It’s something that most new mothers don’t know: breast-feeding doesn’t always work. The way the baby books describeit, breast-feeding is a foolproof, natural act that every woman can perform. But like any bodily function, lactation can fail. While the vast majority of women can breast-feed with no trouble, as many as 5 percent cannot produce enough milk to feed their babies. At a time of increased understanding about the benefits of breast-feeding–the American Academy of Pediatrics now recommends that babies be nursed for 12 months–there’s also new attention being paid to why some women can’t do it.
Addressing the subject is critical. If low milk supply is not rectified promptly, infants can become severely malnourished. In rare instances, breast-fed babies have died; a Brooklyn, N.Y., woman whose breast-fed infant died of starvation was charged with criminally negligent homicide (the charge was later dropped). “People don’t like to talk about this in the breast-feeding-promotion world,” says Marianne Neifert, a Denver-based pediatrician and lactation specialist. When Neifert first published her data on failed breast-feeding in the late 1980s, “nobody wanted to hear it,” she says. But gradually the breast-feeding establishment has come around. “Insufficient milk is real,” says Ruth Lawrence, a neonatologist and member of La Leche League International’s Health Advisory Council. “Sometimes it’s due to lack of support and information. Sometimes it’s unavoidable.”
In Neifert’s new book, “Dr. Mom’s Guide to Breastfeeding,” she divides lactation insufficiency into two types, primary and secondary. Primary insufficiency, which affects between 2 and 5 percent of women, occurs when the body cannot make enough milk to sustain a baby. It can result from breast surgery, a hormone imbalance or inadequate breast tissue, and is rarely correctable. Most women with primary insufficiency will need to supplement with formula. For some, that can be devastating news. “It taps into every woman’s fear that she won’t be a good mother,” says Noelle Walters, 36, a psychotherapist from Madison, N.J., who couldn’t produce enough milk for her son, Will. “I was able to grow this baby and birth this baby, but I couldn’t provide for it.”
An additional 10 to 15 percent of women suffer from what Neifert calls secondary insufficiency, and what others might simply refer to as breast-feeding problems. In those cases, the breasts fill with milk but something interferes with the baby’s getting it, like cracked nipples or the infant’s weak sucking. Secondary insufficiency is generally fixable–if caught early. Remedies include adjusting the nursing position or using warm compresses or a breast pump to relieve engorgement or sore nipples.
While most breast-feeding organizations today acknowledge that the problem of insufficient milk exists, they disagree over its prevalence. According to Marsha Walker, president of the International Lactation Consultant Association, “less than 1 percent” of women suffer from irreversible insufficiency. One reason the numbers are in such dispute is that so many women who can breast-feed just give it up because they think they have insufficient milk. " ‘I just didn’t have enough milk’ has been the No. 1 excuse for stopping breast-feeding," says Maria Parlapiano, director of the Lactation Resource Center in Chatham, N.J. “But often it’s just a misinterpretation of the baby’s behavior, like feeding every two hours.” There are clear warning signs for when nursing is simply not likely to work.
But even mothers short on milk needn’t give up nursing altogether. Herbal supplements like fenugreek and thistle have proved mildly effective in boosting milk production in women with primary insufficiency, as has the prescription drug Reglan. A device made by Medela allows a breast-feeding mother to simultaneously feed her baby formula through a thin tube attached to her nipple. As Sue Anderson discovered, some babies enjoy nursing even after they start on a bottle. Not only does her son, Victor, breast-feed before each bottle, but he also suckles for comfort or to put himself to sleep. “I’m doing the best I can,” she says. “I know he’s getting some benefit from what I’m giving him.” Whatever the benefits of breast milk, they can’t outshine the love of a relaxed and happy mom.
