting someone in the medical community to admit that supplementing isn’t from the devil is a plus. For many women, the real booby trap is in the people who insist that supplementing never works, so those women end up going with straight formula when they would have been perfectly happy doing a mix of both.

    But this article–and most of the comments–still resort to “one-size-fits-all” medicine–assuming that breastfeeding is ALWAYS the best solution and that the ONLY legit reason not to breastfeed is because of some quirk of the woman’s body. It ignores a lot of the other valid reasons not to breastfeed, which range anywhere from a child that’s allergic to all milk proteins (including human, and yes, this does happen despite lactivists’ insistence that it does not) to a mother who is HIV+ and is not living in a country with bad water). No “miracle cure” unearthed by better science is going to change the fact that for some, breast is NOT best, and that infant feeding, like any other decision, needs to be figured out on a case-by-case basis.

    I’m surprised to see the comparison to ED accepted by people who try valiantly to de-sexualize the human breast, to the point of eye-roll-inducing statements that deny reality. The treatment for ED has its side effects, and requires a reliance on modern medicine–which is an anathema to many in the lactivist community, who seem intent on finding booby traps everywhere they look. The commentor who said her booby trap was one bottle of formula raises eyebrows compared to the other commentator who is talking about inducing lactation in adoptive mothers, and the many commentators who talk about how supplementing is working for them. The people who denigrate modern medicine (including the idea of making women comfortable while giving birth, an issue raised by one of the commentors) and yet demand that same modern medical system magically solve this problem come across to me as having very contradictory attitudes.

    If the treatment for not breastfeeding took the mickey out of women who had to endure it (as it currently does for many women who take every herb, medication, and try every technique out there), then by finding some medical treatment, are we just going to create more reasons for people to denigrate bottle-feeding mothers? As it is, a woman who hasn’t tried every hold possible, spent thousands on galactagogues, lactation consultants, and other professionals, spent many hours sobbing, struggling, etc. that she could have spent bonding with her baby, is denigrated as having “not tried hard enough.” She’s told she’s lazy, stupid, ill-informed, and unable to make a proper decision for herself, when in fact she DID analyze what was best, what was best for her family just disagreed with the seething horde of “my way or the highway” militant lactivists. How much worse is this going to be if she/her health care professionals deem the “miracle cure” that this article seeks to find not a good option for herself/her family?

    Medications–herbal and synthetic–have effects. It’s folly even to call them side effects–it just minimizes very real consequences of taking them. We know that everything a mother consumes has the potential to be expressed in her milk; are we going to study this miracle cure in newborns? Or are we going to do what many supposedly evidence-based, risk-averse lactivists currently advocate, which is to assume meds are okay for newborns despite the total lack of evidence and total lack of risk/benefit analysis? I see far, FAR too many people playing armchair doctor and armchair pharmacologist on online breastfeeding resources (including LLLI) and in life in general, encouraging women to breastfeed at all costs, even if their meds are having a demonstrable effect on the child. Just one of those things that makes me want to tear my hair out.

    I think the thing that disturbs me most about this article is the simplistic attitude, that not breastfeeding is a “problem” that has to be “solved.” Isn’t that medicalizing birth and infant feeding–something lactivists bemoan? Apart from countries in which formula is a bad option (because of bad water/bad mfring standards), formula feeding is indeed NOT a problem, and telling a mother “it’s okay, I was formula fed and turned out fine” sounds a lot more to me like empathy than patronizing. A doctor has to juggle many things when giving treatment options, and a doc presented with a mother who is at her wits’ end, harming herself and her child for the sake of breastfeeding, is going to present formula as a medically sound option because THAT’S WHAT S/HE *SHOULD* DO. That’s not a “problem” or “booby trap” or whatever term lactivists want to call it. That’s treating women as ***patients*** and not statistics, and shows ***respect*** and not a lack thereof.

