Musings on low milk supply

I don't know if you've noticed any difference, but you can now access this site at www.askmoxie.org thanks to a wonderful reader who fixed that for me. The moxie.blogs.com/askmoxie URL will also still work, and all the archives are in the same place. If anyone needs a great web design person in Toronto, let me know and I'll hook you up.

Infant Hib vaccine recall in the US.

Can we talk a little more about low breastmilk supply? I have a theory, and I'd love to run it past you to see if it makes sense. I think that the conventional wisdom that very few women have low supply was probably true back before WWII. But that our environment and the way we have babies now has changed our bodies so that low milk supply is more common.

Apparently, when you breastfeed a baby, the milk-producing cells in your breasts multiply and increase their output. So you'll have more milk for subsequent babies. Also, I've heard from an LC that girls who breastfeed develop more milk-producing cells later on than girls who don't, because the act of nursing somehow stimulates the production later on. So I'm wondering if the reverse is true, that those couple of generations who were told to use formula caused us to lose some of the capacity to make milk that our ancestors had 4-5 generations ago.

At the same time, we have so many toxins in our environment now, especially plastics, that we know are messing around with our bodies. There's definitely a link between plastics and hormonal problems that may cause PCOS and infertility, so it seems like that could cause low supply, too.

And at the same that all that's been happening, the way we give birth has changed so much over the last 100 years. There was a whole generation that was basically knocked out cold during delivery, but they didn't breastfeed, so we don't know how that would have affected milk supply. Now, almost every woman is given pitocin and IV fluids, at the least. We know IV fluids cause edema of the breasts in some cases, and edema delays or reduces milk production. (Again, conventional wisdom is that your milk comes in by day 3, but I know dozens of women who didn't get any until day 5 or later after a labor involving IV fluids.)

It seems to me that this might have created/be creating a perfect storm of low production for a higher percentage of women than "should" have low production.

Any thoughts on this? Do you think I'm way off, partially on the mark, forgetting something? Any other theories?

Comments

[Michelle]

I definitely think you are onto something Moxie. I had Pit and IV fluids with my first labor and milk didn't really get her until day 4-5 - thank goodness I had a wonderful doula who is also an LC who kept encouraging me to nurse as often as possible and worked with me on positions, etc. Otherwise I probably would have been discouraged and started supplementing.

With #2 I had a natural labor at home and my milk was in at the end of day 2. I definitely think having a natural labor helped because I felt that "euphoria" after the birth I kept reading about but didn't experience with #1 because epi meds and IV fluids were messing with my chemistry. I can't help but think that rush of oxytoxin that made me feel so good also helped my milk production.

It makes sense that we make more milk with second pregnancies, that is definitely true for me. I have not had the supply issues at all with this one that I had with numero uno.

[Michelle]

I definitely think you are onto something Moxie. I had Pit and IV fluids with my first labor and milk didn't really get her until day 4-5 - thank goodness I had a wonderful doula who is also an LC who kept encouraging me to nurse as often as possible and worked with me on positions, etc. Otherwise I probably would have been discouraged and started supplementing.

With #2 I had a natural labor at home and my milk was in at the end of day 2. I definitely think having a natural labor helped because I felt that "euphoria" after the birth I kept reading about but didn't experience with #1 because epi meds and IV fluids were messing with my chemistry. I can't help but think that rush of oxytoxin that made me feel so good also helped my milk production.

It makes sense that we make more milk with second pregnancies, that is definitely true for me. I have not had the supply issues at all with this one that I had with numero uno.

[Maura]

You know, I should be studying for my pharmacology exam, but lactation is so much more interesting....

I think the real people to look into this question is a combination of gynecologists and veterinarians. There's a board certification in veterinary medicine devoted to theriogenology - how to get animals pregnant, get them to maintain the pregnancy, have live births and lactate on schedule. Obviously this is huge in the dairy industry, and cows can have cystic ovarian syndrome, too. Since a cow that can't get pregnant and lactate is pretty much useless to a dairy farmer, there's been a lot of research in vet med on how to increase production. Most domestic cows now would never survive in the wild, not only because they're painfully stupid, but because they produce so much milk that their offspring could never consume all of it and the dams would die of mastitis.

I think Moxie is right on with thinking that the way in which we have children may have changed our milk supply, but I think it may actually have more to do with what we do with our bodies BEFORE we ever become pregnant. We are waiting longer to have our first child, and often that prolonged waiting is brought about by hormonal contraceptives. Now, vets know that a female animals body is designed to be pregnant (I think human docs know this too...) and that there can be some pretty severe consequences to having multiple estrous cycles without following through with pregnancy. You can get endometrial, ovarian, vaginal, mammary tissue changes - the list goes on and on. For animals the problem can be solved pretty neatly by spaying, but that's not such a good option for women, obviously!

I'm not saying that we should all be getting pregnant when we're 16 and turning out a baby every few years (I didn't have my first until I was 24, and he's still my only), but I think we need to keep in mind that we're not doing things the way our biology is designed, and that may have repurcussions on our overall fertility. I also know that there are women out there who never took oral contraceptives, had their first baby at 21, and weren't able to breastfeed. I don't have any good solutions, unfortunately.

Now that I've rambled on long enough, a personal story. My grandmother was in the hospital, almost 65 years ago, having given birth to my oldest aunt the old-fashioned "twilight birth" way, and was trying to breastfeed her. Now, my grandmother had NO IDEA how to breastfeed a baby and put my aunt on the bed and got on all fours above her and tried to dangle her breast into the baby's mouth. A funny (and sad) picture, until you the nurse came in, saw what my grandmother was doing and said, "You're too stupid to breastfeed. I'll get you some formula." I'm angry just thinking about it...

[Melissa]

I don't know what to say except that you've properly frightened me.

