You get what you expect? Rachel O’Brien IBCLC and the “psychology” of low milk supply

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I have very few regrets about the years that I practiced medicine, but there is one thing that makes me embarrassed every time I think about it.

I was taught that “all breastfeeding women make enough milk.” It was a lie, but I didn’t know it at the time. My experience of breastfeeding my own children did nothing to disabuse me of this falsehood. I had a booming milk supply when I breastfed my own children, routinely pumping 10 oz. at each session.

Are we setting people up for diabetes when we warn them to eat right and exercise?

The consequence was that I counseled women to breastfeed without giving them accurate information to help them. Even worse — and this is the source of my guilt — though I never told anyone outright that I thought they were lying about low milk supply as an excuse to stop breastfeeding, I didn’t believe them. I’m ashamed to think that when I should have offered support, I offered judgment instead.

The only thing I can say in mitigation is that it happened 25 years ago when scientists and physicians knew a lot less about the physiology of breastfeeding than they know now.

Sadly, lactation consultants are still spewing the same lies that I was fed.

Consider Rachel O’Brien IBCLC and her vicious piece You get what you expect; the psychology of low milk supply.

Do you remember what you heard about breastfeeding before you ever tried it yourself? Did you hear other families talking about having a hard time making enough milk? Did you see articles in parenting magazines that told you how to AMP UP YOUR SUPPLY or warned you that 49% of mothers said low milk supply was their biggest “booby trap” or that you may have “less milk than the baby needs”? …

I am NOT saying that all women can breastfeed, and I am NOT saying that low milk supply is a myth. I’m not discounting the stories of anyone who experienced low milk supply. My point is that when we hear about low milk supply over and over, response expectancy theory says that our bodies can respond in the way that we expect them to- by making less milk than we need.

It’s a self-fulfilling prophecy, and we may be perpetuating this when we give well-meaning advice and warnings to others. Are we setting families up for failure?

Low milk supply: It’s your fault; you did something to deserve it.

O’Brien blames the victim.

What’s the truth?

Nancy Hurst notes in 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.

Other studies have found rates even higher. In other words, insufficient milk supply isn’t merely possible, it’s relatively common.

Alison Stuebe, MD and member of the Academy of Breastfeeding Medicine recently acknowledged:

… a substantial proportion of infants born in the US require supplementation. Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation…

Breastfeeding physicians and researchers are well aware that insufficient milk supply is real, but apparently they’ve neglected to tell the truth to IBCLCs.

O’Brien boasts:

For today’s blog post I considered just cutting & pasting my 21,397 word Masters thesis on U.S. mothers and perceived insufficient milk supply.

What evidence does O’Brien provide for the connection between talking about low milk supply and the subsequent development of low milk supply? None, of course, because there is no such evidence. Instead she cites out of date papers about response expectancy theory, a fancy term for the placebo effect.

The placebo effect applies to treatments. When a patient believes a treatment will work he or she may improve when unknowingly receiving a placebo instead. I’m not aware of any research that shows that when a patient is told about a hormone deficiency, he or she will develop that deficiency, but O’Brien bases her conclusions on precisely this inappropriate extrapolation.

Perhaps O’Brien will consider writing future papers like “Diabetes and perceived insufficient insulin” or maybe “Recurrent miscarriage and perceived insufficient progesterone.”

Shouldn’t the same principles enunciated in her blog post apply to diabetes and recurrent miscarriage, too?

It’s a self-fulfilling prophecy, and we may be perpetuating this when we give well-meaning advice and warnings to others. Are we setting families up for failure?

Would we change how we talk about breastfeeding and nursing if we knew that our words may cause problems for the person who is listening to us?

What would happen if we made an effort to discuss the positive parts of our breastfeeding experience AT LEAST as much as we warn about the negative parts?

Are we setting people up for diabetes when we warn them to eat right and exercise? Do we create a self-fulfilling prophecy when we routinely test people for high blood sugar? What would happen if we made an effort to discuss the positive parts of eating pastry and candy as much as we warn about the negative parts?

What would happen is that people would think you were both ignorant and cruel, blaming a sufferer for a disease over which she may have had no control.

And that’s exactly what O’Brien and other IBCLCs do. They blame the victims — women with insufficient milk supply — for the hormonal and anatomical causes over which they have no control.

That’s because IBCLCs are not medical professionals. Instead of offering accurate scientific evidence about insufficient milk supply, they offer lies leavened with a heaping helping of judgment.

That’s not patient care; that’s cruelty.

  • Steph858

    Ye Gads, is that damned video ‘The Secret’ STILL doing the rounds?

  • D/

    I have never had any mother UNNECESSARILY worried about her ability to produce milk that I have been unable to reassure that she is making enough … if, in fact, she is making enough. Appropriately assessing and interpreting infant weights (both daily trends and test weights with feedings) and/ or acknowledging adequate volumes of expressed milk in bottles almost always “cures” perceived insufficient milk production.

    As for actual milk insufficiency, though, I encounter difficulties now on a regular basis with *very* misplaced confidence(s) on all fronts in every baby getting enough milk through exclusive breastfeeding, even in the face of direct assessments showing otherwise. It is beyond frustrating! There’s nothing about exclusively breastfeeding a baby to the point of intentional underfeeding (when it is completely unnecessary to do so) that should inspire confidence on the part of anyone involved.

    I don’t buy it, at all. Confidence isn’t what translates to mothers making enough milk. Confidence translates to mothers feeling good about their mothering ability regardless of whether they can make even a drop of breastmilk or not.

  • Jessica

    On my current BabyCenter birth board, one woman’s three month old baby has gained a mere five ounces in the last MONTH. She refuses to supplement with formula, and complains that she has “trouble” getting her pump to work, so she can’t really supplement or top off baby with her own milk. She thinks baby is getting enough because he has enough wet diapers and seems happy. The responses that he must just be a slow gainer and to get a new pediatrician are boggling my mind. It’s like no one wants to point out the obvious possibility that she has an inadequate milk supply and her baby is not getting enough to eat.

    • moto_librarian

      I hope that someone reports her to CPS.

  • Allie P

    I thought I’d have plenty of milk for my first baby, believed the lie that any deficiency in production was my imagination/my own fault for XYZ (pain relief, not “trying hard enough” etc). Had low milk supply, a baby who was miserable and lost weight, etc. With my second baby, I was resigned to low supply, expecting it, etc. Nursed just fine, baby grew like a weed. Maybe — now prepare yourself for this revolutionary thought — we can’t magic ourselves into physical conditions with good thoughts.

  • FEDUP MD

    Well, based on all the concerns that were given to me about hurting my milk supply from the LC, my milk should never have come in, because she has me terrified that if I didn’t pump every 2 hours, I would never make enough. But of course, being exhausted from being up for 2 days straight plus general anesthesia, sometimes I slept longer than that, so I was convinced I would never make enough. Until of course …. my milk came in. I still have the huge stretch marks. I could easily pump 16 ounces at a time, my max was 20. My kid’s weight took off like a rocket. By the second kid, I told the LCs to just to go away. Didn’t pump at all, and had so much swelling the second time that I got bilateral brachial plexopathies. Yes, it takes a few extra days to come in, but when it does…. Oooof.

  • Jenn Hacker

    Um… You quoted this…”I am NOT saying that all women can breastfeed, and I am NOT saying that low milk supply is a myth. I’m not discounting the stories of anyone who experienced low milk supply.”

    Then said this…”
    Low milk supply: It’s your fault; you did something to deserve it.

    O’Brien blames the victim.”

    Is it really that absurd to say, “there are people that have supply issues. If you are bombarded with information telling you that you WILL have low supply, your body can respond accordingly”?

    Isn’t that EXACTLY what advertising is designed to do? Are you saying that stress absolutely never has an impact on supply?

    No where in that blog post did I see Rachel say, “if you have a physiological reason for low supply IT’S YOUR FAULT”. So your comparison with miscarriages and diabetes are ridiculous.

    • swbarnes2

      What’s the breast cancer rate among women? I bet you know that it’s 1 in 9, because you were “bombarded” by that statistic. Do you think knowing that increases your risk of cancer, because your body responds accordingly when you hear that?

      • Jenn Hacker

        I don’t know of a single case of someone being stressed about breast cancer and as a result, getting breast cancer. Can you cite such a case? There are no shortage of cases where supply is affected by stress. If you are bombarded by people and advertising that tells you you need their product or you will not supply enough to feed your child, you are saying it’s absolutely impossible for that to affect supply?

        I don’t see anywhere in that article where O’Brien discouraged someone from ruling out physiological reasons for low supply. Maybe I missed it.

        • Who?

          What would be the mechanism for low supply due to formula advertising? I can see that knowing formula is available might make you think that you don’t need to flog yourself to feed a baby, since there is a healthy convenient alternative.

          And why, if the link you proposed between stress due to formula advertising and low supply holds together, is it ridiculous to suggest that breast cancer could be caused by the stress of hearing about breast cancer rates?

        • Box of Salt

          Jenn Hacker ” If you are bombarded by people and advertising that tells you you need
          their product or you will not supply enough to feed your child”

          Tell that to the lactation consultants.

          Or are you suggesting that your comment only applies to the advertising of formula?

