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What's the "official line" on physical inability to breast feed?

(104 Posts)
Turniphead1 Thu 17-Jul-08 14:16:45

Picked up a copy of Clare Byam-Cook's "what to expect when you're breast-feeding and what if you can't" book today in the library today.

Now, I NOW know (didn't before) from the wise MNers that Clare is to be taken with a large pinch of salt, as she is not a qualified lactation consultant etc...

But she says early on that she firmly believes that not all women CAN breastfeed, even given experts help, as our bodies are not perect and don't always work as they should. She makes an analogy between people who have bad eyesight etc. This kind of makes sense to me. In fairness, she does stress that this is not the case for the majority of women.

Clare, as is her wont, doesn't give us any science to back up her statement. She doesn't cite any studies that show x% of women phsically can't bf or even how this "inability" to breastfeed might manifest itself.

So, my question esp to the professionals I know who help so much on this topic - have you ever come across someone who literally CANNOT bf? What is the official line from La Leche etc? And how would it manifest itself - just no milk coming out, or not enough, what?

This is not meant to start a row on the topic. I am genuinely interested as someone who struggled a great deal bf'ing DC1 and 2 and despite very good expert help gave up or mixed fed after both babies had failed to regain birthweight by 7-8 weeks (and I was demand feeding, had great latch, took galactagogues, you name it...)..

Wanting to exclusively b'feed DC3 due Dec. But wondering, am I just not "built" to bf?

Message withdrawn at poster's request.

Caz10 Thu 17-Jul-08 14:23:22

i think I have read somewhere that it's only like 2% of women who are physically unable, maybe due to illnesses/hormone imbalance etc?

But I have not a scoot of scientific back up for that grin

Someone who knows better will be along soon!

StarlightMcKenzie Thu 17-Jul-08 14:24:49

Message withdrawn

Doodle2U Thu 17-Jul-08 14:27:03

There is a poster on here whose heart failed a couple of days after giving birth. She was put on medication which she has to remain on for life and that precluded her from breast feeding. Sorry, I cannot remember which poster it was but the fact remains, some women cannot - end of.

Ohireallyshouldnt Thu 17-Jul-08 14:29:58

I was completely and utterly unable to bf both my sons. I have inverted nipples of the variety that when sucked only go to being flat, rather than out. I didn't try that hard with DS1 but with DS2 i was adamant i would be able to do it. I bought special cup things that suck your nipples out and used them religiously, i read everything i could about the subject and how to overcome this specific problem.
When it came to it, was still unable to do it. I had DS1 on a night when i was the ONLY woman in that particular hospital and had the attention of every MW there, all trying to help me. We tried all night. And i tried all the next day too.
Basically, my boobs were so swollen with milk that even the skin around the nipple (aureoli or something?)was stretched taut an so DS2 couldn't ven get a mouthfull of that! It was like he was mouthing the side of a really blown up balloon.
In the end the MW said " its not really working is it?" and were very sympathetic. I started bottle feeding on Day 2.
So although i produced copious amounts of milk, for weeks and weeks, i was completely unable physically to breastfeed.
I have suffered quite a lot because of it. You read everywhere about BFing being the only way to go, and are in general, IMO looked down upon for not being able to do it, even thoughi would have lked to.
Please don't think i am after a row about this i just wanted to let you know my experience, thats all.

LackaDAISYcal Thu 17-Jul-08 14:30:47

when i did my peer supporter course (with the ABM) we were told that the percentage of women who can't feed is very small indeed, and is usually due to a physical reason like breast reduction surgery or mastectomy or the baby has a congenital problem that makes it difficult, if not impossible for them to feed effectively.

I don't know the "official" figures though.

Other reasons may be medication that the woman is on that are just not compatible with BFing, although there is usually always an alternative.

I think most problems, especially in western cultures where BFing is no longer the cultural norm and isn't seen on a daily basis, stem from lack of support in the early days in getting BFing established and off to a flying start.

Do

schneebly Thu 17-Jul-08 14:33:00

I tried and failed twice to breastfeed my children - my nipples bled despite them being latched on for me and the MW's couldnt even get more than a dribble out with an electric pump.

I still think that maybe I might be able to with adequate support and help and will try again if I have DC3 despite how I feel each time I 'fail'

I couldn't not try

sabire Thu 17-Jul-08 14:39:17

My understanding of this is a long way from sophisticated but I think there is probably a huge spectrum - from women who have physical problems with bf that are related to hormone levels or breast structure, who never produce quite enough milk for optimum growth and development, but could probably keep their babies alive (though skinny and miserable until weaned), to women who have outright lactation failure, who make up the 1 or 2% who categorically 'can't' bf. You'd also have to factor in all the women who don't start out with any physical barriers to bf, but genuinely find themselves unable to breastfeed because of physiological damage done by terrible bf management by health professionals in the first few weeks after birth, plus the mums with babies who have problems with latching on because of issues related to the birth.

