Mom Knows Best: Let’s Take Low Milk Supply Seriously

‘Do no harm’ applies to clinical language too

Moms are routinely told by trust-worthy medical professionals that their low milk production is simply perceived, and if they keep trying a bit harder they will eventually successfully produce all the milk their baby needs to grow. This dismissal of a potentially life-threatening issue contributes to the diverse types of mom-guilt that blind moms to the million other ways they are nurturing their babies each day.

So yes, moms are perceiving ‘successful’ breastfeeding as the end-all be-all of motherhood, but no, moms are absolutely not simply ‘perceiving lactational insufficiency,’ as diagnosed by the medical community.

When new moms reach out to a pediatrician, obstetrician, midwife, doula, lactation consultant, or local mom’s group, they are looking for support, guidance, and empathy. Instead, far too many are being gaslit — the last thing over-tired hormonal women need to feel is like they are crazy.

Courtesy of Oxford Languages

This gaslighting is based on the insulting assumption that women can’t be trusted to make informed decisions about their own bodies and babies. Those whom we trust to share knowledge about our bodies too quickly reassure us that breastfeeding will just turn out fine. They fear that informing women about the challenges of breastfeeding will lead to reduced initiation. While this tactic may encourage initiation, it surely reduces continuation as moms are unprepared to manage the unromantic reality of breastfeeding. How strange is it that medical professionals would rather prioritize exclusive breastfeeding, which is unfairly portrayed as the magic bullet to childhood wellbeing, over a mom’s sanity and sense of worth? Hiding the truth forces women to start motherhood blindly, without the support and knowledge they need for guidance and peace of mind.

Hiding the truth can also be fatal: when babies don’t get enough nutrition and hydration, they can’t survive. When low milk supply is deemed perceived and insufficient, mothers are told to trust that their baby is getting adequate nutrition rather than trust their instincts. Clinical language must be revised to reflect the realities of infant feeding — ‘do no harm’ applies to words too.

While it’s challenging to determine the true prevalence of ‘perceived lactational insufficiency,’ a 2008 study analyzed 20 studies conducted in communities around the world to sense the frequency of this gaslighting — the reality is somewhere between 30% to 80%. Of women who wean early, approximately 35% reported perception of low milk supply as the primary reason.

When new moms aren’t supported with prenatal and postpartum lactation education, they’re not given a fair chance to fight the fight that breastfeeding can be.

The assumption that breastfeeding will magically happen, without much research or forethought, leaves new moms feeling broken when they struggle to produce milk. While breastfeeding is definitely a skill that takes trial and error, lots of practice, and a bit of luck, we only have so much influence over how efficiently our mammary epithelial cells make milk.

The fact that we don’t know enough about the physiological challenges of lactation isn’t because they aren’t real; it’s because the current terminology disincentivizes this research. Preliminary research is uncovering real biophysical reasons (genetic markers such as those that control the levels of potassium and sodium) that dictate milk-making — lactation cookies will only go so far.

While frustrating to accept, we hope this reality check provides comfort in knowing that a mom’s concerns are scientifically valid, her effort can only go so far, and her love for her baby is completely unaffected by the genetics of her milk-making cells.

Leila with her daughter Violet, 2013

Let’s stop celebrating moms who sacrifice their sanity and their sense of worth for the sake of forcing breastfeeding to happen. Let’s remember that sacrificing is already inherent to parenting so we may as well determine which sacrifices are worth it. Let’s stop perceiving formula-feeding as an easy way out. Let’s grieve the lack of control we’d hope we have. Let’s normalize genetics that suck. Let’s empower clinicians with more lactation education. Let’s stop gaslighting women — moms with happy and healthy babies are anything but failures.

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