It’s an exquisitely calibrated feedback system of supply and demand. Regularly challenge the organ by removing the amount needed and the organ makes more.
But what if the organ doesn’t make enough? Will the amount produced increase if we challenge the organ more frequently?
Think I’m talking about the breast and pumping? I’m not. I’m talking about the pancreas and classic, juvenile onset (type I) diabetes.
Diabetes (type I) is characterized by a failure of the pancreas to produce the amount of insulin needed. Although blood sugar regulation is meant to be an exquisitely calibrated system of supply and demand, with more insulin produced and released when the body faces a large sugar challenge, it doesn’t work that way in classic diabetes. The pancreas can’t produce more insulin regardless of the stimulus and ingesting ever larger amounts of sugar won’t stimulate the pancreas to produce more insulin; it will simply result in diabetic coma.
Reflecting on the fact that the feedback system of insulin and blood sugar fails utterly in classic diabetes made me wonder whether it makes any sense to imagine that pumping will do anything to increase inadequate breastmilk supply. I can’t find any scientific evidence that it does.
What causes failure of lactogenesis? According to this paper by lactation consultant Nancy Hurst Recognizing and Treating Delayed or Failed Lactogenesis II:
Although actual rates of failed and delayed lactogenesis are unknown, estimates ranging from 5% to 15%, respectively, have been reported.
It’s not a rare problem; it’s a common one.
Delayed lactogenesis II denotes a longer than usual interval between the colostrum phase and copious milk production, but whereby the mother has the ability to achieve full lactation. Failed lactogenesis II is a condition wherein the mother is either able to achieve full lactation but an extrinsic factor has interfered with the process, or one or more factors results in failure to attain an adequate milk production. Failed lactogenesis can be described further in the context of two types of conditions: a primary inability to produce adequate milk volume, or a secondary condition as a result of improper breastfeeding management and/or infant-related problems.
When the problem is a result of improper breastfeeding technique or infant inability to suck properly, pumping can improve the problem because the underlying feedback system of supply and demand is intact. But what if the problem is a failure of the breast to produce enough milk? That failure can be caused by:
… anatomic breast abnormalities or hormonal aberrations. Insufficient mammary glandular tissue, postpartum hemorrhage with Sheehan syndrome, theca-lutein cyst, polycystic ovarian
syndrome, and some breast surgeries have been implicated as possible causes of lactation failure.
Hurst recommends the following treatment plan for both primary and secondary failure to produce adequate breastmilk:
A treatment plan for a delay or suspected lactation failure should include the following key elements: providing adequate infant nutrition, maximizing breast stimulation and complete breast emptying, strategies to measure milk intake during breastfeeding, … and recognition of when maternal lactation potential is reached.
Note that providing adequate infant nutrition is the FIRST step to any treatment plan. Hurst emphasizes that increasing the number of breastfeeding sessions is NOT going to solve the problem. Supplementation may be required.
Determining the need for supplementation is essential in promoting adequate infant growth and energy levels. An infant who is malnourished will not have the energy to breastfeed effectively; recommending that the mother simply increase the number of breastfeeds per day to improve her milk volume and the infant’s milk intake will not improve the situation when failed lactogenesis II is suspected.
How about pumping:
Mechanical breast pumping with an effective hospital-grade breast pump following each breastfeeding should be initiated whenever a delay or failed lactogenesis is suspected. This practice serves to increase breast stimulation and promote complete breast emptying.
That should help if the problem in related to breastfeeding technique or poor infant feeding, but what’s the evidence that pumping will improve output in women with primary failure of lactogenesis?
There is no evidence that pumping improves breastmilk supply in primary failure of lactogenesis. No only is there no scientific evidence to support the recommendation of pumping, as far as I can determine, no one has even studied the issue. If anyone else is aware of any evidence, please share it.
Yes, pumping increases supply in women who have an intact hormonal feedback system of supply and demand. But if the problem is failure of supply, why would demanding more have any impact at all? It is unreasonable (and deadly) to imagine that feeding ever larger amount of sugar to a diabetic will stimulate insulin production. It seems unreasonable (and potentially deadly for an infant) to imagine that pumping more and longer is going to stimulate breastmilk production.
Last week I noted that telling a new mother to breastfeed AND pump is barbaric. I pointed out that the key to a health, happy, thriving infant is a physically and emotionally healthy mother. That means a mother who is getting enough rest, whose mental health needs are being addressed, and who is able to enjoy substantial amounts of time happily bonding with her child. Breastmilk is not necessary, not necessarily best for every mother-infant dyad, and the effort to produce it is positively harmful in some situations.
So lactation consultants telling new mother with primary lactogenesis to pump in addition to breastfeeding is not only barbaric, but also completely ineffective.
Way to go, lactation consultants.
