Why does breastfeeding often fail?

Disappointment motherhood. Mother tired

Breastfeeding is not a matter of will; it is a matter of biology.

That’s the take home message from the paper Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology by Lee and Kelleher, graduate student and professor of cellular physiology respectively.

To pretend that breastfeeding is just a matter of will and support is both empirically wrong and gratuitously cruel.

The most pernicious of the many pernicious lies promoted by lactation consultants is that any woman who wants to breastfeed can do so successfully. That’s why when breastfeeding fails, lactivists insist that it is because the mother didn’t try hard enough or didn’t get enough support. But lactation is a biological process and like any biological process it has a significant failure rate. Those failures of biologically based.

As the authors of the paper explain:

It has long been assumed that once lactation is successfully initiated, the primary factor regulating milk production is infant demand. Thus, most interventions have focused on improving breastfeeding education and early lactation support. However, in addition to infant demand, increasing evidence from studies conducted in experimental animal models, production animals, and breastfeeding women suggests that a diverse array of maternal factors may also affect milk production and composition.

Indeed:

…[I]t has been estimated that the prevalence of women who overtly fail to produce enough milk may be as high as ∼10–15% and can quickly lead to hypernatremia, nutritional deficiencies, or failure to thrive. Moreover, the prevalence of lactation “insufficiency” may be much higher, as ∼40–50% of women in the US and 60–90% of women internationally cite “not producing enough milk” or “baby not satisfied with breast milk” as the primary reasons for weaning prior to 6 mo.

Why does this happen?

In this review, we provide a broad overview on our current understanding of the molecular etiology behind these factors that play a critical role in lactation physiology and the ability to optimally nourish the nursing infant.

Let’s pause here to address the inevitable lactivist claim that we “wouldn’t be here” if breastfeeding had a high failure rate.

To understand why the claim is false, it helps to analogize to miscarriages. Although the survival of the human race depends on successful pregnancies, it is entirely compatible with a natural miscarriage rate of 20%. There is a biological basis for those miscarriages; most are due to serious genetic defects present at conceptions, some are due to hormonal imbalances, and some are the result of factors we have not yet indentified. Furthermore, no amount of maternal effort or outside support can prevent miscarriages. A few can be prevented with medical interventions but most can’t be prevented at all. The same thing applies to insufficient breastmilk production.

Breastmilk production is a complex process:

During early pregnancy, primary hormones, including estrogen, progesterone, prolactin, and placental lactogen, induce the physiological transition of the mammary gland from a nonsecreting branched tissue into a highly active secreting organ comprised of a vast network of ducts and alveoli that are grouped into seven to 10 lobes in humans… In response to progesterone and estrogen withdrawal, concomitant with prolactin release following parturition, the differentiated epithelium gains a remarkable capacity to finely coordinate the synthesis and transport of various milk constituents for the onset of milk secretion, … which usually occurs after full-term birth in humans.

There are many ways that things can go wrong.

Breast hypoplasia or other abnormal breast conditions and previous breast surgeries are certainly factors that contribute to lactation insufficiency… What is much less appreciated and poorly understood is the role that maternal genetics and modifiable factors such as energy balance, diet, and environmental exposures may have on reproductive endocrinology, lactation physiology, and the ability to successfully breastfeed.

Genetics

…[R]ecent advancements have identified numerous genetic variants associated with milk production traits in production animals. A recent study using GWAS data collected from 16,812 Holstein and Jersey dairy cattle identified SNPs in key pathways that are critical for mammary gland development, prolactin signaling, and involution that explained variation in milk production and milk composition. For example, ∼50% of SNPs found in genes critical for prolactin signaling, including SOCS2, STAT3, STAT5A, STAT5B, PRLR, and β-casein, were associated with three or more milk production traits. Additionally, a large number of SNPs in genes that are critical for mammary gland involution, including ATF4, IGFBP4, IRF1, LIFR, OSMR, PTK2, and STAT3, were also associated with milk production traits…

We propose that similar variation may govern lactation physiology, milk production, and composition in breastfeeding women…

Hormones

In addition to prolactin, a complex combination of hormones works together to maintain the differentiated epithelium and milk secretion during lactation, including insulin, glucocorticoids, growth hormone, oxytocin, and thyroid hormone. Secretory activation and milk ejection require insulin and glucocorticoids to synergistically regulate the formation of tight junctions in the mammary gland, stimulate mammary differentiation, and induce milk protein expression. Insulin levels rapidly decrease during early lactation and steadily increase over time.

