ó After struggling to breast-feed her first two children,
Nyssa Retter was determined to do better with her third.
birth without painkillers, which may make newborns slightly
drowsy. She chose a free-standing birth center staffed with
lactation-savvy midwives. She had skin-to-skin contact with
her daughter immediately after birth and consulted with
midwives when her daughter cried and screamed between
the babyís two-week weigh-in, Retter learned that, despite
all her efforts, her daughter was still below her birth weight
and would need formula supplementation.
only then that Retter verbally cornered a lactation consultant
and finally received a diagnosis.
have IGT, donít I?" said Retter, who had read online
about insufficient glandular tissue, a breast condition
strongly associated with the inability to produce enough milk
for a baby.
said the lactation consultant. "I think you do."
era when "breast is best" is trumpeted by the
government, by the medical profession and even by baby formula
companies, an estimated 1 to 5 percent of women are physically
unable to produce enough milk to feed their babies.
women are often ignored by doctors, given the brushoff by
old-school lactation consultants, and essentially left to fend
often see multiple health professionals without getting even a
diagnosis, much less comprehensive care, says Retter, a
co-administrator of the 1,300-member IGT and Low Milk Supply
Support Group on Facebook.
would love for every obstetrician to actively acknowledge this
and work with mothers to do everything they can to maximize
their milk supply," Retter says. "I would just love
for people to even know that it exists, just to acknowledge
us. Just to know that weíre here and help take care of us
and support us."
measure of how little attention chronic, primary or
"true" low milk supply has received, that no one
knows for sure how many women are affected.
cannot find a number for this," says Marianne Neifert, a
clinical professor of pediatrics at the University of Colorado
Denver School of Medicine who co-authored a 1990 study of 319
breast-feeding women that found 15 percent of the women were
unable to produce sufficient milk by three weeks postpartum.
attributes most of the low supply to problems such as sore
nipples and infant feeding difficulties, but she says 4
percent of the 319 women appeared to have chronic low milk
experts say that 1 to 5 percent of Western women are affected,
Neifert says, but she hasnít been able to find any
additional studies that support those numbers.
think itís a significant number of Western women," says
Neifert. "I would say 4 percent or just under 5
commonly recognized causes of chronic low milk supply are IGT
ó in which it is believed that the milk-producing structures
in the breast have failed to develop properly ó and breast
surgery, in which the ducts, or tubes, that carry milk to the
nipple may be severed.
on IGT (also called breast hypoplasia and tuberous breasts)
and its effect on lactation is almost nonexistent, with the
most widely quoted study cobbled together in 2000 by
enterprising nurses and lactation consultants who assembled 33
breast-feeding women with breast characteristics that they
suspected were linked to low milk production.
results were striking. Women with characteristics such as a
wide space between the breasts, breasts with a pronounced lack
of fullness, breasts with unusually small base circumferences,
and breasts that didnít grow during pregnancy, experienced
very high rates of chronic low milk supply.
first month, 55 percent of the women in the study produced
half or less than half of the milk their babies needed.
causes of low milk supply include thyroid disorders, pieces of
retained placenta, which would likely be accompanied by
abnormal postpartum bleeding, polycystic ovary syndrome, which
involves an imbalance of sex hormones, and Sjogrenís
syndrome, an autoimmune disease.
currently no clear-cut test for IGT, and some women with very
strong signs of it make enough milk. Similarly,
surgery-related lactation problems are hard to predict.
only way for a woman with risk factors to really know if she
has chronic low milk supply is to try breast-feeding with
proper technique and pumping, and see if it works.
process can be emotionally brutal.
was the most heartbreaking thing Iíve ever gone
through," says Nichole Pool, 27, of Tehachapi, Calif.,
whose baby nursed and cried more or less continually for three
days, despite help from a lactation consultant. "Hereís
this tiny little person who literally depends on me and my
husband for everything to keep her alive, and I donít
understand why sheís screaming. I just want to fix it. She
wasnít going to the bathroom or anything, and I was just
like, ĎIs something wrong with her?í I didnít sleep for
three days because I just wanted to hold her and make it
are some good lactation consultants, according to Krystal
Revai, a fellow of the Academy of Breastfeeding Medicine, but
if a woman has chronic low milk supply, she should seek the
help of an ABM physician, a doctor with breast-feeding
expertise. If youíre choosing among lactation consultants,
some low milk supply mothers suggest going with one who is
board certified and more likely to be up-to-date in her
such as fenugreek and the medications metoclopramide (Reglan)
and domperidone are sometimes used to boost milk supply, but
evidence that they work generally comes from poor-quality
studies, according to the ABM. Reglanís potential side
effects include depression, and domperidone is not
FDA-approved in the U.S. Herbs have allergic potential and may
women with low milk supply switch to formula feeding, saying
that grueling pumping routines produce minimal milk and major
breast-feed as much as they can, for months or even years.
with low milk supply, itís whatever keeps you sane ó thatís
the most important thing to do," says Retter, 28, who has
been breast-feeding her daughter for two years, supplementing
with formula and documenting her experience at her blog, Diary
of a Lactation Failure. "If (breast-feeding) works for
you, itís worth it to pull through the really hard days,
because once you get an older nursing baby, itís a lot of
STORY CAN END HERE)
Corrine Kolka Welt says she gets calls all the time from women
with low milk supply who want to try prolactin.
Welt, an associate professor at Harvard Medical School and
Massachusetts General Hospital who did a promising pilot study
in which injections of prolactin, a hormone that triggers milk
production, increased milk supply in mothers of pre-term
babies and women with prolactin deficiencies, has nothing to
offer the women who call. Genzyme, the company that produced
the form of prolactin she used in her study, has since stopped
making it, and no one else has stepped in.
many women suffer from chronic low milk supply, they only do
so for a limited amount of time, Welt says. That makes
medications less profitable than, say, insulin or Viagra,
which patients use for years.
someone would take this up and make it, I think there would be
a lot of women who would be interested in trying it,"