Ignorance of Low Milk Supply is Unacceptable
Ignorance of low milk supply and proper management by breastfeeding supporters and medical professionals is UNACCEPTABLE
The fact that this conversation even has to be had is infuriating, but it needs to be had. If you find this conversation offensive, I genuinely suggest you take some time to reflect on your current practices before spending any more time assisting breastfeeding families as you are likely harming them unintentionally, and that is never all right.
Part of what inspired me to pursue a career in breastfeeding support is my personal experience breastfeeding with low supply and the downright dangerous negligence my baby and I experienced at the hands of several lactation consultants and medical providers. My story isn’t unique, it happens all the time. Parents are falsely reassured, a true competent assessment isn’t done by the properly trained professional, and the care required to protect the breastfeeding infant and the milk supply is delayed or denied altogether. This care is directly responsible for the wild success of organizations such as the Fed is Best Foundation which actively undermines breastfeeding success by blaming breastfeeding instead of the negligent care.
So why is this negligent care happening?
A little bit of factual information combined with cultural bias and harmful practices in the hands of people who are ignorant of the limitations of their own information is dangerous. This isn’t unique to breastfeeding by any means, but the breastfeeding support system is rife with opportunities for this type of nonsense to flourish as the norm.
So how does this happen when it comes to breastfeeding and low milk supply?
The perception of low milk supply is a common concern for parents, and these parents bring up their concerns to people that have established themselves in a position to provide education and support. These individuals have likely been trained at some point that the majority of breastfeeding parents are capable of producing enough milk for their baby (which is accurate) and that most parents just need reassurance that their milk supply is fine (also accurate in a lot of cases). However, when you combine that with biases where society dismisses women’s concerns (which is the vast majority of breastfeeding parents), the cultural practice of placing medical professionals as persons of authority on breastfeeding, despite inadequate training and a lack of access to skilled lactation care providers, means we have a situation that endangers breastfeeding relationships and breastfeeding infants.
Let’s take a moment to establish what adequate lactation care looks like when a parent expresses concern about their milk supply so you can better understand why common practices aren’t cutting it:
A breastfeeding parent expresses concern about milk supply, so an initial assessment is done:
We look at how the baby is growing, if weight gain is good in the immediate as well as over time.
We look at diaper counts, what goes in, must go out, and low output is an early sign of low milk consumption.
We check for signs of dehydration.
We get a feeding history to look at how often baby is being fed, how baby is being fed, and what baby is being fed. Parents may have opted to self-identify the need for supplementation, and that needs to factor into our assessment of milk supply.
When we have all of this information, we can make an educated and informed judgment call on if milk supply is adequate, or if there is a potential need for a more in-depth assessment. If there are any red flags or any supplementation going on, a full assessment is justified and is what the parent needs - not some placating reassurance with a statement like “low milk is rare.” Whether low milk occurs 10% of the time or .01% of the time is irrelevant. Every baby needs to be fed, and every breastfeeding relationship desired by the parent needs to be protected without a single failure. Rates of occurrence are irrelevant to the needs of an individual dyad, and if you can’t respect that fact, why are you inserting yourself into breastfeeding care? Education about perceived low supply and reassurance should be reserved for cases in which you can clearly point to the facts that support breastfeeding is going well: baby is gaining weight well without supplementation, diaper counts are within normal limits, breastfeeding is not causing pain or nipple damage, and baby is eating within patterns to be expected of their age. If ALL of these are true for this dyad after assessment, by all means, provide supportive reassurance and breastfeeding education to promote the parent’s confidence in breastfeeding. If any of these statements are not true, there needs to be a more in-depth assessment.
So if further assessment is needed, WHO should be doing it?
This type of assessment needs to be handled by someone qualified to assess lactation in detail, with the ability to do a full assessment of a feed, and the ability to identify possible causes of breastfeeding difficulty. This is not a quick process, so if you don’t have a MINIMUM 45 minutes with this dyad, this is unlikely to be something you can adequately do for this family. This could be done by a peer supporter or a lactation certification that prohibits complicated case management as long as you know where the line to refer out is. Interventions at this level include changing the latch, education about breastfeeding management, and possibly a basic care plan to manage breastfeeding improvement. If supplementation is needed, the care plan should reflect how much and for how long to use the supplement, and there should be an evidence-based plan to improve the situation. If a pain free and effective latch could not be established, you have an obligation to refer to a provider who can assess why and help this dyad.
What happens if the assessment reveals a basic care plan will be insufficient, or turns up concerns about baby’s oral anatomy, the parents breast anatomy, or medical issues possibly influencing lactation outcomes?
At this point, this is where things can go from routine breastfeeding support to more complicated case management, and clinical lactation care becomes the standard of care needed. If a pain free and effective latch could not be established, there needs to be an in-depth oral evaluation done. If there are any abnormalities with the breasts noted, there needs to be a full breast assessment. A medical history may be needed to determine reasons for underlying physiological milk production issues so that appropriate medical referrals can be made. Feeding plans may become much more in-depth, and coordination of care across multiple providers may be necessary. If this doesn’t happen, the entire breastfeeding relationship may be jeopardized due to inappropriate management and failure to properly identify issues.
Sounds pretty simple right? Everyone acts within their own scopes of practice, and acts in an ethically responsible way in regards to their actual availability to do the necessary assessments. Babies get fed, breastfeeding is preserved, and everyone is better off. Except, that’s not what is happening, and breastfeeding families are paying the price.
Every single breastfeeding supporter along the continuum of lactation care is in their own unique position to protect breastfeeding families by adhering to these standards of care. Stop promoting unfounded statistics to dismiss a parent’s concern. Stop trying to provide care if you are not in a position to provide the full assessment needed. Take the initiative to get continuing education on low milk supply. Babies actual lives are dependent on you knowing the signs and being able to competently handle this type of situation. Refer out to competent providers when you need to.
There is no excuse for this ongoing behavior, and we all need to be a part of protecting breastfeeding by correcting these practices.
