to ask you to STOP using these unhelpful phrases?

[StopCallingMeTeresa]

i apologise if this turns into an essay, but...

"Supply equals demand"
or
(worse) "low milk supply is actually quite rare so probably not your problem"

I've just read yet another MN thread where someone said the 2nd one (basically suggesting that a poster with suspected low milk supply probably wasn't in the "tiny tiny" %age of women who don't produce enough milk). It fucks me right off to keep reading this nonsense on here and other breastfeeding support groups/forums because it makes women feel like their actions or perception of low milk supply are the cause... rather than a genuine medical issue which might never be fixed. If a man had erectile dysfunction caused by a non-mental health issue, would we tell him that the problem wasn't a real problem if only he'd try the right thing, mentally?

Personally, this is (obviously) an upsetting issue. I'm 2 months PP and have low milk supply; as in, I produce about 5ml per 1hr pumping session, and I can get about 30ml on an entire day's worth of hours and hours of being hooked up to a pump inbetween breastfeeds.

My baby was delivered and within 48hrs lost so much weight he was admitted into NICU for monitoring. He was shrieking with hunger when he wasn't latched on, whcih was hours and hours of every day - i got about 3hrs of sleep in the first three days of his life, after which i was pretty much told he was in such a risky position we HAD to start supplementing with formula. My baby was literally starving.

• I'm on domperidone to increase milk supply (dr is talking about stopping it now as it has had no affect).
• I've spent every day of his life on a double hospital grade pump.
• Oatmeal breakfasts, flapjacks to inrease milk. I feel sick thinking about oats these days i'm so sick of them.
• I've taken fistfuls and handfuls of supplements every day: goat's rue to develop milk ducts, fenugreek, brewer's yeast, you name it, for 2 solid months.
• I've tackled slow let down by doing extreme skin to skin kangaroo style care the last few weeks; I listen to relaxing music whilst feeding and pumping, smelling my baby and looking at him/pictures of him.

His latch has been checked. No tongue tie.

• I've done about 4 feeding "resets" where I sat in bed and did nothing but skin to skin and feed for 3 days straight while my boyfriend and mum ran around doing everything else.
• i've had other stuff like bottle feed technique checked at my local LLL group, as well as the health visitor.
• GP has checked my thyroid and prolactin levels twice now - all normal.
• We've done a weighted feed at the local support group but i'm simply not producing anywhere near normal levels of breastmilk.

There's NOTHING i can do now to ever exclusively breastfeed as intended. i simply don't produce enough milk for some reason.

... and yet i keep reading on here especially that "low milk supply is rare" (no scientific source or attributation, of course!) and "supply=demand", just like all the other lies i was told at the antenatal group about breastfeeing.

can i ask you to consider the impact on women like me the next time you are writing something like that?

by washing over what is a genuinely distressing problem as if it weren't a real problem, it doesn't contribute towards good maternal mental health and suggests it can be fixed.

sometimes, it can't.

and now i'm trying to accept that it's ok. but then i read BF support threads on here with misleading / ambiguous phrases like that and i struggle.

You’re right, people need to be more careful in their language to avoid hurt.

Primary low milk supply isn’t necessarily all that rare - the evidence base isn’t great but anywhere up to 5%. But it is relatively rare compared to the proportion of women reporting low milk supply (studies vary but 30-50% seems to be quite common, and some studies show higher).

Combined with uninformed comments like ‘there’s no way you’ll have enough milk to feed that baby’ and ‘the baby’s hungry again, you must not have enough milk’ and it’s a pernicious issue.

My milk supply nearly totally failed with my first and it was only luck along with a lot of support and hard work that got it established. It’s horrible and it sucks and I’m so sorry yours hasn’t improved. However I still think it’s worth tackling the misconception that low milk supply from primary cause affects maybe half of women, because there are a lot of women who want to keep feeding and who could but they aren’t getting the support they need because they think it’s pointless and they have low supply.

I have pcos. No medical professional ever warned me I was likely to encounter milk supply issues. My boobs didn't change at all during pregnancy, never leaked. I produced tiny amounts of colostrum and tried my best, but after 4 days of baby screaming with hunger we were readmitted. I tried the hospital grade pump every 2 hours followed by a breast feed followed by bottle feeding expressed milk for 2 nights. This allowed me just over 30 mins sleep every 2 hours and I didn't even have to prepare formula or wash and sterilise bottles myself. I couldn't face the thought of doing it at home.

Women who are likely to struggle due to medical conditions through no fault of their own should be prepared for this by their midwives. Pcos was all over my notes! I still would have tried to bf but I wouldn't have felt like such a failure.

Yanbu Op

Glad you didn't see the 'lies about stopping BF' thread yesterday.