    Any miracle cure to “lactation dysfunction” or whatever you want to call it STILL falls within the golden standard of medicine, which is a proper pro/con analysis. For some women/babies, it STILL won’t be an option. For a group of people who wants more respect for the female body, for the complexities of birth and babies, it’s scary to me that you’re ignoring all sorts of reasons not to breastfeed and STILL advocating a one-size-fits-all “solution.”

    Teri

    August 14, 2011 at 12:55 pm

  39. i could only feed on one side due to a “lump” blocking the ducts in one breast. Years later that lump was diagnosed as cancer. Fortunately it was not the normal aggressive cancer but a slower one. Getting a doctor (or any doctor) to look at it close enough to tell me what it was was impossible. They kept saying that they didn’t know what it was but its not cancer (which it turned out to be). This has left me wondering whether some doctors tend to ignore womens issues (& yep all the doctors were male who didn’t want to look closer & the one that insisted they did was female)

    lucky

    August 16, 2011 at 11:32 pm

  40. This is a fantastic article. I hardly ever talk about nursing to expecting moms anymore, unless we’re alone in private, because so many women react with vitriol to a discussion of how important it is. They usually start out with “I tried for 2 months to nurse, got recurring mastitis, I did everything possible before giving up, and my baby is fine.” I want to say “Why did you try so hard if it doesn’t matter?” Those moms feel so guilty, and they shouldn’t! I also really don’t like it when we tell moms not to feel guilty about not nursing – because by saying it, we prescribe that emotion. We should be talking about anger – “Don’t feel angry, try to forgive your pediatrician for failing you and your friends for not supporting you,” etc. The whole dialog needs to change, especially for moms who weren’t successful.

    Maggie Cain

    April 4, 2012 at 7:05 pm

  41. Ladies please consider these resources. They may comfort you (or another mother) who is mourning the loss of what you imagine your breastfeeding relationship would be. You can also bring them to your healthcare provider to help so that medical professionals can begin to understand as well.

    This is a podcast with Diana Cassar-Uhl (a wonderful IBCLC!) She is speaking about Insufficient Glandular Tissue (IGT) also known as Breast Hypoplasia or Hypoplastic Breasts

    http://motherloveblog.com/2011/07/25/when-the-booby-fairy-doesnt-arrive-a-podcast-interview-on-insufficient-glandular-tissuebreast-hypoplasia-with-diana-cassar-uhl/

    This is another excellent reading from LLL on the topic.
    http://www.llli.org/llleaderweb/lv/lviss2-3-2009p4.html

    Stephanie Kirsch

    April 4, 2012 at 7:13 pm

  42. Thank you for writing this! I can’t tell you how many names I’ve been called and how many people have put me down because, in their eyes, I just wasn’t trying hard enough to breastfeed. I tried EVERYTHING. I met with so many people, and tried everything they told me….. still barely got 1oz a day. Nearly 5 years later, I still feel guilty and ashamed. I hope there ARE more studies done to help moms like me, so that nobody else has to carry this guilt around for years and years.

    Sarah

    April 4, 2012 at 11:03 pm

  43. [...] важной и достойной распространения, под названием When lactation doesn’t work Здесь я привожу ее сокращенный и вольный перевод в [...]

  44. I truly enjoyed this article. If only tears were milk. My son is over 3 weeks old. Tuesday of this week I finally gave up on the wonderful dream of breast feeding. After two doctors this week told me to give up and just be happy I have a healthy baby.
    Apparently there is a big difference between No milk supply and low milk supply. My breast never swelled or really had any changes. I have pumped religiously every two hours since I left the hospital. The hospital made me start supplementing due to my sons rapid Weightloss. I cut the end off one of the feeding tubes and attached it to my nipple so that while giving him the dreaded formula he would still be at the breast. I’ve been on every vitamin known to man to stimulate lactation. I’ve pumped until my nipples have cracked and bled. Ive massaged my breasts till I thought they were going to fall off! My blood work has not shown any abnormalities.
    The first time I went to the store to buy formula. I was so embarrassed. Society doesn’t understand.
    I can’t put into words how it feels to have the intimate bond of breast feeding and providing for your baby, all taken away. Nothing has or probably ever make me feel so inadequate. And I feel that I’ve already learned one of the hardest lessons of motherhood. No matter how much you want what’s best for your child, you can’t always provide it.
    As a nurse I wish I knew who to write or how I could help educate the rest of the world that breastfeeding is such a wonderful gift but not all of us are blessed.

