When breastfeeding isn’t working

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Trust breasts?

It’s not the motto of the lactivist movement, but it could be. If breastfeeding advocates are sure of anything, they’re sure that breasts are the one organ system in the body that never, ever fails. In their view, if breastfeeding isn’t working for you and your baby, there are myriad possible reasons, but it is never the fault of your breasts.

Baby nursing for hours at a time yet still frantic with hunger and not gaining weight?

Don’t trust breasts. Trust women!

A reasonable person might conclude that you aren’t making enough breastmilk. But lactivists aren’t reasonable people. Since breasts are perfect, you surely have enough milk but:

  • You are “misperceiving” the amount of breastmilk you are producing.
  • You are ignorant of normal infant behavior. All babies cry like that.
  • Babies don’t really need to gain steadily. You’re misled by the way that formula fed infants grow.

See, it’s all your head! Because you can trust breasts to work perfectly.

Except that it’s not all in your head. The scientific evidence shows that up to 15% of first time mothers don’t produce enough milk to fully nourish an infant in the early days.

So if you aren’t producing enough breastmilk, especially in the first few days before your milk comes in, a reasonable person might suggest small amounts of formula to tide your baby over, but lactivists aren’t reasonable people. Their “solution” it to flog your breasts and yourself more.

  • You should just nurse more; breastfeeding depends on supply and demand.
  • Pump in between nursing sessions; getting rest is not important.

See, you should just try harder! Because you can trust breasts to work perfectly.

Except that trying harder is not guaranteed to work. Breastfeeding may depend on supply and demand, but so does insulin production. In people with type I diabetes, the pancreas no longer responds to supply and demand as it should. Advising women whose babies are hungry and nursing constantly to just breastfeed or pump more is the equivalent of advising diabetics to just eat more sugar. If an organ is not producing optimally, stressing it more doesn’t work.

Experiencing excruciating pain while breastfeeding?

A reasonable person might conclude that having the force of a vacuum applied to the sensitive tissue of nipple and areola can be profoundly painful, especially early on, but breastfeeding advocates aren’t reasonable people. They’re sure that your pain is your fault!

  • Adjust the baby’s latch. You must be putting him on the breast the wrong way.
  • You aren’t getting enough proper support. If the previous generation had breastfed they would help you.
  • Hire a lactation consultant. She will show you what you are doing wrong.

See, you must be doing it wrong! Because you can trust breasts to work perfectly.

Wait, what? The lactation consultant says that there is nothing wrong with the latch?

Well, then the baby must broken! Maybe he or she has a tongue tie.

While tongue tie can cause pain while breastfeeding, it is relatively uncommon and certainly never cut in nature. Though tongue tie surgery seems simple, it is quite painful for many babies, especially the repeated sweeping of the wound to prevent the tie from reforming during healing.

Think about how painful biting your tongue it; now imagine cutting it. A reasonable person might conclude pumping and bottle feeding, or formula feeding from a bottle were excellent alternatives to subjecting a baby to searing surgical pain, but lactivists aren’t reasonable people.

  • He must have an anterior tongue tie. Cut it.
  • She must have a posterior tongue tie. Cut that, too.
  • Maybe it’s a lip tie. Just keep cutting.

See, it’s the baby’s fault, never the fault of your breasts!

Ready to give up on the painful, frustrating, exhausting process of breastfeeding because your child is starving? A reasonable person might sympathize with your suffering and recommend formula to alleviate it, but breastfeeding advocates aren’t reasonable people:

  • You don’t care about your baby.
  • Where did you get the idea that your pain, exhaustion and mental health matter? They don’t.
  • Who says you need to return to work?
  • You’re obviously a dupe of the formula industry.

Blame formula manufacturers! Blame capitalism! Blame society!

But whatever you do, don’t blame breasts because they’re perfect.

Ridiculous, right? But many women fall for it and end up feeling guilty, anguished and blaming themselves.

I have a better solution:

Don’t trust breasts; trust women.

You know whether breastfeeding is right for your baby and yourself. Don’t let breastfeeding advocates convince you otherwise.

  • KQ Not Signed In

    When my boy was born, the pediatrician suggested clipping his tongue tie. No one had ever mentioned that to me before his birth, and I felt a bit rushed into the decision. He showed no ill effects and his latch was pretty much perfect from the beginning. I have always felt uneasy about it, but we made the best decision we could as overwhelmed, sleep deprived and (in my case) heavily medicated first time brand new parents.