I do reckon that with good bf management and support at least 90% to 95% of women 'can' breastfeed. I think that because that's what you get in countries where women get good social and medical support to breastfeed.

tiktok Thu 17-Jul-08 14:44:41

Look, we are never going to get an answer to this question.

Why? Because breastfeeding is never solely a physical 'thing' - it is a behaviour and a relationship and an interaction, even in lesser mammals.

In a very few cases (like Ohreally's, from the sound of it) the 'delivery' system for the milk to get from A (mother) to B (baby) is so clearly compromised, it ain't gonna happen. You could include women who'd had a double mastectomy in that group.

In another small no. of cases, the mother is on such a toxic drug, that on balance, her baby is better off not having her milk.

In a further small no, the baby has some sort of oral deformity that prevents adequate milk transfer.

Clearly, when it comes to 'amount of milk made' there is a spectrum - I have worked with mothers whose early bf has been dreadful, who have had the worst start to it ever, and who make gallons. Yet others who get things off to a flying start have real problems getting a supply going.

The vast majority of us are more than generously equipped by dint of being pregnant and giving birth to make enough milk for two babies, let alone one - but other stuff gets in the way. Putting an official figure on it all can only be guesswork.

sabire Thu 17-Jul-08 14:47:44

Wanted to add - I do wonder ohireallyshouldn't if your experience of trying to feed would have been different if you'd had a chance to work with a breastfeeding expert - ie a lactation consultant or very experienced bfc both BEFORE and immediately after birth. I suspect that even if the outcome had been the same - ie your baby had to be bottlefed, you would have been left with very different feelings about the whole thing.

You hear stories all the time of women having major problems getting their babies latched on on the postnatal ward, where they are manhandled by midwives, one after the other, all trying to sort out the problem and none of them succeeding. No wonder a mum goes away feeling as though nothing will work. But it's sad to feel this if there's been no real EXPERT input. I think if it was anything other than breastfeeding we wouldn't expect a generalist practitioner to be able to sort out more complex and unusual problems. I mean, if you had a rare problem with your feet that made walking difficult, you wouldn't expect your GP to be able to sort it out would you? So why do we expect your ordinary midwife to be able to sort out complex breastfeeding difficulties?

Blu Thu 17-Jul-08 14:54:21

mmj - please please don't offer the 'bobbins' theory to the woman I know who did everything she could to bf, to the point where finally her baby was in hospital with dehydration being tested for everything but, until someone fiannly said 'will someone please give that child a bottle, NOW'...and it turned out that she has something that physicaly mans that she simply cannot produce milk. She tried and tried to see if it could be fixed before her second child was due, but it just can't.

I will try and find out more details.

But - she's Norwegian...the place where the vast majority of women are able to bf successfully.

ExterminAitch Thu 17-Jul-08 14:55:07

esp as our midwives have grown up in the same culture we have, ie one where seeing women bf just isn't that common.
even if they're dealing with bfing women every day, they're new bfers, which is different, like a&e docs thinking the world's a more frightening place than it is. i think that it must be difficult for midwives themselves to separate out their own feelings on bfing (when many of them just haven't done it themselves, in particular) from the hospital policy and the mothers' feelings. gosh, it's difficult.
maybe another generation or two and it'll be sorted? wink

Ohireallyshouldnt Thu 17-Jul-08 14:55:44

I honestly don't think it would have made any difference who had tried to help me tbh. I feel that i had enough information and "knowledge" through the internet to know what i was supposed to do. Imagine a baby with its face to a smooth glass ball. There was no way he could get anything in his mouth to suck on.
Incidently, even though i bottlefed, i continued to produce so much milk it was ridiculous. I didn't express, although in hindsight i should have done. It was so painful to be so engorged that i made the decision not to express and just make the milk go away. It didn't go away till my son was about 4months tho!
I used to think, "he'll suck a dummy, the end of my finger" etc, so when my boobs weren't so stretched tight a few weeks later, and i could prise a nipple out again, (just about) i used to try again in the bath on my own with him. Just to feel what it would have felt like really (hope thats not a bit sick..). He managed to grab hold once, for a few seconds and it made me cry with guilt. (Never told anyone that).

ExterminAitch Thu 17-Jul-08 14:57:03

<squeeze> it's a total scunner, isn't it, ireally. sad

Caz10 Thu 17-Jul-08 15:00:14

Ohireallyshouldnt sad

Not sick at all imo. How old are your DSs now? Sounds like you tried as hard as you could, so sorry it didn't work out.

onepieceoflollipop Thu 17-Jul-08 15:02:50

Ohireallyshouldnt that brought tears to my eyes. SO sorry that you had such difficulties. Imo your attempts to keep trying were in no way "a bit sick" - just a mother who had desperately wanted to b/f and due to sad circumstances was prevented from doing so. Thank you for sharing your story - I am sure that it will give others comfort/support if they are in the same situation.

