Executive Summary

I had a thought today that I would like to know the answer to. With so much publicized research being done on the properties of breast milk (antimicrobial, stem cell properties, brain development and so on), where is the research into real lactation problems? Where is the safe approved drug to increase milk supply (Metclopramide isn’t really ‘safe’ and Domperidone isn’t really ‘approved’), where are the actual diagnoses for supply problems? Maybe companies would rather head toward synthesizing the properties of breast milk rather than helping to fix bodies to produce it. After all it’s only several hundred thousand women a year, and formula does exist (my tongue is so far into my cheek it might poke through…)

I don’t know. I suspect there is not a satisfactory answer.

So I leave you with this. A short guide to various posts that are intended to be helpful.

I need help:

How to interview a Lactation Consultant

11 things a Lactation Consultant should know how to do (IMO).

Do I need help?

I find my tongue tie resources out of date, though you can see my experience here. For better information I would urge joining this Facebook group. They maintain lists of providers and are fairly knowledgeable about what is to be expected. If a provider is not on their list people can often recommend local alternatives (for instance I know of at least 4 laser tongue tie release places in New Zealand now, but none has made the general list. Do see the New Zealand Tongue Tie resources page instead.)

I need to combination feed-how do I do this?

The big fat Combo feeding FAQ

Walking the line

Benefits of

With low supply

SNS tutorial

Nipple confusion

Managing long term




Body Image

What is causing this?


Potential causes

Birth complications

Rare vs Undiagnosed

My most popular post

Making Milk beads

And the rest of my life.

I think I no longer feel bad, because it isn’t something I did wrong. It’s purely a medical issue.  A medical issue that some people would have me believe is my fault. A medical issue I cannot get satisfactory treatment for and that is largely undiagnosed. That makes me mad.

I lie. I still feel bad and somewhat inadequate, but I no longer feel guilt. I do wonder how much of my feeling bad is a normal level for someone suddenly faced with a non-life threatening failure of a body part. Somehow I can’t imagine people feel a mix of loss of gender identity and self loathing after losing a kidney or having a splenectomy. Or losing a finger or a limb. I’m sure there are other mixed feelings but I wonder how often self hatred/loathing/failure is a part of that.

Not trying hard enough

Not trying hard enough is a phrase that has haunted me most of my life. For a long time it’s been applied vaguely at me in regards to weight loss. Despite my counting calories, and measuring or weighing most everything I eat and seeing no results. I bought into the idea that I must be doing something wrong and that I wasn’t trying hard enough. Now that I’ve finally (finally!) been diagnosed with PCOS I can give myself a little bit less of a hard time.

When breastfeeding went wrong and people actually said to me that I needed to work harder and that I wasn’t trying hard enough (also see: lazy, uneducated, and so on) I again bought into the idea that I wasn’t trying hard enough and it ate me up inside. I mean so many people were saying (mostly without knowing the specifics) that there must be something I was doing wrong.

Thing is, in a normal situation these things are not rocket science. They are simply not that hard. When you aren’t in a normal situation though, all bets are off. There are lots of variations on not normal, so be cool and give support.

This time around has been a really different experience for a lot of reasons. If I had more time I could write guides about horrible sleepy fussy babies with oral particular-ness and how much more this low supply gig sucks when you also have a toddler.  Most importantly though I know this time I am totally awesome and actually pretty damn hardcore for being able to do this.

I ran into some internet comments the other day espousing the same old tired bullshit that low supply is ultra rare and that people who say they have it are all a big bunch of lazy liars and blah blah blah. It made me a bit weepy because I’d forgotten how many of that type of ‘lactivist’ there still are. Here I’d been thinking that recent media exposure on the prevalence of breastfeeding issues had somewhat changed the landscape in the past two years. Ha, I say. Ha.

Someone else in the same stream of comments said something along the lines of ‘Well 99% of pancreases work so diabetes is ultra rare and you only think you have it’. Someone else countered with ‘Don’t eat 50 donuts a day and expect your pancreas to work’. I then thought, if anyone told a type 1 diabetic that eating donuts caused their disease they would just be convinced that person was a moron. Put it all in perspective for me. Anyone who ever thinks I didn’t or I’m not trying hard enough I can automatically dismiss as a moron.


The root of the 1% myth

I finally found the research that is behind the statement that 99%, 98%, ‘almost all women’, can breastfeed. It’s contained in a WHO report from 1989.

In the report nearly 4000 women from Nigeria and Zaire, as well as 450 from Guatemala are followed. No lactation failure is observed. You can read it at the link above.

Here’s my problems with the study in comparison to our industrial world.

Ancestral diet: In pre-industrial societies the population is more likely to be eating what they have been eating for the past several centuries. This means allergies are more likely to have worked themselves out of the population. Us in the western world? We’re eating sugars and processed flours and food additives, colors and dyes and flavors, not to mention foods our ancestors didn’t eat.

Genetic diversity: People in the USA, New Zealand, Australia, Europe, the UK and similar countries are less genetically diverse than African populations. However, this African genetic diversity is cluster or tribally based and not the hybrid mix that is found in the Western/developed world. That is, while many variations on the theme of humanity are present in Africa, they are not mixed as much as might be found elsewhere in the world. This means that while the populations are diverse, each individual population has gained genetic stability for issues like tongue tie and PCOS. Possibly to the point that these issues have been, to some degree, bred out of these populations. (See the comments as there are some important clarifications discussed there)

Chemical exposure: In industrial societies we’ve had decades of being exposed to endocrine disruptors, pesticides and industrial toxins. This means we are more subject to the things that go along with that, like endocrine disorders, autoimmune disease, and genetic mutations.

Modern medical science: We now have women surviving childbirth who may not have without modern medicine, and likely would not in a less developed country. The 2005 WHO report indicates a ‘natural’ childbirth mortality rate of 1-1.5%. This includes issues like high blood loss (a factor in lactation failure), postpartum infection (potentially as a result of retained placenta, another potential lactation issue). We also have women conceiving who may not have in the past.

The 1989 study above puts the blame on psychosocial factors for women not breastfeeding and seems to imply that all lactation failure is a result of perceived insufficiency rather than actual issues.  In addition it makes the assumption about the nearly 4000 African women that secreting milk=enough milk to sustain the infant. For the Guatemalan women the 448 are over an 8 year period and apparently all living children were all successfully breastfed. I’ve mused before that the 98-99% is potentially the percentage of mothers unable to secrete milk at all. A figure that meshes well with the ‘natural’ childbirth mortality rate incidentally. Or unable to physically put the baby to the breast due to serious medical issues like postpartum cardiomyopathy.

All of these factors contribute to a higher rate in developed countries. Simply put we are not women living traditionally in Africa. The differences between the populations considered are of considerable significance. The psychosocial factor is of importance, but for those who did educate themselves, did ‘do everything right’ and still experienced issues, it is clearly not the only meaningful factor.