NEWS: When lactation doesn’t work

Community Leader
Registered: 10-01-2010
NEWS: When lactation doesn’t work
3
Thu, 04-05-2012 - 12:48pm

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

iVillage Member
Registered: 07-11-2006
Thu, 04-05-2012 - 3:01pm

Good read, thanks for posting.

iVillage Member
Registered: 05-20-2008
Tue, 04-10-2012 - 7:12pm

It has long bothered me how so many medical professionals and even mothers themselves seem to view any issue with low milk production as untreatable so not to be worth investigating as to the cause and possible solutions. They seem to all think that formula is good enough since it will resolve the inadequate nutrition issue caused by the low milk supply so why worry about where the low milk supply can be addressed or not. Too often it just assumed that the cause is something the cannot be addressed. In some cases I suspect that poor BF technique is really at play such trying to BF on a strict schedule or improperly supplementing with formula. In other cases their is indeed a knowable cause that can be addressed such tongue-tie or medication causing low supply. Even in cases where the cause of the low supply is currently not addressable with known medical science, we shouldn't just assume that there isn't a discoverable solution that could address the problem of of low supply, if only we undertook proper research into the issue. For example, we now know of several medications that help increase milk supply such as Domperidome that where once unknown to us. We also are learning that certain medications or other substances the mother might be exposed to that can lead to productions problems where once such exposure is eliminated the milk production will go up.

The way I view it, ideally you should always try and determine why you have a low supply (if indeed you do and were not simply misdiagnosed) whenever possible and then try and address the issue, if possible. If not then consider trying to BF as much as your supply will allow, supplementing with formula only as needed. Only if your supply is completely or practically absent should you completely switch to formula (or donated EBM if your OK with that option). Too often it seems that many moms just assume that at the first sign of possible low supply that switching to formula 100% is the only option they have when that may not truly be the case.

(Edited for typos)

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iVillage Member
Registered: 04-13-2008
Wed, 04-11-2012 - 8:29pm
Thanks for yet another beautifully written and insightful post, Charleen.
charleen2008 wrote:
It has long bothered me how so many medical professionals and even mothers trying to be themselves seem to view any issue with low milk production as untreatable so not to be worth investigating as to the cause and possible solutions. They seem to all think that formula is good enough since it will resolve the inadequate nutrition issue caused by the low milk supply why worry about where the low milk supply can be addressed or not. Too often it just assumed that the cause if something the cannot be addressed.
This does seem to be the case. When you read countless comments from both fathers and mothers about how they were in the category of 'having no milk' and attacking those militant breastfeeders, and when you talk to people IRL who you know were doing things which served to decrease supply rather than increase it, it becomes obvious that although 'no milk' or 'low supply' can happen, there are also many cases where it could be resolved.
In some cases I suspect that poor BF technique is really at play such trying to BF on a strict schedule or improperly supplementing with formula. In other cases their is indeed a knowable cause that can be addressed such tongue-tie or medication causing low supply.
I do feel sad for those people who would have been able to overcome low supply, but were not given the opportunity, and the guidance they needed to do so. Or were given misinformation which abounds, that has actually led to the low supply. eg information on strict scheduling and the assumption that this is the best way to go.
It was not all that long ago I saw a case on the consultant/support board, of a mother who was following a specific type of scheduling, the baby had got to 7 or 8 months infact, but now her supply was dwindling. The scheduling which she believed was good meant that she did not seem open to the idea of increasing the number of nursing sessions. At that age, the baby was having quick snacks on awakening, and then playing. But the idea behind this technique was to never 'spoil' the baby by nursing it to sleep at nap time or bed time. They were precisely the times when the baby may have actually stayed on the breast longer, comfort nursed, and allowed her supply to rebuild. But times when the schedule she felt was great disallowed her from nursing.
Even in cases where the cause of the low supply is currently not addressable with known medical science, we shouldn't just assume that there isn't a discoverable solution that could address the problem of of low supply if only we undertook proper research into the issue. For example, we now know of several medications that help increase milk supply such as Domperidome that where once unknown to us. We also are learning that certain medications or other substances the mother might be exposed to that can lead to productions problem that once such exposure is eliminated the milk production will go up.
Along with that, mothers need to be educated that if supply is low, it is far better to stimulate it with a medication if necessary and continue to breastfeed, than to switch to formula. There also tends to be a feeling among some mothers that you absolutely cannot breastfeed with any kind of medication in your system.

The way I view it, ideally you should always try and determine why you have a low supply (if indeed you do and were not simply misdiagnosed) and then try and address the issue if possible. If not then consider trying to BF as much as your supply will allow, supplementing with formula only as needed.
It is rare to see advice on combo feeding, and how to do it without further impacting on your supply. I do think that many people do not realise it is possible. It is an option that whould be mroe widely known. It is also an option that would be very good for a working other who cannot keep up supply with pumping for example. Breastfeeding while at home would be easier and a great way to reconnect with the baby, even if all or some formula had to be used at daycare.

Only if your simply is completely or practically absent should you completely switch to formula (or donated EBM if your OK with that option). Too often it seems that many moms just assume that at the first sign of possible low supply that switching to formula 100% is the only option they have when that may not truly be the case.
Unfortunately, there is an all or nothing mentality around.

Teresa