As I’ve mentioned in the past, I did my Masters degree on U.S. mothers and low milk supply. When I started my research I thought there must be studies out there that would show exactly how many families deal with low supply.
I expected to unearth some sort of perfect algorithm. My ultimate goal was to develop a tool that could help parents quantify their milk production, and get immediate customized help if needed.
But I never made that tool, and I never found that algorithm. Why? Because it turns out there’s very little solid, reliable research out there on low milk supply.
For the most part, “low milk supply” is a symptom, not a diagnosis. We know of plenty of situations that can cause low milk supply, like insufficient glandular tissue, or infrequent or insufficient milk removal, or oral or muscular issues in the baby, or thyroid problems in the nursing parent, or previous breast reduction or other surgeries, or retained placental fragments… the list goes on.
The thing is, we don’t really know how many parents are dealing with low milk supply.
the origins of “the mythical 5%”
There are some figures floating around- you often hear about what I call “the mythical 5%”- which, as best I could find, was traced back to a 1989 WHO (World Health Organization) publication that stated in industrialized countries, “a maximum in the range of 1-5% of women experience lactation failure on purely physiological grounds” (Akre, J. (1989). Health factors which may interfere with breast-feeding. WHO Bulletin Supplement, 67, 41-54.).
That statistic- on lactation failure due to the nursing parent’s physiology– not on any issues with the baby, or issues of breastfeeding management- is now repeatedly used incorrectly to claim that 5% of nursing parents have low milk supply.
Is it really only 5%? I HIGHLY doubt it, but we don’t know, because it would be incredibly unethical to study low milk supply in a controlled setting without intervening. You can’t say “oh, you think your baby isn’t eating enough? Let me lock the two of you in a lab for a week and study you, and watch the baby possibly lose weight and starve.”
When you find out a nursing parent is having trouble, you need to make sure that the baby is getting fed-whether it’s the parent’s milk, donor milk, or infant formula- because ignoring low milk production can have disastrous consequences.
In “Prevention of Breastfeeding Tragedies” (2001), Dr. Marianne Neifert discussed that parents may not recognize insufficient milk supply since they spend so much time with their babies and do not notice baby’s weight loss. Often these babies become lethargic and sleepy- rarely crying or fussing- which parents can mistake for being a “good baby”. As these babies become more and more dehydrated, they eat less and sleep more- what some professionals call being “content to starve.”
low milk supply and survey data
What we DO have data on is whether parents think they have low milk supply. It’s vitally important here that you understand me- I am not, not, NOT saying these parents are making things up. I’m not saying low milk supply is a myth. I’m not blaming anyone, I’m not casting doubt, I’m not accusing anyone of lying. I’m simply talking about how many parents in the United States have reported that they didn’t make enough milk for their baby.
- Studies in 2005 and 2009 found that the #1 reported reason for weaning is low milk supply (Wambach, K.,Campbell, S. H.,Gill, S. L., Dodgson, J. E., Abiona,T.C., & Heinig, M. J. (2005). Clinical lactation practice: 20 years of evidence. Journal of Human Lactation, 21, 245-258.) and (Mercer, J. & Thulier, D. (2009) Variables associated with breastfeeding duration. The journal of obstetric, gynecologic, & neonatal nursing. 38 (3), 259-268.)
- A 1994 national study of WIC participants found that 55% of respondents felt they didn’t make enough milk for their babies, and 34% reported that their milk supply was low in the first month of baby’s life (Fein, S., Grummer-Strawn, L., Labiner-Wolfe, J., Scanlon, K., & Shealy, K. (2008). Characteristics of breastfeeding practices among US mothers. Pediatrics, 122, s50-s55.)
- A 2005 survey of parents who stopped breastfeeding found that 45.5% of parents said they didn’t make enough milk, but only 11.7% of respondents reported that a health professional said baby wasn’t gaining well (Ahluwalia, I., Hsia, J., & Morrow, B. (2005) Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics, 116 (6), 1408-1413.)
- A worldwide study found that approximately 35% of parents report that they weaned because they didn’t make enough milk, and between 30-80% of ALL nursing parents report not making enough milk at some point (Gatti, L. (2008) Maternal perceptions of insufficient milk supply in breastfeeding. Journal of Nursing Scholarship, 40 (4). 355-363.)
Do you see how none of these survey results are jiving with that mythical 5% figure? The studies above report low milk supply concerns in a huge percentage of nursing families. This is a problem. A massive problem. What on earth is going on here? If the 5% is correct (and again, I don’t think it is) then where are the other reported 30-75% coming from?
Let’s dig deeper.
upcoming posts in the low milk supply series
In part 2 of this series, I’ll be discussing breastfeeding data sources from 1948 to present day and what it can teach us about low milk supply. Did you know that MOST of the data we have from breastfeeding parents in the USA is thanks to infant formula companies?
In part 3, we’ll talk about health care providers and what they know about milk production and insufficient milk supply- and why this matters.
In part 4 (which may need to grow into part 4, 5 and 6) we’ll delve into what parents know about milk production, what they hear about milk supply, and what symptoms make them suspect low milk supply.
Stick with me, folks. It’s gonna be a long, bumpy, milky ride. If you want to take the trip with me, you can subscribe to my blog via email here.
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