A Mother's Dilemma

Last Editorial Review: 1/30/2005

Not enough milk?

WebMD Feature

July 31, 2000 -- Breastfeeding my first son Julian hadn't gone as I had planned. For months I prepared, just like all the moms I knew. I attended a breastfeeding workshop, selected a pro-breastfeeding pediatrician, hired an ardent breastfeeding advocate to be our birth and labor coach, and read up on the subject in many pregnancy and parenting books.

All to no avail. After Julian was born, I immediately knew something was wrong: My breasts didn't engorge or leak milk. I couldn't hear Julian swallow. And he never seemed satisfied after feedings. The problem, I discovered, was that my milk simply failed to come in. That discovery launched a confusing and emotional struggle to provide my son with the benefits of nursing while making sure he got enough to eat.

Between Two Camps

At first, everyone pooh-poohed my concerns. But within days they agreed there was a problem. Julian was rapidly losing weight, and he wasn't peeing or pooping. The hospital strongly recommended supplementing with formula, and I reluctantly allowed them to do so in 1- and 2-ounce increments, remembering all the dire warnings I'd read about the evils of supplementation. It was a slippery slope that would lead to more bottles and less nursing, then to less supply and, ultimately, to what the pro-breastfeeding experts called the worst of all possible fates -- "premature weaning."

Family members, friends, and professionals around me fell into two camps, neither terribly supportive. One urged me to give up on breastfeeding altogether and could not understand my dismay over what was happening. The other was convinced that I was doing something wrong and heaped upon me huge amounts of guilt.

My doula, a birth and post-partum coach I hired, ruefully told my husband and me that we'd "gone a bit overboard" after we confessed to giving the baby 5 ounces of formula the previous night despite fervent efforts to nurse. She also suggested that my milk supply had been derailed by how "career-minded" I'd been before having the baby. Much later, I discovered that the community of lactation professionals was just beginning to grudgingly admit that there really are bonafide cases of low milk supply.

Finding My Way

I eventually managed to establish a limited breastfeeding relationship with Julian. But it was only through a level of dedicated effort that, in retrospect, I feel was insane. I nursed on demand. I used a breast pump between feedings and ingested tons of fenugreek pills and tea. I tried several days of bed rest, conferred with lactation consultants, and pored through my large library of nursing references. I tried supplementing with an eyedropper to avoid the dreaded bottle, which resulted in an angry, hungry baby an hour later, and terribly chafed nipples.

What finally made a difference was using a supplemental nursing system, an ingenious contraption that delivers formula into the baby's mouth via a tiny plastic tube taped to the mom's nipple while he nurses. I used it at every feeding. After a few weeks, my breasts leaked milk for the first time. And a few weeks later, I first experienced the sensation of "letdown" -- the feeling of milk flowing in the breast. The nursing system had worked for me. But having to simultaneously fiddle with the tubes, tape, formula, and baby was a hassle. One night I forgot to screw the cap on tightly and spilled formula all over our bed.

Eventually I was able to hang up the nursing system. I found it easier to nurse Julian for the few minutes' worth of milk I had and follow up with a full bottle of formula. When I went back to work at six months, my scanty supply diminished further. (Pumping had been out of the question because I never succeeded in pumping more than 10 milliliters at a time). And by nine months, Julian lost interest in nursing altogether.

Breasts Dry, Eyes Wet

Breastfeeding advocates respond to my story warmly with "Oh, what a wonderful mother you are to have made such an effort for your child!" Or, "Your story makes me so sad for all the women who don't even bother to try." Although well meant, these comments miss the point.

Instead of enjoying those precious, fleeting days with my newborn, I spent two months crying at every feeding. I had really looked forward to nursing and wanted to provide my child with the benefits I had read about. And as I'd always been insecure about my small-breastedness, I was excited to be part of something in which, supposedly, size didn't matter.

Instead, I found myself dreading the thought of going out and bottle-feeding in public. All my new-mom friends breastfed with aplomb, and it was painful to be around them. I forgot to bring formula to one new-moms'-group outing, and when Julian got fussy with hunger, I finally explained to the group that I had to leave. One of my friends asked, in all innocence, "Can't you just breastfeed?" I felt my face grow hot with mortification as I stammered that I couldn't, and when I got home I sobbed and sobbed. I eventually turned to psychotherapy to deal with the depression over my breastfeeding failure.

So I was a mess, but Julian was fine. Four years later, he's healthy, beautiful, and bright. It's absolutely impossible to tell which of his peers were exclusively breastfed and which weren't. It simply doesn't seem to matter. And I have come to see that my efforts didn't necessarily prove what a wonderful, devoted mother I was. Rather, they demonstrated how pervasive the mentality of "breast is best, at all costs" has become and the extremes to which a supposedly rational person can go to pursue this ideal.

A New Strategy

With this realization, and hazed by my first experience, I determined to do things differently the second time around. I decided that I'd give it everything I had for four weeks and then give myself permission to quit, guilt-free, if breastfeeding wasn't working and if I was miserable. I amassed the paraphernalia I'd need: a breast pump, a baby scale to monitor the baby's weight gains and losses, a new supplemental nursing system, and yes, clean bottles and fresh cans of formula powder. I informed everyone around me of the plan and insisted on their support, both for the up-front effort and for whatever I decided afterward. I was ready.

Things got off to a good start with an easy birth, and brand-new Eliot came home with me the second day. On day three, my milk came in, and I was actually thrilled by the aches and pains of engorgement. Nevertheless, I still didn't make enough milk to exclusively breastfeed. The difference this time, though, was that I was content in feeding him what I had. I no longer saw supplementing with formula as a failure of motherhood.

My new lactation consultant was not only knowledgeable on the issue of low milk supply but compassionate and supportive as well. She also armed me with information about Reglan, which I persuaded my doctor to prescribe for me. (Reglan, a prescription medication ordinarily used for gastrointestinal problems, is reported to be an effective lactation-inducer.)

With that extra boost I made it to the end of my one-month "trial" period with a well-established, though not exclusive, breastfeeding relationship, which my 1-year-old and I still enjoy today.

A support group called Mothers Overcoming Breastfeeding Issues (MOBI) connected me with a large number of women whose experiences were almost identical to my own. I also learned about treatments, like Reglan, which could help promote milk production.

While resources like MOBI and my lactation consultant helped the second time around, no woman should endure the guilt trips I suffered. Women who want to and can breastfeed deserve every support -- medical, societal, and legislative -- to do so. But breastfeeding is not the be-all and end-all of motherhood. Women who can't or choose not to nurse also deserve support and respect. Feeding your children enough -- and with love -- is what really matters.

Naomi Williams is an editorial production manager for WebMD.

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