While completely natural and an ideal first food for babies, breastfeeding is not without it’s challenges. But for some mothers, cracked nipples and latching difficulties are the least of their problems. What do women do when they simply can’t produce enough milk for their babies?
Lifting baby to her breast is one of the first ways a mother is encouraged to interact with her newborn. To be able to comfort a tiny infant and nourish them with our milk is a beautiful thing, and possibly something many mothers take for granted. We enter motherhood with an expectation that breastfeeding will be our experience, should we choose it, like it has been for mothers since the beginning of time. However, some women face insurmountable obstacles, and despite their best intentions and courageous efforts, they are unable to feed their babies on breast milk alone. One such mum, Carey La Trobe, shared her story with us.
My breasts started developing when I was 13, but then they stopped that same year. They still look as pubescent as they did back then. The strange thing is that the females in my familyhave very large breasts; my grandmother even had a breast reduction due to back pain.
During my first pregnancy my breasts never grew in size. In September 2010 I gave birth to a healthy baby boy. I stayed at Birthcare Parnell for four nights and I’m so glad I did. It became evident that first night that feeding wasn’t going very well and in the morning the lactation consultant explained that women with my shaped breasts would struggle to breastfeed. I told her quite bluntly that I was going to challenge that theory. That night my baby cried for hours and hours and a midwife advised me to supplement with formula because he was hungry. I did, and he was immediately settled. However, I was determined to breastfeed and decided to trial it for three months. My husband and I didn’t want to rely on formula so we decided to offer the breast first and then offer formula after each feed. The supplementary formula seemed to always be needed, but I was determined to continue to breastfeed. Having lost my mum to breast cancer, I knew my own breast cancer risks were higher if I didn’t breastfeed.
Those first couple of weeks were tough. My baby lost weight, developed jaundice and became weak and sleepy. My midwife reassured me everything was fine and he was doing well. After all, he wasn’t crying and so we thought he can’t have been too hungry. What we didn’t realize was that he was too tired and weak to cry.
Offering the breast first wasn’t easy. I always had to give him both breasts every feed, for 30-45 minutes each side. After the first two weeks my son continued to lose weight so we reluctantly had to increase the formula. It got to the stage where I was feeding every two hours through the night for an hour each feed time (30 minutes per side). This was almost breaking point for me. We cut breastfeeds back to three hourly, and dropped each feed time to 45 minutes, topping up with formula. I continued to express for 10 minutes per breast in between each feed, producing little more than 1-3 mls from both breasts combined. Finally, after four weeks, my baby reached his birth weight.
I did everything everyone suggested to do in those early weeks; I drank plenty of fluids, ate well, rested when I could, and expressed between feeds with a fully automated pump. I was co-sleeping with my son and was having lots of skin-to-skin contact to stimulate more milk. I also ate sardines, took fenugreek and Domperidone pills to increase my supply. I phoned helplines, including the La Leche League, and went to Plunket’s breastfeeding classes for four weeks.
I continued to breastfeed and top up with formula for his first three months. I was consistent with the routine, to the point that I wouldn’t cut it short under any circumstances, not even by a minute, as it might threaten my ‘milk production’. If my baby fell asleep while feeding I would grab the pump to continue for the set time. By the end of three months I was only able to express 5ml from both breasts together (no, that’s not a typo; just the 5mls). A three-month old requires around 150–200 mls per feed.
I spoke with my doctor, a gynaecologist and read numerous books as I was bewildered as to why I couldn’t breast-feed. After all, I gave it my best shot and I’m certain many would agree. It was not until I met with an endocrinologist recently that I received some understanding.
Dr Stella Milsom from Fertility Associates explained to me that my issue was probably not hormonal, as I had conceived easily, but that for unexplained reasons my hypoplastic breasts just never developed enough subcutaneous, or fatty tissue.
I view breastfeeding as a very natural part of life and I was looking forward to breastfeeding my baby. I had hoped that this would be when my breasts would finally grow! Alas, they didn’t.