    Now that he’s getting his adult teeth in, it’s become apparent that he has a very low, very thick band of tissue along his upper lip that is keeping his top teeth very gapped. The orthodontist said this is very related to tongue tie – that if he has this band on the top he probably had a big one on the bottom too – and that he will likely need both braces and to have the top tie surgically removed as well.

    So…now I think I feel less guilty? Maybe? But not? It’s so overdone right now, and that hospital was extremely BFHI and I had terrible experiences directly because of it. But the pediatrician was our first choice and was wonderful, and now there’s evidence that he did, in fact, have a tie.

    • Who?

      Parenting can be so demoralising.

      My daughter, during hayfever season, had terrible hayfever and a persistent cough. Every year. Eventually, tiring of treating her for asthma we weren’t sure she had, we took her to a paediatric ENT. She aced the lung capacity test, and the doctor started asking questions. One of which was ‘do you get a burning sensation in your chest/throat after eating’? Yes, of course, child replied, for as long as I can remember. And on went the appointment. On the way home I asked her why she’d never mentioned this burning. ‘I thought everyone had it’. Of course.

      I feel terrible that she went through all that, and while we did eventually get her sorted out she’s still, as an adult, prone to terrible hayfever.

      You made the best decision you could at the time with the information available. You’re ready to learn more and change your mind. That’s enough.

  • NoLongerCrunching

    Holy shit. Don’t trust breasts; trust women. That should be plastered over literally everything surface of everything pregnant mothers encounter. This is probably my favorite sentence you have ever written, Dr. Amy.

  • rational thinker

    A little off topic but I just found something today on Netflix and it is absolutely disgusting how many lies and propaganda in these two documentaries. I think it may even be worse than business of being born. Its called the birth reborn and the birth reborn 2. Has anyone seen these?

    • space_upstairs

      No, but so far I’ve only seen one health documentary on Netflix that doesn’t go into conspiracy territory: “Take Your Pills,” about the common use of stimulant drugs. No quacks and sketchy media sources, and a balanced view of the question of ADHD and the off-label and illegal uses of stimulants. It inspired me to check out another documentary regarding prescription drug abuse that I hadn’t already seen gutted on Science-Based Medicine (Prescription Thugs), but that one trotted out RT and homeopaths and people who refused to use even Tylenol after some 30 minutes.

    • RudyTooty

      This is an 8 minute promo on YouTube from a film of the same name.

      This?

      https://youtu.be/3B33_hNha_8

      • rational thinker

        yes that’s the first one mostly about “obstetric violence”. There is a second one and they are from brazil so most of it is subtitled Spanish. Its mostly about how homebirth is safer and how we need more cpm’s not cnm’s.The second one is mainly about c sections and how they were all “birth raped”. So many lies in both of these but second one I think is worse and of course all the women seem to be upper class and very well off.

        • RudyTooty

          8 minutes was enough for me.

          One the problems with these ‘documentaries’ is that they possess a grain of truth. (And by grain, I mean precisely 0.065 grams of truth in a 10 pound bag of bullshit).

          So they lead with something that’s kinda, sorta, barely true… or that sounds half-reasonable …. to some people …. and then launch into the OH NOES! CESAREAN BIRTH MEANS THE END OF CIVILIZATION.

          You watched the documentaries? What things did you find most appalling?

          • rational thinker

            oh my god they literally said that at the end of the first one CESAREAN BIRTH MEANS THE END OF CIVILIZATION lmao

          • RudyTooty

            Yeah, that was a direct quote. That wasn’t hyperbole.

            Well, it is…. but they said it!

          • Cristina

            That sounds like what what’s-her-face was going on about – babies at home just in case the apocalypse ever happened

          • rational thinker

            yeah her, she and Allison Dixley should be best friends.

          • She’s not as bad as that Cecilia person who thinks we shouldn’t be saving African children from starvation and disease because they’ll just grow up to kill each other. (I am not exaggerating her beliefs. She actually stated and defended that notion.) For me, that woman is the bottom end of the commentariat scale.

          • rational thinker

            wow….I guess she likes to be open and honest about her racism

          • rational thinker

            in the second one at start of film you see a doctor getting a breach baby out and it was amazing to watch sure if you don’t know what he was doing it does look kind of violent. Then you find out later that she was told she needed a section but she wanted her experience so she refused. You can tell the baby was stuck too but the doctor did amazing job and saved that baby. If she was at home that baby would have died. Instead of being grateful she starts with the whole birth rape thing. Does she even understand how close she was to losing that baby.