[Amanda]

I'm skeptical of diagnosis of "low milk supply" - how many women have truly educated and supportive doctors/midwives/lactation consultants making the diagnosis? I've sat in LLL meetings and heard just awful stories from women who had trouble breastfeeding their first and were basically told they would never be able to meet the nutritional needs of a growing newborn. Luckily they found LLL before the second one arrived and were able to self-diagnose the trouble they had with the first. Often it was unrealistic expectations of how often a baby nurses (cluster feeding from 6-10pm is a great example that I think throws a lot of women off).

I thought that some of the justification for the claim that nearly all women can successfully breastfeed came from Sweden or Norway where like 95% of women exclusively breastfeed for at least the first year (obviously they have fantastic maternity leave and other benefits that encourage this). I'm not sure if their birth process is different over there, or what else goes into it but it certainly makes it seem like low supply shouldn't be that common.

Poor nutrition probably has an effect too. For me, it wasn't about calories, but about the right mix of protein/fat to keep a good milk supply.

[Jen (yup, another one)]

I think there may be a higher proportion of women with supply problems now than in the past, and the reasons you posit sound valid to me. Another problem is a policy issue, though, and that of course is inadequate childcare leave in the US. I bet that in countries with 6 months or more of paid childcare leave there are fewer women with supply problems than places where many women return to work in 6 or 12 weeks. You're still establishing/stabilizing your supply at that point, so going back to work can make it even harder to build or maintain an adequate supply, with all the challenges inherent in pumping and working and oh, you know, finding time in the day to eat and sleep.

[amy]

What you say makes sense to me, Moxie, but I'm not as studied on the subject as most of your regular commenters, so I'll just offer my data point.

First pregnancy. I was 31 at time of delivery. Emergency c-section 5 weeks early due to low amniotic fluid (baby was compressing cord). I had been drinking 2.5 liters of water a day for weeks (diet-controlled gestational diabetes), but had no signs of edema. Received 2 bags of IV fluids squeezed in immediately before surgery. Edema all over the place post-surgery. Milk didn't come in until end of 5th day. Low supply early, but supply rebounded (bounded?) and eventually I could have fed two babies. I also pumped exclusively and responded well to my pump, after a while.

If I have that much milk again (if I have another), I'll have to donate. It was a shame to have so much more milk than we needed and to have it so easily, but by the time I learned about donation, my daughter was right about a year and the cut off was something like 9 months.

[shannon]

Those are some really interesting thoughts Moxie, and seem to make sense to me based on my experience and history. I'd love to see some research into this!

My data points -- my mother had three children, all unmedicated births, and breastfed all of us until we were at least two. I'm 26 and just had my first in July -- pitocin and IV fluids during the birth; my milk didn't come in until the end of the 3rd day, but if anything I have an over-abundant supply. To Maura's points we were both on the younger side when we started having kids (25 and 26), and neither of us has used hormonal birth control for any length of time (I think about 6 mos. in each of our cases).

My only hesitation with this line of thinking is that it might feed into the guilt that mothers who have low supply or aren't able to breastfeed might feel, ie. feeling that it's their fault for having medicated labors, environmental exposures before/during pregnancy, or not "trying hard enough" with previous children.

Anyway, I would LOVE to see better support for breastfeeding in hospitals -- mine happened to be great, but I have friends who had either NO support or misinformation from nurses who trained many years ago.

[amy]

[I think Typepad ate my comment, but if not, please forgive the duplicate.]

What you say makes sense to me, Moxie, but I'm not as studied on the subject as most of your regular commenters, so I'll just offer my data point.

First pregnancy. I was 31 at delivery. Emergency c-section 5 weeks early due to low amniotic fluid (baby was compressing cord). I had been drinking 2.5 liters of water a day for weeks (diet-controlled gestational diabetes), but had no signs of edema. Received 2 bags of IV fluids squeezed in immediately before surgery. Edema all over the place post-surgery. Milk didn't come in until end of 5th day. Low supply early, but supply rebounded (bounded?) and eventually I could have fed two babies. I also pumped exclusively and responded well to my pump, after a while.

If I have that much milk again (if I have another), I'll have to donate. It was a shame to have so much more milk than we needed and to have it so easily, but by the time I learned about donation, my daughter was right about a year and the cut off was something like 9 months.

[electriclady]

I was breastfed for 6 months (and am one of the only 30-somethings I know who WAS breastfed), but I still had extremely low supply. On the other hand, I also have PCOS and had a C-section, both of which are associated with breastfeeding difficulties.

I think the environmental factors are the missing link here. I know a lot of people who pooh pooh the plastics/hormones/pesticides alarm, saying in effect, "Well, you [chewed on vinyl/ate lead paint chips/were exposed to XYZ in utero] and you turned out just fine!" ("you" meaning our generation). But we DIDN'T turn out just fine. We didn't end up with two heads and webbed feet, maybe, but we have all these low-grade problems, like increased rates of a host of health issues--including infertility and breastfeeding problems--that may not be fatal but certainly affect us deeply.

[Maya's dad]

No comment on the milk supply issue. But, our 2-month old received the Hib vaccine & others yesterday. This sort of recall is not the thing you'd like to hear the day after your child receives the vaccine. Yikes!

[electriclady]

I was breastfed for 6 months (and am one of the only 30-somethings I know who WAS breastfed), but I still had extremely low supply. On the other hand, I also have PCOS and had a C-section, both of which are associated with breastfeeding difficulties.

I think the environmental factors are the missing link here. I know a lot of people who pooh pooh the plastics/hormones/pesticides alarm, saying in effect, "Well, you [chewed on vinyl/ate lead paint chips/were exposed to XYZ in utero] and you turned out just fine!" ("you" meaning our generation). But we DIDN'T turn out just fine. We didn't end up with two heads and webbed feet, maybe, but we have all these low-grade problems, like increased rates of a host of health issues--including infertility and breastfeeding problems--that may not be fatal but certainly affect us deeply.

