It is estimated that 95% of women who conceived naturally are physiologically able to breastfeed. This means that, so long as the mothers nurse the baby(ies) on cue, their bodies will be able to produce the right amount of milk. But this means that 5% of women cannot physiologically produce milk, cannot produce enough milk, or can produce milk but something impedes the milk from reaching the baby. That’s 5 women out of every 100 who cannot nourish their babies 100%, no matter how much determination they have and no matter their desire to breastfeed.
The reasons are myriad, but reasons are both maternal and neonatal. Let’s focus on the maternal side. For the birth mother, they include long words such as:
- mammary hypoplasia
- insufficient glandular tissue
- breast reduction or augmentation
- breast injury damaging glandular tissue
- breast removal (mastectomy)
- thyroid or other hormonal imbalances
- PCOS or other auto-immune issues
- retained placental fragments
- late onset lactogenesis
When these mothers hear “I stopped breastfeeding because I didn’t have enough milk”, their hearts often break. They may have tried and tried and tried. But their bodies just didn’t produce or wasn’t able to provide what their baby needed. And by no fault of their own. With accurate diagnosis, whether or not a mother is able to provide 100% of the baby’s needs for milk, even with intervention, cannot be estimated, each mother and each set of circumstances play a role.
For those who cannot feed 100%, they can seek out donor milk or use formula. This milk can be offered in bottles using paced-feeding methods or in supplemental nursers such as the SNS or Lact-Aid. The latter is particularly appealing to mothers as it promotes the intimacy of breastfeeding as the supplement is given at the breast. In fact, with supplemental nursers, it’s even possible to “breastfeed” 100% of the time, even if you do not feed human milk 100% of the time.
No matter the method to offer supplements, many times these mothers are judged when they are seen to not be breastfeeding their children. No mother should be judged. Most mothers try the best they can with the information they have at the time. It’s especially hurtful, however, when the mother wanted to nurse but could not.
Low Supply & the Mother
In my work as a breastfeeding counsellor, I’ve met many women who said “I didn’t have enough”. And probably 5% of these women had one of the above issues. The other 95% had either “perceived low supply” or actual low supply, but low supply not based on a physiological inability to produce milk. It was another issue. Let me explain.
Perceived low supply often manifests itself from lack of confidence in one’s ability to nourish a child, from misinformation about normal infant behaviour & nursing patterns (see this blog about the 3-8 week crisis), and/or from cultural booby traps that set mothers up for failure, before they have even given birth. In these cases, the mother’s supply is often fine, but circumstances lead her to believe she doesn’t have enough milk. Without receiving accurate information & support at this time, parents often supplement their babies, the supplementation then reducing the baby’s time breastfeeding, thus interfering with supply & demand, ultimately resulting in actual low production and eventually early cessation of breastfeeding.
In other cases, breastfeeding gets off to a rocky start and low supply ensues due to misinformation or poor support. For example, many parents have been taught that babies breastfeed every 4 hours, this idea repeated by family & friends (feeding “again”?) and even by health care professionals. So they try to feed every four hours, even though they hear their babies asking for more before that time period (often forcing themselves to ignore their maternal instincts, which can dull that instinct long term). Infants, however, don’t read watches. If we try to manage breastfeeding by limiting a baby’s access to the breast (his all-in-one source of water, food, antibodies, comfort & love), the mother’s body will react by producing less. And the fewer times baby nurses, the less milk the mother’s body will make. If there is very early management of breastfeeding, the mother’s body may not reach its full production potential.
Low Supply & the Baby
Sometimes the baby isn’t able to “transfer milk” effectively, either due to an easily corrected latch or due to a physiologic issue, such as a high palate, tongue-tie, and/or lip tie. If the latch isn’t fixed or the baby’s issue not corrected (with a tongue or lip tie release or cranial sacral therapy to work on the palate), the milk that is there won’t reach the baby, meaning the mother’s body will think the baby does not need the milk, so will respond by producing less, ultimately leading to low supply as well.
So what’s the point of this blog? There are several:
- Breastfeeding isn’t just about the milk!
- Learn about breastfeeding & infant behaviour BEFORE the baby is born. The production of milk is innate, the act of breastfeeding & babycare is learned.
If you learn BEFORE (by reading and by attending mother’s groups where you can SEE mothers breastfeeding), when baby is here you’ll have a better idea of what’s normal & what’s not. If something’s “not normal” you can get early help.
- Get to know your body and breasts/nipples!
Did your breasts grow during pregnancy? Do you have hormonal issues? PCOS? Thyroid? Knowing about these things in advance mean that you can be prepared for a possible effect on supply. You may also be able to act DURING pregnancy.
- If you feel like you have low supply but wish to continue breastfeeding ASK a breastfeeding counsellor or lactation consultant or both! They can help you figure things out and can suggest tips to up low supply IF this is the issue.
- Some mothers truly cannot breastfeed 100%. Know that paced-bottled feeding & supplemental nursers are an option.
- If you want to stop breastfeeding as it’s not working for you (for whatever reason), think about how you talk about this choice. Instead of perpetuating the idea that many mothers are not able to produce enough milk by saying “I couldn’t make enough” take ownership of your choice and give the true answer.
Comments? Experience with low supply? We’d love your comments below.
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