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The Breastfeeding Conspiracy

My milk came in five days after my son, Ezra, was born in 2007. I was able to feed him successfully until he was six weeks old. At that point, things changed. Ezra began to feed for four hours at a time, gnawing and tearing at my breast, which I began to fear was a dry well.

My pediatrician said the more the baby sucks, the more milk you make, end of story. A lactation consultant told me that if I could just relax more, my body would provide. I took all of their advice: I drank more water, took herbal supplements, pumped after every feeding to stimulate further production and even took a “nursing vacation” – three days in bed with baby, ready to feed at all times (the idea being that once you’ve removed stress and outside interference, and all you’re asking your body to do is keep the milk a-coming). Nothing worked. A week later, Ezra had lost half a pound.

Why was my milk supply drying up? It turns out I had what is denigratingly called “lactation failure” – a condition shared by 15% of nursing mothers. But what I didn’t know, and what many women don’t know – is that it’s not our fault.

There are two types of lactation failure: primary and secondary. Secondary failure, which affects 11% of women, means that they were able to produce enough milk at one point, but then their production dwindles, typically due to insufficient nutrition, poor milk supply management or problems with the child’s sucking.

But 4% have what is known as “primary lactation failure,” which means that no matter what you do, you just can’t make enough milk. Common reasons for this are glandular tissue problems, breast-shape, prior breast surgery or Sheehan’s syndrome, in which women who have a massive postpartum hemorrhage experience shock to the pituitary gland. (The pituitary regulates prolactin, the hormone that supplies breast milk.) Less common causes of primary lactation failure include high or low blood pressure, anemia and certain medications.

Primary, secondary – Ezra didn’t care about my diagnosis; he was starving. As I strove to find the answer, not one of the half-dozen L.A-based professionals I spoke with mentioned that there was a condition called primary lactation failure. In fact, every time I asked if it was possible that I just couldn’t produce enough milk, each told me there was no such thing. One said that if I had tried a little harder, then perhaps I wouldn’t be in this situation. I was inconsolable.

The La Leche League website was no more helpful. All I could come up with was a page that suggested I was either not breastfeeding enough, malnourished, dehydrated or just doing it wrong. “Some mothers think their babies are not getting enough milk when they are actually getting plenty of milk,” it reads. What it doesn’t say: You might not be capable of making enough milk.

These resources are surely helpful for treating someone with secondary lactation failure, but for the rest of us, they’re not only useless but guilt-provoking. Why won’t anyone acknowledge that some women simply don’t produce enough milk?

As it turns out, the answer may have to do with the origins of the lactation movement. “There’s an older generation of lactation consultants that came out of the La Leche League,” says Veronica Tingzon, a certified lactation consultant since 2005. “Like any movement, it was built on passion. These are some tough women who had to really fight to get women off formula and bottles.”

“I believe the reason women aren’t told about lactation failure is that there is a fear that it will lead to many women giving up before they’ve given breastfeeding a fair shot,” says Daria Hoffman, a certified lactation educator in Los Angeles. “It’s already often a struggle to prove to women that breast milk is superior to formula, though our numbers are improving, finally.” She’s right. In 1980, breastfeeding rates for women who breastfed “for at least some period of time” were at 54%. By 2004, it was up to 75%.

Why won’t anyone acknowledge that some women simply don’t produce enough milk? “Many women doubt their bodies and their ability to properly provide milk to their babies,” Hoffman continues. “The number one concern women have about breastfeeding is that they won’t – or don’t – have enough milk. Just think of the language associated with the term “lactation failure;” it denotes that as women, we have failed to provide this basic necessity to our child.”

“In a lot of the [consumer breastfeeding] literature, they call lactation failure ‘perceived insufficient milk,’” says Dr. Marianne Neifert, author of Great Expectations: The Essential Guide to Breastfeeding and co-founder of one of the first breastfeeding centers in the U.S. “Yes, some of it is perceived, but there is a lot of real low milk [supply] out there. The typical attitude is that everyone can breastfeed except the ones who have bad attitudes or did something wrong, [but] there are so many factors that lead to not making milk.”

Corky Harvey, co-founder of The Pump Station in Los Angeles, believes that many lactation professionals fear that women will stop breastfeeding if it seems too challenging. “Perhaps, in their zealousness, [lactation professionals] want you to understand that you can do this. Maybe they don’t mention the fact that a very small percentage can’t.”

Though Harvey is not directly referring to La Leche League when she says this, LLL’s influence is clearly in play. Formed in 1957 by seven women who were alarmed at the drop in breastfeeding rates to 20%, La Leche has global reach and is the world’s premier organization for breastfeeding support. They train leaders to visit or call new mothers who need help with breastfeeding, and many women who have trouble end up on their website or help line.

When I asked LLL why there was no hint as to the possibility of lactation failure on their comprehensive website, Loretta McCallister, LLL’s press representative, told me: “It probably hasn’t come up. It might be a story that hasn’t been presented. We are in the process of continually changing things on the website. That story would be a good addition.”

It’s impossible to believe that the go-to source for breastfeeding support has yet to come across a woman with primary lactation failure. In the numerous instances on the website where women ask about low milk supply, each time they’re greeted with the same answers I got: hydrate, eat well and try herbs like fenugreek. “Most commonly, the reason for low milk supply is a wrong position or something they’re not doing correctly,” says McCallister. “If I tell them it’s possible they won’t produce enough milk, they’ll use it as a crutch. They’ll give up. We want them to stay positive.” Perhaps LLL should acknowledge that it’s especially hard to stay positive when the supposed experts tell you you’re doing something wrong.

McCallister confirms that when a woman calls LLL and speaks with a leader, she is never told that primary lactation failure may be at play. “We ask questions and try to identify problems.” So are leaders trained to identify primary failure? “They’re trained to be reflective and empathetic. Most women just need some confidence and support. If they call back after trying everything the leader says, we tell them to talk to their health care professional.”

I understand that breastfeeding is an emotional and political subject. I understand that LLL and other breastfeeding advocates are fighting against an often hostile culture. There’s a war going on, but I feel like a victim of friendly fire. Had I been lucky, I would have consulted with The Pump Station and not just LLL before resigning myself to formula.

Harvey insists that while there are some overzealous lactation specialists, a good consultant sees the unique woman behind each pair of breasts. “We help you try. We do whatever it is we can to help. And in the percentage where nothing helps, in primary lactation failures, we say, ‘It’s okay for you to say uncle.’ We cry with them. [Imagine] the relief on women’s faces, on their cheeks, when they find out that there was a real reason they struggled, that they were not failures.”

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