Insufficient Milk Syndrome: A Fallacy Becomes a Reality
by Dr. Linda Folden Palmer
Revised July, 2008
There is a very tiny percentage of unaltered women who truly, physiologically, will not be able to create breastmilk. There are far more mothers whose ability to breastfeed becomes jeopardized by interruptions in the natural processes, by stress, and by bad advice. If you listen to the complaints to and advice from pediatricians, you would believe that insufficient breastmilk is a very popular problem. The truly unfortunate syndrome is rather one of most pediatricians recieving all of their infant feeding education from formula manufacturers; very inaccurate and unnatural advice that creates multitude opportunities for the requirement of formula supplementations.
The fact is, mother’s breasts are designed to produce as much milk as baby desires, whenever natural feeding is allowed. Careful studies demonstrate that nearly all mothers who initially complain of insufficient milk are in fact producing adequate quantities, and their babies are growing normally.
A survey of lactation literature seems to point to around 1.5 percent of all women around the world who physiologically cannot produce any, or sufficient milk. These are the moms who originally would have needed to opt for donor milk, and artificial breastmilk (formula) lacking immune provisions.
In the United States the percentage of mothers who desire to breastfeed but end up being unable to is closer to 15%. Interruptions of hormones during or after birth, interruption with the hormonal bonding process, lack of nursing in the first hour after birth, heavily sedated newborns, and stress during or after pregnancy are a few factors responsible. Infrequent feedings, scheduled feedings, and formula supplementation are the next factors in line to jeopardize successful breastfeeding. Regular, frequent stimulation of oxytocin and prolactin by the act of breastfeeding is required to keep milk levels flowing. Constant babble about whether baby sleeps through the night is the final threat to successful breastfeeding. Human babies are designed to be fed during the night. Most all of these moms can become successful with specialized attention from a good lactation consultant.
Besides all of these problems, often simply a faulty perception of insufficiency becomes a reality.
Supply and demand
When a baby cries with hunger but a schedule prevents feeding, mother’s body still responds to the cries with oxytocin release. But when the milk is not taken, prolactin is not produced; thus, there is no milk production when suckling does not occur. Just as a dog will stop responding to your call when no reward is given, hormone and milk production decrease when the body perceives that the need is less. Then when formula supplements are provided to an infant, the amount it takes from the breast is further reduced, again decreasing the amount the breast believes it should produce.
If milk production is suspected to be inadequate, the last thing to do is to provide a supplement to baby. The first thing to do is to increase nursing time and frequency and make sure the mother is not dehydrated. The milk supply can be quickly renewed within a few days in this way if supplementation or infrequent feedings have caused decreased production.
Am I full yet?
In addition to self-serving marketing, poor medical advice and misinformed family advisors, another reason many mothers feel they have inadequate milk is that a few days after birth and then for several weeks more, there is a sensation of breast engorgement. This sensation is natural in the beginning and is probably designed to guide mother’s behavior to get breastfeeding established.
After a while, as the breasts “figure out” the milk levels required, and hormone levels adjust, this engorged sensation lessens or disappears and breasts remain less full, producing most milk only on demand. As this breast filling reduces, some mothers wait for prolonged intervals to feed until they feel their breasts are engorged. Every time this happens, the breasts fill more and more slowly and produce milk with less fervor. Hence, a natural process turns into a true problem.
Trying to maintain an engorged sensation can also lead to mastitis, an inflammation of breast ducts due to pooling of bacteria or Candida. At this point, certain ducts do not produce normally. Slower but not inadequate milk production is the result.
Priming the pump
The production of any notable quantity of milk does not occur for two to four days after birth. This too is by design. If formula supplements are given during the period when there should be frequent suckling and taking of important colostrum, the stimulation of milk production will be inadequate. In fact, the likelihood of breastfeeding is dangerously impaired by early formula supplementation.
The first few days of colostrum provides a high degree of important immune protection during this most vulnerable period. At the same time, with minimal fluid intake and little to digest, the infant’s system rids itself of excess fluid and develops balanced kidney control, clears intestine-clogging meconium and ramps up for its first attempts at digestion, with the help of some initial growth-promoting factors received from the colostrum. At birth, the system is not instantly ready to begin full digestive and elimination duties but needs a few days of “priming.” This is well known for premature infants but not always remembered in term newborns.
When There's Just No Milk
Any time mother’s milk production has diminished or disappears, which occurs during instances such as restricted access to a preterm baby in intensive care (which should not occur), relactation can be induced with frequent pumping and suckling and sometimes with hormonal supplements. By this same means, some adopted babies can be breastfed as well. Some mothers who create no milk still nurse their babies at their breasts for the hormonal, neurological and emotional benefits as well as simple comforting and sleep-inducing. Using an SNS device, a milkless mom can provide donor milk or formula while baby nurses at her breast.
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D.J. Chapman and R. Perez-Escamilla, “Identification of risk factors for delayed onset of lactation,” J Am Diet Assoc 99, no. 4 (Apr 1999): 450-4.
K Nemba, “Induced lactation: a study of 37 non-puerperal mothers,” J Trop Pedatr 40, no. 4 (Aug 1994): 240-2.