        • swbarnes2

          Why is hearing “not all women can breastfeed” so insanely stressful that it drastically alters hormones? Do you think that woman are delicate flowers, who, faint on hearing about unpleasant possibilities? If women can hear “1 in 9 women will develop breast cancer” and not collapse into terrified wrecks, why is hearing “15% of women can’t breastfeed” going to be so much more devastating?

          What IS stressful is having harebrained LC’s and brainwashed ideologues gaslighting them, telling them that of COURSE they can do this, that failure is not a biologically possibility, even when the woman herself can observe that it’s not working, that her baby is hungry.

        • The Bofa on the Sofa

          If you are bombarded by people and advertising that tells you you need
          their product or you will not supply enough to feed your child, you are
          saying it’s absolutely impossible for that to affect supply?

          Quick yes or no question: do you think Viagra commercials cause men to have erectile dysfunction?

    • Sue

      “Isn’t that EXACTLY what advertising is designed to do?”

      Of course not. Advertising is designed to influence choices, not physiological body functions.

      O’Brien is just running another variation of the ‘trust your body’ trope. If you don’t BELIEVE, it won’t work.

      That’s just nonsense.

    • Nick Sanders

      Isn’t that EXACTLY what advertising is designed to do?

      Advertising is designed to increase interest in a product. While it an make people decide something they never cared about before is now a problem in need of a solution (I’m looking at you magnetic pen necklace), or change minor perceptions (“Ooh, that looks delicious, maybe I am hungry after all.”), advertisers can still only dream about greatly altering bodily functions.

      Are you saying that stress absolutely never has an impact on supply?

      That’s a hell of a false dichotomy.

  • BeatriceC

    MK Update: He’s down another couple pounds since his last doctor’s appointment mid-May. For those counting, we’re at a total loss of 35 pounds. He was in size 32 waistband jeans before all this started and he can now get his little brother’s size 28’s on (comfortably around the waist, but they’re too short). The polyp they pulled out is just a normal, non-exciting one. There’s some evidence that there may be others in the part of the intestine that the scopes couldn’t see, and that might be what the known mass is. So they’re working on getting insurance approval for a capsule camera to get a look at that part. They are also re-submitting the request for the nutrition drinks for insurance and gave me a week’s supply of samples to help with affording them. At this point they’re thinking some sort of juvenile polyp disorder and/or some sort of delayed stomach emptying, but need blood work to confirm a few things. They also started him on cyprohetadine, which she said might help if there’s a problem with delayed stomach emptying and won’t hurt if it’s not.

    • Charybdis

      It sounds as if they are leaning towards gastroparesis as the issue. Hopefully they can get approval for the capsule camera so they can get a good look/data at the entire GI tract. At least they are not talking surgery at the moment.

      Now, how about you? What did your allergy doc say about the chocolate, or is there more testing for you too? (please don’t let BeatriceC be allergic to chocolate, it can’t be the chocolate….)

      • BeatriceC

        Tuesday’s skin test was, in fact, positive for cocoa. I was also a moderate positive to potato (which I’d begun to suspect), and mild positives to oranges, green beans and latex. I’d suspected the oranges and latex, but not the green beans. MrC and I have had to switch to non-latex condoms when we have the need for them (usually not, but there are situations they are necessary) because I wound up with an uncomfortable skin reaction with latex. Oranges have always made my mouth numb. Green beans just came out of nowhere. I didn’t have a positive result for any of the foods that are normally cross-reactive with latex, but I don’t eat very many of those to begin with. They sent blood work off for some other stuff, so I’m still waiting on that. I’m getting kind of worried on one issues. I now have known (and in the case of tomatoes, extremely severe) allergies to tomatoes, potatoes and eggplant; all members of the nightshade family. One of my diet staples is bell peppers, which is also a nightshade. I use a red pepper sauce in place of tomato sauce in a lot of recipes. I am so screwed if I keep on this path and develop allergies to the rest of the nightshade family.

        • Mattie

          This is really interesting, I have a friend who had tummy issues from tomatoes and potatoes, we wondered why on earth they could be causing similar issues, perhaps the answer is nightshade 😀

          • BeatriceC

            That they’re both nightshades is a reasonable hypothesis. Of course one is the fruit and one is the root of two different plants in the family, but it’s still possible.

    • Nick Sanders

      I hope he is diagnosed soon, and with something they can fix.

  • Puffin

    I got my ‘having your baby at our hospital’ info pack from my OB, complete with two booklets totaling 160 pages of information of varying usefulness. One of the booklets is a 40 page booklet on breastfeeding. The booklet, as I read through it is full of misinformation, unsupported claims, and old wives’ tales. Some useful stuff, but it totally downplays the difficulties that breastfeeding can have, and doesn’t touch on formula or combo feeding at all. The larger ‘having your baby at our hospital’ info book has two pages on formula, one of which is about 1/3 a warning about the risks of formula feeding.

    It makes me angry that this is what our patients are getting.

    I breastfed each of my other kids for two years, and I had oversupply issues (though I never responded well to pumping which is why we’re combo feeding kid 3 from the start; I’m not taking time off this time.) I anticipated being able to breastfeed easily, but it was still damn hard to get started. It hurt like the dickens.

    • Anne Catherine

      most breastfeeding literature is just like that —-I saw a friend’s ICBLC training book–it was really appalling ….

  • carovee

    Uh, no. I expected to have vast flowing rivers of milk. I expected to feel the discomfort of my milk coming in. I expected my breasts to behave exactly as advertised in the many pamphlets and book chapters on breastfeeding that I read. Guess what? I got none of that. Luckily I have a thriving kiddo thanks to formula.

    • moto_librarian

      Yup. That was my experience as well.

  • Francesca Violi

    These alternative-natural crowd often accuse real medicine of wanting to over- control our bodies, instead of letting their natural capacities kick in etc etc. but then they really have a knack about this supposed capacity of our mind to perfectly control every tissue, chemical reaction and function in our body. It is definitely a recurring argument that negativity, fear, unspoken traumas, “unbalances”, etc. cause all sort of illnesses and to heal you just have to get rid of these negative feelings and thoughts. To me this fantasy is one of the most irritating features in such “natural” philosophies, they just can’t accept that the world and even their own body may behave in a way that has nothing to do with what they want, hope, or deserve.

  • yentavegan

    Are there indicators, prior to the newborn failing to thrive, a parent can use to predict low milk output?
    1. Mothers breasts do not change noticeably in heft, weight , size or sensitivity during the pregnancy
    2. Mother loses blood during delivery in an amount that impacts her consciousness…if blood loss made mom woozy /and requires medical intervention milk production can be irreparably supressed
    3. Breasts do not swell and experience the initial hormonal dependent whoosh of milk production ( engorgement)

    When these indicators are present , no amount of power pumping, lactation cookies, herbs, off label medications will create a full abundant milk supply.

    • Jules B

      I had 1 and 3.

    • carovee

      I only had 3. Also, my nipples were huge and pointy until about 2 weeks before giving birth at which point they became flat, soft and hard to latch.

    • Megan

      I had all three the first time. Guess I should’ve seen the proverbial writing on the wall. Second time I had one and three but to a lesser extent.

    • OttawaAlison

      Other indicators:
      Widely spaced breasts
      Insulin Resistance and/or family history of type 2 diabetes

    • KeeperOfTheBooks

      The LCs and nurses I saw also seemed to assume that *any* milk output=sufficient milk output.
      I had a CS, and nursed for the first time in the OR. I was determined to breastfeed. By day 2, a LC asked if I’d had any engorgement, sensation of letdown, etc. I said no. She then expressed a few drops of milk from one of my breasts, and said, “Oh, see? You’ve got milk,” and left it at that. Breasts never changed during pregnancy, and while I didn’t lose unusual amounts of blood during DD’s (C-section) delivery, I also didn’t experience any sort of engorgement until about 10-14 days postpartum despite incessant pumping and nursing plus taking huge quantities of fenugreek.
      This is the sort of information that would have been really useful at the time. I wouldn’t have stopped breastfeeding because I heard it, but I would have taken a more realistic view of my chances of exclusively breastfeeding. Instead, I tortured myself for weeks because I was sure if I just tried hard enough, I’d have enough milk. Bonus points to the LLL leader who suggested that my problem might have been that I didn’t want my (desperately-hoped-for) baby.

  • Tosca

    The placebo effect works on conditions with “soft” endpoints – ie, things that can only be subjectively described. It’s been found to have no effect on “hard” endpoints. A person taking a placebo for anemia may report feeling less tired and breathless; their hemoglobin levels won’t rise. A placebo may effect a person’s blood pressure and heartrate if their elevated levels are due to stress; it won’t if they’re due to organic illness.

    Is there a proven correlation between low milk production and stress? It seems reasonable, but has it ever been properly researched. If there is, wouldn’t the stress of intense efforts to breastfeed, further reduce milk supply?

