One of the most pernicious of the many pernicious aspects of breastfeeding promotion is the insistence by lactation consultants that all women can make enough breastmilk to fully nourish an infant.
Not only is it factually false, but it has given impetus to two additional erroneous beliefs:
1. Insistence that low supply is a misperception on the part of the mother
2. Belief that documented low breastmilk supply, and the relentless infant hunger that results, is the mother’s fault.
The assumption (sometimes stated, often implied) is that women who have low supply aren’t trying hard enough, aren’t breastfeeding often enough and long enough, aren’t pumping enough, shouldn’t have had an epidural or C-section, never should have let the baby have a pacifier, etc.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Low breastmilk supply is as real as diabetes. [/pullquote]
These are incredibly harmful beliefs. First, they hurt new mothers who are desperately trying to breastfeed without success. The only thing more devastating than hearing your baby scream incessantly from hunger is being told that it is only your imagination or worse, the result of your selfishness. It’s the equivalent to insisting that those with type I diabetes lack insulin because they are too lazy to produce it.
Fortunately, within the past year or so, increasing attention has been paid to the harmful impact of such claims on maternal mental health. Women have been sharing their stories of guilt, shame and depression and pushing back against the overwhelming pressure to breastfeed exclusively.
The second harmful aspect of such beliefs often goes overlooked. By insisting that low breastmilk supply is imaginary or simply a matter of maternal effort, lactivists have systematically failed to investigate biological causes of low supply. That’s the equivalent to refusing to look for a cause of type I diabetes and blaming diabetics instead.
The truth is that low breastmilk supply (like diabetes) is real, is no one’s “fault” and has a biomarker to prove it.
Earlier this year I wrote about the discovery of a biomarker for low breastmilk supply: high sodium concentration within breastmilk.
High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate. This association has subsequently been confirmed.Several possibilities have been suggested as to the cause of increased sodium levels in breast milk… It has been shown that sodium values are not affected by the mother’s diet or by the method of milk expression …
Subsequent research demonstrated that women who expressed concerns about breastmilk supply were more likely to have the biomarker than women who did not.
If concerns about milk supply among exclusively breastfeeding women were primarily owing to a lack of knowledge about the signs of abundant milk production, then the expected outcome would be no difference in breast milk Na:K as compared with exclusively breastfeeding women without milk supply concerns… Instead, the observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception.
These findings also challenge the belief that all women make enough breastmilk to fully nourish an infant and it is their fault if they don’t.
Now comes evidence of a genetic basis for low milk supply. Milk cell gene expression of mothers with low breast milk production is a basic science paper with important clinical implications. It was funded by a grant from Medela AG, a maker of breast pumps.
Initial analysis found cells isolated from women with low milk production showed significantly lower expression of the genes estrogen related receptor beta (ESRRB, p=0.027) and neurotrophin receptors sortilin (SORT, p=0.010) and tyrosine receptor kinase 2 splice variant 1 (TRKB1, p=0.007) and higher expression of a progenitor marker (REX1, p=0.025) compared with cells isolated from women with normal production.
The authors concluded:
Preliminary findings suggest variations in cell signalling and function, examined through gene expression that might contribute to low milk production. Further investigations will potentially determine significant roles of key genes enabling successful human lactation.
This shouldn’t be surprising. Genes control everything from height to eye color to susceptibility to disease. Why wouldn’t they also control breastmilk supply?
By investigating the biological basis for low milk supply we can find the cause and, hopefully, a cure. Alternatively, we may find that as with type I diabetes, no cure is currently possible, and supplementing (with insulin in diabetes, with formula in low breastmilk supply) is the only course of action. In either case, it should relieve the stigma on new mothers with low supply.
Low breastmilk supply is as real as diabetes and it poses a substantial health threat to infants. It’s not a mistaken maternal perception; it’s not mothers’ fault; and it can’t be fixed with greater maternal effort.
It’s almost certainly genetic.
Thank you. I had insufficient supply with my first, and am expecting my second. I’m also expecting insufficient milk supply and have a list of postnatal preferences for feeding in hospital and formula ready. And while I know going directly to exclusive formula is a perfectly valid and good choice, I enjoyed the breastfeeding itself so we’ll do some of that if baby is willing too. But it’s so nice to be acknowledged that it’s 1/not my fault and 2/ not being told “you get more glandular tissue each pregnancy so it will be different this time!”. Yes, it will be different this time, but that’s because I’ll be ok with the formula.. and thank you for that too.