To be honest, I struggle with feelings of inadequacy as a woman and as a mother knowing that I can’t breastfeed. The stigma around bottle-feeding was evident every time I took out the bottle. I felt I had to explain why I was bottle-feeding whenever I pulled the formula tins off the shelf, walked around the supermarket with them in my trolley or prepared a bottle for my child. I made good use of curtained parenting rooms to avoid the glares. I didn’t like to bring up my struggle with people because of all the advice that I had already tried and the guilt that came when it didn’t work.
When I see the photos of my first born with his gaunt face and bony frame it still makes me quite emotional. I have to keep reminding myself that I did try very hard. I did my best.
I consider women who can breastfeed to be very fortunate indeed. My body was able to conceive naturally, I could give birth naturally but not naturally feed my baby. I am certainly grateful to be parenting in a time where there is another option. I became grateful for formula – while it’s a taboo word to some, it meant life for my baby.
I decided to bottle-feed my second baby from day one, knowing that I gave it my all for my first child but resigned to the fact that it was not the best option for my family. When I see both my boys running around and making the most of life, there is no doubt in my mind that I made the right decision.
Lactation consultant Maggie Morgan says in her experience, about 1-5% of women will find it impossible to fully breastfeed their baby due to insufficient milk supply, like Carey did. While there is not yet a great deal of research into the issue, there are a range of medical reasons that could render a woman unable to breastfeed. These include breast hypoplasia (lack of growth of glandular breast tissue resulting in fewer milk glands than normal) and disruption to the endocrine system (the glands that secrete hormones into the circulatory system) relating to lactation.
Maggie, who is currently conducting her own research into low breast milk production, says there needs to be more investigation into conditions like polycystic ovary syndrome and its effect on breastfeeding. “Women who have had fertility issues can also then have problems with breastfeeding. We think this may be due to the disruption to the hormonal makeup in the individual woman.”
For mothers with babies born prematurely who are struggling to express, donor milk is sometimes available through the hospital. The issue of milk banks is an article-worthy subject in itself and, conveniently enough, you can find one we prepared earlier here.
Worried about milk production?
Maggie says in the first four to six weeks your midwife should notice if you’re struggling to feed your baby and help with any problems. A referral to a lactation consultant is a helpful next step, as is contact with any of the community breastfeeding support groups.
Frequency of feeding and expressing will be assessed, as will baby’s weight, growth and output. You will be asked if your breasts grew during pregnancy and if there has been the normal fullness of the breast following the birth. Hypoplastic breasts, for example, don’t change in size or shape during pregnancy, nor do they become engorged postpartum.
“I would take a history from the woman, check her breasts and offer some strategies. Any problems could be related to nipple pain, not feeding or expressing enough or stress which can inhibit let-down. If she really does have low supply, she might be recommended herbal remedies such as fenugreek or lactagogue teas, or prescribed medication such as Domperidone which helps increase prolactin, the hormone responsible for milk production,” says Maggie. However, for some reason there may still be no increase in supply.
If there are concerns about a baby not gaining weight or, if the mother is producing less than 50mls each time she expresses, Maggie suggests mixed feeding whereby a mother can still breastfeed but baby will be supplemented with formula. “I looked after a mother who had a very low supply but continued breastfeeding her twins, once in the morning and then last thing in the evening. She bottle-fed them formula the rest of the time.” As Maggie regularly observes, the decision to mix feed or switch completely from breastfeeding to bottle is very personal and strategies for coping with low milk supply vary from woman to woman.
Publicity for formula is restricted in New Zealand, in line with WHO Code recommendations which strive to promote breastfeeding as the ideal first food for baby the world over. However, while advice is not allowed to be shared in a group setting, health professionals can provide advice on formula feeding when a parent obviously requires it. The Ministry of Health has a pamphlet on how to make up infant formula correctly that can be given to parents, and health professionals can give advice on the type of formula to use.
Maggie’s recommended reading
“There is a really good book I use called The Breastfeeding Mother’s Guide To Making More Milk by Diane West and Lisa Marasco. It explains how the breasts and breastfeeding work, common problems and how to help increase supply. Most importantly, other women share their stories and this is what a lot of the women I work with find really encouraging – knowing that they are not the only ones with a low milk production problem.”
AS FEATURED IN ISSUE 28 OF OHbaby! MAGAZINE. CHECK OUT OTHER ARTICLES IN THIS ISSUE BELOW