    • KeeperOfTheBooks

      It would make sense. One of our more interesting frequent commenters is a dairy farmer, and she’s written in the past about how they treat their newly-calved cows. The short version is that it’s SOP for the cows to be put into a very low-stress environment, given good food, and not milked very much for the first couple of days. Given that dairy farmers’ livings are based on cows’ lactation, you’d think they might be onto something!
      Similarly, a number of Hispanic communities have excellent support systems in place for new moms. Locally, the way it works is this: new mom has baby. New mom goes home, where she has sisters/mom/grandma/aunties there to take care of the house and other kids, if any, as well as taking night shifts with baby. Mom’s job is to lie in bed, eat good food, and rest. She’ll nurse during the day, and a little at night, but someone else will take over the rest of nighttime duties and also supplement with a bottle or two of formula over the night, letting mom get long stretches of uninterrupted sleep. After a week or two, mom’s exclusively breastfeeding, and problems in that regard are rare and reflective of the 5-10% number of moms with lactation issues generally cited in reputable literature.
      Personally, I suspect the combination of lots of rest, good food, and low stress mean that mom’s body can focus on recuperating from the birth and making milk, rather than straining its resources to the utmost. Drives the local lactivists utterly mad. (Mind you, I consider that a bonus…)

      • CandiO

        That’s been my experiences with all the local Hispanic communities I have worked with through the years. The mom has a baby, does not breastfeed in the hospital. Has lots of aunts/sisters/grandmoms for help in the hospital and at home. Goes home, milk comes in days later and she successfully breastfeeds for months or years.

    • Maternal exhaustion certainly does.

      • yentavegan

        (Low thyroid presents as exhaustion). Exhaustion due to power pumping, nursing every two hours, finger feeding, etc…because milk production is low..I sometimes think mothers exhaust themselves due to low milk supply and maybe not the other way around.

  • Marie

    I had recurrent miscarriage and actually was told by some lay people that I was just “too pessimistic.”

    • guest

      Yes, or you were “too stressed” to get pregnant. The people who say that make me really angry.

    • lilin

      I can’t get my head around saying this to a person. How? Why? Could I ask who said that too you? It just seems crazy.

    • MaineJen

      WTF is wrong with people.

    • Puffin

      Yeah, I got crap like that too. No, my eight first trimester losses were not due to stress or a negative attitude. ‘Thinking positive’ is not going to prevent another miscarriage. My losses were due to medical issues. I got to the point where I told people that right out, in detail.

  • Maestro_Wu

    OT:

    Would it be okay for me to impose upon this august group for an opinion? I have really nowhere else to go.

    I am an American pregnant with my fourth child and living in Germany. For background, it is all midwife-led care here, which is not altogether a bad thing. However, they are stingy with epidurals and other pain medication, and they often recommend homeopathics and other things with little scientific backing. For example, the go-to way to induce labor in postdates women (in mainstream public hospitals) is with an apricot champagne cocktail that contains castor oil. For my third baby, I requested oxytocin and they looked at me like I was insane.

    Anyway, this time I am 37 weeks along with a transverse baby. I was supposed to have an external cephalic version earlier this week, but now the OB says he thinks it is fine to put it off until at least 39 weeks (maybe longer) then just induce immediately. From everything I have read in the literature (by which I mean NIH studies and RCOG guidelines, not babycenter.com), the external cephalic version would have had about a 75% likelihood of success at 37 weeks, but the success rate will continue to drop the further along I get as the baby gets bigger. I am looking to avoid a c-section because they are the leading cause of maternal morbidity, not to mention there are a lot of stairs in my house.

    Also, most sites (including this one) have transverse-lie-related horror stories. Some studies I have read recommend hospitalization at 37 weeks to mitigate the risk of cord prolapse; this guy did not so much as examine me before sending me on my way because he said he was overscheduled. His nurse checked my blood pressure and I gave a urine sample, that was it. I haven’t had an ultrasound or vaginal exam since 35 weeks, and since the doctor was too busy to do one this time, I won’t be offered one again until 39 weeks.

    The thing is, I know that the more pregnant I get, the less clearly I think, so I don’t want to overreact.

    I am looking for someone to tell me if I should indeed be seeking a second opinion (which I can do on this insurance plan, but it’s tricky) or if this guy’s hands-off optimism is appropriate.

    Can anyone provide me with a reality check?

    • Mattie

      seeing as 37 weeks is ‘term’ (at least that’s what women are told here haha) or at the very least not very premature, could you just request they do the ECV/induction earlier? Kind of a compromise?

      • Maestro_Wu

        I did. He said that important brain development takes place between 37 and 39 weeks, so transverse lie is not a valid medical reason for induction, and an external cephalic version may force us to induce if something happens during the procedure. And while I have no arguements about the value of brain development (because I want my kids to be able to get good jobs so they can look after me when I am old), I think a pretty-good baby at 37 weeks beats a dead baby at 39 weeks. If, you know, transverse lie is indeed all that deadly. Plus I think my health matters too, and having busted up my pelvic floor already with three vaginal deliveries, I would rather do an ECV now to avoid a c-section later. But this guy is the OB department head, so he didn’t really want to discuss it with me, he wanted to walk out and go to his next appointment. Doctors are not big on discussions here, more like edicts. I can theoretically go for a second opinion at a different hospital 45 minutes from my house, but if y’all think the ECV/induction plan at 39 weeks is valid, then maybe I should just shut up and color. I knew I should have gone to medical school. I just couldn’t hack the organic chemistry. 🙂

        • Mattie

          DEFINITELY get a second opinion, he sounds like a bit of a fruit loop

          • Maestro_Wu

            Thanks, everyone! I greatly appreciate the advice. I went for a second opinion at a major university hospital whose website talks up their prowess at baby-turning. They agreed to do it… and then the baby turned on his own. Maybe he just likes the attention. 🙂

          • Irène Delse

            Hooray for babies who turn by themselves!

        • Dr Kitty

          My take, he thinks your chances of a successful ECV are lower than the statistics would have you believe.

          He possibly thinks the odds of requiring an immediate CS due to foetal distress during ECV or the ECV failing to turn the baby or to keep it cephalic for long are much higher than the chance of a successful ECV and an induction a week or two later.

          Therefore he wants to wait until 39w to avoid any issues of later prematurity, because he may think that whatever day you decide to do the ECV is most probably the day you’ll have to deliver.

          Whether or not you seek a second opinion might be down whether or not his belief that ECV is unlikely to work for you is justified by your medical history or not. Which probably means asking him what he thinks the odds are for you, and why they might be different in your specific case to the average.

    • Chant de la Mer

      I’m sorry, I don’t know anything about transverse babies, just that they can’t be born like that and if baby doesn’t move that means a c-section for sure. I think if you can get a 2nd opinion you should do so since from what I remember commenters on here say, a lot of times the external versions fail and usually because the baby is in that position for a reason. I don’t think you are overreacting to the doctor’s cavalier attitude.

    • swbarnes2

      I thought you were NOT supposed to induce a transverse baby, because it has to be a C-section? Or would you induce only if the ECV successfully flips the kid head down, so that hopefully you get the kid out before it flips back?

      • Mattie

        I believe the idea of breaking waters/inducing after an ECV (also one for breech) is to get the head to engage so baby doesn’t move back, not sure how effective it is, and if baby doesn’t tolerate the ECV then it’s gonna be a section anyway

    • Glia

      I’d get a second opinion. What he is saying is very different from 1) what my OB told me about my breech monster and 2) what I read when I was abusing my institutional journal access to decide whether to attempt an ECV. My understanding was that 37 weeks is considered about optimal for timing, and after that, it becomes more difficult. It may be somewhat different, since I could swear I remember reading somewhere that transverse babies were more likely to flip back after the version than breech, but still, I would probably seek it out. If nothing else, you don’t sound all that confident with this doctor now.

    • AnnaPDE

      Get a second opinion and say you’re a Privatpatient if they don’t want to give you an appointment quickly. Sorting out the bill later is much more easy to do than rewinding lost time…
      And yes, a lot of German patient care is disgustingly woo-infested, due to patient demand. Try asking the doctor directly for non-population treatment, many of them are relieved to have a rational patient for a change.

    • Montserrat Blanco

      I am not an expert in obstetrics, but it does sound like he is preparing for a CS. In any case, I just wanted to share a positive CS recovery story. I recovered very quickly from mine and stairs were not an issue at all. I was exercising two weeks after mine and running three weeks after mine. I hope you have a safe delivery and recover well from it regardless of the method.

    • yentavegan

      I had two c/sections. The morbidity statistic is compunded by mothers already in ill health prior to c/sec and labor going into crisis and having an emergency c/sec. I was able to go up and down stairs within a week of the c/sec. Both were non emergencies and planned. Hope my experience, although anecdotal , helps

  • Amy

    You get what you expect?!? Then breastfeeding should have been an absolute BREEZE for me. My mom nursed me and my sisters into toddlerhood (my middle sister was weaned with a lecture that once she was in school she would be too big to nurse) and repeatedly assured me that nursing was easy, she had just latched us on and we fed.

    HAH.

    Two months of exclusive pumping, numerous (thankfully at least covered by insurance) IBCLC visits, and six months of using nipple shields later, I was able to latch my baby on. That’s not remotely what I was expecting.

  • Debbie

    And how dare you say an IBCLC is not a medical professional I have been a nurse for 31 years and an IBCLC for 16 and 90% of the bad advice my patients get come from doctors with their heads up their asses

    • Amy

      In your experience, is it professional to say your colleagues have their heads up their asses? And exactly what kind of “bad advice” are we talking about here? Are those doctors advising their patients to starve their babies, feed them soda pop and ice cream, dope them up with Benadryl to make them sleep….? Or is that “bad advice” merely that it’s okay to use formula?