[kinky]

Hey, Moxie, do you know about the most excellent resource, www.lowmilksupply.org? It's a great site with lots of information and support.

[electriclady]

I was breastfed for 6 months (and am one of the only 30-somethings I know who WAS breastfed), but I still had extremely low supply. On the other hand, I also have PCOS and had a C-section, both of which are associated with breastfeeding difficulties.

I think the environmental factors are the missing link here. I know a lot of people who pooh pooh the plastics/hormones/pesticides alarm, saying in effect, "Well, you [chewed on vinyl/ate lead paint chips/were exposed to XYZ in utero] and you turned out just fine!" ("you" meaning our generation). But we DIDN'T turn out just fine. We didn't end up with two heads and webbed feet, maybe, but we have all these low-grade problems, like increased rates of a host of health issues--including infertility and breastfeeding problems--that may not be fatal but certainly affect us deeply.

And I'm a little tired of people saying that "true" low milk supply is very rare and people just need to be taught better. Whether it's because your body is physically incapable of making enough milk (like mine) or it's because you don't have the right support, if you're not making enough milk, you're not making enough milk, and women going through this need to be truly supported, not told that it's basically their fault for not trying hard enough. (This is not directed at Amanda, but at some of the breastfeeding info I've seen out there.)

[electriclady]

(Ugh, sorry for the multiple post, Typepad is very temperamental today!)

[paola]

Mmmmmm. I'm not totally convinced. Breastmilk tends to come in earlier after the second birth, simply because the body 'remembers' how to produce milk, having been programed during a previous pregnancy. Mine came in after a day or so after my second was born.

In Italy most births are 'natural', in the sense that absolutely no pain killers are given, including epidurals, unless you're having a C-section or you pay for it, and seeing we have the best health system in the world (along with the French one), no one gives birth in private facilities and therefore pays for their time in hospital.

Therefore in theory, Italian women should have an abundant supply of milk, if breastfeeding. However, Italian woman have one of the lowest rates of breastfeeding in the western world and those that do, rarely exclusively breastfeeding due to supply problems. I'm a freak here having breastfed my first child for 17 months and 'still' nursing my second at 11 months. Almost all the women I know either managed until they start on solids at 6 months and then their supply dwindles, or have to supplement with formula, or simply never even get started as they 'didn't have any milk'. I think this is due to just not getting enough support before the birth and while in hospital ( I never got any and was fortunate to have met a LLL member who mentioned that breastfeeding 'wasn't as easy as people thought' and got help from their international site). There are no such things as women's groups ( at least not in any small towns, like where I live)who can put you on the right track, or where you can share experience, and the only help you get is from your own mothers, MILs, aunts etc, who often just tell you you have no milk, so try formula, without encouraging you to persist. Only this year in my town has a obstetrician started paying house-calls on new mothers 'in difficulty'.

[Sherry]

I'm not sure about the toxins and the birthing process. Maybe. I think the main problem is returning to work and pumping. I could have fed an army of infants for the first four months, but for the three months after that it has dwindled and dwindled. Work, poor pump, birth control medicine (even progestin only), antidepressant, a baby who sleeps through the night more often than not, and maybe my age (39) -- I'm guessing those are the factors that have done me in.

[Maura]

Melissa,

I hope I didn't scare you! I'm not saying that women who don't have many/early children are doomed, just that their risk of certain conditions goes up a little. That's why your primary care physician asks you things like how many children you've given birth to, what medications you're on (including birth contol), etc. Also, for many women oral contraceptives can be GOOD for correcting hormonal imbalances. I'm just throwing my thoughts out there as a probably too cerebral student.

PS
I think there have been some other excellent points made re: support and problems with early lactation.

We all need to remember, too, that mature milk doesn't "come in" until 3-5 days with a first child, and that's normal! Too many doctors are working on old information on that. The time it takes for mature milk to come in with each subsequent birth is shorter and shorter.

[paola]

Mmmmmm. I'm not totally convinced. Breastmilk tends to come in earlier after the second birth, simply because the body 'remembers' how to produce milk, having been programed during a previous pregnancy. Mine came in after a day or so after my second was born.

In Italy most births are 'natural', in the sense that absolutely no pain killers are given, including epidurals, unless you're having a C-section or you pay for it, and seeing we have the best health system in the world (along with the French one), no one gives birth in private facilities and therefore pays for their time in hospital.

Therefore in theory, Italian women should have an abundant supply of milk, if breastfeeding. However Italian woman have one of the lowest rates of breastfeeding in the western world and those that do, rarely exclusively breastfeeding due to supply problems. I'm a freak here having breastfed my first child for 17 months and 'still' nursing my second. Almost all the woman I know either managed until they start on solids at 6 months and then their supply dwindles, or have to supplement with formula, or simply never even go started as they 'didn't have any milk'. I think this is due to just not getting enough support before the birth and while in hospital ( I never got any and was fortunate to have met a LLL member who mentioned that breastfeeding 'wasn't as easy as people thought' and got help from their international site). There are no such things as women's groups ( at least not in any small towns, like where I live)who can put you on the right track, or where you can share experience, and the only help you get is from your own mothers, MILs, aunts etc, who often just tell you you have no milk, so try formula, without encouraging you to persist. Only this year in my town has a obstetrician started paying house-calls on new mothers 'in difficulty'.