jm54 Thu 17-Jul-08 15:04:56

I tried to breastfed my ds from birth. When he was weighed as we were preparing to leave hospital on day 5 it came to light that he had lost a dangerous percentage of his birthweight and was suffering early signs of dehydration. Turned out that very little had been coming out the whole time I'd been feeding him. With hindsight I should have noticed that my breasts had never 'filled' in the way I've heard others describe. Anyway, he had to be given formula immediately, but I was determined to persist with b/f, so I pumped and pumped to stimulate supply, continued to 'feed' him (ha!) and went on medication that was supposed to stimulate my supply. None of this worked. I attended a b/f clinic for 3 months, tried every trick in the book, but my supply never became much more than a trickle. I was devastated that I was unable to sustain my baby but never lost sight of the fact that I had a healthy baby and thus nothing to feel sorry for myself about. I continued to b/f him my meagre supply topped up by formula until he was 6 months old and began to refuse the breast.

In summary, I can vouch for the fact that, for whatever reason, some women simply cannot breastfeed despite their very best efforts, and I cannot tell you how the cynical looks of the b/f militia can cut you to the quick.

tiktok Thu 17-Jul-08 15:05:05

sabire's point - about specialising - is a good one. In the US, there are private lactation consultants whose main job is to sort out the rare, the exotic , the complicated, the head-scratchingly-defeating cases that no one else has ever come across before, let alone treated. We don't have this level of specialisation among breastfeeding supporters anywhere, I don't think. There are prob only a handful of US ones.

Blu: "it turned out that she has something that physically means that she simply cannot produce milk" is intriguing...there really are no cases in the literature (as opposed to anecdote) where someone produces literally nothing at all, so there is something else going on there or the story has changed in the telling.

kerala Thu 17-Jul-08 15:10:06

A woman I met at antenatal classes was very very pro breastfeeding, had lots of support and even linked up to a machine thing that hooked round her neck to stimulate bf-ing. Was heartbreaking to see how hard she tried but it just didnt work. Apparantly her brother had nearly died when a baby as her mother hadnt been able to feed him either. So anecdotally I would say its rare but does happen.

tiktok Thu 17-Jul-08 15:10:39

jm - who has looked at you that way? That's cruel.

Your story is not that uncommon - you are at the other end of the spectrum from the mothers in my first post who have a rotten start to bf but still produce gallons. In your case, no one spotted that your baby was not transferring milk. It took 5 days and your baby to show signs of illness before the people whose job it was to check these things noticed there was something wrong - that's disgraceful.

Don't get cross at the 'bf militia' (who are they?) but at the lack of help you had in the beginning. If there had been some intervention to help you get going on day 1, it might have been a different story. You did fantastically well to keep motivated to breastfeed partially - nothing in your story suggests to me that you are someone who can't breastfeed.

Turniphead1 Thu 17-Jul-08 15:11:03

ohireally didn't mean to raise unhappy memories for you. As others have said, you really did your best.

The replies are very interesting, thank you. I wasn't looking for exact percentages, per se - just wondering was inability deemed to exist I suppose.

As Tiktok says - there are SO many factors in b'fing that it would be nigh-on impossible to find a study that isolated the factors into the physical.

ExterminAitch Thu 17-Jul-08 15:11:41

yep, tiktok, it was only when i got to medical specialists that i got answers about my stuff. what was interesting is that amongst other things i'd wondered if the drugs i was on for high bp might interfere with my supply. my obs had done a literature search and found nothing, because there is nothing. however, the minute i asked the bfing specialists they said 'it is definitely something we can say we have observed'.
there's a big knowledge gap there, some things only teh experience of seeing desperate women come through your doors looking for help with the most arcane bfing problems can teach you.

Ohireallyshouldnt Thu 17-Jul-08 15:12:05

They are 5y and 18m. Its been hard as my best friend BF both her boys and when at 6 months she stopped bfing DS2 and wanted to bottle feed, she would poo-poo any advice i had with "well you just don't understand having never done it".

I am an expert bottle feeder and honestly don't belive i have harmed my children, but i would have loved to have been able to have the choice. I know the argument is always that breastfeeders are not welcome in cafes /by MILs / society etc etc and that women should be encouraged (i agree), so i wonder why i have to feel so bad about not being able to do it. I can't earn Nectar / Boots advantage points on formula milk, the pages on botte feeding in Emmas Diary / Bounty are hidden and one page long, compared to pages and pages about bfing. I could not be advised on which formula to choose as the MW wasn't allowed to, and advertising of all newborn formula is banned. All in all, i was made to feel like i was doing something so criminally awful against my children and should be punished for it.
I do think BF is best, but i think bottle feeders should not be made to feel so bad about it, especially as it might not be a straight choice.
Hope i don't sound "High Horse-y" sorry...

devonblue Thu 17-Jul-08 15:12:33

pediatrics.aappublications.org/cgi/content/abstract/76/5/823

Some people seem to have insufficient glandular development in their breasts as described above. I found this idea interesting as a possible reason why my supply seemed so low.

There are lots of other articles on it.

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