    Marybeth Roland

    April 5, 2012 at 9:58 am

    • Marybeth, I wish I could say something to make everything better. I do know exactly how you feel & you are not alone. It took me months before I could even bring myself to buy or even mix the formula, I asked my husband to do it. On one trip to Whole Foods for the organic formula, the elderly cashier was making conversation with him & asked him how old his baby was. He told her 3 weeks & she told him that “breastfeeding was best”. I’m sooo glad I wasn’t with him because I probably would have burst into tears in the middle of Whole Foods.

      If you want support, please join this Facebook group: https://www.facebook.com/groups/IGTmamas/

      Another support group to consider is MOBI.

      Claire

      April 5, 2012 at 1:39 pm

    • Hi Marybeth,
      I feel for you so much. Please don’t beat yourself up, you are a courageous mumma who successfully gave her baby 3 weeks of liquid gold, no matter how small the volume may have been. Cuddle your baby lots & tell him or her how well you did.
      I still beat myself up 2 years later for not realizing my first baby was starving for 2 weeks & i had to make that awful shameful trip to get formula. I’m a senior nurse in neonatal intensive care & I had no strong feelings against formula but when it came to giving it to my son it felt so wrong! But you know, I had to accept that he needed it, albeit as topups, and without it he would’ve been worse off.
      I hope if you go on to have further kids that things improve as they did for me with my second baby. I plan to become a lactation consultant in the next year & I would reallylike to write some journal articles on IGT when I get settled (2 kids are very demanding!). I just don’t think enough Lact cons are familiar with this! Please contact me if you are interested in authoring one with me when you have more time.
      Sincerely, Naomi

      Naomi Drew

      April 6, 2012 at 5:42 am

    • I am in the same boat. I cried when I had to put my last child on formula. I am pregnant with my 4th and last child and doin alot of research on what I can do to keep my milk supply coming. My 3 older children were each hospitalized for not gaining weight and it made me feel like I was starving my children and if I didn’t put them over to formula, I was a bad mom. So I know exactly how you feel and if you found ways to keep your milk supply coming, please let me know.

      Karmen

      August 15, 2012 at 1:54 pm

  45. I just saw this reposted on KellyMom, read through the blog, then through the blog comments, and saw my comments from 2010 on here! I wanted to follow up for those of you who went through a similar experience. I had mastitis 8 times with my daughter that never went away, so I started weaning at 6 months and completely weaned at 9 months. I posted as “Stacey” in the comments above. After slowly weaning, my health got better and the mastitis went away.

    I then had my son 23 months after having my daughter. I had trouble with plugged ducts, but with new ideas at hand, I’ve only had 1 real case of mastitis since having him 8 months ago! So there is indeed hope for women who had experienced recurrent mastitis with previous children. I will make a quick list of what has helped me this time around: accupuncture from the get go to identify potential plugged ducts (I stopped this at 4 months once the plugged ducts seemed to resolve themselves), placing cabbage leaves and ice IMMEDIATELY on breast if I feel any sort of discomfort or pain, feeding on demand and avoiding the pump at all costs (which has meant running home from work to nurse my baby), taking four 1200mg pills of lecithin everyday coupled with 1000mg of Vit C, 1 dose of probiotics, and 1 prenatal, never EVER wearing a wire bra, drinking TONS of water, and nursing at least 2x a night (which is a pain, but it prevents mastitis).

    I hope this gives some women hope who have experienced recurrent mastitis.

    tenure.track.mommy

    April 6, 2012 at 6:16 pm

  46. Very interesting article.
    We must remember that breast feeding is the nature’s way and is designed to directly benefit the mother and baby.
    Artificial milk powder made for infants is a global business that benefits many economic interests.