I normally love your analogies Dr. Amy, but this one puzzles me as Type 1 Diabetes is an autoimmune disease and primary failure of lactogenesis II is (usually) not caused by an autoimmune disease. I agree with your point, I think the pressures placed on women to breastfeed can be very damaging. I’m just confused as to why you’re comparing it to something with a different mechanism.
I can no more change the amount of lactating tissue present in my breasts than a Type I diabetic can increase the number of insulin producing cells in their pancreas.
Different mechanism but still 100% out of the control of the person involved. Yet mothers are shamed for not trying harder to breastfeed in a way that no Type I diabetic is shamed for not making more of their own insulin.
I can’t tell you enough how much I have appreciated your recent posts about breastfeeding. I have had zero guilt about the way I gave birth but I’ve had lots of guilt about being unable to breastfeed – mostly because I bought into the idea that I didn’t “try hard enough” and that meant I didn’t REALLY care about giving my kids the best start in life – and it helps a lot to have hear someone (actually, many someones, if I include the comments section, which is always my favorite part of this blog) say that I don’t have to “prove” how much I love my child by torturing myself with endless hours of pumping to increase a woefully inadequate breastmilk supply. Thank you.
Slightly OT, is there any literature about the claim that as the baby ages, their breastmilk intake will not increase? That the milk composition changes as the baby gets older? Or is this more unscientific lactivist propaganda?
Kellymom has an article on this with references: http://kellymom.com/bf/pumpingmoms/pumping/milkcalc/ All of the studies she cites are quite old (the newest is from 2002), and I have no idea whether there is any current research on milk intake.
My anecdotal experience was that the size of bottles my son took per feeding while I was at work were fairly stable after the first month of life – somewhere between 3.5 and 4 oz, or total workday intake of 12-14 oz. On a few occasions I am told he still acted hungry and would get additional milk, but far more frequently he wouldn’t finish an entire bottle. He stayed on the same growth curve for most of the first year.
My anectdata agrees with Jessica’s comment. I went back to work at 12 weeks and the total amount of breastmilk he took a day stayed pretty stable through most of the first year. He did start wanting more per bottle but fewer of them a day. I EP’d and he was generally around 30-35 oz per 24 hours. Growth curve dropped slightly but kid started at 95%+ so slowing down to 85-90% was nbd.
As for the milk composition changing, I only noticed that with early milk (frozen while I was still on maternity leave) he tended to 1) poo more/have looser stools and 2) maybe drink a tiny bit more/get hungry just a little faster than with closer to age milk. Not enough to make a big difference though I did intentionally give him thawed early milk instead of fresh when he was constipated because it seemed to help him go.
I don’t think this idea that babies’ milk intake won’t increase when they get older is correct. Of course, milk intake is very low at birth and then increases over the first few months as the baby gets larger. My life cycle nutrition textbook “Nutrition through the life cycle” by Brown says that an infant consumes on average 600 ml at one month, and this increases to 750-800 ml over the next few months. Then milk intake will change depending on what complementary foods the baby is eating and its general activity levels and development. For example, crawling uses lots of energy so infants that start to crawl want to increase their energy intake, and whether that comes from breast milk or complementary foods depends on the infant and their preferences and access to both.
In terms of breast milk composition changing as infants get older, this is partially true in that there is a shift from colostrum to mature milk over the first week or so of life. After that, in as much as breast milk composition is “constant” (it is not by a long shot) there are no trends as far as I am aware.
Another example would be thyroid function. Exquisitely calibrated…except when the gland has burned out or failed.
Even more totally OT than Anna, but do we have any oncologists in the house? Some of you may have been aware of the situation in the UK, where a family took their 5 year old with cancer out of hospital (and the country) resulting in an international manhunt. The child has now been found and the family has posted this video:
https://www.youtube.com/watch?v=14ETQn9ZPwk&feature=youtu.be
It would be useful to have some background from knowledgable person. Recalcitrant doctors or parent putting too much faith in Dr Google??
Not dealing with video, have no facts, but: Have you asked about this over Respectful Insolence? Orac and Dr. Amy don’t get on, but cancer quackery is that guy’s beat, and he covers it very well.
This is totally OT, but we currently have a very patchy internet connection which might be gone again tomorrow. So I just wanted to share a dialogue I had with my OB last week.
Me: “Is long early labor, as in over 24 hours, dangerous in itself? I mean without leakage of amniotic fluid and without indication of fetal distress.”
OB: “No. Why would you think it’s dangerous? It’s totally normal. The early labor stage serves to prepare your body for giving birth, and often lasts long, especially for new mothers.”
Me: “A doctor in a hospital wanted to give me pitocin to speed things up during early labor. I was comfortable and the baby appeared to be fine. I chose to refuse the pitocin and go home to wait. Was I irresponsible?”
OB: “Not at all. In our hospital, if the mother is comfortable enough, we routinely send women in early labor home, to wait for things to develop. That is what we’d probably recommend for you, too.”