    • You’re a medical professional because you’re a nurse. Being an IBCLC doesn’t require much, if any, medical knowledge or credentials as shown by the numerous IBCLCs without even a college degree. Some college courses, yes. Actual BS (or even BA)? Not required.

      • Mattie

        I dunno, some have plenty of BS 😉

    • Glittercrush

      >_>

    • Who?

      I’m completely convinced. You should come here often and share your wisdom.

      In return, if you read carefully, you might pick up some useful grammar tips and even some communication skills. Though they would have to compete with your ignorance and vulgarity, which may prove overwhelming.

    • Alas, a great deal of my work for years comprised repairing damage done by lactation consultants. I’ve known a few good ones, but most were not.

  • Debbie

    I think you need to re read her article you are the biggest joke on the Internet and stick to your specialty

    • guest

      I always find that run-on sentences make for the most convincing and professional communication.

      • AirPlant

        Is it really a sentence if there is no punctuation?

        • guest

          It’s hard to say.

          • Allie

            In theory, I believe so. A complete sentence can be comprised of a subject and verb alone, and the punctuation is just icing. In practice, that mess was not a sentence, subject and verb notwithstanding.

          • Who?

            Whatever it technically is, it is not effective communication.

          • guest

            It’s most intriguingly bad. She took one sentence “I think you need to reread here article and stick to your speciality” and then put another sentence “You are the biggest joke on the Internet” and instead of putting them together sequentially, she put sentence two IN THE MIDDLE of sentence one.

          • Who?

            She has a lot of feelings.

            Thankfully, she doesn’t (usually) go here.

          • Heidi

            The way it reads, Dr. Amy is the biggest joke on the internet and sticks to her specialty. I’d have to agree with Debbie! I do consider female breasts a part of an OB’s specialty! Otherwise, I guess I’ve been letting my OB/GYNs feel me up for funsies

  • Jen

    I have a question for this group regarding the purported benefits of breastfeeding. Specifically that breastfed babies have 1-2 fewer instances of diarrhea and colds in the first year. Do the studies on this control for whether or not those babies are in day care? I wonder because it’s more likely that a mom that doesn’t work and doesn’t use day care services would be successful in breastfeeding for a full year. Could the reason that breastfed babies get less of these illnesses actually be a result of being exposed to fewer communicable illnesses through daycare? I’m just curious if the data that exists looks at this potential confounding factor.

    • The Bofa on the Sofa

      Do the studies on this control for whether or not those babies are in day care?

      Great question.

    • Gene

      It’s an excellent question. I work full time and my kids were in daycare starting at 6-8 weeks. They were all breastfed exclusively and, honestly, very rarely hot colds and maybe once a diarrheal illness. HOWEVER, they were also in a small home daycare (maybe 5 kids max). I have a feeling that was more of a contributing factor than the breastmilk.

    • Megan

      Not that I could ever tell, and this is a big pet peeve of mine. Working women are more likely to formula feed. Working women are also more likely to send their child to daycare. Kids in daycare get sick more often. Coincidence? Wouldn’t we all like to know…

    • Guestll

      My daughter was EBF for 6 months, and breastfed for nearly two years. I went back to my job part-time when she was 9 months old. She had never been sick to that point. Two days a week, she went to a large daycare centre. She was almost constantly ill with colds and gastro bugs for an entire year. It was horrible, and with the benefit of hindsight, I would have chosen a much smaller daycare centre, or hired a nanny.

      The possible upside is that she’s now 5 and in Kindergarten and she is rarely ill. She has missed a total of 1 day of school for sickness this year, despite several waves of cold/gastro viruses wending their way through her school and classroom.

    • Heidi

      I’ve never heard that BF babies get 1-2 fewer colds a year individually. Last I read, FF babies get 8% more colds and mild GI issues. Which, if I’m understanding correctly, means if there 84 colds among 100 BF babies, there will be 90 among 100 FF babies. But I could be butchering that science/statistic!

      • The Bofa on the Sofa

        I think the idea is that assuming that a BF baby has a total of 12 colds/GI issues a year on average, then a FF baby would have 13.

        That’s where the “1 additional cold/GI issue” comes in

        • Heidi

          http://www.skepticalob.com/2016/02/which-saves-more-lives-in-the-us-formula-or-breastmilk.html

          “But the benefits of breastmilk are restricted to approximately 8% fewer colds and episodes of diarrheal illness across the entire population of infants. ” That’s where I got it from.

          • The Bofa on the Sofa

            Yep. And that’s how I got the 13 vs 12.

          • Heidi

            But the way I’m reading it, that would be among individuals and not an across an entire population. Am I misinterpreting it?

          • Amy

            A percent is a percent is a percent. 8% fewer across an entire population would mean a larger total difference in the number of illnesses than in an individual baby. But 12/13 in a single baby IS 8% less than 13/13.

          • Heidi

            I see what you are saying. I guess, it’s worded as “entire population” though because I’m guessing the results didn’t come back that every baby in the BF group got 12 colds, for example and every baby in the FF group got 13 colds, that it just averaged out to 8% more in the FF group?

          • Amy

            Most likely. Since every baby is different and there are so many confounding factors, there’s no way every baby in each group got the same number of colds 🙂

        • Heidi

          I can’t find the article, and it may have been on Dr. Amy’s facebook page instead, something along the lines that 100 women would have to exclusively breastfeed to have something like 5 or 6 less colds out of the whole group of 100.

        • Heidi

          I get what you and Amy are saying and that makes total sense now to my sleep-deprived brain! But surely the average baby doesn’t get 12 to 13 colds a year do they? My baby is 6 mos. and so far has had zero. I’m thinking most babies might get one or two colds a year, which makes that 8% seem less than impressive, and would make what lactivists are saying an exaggeration but I have no idea how many colds a baby usually gets.

          • Allie

            In my experience 1-2 a year until daycare, then 12-13 a year : / So, Jen could be onto something.

          • Heidi

            Babycenter did say daycare, you could expect up to 12 colds a year. I guess when kindergarten starts, we’ll get to know the joys of a cold about once a month…eek.

          • The Bofa on the Sofa

            Our first stayed at home for the first 14 months, and had only 1 cold the entire time – after his baptism where he had gone to church.

            Then, he started daycare. My usual description is that he couldn’t look at the fucking door without getting a fever. We went through 6 months of being sick every other week, and probably 6 ear infections. He caught up on everything he had missed.

            And then he brought it home for our younger guy, who caught his first cold at 1 month. 5 years later, we are still waiting for it to go away….

          • Heidi_storage

            I am a stay-at-home mom, and my kid was bottlefed my expressed breastmilk for about 9 months. She had maybe 10 or 11 colds plus one bout of flu, most contracted at church. (No ear infections, and she is actually a healthy little beast. She recovers quickly from illness.) My son caught maybe 3 colds his first year of life. Babies–they’re all different!

        • Heidi

          So according to Babycenter, the average baby gets 4-6 colds a year. So if a BF baby gets 5 colds, that means a FF baby gets 5.4 colds. I guess they took the liberty of rounding up!

    • Anne Catherine

      I agree. I’m not quite sure what research she cites on this one, but I personally think that day care and other confounding variables could explain this difference.

      A lot of studies do account for variables, but really you can’t adjust for everything.

      Plus… I really don’t see what the mechanism might be for breastfeeding to prevent colds when the antibodies in breastmilk don’t cross out the GI system and into circulation.

      Anyone have any ideas on how breastmilk could prevent colds?

      • Inmara

        Antibodies IgA sick to lining of stomach and don’t let viruses cross into bloodstream. That’s a proven mechanism and makes this specific difference (and lasts only as long as nursing continues).

        • Anne Catherine

          But I’m not so sure that a Rhinovirus can live in the GI tract….I think that the stomach acids kill it. I have heard this and found it a few places on the internet this morning..

          • Sue

            Rhinovirus is acquired via the respiratory tract anyway – not by ingestion.

          • Anne Catherine

            Right –I thought so too so how can maternal IgA in the gut (from breastmilk) prevent colds? Or ear infections for that matter….

    • Sue

      Most of the statistics cited about breastfeeding outcomes in developed societies come from the PROBIT study, published in JAMA 2001:

      Promotion of Breastfeeding Intervention Trial (PROBIT)
      A Randomized Trial in the Republic of Belarus
      at http://jama.jamanetwork.com/article.aspx?articleid=193490&resultclick=1

      It’s a few years old now, but I haven’t heard of more recent work of the same quality.

      The aim of PROBIT was to see whether the test intervention could increase BF rates, but they also analysed the health outcomes of the infants.

      Table 4 contains the actual results for the various health outcomes. Results were adjusted for number of children in the family and for maternal smoking, but not for child care exposure.

      I agree that exposure is the main determinant of infection rates.

    • Julia B

      Have a bit of a look in Pubmed to see what you come up with. This recent study (Alexandrino) was done in Portugal in six day care centres and found that breastfeeding reduced risk of lower respiratory tract infections (http://www.ncbi.nlm.nih.gov/pubmed/26884444). There are plenty more studies done specifically in day care centres that look at the effect of breastfeeding on various illnesses.

  • Taysha

    Her thesis was under 25k words?

    mine was 116k. What a slacker. But it’s hard to arm wave for long periods of time.

    • Amy

      Seriously. For my graduate program I went for the project/capstone option because working full-time, parenting two kids, AND writing a thesis just wasn’t going to happen. And my PAPER for the project was around 20K words. A paper. Written in about a week.

