One of the biggest heartbreaks of motherhood may also be one of its earliest (way to test our strength there, universe): Wanting to breastfeed your baby but not being able to. And anyone who has Googled “Am I making enough milk?!” in the middle of the night may not find much comfort on the internet. (Go figure.) Here, former Harvard Medical School instructor, ob-gyn and mother of four breastfed children Dr. Amy Tuteur shares scientific evidence that not all moms are able to nurse, no matter how hard they try. Plus, evidence that that’s really and truly OK.
Q) What are some of the most common misconceptions about breastfeeding?
The assumption, in the breastfeeding world, is that breastfeeding is always perfect. And to the extent that it isn’t perfect, it’s the fault of the woman involved. And that’s very harmful in a number of ways. It’s also incredibly unrealistic, because every natural process has a failure rate. The natural rate of miscarriage is 20 percent. So one in five pregnancies don’t survive long enough to make it to term. Also, 12 percent of women are infertile. If there’s that much “failure,” then why wouldn’t there be failure with breastfeeding? And there is, actually.
Q) When a mom fears she’s not producing enough milk, or that her baby is not satisfied after a feeding, she may be encouraged by lactationists to just keep nursing, and to pump between feedings to increase her supply. She may also be advised not to supplement with formula, as that may interfere with “supply and demand” or her ability to produce more milk. Is this good advice?
If you look at most pro-breastfeeding articles, they’ll tell you that insufficient breastmilk is rare when it is, in fact, common. They even sometimes [say it occurs in only] 1 to 2 percent of mothers. The scientific literature shows that up to 15 percent of first-time mothers will not be able to make enough milk, especially in the early days. So there’s a high incidence of insufficient breastmilk. I’m not saying that this is a cynical thing. Lactation consultants believe what they’re taught. But what they’re taught isn’t true. They’re also taught that the benefits of breastfeeding are massive when the fact is, the benefits of breastfeeding are trivial. The assumption is always that any problems nursing are psychological or [due to] lack of effort and not genetics.
Q) So is the ability to breastfeed successfully—to have enough milk—genetic?
Probably. Some [scientists] have found that there are biomarkers for insufficient breastmilk. It turns out that the breastmilk of women who are not making enough has much more sodium in it. So it turns out that women who believe that they’re making less milk are actually making less milk, and that their milk is different. These findings have important implications:
- Low breastmilk supply is an objective reality.
- Low milk supply is relatively common.
- Low milk supply is NOT maternal misperception.
Lactation consultants can satiate you by saying, “You’re making as much as your baby needs.” And of course different babies need different amounts, so it’s very difficult to say X amount is too little. But this study puts to lie this idea that women who don’t make enough aren’t trying hard enough or aren’t getting enough support. It’s not nurture. It’s nature.
Q) So if you feel you are not making enough milk, you should treat that seriously?
Absolutely. A recent study showed that exclusively breastfed infants have double the chance of being readmitted to the hospital as formula-fed infants because of breastfeeding problems. They’re starving. Either they’re malnourished or they’re dehydrated or they’re very jaundiced. And in the meantime, the lactation consultant is saying, “Just breastfeed, just breastfeed more, just pump in between breastfeeding.” The problem is, the focus is on the process not the outcome. So the focus is on how many babies go home from the hospital being exclusively breastfed, not on how many babies have to be readmitted because of the pressure to exclusively breastfeed. Supplementing with formula will not hurt your breastfeeding relationship. In fact, studies show that judicious formula supplementation in the first few days increases the chances of exclusive breastfeeding and increases the length for which women will exclusively breastfeed. And pacifiers! Not only are they good for babies and mothers, but they actually prevent SIDS. Not to mention that actually there’s no impact of pacifiers on breastfeeding. I think whoever invented the pacifier should get the Nobel Prize. Look, I say this as someone who breastfed four children without really any problems, who were fat and happy. I liked breastfeeding; breastfeeding can be a good thing. But it’s not perfect because nothing in nature is perfect. Up until I had my fourth child, I was working part-time. And then I actually walked away from my career, and I stayed home with my kids because that was what I wanted to do. But the fact is that a lot of women are being pressured to do things that they don’t want to do, that interfere with their career. People are more concerned with how many women exclusively breastfeed than whether or not anyone is actually benefiting from it.