So, dear Dr. Tuteur… my doctor, who treats me and knows me, does not think I “risked my baby’s life and brain function just so I could boast of giving birth without pit”. In fact, she thinks I did a perfectly reasonable thing.
You, IMHO, owe me a public apology.
An apology for what?
And what of the doctor who ACTUALLY WAS treating you and knew your particular case AT THE TIME?
You wanted to avoid pit. You have boasted about leaving AMA so you could avoid it. You did exactly what you wanted and everything turned out fine. I am wondering why you expect applause as well.
How is it leaving AMA, when the doctor advises it and is fine with it?
No, Her doctor at the time did NOT advise it. He advised the exact opposite. She left AMA because she did not like his treatment recommendation because it included pit and pit is evil doncha know. So she decided that she “knew better” and left and boasted about how it all turned out well in the end and her baby was fine after all. Dr. Amy has pointed out that that is nothing to brag about and since that time Anna T seems to have gone to great lengths to prove that it actually WAS brag-worthy including this most recent which was presenting her case as a hypothetical to a different doctor. But of course that’s ridiculous, this new doc can’t see the strip, or check her cervix or have her vitals or her prenatal labs. I’m sure her new OB’s response would have been very different if she had phrased it “Can you think of any reasons why an OB would have recommended to me that I stay given that women with intact membranes and not yet in active labor are frequently sent home?”
Ah – sounds like there’s some back story I missed.
You asked the question with the qualifier ”without indication of fetal distress.” Are you certain about that?
ANd what about all the stories we hear about people sent home in early labour who end up giving birth out of hospital?
Your post oozes smugness. Why?
Seriously????
Anna, as someone that often has to explain a recommended treatment protocol to clients/patients, there is a difference between “indicated” and “necessary”.
If a patient presents with X symptoms, there may be 5 different tests/treatments that are “indicated”. There is no way, without a crystal ball, to know which are “necessary” without hindsight.
Pitocin in a long early labor is “indicated”. Just because you have decided that it wasn’t “necessary” in your labor, does not mean that it wasn’t “indicated”. Which is why your consult OB said “probably”.
We get it Anna. Dr. Amy is a big meanie who hurt you feelings a couple months ago but the fact that you are fixating on this so much that you had to ask your doctor to validate your decision to leave the hospital AMA (you didn’t tell him/her that part though) is not healthy.
“What would you have done if your OB said”
She would have done just what she did in labor – leave. And I guarantee her doctor knows or at least guesses this.
Anna’s OB “knows” her…so of course he wasn’t going to say “Well we’d probably advise you stay, break your waters, start a pitocin drip and hook you up to continuous monitoring” even if he believes that may have been an indicated course of action. Because she’d turn tail and leave. She’s looking for a specific answer and he knows that too. I’m not saying that his answer wasn’t sincere…but doctors know where their patients lie on the scale of NCB –> interventionism.
The crazies always post on the weekend.
Your consult OB makes the qualification of a long “early labor stage” being normal. WERE you in EARLY labor? I had prodromal labor for a few weeks with my second child, and even had regular contractions with increasing intensity for several days before I gave birth, but my contractions would always disappear about an hour after I started timing them. If I’d gone to the hospital, I may have been sent home because my contractions would likely have gone away before we finished the intake paperwork, especially since I was just 3-4cm dilated (according to the cervical check done at my last doctor’s appointment, the day before my daughter’s birthday).
I share this to say that yes, it’s commonly known by OBs and moms everywhere that early labor can last for a loooooong time – but once a woman is in active labor and THEN her contractions stall out, that’s a whole different ball game.
In case anyone needs a recap, here is the birth as described by Anna T in a previous post:
“Example of pushing unnecessary interventions:
A healthy 23-year-old woman arrives at the hospital too soon because it’s her first, so she panicked and rushed to the L&D at the first contraction. She’s full-term and 1 cm dilated.
Instead of sending her home, the doctor suggests a long walk. After several hours, she is only 3 cm dilated.
The woman is feeling fine, monitor shows the baby is feeling fine, and very importantly, amniotic fluid is intact. But the contractions have stopped and she’s still at only 3 cm.
The doctor admits her to the L&D and matter-of-factly says, “we are going to augment you”. Please note he uses the Latin word “augmentation”, while the conversation is held in *Hebrew*, and most Hebrew-speakers do NOT know what “augmentation” is.
(Perhaps the doctor doesn’t know that??)
The woman, whose language skills are not that poor, asks “do you mean pitocin?”
The doctor (reluctantly): “yes.”
The woman: “I’d rather wait.”
The doctor (annoyed): “You can’t occupy an L&D room forever!” (Exact. Quote. No. Mistake.)
The woman: “Then I’d rather go home and wait.”