    • Roadstergal

      I couldn’t tell you how long my masters’ thesis was. It was long enough to convey the content, but not longer than that; I never sat down to do a word count. 25K words does sound quite short, though…

      • KeeperOfTheBooks

        For comparison, I persuaded a prof during undergrad to create an independent study class for me. The intent was to have me write papers in her/my area of specialty to prepare me better for grad school. (This was an extremely small undergrad program in an even smaller school, and I was the only student they’d had in decades who was interested in the particular graduate area I wanted to pursue.)
        That semester, I had to write three 25K+ word papers on top of the other 16-18 hours (can’t remember which) I was taking.
        Ergo, I am not terribly impressed by a master’s-level thesis of the same length. Word counts, of course, aren’t everything, but if I could pump out three of those suckers in a single undergrad semester…

      • MI Dawn

        Yeah, I have no clue how long mine was, either. Nor do I have a copy of it anywhere. I suppose, if I was really interested, I could reach out to SUNY Stony Brook and see if they have it on file somewhere.

  • Are you nuts

    In the words of Cher Horowitz from Clueless, “Freshman psych rears its ugly head.”

  • MaeveClifford

    I wonder if annovulatory women just need to stop their “self-fulfilling prophecy” of failure to ovulate. It’s obviously their negative thoughts preventing a much wanted pregnancy. Not a medical condition like a hormonal imbalance. It’s all those infertility articles they read in magazines. They’d never have thought to become infertile themselves if they hadn’t had that negative idea planted in their pretty little heads.

    Ugh, except there ARE people who spout that kind of thing (just stop trying and it’ll happen!!).

    • Steph858

      Well, Murphy’s Law incorporates the Subsection: Law of Inverse Fertility. So if a woman really wants to become pregnant she’ll struggle; conversely, if she doesn’t want to become pregnant then she will at the most inconvenient time. So I guess the advice to ‘just stop trying’ is basically saying “Try to trick the Imp of the Perverse into thinking that you’ve changed your mind and don’t want kids any more: THEN you’ll get pregnant.” If offered in a humorous manner among friends who share that kind of sense of humour (in the same manner as an IT Engineer telling his friend “Be careful not to let the Magic Smoke out of your computer; it’ll never work once the Magic Smoke has escaped!”) then no harm done. If it’s a serious suggestion, blaming her for trying too hard, then that’s another story.

  • The Bofa on the Sofa

    I just remember Mel’s comment about how lactation failure of first time mother DAIRY COWS is 10%. These animals are bred for their ability to make milk, and 10% don’t do it with their first calf.

    Why should we think that humans are any better?

    • Heidi

      I’m sure those 10% overheard about milk supply troubles amongst the herd and worried too much about it!

      • Mel

        We’ve tried to get them to stop talking about it, but you know cows….. 🙂

        That would be doubly ironic since first-calf heifers on our farm are kept at a different barn a full mile up the road during their pregnancy until a few weeks before giving birth so the heifers could have only heard about this in the 3 weeks prior to giving birth.

  • Jennifer

    I realize this is off topic but I noticed when a lot of news articles and social media posts do acknowledge the downsides of bf they tell gut wrenching stories of women practically chafing off their nipples to nurse or babies almost starving etc etc. Ok that is great to let future mothers know low supply can happen. However I hate that we feel the need to go through all that torture. Like you’re not a real mom unless you are in excruciating pain. Why can’t a story be told about a mom who tried bf, didn’t get great supply, weighed the evidence and moved on. Why make her go through the fire first? I guess my story is boring but I just hate this mommy martyr narrative I hear everywhere. If something sucks that much and isn’t necessary, just don’t do it.

    • TheArtistFormerlyKnownAsYoya

      There’s something in our collective psychology that says that women must suffer for their children, and the more they suffer, the better. My mother in law told me to put cocoa butter on my belly 3x a day to avoid stretch marks, but, she said, “more stretch marks just mean you’re a better mother”.

      • CSN0116

        Yes, people have criticized the fact that I schedule my children from birth. There is some wriggle room but all feeds, naps, and overnight sleeps are scheduled and I transition my babies to it. It’s not a violent process, not at all. They take to it like ducks to water and are very content babies, STTN very “early” and taking loads of good naps. I like it; they like it …but it makes life easy. That’s where people get pissy. “Well you don’t get to have a kid and make it conform to you” or “Babies know what they need, good moms listen to their babies.” OK – maybe. But I’ve found a gentle way to make the babies and myself happy and drama-free. They cry very little and I never walk around a zombie. Is it a sin that I’ve found something that works for us but makes being a brand new mother *very* easy and enjoyable? Pffft, I’m expected to be a martyr. If I don’t suffer it ain’t real.

        • AirPlant

          I want to sit at your feet and learn your ways. Do you have a newsletter that I can subscribe to?

          • CSN0116

            Ha, no. I learned from a goddess when we had our twins, and I took her wisdom and applied it to all the others. She markets herself as an infant sleep trainer but does not specialize in fixing babies whose sleep patterns are in need of repair (though she does do that in some cases) – you hire her as to never fuck up and need repair. She advocates initiating healthy feeding and sleeping habits from birth, as to never need correction. So you hire her when you’re pregnant or immediately postpartum. She works with breastfeeding and EFF moms alike and seriously has a 99% success rate. She’s amazeballs.

          • Jennifer

            Does she have a book and/or website?

          • CSN0116
          • Megan

            I like that she devotes part of her time to educating about formula feeding, not just breastfeeding. She sounds amazingly helpful.

          • CSN0116

            She’s amazing in real life. Her website could say a lot more about her, but she has such a word of mouth cult following around here these days, I don’t think she needs much marketing at the moment.

          • Megan

            I wish you could just purchase her schedule. I imagine it’s similar to what I already do but I’d be interested in seeing it, especially since I live hours from Buffalo.

          • CSN0116

            Eh, call/email and ask!

          • Bombshellrisa

            Have you read Pamela Druckerman’s book about raising her kids in France? Some really interesting discussion about helping babies to sleep through the night and putting them on a feeding schedule.

          • Megan

            I have not though Ive heard good things about it. With my first daughter I was very loosey goosey about schedule and she did not STTN until 5 months old. With Little Lady, I knew I’d be going back to work sooner and parenting two kids so I tried to really start off on the right foot. She’s been put down drowsy but awake the vast majority of the time since birth and I started an eat-play-sleep schedule pretty much from day one as best I could. Her reflux put a wrench in things but we are now starting to really be able to space feedings out more. She is sleeping 6-7 hours at a time now so I think we’ve made good progress. I can handle one night waking and since she’s little and needs the weight gain, I don’t mind it.

            Our biggest issue right now is that she started at daycare a day a week last week and they are unable to darken the room or do white noise for naps (both of which I do at home) so she basically has no nap schedule there. She’ll be there three days a week starting in July. Not sure what, if anything, I can do to help her get on a schedule of some kind in this environment. They are willing to take my lead schedule-wise but she literally naps no longer than 30 minutes at a time, often only 5-10 minutes.

          • CharlotteB

            Feel free to ignore, but can you drop the white noise or dark room? Basically, make home naps resemble daycare naps? If they’ll follow your schedule, maybe adapt your environment? Easier said then done, though. :/

            My kid is in daycare 3 days a week, and I try to stick to the daycare schedule. He also naps on the living room floor at home, since at daycare they have little mats they nap on. We call it the “nap station” and he goes and chills out there from time to time during the day.

          • Megan

            I have tried this. My problem is my older daughter. It’s like she knows that I want her to be quiet during her sisters naps so she starts screaming as soon as she’s asleep. It would be easier if we didn’t have such a small house but you can hear everything everywhere. I could try making the nursery less dark but I kind of have to keep the white noise to drown out the toddler circus.

          • Heidi

            So how do you put a baby on a feeding schedule? I’ve tried offering him a bottle when it’s been long enough and he absolutely won’t take it. I’ve tried to get him to take bigger bottles at night but have had no luck. At 6 months, he still wakes at about 2am and 5am to eat. Is she the one that does a “dream feed”?

          • Bombshellrisa

            One of the things that is suppose to work is to put the routine in motion, distract during the day for a few more minutes each try until the baby is eating at specific times. One of the things that is suggested is pausing and making sure that your baby really does need something when they cry in the night, it’s not just them needing to connect a sleep cycle.

          • Who?

            I think you’d need to feel confident baby was very well fed-which with number 1 I never really did-to do this with food.

            At night, hell yes. I remember one night when our daughter was little my husband and I lying perfectly still while she murmured to herself and then dropped back to sleep. We’d made the mistake of picking up number 1 every time he so much as whimpered, thus teaching him for the first six months or so of his life that we were the 24 hour dog and pony show.

          • Bombshellrisa

            It was the LC who insisted we feed Ds on a schedule, it irritated me at first because it felt like my life was put baby to breast/feed baby/pump for baby/wash pump parts. Have 39 minutes until the cycle started over again. Repeat. It turned out to work well for us once the schedule was established.
            I agree about night. It was really hard though, because the crying made me want to fix it. Or the whimpering. Infants make so much noise when they sleep!

        • Roadstergal

          “but it makes life easy.”