[Anna]

There are people out there who truly have low milk supply issues due to circumstances that inevitably cause it, as in my case, a breast reduction 11 years ago. I was 21 when I had the surgery, and I was adament with my doctor that I wanted to breastfeed when I had children (I'm glad I had the foresight then to demand this!) and my doctor performed a technique that kept as many ducts in tact as possible. I'm proud to say that my daughter is almost 9 months, and we're nursing strong! I've had to supplement her with formula (we tried to exclusively breastfeed, and she wasn't gaining weight at a healthy rate) but at the moment, she's only getting 6 ounces of formula at night, coupled with nursing. Milk supply has been on my mind from the very beginning, and I guess you could say I have quite a few strikes against me in that department, even aside from my reduction. I had a c-section, filled with tons of fluids, and I was a formula fed baby.
With those odds, you'd think I'd barely get a drop of milk out of these jugs! I've been on every type of galactagogue you can think of, plus weekly acupuncture treatments. I really think the acupuncture was (and is) my saving grace. Once I started it, my production increased and I dropped A to just the nighttime supplement.
Sorry for the lengthy story, but I guess my point is that low supply does happen due to certain circumstances.

[Heather in WA]

I never used BC pills. I am going with the age (37) and toxins theory. ;-) I can't IMAGINE having a natural childbirth--I had two 2nd degree tears (she has the shoulders of a linebacker) and felt awful for months afterward. I would have died w/o drugs. Ugh. Plus, I'm just generally a wimp. My milk came in on day 3.

I'm feeling pretty...oh...how to describe...fortunate? that hubby (41) and I were BOTH BF as children. Him because his dad was a pediatrician and me because my parents were broke.

[marypoppins]

Genetics unfortunately does work that way Moxie. It takes hundreds of generations before any significant change can happen to our genes and so the ability to breastfeed or not simply doesn't change in one or two.

[marypoppins]

Genetics unfortunately does work that way Moxie. It takes hundreds of generations before any significant change can happen to our genes and so the ability to breastfeed or not simply doesn't change in one or two.

[marypoppins]

Genetics unfortunately does work that way Moxie. It takes hundreds of generations before any significant change can happen to our genes and so the ability to breastfeed or not simply doesn't change in one or two.

[marypoppins]

Genetics unfortunately does work that way Moxie. It takes hundreds of generations before any significant change can happen to our genes and so the ability to breastfeed or not simply doesn't change in one or two.

[marypoppins]

Oh goodness!!!! Sorry folks

[caramama]

I have lots of thoughts, but most people have covered them.

I just want to add another issue I think contributes: The growth chart that most peditricians in the US use is based on studies that include many formula-fed babies. The formula-fed babies throws the charts off for babies who are breastfeed, both in the percentages and in the curve. I believe that many doctors think a baby isn't getting enough milk because they aren't growing according to that chart and diagnose mothers as not having adequate milk supply. Because the mothers are always to blame, not inaccurate studies and out-of-date knowledge.

Here's some good info on kellymom.com: http://www.kellymom.com/babyconcerns/growth/growthcharts.html

[Aaron]

You are so on to something Moxie. I always thought I would want an epidural etc..etc.. when I gave birth. Luckily my husband and I attended a pre natal class that was taught by a doula who educated us about the possible complications of medical intervention on childbirth. I don't diss anyone who has an epidural or any other sort of intervention, it damn well hurts!! But I am very glad that I was able to have a natural child birth, assisted by a midwife in a hospital. No IV's nothing! As a result (but probably not solely b/c) E latched immediately after being born and my milk came in day two.
I struggled with back pain and the absoluty excruciating nipple pain I felt while nursing for three months, but I wouldn't let myself quite before 3 months. I say that about anything new, you have to give it at least 3 months before you make any permanent decision. I can happily say we are still going strong 5 months later. There were definitely times over the last 5 months that I thought my milk supply was dwindling, but I can more than likely attribute that to my lack of sleep and trying to explain why E wouldn't sleep all of sudden (ended up being growth spurt and then sleep regression).

[Ewokmama]

I think there is truth in what you are saying, Moxie, and it does seem that low milk supply is more common these days, but I also think there is an issue of mistakenly diagnosed low milk supply. I have known several women who think they have low milk supply and yet are able to pump a completely normal amount of milk, or they are actually overfeeding their babies expressed milk because they don't have the right information (or they notice that their breasts are less full, and it's actually a normal regulation of supply). I also often see women say they have low milk supply because they can't pump after breastfeeding all day. It's not low milk supply - it's perfect milk supply, perfectly aligned to what the child needs.

There are lots of women out there who unfortunately don't know what to do to keep their supply up and as a result end up with low milk supply. Many could take steps to increase their supply but quit instead (and will forever after tell people they had to quit due to low milk supply). Please, don't read into this, I am not condemning those who stop breastfeeding for whatever reason, and certainly I am aware that many women out there do everything possible to get their supply back. I just think a distinction should be made between natural low milk supply and low supply due to changeable factors because if the wrong information gets passed along, it could be very detrimental to a newly breastfeeding mom.

And, my data point - birth with pitocin and IV, milk came in on the 4th day, suspected PCOS, and monster oversupply.

[sue]

Low milk supply - my favorite topic! I've had two children, both born naturally (no drugs, pit, inducement, or other interference, but at the hospital). With my first, I tried desperately to breastfeed for a few weeks but then quit due to poor weight gain/not enough diapers/screaming baby/nipple confusion/ppd/clusterfuck. With my second, I hired a mother's helper (ok, two), and a houselceaner, and sat down for months (well, lay down, since I fell down the stairs and broke my tailbone right after the baby was born. ouch) to devote myself to breastfeeding to new guy. With all that help, plus domperidone (shipped in from Vanuatu - woohoo!), goat's rue, fenugreek, blessed thistle, barley, oatmeal, etc I make *almost* enough for my baby to eat. I have to give him a few ounces per day in an at-breast-supplementer. I've become a bit of a fanatic. My cause of low milksupply is, at root, the fact that I had a breast reduction 11 years ago. But why did I fail my first child, and succeed with my second? Here are my thoughts -