A good friend of mine just had her second baby this week. She also has IGT, and had a horrific time with her first baby because she believed all of the dire warnings about how horrible formula is. She knows better now, and from the very first feed she’s supplemented with formula. Her experience has been night and day different. She’s happy, the baby’s happy, and her recovery is going splendidly.
That’s so good to hear! Formula is such a great invention.
For me, the biggest factors were age and income. I was of advance maternal age when #2 was born. Yes, thanks age 35. Plus my husbands age. (he’s a few years older than me) So thinking ahead to how old I would be when ready to even think about getting pregnant with #3 and starting over with a newborn would put me well past age 35. I’m currently a SAHM, but would like to go back to work when my kids are in school, so it would be that much longer before we’d have the extra income. Yes, I get baby fever when I see a new baby! But, I’m happy with my decision and so is my husband.
Sounds a lot like me. My last was at 34. My husband is also a few years older. I’m a SAHM and would at some point like to return to work. Our income right now is very doable with only one income, but I miss work and if I was working I would have so much more to give and use to help others. My DH does not want anymore because he says he’s too old. He wants to enjoy retirement while not also supporting a child in college. 🙂
I absolutely believe it is, after all, almost everything else health related has some kind of genetic component to it. Don’t see why breastfeeding wouldn’t.
I couldn’t bf, but doing some reading from other ladies on my babycentre forum’s experiences, I think I may have had an oversupply; I certainly had a lot of the symptoms that other women with it discussed. Agonizing pain with letdown (and at any other time), spewing every which way any time I changed, waking up properly soaked, and took for-fucking-ever to dry it up. I don’t recall my mother ever making a bottle of formula for my younger sister, but I do remember seeing her hand express (I was quite little, so could be wrong on this, admittedly). My grandma? MASSIVE oversupply. A few months after after my aunt was born, my grandma’s SIL died from childbirth complications. Being an ultra-conservative community in the 50’s, the baby and her older brother came to live with my grandma (because apparently they couldn’t stay with dad without a mother figure. They didn’t go back to him until he remarried). And grandma nursed both babies. Easily. So yes, I absolutely believe there is a genetic component.
DOWN WITH TRIPLE FEEDING FOREVER!!!! Seriously, that recommendation implies more than anything else that you can build your supply if you just try harder. Granted, I have IGT, which is a different issue, but none of my LCs told me this. They just let me beat myself up and pay them for the privilege, all while sticking to an inhumane schedule that did nothing but drive our whole family bonkers. How do we speed up this research? If I could have another baby, I would volunteer us as subjects in a heartbeat.
Very OT question, since I don’t have a real life mom’s group. Did you all ‘know’ when you were done having kids? I’m so torn on whether we should have a third. Rationally, two is obviously easier and cheaper. We can divide and conquer at bedtime, etc. But every time a friend announces a pregnancy I get a twinge of jealousy, and I have a hard time feeling like I’m done. One of the NPs I work with straight up told me to stop at 2, for sanity reasons. It seems like 3 kids is the most stressful for many families I know (including my own parents). Thoughts?
I knew I was done after three, and I have drowned. One more anecdata.
I didn’t feel like I was done after two. Neither did my husband.
I can’t give you good advice. I wish I could.
My husband and I always assumed we would have 3. Soon after the birth of our second, he suggested we stop now and I accused him of murdering our future-born child (hey, I was postpartum). After some time, though, I gradually came to realize that I was very much enjoying the hints of freedom we would fully get once our kids are a little older. The thought of dialing that back to zero with having a third was too much. And then my younger kid turned 2, and nope I do not want to do that a third time, no thank you. So my advice is to think ahead to the things you’re looking forward to doing, and can’t realistically do/feel until your kids are in elementary school or so. Does it sound like something you can put off long enough to have another kid? Does having to wait longer feel unbearable? (If you land somewhere in between, my advice is just crap and I’m sorry for wasting your time. :)) So the short answer is that I didn’t just “know” when we were done. I needed to work through my emotions and information logically.