Glad it was pulled

That advice does apply to many breastfeeding mothers though, but you are clearly in the minority who do have a low milk supply. The advice isn't helpful to you, but neither is it calling you a failure.
If you're seeking medical advice for something you're past the point of taking helpful hints and tips from strangers on the internet..,

I bf all 3 of mine, for a year each. I refused to even consider any ff. I also permanently wrecked my MH and eventually my relationship due to untreated PND after my first and second, definitely made worse by feeding issues and anxiety. And my 3rd actually collapsed cyanotic at a week old because her blood sugar dropped so low and everyone thought I was doing ok because I said I was. It was a long time ago, but I still wish someone had told me to give them a bottle and myself a rest. It wasnt more important to be a perfect breastfeeder than to be a good Mum and a healthy person, but I thought it was. My DGC is ff.

fivelittleducks

I’m so sorry. I echo the suggestion to get advice on PND.

To everyone else so desperate to point out how most women can breastfeed, please think about the impact of what you’re saying on other women.

Constructive advice to someone who is asking about supply is all very well but this determination on MN to shout down women who say they couldn’t breastfeed with “actually you probably could as only a tiny percentage medically can’t” has to stop.

OP well done with the efforts you have made, go easy on yourself

The thing with low supply is that it's said as though that is the problem when really it is a symptom. Many women have low supply when that's not the root problem, and solving the problem (if possible) would fix the supply problem. I think this is what people are trying to get at. The small number who have 'genuinely' low supply, is probably meant to be those who have unexplainable or unfixable low supply, I completely agree that it's ambiguous and could be misleading, but it isn't a lie in most cases (and in the rare few it isn't intentional). If anything I think the phrase is intended to reassure women that it probably isn't their fault, and goes on to suggest either practical suggestions of things they can do (all of which you've done) or medical explanations for the low supply (which you've had investigated). Besides which, if someone is asking for support or help with breastfeeding, that's what they need. Being told if there's suspected low supply so they need to move to formula isn't helpful, most will do that if/when necessary but they're trying to fix the problem first.

As an example, I was diagnosed with low supply when I asked for help because dd wasn't feeding right or gaining weight. They refused to investigate any problem with dd because of my low supply. Increasing my supply had no effect because it really wasn't the problem, I just ended with a freezer of milk because she wouldn't take a bottle and a baby who lost weight because I was expressing too much. I was told that this was evidence she needed formula and you can always force fed a baby a bottle.

Another example, a friend was diagnosed with low supply due to slow weight gain. She was pressured into mix feeding, which did cause weight gain but also a very sicky and screamy baby. Eventually diagnosed with cmpa. Change of diet and formula helped massively. By 4 months managed to drop the formula, so clearly physically able to produce sufficient milk for a newborn. Arguably, investigating if there was a digestive problem would have been a better help to that baby and mum.

Ok so that's interesting - my boobs didn't change at all when pregnant. My boobs never get full or sore. My colostrum levels (5ml per feed at most, with a syringe) basically just went from yellow to white. It never increased in volume or "came in". I don't leak milk, ever.
In fact I'm wearing my normal non maternity bras comfortably now, and was in hospital?

Lots of women think they have low supply when their milk hasn't even come in yet.

No they don’t. Unless they’ve not listened to any medical advice and been given no information at all about breastfeeding when pregnant (unlikely for most) most women understanding perfectly well that milk doesn’t come in straight away, and when it’s taking too long and when their baby isn’t getting enough.

Oh and the fact that breastfeeding support is so utterly, utterly shit unless you can pay for it in one way or another is a total disgrace and a huge cause of problems as far as I can see. Far too much money spent on promotion and not enough on trained support. Almost every NHS midwife, HV, breastfeeding support person I saw was clueless and some hurt more than they helped.

Including the midwife who blithely told me there was no way my (10.5lb) 5 day old second child could possibly be getting enough milk at his size and the length/frequency of his feeds. Especially after the shitty start with DS1. Then she found he’d actually gained weight since birth - but if he’d been my first it would have fucked up my confidence and made me paranoid about my supply.

YADNBU.

I could have written your post.

Hugs. Hold your head high that you've done everything you can.

For me, it still stings a little even 10 years on when I hear people say such things, but now I have a very happy and healthy 10 year old - it made no jot of difference not BF her and we have the most incredible bond.

YANBU I was near identical to your situation with DD1. I still think a massive factor in all this was a 48 hour labour and being kicked out of hospital within 24 hours when you can't think straight, let alone know how to feed. It was counter productive as we ended up back in hospital on day 4 with a dehydrated baby.
Whilst I am sure my problem was also hormone related (PCOS) I strongly believe there just isn't the support. I'm not talking about a breast feeding cafe or whatever once a week I'm talking a week in hospital to learn how to do it - that's what my mum had 40 years ago. I know things are different now, cash strapped NHS etc etc but the government should not push the breast is best agenda without investment to properly back it up.
And the self righteous breastapo fuck me right off too!

I echo low supply because a consequence/symptoms in most cases rather than a root cause and the idea is to investigate further. This is to not say it's always going to work. But it is unhelpful for new mums to hear others say 'oh well I had low supply too' as well as it makes it sound doomed when it often isnt.

