Lactation Failure: It Happened to Me

by Lisa Selin Davis

Lactation Failure: It Happened to Me

Breast hypoplasia, a condition in which breasts cannot produce breastmilk, is real. So why won’t the people who are supposed to help women with breastfeeding problems admit it? Plus: why formula-feeding was this mom’s salvation

Five days after the birth of my first daughter, I held her in my arms as my husband held me. My head was bent against his shoulder, and I was sobbing so heavily that I shook. I could barely breathe, but I pushed out the words: “I. Just. Want. To. Feed. My. Baby.” 

That I wouldn’t be able to, and that no lactation consultant or midwife would admit this, turned what would have been a disappointing situation into a near health crisis for my daughter.

I had been told that it might take as long as three days for my milk to come in, so by day four I was perplexed. By the end of that day confusion gave way to disappointment. I was never particularly fond of my breasts, and I’d been looking forward to a new sense of appreciation for them; hey, they might not be Playboy material but they could sustain a life! By day five, panic had set in. The baby was getting crankier, and I was agitated and devastated, the oxytocin from childbirth flooding from my body with no pleasure hormones from breastfeeding to replace them.

On the phone, my midwives sounded as perplexed as I was. I’d had a natural childbirth, and was totally committed to nursing. My mother was able to breastfeed. It must just be that we weren’t trying hard enough, or that the baby wasn’t latching properly. They prescribed a militant regimen of water-drinking and pumping—15 minutes on, 10 minutes off, for two hours straight, then a two-hour break until I started again. I fed the baby the pathetic quarter-ounce yield and prayed for that mythical sensation I’d heard about called let-down. 

A day later, when I told the midwives that nothing had changed, they just said, “Huh. We’ve never heard of this before.” Let down, indeed. Whatever happened, they said, don’t introduce the bottle, or give formula. I was presented with a list of what horrors might unfold if I did: obesity, compromised immune system, lowered IQ.

Not sure what else to do, I went on a tear of western and eastern medicine. The acupuncturist gave me a tincture to rub on my sternum and prescribed a pig’s blood soup, available in Chinatown. The lactation consultant weighed my baby before and after a feeding and pronounced that she was getting milk, even though the baby had soiled her diaper during the feeding (explaining the weight gain) and there were literally three squeezable drops of yellow-ish liquid emanating from my breasts. Though she is quite well-known in New York City and the subject of a New York Times profile, the LC also told me that she’d never heard of a body that just couldn’t produce breast milk. She gave me some exercises to do with the baby’s mouth, suggested that I use a supplemental nursing system or spoon-feed formula, and that I Just Keep Trying, the unofficial motto of LCs everywhere.

A week after the birth, the pediatrician gave it to me straight: my daughter had lost more than 20% of her birth weight and needed nutrition immediately. “Formula is perfectly fine,” she said, in sharp contrast to everything else I’d heard. And then she added this: “Your milk might never come in. It happens sometimes.” 

My whole body exhaled. Though I was still swimming in panic and shame, she had confirmed my quiet suspicion and given me a free pass to do what all my instincts urged: feed my baby however I could. To keep her alive.

Three and half years later, I continue to wonder: why didn’t the midwives and lactation consultants admit that lactation failure was even a possibility? Amy Evans, M.D., a pediatrician in Fresno, CA with a subspecialty in breastfeeding, told me that at least 5% of women have medical conditions that make breastfeeding extremely difficult or impossible, including insufficient glandular material and breast hypoplasia, which is what I have—breasts with underdeveloped ducts, that just don’t have the apparatus to create an adequate milk supply. Hypoplastic breasts have some identifiable characteristics, like fullness on the sides of the breasts but not in the middle, yet not one person I consulted ever mentioned this condition, or even examined my breasts. I learned about it from a friend, who heard about it on Facebook. I had to seek out a breastfeeding doctor to confirm it.

I do understand the fervor of lactation consultants, midwives and other medical and lay professionals to delay a diagnosis of failure. After all, most women struggle tremendously with breastfeeding in the weeks after giving birth—it’s painful, the latch might not come naturally, and sometimes milk supply is simply delayed. Todd Wolynn, M.D., who is both a lactation consultant and a pediatrician in Pittsburgh, PA told me that almost all women can successfully breastfeed if they get adequate support in the first week when the learning curve is sharpest.

And I understand that breastfeeding needs to be marketed just as zealously as formula-feeding to counteract the power and reach that formula companies have. After all, every breastfeeding mother is one less customer for them, and so they have ingenious marketing methods (like, until the recently enacted bans in some cities, giving you free formula at the hospital, just as your breastfeeding frustration begins) to get and keep you hooked on the stuff. It’s a heck of a lot easier, if more expensive, to formula-feed, so breastfeeding advocates have to try extra hard to help women surmount the trials of those first weeks and support women enough to make it work.

Except that sometimes it just doesn’t. In my case, what should have been support was actually ignorance and pressure—pressure that left my child starving for a week—accompanied by shame and guilt and fear. Lactation consultants took my money—hundreds of dollars of it—and never told me what my pediatrician uttered immediately in her judgment-free and matter-of-fact way: it ain’t gonna happen.

I don’t mean to villainize lactation consultants and midwives. They perform an important function in modern American society. In addition to their medical training, they are the keepers of a kind of folk knowledge that got lost in the better-living-through-chemistry 1950s, when powdered, cow’s milk-based Similac (“similar to lactation”) made its entrance to the scene—and to the hospital—and changed baby feeding as we know it. The medical world has taken over what was once women’s work, with much information lost in the shift. LCs and midwives give us the help that our mothers and aunts and older sisters and neighbors were able to offer in a less medicalized, more communal time.

But in their enthusiasm for breastfeeding, their desire to reclaim the act, some seem unwilling to acknowledge the medical reality of lactation failure, even though as many as 200,000 women may experience it each year. If you are one of those women desperate to breastfeed, terrified of what you’ve been told will happen if you don’t, the denial will make you feel crazy, on top of terrified.

Situations like mine are slowly eroding the denial of lactation failure in the medical and lactation community. I’ve been told by doctors, doulas and lactation consultants themselves that LCs are more and more likely to be kept, um, abreast, of these very real, if rare, medical conditions, and that their training more and more includes information on breast hypoplasia. Lactation consultants aren’t regulated by any governing body, though, so training is not standardized, and anyone can call herself one (you should look for certification from the International Board of Lactation Consultant Examiners if you need one).

But in the meantime, thousands of women each year are experiencing the confusion and terror that I did. So let me take a moment to allay your fears. If no milk materializes from your breasts despite how much and how long you’ve tried, and your baby gets nothing but formula from a bottle (or banked, pasteurized breast milk from somebody else, if you can find and afford it), for her first year of life, she will be fine. Three years after my fiasco, I’m happy to report that my own formula-fed daughter is vivacious, smart, and has a terrific immune system.

I will always regret that I couldn’t breastfeed, but what I regret even more is the cloud of misinformation that continues to swirl around breastfeeding. Lactation failure is real, yes, but the real failure comes from mistreating women who experience it.