          It sounds like it makes life easy for both you and the kids. I mean, kids do better when they get consistent good sleep! (I know that sounds obvious, but so many people are against setting that up early on…)

          • Megan

            Reminds me of the response (mostly outrage) to the recent news about that pediatric practice in NYC advocating sleep training at 2 months old.

          • Bombshellrisa

            Was that TriBeCa pediatrics?

          • Megan

            Yes.

          • TheArtistFormerlyKnownAsYoya

            But don’t you know, ease of life for babies is inversely correlated with ease of life for mothers!

          • Bombshellrisa

            It’s true! I think that kids do better when they know what to expect or at least anticipate. That includes when it’s time to rest,

        • KeeperOfTheBooks

          This. The first month or so I had DD, I made us both miserable via a total lack of schedule. Which is, to a point, to be expected with a newborn, but not to the point I took it. Once I got her on a loose eat-play-sleep schedule, we were both MUCH happier.

        • Karen in SC

          You should write a book!

      • not-a-princess

        It happens with childbirth too. The crown princess of Sweden gave birth a few weeks ago and the first question from the media was whether she’d had pain relief. Same thing when the crown princess of Denmark gave birth, there was tremendous media pressure for her to suffer through it without pain medication.

        • KeeperOfTheBooks

          When the Duchess of Cambridge was in her last week or two of pregnancy, I remember that I theorized that she’d have given quite nearly anything to be able to tell the next non-medical person who asked about the state of her cervix to sod off.

    • Amy M

      That’s pretty much how it went for me. I have twins and I figured that was challenging enough wo/making myself crazy over breastfeeding. Like CSN0116, we had something of a schedule too—initially it was because my little preemies wouldn’t wake on their own to eat, so we had to, but they stuck to it. We were lucky—the babies were healthy, slept fairly well, and weren’t colicky. I still ended up with PPD triggered by sleep dep, but I’m wicked sensitive to sleep dep. My husband and I did everything we could to minimize the sleep dep for both of us—no martyrs in our house.

    • Megan

      My first time was the ridiculous “try everything and kill yourself” routine. This time as soon as it became apparent it wasn’t working, EFF it was. Know better, do better.

  • attitude devant

    I fell afoul of this 26 years ago and I’m STILL pissed about it. I had read in my own maternal-child health textbooks that mothers ALWAYS make enough milk and my daughter had plenty wet diapers so I didn’t know that she was not getting enough calories….until my ped gently told me she needed formula because she wasn’t gaining. At all. We added formula and that was all it took. How DARE they lie to all of us and put our children at risk?

    • Jules B

      Exactly. I am over the stress and heartache I had to go through – but I doubt I will ever get over the fact that their ideology and refusal to give me all the necessary information actually could have harmed my child. It’s disgusting.

      • attitude devant

        It’s just like the NCB philosophy: Women were made to birth segues into women were made to breastfeed their young. And no thought given at all to the VAST numbers of women who simply didn’t have babies just fall out and have their newborns do the breast crawl and latch immediately.

        I remember being amazed that I had a FTT child, something I was told was rare if loving parents were present, and yet there we all were….

  • The Bofa on the Sofa

    For today’s blog post I considered just cutting & pasting my 21,397 word Masters thesis

    Quick question: is a 21K word Masters thesis supposed to impress me? At 300 words per page, that’s all of 70 pages. I just looked at a few of the Masters theses on my shelf. All more than 100 pages. Given that there are figures, I would say probably 25K words.

    Wow, her thesis was 21 thousand words! Does she think I am impressed?

    I knew a guy who wrote a Masters thesis on the acting of Laurance Olivier. It was about that length. So what?

    • CSN0116

      The 21K popped out at me right away too!

    • Heidi

      21,000 words of pure word vomit, too, I’m sure.

    • Megan

      It’s like when CPM’s talk about how they saw 75 WHOLE BIRTHS during their training.

      • Karen in SC

        and that OBs *never* see a natural birth at all, so they WIN.

    • CharlotteB

      I think length varies widely by discipline and university. My department requires a thesis that is atrticle-length, which in our field is somewhere around a minimum of 50 pages. (Humanities field).

      Generally though, my feeling is that if word count is the most notable thing about your thesis, then you’re doing it wrong.

      I had a friend go on and on about how his thesis was longer than mine. I looked it up in our library…it was ONE PAGE longer. Anyway.

      • Mariana

        Yes! This!
        I have a cousin who went to Princeton for his PhD in Economics. At the end he was very excited to be done with his thesis and posted a picture of him holding a single sheet of paper covered in Math work with the caption: “finished thesis, now all I need is the wordy part!”. His thesis was very concise, but they gave him a degree… So I guess everything he needed was there?

    • BeatriceC

      I wrote a paper on the representation of queen Elizabeth I in literature for an undergrad class that was longer than that (about 80 pages), during undergrad. I’m not impressed.

      • Bombshellrisa

        OT but are you still taking suggestions for books? “Girl waits with gun” by Amy Stewart. It’s about the first women sheriffs in the US. I just started it. Also “The Lake House” by Kate Morton

        • Erin

          Second “The Lake House”, husband bought it me for Christmas. On Boxing Day, I hid with a large Gin and Tonic leaving MiL and SiL to babysit whilst I read it. Loved every minute.

          • KeeperOfTheBooks

            Still further off topic, but the idea of mom hiding with a grand book and a large drink while baby is cared for by doting relatives makes me smile!

          • Bombshellrisa

            I couldn’t put that book down! A friend of mine insisted I read “The Lake House” and I am glad I listened.

    • guest

      Even in her own terms, I’m not impressed since I’m currently adding a new chapter to a 70,000-word academic book.

  • Heidi

    I’m so glad I live in a town where the BF woo seems pretty minimal and my pediatrician is fine with what I feed my baby so long as it’s appropriate. He knows my baby only gets 1/4 to 1/3 of his food a day from breast milk and has NEVER said anything negatively about it. I feel bad enough being bombarded with ignorant opinions and suggestions on the internet! I think I was pretty smart about it and did the best for my baby. I tried nursing in the beginning, baby would nurse for over an hour, I’d unlatch baby, offer him formula, and repeat the process. My milk supply never did pick up because it was never going to. It’s not normal to have to nurse a baby for over an hour and STILL drink a bottle afterwards! My body didn’t “know” I was offering formula afterwards. Baby would have lost weight, became dehydrated and other negatives, no doubt in my mind, had I not been sensible about formula and breastfeeding.

  • guest

    Yeah, like every time I hear about low blood product supplies in banks, my body decreases blood production…..

    • momofone

      I’m just sitting here trying not to think about having T1 diabetes. My currently-functioning pancreas might not survive it.

  • OttawaAlison

    It’s gaslighting pure and simple. She completely discounts the experience of many many women.

  • Gatita

    I keep hearing that the amount you pump isn’t an indication of how much you produce but is that actually true? I’m assuming there aren’t any studies but you could design one. Try doing weighed feeds with babies and then compare to how much the mothers produce while pumping. If they are about the same, then pumping small amounts of milk would be a big honking sign that the baby needs to be supplemented with formula.

    • CSN0116

      They are very comparable and LCs are full of shit when they state otherwise.

      I’ve mentioned before that “back in the day” I worked in a lactation boutique. I worked alongside a *good* IBCLC. She booked private consults all day long. One of my tasks was to check in her clients, fill out their paperwork, weigh their babies (who she always instructed must come hungry so that she could observe a feeding), and then weigh them again after their feed.

      One of the questions on the intake forms was always, “are you pumping, with a double electric, and how much do you produce when you pump?”

      Well, son of a bitch if those weighted feeds and my intake forms didn’t match up 9 times out of 10. And the 1 out of 10 often showed MORE milk coming via pump, not less. I did this 1,000 times over, at least. There’s your study 😛 lol

      • Mattie

        This is really interesting, is it all to do with the ‘type’ of pump, I’d imagine that hospital-grade is significantly better than a ‘regular electric’ and miles better than a manual pump

        • CSN0116

          It has much to do with that, yes. Your Medela Pump n Style (hospital grade consumer pump that I would sell the most of) seems to be as efficient, if not more efficient, than a human baby at emptying breasts. The thing is bad ass, and of my “1,000” number that I throw out up there, 900+ used it. The second one I sold was the Ameda Purely Yours. It was not as popular on the East Coast at the time, but was also very effective. Medela was the first to have the staggered sucking option (fast at first, then slow and elongated to mimic baby) and that really makes a difference …speaking as a former pump saleswoman 😉

          • guest

            My good IBCLC told me about the staggered thing. I was using a used Medela (the Swing, I think) that was not considered idea, but it worked for me. The weird thing was, I figured out that the staggered approach worked best while in the hospital, just observing how the hospital pump worked – I’d gotten very little guidance on how to use it. BUT, it’s a lot easier to figure that out through trial and observation when you’re a natural overproducer. I could very quickly see the results of various things I tried.

          • CSN0116

            The gold standard that we would rent out to moms of multiples, or women struggling to produce with a pump, was the Medela Symphony. Back then it was strictly hospital grade and could be purchased from a medical supplier, but for thousands. Now they appear to be available to consumers as well? My guess is you probably had the Symphony in the hospital. On all of Medela’s pumps, however, you can override the staggered suck and just set a steady pace. Some women preferred that.