Education -
By this I mean, education about what it means to have a baby in general, and what it means to breastfeed in particular. I feel we have lost an enormous amount of cultural knowledge in the past 75 years. When I had my first, I was among the first of my friends to have a baby, I live far from my hometown, and my mother is dead. Who do you ask about all the crazy stuff a newborn does? I think we expect, and are expected to, get back to our busy prebaby selves much too quickly. It's simply unrealistic to go back to work, lost weight, cook dinner, clean the house, and maintain a semblance of a social life while nursing an infant. Something has to go. i remember thinking, with my first, that something must be wrong - the baby nursed waaay too much (of course, something was wrong, but my second nursed just as much, and he was gettting plenty of food). The sheer inconvenience of having a baby is so overwhelming - it feels like something is wrong when the baby nurses so much (I have a friend who exclusively pumps because she says her baby takes too long at the breast and she can't finish her chores. how awful is that? not her, but the expectations placed on her)

Education about the ramifications of birth. After I had my first, I was severely anemic due to blood loss at delivery. Was I told that anemia is linked to low milk supply? Nope. I changed practitioners for my second, and the first thing he said to me when he got my records was "I see you got really anemic after delivery last time. We'll have to make sure you get lots of iron. It'll really help your milk supply" Also, education about supplements and diet choices that can increase milk supply. I asked EVERYONE I could think of if there was anything I could do to increase my supply, and I was only told to pump. Andthat I should give formula to supplement (slippery slope). By the midwife, the lactation consultants (3 of them), the doula, and the pediatrician. It wasn't until my second that I found people who had helpful answers. I think practitioners themselves need to be much more educated about low milk supply, and what can help it. And what can cause it - environmentaal factors, diet, fatigue, depression, etc. I feel like too many LC's only know about helping with latch problems.

Ok, that was a bit of a rant. Honestly, I think that, wiht my second child, I knew to expect that nothing about having a newborn (or any age child)is convenient or easy, so I was better able to accept that breastfeeding is difficult at the beginning and that doesn't mean there's something wrong. I was more willing to just sit on the couch all day and nurse - I didn't have to be out running around folding laundry and walking on the treadmill to lost my baby weight. I think that I finally understood that the most important thing is to nourish my baby (so sad that it took me a whole child to figure that out. I guess she reaps the benefits now, but still) and that if I'm fat for a year, that's ok. And, of course, I think that all the supplements made a huge difference (my supply has more than doubled on them) - but the attitude adjustment was more important, since I could still nurse the baby with a 50% supply (with an at breast supplementer and formula). So I guess I think one of the biggest issues is having the communal knowledge of what normal.

[caramama]

For the record, I had an IV, an epidural and ended up with a C-section, but was able to get a latch when I got my baby 1 hour after delivery and my milk came in on day 2. I know I was very fortunate in this and that I've not had a low supply issue. Not that this disputes what Moxie or others are posing, but it was not true for me.

[midlife mommy]

I had a low milk supply, and my daughter was diagnosed with "failure to thrive," because she wasn't gaining weight (talk about feeling inadequate). I did build it up with a merciless pumping and feeding schedule for several days that was prescribed by the pediatrician, and my daughter did start to gain weight.

The pediatrician said that low milk supply has been correlated with infertilty treatments, being an older mom, and having larger breasts, all of which were true in my case. I have never done any research to confirm that she was correct.

For whatever it's worth, my mother didn't breast feed me.

[marypoppins]

Oh goodness!!!! Sorry folks

[sue]

Here's a non-rant comment

I do think diet contributes extraordinarily to low or high milk supply. There's a WONDERFUL book called

Mother Food by Hilary Jacobson

The website is
www.mother-food.com

She has so many ideas about food that is good (or bad) for lactation, and backs it up with research. This book helped me immensely.

[bree]

I think it's possible some women assume they don't have enough milk when their babies just want to nurse all the time. I wondered briefly about that with mine, but I had read a lot of very pro-bf books (and sites like kellymom) that informed me that it can be 'normal' for an infant to want to bf less than an hour after ending the last feeding. I had read some books (Baby Whisperer comes to mind) that had suggested a three- to four-hour feeding cycle was 'normal' even for a breastfed baby. My son is seven months old and he's still breastfeeding every three hours through most of the day and night. The other data point I was missing in those early days was that feeding cycles are timed from the START of each feed. So in the early days when it would take an hour to feed and my baby was hungry less than an hour later, we were actually on a two-hour cycle, not a one-hour one. I pretty much sat on the couch with my boob out for the first three months.

Also, I agree with those folks who say being able to stay home with the baby helps with supply. I have trouble expressing milk (partly because my baby feeds so frequently that it's hard to find a time when I have milk and he's not hoovering it down) and if I had to return to work while I was still establishing supply, I might have given up because it wouldn't have looked like I was making enough milk. Also, the books I've read say that if you're having supply problems or your baby's in a growth spurt, the best thing you can do is take a few days and do nothing but nurse and cuddle with the baby, as extra activity and stress can interfere with supply. If you're working that's not exactly an option most of the time.

I feel very lucky I live in Canada and am able to take a one-year leave to be home with my babe.

[Andromeda]

"So I'm wondering if the reverse is true, that those couple of generations who were told to use formula caused us to lose some of the capacity to make milk that our ancestors had 4-5 generations ago."

I don't buy it. This sounds like Lamarckian evolution -- the idea that children inherit changes that have been behaviorally produced in their parents -- and Lamarckian evolution was discredited with Darwin and genetics. Those generations may have been using formula, but that wouldn't have affected their genetic predisposition toward milk cell production, merely how much that happened to be expressed. But we inherit the genetic predisposition, not what our parents did with it. That predisposition can be expressed differently in us if we have different environmental influences.