Obesity

Growing evidence suggests that in addition to systemic inflammation, obesity is also associated with an inflammatory microenvironment in the mammary gland, which has recently been associated with premature involution in murine models… Fundamentally, the altered mammary gland microenvironment that occurs in obesity can lead to failed secretory activation or suboptimal lactation, whereby the mammary gland is incapable of secreting copious milk to nourish the newborn.

Nutrition

In recent years, increasing evidence shows not only that adequate nutrient intake and appropriate nutrient homeostasis are important for maintaining maternal energy balance but that suboptimal nutrition has significant effects on breast physiology and milk production, secretion, and composition. Nutrient deficiencies can result in failed secretory activation from several perspectives, such as inefficient hormone responsiveness, and defects in cellular processes involved in morphogenesis and secretory pathways. Moreover, energy/nutrient imbalance may cause more perverse effects on immune response and increased risk of mastitis…

Environmental factors

Thus far, only a few studies in women have shown an association between toxins like PCBs and dichlorodiphenyl dichloroethene and lactation defects such that exposure to these toxins is associated with shorter breastfeeding duration…

…[N]atural components such as heavy metals exposure can affect the mammary gland during lactation. Some heavy metals (copper, zinc, and manganese) are biologically essential; however, the most pollutant heavy metals are lead, cadmium, and mercury that bioaccumulate following absorption, causing adverse health effects.

The bottom line is that lactation insufficiency is common; it can be caused by non-modifiable factors like structural breast abnormalities, genetics, hormonal imbalances and environmental exposures. No amount of maternal effort and no amount of lactation support has any impact on those factors.

To pretend that breastfeeding is just a matter of will and support is both empirically wrong and gratuitously cruel.

  • chloe b

    It’s a myth that if a breast fed baby is eating all the time then they are not getting enough. Mine cluster fed a lot and were always around 98th centile for weight and 25th for height. I guess they were just greedy. If I had given them less they would be fine but then they would be screaming. I tried a dummy but only got so far. Weight gain is the most accurate gauge as to whether or not a baby is actually thriving and I have actually been told off for mine being too fat. My oldest is 6 now and her weight is fine I think she’s in the 60s for centile but I am bigger also.

    • rational thinker

      I don’t think its a myth, My best guess is maybe 80% of cluster feeding babies are not getting enough. Most insurance companies will now cover the full cost of a breast pump, I think they should also cover an infant scale for breastfeeding mothers to have at home. This may help the huge costs of the many newborn readmissions due to low milk intake.

  • Platos_Redhaired_Stepchild

    Its also a luxury. Being able to breast feed a kid in America is a luxury. Most Americans can’t afford the time it takes to breast feed or the supplies to breast feed their kid a full year.

    • Charybdis

      Now, now, the lactivists will tell you that breastfeeding is FREE! No supplies needed! Just you, baby and working breasts. Nothing else is needed!
      It’s why they deny there is an actual “breastfeeding industry” for things like pumps, extra pump parts, sterilization equipment, milk storage bags, pillows, nursing bras/clothes, breast pads, nipple creams, LC/IBCLC consult fees, galactagogues, etc. “All those things are NICE to have, but they are not NECESSARY to breastfeed.”

  • Sue

    Assuming that one can will complex glandular breast tissue to work correctly would be like assuming you could will your pancreas or kidney to work correctly.

    • Roadstergal

      They’re faith healers. Like the grifters who tell Type 1 diabetics to throw away their insulin and trust in god, these women tell you to throw away the formula and trust in Mama Nature.

  • Empress of the Iguana People

    Did anyone else think the woman in the photo was Stockard Channing for a moment?

  • Young CC Prof

    Gee, it’s genetic? I wonder if that’s why human farmers have relied on a generations-long process of culling for their milk cows (or milk goats, or laying chickens) rather than just encouraging them to produce more and feeding them oatmeal.