The doctor (incredulous): “You want to go HOME?”
Woman gets up from the bed, changes into her own clothes, husband picks up the bag, and they leave to home (which is located 5 minutes from the nearest hospital) to wait things out. Baby is born safely and naturally in *another* hospital 24 hours later, without ANY interventions or pain meds.
That was me.
Do you think I should have agreed to an induction? I don’t. I could have, and it probably wouldn’t have damaged me, but I didn’t want one and didn’t need one.”
I don’t understand people who feel put upon when they are offered an intervention. “How dare anyone offer me pain relief just because I was in pain!” “How dare anyone offer to speed up labor just because labor was going slowly!” The doctor maybe should have sent her home to wait it out, but he had no way of knowing how slowly or quickly labor would proceed.
So this is why pumping fixed my supply while I fixed her latching problem? But it wouldn’t have worked if it was my body’s inability!? Interesting! When is domeperidone indicated, if at all? Supplementing is recommended in either form of supply issues? Well that’s what I did anyways even though my body was fine…
Interesting that people don’t feel upset* or guilty when their pancreases can’t produce enough insulin.
*Being told you have an incurable disease can and does upset people. That’s normal.
Balance – birth should not be so value and judgement laden that reasonable options come with massive amounts of guilt, and consequent depression.
I tried desperately to breastfeed by first son and never could make enough milk despite all of the mechanics being fine. Nearly six years later, I am still physically ill when I think back on that first month being a mom. The woman who taught my breastfeeding class had emphatically declared “There is no such thing as a woman who doesn’t produce enough milk!” and yet here I was with a baby boy who was back down to his birthweight at 1 month despite nursing around the clock for hours at a time (not exaggerating). No one had ever suggested this could happen; none of the 5 hospital-based LCs I consulted had any explanation or diagnosis. I did the nurse, pump, bottle routine for a week, which produced a higher volume of tears than milk. I was told to keep nursing, and that “Sometimes you have to surrender to your baby” as if the problem was me. At our last weigh-in, when it was clear none of their interventions were working, they just gave me some free formula and sent me home feeling like a big steaming pile of shit. Dr. Amy, thank you for helping bring some sanity to the discussion. Your perspective is SO appreciated!!
I am so sorry you went through this. My story is somewhat similar, and I felt horrible about the whole deal, too. The first month of my daughter’s life was a miserable, sleep-deprived, painful blur because of what the NCB/lactivist types had taught me so well.
I hope you find more healing and peace as time goes on. My fantastic OB told me that only I could decide how to feed my baby, and that the important thing was that she was fed and loved, and my DH has said repeatedly through the whole process that DD won’t remember how she was fed; she’ll only have the general “mama loves me and took care of me” knowledge that any baby-and-eventually-toddler has. Both were right, and anyone who says differently is flat. out. wrong.
Your story is just so typical, when ‘lactation consultants’ are the advisers. Truth is, they are not lactation consultants, but ‘make sure everyone breastfeeds and shame those who don’t by repeating mantra’s that you have no clue are true.’ Countless women have had theirpost baby ‘honeymoon’ destroyed, and turned into a nightmare instead. All the stories are similar, baby doesn’t stop crying, mother feeds and feeds and feeds and feeds. And she feeds and pumpsand uses a lactation aid altogether. The baby’s weight is dropping, dropping, but that is ‘normal’, and we don’t judge a womans ability to produce milk by how much she can pump. Even if she can barely cover the bottom of the bottle after a day’s pumping, it doesn’t mean she cannot produce milk, because the baby’s mechanism to extract milk is different than that of a pump. Just keep at it, you’ll get there, an endless nightmare. The mother usually ends up sobbing and tearing her hairs out and desperately wishing that someone would just take this screaming thing away. It happened to me with my son sixteen years ago, and I still haven’t gotten over the guilt of starving him, even though I thought and was advised that I was doing the right thing. ‘Hes fine now, and doesn’t remember it’, does nothing; at the timehe was starving and suffering, and I caused it. The punishment for abuse does not depend on the abused’s ability to remember it. Again, I say that lactation consultants ought to be arrested
for posing as proffesionals and knowing not a thing, causing unforgivable newborn abuse and exhaustion and desperation of the mothers.
“[A]nd recognition of when maternal lactation potential is reached.” In my experience, that part is key. I think it is fine to suggest to mothers that extra pumping *may* help increase their supply, depending on what the underlying problem is. If this is explained, and the mother wants to give it a shot, it’s a good idea to do so provided that it’s a temporary measure. This is what so bothered me with all the “help” I got. Nobody, nobody, nobody assumed that there could be an underlying issue with my physiology that caused inadequate milk supply (I still don’t know if there is one). And nobody, nobody, NOBODY considered the fact that my baby did not breastfeed normally and was not, at any point, more efficient than a pump (as they insisted she was). In general, it seems to me that there are a whole lot of breastfeeding situations that are non-normal, not because someone (i.e. mom) is not trying hard enough, but just because that’s how it is. But LCs and all the help in hospitals don’t seem to recognize that, and insist on treating every situation as if everything is normal, and all supply issues are due to mismanagement.