    Guida Kurzer

    April 9, 2012 at 1:29 pm

    • Nature doesn’t always work the way its supposed to.

      Claire

      April 9, 2012 at 2:07 pm

    • That’s a very narrow minded perspective of the issue. Those of us who CAN’T breast feed because we have NO or little glandular tissue don’t have much of a choice when it comes to how to get milk into our babies. ABM is the difference between our babies living or not. We feel beaten up enough about having to formula supplement, and sometimes donor milk is not a possibility due to unavailability or mother’s choice so we do the next best thing. Please remember how hurtful comments like this can be to a mother!

      Naomi

      April 9, 2012 at 8:45 pm

      • Yup. I did not produce anything. I am sick of being told I am a bad mother poisoning her child because there is no way I could ever feed him. The holier than thou attitude of some mothers disgusts me.

        E

        September 5, 2012 at 1:51 am

  47. [...] I appreciate that 6 months of exclusive breastfeeding is a lofty goal. I see mothers in my practice who struggle with breastfeeding, and we talk a great deal about the gap between what is recommended under ideal circumstances, and what is possible for this particular mom and baby.  Sometimes, breastfeeding does not work. [...]

  48. I am on my 4th and last child and am very determined to breastfeed my new baby. I have had many difficulties breastfeeding my last three where I dried up so early and my children were eventually hospitalized for not gaining weight. I was majorly devistated with that conclusion when it came to my last child probably because I knew I was going to lose that bond. I have been doin research on how to keep my milk supply going and medications to take and foods to eat.

    Karmen

    August 15, 2012 at 1:40 pm

  49. I was wondering if any comparative studies have been done on the statistics of lactation failure in various cultures both developed and less developed. Please post if you are aware of any – or any statistics on how many women’s milk never comes in (in the US), with a healthy full term new born, in an environment supportive of breastfeeding. We need to help mothers who struggle with this.

    Jessica Isles

    October 15, 2012 at 1:49 pm

  50. [...] Jessica Isles posted a great question today on my blog, “When Lactation Doesn’t Work:” [...]

  51. [...] Jessica Isles posted a great question today on my blog, “When Lactation Doesn’t Work: [...]

  52. Hello
    I’d like to use a quote from this article for an article I’m writing for a parenting magazine. How do I go about obtaining permission for this?

    Ann Noser

    January 2, 2013 at 10:21 am

  53. I am crying.. because I have been hell bent on breastfeeding my second child. My first, I was 19, and was told I was starving my baby. That I needed to supplement, and that, supplementing wouldn’t hurt my supply, only help it.. I was lied to. I suffered from extreme guilt, because I was starving my baby, and then because I was feeding her formula. Now.. I am 2 months into this again.. trying not to listen to anyone, but my own instincts… I am have let everything else go, and am nursing around the clock. Every night at 8 or 9, I am fetal position begging God to let my milk let down just one more time so I.can see my daughter full. My poor husband just watches in agony.. trying to convince me that a bottle is okay, and doesn’t make me a bad mom… and yet i just can’t give up again. Knowing that maybe, there might be a bigger issue then me not workong hard enough.. gives me hope.. I am desperate for a medical professional to help me… I just don’t know where to turn! The lactation consultants say one thing, my pediatrician another, my midwife seemed clueless… More information and reseqrch is vital!! I loved this article. Made me feel less crazy.

