Almost every class, website, online discussion, book, brochure and conversation related to breastfeeding references a statistic:
- “only 1-5% of women are unable to breastfeed.”
- “an estimated 1 to 5 percent of women are physically unable to produce enough milk to feed their babies.”
- “less than 5% of women experience lactation failure.”
As one of the illustrious 1-5% of women who didn’t produce enough milk, I wondered, what does this statistic mean and where does it come from? It almost always comes up in one of the following contexts:
- Reassurance: “You are likely able to produce enough breast milk for your baby. After all, only 1-5% of women can’t.”
- Advice: “If you try harder, you can do it. After all, only 1-5% of women can’t. Here, let me tell you some ways you can increase your supply…”
- Shame: “You shouldn’t have weaned early. You didn’t have a legitimate reason. After all, only 1-5% of women can’t breastfeed.”
As a woman who experienced “lactation failure,” firstly, fuck that term in the neck, and secondly, I hate hate hate it when a statistic doesn’t reference something definable or specific and doesn’t really add much to a discussion of whether or not a woman is able to breastfeed, for how long or to what extent.
So…I went to the original source. What did I find? A 1990 study, which included 319 mostly white, middle class, college-educated, first-time moms, who were motivated to breastfeed their healthy, full-term, singleton babies. Fifteen percent of the women were unable to produce sufficient milk by three weeks postpartum. While many of them were able to overcome supply challenges with assistance, 4 percent of the 319 women appeared to have chronic low milk supply. The results of that study really don’t tell us anything about supply issues in the wider population. Not to mention women in other countries. The study’s own co-author, Marianne Neifert, a clinical professor of pediatrics at the University of Colorado Denver School of Medicine, was quoted in a 2013 article – “You cannot find a number for this,” and “she hasn’t been able to find any additional studies that support those numbers.”
When I was diagnosed with insufficient glandular tissue (IGT), I searched extensively and discovered that research on IGT is almost nonexistent. My breastfeeding specialist physician shared with me a 2000 study, conducted by well-meaning nurses and lactation consultants who sought to understand IGT/breast hypoplasia and document how women with different breast characteristics that they had associated with low milk production fared when breastfeeding. This study was important, but limited in size and scope, including only 34 women. Also, some women with the markers they identified had no problems producing milk.
Not to mention that there are a ton of other physical causes of low milk supply, including thyroid disorders, retained placenta, polycystic ovary syndrome, insulin resistance, hormonal disorders and surgery. But, again, having one or more of these conditions doesn’t necessarily mean that a woman will be unable to produce milk. Additionally, other conditions can make breastfeeding excruciatingly painful or impossible. Baby may not be able to latch or transfer milk. A woman may not respond to the pump. A woman may have inverted nipples. A woman may have a trauma history or post partum depression or other mental health issues that make breastfeeding impossible and/or that require medications that are incompatible with breastfeeding. This challenges lactation consultants and peer advocates, who are trying to help women navigate their own bodies and babies (who contrary to popular mythology may not instinctively know how to latch and transfer breast milk). How can you predict when a woman won’t be able to breast feed? The answer is frustrating – you can’t. Thus, they reach for a handy statistic to encourage women to try.
Literally the only way to know for sure if breastfeeding will work is to try it and see if it works. Which, I can tell you from experience can be a horrible, demoralizing, scary process. We are talking about feeding a newborn. Failure can mean starving your baby. And if you don’t have access to experienced professionals and advocates, you are likely to hear a lot about a mythical 1-5% of women.
Bottom line – any reference to the percentage of women who can or cannot breastfeed is made up, pseudoscience bullshit. There’s no way to measure how many women can physically lactate, make enough milk, get baby to latch/or respond to the pump, not experience pain or infections and continue to produce enough milk over the long-term for baby’s health and nutritional needs. There’s no fucking study or body of research that provides that figure. It’s fake. And even if it was real, physical ability is by far not the only factor influencing the ability to breastfeed – limited or no maternity leave, not being able to pump at work, illness, lack of support, lack of time/energy, past history of sexual trauma, medications, not wanting to or choosing to, etc. fucking etc. can result in a woman not being “able” to breastfeed.
Using this statistic is shaming, a red herring and not relevant to general discussions about breastfeeding and more importantly, discussions with individual women about how they feed their babies and why. So, please, cut it out.
Featured Image: from the 1977 edition of the Womanly Art of Breastfeeding, La Leche League. Illustrated by Joy Sidor
Beautiful baby image: Steph, all rights reserved.