That was actually really helpful, thanks. I do think about my future freedom a lot. My oldest started preschool and it’s given me a glimpse of the free time I might have someday. He’s almost four, and I love his independence. Going places with him is so easy. I think logically it makes sense for us to stop, I just have this biological urge to have more.
I think your gut feelings about the matter count quite a lot for figuring it out, so I hope you’re not dismissing that biological urge as something to be ignored. Maybe it should be, maybe it shouldn’t; it’s a feeling to be examined IMO. If holding a baby and getting to hand it back to someone else isn’t an exciting prospect, then that should definitely be given weight to figuring out what’s best for your family.
The biological urge never stops. I’ve had 52 year old haredi grandmothers, with 8 or 9 children of their own (and several dozen grandchildren) want to begin fertility treatment for “just one more”. I had one tell me that her “arms felt empty without a baby in them”. Personally, I felt she needed counseling.
Hah … so wierd. It’s not very different from people that breed dogs just because they like puppies so much. Because they’re cute & all.
Years ago, we were having this conversation, driving to the park early on a lovely Sunday morning to take our then toddler aged children for a walk with their sporty/outdoorsy aunt.
In the car on the way, we’d pretty much decided to try for number 3.
At the park, we ran into aunt’s friend, with her 18 month old and new baby. No one had slept, older one had green nose, mother looked like hell.
Plans shelved, where they remain to this day. We reckoned it was a message from the universe.
My 19 month old just spread the contents of his diaper all over the floor because he was kicking and flailing while I was trying to change him. That might be a sign.
Part of me still wants a 3rd, but between the logical financial reasons (several relatives thought we shouldn’t have tried for a 2nd because money is tight), the physical and psychological strain on both of us, and the fact that my desire for a 3rd is no where near as strong as for a 1st and 2nd. That said, if we had a miracle, we’d keep him/her, but I don’t think we shall deliberately seek out another frozen embryo transfer. (I have 6 more in deep freeze).
If you and your partner want 3 and your health isn’t a problem, I don’t see why not. Even your parents’ experience isn’t going to be yours. Mom and Dad’s relationship lasted 13 years, my partner and I have been together 20 and going strong. (very useful when you’re both dealing with depression; runs in our families.) I’ve friends with 4 and they love it. One set’s kids are in their 30s, the other set’s are 3-10.
I think some people just “know,” but for me, I don’t. I guess part of it is that I always pictured myself with 2, but after infertility, multiple miscarriages, and now being 35, it’s starting to look like we’re one and done. I have been having a hard time about it, so I think some of us just kind of need time to process.
This only child (me) has had a perfectly wonderful life, so don’t get your knickers in a twist about it. It’s quality, not quantity, that matters. And who knows? You could wind up being a grandmother to half a dozen! That’s where the real fun is.
Been there. Infertility makes you appreciate the kid you have, but the process is soul-sucking. My husband and I set a deadline to make the final decision ( it was a Disney trip). We were leaning towards one-and-done for various reasons, and after that trip we made it final. Do I sometimes covet other people’s babies? Well, yeah! If we were normally fertile would we have probably had more kids? Most likely. It took awhile, but I am comfortable with our decision most of the time. Our daughter is everything I was dreaming of in a child (and so much more – she is such an individual!) My only residual regrets occur when the topic of parents losing children to death comes up. I have to shove that scenario out of my mind.
The topic of parents losing children to death is one I have to avoid, too. I’ve already got anxiety issues, so when that topic comes up, -I hate using this phrase – but it triggers me.
As time goes on, I do get more comfortable with the idea of her being an only. Since my most recent loss would have put me with a newborn in August, this month has been particularly difficult on me. I hope that in time, I will be at peace with the hand I’ve been dealt.
Weird I know, but I have four, and I find that less stressful than when I “only” had three (odd man out and all that). There are economies of scale that come into play with a larger family (though only you know if your financial situation would truly permit another).
I was definitely done after four. I was 35 when my last child was born and the heightened risks freaked me out a bit. Got my tubes tied while my husband was deployed (he knew ahead of time, lol) and have never regretted it. We had always thought we’d have at least two, maybe three. Number 3 came along, but neither of us pushed towards permanent sterilization. So when number four was discovered “unexpectedly” (I put it in quotes because we weren’t super careful) we had a decision to make. A few long talks (and a family dinner where we noticed the empty sixth chair at our table and shared a meaningful looking), and we knew our decision. I don’t regret it for a moment (and she’s solidly in the terrible twos right now, if that means anything).