I was in tears on my third night in hospital with a baby that was feeding for an hour and a half, sleeping for 20 minutes and then feeding for an hour and a half. Neither of us were getting any sleep and I was post c-section. I was in the nursery in tears asking the nurse if it was normal. The nurse replied that it was normal for newborns to feed for an hour and sleep for an hour. And I said “but I just said she sleeps for 20 minutes and is trying to feed for an hour and a half”.. She then tried to “help with my latch” which was just another depressing night plodding along “trying” to breastfeed when we were already both exhausted.
There just didn’t seem to be any recognition once you were outside the norm. There just seemed to be nowhere to go but the “do more” and “keep breastfeeding”. I said to my husband that I felt like I was in no-man’s land.
YES. This is a healthy way to look at this issue. I have nothing to add.
Kind of a weird example to throw in, but my two breasts make
So do mine. Assuming you meant “make different amounts”. Pumping and trying to feed on one side preferentially can change it a bit for me. I have no idea how common it is. For myself, I just assumed a bit lopsided is the norm. My feet aren’t the same size, my ears don’t hear the same, ..
Yup, that is what I meant. When I was first typing I clicked “enter” too soon, which posted a very strange sentence fragment. 🙂
The difference was not very big, but with both of my kids I produced (and continue to produce) more on the left side, though as a lefty I was more comfortable nursing to the right. Annoying. I reward the good boob with lots of praise and chastise the other for not being sufficiently committed to EBF. BAD BOOB! BAD!
Eeek! Don’t say that out loud, you might give a whack-a-doodle lactivist bad ideas!
One of the lactation consultants told me when I asked about this is “remember, your breasts are not “the twins”. They are distant cousins that don’t communicate well”. Meaning I shouldn’t be concerned if one side was making lots of milk and the other wasn’t.
Seems pretty common, from people I’ve talked to. My right side made more than my left.
Very common. My left side always produced more milk, and though I nursed my son on both sides for the first year, he always preferred the left. After he turned one he started to refuse the right breast. I gave up offering it at that point and he nursed exclusively off the left for another seven months.
Huh. You’re me! I was so impressed with Lefty. Didn’t care for being lopsided, though.
Ha! For what it’s worth, my mother also reported that I preferred the left side and after a while she nursed me exclusively on that side.
My right side always produces more–up to 2 oz. per pumping session sometimes. My left side is bigger, though, so I don’t know if the two are related.
This is very common. This is the case for me too. This was the thing that really drove home for me that women can have very different abilities to produce milk. As I’ve written before, with my first I switched over early on to exclusive pumping due to an abnormal “crush” latch. Since I was using a hospital grade double pump, both breasts ALWAYS received the exact same stimulation. But one produced a lot more than the other. If I hadn’t lucked out and had at least one “good breast” but instead had been issued 2 of the “bad breasts” I never could have made enough milk. And think how easy it would have been if I had had 2 of the “good breasts”! I could have pumped a lot less often.
And I know it wasn’t a one time fluke because with my second baby (which was mainly breastfed right from the breast but I did do pumping at work) the same side always produced twice as much milk.
I had one side that produced more, but it was different with each kid. First kid liked to comfort nurse on the left, second kid preferred the right.
Mine were similar too! Oddly enough, the small side actually made the most milk and was easiest to feed off for our two girls, but it changed completely for our son – the big side was easier to feed off and produced more milk for him. I had to lie down for every feed with him though, otherwise he couldn’t latch properly and ended up gulping air.
This speaks directly to a point I made on another thread: lactation consultants aren’t getting medical histories from their clients. So how the fuck are they supposed to offer informed advice when they don’t know about any medical conditions that could impact milk supply? And what makes this worse is that the percentage of women they see with medical problems is going to be way higher than 5-15% because only the women struggling to nurse are going to hire a lactation consultant. So the whole profession seems to rest on a pile of bullshit with no actual research to back up what they’re doing. It enrages me because they are dealing with emotionally vulnerable women and potentially inflicting a huge amount of damage.
“the percentage of women they see with medical problems is going to be
way higher than 5-15% because only the women struggling to nurse are
going to hire a lactation consultant.”
I’ve wondered about this before. How can they be so absolutely clueless when so many of the women they see have these sorts of problems? It’s mind-boggling.
The problems are caused by friends and relatives “sabotaging” the nursing relationship. Or by not nursing often enough. Or by the mother lying about nursing often enough.