    Courtney Casper

    January 2, 2013 at 5:33 pm

    • Courtney, I’m so sorry to hear about your experience. I went through the same thing with my baby girl. Supplementing isn’t giving up. The first rule is to feed the baby to make sure baby has enough wet diapers. You can breastfeed AND supplement, so that baby gets all the milk you made. Please join this facebook group, I think the women there would be alot of support to you & could help you to breastfeed. I never made enough milk for my daughter but she’s now 17.5 months & still breastfeeds. https://www.facebook.com/groups/IGTmamas/

      Claire

      January 3, 2013 at 8:12 am

  54. Yes more help should be given to mothers who have lactation failure but thankfully it is not an ‘all too common’ problem. It is in fact rare and far less common than erectile dysfunction. But it would be great to see more research into a formula that won’t put babies at risk of the various ailments that current formula does. Industry doesn’t seem to be making progress as their eyes are on the profits and current formula is very inexpensive to produce and the mark up is very high

    Jessica Isles

    January 2, 2013 at 6:01 pm

  55. There is definitely *something* out there that needs to be discovered for us! My two sisters and I ALL could not breastfeed. We collectively have 6 children. Each birth resulted in almost no milk whatsoever. We all sat for weeks with the baby at the breast nearly all day and all night. Each baby starved with no wet or dirty diapers until formula was given.

    Let me just say, this is not a problem of low milk supply as quite a number of moms have. This is virtually NO milk supply at all, despite very, very dedicated attempts. When you only have *drops* of milk to give, there is no real solution other than to give formula.

    If there is a medical study, sign us up. All three sisters with no milk. We all wonder what we were exposed to or what is wrong with us. I have had my thyroid and prolactin checked and they were normal. I think our breasts didn’t develop properly at puberty. We have all been pretty flat chested.

    It’s been so sad for us.

    Michelle

    February 12, 2013 at 3:43 pm

  56. Nice effort to highlight the importance of breastfeeding. It is a natural phenomena and humans are deviating from it
    resulting in poor health of child. There is a need to allocate more funds and research at global level under unicef to resolve this issue. Formula milk is not the solution of this problem but it is becoming scape route to ignore the issue which human race is facing in the name of industrial age.

    omer

    May 18, 2013 at 2:52 am

  57. This is a wonderful article. I am so encouraged to see a doctor make a call for change. My daughter is five months old. With very rigorous pumping and herbal supplementation, I am able to make about half of my daughter’s nutritional needs for a day (I was unable to make any at the start).

    My pediatrician often asks why I don’t just exclusively formula feed. My obstetrician told me breastfeeding is just a bodily function and some people don’t have good systems in place to support it. Nobody was willing to sit down with me and discuss my goals for breastfeeding or why this heartbreaking loss occurred. None of my doctors or my daughter’s doctors acknowledged that lactation “failure” is painful and real.

    Later in the process, I found a supportive lactation consultant who has helped tremendously. I only wish that my medical doctors had ANY knowledge about lactation “failure.” I had an endocrinologist tell me that hormones have nothing to do with lactation failure. I now know this is untrue.

    As a woman who was told “you need to feed your baby formula or she will die,” I find it important that medical professionals are then able to say ‘this is why this is happening, it is not your fault, and this is what we can do to keep your baby healthy and support your goal to breastfeed.’

    Jessica P.

    May 18, 2013 at 2:55 am

  58. Injectable prolactin, like injectable insulin, oxytocin, and other hormones sees like an obvious galactologue. Women should demand this and maybe big pharma will make it. I’m angry it hasn’t been done yet.

    Ani

    May 19, 2013 at 1:14 am

    • Inhaled oxytocin was used clinically in the 1980s for breastfeeding difficulties. Recombinant prolactin has been studied among women with lactation insufficiency (see http://www.ncbi.nlm.nih.gov/pubmed/21262884 and http://www.ncbi.nlm.nih.gov/pubmed/20718766 ). However, it is not available clinically.

      astuebe

      May 19, 2013 at 6:02 am

    • I agree that more treatments should be available but what are folks willing to pay for these treatments? Stop interference with already existing meds that work and make available. Put appropriate practices in place for m

      Lafyjfk

      May 19, 2013 at 6:40 am

  59. what are the medicine that can be taking to make a woman to breastfeed after given birth

    daniel

    July 16, 2013 at 12:11 pm

  60. Thank you so much for writing this. No matter what I did, my milk never came in with my daughter. She and I both cried every feeding when we were trying to breast feed. When I finally gave up when she was 3 weeks old, I never got engorged, I never had any leakage, nothing. I talked to her ped, to 3 different LC’s and everyone told me “just nurse more, it will come”. How the HELL am I supposed to force a newborn baby who screams like I’m killing her every time I hold her to the breast to nurse???