I can imagine that, if humans were largely formula-fed for a very long time, then low milk supply would cease to be selected against. (Obviously if humans can only eat milk, the babies of women with low milk supply are going to be more likely to survive, so there will be evolutionary pressure against any genes that decrease milk supply. However, if babies can eat other things, it doesn't really matter whether the moms have low milk supply or not. Or at least doesn't matter as much -- there are still some health benefits for breastfed babies -- but it's not as stark as the difference between "starving" and "not starving".) So anyway, yeah, if a large percentage of human babies were breastfed for a very long time, selection pressure against low milk supply genes would decrease, so those genes would become more common. But 4-5 generations is nothing, evolutionarily speaking. I just can't see enough pressure having been exerted over that time period to significantly alter the frequency of various milk production genes in the population (particularly given that many women *did* continue to breastfeed in that time, and breastfed and formula-fed populations can interbreed freely).

[Dawn]

Ah... that must be why I had 210 new posts in my reader from you...

As for the theory of pitocin etc affecting when the milk comes in, I had used my hand pump some in the week before labor to 1. figure out how it worked and 2. try to stimulate labor, I was already getting colostrum at that time. I didn't have any drugs in labor, apparently they gave me pit to shrink my uterus after delivery (which I have issues with, but whatever). Alex was born at 247am on a Wednesday morning and my milk was in by the first time I pumped on Thursday morning, so probably about 24 hours to get my milk in.

[bree]

Oh, and my data points re: IV fluids and epidurals - I had gone in hoping for an all-natural birth but after 30 hours of labor they broke my water for me, and the pain was so bad after that I finally agreed to an epidural. After the epi, they discovered that the baby was stuck and hours of fruitless pushing later, I had to have an emergency C-section. I actually had a few doses of meds through the epidural because I had to wait a few hours for an anesthetist. I had IV fluids during this, and had to have the knock-out gas during the surgery because I could feel the pinpricks during the test cut. Because I had been out during the surgery I had to wait about an hour I think to hold my baby. He latched on right away and was a strong sucker from the beginning, but he howled for the first three days. I realized later that it was because he was starving. I was producing colostrum, but probably not much. I guess this, because a nurse finally pressed us to give Wes 1oz of formula in the middle of the night when he had been screaming for hours and was so upset he wouldn't nurse. Your thoughts here make me wonder if the interventions in the birth might have been part of the reason he was so hungry. Maybe if I had been able to avoid the painkillers and IVs and delay after the birth my milk would have come in faster. I'm lucky that both my mother and mother-in-law breastfed their babies, so they were very supportive of my efforts and didn't push formula, and most of the nurses were the same. I was also able to meet with a lactation consultant who reassured me that I was doing all the right things. Finally, we have post-partum visits from a public health nurse here, and she also was helpful - and called me when Wes was six weeks old to reassure me that if he was nursing around the clock it was nothing to worry about, just the expected growth spurt!

[Charisse]

My labor nurse told me higher age is associated with longer time for milk to come in--apparently for very young (under 20) moms it sometimes even happens the same day.

I was breastfed for 14 months, and lucked into a short labor with no IV fluids at age 32. Milk was in within 36 hours. That would tend to support the theory, but I have no idea what's actually going on. The short labor also meant that my baby was very gung-ho to suck from the beginning, and didn't go through the sleepy period you hear about. (I think that's more a function of the short labor & extremely short 2nd stage--and obviously not all historical babies had that.)

[laurie]

I've been thinking about everything you posted for the last nine months. I was thirty when I got pregnant, 31 when I delivered. Completely natural birth, my strong, healthy boy was at my breast within minutes and my milk came in on day 3.

Both my husband and I were breastfed and it was a foregone conclusion for me that breastfeeding was how I would feed my baby. I heard (on this site and some other places) that lining up support was important and yadda yadda yadda, but I had the idea that it couldn't possibly be that hard, right? Holy crap. I wish someone had said (and maybe they did, and I just wasn't listening, but nowhere in anything I read did I see the words, "this will be hard. Harder than that, even. Maybe the hardest thing ever...") that breastfeeding can be incredibly difficult. I kind of took the approach that since I was trusting physiology for the birth, I could trust physiology for the nursing. Funny, too, because I felt like I knew a lot about the physiology of birth, but realized very quickly that I knew little or nothing about the physiology of nursing.

We nursed constantly, and honestly, I hated it for quite a while. I was not prepared for how inside out I felt after ds was born, I wasn't prepared for what was approved as a "good latch" to make me hiss with pain every time for the first two weeks or so. I still feel guilty that I had such strong negative feelings about bfing, and maybe that played a role.

After a month of seriously constant nursing and my ds only just coming back to birthweight, but being otherwise strong and bright and healthy, we finally were advised to go see an lc. Then the blood, sweat and tears really kicked in. Trying to nurse a hungry baby and then pump immediately afterward for a measly ounce or so while still feeling that your baby (who will not be put down) is hungry and the pumping and the tears, and the formula and the SNS and the tears and the pumping... I'm not trying to elevate myself as a martyr, I'm just stubborn as all hell.

We kept up trying to pump and supplementing breastmilk and some (2-4 oz) of formula a day until I just quit pumping. And then I just quit the formula. Right around three months, finally something happened and my ds and I seemed to have synced up, somehow. He was still only gaining about 4 oz a week, but we went with it since he has been strong and healthy since birth.

So I have a scrappy little nursling and nine months out, he's still nursing about every two hours. I have spent a lot of time wondering about unseen variables like weird chemical exposures (How many gazillions of industrial chemicals have been found in human breastmilk? What kind of weird things have I been exposed to?), since I can't quite account for the slow weight gain and all the difficulty. I really believe that we had decent support and fed on demand and ended up co-sleeping and did all manner of things to support breastfeeding right from the start (probably should have seen an lc sooner) and it seems to me that we should have been awash in a sea of milk. I am not aware of any medical issues on my part that would predispose me to supply issues. I am immensely grateful that I get to SAH, otherwise, my babe would have been on formula long ago out of simple necessity.