Jeez yes. Bf threads are horrible. Im usually the poster getting angry at anti bf (esp past 12 mths), but giving women a hard time about struggling to bf is terrible. Formula is a magic thing. Theres evidence of baby bottles found in Roman sites.... Women have been struggling to bf forever. Before formula and hygenic bottle sanitisation, rich babies were fed from wetnurses, and poor babies.... Thank god for formula. OP, YANBU. And if you decide to ditch the boob, thats totally understandable.

'Being' not 'because'

Far too much money spent on promotion and not enough on trained support.

This! 100% the main problem.

OP you’ve been through a lot and worked damn hard at something really challenging.

In case you need to hear it - if you want to stop trying and simply formula feed your baby, then that’s the right thing to do. You being well and happy and enjoying your baby is far more important than the type of milk (I say that as a midwife and massive BF advocate whose hoping to BF her baby).

Some people just don't get much out expressing. My second child was born on the 50th centile and shot up to the 98th very quickly. He was exclusively breastfed. Yet when I expressed I struggled to get 5oz out of both boobs. Either I was producing double cream or the pump just doesn't work well for me (it's the expensive one that's everywhere, not a cheap one).

Sounds like you've done everything to try, I think there comes a point where you just have to say fed is best. I struggled with my first child but I just couldn't accept she needed formula. The midwife didn't discharge us for over 5 weeks and even then my baby was only just on the graph. I think in my head I felt like formula was like heroin or something, I just wanted to exclusively breastfeed so much. Eventually when it got to the point of my baby looking like a newborn at 3 months I topped up with 1 bottle a day, really it should have been 50/50. It's hard to accept when you are living it, but looking back at pictures of how skinny she was I just wish I'd given her more formula. She's caught up now and is a healthy 3 year old.

I also have hypoplasia (?) - IGT.
My boobs didn't really change during pregnancy. I pumped - like you, squeezing out 5 ml after AGES pumping. After 5 weeks I was told by the PHN to introduce a ff. So I did. I supplemented with formula at every feed , 60 ml I think. I continued breastfeeding too. I then was able to drop bottle feeds gradually. I held off on the first bottle til 9am, then 10am , then 11 etc. Until DS was only on a bottle feed at 6 pm and maybe one later on if he seemed hungry. When he started solids we dropped the formula. He's still breastfeeding and he's nearly 2.
So please don't feel it's an all or nothing situation. Mixed feeding might not have been your number one choice but it's ok.

I know that my post is not really what you asked but I thought I'd share my experience

If you wanted to, you could try just breastfeeding, no pump, no supplementary feed for baby - keeping an eye on weight obviously though there might be a small dip at first

I think OP tried this and baby ended up in NICU

YANBU. and this thread has been an education as i i'd never heard that PCOS could impact - might be partly what was up with me.

i gave up with DD after 3 weeks because i was having to mix feed and couldn't cope with breastfeeding AND making up bottles considering everything else that was going on at that point, but thought that my lack of milk was related to the fact i had a retained placenta for 11 days. then had DS without that complication (and only 4 pints of blood loss rather than 6 - woo hoo!) but had the same problem - although managed to keep going with the mix feeding till 6 months with him.

try to ignore the comments - you know the reality of your situation and randoms on the internet are talking about generalities based on unclear scientific data... you're doing really well and have clearly done everything you could to try and EBF. i remember being in your position at the time i had had to give up BFing and being really emotional/upset about other people's comments and looking back it wasn't worth wasting any energy on it!

Thanks @BeardyButton - I genuinely needed to hear that. I always feel that me and DD were biologically inferior because I couldn’t breastfeed

StopCallingMeTeresa the boobs not changing and not getting engorged is not always a sign of low supply though. I have tiny boobs, they never got bigger, I don't get engorged, I didn't leak until 6-8 weeks post partum, but I can feed an army with my milk (I'm direct feeding one, pumping to provide exclusive breastmilk for another AND donating to the local bank). So again, it's a case of it being really individual so saying all women who don't get bigger boobs or don't leak can't breastfeed would be wrong. But me telling you that you can still breastfeed despite your issues would also be wrong!

I'm sorry, I have a lot of sympathy for your situation but I do think YABU. There is plenty of evidence - see Perceived Insufficient Milk (Neifert & Bunik, 2013). You may well be in the 1% - I'm not challenging that at all, it sounds like you have had lots of breastfeeding support - but if you're in the 1% that means so many other women could continue breastfeeding with support, so we must continue to tell people it's highly unlikely they have low supply - because that's a fact. Expressing is not representative of what a baby gets at all. I was lucky and had no supply issues and could breastfeed but could never express - I'd do it for an hour and get less than an ounce and it cost me a fortune trying out pumps worth hundreds but nothing would get that milk out except my babies. They were definitely getting more than an ounce an hour.

Been where you are. Women have struggled with bf for centuries- there is evidence of crudely made bottles dating back to Ancient Egypt. Wet nurses were frequently used throughout the ages. The statistic of 1% is rubbish. I had lactation failure with my 1st - books never changed, couldn't establish a supply. With dd2 I faired better, but it never became easy.