As much as many of us who are breastfeeding junkies don’t want to believe it actually can happen, it can and it does. Breastfeeding is a general term most likely defined as the act of placing a baby at the breast and while the baby suckles, milk is transferred from mom to the baby. But as simple as that is for the majority of moms and babies worldwide, for a few small percent, it is not that easy.
So where does it go off for some moms (we will talk about the baby later)? The body is a well defined machine, and when something is a bit off it can cause problems or challenges. A rare but very challenging issue is Insufficient Glandular Tissue. In this situation, when mom was going through puberty her breast never develop enough glandular tissue to produce an adequate supply of milk. Some women are only able to produce 2-5 ml per feeding per breast while others can produce 15-30ml. In these cases it does not matter how frequent baby feeds or she pumps nor how much herbs she takes to increase her supply. Her breast can only produce so much because there is a lack of sufficient glandular tissue. She simply doesn’t have enough structure to produce higher volume. Her body is making milk, just usually not enough for each feeding.
Other causes are when the endocrine system has an imbalance. When the placenta clears the body the drop in progesterone causes Lactogenesis II, what many call “the mature milk”. This happens because of a drop in hormones, from that point it then becomes an autocrine action. The basic demand and supply action. However if there are hormone imbalances, it can cause an upset. For some women it is worse than others. Seeking help beyond a lactation consultant to an endocrinologist can sometimes prove helpful, but just because we know there is an imbalance doesn’t mean it is an easy fix. Once again these challenges often cause a volume issue.
In some cases, the mother may have a medical issue in which a medication which is contraindicated with breastfeeding is necessary to treat the disease or a type of medical test that would cause a temporary need to cease feeding the baby breastmilk, until the medication/treatment had cleared mom’s system. This is seen more commonly in radiology type testing. In these producing the milk is not the problem, but what has transferred in to the milk from moms body can be an issue for baby.
Breastfeeding is an action in which two participants benefit. But, sometimes mom has a wonderful supply of milk, but the baby has some challenges. In these cases it often has to do with oral structure or oral motor problems. While the breast has done its job producing the milk, it is now baby’s job to remove the milk.
Babies who have a cleft palate/lip for example, usually have the ability to suckle, but because of the opening caused by the cleft, there is not enough suction created to move the milk from the breast to the baby. There are varying degrees of cleft palate and lip which in return affect the capacity of baby to move the milk.
Babies born premature can have many challenges, and may take several weeks, before they are able to coordinate the suck, swallow, breath rhythm needed to breastfeed. The neurologically impaired baby may not have the capacity to suckle effectively as well.
Then, there are various shape and sizes of nipples to which some babies just have a hard time manipulating the nipple in their mouth, and some just need a little time to acclimate to the breast.
Regardless of the situation you may find yourself in when working with moms and babies, the most critical thing you can do is offer good support and education. When faced with disappointing news that is opposite of her dream of nursing her baby, have a heart to heart discussion and help her explore realistic boundaries for her and her baby. For example, for the mom who has insufficient glandular tissue, a realistic picture might look like this: She would be encouraged to provide what milk she is producing as “immunizing” her baby, and allowing the baby to suckle at the breast with a device/tube alongside the nipple, that provides an infant formula, in addition to what her baby is getting from her breast.
Our job is to provide evidenced base information and support moms and babies. It is never to judge, and yes sometimes it is to sit with a mom, when she hears the devastating news that breastfeeding isn’t going to look like what she had in mind, and hold her hand and tell her your sorry, but that you are here to support her.
Kathy Bradley, IBCLC, CD, ICCE
Kathy has been involved with perinatal education and health care since 1989. She is owner of Childbirth Concierge™ and holds a degree in Communication and Public Relations. She is an Internationally Board Certified Lactation Consultant, Childbirth Educator, Certified Doula, and serves on the Council of Licensed Midwifery for Florida Department of Health. She is the Director of Perinatal Education with the Commonsense Childbirth School of Midwifery, and works with mom and babies at Winnie Palmer Hospital in Orlando, FL. Kathy has also been in private practice since 1991 and resides in Rockledge , Florida with her five children. You can reach her at firstname.lastname@example.org
Please note that the author acknowledges that not all the challenges presented here are defined as situations in which mom and baby can NOT breastfeed, but that there are varying degrees and each situation is specific and unique to each mother and baby.