'There Are No Tests': The Stunning Lack of Medical Support for Breastfeeding Women

'There Are No Tests': The Stunning Lack of Medical Support for Breastfeeding Women
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The following post is the fourth in a series of excerpts adapted from Unlatched: The Evolution of Breastfeeding and the Making of a Controversy by Jennifer Grayson, out now from HarperCollins.

"If you've got something wrong with your liver, what would you expect to happen?" asked Professor Peter Hartmann in a soft-spoken Aussie accent.

I was video chatting with Hartmann, founder of the Human Lactation Research Group at the University of Western Australia, and inarguably one of the world's leading authorities on human lactation. He likewise could be called a pioneer in that space. Now in his seventies, he is also professor emeritus and senior honorary research fellow at the university's School of Chemistry and Biochemistry (read: retired but not really retired).

When he arrived at the school in 1972, after beginning his career in bovine lactation, and began to apply for research grants to study breastfeeding women (the birth of his daughter in 1971 turned his interest toward humans), less than 50 percent of Australian women were breastfeeding. "They wanted to know why I wanted to study these 'unusual women,'" he said with a smirk.

As the neatly bearded Hartmann smiled at me from behind his desk, I had an inkling that he was setting me up for a professorial explanation. I ventured, "What would happen if there was something wrong with my liver? Um, I would be in danger of possibly dying or my whole body shutting down."

Hartmann stared at me patiently. "Yes, but what preventive measures would you take?"

I scanned my brain for any knowledge I had about ways to prevent liver failure (not mixing alcohol and Tylenol?) and then guessed that this probably wasn't what he was driving at. "What do you mean?" I asked.

He tried again. "If something was wrong with your liver, would you go to the doctor?"

"Yeah, of course," I replied.

"OK, stop right there," he said. "If you've got a breastfeeding problem and you go to the doctor, what's going to happen?"

"Well, yes, I know," I started. "If you're lucky enough to have access to one of the few breastfeeding medicine doctors in the US, maybe they'll order a couple of diagnostic tests. Otherwise, hopefully, you'll be referred to a lactation consultant."

"There are no tests," he said. I spied a twinkle behind his glasses. "No tests for normality."

Translation: If a mother was having a hard time getting her infant to latch on, or she thought that her body wasn't producing enough milk, a lactation consultant could help her only with the mechanics and would doubtless suggest she put her baby to the breast more frequently. A breastfeeding medicine specialist (essentially a doctor with lactation consultant qualifications) could also check for overall hormonal imbalances, such as a thyroid condition, that could impede milk production.

But Hartmann pointed out that there was no specific test that targeted the breasts -- the organs themselves -- to see if their function was "normal." In fact, he added, the reference range for what is normal doesn't even exist. He offered the analogy of being screened for diabetes with a glucose tolerance test. If results fall outside the expected range, the patient is likely to be diagnosed with the disease.

Yet no one had definitively determined the same kind of expected range (known as a reference value) for lactation, even though Hartmann and his colleagues knew from their own research that a woman's daily milk production could fluctuate from about 500 mL to as much as 1,200 mL a day. They had also pinpointed other biochemical indicators such as progesterone, which dropped off precipitously after a baby was born and before the onset of lactation.

"Every hospital around can measure progesterone," he stated. "Why wouldn't you measure progesterone in a mother who seems like she's having a bit of a hard time with initiation?"

Hartmann thinks the utter void of knowledge about the breast is downright astonishing, especially given its role as one of humankind's most essential organs. "The energy output in lactating breasts is about 30 percent of a mother's resting energy in total. That's more than the brain. That's more than the heart!" he exclaimed. "Anything in the body that consumes 30 percent of its energy has, evolutionary-wise, got to be incredibly important for survival."

Of course, if prehistoric mothers had been facing problems of milk insufficiency with the global pervasiveness that exists today, it is pretty conceivable that mankind would have died out a long time ago. It's been estimated that anywhere from 1 to 5 percent of women are physically unable to produce breast milk, which is known medically as "failed lactation." (Yup, we've got a term for it, but we don't have any idea how to definitively diagnose or possibly treat it.)

But looking at the data, it was clear that the problem had become more widespread. In the Unites States alone, an astounding 50 percent of mothers cited insufficient milk, or low supply, as their reason for stopping breastfeeding, in one recent study.

This isn't normal, said Hartmann, and expressed his moral concerns about the situation we had created -- that we were promoting "breast is best" while simultaneously allowing women to breastfeed through horrific pain and without the medical knowledge to reassure them that they were actually making enough milk to feed their children. But he also believed that something had gone terribly wrong in our modern world...

Excerpt adapted from Unlatched: The Evolution of Breastfeeding and the Making of a Controversy. Copyright © 2016 Jennifer Grayson. Reprinted with permission from HarperCollins.

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