I don’t know if you ever really “know” that you’re done. I knew I’m getting too oldest go this, and if I had wanted a very large family I should have started sooner. But I know I am content with what I have. I guess that has to be enough. Sorry I can’t be more helpful.
No regrets, even when he peed on the floor 4 times yesterday rather than the toilet. Grr
A very smart person I knew told me that the third child doesn’t triple the work that one has with only one child, it’s like 1 to the third power. Having three myself, very close together, I know that the third is, in many ways, a real game changer. From trying to figure out how two parents can go to three PTA meetings which are all on the same night, at the same time, to finding babysitters who can, and are willing to, cope with three small children, to a bigger car, daycare costs, and even, sometimes, a bigger apartment or home.
I don’t know the ages of your two, but getting “twinges” is perfectly normal. Heck, Just not having my 7 month old granddaughter for a week when my daughter et al went to Eilat for a week made me sad. However, I would advise thinking it all through really carefully before jumping to any conclusion. And of course, your husband’s involved as well!
Oddly (or perhaps not) this holds true with pet birds, too. I had two birds and no trouble taking care of them. I took on a third for a whole summer, bird-sitting for some people I knew who were spending the summer abroad. The third bird threw everything into chaos. He was a perfectly nice bird, it was just the increase in noise and mess seemed tenfold.
I knew, but I don’t think that means anything for anyone else. I set out to have one kid knowing I couldn’t afford more than one, and had twins. So I shut that factory right down, because if I thought I couldn’t afford two, no way could I afford three (and not just the $ element, but the time). Even so, I get wistful sometimes, wishing I could have another baby – but I think I really just want to babysit an infant for a few hours a week.
I didn’t feel done after 2. My husband was fine with stopping at 2, but he’d also have been fine with stopping at 0, or 1. I spent a couple of years stressing out over it and feeling very torn because it’s definitely easier to stop at 2. We already had the big-family upgrades–minivan, 4 bedroom house, stay-at-home parent–so financially slotting in a 3rd did not require big changes. Long story short, my baby is 5 weeks old now. My husband has said THREE IS IT since before we conceived him. I tease him with stuff like “Oh, he’s so adorable, don’t you just want to have another” but I feel pretty good about being done at this point.
Okay, so I won’t get to snuggle any more newborns, and that does make me a little sad, but I’ll also never have to be pregnant again and this last pregnancy, particularly, really did a number on me and on our family. And I look forward to all the cool things we can do more easily as the kids get older and there are no more babies coming up behind requiring more attention. I look forward to everybody being potty-trained, everybody being in school and my husband getting to start his career again and having some more personal satisfaction, going on family outings and trips where everyone is old enough to understand and enjoy themselves, playing board games, etc.
I read somewhere to consider how many babies you want to have and how many kids you want to raise and how many adult kids you want to have some day, and if these numbers aren’t all the same, kind of look at them all and decide where you’re going to go from there and at what stage you’re willing to put up with not having your ideal number. Babies are really cute but at the same time I think that I also legitimately like bigger kids better, so it’s pretty easy for me to say that 3 was my target number of kids to raise and I’m okay not having more babies.
As others have said, the increase in complication with a third child is astronomical. Indeed, it was having my third which made me realise why most people stop at two.
We had our older boys quite close together (17 months; should have been eighteen, but he was a month early) because we succeeded at the first attempt. We were still young, and planned to consider a third when the first two were at school. Our daughter arrived seventeen months later. Oops. Three under three was tough at times, but I consoled myself that at least they were growing up together. I occasionally wondered if I should have a fourth – but not seriously, and when my eldest was nine I started a business.
Then, when my eldest was eleven, and I was 34, I became pregnant again – with twins. Terrible timing, but we managed (somehow). I must say that it was fun (for a given value of fun) to have three children going through adolescence at the same time as having two going through the terrible twos. Anyway, the kids thrived, we survived, and it is enormous fun to have a large family now that they are all grown up and have kids of their own (I have seven grandchildren, aged from one to sixteen).
I was absolutely certain I was done after the twins, though; I realised that when a friend had a baby and I found myself looking forward to being a grandparent.