    • Roadstergal

      And even these highly specially bred animals still sometimes fail to lactate enough.

      I’m glad we haven’t bred humans for milk production. I’m a little skeeved out at the idea of breeding us for anything in the first place, but I can think of a whole big pile of things to breed for preferentially if you put a gun to my head and told me to do it.

    • momofone

      Clearly someone needs to make the cows lactation cookies.

      • KeeperOfTheBooks

        Ohhhh Mel? Paging Mellll!!!! In your free time, have you considered making the cows lactation cookies? I feel you could get a hilarious cow story out of that…

    • AnnaPDE

      If threatening to kill and eat a cow if it doesn’t give enough milk isn’t an extreme form of encouragement, I don’t know what is. 😉

  • CSN0116

    I feel as if there could be a huge market in lactation “failure” therapy. Like, mental health counseling that focuses exclusively on helping women who have been brutalized into feeling worthless due to lactivist tactics. Group and individual sessions.

    • Casual Verbosity

      The more I read about this, the more I feel this is a need I’d like to fill. I’m still at least two years of education and training out from becoming a psychologist, but I feel it’s an area where I could really help people when I do get there.

  • Emilie Bishop

    Gee, breastfeeding is complicated? Like, way more complicated than anyone knew? (Just like health insurance…)

    This paper and others have no hesitation about saying insufficient glandular tissue is an indicator of low supply, and the physical symptoms often make it easy to spot if you know what to look for. But I’ve yet to find much about what causes the malformation of breast tissue in puberty. Anyone have any info on that?

    • Anj Fabian

      I’d put my money on the tissue not responding to hormonal stimulation. There’s hormones and there’s receptors. Without enough functional receptors, the tissue won’t respond. You flip the switch but nothing happens.

      Genetic? Developmental? I don’t know.

    • Helen

      Getting shortchanged in the genes that cause breast tissue to develop? Lack of glandular breast tissue has been present in my maternal line for several generations. Supplementation with cow’s milk and formula has allowed us to still produce thriving children.

    • Azuran

      Different people probably have different reasons. Genetics, abnormal fetal development, lack or excess of some hormones during puberty, defective hormone receptors, defective hormones, possibly illnesses or malnutrition during puberty/pregnancy or maybe medications.

      It’s actually incredible how little we actually know about breastfeeding in humans. All that money they wasted on the BFHI would have probably been a lot more useful on actual research.

    • KeeperOfTheBooks

      I’d be interested in hearing it.
      I had a…bizarre…upbringing that I’ve written about a little here. Basically, religious nutjobs as parents who held, among other beliefs, that anything having to do with female sexuality was dirty/bad/evil/whatever. So, by the time I started to develop my intrinsically immodest C-cups (*cue eyeroll here*), I just got so stressed by the whole business that I found a line of super-tight sports bras marketed, I later discovered, almost exclusively to women who wanted to pass for men, and wore them exclusively day and night from the time that I was 13-14 until I left home at 18.
      While my breasts do look normal (whatever that might mean) now, I wonder if that extended breastbinding might have messed around with the glandular tissue. I’d be interested to find out.

      • Emilie Bishop

        I’m sorry for your experience. That sounds so awful, physically and emotionally. For a point of reference, though, my breasts felt like they sprouted overnight when I was between ten and eleven. They were the same size and shape they are now–a small B cup, about three finger-widths of space between them, and tubular rather than rounded. They got a little fuller during pregnancy, but my old bras still fit. I was never engorged, even as my milk changed over from colostrum, and I never made more than half what my son needed to eat (less as he got bigger). In other words, my breasts have always been just as they are right now. I think glandular tissue issues are largely present or not.

        • KeeperOfTheBooks

          Hmmm, interesting! Thanks for the perspective.
          I honestly can’t remember what the timeframe was on my breasts growing, but they’re fairly rounded, not particularly widely-spaced, etc. On the other hand, they have never changed size or shape during pregnancy.
          I think your theory is probably correct about glandular tissue being present or not.

  • Sarah

    The only thing our success as a species proves about breastfeeding is that enough of us got enough breastmilk enough of the time to survive long enough to reproduce. That’s it.

