This is a question I hear from a lot of moms who are doing everything right, following all the advice and still they’re not producing enough milk for their baby.
I met with Elisa*, a mom, who I’d cared for throughout all of her 4 pregnancies. She was the kind of mom who makes it all seem so easy. She juggled part time work as a nurse while also caring for her children. She breastfed her first three children exclusively without any issues and said to me once, “If I can do it, then there’s no reason why every mom can’t breastfeed. I think it’s just laziness.” Elisa was dismissive of the reality that many moms face. Then, without warning, the unexpected happened with her fourth child.
Elisa is shocked
Elisa’s pregnancy and delivery were uneventful, she even took more time off for this fourth baby, because she knew he would be her last. Elisa wanted to enjoy and savor the time she had with her beautiful baby boy. I called to check on her 1 week after her delivery and she was distraught. Her milk hadn’t come in. She was putting the baby to her breast every 2 hours, pumping in between, resting, drinking tons of fluids. She had her sister come to watch her other kids. Her husband bought fenugreek and mother’s milk tea. Even after pumping for 15 minutes, all that she saw was a pathetic trickle of milk. This was shocking because in the past she had more than enough milk with her other 3 babies. She had been able to stock the freezer with her abundant supply.
Pumping, Resting and Fluids
I asked her to come in right away and we reviewed all of the recommended techniques to help her increase her milk supply. She was doing everything right. Elisa rested, relaxed, pumped, drank extra liquids. Her technique was perfect, the baby was a good sucker, he didn’t thrust his tongue or have any issues, except that he was hungry. She got a massage, then tried herbs, she tried everything to help her produce more than a few drops of breast milk.
Elisa would have stood on her head if it would have helped. Nothing worked! As a nurse she knew that she had to supplement with formula until her milk came in or she produced more than a few drops. She continued trying for a few weeks, which I had to admire because after a few days most of us mere mortals might have given up. By week 4, when she looked into the bottle that was attached to the pump and only saw about 2 teaspoons after 20 minutes, even she had to concede that it just wasn’t working. She wasn’t making enough milk for her baby. And, she wasn’t lazy, far from it. Her body didn’t work the way she wanted it to. It was maddening and frustrating. She was angry and disappointed.
Elisa’s routine was to put the baby to her breasts, then offer a bottle of prepared formula. After he finished eating, she would pump. Thank goodness, he was growing and thriving, while she did her best to breastfeed. When I saw her at week 6, she told me that she decided to stop pumping and spend that time caring for her other children and herself. “I’m exhausted,” she revealed. “I thought that breastfeeding was the holy grail, but I know that there’s so much more to being a good mom.”
It’s not always easy
I saw Elisa again when her baby was 6 months old. She was more rested and philosophical. “I learned a lot, “ Elisa said while bouncing her healthy boy on her lap. “I thought that breastfeeding was easy, just because it had been so easy for me with my first 3. I didn’t realize until I had to deal with the reality of the unexpected that not being able to breastfeed was something that many women had to deal with.” She went on to describe how sorry she felt for being so judgmental of other moms who weren’t breastfeeding. “I really had to examine my prejudices and attitudes,” she said. “I was guilty of thinking that just because I had it all figured out, that everyone else did too and then I got a big dose of reality.”
“You see,” she explained, “I was definitely a Type A person. I had everything planned and did everything in my life perfectly. I had no time or patience for anyone who didn’t measure up to my standards. Then life threw me a curve ball. What would I have done without formula? What would have happened to my baby. He had to eat!”
Each mom’s experience with feeding her baby is as unique as she is. There are many different reasons why a mom uses formula, some are within her control and some are not. The most important aspect is to provide support to all moms. We, as health care providers need to provide all the support, education and help for breastfeeding that we can. If breastfeeding isn’t working out, for whatever reason, then,we also have to be realistic, not induce guilt and help that family in their own unique situation find the best solution, because after all, the most important factor is making sure our babies get the healthy nutrition they need to grow up healthy and strong.