    She’s nine months old now, and doing perfectly fine on bottles. But every time I read a blog post, article, or whatever, about how “breastfeeding is so much better!” I still burst into tears.

    So thank you for posting that I’m NOT a failure.

    Caitlin

    July 18, 2013 at 11:10 am

  61. With my first born, I didn’t know what I was doing and I had a hard time getting things going. I even hired a lactation consultant to come to my house within the first week because of the struggle. I wanted to breastfeed 100% badly and just couldn’t. No one seemed to have an answers. I blamed myself and had guilt for a long while.
    Then I became pregnant with twins and my OBGYN and ped said,” oh Breastfeeding twins is hard”. I brought it up before their birth because I wanted more support this go around. They made me feel like I was crazy for even thinking of trying. When they were born 6 weeks early and in the NICU for 3 weeks- it was a rough start especially since I had to rely on the pump. I started pumping 3 hours after birth(no milk), I pumped 20 min every 3 hrs/24 hrs/day. Nurses, drs, family just kept making light of it, saying, “oh it will come in, why do you get some rest- sleep through the night”. I still pumped anyway. When I left the hospital without the babies, I still pumped 24/7, brought milk in, pumped at the NICU, tried to get the twins to latch at 36 weeks (very difficult). My supply via pumping came up to about 500-600mls and stayed there for a long while. I had a hard time getting past that number (I knew I needed tons of milk for the twins-just wasn’t happening). When we all finally came home, I was exhausted, twins is really hard but I didn’t want to give up. I would do a combination of breast or pumped milk (eventually I had to supplement more and more despite my pumping 8 times a day!!). I realize now that it wasn’t my fault, something in my hormones, chemistry, breast tissue just didnt allow me to do what I wanted. Believe me, if there was milk, I would have kept pumping it out and kept putting the babies to my breasts. I decided some was better than none so I pumped 6-7 times a day for 7 months. I was a commitment for sure. (Even did it at work- in the bathroom!)
    My routine eventually just went to pumped breastmilk. When I was latching one and bottle feeding the other and pumping it became too confusing and the schedule didn’t work (with twins- it’s all about schedule). I would pump 20 min everytime I fed them, I used a hospital rented pump, I brought my portable/ backpack pump along with me places. I made it work. It was really hard but I did it. I still wish I had made more milk. Its hard for some to understand, it makes you feel robbed of a wonderful experience. I had friends who had a hard time with it and friends who made it seem easy as they walked around the park Breastfeeding their newborn as they looked after their toddler playing?? It seemed so unfair at the time. To this day, I’m envious that some women are able to do it 100% for a year!!
    Well, we are done expanding our family now. Three is plenty for us. We are enjoying them all so much. My long term goal is to become a lactation consultant. I’m a registered dietitian currently and my dream would be to help other mothers get on the right track and help them do the best that they can do.

    K. Novello

    July 27, 2013 at 7:54 pm

  62. I had a lactation failure n my doc scolded me so harsh… dn 1day i told him my baby is getting weaker it was only d 8 th day of delivry… doc checked n recognized my baby is dehydrated… wat the bullshit of doc.. constantly throughout baby’s treatment he forced me to breastfeed.. but aall in vain… i finally staarted bottle feeding without telling doctor.. n today finally my baby is healthy… n my family reaction was tooooo harsh on me… dey said bad things to me… but wat could i do… im still tensed for mh next baby

    sara

    March 18, 2014 at 11:58 pm

  63. […] also need to explore how best to support moms when lactation doesn’t work. Earlier this week, I met with a medical student, who shared that she was breastfed for 18 months, […]


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