  • attitude devant

    “We wouldn’t be here” if breastfeeding had a high failure rate, say the lactivists, and yet here we are, and yet yes it does. Why? Because wet nurses have been around for millenia, and so has formula. We have brains and a circle of friends. We use both. Formula recipes exist from Egyptian times. Wet nurses are described in religious texts, histories of the French Revolution (the royal wet nurse was nicknamed “Madame Poitrine”), and operatic biographies (Mirella Freni and Luciano Pavarotti had the same wet nurse). It’s comically ironic that the most basic biologic essentialism concerning feeding infants is undone by the ingenuity and cooperation of humans since the dawn of time.

    Nursing babies is great. I was never able to do it successfully. My kids are fine adults now, and I think about breastfeeding…..almost never.

    • Mel

      A lot of epidemic diseases have much higher rates of mortality than 10%-15% and we’re still around.

      Humans are social animals. I suspect many babies survived because a woman who produces copious breast milk could make up the difference for friends or relatives that had babies who were always hungry. Women also shared tips for supplementing with various foods. Humans don’t like watching babies starve to death so women would have lots of people trying to help in one way or another.

      • Lilly de Lure

        Also, even if a substitute food isn’t nutritionally complete and wouldn’t be recommended by any sane health professional in the first world (like cow or goat milk mixed with honey) all it needs to do is keep the baby from starving until it can be weaned, say about 3 months if desperate – the baby may face health challenges and be sickly in its early few years but it’ll still be alive and capable of reproducing as an adult.

    • Roadstergal

      Lots of babies can die and the species still survives.

      Women used to have 10-15+ babies. We build in a buffer when they don’t all make it.
      I don’t think the lactivists realize how utterly monstrous they’re being. Or maybe they do…

      • attitude devant

        I think they literally don’t care about the individuals. Their entire focus is highlighting their own ‘achievement’ as the norm for all of us.

      • Casual Verbosity

        I wouldn’t be surprised if many of them just genuinely can’t engage in basic perspective taking. “Everything was fine and easy for me, therefore your problems are just excuses.”
        You see it in so many other areas as well. A common one in Australia at the moment is in regards to the housing-market (spoiler alert: it’s grim for anyone who doesn’t already own a family home and several investment properties). There are so many: “Well I worked 26 hours a day, subsisted on air, and bought a shoebox in a dangerous part of town that’s now been gentrified by hipsters – therefore there’s no problem and you’re just whinging.” Some people just lack the capacity to see past the end of their nose.

        • Empress of the Iguana People

          My husband sees this a lot at the IRS (the US’s federal income tax collector, in case any non-US lurkers weren’t sure). Employees forget how other people react to the IRS. And other people don’t realize that the regulations and complexities aren’t set by the IRS, but by Congress.

        • Sarah

          See also, far too many British people who were able to purchase a property before 2002ish and think their current elevated position is due to brains rather than age.

      • Sue

        How does “Nature” “allow” other evolved mammals to have more offspring than nipples, “knowing” that some will die?

      • Platos_Redhaired_Stepchild

        Their common refrain when one of the kids die is “It wasn’t meant to be!” so yeah they know.

    • fiftyfifty1

      “Nursing babies is great.”

      meh

      • Helen

        For some people it is indeed a great experience. And some of those people can even do it exclusively.

        But no one should feel that they _have_ to do it.

    • Sue

      Just like the “wouldn’t be here” if we needed vaccines? Cos parents weren’t sad to lose almost all of their multiple children to infectious diseases, so long as there were replacement numbers?

      These people don’t understand science in general – let along evolution.

  • Mel

    Precious little in my son’s life has been straight-forward or achievable through just “will” and “unlicensed, questionably trained support”.

    I managed to pump breastmilk for him when he was a micropreemie; I received far more support from my mom, my aunt, and my dairy farmer husband about lactation than I did from the lactation consultant at the NICU. The moment that she admitted that she was surprised that I had managed to a)pump enough breast milk for him by the time he was term and b) was still pumping 4+ months after birth was the moment I lost what little respect I had for her. I wonder how many preemie and micropreemie moms thought they failed when they couldn’t breastfeed because they believed the drivel she was preaching.