I had to have a total hysterectomy a couple of years after having them, when pre-cancerous tumours were found on both ovaries, and I wasn’t remotely disappointed. Just relieved at the removal of both any chance of dying from the family cancer, and the possibility of pregnancy.
As someone who’s never made enough milk, I just want to say thank you for this. Thank you, thank you. We are currently trying for our third and I’m considering not even trying breastfeeding at all this time though it did seem to keep the postpartum mood issues at bay for a while…
I don’t think this paper supports your post title.
This papers is looking at gene expression, which can be driven by things other than genetics.
A genetic paper would have sequencing or genotyping data, and associations between low breastmilk and certain alleles. I don’t see that here.
There’s also no cause and effect evidence here…no way to know if the low expression of those genes is causing the low production. This is more like the biomarker paper you wrote about before, with expression of certain genes as the biomarker.
There’s not a lot of paper here, I can’t tell what tissues they tested.
Yeah, there’s not a lot of ‘there’ there. It seems to be a poster and not a paper? At least, I don’t seem to be able to access the copy if it’s a paper…
12 vs 14 moms, no comments on how far postpartum they are. A fishing expedition of just gene expression, t-tests on 28 genes with no mention of the housekeeper. :p
“Monitoring 24 hour milk production profiles can help diagnose low milk production which may be improved with pumping regimes and support.”
[Citation needed]
I’m sure genetics are a factor, but it’s not going to be a simple Mendelian deal (or should that be Medelan?). You’d need to have a study with a lot of ns, well-balanced arms, and GWAS.
You know what you could have done with that money, Medela?
Taken 26 reasonably middle-class healthy new moms who were not currently making milk, and split them into 13 and 13. 13: pump and nurse ’round the clock, put baby to breast whenever s/he is hungry. Other 13: rest and rehydrate, feed baby with formula when s/he is hungry. See if there’s any difference on when milk comes in.
It wouldn’t be definitive, not in the least, but it would be the very least amount of start that the ‘may be improved’ statement deserves. And it wouldn’t even require a lab.
Honest companies actually test whether their shite works.
LCs should be doing this, not pump companies. LCs have more of an ethical obligation to stop pushing useless interventions.
So some anecdata: two families and the BF adventures.
My mom is a B cup. Breastfed two without issues (over a year each). I’m a B cup and breastfed three in my late 30s and early 40s for over a year each. My sister is an A cup on a good day. She breastfed twins for well over a year without supplementation. We are cows.
A friend of mine’s mom is well endowed. Her milk never came in for any of her kids. My friend looks like a legit Victoria’s Secret model (tall, thin, natural DD breasts). Milk never came in with her kids. Her sis has the same body type. No kids yet, but odds are her gorgeous boobs won’t make a drop.
Think Genetics MIGHT contribute to this? Nah…
We were taught that large breasts often have fewer milk-producing cells than small breasts — but have more fat cells.
The devil you say, Doc!
They sort of acknowledge oversupply (or where do they think donor milk comes from?) and the gods know that people like me weren’t trying too hard to make milk. Logically if some of us make too much, others of us will make too little. Granted, one shouldn’t trust mere common sense automatically in science, but it’s usually a good place to start.
My grandmother couldn’t breastfeed her first five children, but was able to breastfeed her sixth. My mom had oversupply for both my sister and I. I had crazy engorgement, but no milk coming out. With my first I tried pumping and taking domperidone. I never made even one ounce. With my second, I saw the writing on the wall and didn’t try so hard. So much on the internet seemed to say I just needed to relax and the milk would flow. Well, I’m pretty relaxed and I’m pretty sure my relaxation level wasn’t the problem. When I posted about this here before someone (Azuran?) told me they have drugs they can give dairy cows with delayed milk ejection reflex. I was pretty surprised at how little the medical world could do for me except shrug.
Wasn’t me, but I do also remember someone else saying this.
Mel, maybe? She’s our resident dairy farmer
We shoot cows up with oxytocin if they have problems with milk let-down reflex. I don’t know much about the process other than the cows who need the shots have a little paint dot to let the milkers know to give them the shot.
We have to give them a shot every time they are milked so 2-3 shots per day.
I’m not needle-phobic, but I would not want to have to give myself 8-12 shots a day to feed a newborn.