            Then, not to go on and on here, a lot of women who couldn’t seem to produce from the pump ended up just needed larger sized cups. The ones that come with the pump are standard. We sold cups that went up 2 more sizes. Getting a bigger cup fixed things far majority of the time. I would take a flexible ruler to women’s nipples and areolas to size them. God it’s sad how much I know about this shit 🙁 As said before, my time in the boutique is the total reason why I never BF.

          • Dr Kitty

            With my daughter I had a fairly rubbish manual pump and a very rubbish electric single pump and got 2-4oz per 30minute pumping session.
            This time around I had an Ameda Lactaline double pump with properly sized cups and silicon shields inside the cups, and I always just cranked the damn thing up fully.
            I could get 10oz in 10minutes right up until baby was six months old.
            Then he started crawling, his caloric needs went through the roof and although I was feeding him every 2hrs during the night, I was only getting 6oz per pumping session, and having to do that twice a day.

            My supply never tanked, I absolutely could have killed myself feeding him 8-12 times in 24 hrs and pumping twice a day, while losing weight and suffering from sleep deprivation, but cutting out the pumping and giving him 12-16oz of formula a day while breastfeeding him when it is convenient (3-6 times a day) has worked better.

            By all means get a good pump, but don’t martyr yourself using it.

          • guest

            I did get a set of larger cups in the hospital, because the first set was uncomfortable.

          • Jules B

            I was able to rent that hospital grade Medela with the staggered option once I switched to exclusive pumping and it made ALL the difference to my output (before that I just had a small electric Medela…the round one). I also got the correct sized flange, which made an output difference as well (and was way more comfortable, which helped me relax). I still had to supplement with formula but yeah, that Medela pump was awesome in getting every ounce of milk out of me possible!

        • CharlotteB

          See though–I pumped more milk in less time with a single, manual hand pump. I had a pump-n-syle, used at Symphony at school, and got about the same from both, with 20 mins of pumping. But with the manual pump, I got about the same amount in 1/2-3/4 of the time.

          • CSN0116

            Fascinating!

          • CharlotteB

            My hunch is that I used more pressure with the hand pump, (not going to lie, I never got over being afraid of the electric one–worried my nipples would just sort of get sucked in) plus, since the tempo/speed varied a lot, it was more like how my son actually ate.

            However, all the pumping I did turned out to be a gigantic waste of time as the thawed milk smelled like soap, and I threw out the measly 100 oz I managed to freeze. I did record what I pumped, and if I got more than 2 oz from one one boob in 20 mins, THAT was a big day. I averaged between 2-3 oz, from both breasts, in 20 mins of pumping.

            Seems like studying pump vs. baby extraction/output would be pretty straightforward. You could provide moms with a baby scale and pump, have them do before and after weights, and then one pump session/day and record duration and output. I’m guessing it wouldn’t be super popular with lactivists, though.

          • Glia

            I had the same experience! Actually, after much trial and error, I ended up with a sort of elaborate ritual of using the electric on one side while using the manual (which I found more uncomfortable but also more efficient) on the other.

          • CharlotteB

            I’ve become a little bit of an advocate for the manual pump. (Only when asked, though, obviously.) It was really helpful for travel because it was light, I could store the parts in a cosmetic bag, all the bits and pieces worked with my pump-n-style since I had a Medela hand pump. I got it when I was flying to a conference with my baby–I did combo feed so it wasn’t really about food for him, but I didn’t feel comfortable nursing in public and figured I could easily use the hand pump under a cover if I needed to for comfort. Medela also makes wipes to clean the pump parts, so you don’t have to try to wash the thing in an airplane bathroom. Big, big fan.

      • As a rough measure, one can simply weigh the baby immediately before and after feeding, without changing clothes or diaper. The difference in weight is how much the baby drank. It does work, although it’s not exact.

    • Inmara

      I think the one plausible scenario where pumping doesn’t produce as much as BF is if letdown reflex doesn’t kick in without a real baby at breast. Also, not all women have access to hospital grade pumps; where I live they are used very rarely because there is no need to pump for feeding baby while mom is working; manual or regular electric pumps are used just for increasing supply and making some milk bank for occasional feedings.

      • Gatita

        Sure, but let’s say we do weighed feeds and have mom pump with a hospital grade pump as part of the pediatrician’s exam of the baby in the first couple of weeks. Then we’d be able to track babies who are at risk for FTT before they lose too much weight. But what’s happening instead is LCs are ignoring the pumped amount or insisting it never correlates with an inability to produce enough milk.

      • Megan

        I’ve personally noted absolutely no difference between my Hygeia pump and the hospital Medela Symphony pump. I think a high quality personal double electric is usually just as good.

    • Adelaide

      Just a bit of personal experience, but I have always had enough for my babies, but I have never been able to pump more than an ounce per side even with a hospital grade pump. Obviously my babies were getting more milk than that though. For some ladies pumps work, for others they don’t. I knew one lady who hated pumps and thought they were useless, but had no problem hand expressing enough milk for her baby (locked in her classroom supply closet no less).
      In my limited experience 90% of what you hear about breastfeeding is just somebody’s personal experience that they assume applies to everybody.

    • AnnaPDE

      I guess if your pump is incompatible with your breasts… My Medela Swing never got a good letdown going. The Spectra I use now pumps about as fast as LO drinks when he’s really hungry, except it doesn’t fill up/fall asleep/get distracted, so I can keep going until the breast is really empty.
      I call it Insatiable Korean Robo-kid. 🙂

  • Tori

    I thought ‘low supply’ existed, but my definition of low supply was something that could be made ‘normal’ with domperidone and pumping. Tried all that and then some – still couldn’t produce more than maybe 30% of my 6 week olds needs with the rest formula. Realising I couldn’t breastfeed exclusively was heartbreaking because I’d not considered any other option of feeding despite 2 people warning me beforehand that breastfeeding isn’t always possible. It took me until baby was 3 months old to acknowledge that fact. By the sounds of it according to Rachel it’s my friend’s and ob’s fault I had low supply because they mentioned it to me antenatally.. Well that sounds like magical thinking!

  • Gatita

    OT: “I saw the baby bison that tourists tried to rescue. Here’s what you don’t know about the story.”

    https://www.washingtonpost.com/news/animalia/wp/2016/06/07/i-saw-the-baby-bison-that-tourists-tried-to-rescue-heres-what-you-dont-know-about-the-story/?wpmm=1&wpisrc=nl_most-draw6

    Nature: It’s so natural:

    Every year in Lamar Valley, we see bison calves by themselves, destined to perish. Their mothers might have died in childbirth, abandoned them or become separated during a river crossing. We watch as the calf runs from cow to cow, looking for its mother. We watch the other cows react with violence, particularly if the calf attempts to nurse. A wild bison cow will not adopt another’s calf. I have seen calves take up with bulls, which sometimes tolerate them. But eventually the calves are too weak to keep up during the daily roaming and are most likely captured by a coyote, wolf or bear.

    • Kelly

      I read that yesterday and now that story makes so much more sense. I thought they took the baby bison away from the mom but it turns out that nature sucks.

  • Mattie

    Out of interest, when people talk of ‘delayed lactation’ how is that defined/how late is it to be classed as delayed?

    • Inmara

      The study to which ABM article refers used 72 hours http://www.ncbi.nlm.nih.gov/pubmed/20573792

      • Mattie

        cool thanks, I’m interested cause the NHS website says that it’s usual for milk to come in between 2 and 4 days and colostrum is sufficient until then

        • Inmara

          Apparently they didn’t ask babies if it’s really sufficient, mine would have told them something…

          • Mattie

            No haha it’s just concerning cause this is the website lay people go to for information so it needs to be right, it does correlate with what midwives say to new mothers (and what they are taught in midwifery education) at least when I was there

  • Sara N.

    Yes, Rachel, I do remember what I heard about breastfeeding before I ever tried it. I heard that all women make enough milk. I heard that supplementing with formula would only damage supply. So thank god for my nurse, Sue, who on day 3 of hour hospital stay after delivering my son, walked in holding a bottle of formula and said he had lost too much weight and the pediatrician had ordered formula supplementation. She didn’t ask, she didn’t just tell me and hand me the bottle of formula and walk out. No. She picked up my son and stuck the bottle in his mouth and fed him without giving me time to react. THANK GOD. Because if I’d had just thirty more seconds to react, I would have refused, and my son would have slowly starved to death. As it turns out, I was only producing mere DROPS at that point. With prescription medication, pumping round the clock on a hospital grade pump, daily LC visits, waking my son up every two hours to nurse… I got up to a max of 4 ounces PER DAY.

    All the while, the LCs, chiropractors, and the entire internet told me “when you get up to a full supply” and I totally believed them. I thought they were the experts. I had no doubt I would get a full supply. Well guess what? If that unrelenting belief that I could magically make my body do something wasn’t enough to make it do something, then I highly doubt there is some sort of magical belief that would prevent it from doing something.

    Do you know what my complete certainty and confidence in my boobs got me when after six months of this it was painfully obvious that I would never make more than 4oz of milk a day? Complete fucking insanity and suicidal PPD.

    “Would we change how we talk about breastfeeding and nursing if we knew that our words may cause problems for the person who is listening to us?

    What would happen if we made an effort to discuss the positive parts of our breastfeeding experience AT LEAST as much as we warn about the negative parts?

    Could a change of attitude change the breastfeeding rates in our country?”