I’ve worked at a peer to peer breastfeeding counselor for 7 years. I think for me the take away from my experiences is that we never know what’s going to happen or how much milk a mother can or will make until given the opportunity. I don’t find percentages to be helpful in the least when it comes to women getting the best breastfeeding support possible.
I myself have many of the physical markers for IGT. I was told I would always need to supplement in the hospital after the birth of my first baby. That I would never make enough milk. That my nipples were the wrong shape to nurse and I HAD to use a nipple shield. (This was almost ten years ago in a military hospital)
I went on to exclusively breastfeed four babies and be a milk donor.
I’ve seen women with NO known risk factors have unexplained low milk supply.
I wish doctors were better at identifying the risk factors for *potential* low supply during pregnancy (like IGT, PCOS, infertility, thyroid conditions, insulin resistance, diabetes, breast surgery, etc.) and then refer mothers to really good prenatal and postpartum breastfeeding care with an IBCLC and peer to peer support groups. So she can maximize the odds of good milk supply AND someone can closely monitor the baby and mother’s wellbeing. Every mother/baby dyad really needs better follow up care in my opinion.
I wish we had better evidence based information for lactation failure. Unfortunately, there seems to be little interest in breasts unless we want to make them bigger or if they have cancer. There are some good studies being done now, and I look forward to having more information.
YES! I had such a better nursing relationship with my son working with a team of professionals who knew I was likely to have supply issues and supported me in figuring out a new set of goals, rather than with my daughter where I was told time after time to just nurse more.
One thing that makes me absolutely INSANE about this is when I get a call from a mom a few weeks into breastfeeding. Baby isn’t gaining, things are not good, mom is upset.
We talk a bit and it comes out that she had a breast reduction a few years a go. Or used reproductive technology to conceive. And her health care providers were 100% aware of these facts and never once even mentioned to her that it could affect her ability to make milk. When I share with her that those factors may be what’s going on, the moms while sad are so glad to have answers. And then we can move on to meeting her goals and making things work for her family.
I think professionals are scared to have these conversations because they don’t want to discourage women. But, we are talking about feeding babies!
Other things that can go wrong: supply is more than fine, but continual unexplainable breast infections resulting eventually in only green slime coming out. Constant pain and fevers, missing 2 weeks of actually caring for your baby.
I was put on meds that stopped milk from being made, by my doctor, best thing ever. All the experts had to say was “this shouldn’t be happening, we’re doing all the right things” and “try massaging them more” and eventually “you can quit, but do it slowly, over 2 months” (like 2 more months of infections was no issue).
My mom had the same thing back when. It was so bad that her doctors had to put her on the milk-stopping meds right from the birth on to prevent weeks of illness for her last child. The middle child, they waited to see if it would happen again first.
My bearsts were fine. My babies were wrong!
Nah, not really, but big tits and small babies were just not a good match so I experienced feeding problems with both of them.
The main difference was that with the first one I’d swallowed the “of course you can” story hook, line and sinker and was devastated and desperate. With the little one I was prepared. Sure, I needed to pump, and needed a finger feeder, and needed to supplement in the beginning, and a shield, but it was comparatively stress free because those were just a few more things I needed to do to care for my baby.
I think that the 5% number is underestimated—
Here are few more studies:
Moritz ML. Preventing breastfeeding-associated hypernatraemia: an argument for supplemental feeding. Arch Dis Child Fetal Neonatal Ed. 2013;98(5):F378-9.
..”Prospective studies with full lactation support consistently show that approximately 15% of exclusively breastfed infants develop excessive weight loss, exceeding 10% of birth weight, within the first week of life”.
Here is another study that followed over 200 women who pledged to exclusive breastfeed for 2 weeks–12% had excess weight loss.
And here a a few studies on dehydration in exclusively breastfed infants infants:
“ Hypernatremic dehydration requiring hospitalization is common among breastfed neonates”
“The incidence of neonatal hyperbilirubinemia in our hospital has increased since the implementation of breastfeeding promotion”
“The incidence of hypernatremic dehydration secondary to inadequate breast-feeding was 4.1%, occurring in 169 term infants among 4136 hospitalized term neonates “
Not just under-estimated, but also impossible to define.
I’m really glad my wonderful midwife (actual healthcare professional in Germany, not to confuse with American birth fanatists, though you get them, too) had a pack of formula in her car and we could avoid that disaster.
You have done the world a great service with this column! I have just shared it in a converstaion in a closed Facebook Group for breastfeeding peer support volunteers.