Sorry, quite a long post. It seems that I have heard of a number of women my age with no real indication for low milk supply who seem to have just that, even with good support for bfing, it appears that there is an undue amount of difficulty in a number of cases.

[laurie]

I've been thinking about everything you posted for the last nine months. I was thirty when I got pregnant, 31 when I delivered. Completely natural birth, my strong, healthy boy was at my breast within minutes and my milk came in on day 3.

Both my husband and I were breastfed and it was a foregone conclusion for me that breastfeeding was how I would feed my baby. I heard (on this site and some other places) that lining up support was important and yadda yadda yadda, but I had the idea that it couldn't possibly be that hard, right? Holy crap. I wish someone had said (and maybe they did, and I just wasn't listening, but nowhere in anything I read did I see the words, "this will be hard. Harder than that, even. Maybe the hardest thing ever...") that breastfeeding can be incredibly difficult. I kind of took the approach that since I was trusting physiology for the birth, I could trust physiology for the nursing. Funny, too, because I felt like I knew a lot about the physiology of birth, but realized very quickly that I knew little or nothing about the physiology of nursing.

We nursed constantly, and honestly, I hated it for quite a while. I was not prepared for how inside out I felt after ds was born, I wasn't prepared for what was approved as a "good latch" to make me hiss with pain every time for the first two weeks or so. I still feel guilty that I had such strong negative feelings about bfing, and maybe that played a role.

After a month of seriously constant nursing and my ds only just coming back to birthweight, but being otherwise strong and bright and healthy, we finally were advised to go see an lc. Then the blood, sweat and tears really kicked in. Trying to nurse a hungry baby and then pump immediately afterward for a measly ounce or so while still feeling that your baby (who will not be put down) is hungry and the pumping and the tears, and the formula and the SNS and the tears and the pumping... I'm not trying to elevate myself as a martyr, I'm just stubborn as all hell.

We kept up trying to pump and supplementing breastmilk and some (2-4 oz) of formula a day until I just quit pumping. And then I just quit the formula. Right around three months, finally something happened and my ds and I seemed to have synced up, somehow. He was still only gaining about 4 oz a week, but we went with it since he has been strong and healthy since birth.

So I have a scrappy little nursling and nine months out, he's still nursing about every two hours. I have spent a lot of time wondering about unseen variables like weird chemical exposures (How many gazillions of industrial chemicals have been found in human breastmilk? What kind of weird things have I been exposed to?), since I can't quite account for the slow weight gain and all the difficulty. I really believe that we had decent support and fed on demand and ended up co-sleeping and did all manner of things to support breastfeeding right from the start (probably should have seen an lc sooner) and it seems to me that we should have been awash in a sea of milk. I am not aware of any medical issues on my part that would predispose me to supply issues. I am immensely grateful that I get to SAH, otherwise, my babe would have been on formula long ago out of simple necessity.

Sorry, quite a long post. It seems that I have heard of a number of women my age with no real indication for low milk supply who seem to have just that, even with good support for bfing, it appears that there is an undue amount of difficulty in a number of cases.

[Charisse]

Another thing somebody mentioned up-thread was that large breasts were more associated with low supply--isn't it the case that (at least in the US) breast size has been increasing over the last 50 years? I wonder if that has something to do with it.

In my highly anecdotal, circle of friends reports, women with larger breasts seemed to be much more likely to need assistance getting their supply going.

[Bea]

I had pitocin, IV fluids, and an epidural, and I had no colostrum for a full 7 days after giving birth, and my milk came in a few days after that, I sometimes wonder if that is what caused the issues, luckily, I used the Medela SNS, and I have *just enough* milk for my 1 year old. Out of my friends, I'm the only one who has had an issue with low milk supply, although, I did have one of the more traumatic birth experiences, I definitely think it has something to do with it.

[Kathy]

I do understand those who are pointing out lack of education and support as the problem -- I myself have ranted and raved to friends about all the women who think they lost their milk when their supply evened out after a few months.

BUT, please, let's not discount that there's something biological and real going on here, and it can hurt like hell when it happens to you. I think it's a little more complicated than Darwinian evolution. Reproductive Endocrinologists know that all of the assisted reproduction happening today is producing an even larger number of children who will grow up to have trouble conceiving. Milk production and hormones may be more complicated than we currently believe.

Girls are getting their periods younger and younger, maternal age for first births is rising, I believe PCOS has become one of the leading gynecological problems, and some huge number of women (I once heard 1 in 6) needs help conceiving. Sub- or infertility is a huge risk factor for low milk supply, right? Plus, prematurity. I haven't heard prematurity called an "epidemic," but I believe that there are more preemies born each year than children diagnosed with autism.

My risk factors for low supply include PCOS, large breasts, and a premature baby with a weird suck who couldn't be held for days or put to the breast for a month. Her birth was a high-tech, pumped-full-of-meds, emergency c-section after a long hospital stay. I couldn't see her for 24 hours, because I had to have magnesium sulfate to prevent a stroke or seizure.

I was lucky enough that all of this happened at a hospital with an AMAZING lactation staff, one of the few hospitals in the US that gets the W.H.O. "Baby-Friendly" seal of approval. We had all of the education and support a person could ask for, but we still couldn't make breastfeeding work. I tortured myself with pumping, Reglan, and months of trying to do the impossible.

And, when I eventually couldn't pump enough for my daughter, I felt like a failure as a mother and as a woman. I read _The Womanly Art of Breastfeeding_ (full disclosure: I've never been to a LLL meeting, just read the book), and felt like CRAP, because the book made it seem like ANYONE could breastfeed with enough effort. "I am 50, had a breast reduction, and adopted twins with Downs Syndrome. Breastfeeding them was the hardest thing I've ever done but now I'm so glad that I just stuck with it! If I could breastfeed, anyone can!" Of course I'm exaggerating, but that's how it felt.