    WHERE HAVE YOU BEEN, RACHEL? This has been in practice for at least a decade. It’s all but against the law to let women in on the secret that not everyone can breastfeed. I wish someone had let me in on it before I basically missed the first 6 months of my son’s life in a blur of sleep deprivation and depression.

    • Megan

      I was going to type basically the same comment. Before I had my first I was only told that I would definitely be able to breastfeed. Not making enough milk wasn’t even considered. I find it downright laughable the Rachel doesn’t think this is what most women are told.
      On my best day (yes day, singular; it was a one-off), I only ever produced 12 ounces. Usually it was 8-9 ounces. That was with domperidone and pumping every 2 hours with a high quality pump, taking goat’s rue and even doing quite a bit of power pumping (which is code for “torture technique the CIA hasn’t discovered yet”).

  • CSN0116

    You know, she’s on to something but totally misses the point. Can one psychologically will themselves into or out of tasks, of course. Physiologically …no. Ya get what ya get and might be able to introduce physical things (like medication) into the body to modify responses, but using the mind …again, no.

    However…

    She would be better looking at what about “the psychology” of breast feeding causes women to fail. Because that *is* very real. But that would mean talking about what an ugly and torturous process it can sometimes be, and that’s bad for business. Unless it comes easy-peasy, a woman must will herself into foregoing copious amounts of time, productivity, and sleep, while (often) enduring pain, engorgement, bleeding, blisters, infection, etc. All of this can very well result in things like anxiety and depression, which can become so overwhelming that the woman stops practicing a healthy life style which negatively affects her milk supply, or she gives up the activity altogether.

    There’s a definite breastfeeding “psychology,” but I refer to it as a “mind fuck.”

    • Roadstergal

      I think that dovetails very nicely with what some commenters here have noted about the negative breastfeeding effects of ‘just one drop ruins your baby forever.’ If formula is seen as just a food, just a breastmilk equivalent, then if you need to supplement a little as part of achieving or maintaining breastfeeding, no big deal. If it’s seen as The Evil Thing That Ruins Your Baby – well, once you give that Just One Drop, why bother breastfeeding?

      • CSN0116

        Ahhh yes, lactivism shoots itself in the foot again. That’s what happens when emotion trumps logic.

      • KeeperOfTheBooks

        YESYESYES. This is a periodic rant of mine. In the search for the “perfect” (I use quotation marks because formula or breastmilk, it doesn’t matter in full-term babies), lactivism discourages moms from pursuing breastfeeding who otherwise might. I recently posted about a friend who had a bad experience at her hospital–wanted to breastfeed, was too out of it post-CS to do so immediately, wasn’t “allowed” to send baby to the nursery even though she couldn’t stay conscious, and then was told she couldn’t pump or use a nipple shield, despite raw, bleeding nipples, because then baby would just have to be weaned off of it.
        Result? Mom, quite reasonably, said “screw it” and went to straight formula, when if the idiot nurses and LCs had just let her pump/use a shield for a day or two, she might still be nursing. Again, it doesn’t matter in the long run–but if their goal is to increase BFing rates, being a bit less dogmatic about it would be a damn good way to start.

        • Glia

          Totally agree! The LC at my hospital (who was very good) gave me a nipple shield the first day to help me get n00b to latch. It worked, and he started nursing great. I never did get him weaned off of it, and for awhile I felt bad about that, but then I realized, it was working, so what’s the problem? If we hadn’t had it, we might not have managed at all, but as it was, we went until almost 15 months! If BF is so amazing, then surely things that allow some is better than emphasizing that anything other than exclusive is basically a waste, right?

          • KeeperOfTheBooks

            Exactly! As another friend pointed out in the middle of all this–“Okay, so let’s say baby never does wean off the nipple shield. Who the hell cares, as long as it works for mom and baby?” She also always used a nipple shield with one of her babies, and it meant that they exceeded her breastfeeding goals vs giving up after a few days.

  • KBCme

    I have heard that condescending, “You know, only 5% of women don’t make enough.” I’d really love to see a modern study on that. I was one of the 5%, I guess. I’d pump for 3-4 hours a day and get maaaybe 8 oz. My baby was taking about 24 oz a day at that time. So yeah, that’s not going to cut it.

    • CSN0116

      But the pump is not a clear indicator of your supply and what your baby gets from you. It’s evil, yo. /s

      • Can’t fool me twice

        Sing it! I have a child who was an ineffective nurser. My first LC was crunchy AF, so you can imagine what a disaster it was to work with her.

        I FINALLY moved up the chain to the local IBCLC celebrity. She’s the one who was all “your baby is an ineffective nurser, and right now you’re not producing enough when pumping. Formula is your friend, and take some time out for you, because you’re losing it.” (paraphrase)

        When I told the crunchy LC that I just wasn’t pumping enough and had started formula, she started in on the “the pump isn’t a good indicator” shizz, and I was like “the pump IS my indicator, because my baby isn’t getting anything out of me.”

        She gave up on me as a lost-cause after that. Didn’t bother telling her when 1) my supply came in, and 2) my baby ultimately figured out how to nurse. Because I didn’t want her claiming that “victory” as her own.

    • Jennifer

      And even when they’re saying 5%, they make it sound like zero. According to NIH, there were 3,999,386 babies born in the U.S. in 2010. So that’s about about 200,000 women for the mammo-fascists to torture each and every year.

    • KeeperOfTheBooks

      Heh. I’d pump for about 3 hours a day, and get perhaps an ounce…total…from both breasts combined.
      But yeah, it was just me not being positive enough!

  • lawyer jane

    The cruelest is when you can jussst eke out enough milk so your child is not officially Failure to Thrive, but to do so you have to keep on nursing 3x/night and pumping 6x/day when you have gone back to work … and you wonder at night why your baby’s ribs are showing … ask me how I know!

    • CSN0116

      🙁

    • anotheramy

      Yes, yes, yes. It’s awful! And trying to exclusively breastfeed made me feel *so* drained, in a way I can’t even describe, like my vigor was being slowly from my body. It was more than just typical parental sleep deprivation. I didn’t realize breastfeeding/ trying to make enough milk was the cause until I weaned and then when baby #3 came along.

    • Glia

      I managed to keep my (big) baby on his growth curve, but I always had juuuuuust barely enough milk for him. Just enough not to “give up” or “give in” and supplement. Just enough to worry every single day if he was hungry. Just enough enough to see him through while I worked, but came home to a hungry baby who ate and ate and ate in the evenings and woke up multiple times each night. I was in such a haze of nurse-work-pump-work-pump-nurse, and barely sleeping, that it never even OCCURRED to me until after he was getting solids and not needing as much milk, that maybe he was sleeping badly because he wasn’t getting enough during the day. I still feel guilty that I basically kept my poor baby on the edge of hunger for months, and complained about how often he woke me up during that time.

      • Jules B

        I have talked to a lot of women who EBF, but whose babies just seemed to be hungry all the time (including all night). I suspect that a lot of them were/are getting “just enough.” But of course, according to lactivist propaganda, babies are supposed to act like that, it’s normal etc etc.

  • Amy M

    Well, we should stop talking about cancer, autism and asthma too. After all, if believing that its physiologically possible to have low milk supply causes low milk supply, then no wonder rates of cancer, autism and asthma have increased over the past few decades!! Those ailments/disorders are constantly in the media, and so many people are afraid of them!

    Wait a second…I have asthma. I was diagnosed before the age of 5, and certainly I’d never even heard of asthma before that. I wasn’t reading medical journals or watching the news either. I doubt my parents feared asthma because it hadn’t been on their radar until I (and then my younger sister) ended up with it. How did we get asthma if none of us feared it, or talked about it?!!

    Seriously? Way to science, O’Brien…and work on your compassion skills too.

  • BeatriceC

    Ugh. The “it’s all over in your head” line. That’s on my top ten list of things that piss me off the most.

    • Inmara

      And there are SO MANY PEOPLE who are dead set in this mindset. “I didn’t want to learn about possible pregnancy complications because negative thoughts will attract negative things!” (almost verbatim from a conversation in my postpartum room)

  • Squillo

    Short version: It’s all in your pretty little head. Like labor pain, menstrual pain, dyspareunia, and every other malady that strikes women.

  • Cartman36

    i guess I should stop mentioning my hypothyroidism that started after my first pregnancy to expectant mothers, nay any woman of child bearing age, because I would hate for their thyroid to stop working because of what they heard from me.

    • fiftyfifty1

      Well, hypothyroid does run in families. Probably some silly older female relative complained to you about hers and that’s how you caught yours.

  • MI Dawn

    Anecdotes: I heard all my life that my mother gave up breastfeeding me because she had “too much” milk and she couldn’t tolerate the constant engorgement and sat in the bathtub crying. I guess that should have pre-disposed me to having too much milk. Instead, I had what I considered a normal milk supply.

    My best friend was bottlefed because she heard all her life that her mother couldn’t make enough milk for her. She successfully breastfed 3 children for 2+ years each.

    2 other friends were breastfed and heard it was normal, natural, and everyone makes enough milk. 1 breastfed with no issues after supplementing until her milk came in (per her mom’s suggestion). The other had a severe low milk supply (baby lost over 10% of weight in a week), fought supplementing and ended up bottlefeeding when she was threatened with hospitalization for the baby due to dehydration and failure to thrive risk.

    Psychology risk – Rachel, you don’t understand psychology.