That comes as absolutely unsurprising.
It a widely known fact that milk production is mostly genetic in dairy cows. Dairy farmers have been keeping the calfs of their highest productive cows for generations. Holstein cows have massive milk production compared to other breeds of cows, and this was achieved with nothing but selective breeding.
I am always fascinated to go to the fair and see cows that are “beefy” all over and compare them to the cows that look to be skin and bones except for their enormous stomach and udder.
To which, the response is, “Duh!” but such leaps are apparently too hard for some.
Ask any dairy farmer (like Mel). It’s the whole basis of what they do!
One of my favorite dairy farm tidbits is that, despite having cows that are bred for the ability to make milk, they still find about a 10% failure rate in lactation after their first calf.
10% of dairy cows don’t make enough milk to feed their calf. These are DAIRY COWS. That’s what they are made to do. And still 10% fail.
Of course, this will cause some to argue that only women who can successfully breastfeed should be allowed to breed in the first place. Let’s get rid of that faulty gene that prevents the liquid gold from flowing forth from the nip!
Oh, I’ve seen that nasty argument already. You know, as if I somehow knew that I wasn’t going to be able to successfully breastfeed in the first place.
Well, I knew that I wasn’t going to be able to successfully breastfeed – didn’t stop me! 🙂
And if those dairy farmers would just not breed those heifers that won’t produce milk…
Yeah, I didn’t find out my medicine was unsafe until I was 16 weeks pregnant. It was one of the few proven safe for pregnancy, I never even considered that it wouldn’t be for BFing until my consultant brought it up.
But then again, they’d probably say I shouldn’t breed with my nasty lupus genes anyways. So why do I give a shit what they think.
yep, or worse, that we’ve messed up the gene pool by using formula to let their babies survive.
Said in whispers, and in undertones..but said nonetheless. I have come face to face with this mentality. THey are racists and bigots, no matter how much organic food they eat and clothing they wear.
Too right. And most unfortunately, we have had too many appalling examples in the comments section of this very site; Mr. (Or Miss) Autism-must-be-eradicated is the latest example, but not the only one.
Except that even for women with low supply issues, infant survival would be mixed.
A small daughter born in a time when the family had access to a protein and fat rich food that could be used as a supplement could well survive while a big boy born during a time of shortage could starve. Or a large son who can be wet-nursed by a sister or sister-in-law may make it.
Evolution is really tricky; very few traits are so horrible that an individual cannot reproduce successfully in a excellent circumstance.
Is that 10% can’t feed their calves, or that 10% don’t make up to the standards of commercial production?
Mel can clarify, but I took it to be can’t feed their calves
If we are talking dairy cows, it’s probably relative to the standards of production, since dairy cows don’t feed their own calf after they get the colostrum. (Note that it’s still possible for the cow to not have enough colostrum or for the calf to not be able to get it for various reasons)
Beef cows generally feed their own, so in this situation, it probably means ‘can’t feed their calves’
Also a very well known fact that milk production is significantly lower after the first calf.
Seems to me it would be a good idea for lactation consultant to work a few weeks on a dairy farm. They’d learn a lot.
In dairy, we mean below production standards – but the numbers are about the same for beefers who can’t produce enough colostrum to tide a calf over to milk production and beef heifers who don’t produce enough milk on the first lactation to sustain a calf.
The difference is that a beef heifer who loses her first calf is worth keeping around since if she doesn’t have delayed lactation or has slightly higher production she could support a calf next year.
I’m still looking for a paper that cites that material on lactation failure rates. The tricky bit is that most farms track things like how many heifers of a given age class are culled, but that includes heifers who are culled for unrelated problems like unthrifty growth or illness.
Too bad lactivists don’t care about research.
I wonder, if they think low production is based on selfishness (??) does this mean that those of us with oversupply are just, like, super selfless? Because trust me….I’m not.
Bah, it’s funded by Medela, and so is biased. Because, you know, Medela has a vested interest in convincing women not to breastfeed….
somehow.
They just want to convince women they need a breast pump! Evil!
Exactly. So by showing women that they aren’t producing enough milk, it will make them pump more, obviously.
The Introduction even talks about boosting milk supply with pumping.
How does that work if it is genetics?
That’s the lore, yes
See my comment above. :p