At a hospital support group for women who are having trouble breastfeeding, the facilitator said that low milk supply is, indeed, a much bigger problem for this generation. She also said that there's all of this sympathy and understanding for women who are infertile, but when it's the breast part of your reproductive system that goes haywire, where is that support? That really resonated with me.

[Meika]

Loooove this topic! I think the idea that being formula-fed has made us less able to produce ourselves is interesting - it does seem like I've heard something about genes being turned on or off as a result of different environmental influences - could there be hormones present in breastmilk and not in formula that serve this function?

My story: I was just shy of 30 when I gave birth and had an unmedicated delivery with a longish (17 hour) labor. My milk came in within about 36 hours and my daugther had regained her birthweight by the time we left the clinic five at five days ol (had her in Japan - standard stay there). I struggled with low supply from the time she was three or four months old and she completely self-weaned a few weeks ago at the age of nine months. The internet was my primary breastfeeding support tool, and I know there are things I could have done differently, the primary one being that I pumped one bottle every evening for her dad to give her; less often probably would have been better. I also started drinking Mother's Milk tea by the gallon when we returned to the U.S. (she was six months old), which did help my supply - it probably bought us an additional month or so. But how does one avoid supplementation when their kid is clearly HUNGRY?? Oh, and I haven't been able to let down for a pump since baby was maybe five months old.

I have a hunch that part of my issue was genetic. I am a firstborn (my mom had an unmedicated labor and breastfed me to 9 months or a year). She got a lot of flak for breastfeeding me - her family told her she was starving me. The thing is, heh, I was a *really skinny* baby and very cranky... which makes me wonder if my mom had supply issues, too. Both my younger brothers were rounder and happier babies than I was.

Another international supply data point: From what I heard, many Japanese women have a very difficult time with supply. My (also-Japanese )neighbor theorized that it was because they were so skinny - my doctor didn't want me to gain more than 8 kilos at the absolute maximum (um, 18-20 pounds?) and would've preferred less. Only gaining a few kilos is really not uncommon. Could there be an ideal weight for breastfeeding, and could being either over or under this cause trouble?

Sorry the little epic I've written here...

[cb]

No drugs, no IV but I had bf problems. Like another poster, faith that nature would take it's course and had no idea how HARD bf would be. I also got some bad advice in the hospital and limited support. On nurse said, "dont' let her pacify" and when asking for help another said, "you can feed her formula." I also think the weight gain expectations are skewed toward formula feeding.
Long story short: I kept at it, nursed, supplemented, & pumped for 3 months. Started domperidone at 10 weeks and within 2 we were supplement free. She's now 10 months and we're still bf.
I think there's a social component as well. A provocative idea put for by a LC I saw: historically, when babies were born, the mother who's milk was already in would nurse the newborn and a six month old, for example, would nurse on the woman who had just delivered to help her milk come in.
We've lost that female community. We're now expected to do it all, by ourselves. This, in itself, makes bf harder.

[stacy]

It's funny you mention this today. A local friend of mine has just taken her 1 month old to the pediatrician. The baby weighs 9lbs. 6oz. now. A nice size for a 1 month old, and 1 lb. 8 oz. over her birthweight. Her mama is thrilled.

What did the pediatrician say? "Babies need to gain 2 lbs. a month, at least, or they are diagnosed with failure to thrive." Ouch. If the baby doesn't fall into line on this by her next appointment, mama is supposed to begin formula supplementation and weekly weigh-ins.

Fortunately, this mama is educated and on her second baby. She knows she's been fed a line of crap, and she's about to look for a new pediatrician. But for every knowledgeable mother like her, there are a dozen mamas who trust their lousy pediatricians entirely - even though so many of them know so little about breastfeeding and breastfed babies.

Personally, I was lucky. Even though the birth was *terrible* and I had all the interventions in the world - up to and including an unneccessarian - my milk came in fast and abundant. I honestly think part of it was psychological. I really didn't know that I was "supposed" to have trouble making milk after a cesarean surgery. So I didn't worry about it; I just nursed the kid until my nipples bled.

I gained 70 lbs. in pregnancy, something that clearly disgusted and horrified each of my "care providers." But I do think that helped, too, in boosting my supply.

[Kathy]

"Unneccessarian." hee-hee. I like that.

My friend is an anesthesiologist at a large women's hospital. She sees a lot of first-time moms who have natural birth plans and doulas, and then during labor change their minds and ask for epidurals. My friend calls them "epidoulas."

[Melinda]

Don't have much to add to the surrent discussion that hasn't already been said.

But I do want to give a hug to Maura's grandma. The picture you painted of your grandmother trying to breastfeed and being so disrespected by someone who should care made me cry. How silly to cry over something that happened 65 years ago. But what a hurtful thing to have done to a new mother. I hope she is able to look back on that incident and laugh at that nurse becuase she found the support she needed elsewhere.

Oh - the things that make a new mother cry.

[cagey]

After nearly 2 years of attending my hospital's breastfeeding support group, I have seen mother after mother coming through the ranks and struggling. I still attend this group as a somewhat experienced mother in the hopes that i can provide comfort/support to a new mother who is breastfeeding. What always breaks my heart is seeing a mother come in, struggling to get it down and then hearing her say that she will be going back to work in just a few weeks. She leaves the group and we know that in all probability that did not help her situation.

Until we have a society and a work environment that encourages mothers to breastfeed, we will still have problems with breastfeeding, including low supply. After all, the other part of "supply" is "demand". The low numbers of women breastfeeding for the full 12 months is not just due to low supply issues.