    Thanks to lots of completely unnatural interventions including hydrolyzed formula , I’m commenting while listening to my baby boy sing his “sad baby nap song”.

    I guess I could chose to wring my hands about how unnatural his life has been – but I much prefer enjoying life with a wiggly, giggly, happy-go-lucky little Spawn-baby.

    • kilda

      aw. Now I want to hear the sad baby nap song.

      • Empress of the Iguana People

        My daughter does this. It’s half crying, half singing.

      • Mel

        He yowls quietly. It’s pretty funny.

    • BeatriceC

      By the time my third NICU baby rolled around I basically told the hospital LC’s to jump off a bridge and nearly everything they said was completely false. I was going to sleep, and my milk was going to come in like Niagara Falls halfway through day three, like it had in every single other one of my pregnancies, regardless of gestational age, survival of the baby, or the amount and frequency I pumped, thank you very much. Stay the hell away from my boobs and we’ll be fine. I’m gonna go sleep now.

    • Ozlsn

      I think I was lucky with the lactation nurse I had in NICU – she was doing it part-time on top of her actual, paid role (the hospital finally coughed up funding to support her doing it when they realised how much it helped the mums in there). She was very supportive, non-judgemental and was willing to listen and get answers to questions she hadn’t come across before. She also encouraged us to not worry about supplementing with formula – unsurprisingly a lot of babies were having fortified EBM due to IUGR. Most importantly I think she was helpful with women who couldn’t produce enough, or (like one of my friends) had babies who turned out to be extremely intolerant of breastmilk – she encouraged them to not feel guilty or upset but instead to focus on what they had managed to produce/that there were fantastic alternatives available. I wish they were all as helpful and supportive.

    • Sue

      Glad to hear you’re enjoying little Mr Wiggly-Giggly! He sounds delightful.

  • crazy mama, PhD

    Thinking about nutrition… I wonder how much lactivist advice is actually counterproductive to milk production? Maybe telling new moms to hand the baby off once in a while so they could get a good meal and some rest, even if it means giving baby the occasional bottle, would boost milk supply better than the “do nothing but nurse 24/7!!!” advice that is so popular.

    • Mel

      In my experience, the NICU lactation staff gave postpartum advice that was shitty from dairy farming POV.

      The three big things we do with “fresh” cows to maximize milk production letting their bodies heal are lots of high-energy feed, unlimited access to water, and access to plenty of sleeping areas. If a cow is ill or had a traumatic birth, we skip milkings for as long as she needs; it’s cruel to make a sick cow go through milkings unless she’s uncomfortable from engorgement.

      Compare that with the LC’s advice to me that I should pump every 2 hours round the clock for the first two weeks. The fact that I was hospitalized for 7 days postpartum with uncontrolled high blood pressure was apparently not a good enough reason to adjust that advice. I pumped about 6-7x a day while I was in the hospital based on how I was feeling and when I felt like I needed to pump.

      Turns out someone had done research on postpartum pumping in preemie moms; they found successful mothers pumped at least 5x a day for a total of at least 100 minutes – instead of 12x a day for a total of 240 minutes.

      I’ve always wondered how many NICU moms stopped pumping because they couldn’t do 12x a day in the first two weeks and assumed that they missed a critical window due to what the LCs said. I kept pumping and found that my milk supply slowly increased over time – something that didn’t seem possible based on the LCs spiel but matched what we saw in cows.

      • guest

        I ignore my LC’s advice to wake myself up in the hospital to pump. I was lucky in that I could see I was pumping enough during the daytime (I had a chart of targets to try and hit each day for twins), and I chose to sleep – the babies were in the NICU, and I had had surgery and was on pain meds. (I still got woken up some for nurse checks and such.) While I had some trouble establishing breastfeeding, low supply was never a problem. Within a week the NICU was telling me not to bring anymore pumped milk in, because they had more than enough already. I do think the rest helped. My milk didn’t fully come in until about a week and a half after birth, but I was producing a lot of colostrum, I guess? I do know one morning I woke up and was like, oh, I thought I was producing milk already, but THIS is what people mean: leaking everywhere, rock hard boobs, and more opaque white milk.