Yes. A basic lack of understanding of the idea that their samples are different from population samples. They hear the stat 5%, and then assume that 95% of their patients must therefore not really have a “true” problem. When the reality is that the majority of their patients DO really have a true problem because all the women without a problem are breastfeeding easily and happily at home.
yes, this is interesting. In fact, it is more common to go the other direction. It’s common for doctors to overstate how common something is, because they see so much of it. It’s like how psychiatrists start to wonder if the whole world is crazy, because it’s like everyone they see is.
But this turns it completely on it’s head.
Lactation consultants have far less training in science and statistics than nurses do. It is simply asking too much to expect them to understand that the patient population they are treating is not representative of the population as a whole. Way beyond their pay grade.
Most of the LCs I’ve seen were nurses too. Not sure what other people’s experiences are. And I guess I’ve lucked out because they all seemed very willing to help but not anti-formula. I do believed their is a need for LCs. But I think that should only see new mothers who ask for help, which is how it was at my hospital. And I think they should have the science background even if they aren’t already nurses.
I saw two different lactation consultants while I was in the hospital. They gave different and contradictory advice. Makes me think it’s a lot more art than science, at least how they actually practice.
I’m an LC as well as a CNM, and people not understanding the anatomic and hormonal etiologies of primary failure sets my teeth on edge. It is basic anatomy and physiology!
Always, always, always the most important thing is making sure the baby is getting an adequate caloric intake.
You guys know it is possible to reverse your Diabetes right?I reversed mine. I would check this out http://tinyurl.com/lkpovzv ,,.,.,.
Dairy farmers have a ton of experience with primary and secondary lactation failure – and the process is surprisingly similar in humans and cows.
Reality: If a first calf heifer doesn’t ramp up in milk production on 3x a day milking, she’s not going to ramp up on 10x a day. (And that would be animal abuse and probably lead to a raging case of mastitis.) You know within 30 days – and the trend line is pretty clear within 14 days.
Nice difference between dairy cows and humans: A low-producing heifer becomes hamburger. A woman with lactation failure with access to safe water supply has no discernible difference is life outcome
Fascinating. Humans aren’t cows, but research on cows is still useful to have. Is there much written, or is this just “known”?
There is tons written on the subject. One (relatively) easy way to get research money is to run a study on an important agricultural crop.
There’s a huge literature on artificial selection for virtually any aspect of a domesticated crop or animal. And that includes breeding for dairy production.
Oh my gosh absolutely. Lactation in the dairy cow is insanely well characterized – many farmers use a computerized system that tracks all the important parameters for each cow in the herd. This information can be exported and (with permission, naturally) used by veterinarians as the basis for research on useful interventions in management.
Milking a cow ten times a day doesn’t really change much. Shoot, there are dairies that use the robot milking machines (in wh the cow chooses when and how often to be milked) and some cows do choose to get milked every three hours but the daily production is not markedly increased.
Milking a low producer more often to increase production is not something I would ever suggest. Examine to find out what the medical problem is, yes; ship her (“beef her”) if it can’t be treated, yes. And, okay, sometimes we can make a useful difference on a farm by watching the milking parlor and suggesting changes in the protocol- but those changes aren’t going to make a low producer into a high producer.
fascinating!
And let’s not forget that, for 10,000 years, humans have been turning low-producing cows into dinner and helping low-producing women keep their babies alive through wet-nursing or animal milk, so the incidence of low milk supply among humans is probably higher.
Mel, do farmers increase pumping frequency for low producing cows, either temporarily or permanently? I have no idea about this. My grandparents ran a dairy farm but from what I remember, all the cows were milked the same amount: twice daily I thought.
To this day, I don’t know why I couldn’t pump enough milk. (I was and am totally ok with it). Maybe it was because pumping wasn’t going to work as well as actual nursing, which I didn’t do once we left the hospital. Maybe it was because I was diagnosed with PCOS. Maybe its because I had a PPH and was anemic. Maybe it was because I didn’t experience much in the way of breast changes during pregnancy. But, going on the supply/demand angle, I figured that if I pumped as often as the babies ate (about every 3hr) I should be able to increase my supply. This worked a little, but after 2 weeks, plateaued at a minimal amount, and I had constant plugged ducts. Was this primary lactation failure or secondary? I don’t know, but after 4wks of pumping with little improvement, I threw in the towel and went to 100% formula. No regrets, except that if it was primary failure, I sure wasted a lot of time with that stupid pump.
What happened in the first 5 days? Was your PCOS being treated?
Well, a few years after that the PCOS diagnosis was retracted. It’s clear that there is something wrong with my hormones (I don’t cycle), but no one knows what it is. The PCOS diagnosis came about because I couldn’t conceive (duh, no ovulation) and I had several characteristics that fell under the PCOS umbrella (anovulation, many tiny cysts on my ovaries, acne). Since I was never obese or hirsute, a later doctor decided PCOS was incorrect.