          • rational thinker

            The first one had all the usual lies and saying vbac are safer and at home no less. They also said its about more than a safe delivery and they said that being in labor 3 days is a variation of normal. When I had my kids I wasn’t concerned with an experience I just wanted to get my baby out safely.

          • AirPlant

            I just would like someone to explain to me what is so amazing about experiencing a vaginal birth. It honestly sounds pretty freaking awful and if your baby is breach that is like an extra level of terrible just waiting to happen.

          • RudyTooty

            It can be not-a-bad-thing — maybe even *amazing* for some. Or it can be a terrible thing. Just like anything else we do.

            Declaring vaginal birth universally amazing and empowering for everyone, no exceptions, is the problem.

          • rational thinker

            my first was bad I had 4rth degree tears, but my second was great no tearing

  • rational thinker

    It is my opinion that cutting a babys mouth so mom can breastfeed is some form of child abuse. Is having to use a bottle really so bad.

    • Hannah83

      This! I’m from Europe. In my country, cutting tongue ties is totally uncommon (I have not heard of anyone who has done it or intended to do it). To me, it appears to be rather barbaric.

    • Madtowngirl

      I consented to having my daughter’s “tongue tie” clipped, because the LC in the hospital insisted she had a tongue tie. She told me I’d probably need to push the pediatrician into the procedure. Why that wasn’t a red flag to me, I don’t know. I thought I could trust the LC. And she was right, the pediatrician hesistated, but didn’t fight me. I suspect the doctor was tired of fighting the BFHI on this. I regret doing that, and it changed absolutely nothing about my daughter’s latch. Thankfully, there doesn’t seem to be any permanent scarring, but I won’t be putting baby #2 through it.

    • zuul

      Even though it was determined that I have mammary hypoplasia, and the baby had a “textbook perfect” latch, the LC the hospital assigned to me recommended having her tongue and lip cut “just in case” and gave me the phone number of a guy who would do it under the table for cash.

      “just in case”

      This same LC also told me I could buy domperidone and metoclopramide off of the internet without a prescription, to help increase my milk supply….because why wouldn’t I try every option, if I really loved my baby?

      The whole LC culture is just psychotic.

      • rational thinker

        She should be reported for that. I wonder if the guy who would do it for cash was even a doctor.

    • demodocus

      Aye. My nephew’s was cut, but he had that really serious kind that makes you look like you have a forked tongue. Sis wasn’t bf’ing*; they were worried about something else for him.

      *Not past the first 2 weeks, anyway. Chemo and nursing do not go well, but it took that long to confirm the cancer riddling her uterus. Eleven years later, she’s still battling and nephew is healthy as a horse.

    • AnnaPDE

      Sometimes it’s more complicated than that.

      Yes, way too many tongue tie clips are just “we don’t know exactly what’s happening but BF is so-so” shots in the dark, and in some places (like here in Brisbane) they are extremely popular. Preferably with laser surgery, which looks less bloody from the outside but hurts just as much, especially afterwards. $800 a pop at dentists who basically do not much else.

      However, there are ties that don’t just completely prevent the baby from transferring milk from the breast (the nipple-crushing effectiveness, in contrast, is amazing), but also interfere with bottle feeding badly enough to produce a few choking episodes with every bottle: For example, when the tongue tip can’t reach the gums at all, and there’s hardly any sideways mobility.

      Been there, done that with my son. The tie was clipped in the end, by an actual surgeon at the hospital, who was anti-stretches and pro-post op pain relief, and didn’t charge anything. But the way there included a kid who was hungry and losing weight for 3 weeks, while LCs pretended it was “just” a lazy kid, and the pediatrician deliberately ignoring the obvious problem because “TT is overdiagnosed”, and a FTT appointment at the hospital over Christmas.

      Thanks TT wars.

      • It’s true. Sometimes you actually DO need a tounge tie clipped. My brother had his tongue-tie clipped when he was already on solid food, because it was interfering with his ability to speak.

        Then again, I don’t recall my mother being huge about breast feeding. She didn’t stop working till baby brother was born, so I was on a bottle pretty early. I don’t actually remember if he was also or if he managed a latch with the tongue tie.