        • Ozlsn

          Mine was about a week after birth too. Those boulders hurt! I still wonder if it would have been quicker coming in if I wasn’t post-CS/didn’t have a prem, or if he was expected to starve on the quite tiny amounts of colostrum I produced for that time.

      • kilda

        Mel, after reading many of your comments, I have decided that operating a dairy farm for a certain period of time should be a requirement to become a lactation consultant.

        • Roadstergal

          Interning on a successful one, at least. 🙂

      • NoLongerCrunching

        Do you have a link to that study? I’d really like to read it.

        • Mel

          Let me hunt it down again. It may take me a few days. I found it in the middle of the night while Spawn was in the NICU and now that I’m less stressed and sleeping I have no idea which search terms I used.

      • Azuran

        But newborns don’t eat every 2 hours for the first 2 weeks…..So why should we pump that much?

        • Empress of the Iguana People

          Some genius told me that because my ebf kid slept a 4 hour stretch every night since his 2nd at least, that was the reason why I got my period back after only 8 weeks. *eyeroll*

          • Azuran

            XD I had to wake my baby up myself every 4 hours to feed her for the first few days after she was born. Even after I stopped waking her up, she still slept about 4 hours stretch. And she has been sleeping a 6-8 hours stretch since she was 2 months old (and even skipped a few nights completely). Got my period after 6 months.

          • Empress of the Iguana People

            *squints at you in jealous irritation*

          • Azuran

            To be fair, she does good nights but she’s a horrible napper.
            I can’t get rid of her at all during the day. Whenever I put her down when she’s napping she wakes up. I’m basically a glorified pillow and the length of her naps are dictated by my bladder.

          • Mad Hatter

            I wonder if genetics has a lot to do with that too. I nursed every 1-2 hours around the clock and my period came back at 5 weeks. Same with the 2nd kid but was only nursing 2-3 hours. My mom would get hers about 6 weeks with all 4 ebf kids.

          • Empress of the Iguana People

            Probably. Mine came back both times at 8 weeks, even with kid2 being eff. And both my mother’s mother and my mother’s paternal grandmother had kids 12 months apart. My sister, the brat, told me it’s one of the positives of having gotten a hysterectomy. Not that she recommends the *reason* why she got one at 28, but that’s another issue.

      • Lilly de Lure

        Fascinating – maybe it should be made mandatory for all lactation consultants to work at a diary farm before being let loose on patients (with the hint: if farmers consider a practice too cruel to inflict on dairy cows, maybe they should think twice before advocating it for human mothers)?

      • Charybdis

        Can humans get milk fever?

        • Mel

          Milk fever is low blood calcium levels due to a cow’s inability to mobilize enough calcium in the immediate post-partum level. I’ve never heard of it in humans which makes me suspect that it’s a side effect of artificial selection for massive milk production in dairy cows.

      • Ozlsn

        Interesting. The 5X/day is about what I did – I pretty much decided after the first week that the baby was sleeping from midnight to 6am because I was so tired. 12X/day is ridiculous – we were told 6X/day, so every 3-4 hours roughly. How can you do literally anything else if you’re expressing every 2 hours? I found it difficult to fit in with double that gap.

      • Krista

        Not to mention, there is nothing remotely natural about pumping. It’s a thoroughly modern invention. For people who glorify nature so much, I don’t get how they are obsessed with pumping. It’s an intervention. If it needs a ridiculous routine of endless pumping in order to be successful, then they are basically admitting that it would fail if things were left to their own natural devices.

        • lsn

          Yeah I had never actually heard of expressing before I was pregnant, ditto tongue ties or – my most recent discovery – lip ties. The number of interventions potentially needed for an allegedly easy, totally natural process is staggering. And when you start getting into very limited diet as well so you can breastfeed because the baby is reacting badly… well, some women are a lot more dedicated to the idea than I would be.

    • Roadstergal

      I know of not one single non-essential bodily function that works _better_ with sleep deprivation and stress.

      • Even the essential ones start failing with sleep deprivation and stress! Heart rate increases and/or spikes, blood pressure increases, and eventually hallucinations and death.