Anyway, first five days: Days 1-3 were spent in the hospital. My boys were 4wk premature, but they didn’t need NICU. Sometime on Day 2 the hospital gave me pumping stuff, and I was able to extract a tiny drop of colostrum. It didn’t even make it out of the cone thing you put on your breast. I was trying to tandem nurse the boys every 3hr, with SNS full of formula. As soon as we got home, I realized there weren’t enough nurses around to help with the SNS/tandem feed, so I decided to exclusively pump. The next day, Day 4, my milk finally came in, but not very much. I pumped every 3-4hrs round the clock for 4 wks, to no avail. Since I wasn’t producing much, had plugged ducts and mastitis and I desperately needed more sleep, stopping the pumping was a no-brainer. I should have just started with formula from the outset, and not even tried to breastfeed—would’ve saved me a lot of trouble. Still, there were times when I wondered exactly what the trouble was, or if it was (most likely) a combination of factors.
Anyway, there it is, very TMI, sorry.
See: http://www.theguardian.com/lifeandstyle/2014/aug/29/new-mothers-discharged-hospital-too-early-nhs
Early discharge, or rather too-early discharge, especially when coupled with inadequate [or absent] followup by district midwives, is, IMO, a curse rather than a blessing, and not just where breastfeeding is concerned. I saw a lot of problems due entirely to being sent home too fast on my community postpartum rounds when I was in the UK, and this was over 40 years ago!
I was in for five days. It took 30-40 minutes to get a midwife to respond to the call bell. My baby had feeding issues and needed an NG tube inserted because she became too lethargic to feed. Even so, once she had 24 hours with the tube and enough wet nappies were we sent home being told that 10 minutes on each side was fine and never being seen by an LC. Guess what? It wasn’t she continued to lose weight until the HV came (we were in the hospital so long we missed the midwives visiting) and didn’t regain her birthweight until 4 weeks. So all the time in the hospital didn’t help since they were so overworked.
In the US, it seems that most mothers and babies leave after 2 days, if a vaginal delivery. A C section would be 4 or 5. I didn’t have a C section, but they wanted to keep the babies an extra day, just to make sure their weight loss had stabilized. I was able to stay with them on the grounds that I was “breastfeeding” and was considered a boarder. By the time we went home, I was glad to go home, and give up the nursing attempts. But 6hrs could’ve been fatal, since I had the PPH 8 or 9 hours after the boys were born.
6 hour discharge is feasible when there is a good working liasion with the community midwife — who, if she doesn’t accompany the woman home, visits within a couple of hours, and sees both the woman and baby once or twice a day until the 10th postpartum day, and can be summoned immediately in an emergency. That was the hallmark of the “domino” system [which was not in use in the Cambridge region when I was studying there]. Otherwise, 48 hours was the usual hospital stay for NSVD — as it is in the US, but that means that the majority of mothers have not established breastfeeding, as their milk hasn’t come in before discharge [and the babies often have little appetite].
I used to joke, in the US, that we ought to discharge women after a good night’s sleep, and then readmit them either for the weekend, or around the 4th PP day, when they’ve come down off the cloud and need encouragement.
But then, I think women should be offered a paid “pregnancy leave” similar to maternity leave, to be used, if necessary, during the first trimester, when many women either feel rotten or are exhausted.
“EDITED because: no one cares, tl;dr”
That’s why I’m baffled that there isn’t more research/discussion into things that might be preventing successful lactation, like chronic anaemia. Even the PCOS link wasn’t told to me (I was diagnosed with PCOS at the time due to polycystic ovaries and infertility but turned out to not actually have it and these were instead symptoms of an underlying inflammatory condition that was undiagnosed at the time).
It seems that informing women that are encountering difficulties that there might be an underlying reason that is beyond their control is “undermining breastfeeding” for some twisted reason…
I agree. Luckily, I didn’t really care that I couldn’t breastfeed, and went to formula wo/a backward glance. However, I’m sure there are many women who have similar conditions and factors, who want to breastfeed, and should get the help they need. And if it isn’t going to work, they should be told that it is FINE to use formula, no guilt necessary.
The problem with this is that we cannot know if it is primary failure of lactogenesis or secondary until after increased stimulation has been tried, probably for about 5 days until you see a trend. Any good LC knows that feeding the baby is the first and most important priority. There are plenty of LCs out there basically committing malpractice IMO, so that is a huge problem.
One thing that I agree with 100% is that a regimen of breastfeeding, supplementing and pumping is barbaric. That ends up taking an hour, and then you have to start over in two hours.
Here is what I usually recommend right off the bat: feed the baby first, because that is what the infant needs, and it is very painful to a mother to not meet her infant’s needs. Then pump 15 min, storing the whole kit minus the tubes in the fridge in between pumpings, and only washing it out once a day. At night, dont go longer than 5 h without pumping, and let the baby wake you, dont let alarms. Remember, this is only for 5 days to establish a trend. Practice breastfeeding whenever mom wants to, not on a schedule. Skin-to-skin contact in whatever way is easiest for mom.