        • AnnaPDE

          My sister and I have pretty bad ties. Our mother managed to BF us both (though that was more her boobs doing an excellent job despite us), but we both have some speech and jaw issues that probably would’ve worked out a lot nicer without that tie.
          Then again in the grand scheme of things it’s not all that much worse than, say, wearing glasses.

          Everyone’s a bit broken in one way or another: Boobs, uterus, tongue, eyes, pancreas, you name it. And if not from birth, then a little misstep on a trampoline will take care of those appallingly perfect ankle ligaments, or a good bike accident of the much too complete teeth…
          Sometimes it’s worth fixing, sometimes not, and mostly you only know when the situation actually arises, or even more annoyingly, in hindsight.

    • zuul

      For babies who actually have tongue ties, the ethics are notreally in question. It is a real condition that sometimes requires surgical intervention so that people can eat, drink, and speak without great difficulty or discomfort.

      But a lot of LCs are running around recommending the procedure for all babies, as a preventative measure, which is just bizarre. A tongue tie is not hard to diagnose – and just about every child who has trouble breastfeeding is getting checked for it by a pediatrician, sometimes while they are still in the hospital.

      My baby was checked and didn’t have one. One of her favorite things to do as a newborn was stick her tongue all the way out like Gene Simmons, so…yeah. Not buying into the “well, just in case all the doctors were wrong” argument the LC gave me.

      On the other hand, if a pediatrician had diagnosed her with a tongue tie and recommended cutting it, I would have had the procedure done.

      • rational thinker

        I forget what the real percentage is that actually need it, maybe 5% im not sure. But an lc should never be diagnosing it. Only a pediatrician or maybe even speech pathologist. The medical community should really put a stop to it but I think even they don’t want to go up against the BFHI. Or they would be labeled as anti breastfeeding or something.

  • Elizabeth A

    I’ve really never understood the tongue tie thing – surely our cavewoman ancestors did not slice at babies’ frenulums? If every part of a mother’s body is supposed to work perfectly as-is, why does a baby’s require any alteration at all? There’s just this huge discontinuity in the logic around this issue.

    It is my firm belief that many breastfeeding problems could be resolved by a snack and a nap for everyone involved. Infants have the same trouble thinking while hungry that all of us do. Get ’em when they aren’t hangry and they often figure it out. And the lack of care that many new parents experience post-partum is shocking and can’t possibly be helping a damn thing.

    If the feeding problem doesn’t improve with food and rest for everyone, it may be a bigger deal, but the good news is that formula is safe, relatively inexpensive (compared to medical intervention), easy to use, and readily available.

    • demodocus

      I’d love to have a nap right now

    • kilda

      they were hoping you wouldn’t notice that logic disconnect. I find it interesting that they believe the birth process and breastfeeding are both perfectly designed for their function and the only problems come from medical interference, but babies’ tongues, yeah those are so often just, like, all wrong and need to be cut to fix them.
      “you were made to do this! Your body is not a lemon! …… now that baby of yours, you might have to take a knife to him to get him to work right.”

      • Merrie

        Now I feel bad about getting my older son’s tongue tie clipped. They really did the hard sell in the hospital, like “It might not seem to be affecting breastfeeding now, but it might be a problem later, might as well do it now, easy procedure” etc. etc. Then we got billed $250. Not great.

        • Jen

          I had the exact same experience and regret.

      • Griffin

        Yeah, it’s narcissistic thinking – whatever works on the mother will be deployed, and stuff the complete lack of logical connection between statements.

    • Azuran

      Oh it’s always like that. Your baby knows when to be born, But it doesn’t know how to latch properly, apparently. Also, here, take castor oil.
      You are definitely making enough milk, no such thing as low supply, here take those lactation cookies to improve your not deficient breastmilk production. And breastfeed and pump every hours also.

      • zuul

        But make sure to get at least 8 hours of uninterrupted sleep every night, and three square meals a day, and at least 10 glasses of water, while pumping and feeding every hour and caring for a newborn.

        And make sure those hose lactation cookies are chockful of flax meal, which by the way will thin the blood and can cause serious bleeding problems post-partum. But the massive blood loss won’t contributing to your lack of supply, either, because low milk supply doesn’t exist.

        Am I doing it right? Can I get an LC certification yet?

        • zuul

          sorry, meant to post “won’t be contributing”

        • Juana

          Oh, and you might just square the circle as well, while you’re at it.

      • azuran yes but

      • azuran what