      • mabelcruet

        Bowels! Or maybe it’s just me who gets nervous diarrhoea/intestinal hurry. All I know is that it made exam season a flipping nightmare.

        • Sarah

          Ha! I think in that scenario, better doesn’t necessarily mean more frequent…

          • mabelcruet

            It’s maybe just me, but my exam diet is abysmal and chockfull of stodge, so a little bit of stress related intestinal hurry is useful at times!

          • Sarah

            I get the same, and frankly my fibre consumption is through the roof.

          • Roadstergal

            Totally – I’m happy and regular without stress, and with it, I’m WAY too frequent. :/

            ETA – or bound up. It seems to go one direction or the other stochastically.

        • Charybdis

          No, you aren’t alone in that particular GI “quirk”. I hate it so, so much.

    • CSN0116

      I was chatting with a neighbor/NICU nurse. She told me that women from our local Yemen population have the highest rates of breast feeding success that she has seen since she started practicing. Why? They practice prelacteal feeding (with formula) and do not initiate nursing until about 1 week out. They go home surrounded by female family members to care for them for a solid month or more.

      • KeeperOfTheBooks

        Similar situation here with the local Latina population. They usually have large extended families, and SOP is for mom and new baby to go home, and mom goes straight to bed to do nothing but sleep, eat delicious food prepared by someone else, and nurse kiddo during the day and a couple of times at night, with grandma/auntie/sister/whoever giving a bottle or two at night as well so that mom gets solid blocks of sleep. Someone else handles all housework, non-nursing baby care, et all. At the end of a couple of weeks, mom is usually breastfeeding exclusively, and, more importantly, is well-healed and well-rested thanks to all the support and sleep.
        Apparently, it drives the local LCs bonkers (EEEK they’re DOING IT WRONG!! by NOT EXCLUSIVELY BREASTFEEDING FROM DAY ONE!!!!), which I personally consider to be a bonus.

    • CSN0116

      What is the point in “nursing” when no milk (or even really colostrum) is present? I’m thinking immediately latching after birth and such. As an EFF mom 5 times over, it doesn’t bring milk in… milk arrives regardless.

      • StephanieA

        According to my hospital’s LC, there is research showing that frequent early feeds correlate with higher milk production. I haven’t tried to research this any further because I generally ignore what LC’s say.

        • CSN0116

          Thanks! I really need to understand this better.

        • Mad Hatter

          That’s why they say cluster feeding around the clock is normal and your baby’s stomach is the size of a marble.

  • mabelcruet

    Bring it right back to basics. There is not a single part of the human body that is 100% perfect 100% of the time in 100% of people. Whether it’s an anomaly of anatomy, physiology, biochemistry, or a physical aberration, or a functional issue, whatever-something can go wrong in any cell, any organ, any tissue, in any body. So why is it so hard to accept that failure of lactation is natural, common, and nothing to be ashamed of? It’s like being ashamed if you get Addison’s disease because your adrenal glands don’t work right, or diabetes because your pancreas goes wonky.

    I don’t have kids and never will (unless I go to Italy and find that fertility specialist who is getting old age pensioners pregnant), so I maybe don’t have a feel for the emotional aspects of breast feeding, but your body let’s you down all the time in lots of ways, it’s not a machine working at 100% efficiency, so why do lactivists act as though it is?

    • swbarnes2

      Because they have tied the feminine body functions to the virtue and worth of women. No one thinks that bad eyes, or arthritis makes you a bad person, but these women have convinced themselves that their value as people hinges on their ability to have their bodies do female things flawlessly. So to tell a woman that she can’t deliver vaginally, or breastfeed, is akin to telling her she is a bad person, or a failure. Rather than evaluate the premise leading to that conclusion, (maybe the virtue of a woman has nothign to do with her milk supply) they just deny that women can be failed by their bodies like that. (She must be able to breastfeed, MOAR PUMPING, MOAR SUPPORT!)

      • CSN0116

        VERY well put

      • mabelcruet

        Which is why lactivists and that ilk are supremely anti-feminist. They reduce women to their basic biological function and considers their value lies entirely in their basic female attributes of birthing and breast feeding. Women’s value is so much more than what they do or don’t do with their lady parts.