Reached my character limit so continuing here:
Once a trend showing whether output is increasing or staying stable has been established, the mom can make a decision about how to proceed. Remember, I am working with moms who want to breastfeed; but I always present all their options, from fully formula feeding to making peace with the milk supply they have and doing combo feeding.
That makes sense. Pumping for a few days, to see if more milk will come, is quite reasonable. But setting a NEAR time limit is also important. When I first started having trouble, I decided 2 weeks would be my limit. For two weeks, I would do everything I reasonably could to breastfeed, then reassess, with quitting as an option.
I think also it needs to be recognised that “exclusively breastfeeding” for 24 hours can just be a fluke. I was on a feed, pump, topup regime in hospital on days 3 and 4. For the last 24 hours prior to hospital release I managed to “exclusively breastfeed” without topups – I suspect because my baby was so damned exhausted she gave up. She was still taking an hour and a half to breastfeed – she just slept a little longer in those 24 hours.
Well for me I had to bf, then top up with formula, then pump which all took 2 – 2 1/2 hours. One hour would have been a Godsend.
That was me too.
And of course she would often wake up while I was pumping. It didn’t take long before I quit that insanity. Although then I just let her bf for hours. Oh well!
Yep – I gave up pumping for all but one when my husband was home and able to help.
If only more LCs recommended this approach! Sane and balanced and with a definite end in sight, so mom can reevaluate her goals based on how things are going. Also, it NEVER occurred to me to store the pump parts in the fridge and wash once a day. That alone would probably have made the experience of pumping about a hundred times less annoying.
One of the very odd things I’ve also seen on the Internet is advice for how to lactate if you have NEVER GIVEN BIRTH. Seriously, what’s the likelihood that a nulliparous woman will produce enough milk to exclusively breastfeed? Honest to goodness it’s ridiculous advice.
A full supply is unlikely, but I worked with an adoptive mom who used Jack Newman’s method and produced 5-6 oz/day.
At what cost? I’m talking in terms of time/expense/emotional output. Genuinely curious how much effort was involved in producing 5-6 oz/day.
It was a lot of effort. But she wanted to do it.
If someone wants to do so, nothing wrong with that. Certainly a lactation consultant should encourage the woman to speak with OBGYN services about the relative risks and benefits of using medications for this method (I don’t know much about galactalogues), and acknowledge that exclusively breastfeeding is may not happen.
I agree 100%.
Ok. So now I’m wondering…I stopped BF 3 months ago and I can still get a drop or two. If I adopted a baby, how hard would it be to get BF going again?? A completely hypothetical question!
I had friend whose baby just would not ever latch. She went right to formula, but then had to switch to soy. Some nosy old woman told her she should just re-lactate (presumably so the baby wouldn’t have to drink soy). Of course, no thought to the fact my friend would in addition to the effort to make milk have to eat a restricted diet. Thankfully my friend thought the woman was crazy…but can a woman stop BF then try to bring their supply back up at a later point?
Relactation has definitely happened to some women. How common it is for relactation to actually work and supply a baby with a useful amount of milk is another matter.
I feel like I could probably relactate fairly easily. Not going to test it out, however!
A friend of mine did manage to relactate to the point of being able to more or less breastfeed without need for formula once her son was old enough to also take solid foods in reasonable amounts. I want to say he got formula exclusively for about 2 months before she started relactating.
I am totally curious too. I stopped 4 years ago, and still get a drop if I pinch my nipple after a breast self exam.
Actually, a huge number of women, even those who have never given birth, drip a bit now and then, especially if stimulated.
That’s one feed for my two month old grandson. Gee whiz.
It can be done, especially if you take hormones to help.
I wonder what the hormones do your risk of breast cancer.
I have no idea, but I’m sure they’d have some interesting short-term side effects.
I once saw something on the internet about men breastfeeding. I can’t remember where (and I don’t want to please don’t make me) but I am pretty sure it wasn’t a satire site.
Are you sure it wasn’t this?
https://www.youtube.com/watch?v=6OkcucXIuVI
Unfortunately, yes I am sure.
With the comment about hormones below, I actually started to wonder if a male could lactate if they were on, say, MtF levels. Wouldn’t it be fun to bring the overwork and the guilt to the male side of things, too? If you really loved your children, you’d take a bunch of hormones so they could have two parents’ worth of breast milk!
There was a Mental Floss article. http://blogs.static.mentalfloss.com/blogs/archives/20193.html
Not the same thing, I know someone who lost a baby who was a very early preemie, then pumped for a while, and managed to keep her milk going until she adopted a preemie, whom she then was able to nurse exclusively.