“What type of freak am I?” Samantha wondered only two weeks after the birth of her daughter, Caroline. Just as she was embracing her new role as a mother, Samantha heard this question echo relentlessly in her mind, assaulting her confidence and self-worth.
Samantha defined herself as a freak because she could not produce enough milk for her newborn baby. After her uncomplicated vaginal delivery, breastfeeding was off to a great start. Or so she thought. The hospital lactation consultants told her the latch looked great, and her colostrum was flowing; all was well. Until it wasn’t.
Despite breastfeeding on demand, Caroline continued to lose weight in the hospital and Samantha was told to supplement. Although Samantha left the hospital with bottles of free formula, she still hoped her supply would increase so she could stick with her goal of exclusively breastfeeding her daughter.
The next two months of Samantha’s life were a whirlwind of anxiety, frustration, and hopelessness. Samantha breastfed little Caroline on demand, pumped her breasts after feeding, and yet her colostrum still did not transition to breastmilk until a week after she delivered. And the milk that did arrive was not enough to feed Caroline exclusively. Samantha soon reached out to an International Board Certified Lactation Consultant (IBCLC) to help determine the cause of her low milk supply. After ruling out infant-related causes such as tongue-tie or a shallow latch, the lactation consultant encouraged Samantha to get her thyroid levels checked. Postpartum thyroiditis, which affects 5-10% of women during the postpartum period, can adversely affect a woman’s milk production. Samantha’s obgyn ran the necessary labs but refused to interpret them, insisting she go to an endocrinologist. The endocrinologist told Samantha she was too stressed. The pediatrician told her to keep trying. And after several weeks of breastfeeding, pumping, supplementing, and blaming herself, Samantha stopped breastfeeding altogether.
We create “freaks” like Samantha every day and the formula companies reap the benefits. No, Samantha is not a freak. She has a medical condition that is making it impossible for her mammary organ to function normally. But we fail to diagnose and treat this condition. And we fail to perform the research necessary to reveal the true prevalence of this condition. But it is Samantha, and women like her that must carry the burden of those collective failures, feeling as though they themselves have somehow failed. And when they do not make enough milk, after learning from classes and books that true low milk supply is very rare, they feel like freaks. Can we blame them? Nope. But we can, and must, do more to help them.
What we call “breastfeeding” is actually two separate things: breastfeeding and lactation. Breastfeeding is the relationship between a mother and her baby in which the mother provides nutrition, comfort, and immune protection for her child. Lactation is the job the mammary organ must perform in order for breastfeeding to happen successfully. In our country, we have made extraordinary strides toward helping moms to breastfeed through both prenatal education as well as clinical support. Breastfeeding initiation rates are at an all-time high, and when mothers struggle, help is often ubiquitous, either in hospital-based support groups, La Leche League meetings, or from IBCLCs in the hospital, pediatrician’s office or private practice.
Unfortunately, we have not made similar strides in the field of lactation support. Not one medical professional currently carries the responsibility of screening, diagnosing and treating women for mammary organ dysfunction and failure (MODF). When the mammary organ is dysfunctional or fails outright, a mother has nowhere to turn. An IBCLC can only do so much to help a mother’s milk supply. Pumping, herbs, increasing skin-to-skin contact—these are the tools we IBCLCs have, and sometimes they are not enough.
Our healthcare system is failing new mothers and babies by not putting the same emphasis on lactation as it does on breastfeeding. What good is it to build a restaurant, hire a staff of waiters, and set the tables if there is not and never will be enough food in the kitchen? Our medical community needs to do more to ensure that the mothers who plan to breastfeed will not have the rug pulled out from under them at the very moment they are trying to gain their balance. Samantha describes feeling like Sisyphus, exhausted and utterly defeated in the face of the impossible. She recalls sitting alone in the baby’s nursery pumping while visitors and family enjoyed the baby in the other room. Isolated, overwhelmed, and inadequate. This is the fate that women who attempt to breastfeed exclusively but fail to lactate sufficiently are forced to accept.
Samantha eventually came to terms with her fate. But it took a long time. For awhile, she felt ashamed any time she would bottle-feed in public. “I would wonder,” she says, “if they could tell it was formula in the bottle. If they were judging me for my choice.” She pauses. “You know what? It was not a choice. It was not a choice for me and I want to know why.”
All mothers should have the choice to feed their baby however they wish and not be judged based on whether their nipple or their formula can is showing. But when mothers do not have a choice, when they are forced into a decision, backed into a corner at their most fragile, during one of the most physically and emotionally demanding times in their life, told by their doctor, their baby’s doctor, to relax, to get some rest, rather than given the medical care they need to fix a physiological problem, then something is very, very wrong.
Did you have a similar experience? If so, and you would like to share, please email me anytime: alex@bcclactation.com. I am currently researching ways to incorporate mammary function screening into our healthcare model. The more evidence and support we have for this, the more likely it will become a reality.