"Oh you breastfeed? That's great! I tried it but I just couldn't make enough milk."
My husband will give me his secret sign for "please don't go there" and I will struggle to continue to converse without circling back to that comment. I mean, why mention it if you don't want to talk about it, right? But, then again, even IF you can navigate those choppy waters without the other mother feeling guilty or judged it's still SUCH a long conversation that involves asking a lot of personal questions. I always have this internal debate with myself about whether or not to even acknowledge the comment.
"Maybe she really couldn't! Maybe she has IGT or PCOS or She had a postpartum hemorrhage that caused her to need a blood transfusion, Maybe she had a double mastectomy? Or maybe..."
I go down the entire list of all the legitimate medical reasons why a woman really might not have been able to make enough milk for her baby. And there are a LOT of reasons why a woman wouldn't be able to.
"But all of those reasons combined only factor for about 5% of mothers total."
Oh, good point, self. 95% of women are capable of producing a perfectly adequate quantity of milk for their babies. So what gives? Why did this woman (or any woman whose lobbed this brain bomb at me) have difficulty making enough? I want to know, I want to ask and dig deep to the root of the issue and be all *shooting star* "The More You Know..." and the woman in question be all like "Gee, thanks! That's good to know, I will bank that for later."
That way when she meets a new mom who is just starting breastfeeding and she asks "How's it going?" and New Mom says "It's hard, I don't know if (s)he's getting enough." This random lady can harken back to our enlightening conversation and provide helpful information instead of offering this little ditty, "I didn't make enough milk, it's good that you're trying though." which, as a new mom, I only heard someone say about a ZILLION times and, believe it or not, I did not find that helpful or encouraging to hear. Sorry Zillions of moms.
And since I'm not super confident that I would be able to randomly converse with a stranger in a public setting about something so personal without:
A.) Being taken for a judgmental "sanctimommy" over something that happened in the past (and thusly cannot go back and change).
B.) Bringing a bunch of icky feels that this mom might have over the situation to the surface.
C.) Having some guy within earshot cut me off mid-sentence saying something like "Woah-ho-ho! Uh oh, ladies are over here talking about lady stuff, ugh! Amiright, fellas?"
and D.) Making my husband who is already really hard to drag to social gatherings even more uncomfortable thereby lessening my chances of getting to go out and do grown-up things in the future.
I think it would be really cathartic to get it all out here. Disclaimer, yes there are plenty of medical, diagnosable reasons why a mom might not be able to make enough milk, but as I've pointed out before, all of those reasons combined only equal 5% of all mothers so let's go ahead and assume that all my hypothetical moms are in the 95%.
Ok, let's get down to brass tacks. Here are some super common reasons why a lot of moms think that they don't make enough milk.
*"My baby is hungry all the time, I just can't keep up!"
*"My baby was only x percentile on the growth chart my doctor advised me to supplement."
*"My doctor advised me to top-up after nursing and she gobbled up x ounces so quick! She must have been starving!"
*"I pumped and was only able to get x ounces in x amount of time when I used to be able to fill a gallon jug every half hour!"
*"My breasts stopped feeling full/I stopped feeling a let-down."
I have heard lots of variations of the above and, logically, all of those concerns make complete sense. It's not a huge leap to assume that if your baby gobbles up a whole other meal, after already finishing a meal, that the first meal might not have been enough. Or if your baby wants to nurse constantly that they aren't getting enough. But you're a mom now and, well, logic doesn't always apply.
Your baby being "hungry all the time" usually has very little to do with food at all. It's almost always misunderstood newborn behavior. Before your baby was born he lived inside you being fed constantly by the placenta.
Your baby had never experienced the feeling of hunger before being born. Your baby has also never been cold, heard loud noises, seen bright lights, or physically separated from you before either. It's all new and it's all very scary. You are the only familiar thing your baby has in this world. Your breasts fill all of your babies needs: warmth, comfort and food. Your breasts are the equivalent of drinking the world's greatest hot chocolate, while sitting on the world's comfiest couch next to the world's toastiest fire after a long, hard day of being Liam Neeson's character from "The Grey". Since I'm pretty sure babies enjoy being born about as much as women enjoy giving birth to them.
And each time they are suckling they only get a few drops out at a time. That's totally normal and all their tiny tummies can handle right now. Their tummies are only about the size of a thimble and already full of the amniotic fluid that they've been swallowing while getting ready to be born. They need a little bit of milk frequently. This also primes your breasts for making more milk. So the more they nurse right now, the better.
But now you might be thinking, "I know all that! My issue came later when my baby was 2 months old!" I get that. Baby is born, you start breastfeeding, two weeks or a month later you start feeling like you really have a handle on it. You might even be able to actually get stuff done, like take a shower or do laundry. And then suddenly your baby wants to nurse like it's day 1 again! Screams bloody murder if you try to put her down! But you haven't changed anything. Your diet is the same, you drink enough water, what is going on?
Guess what? You hit the first big growth spurt and this is your life now, slave to an insatiable boob leech. Start learning how to do everything with one hand. Honestly it is an indictment on our healthcare system that every mother of a 2 month old who comes in for a well check with her hair a mess, wearing sweats with a baby attached to her boob isn't immediately treated to shoulder rub and a box of chocolates, while Ryan Gosling holds her hand and tells her she's beautiful. The only thing a pediatrician should ever say to a mom who managed to make it out of the house like that is "This is perfectly normal. You are doing great!" Because (unless she is one of the 5%) she is doing great! And to be perfectly frank, your average pediatrician is probably not qualified to determine whether you are in the 5% or not.
Now you might be thinking, "But my baby lost/didn't gain x ounces."
It would be nice if it were as simple as looking on a scale to see how healthy a person is but it's not. It's just not. "Yes you can, that's why those helpful charts exist! Because some smart doctor people got together and showed us how to measure health in those helpful percentiles!" Growth charts are helpful tools for getting an idea of where your baby is health-wise, but unfortunately, many pediatricians make their determination on the growth chart alone. And there is a lot wrong with that.
For example, did you know that your exclusively breast fed baby is probably being measured by the wrong growth chart?! The most commonly used growth chart does not factor for the exclusively breast fed infant which can lead to your baby being wrongly viewed as growing inadequately. Tell your pediatrician that you would like your baby to be measured by the correct growth chart created by the World Health Organization.
Additionally, these charts are based on the average growth of infants around the world. A world in which there are lots of different kinds of people, of different shapes and sizes, who have different shaped/sized babies who all grow differently. In order for the chart to exist someone had to be in the 1st percentile just like someone has to be in the 99th percentile. Doesn't it seem strange that we are making life decisions for our children based on how their size compares with other babies in the world? This is not to say that "failure to thrive" or any other difficulty doesn't arise, again I remind you we are talking about the 95% of women here who are capable of producing enough milk for their babies.
So your pediatrician expressed some concern over your baby's weight gain not being where he/she would ideally like it to be. Maybe they suggested you top up after each feeding. Or maybe in the haze of exhaustion and confusion you experienced once Hurricane Growth Spurt hit, you lost your confidence and decided to top up after each feeding just to make sure that this insanity wasn't caused by your baby not getting enough to eat. And lo and behold it works like magic! Your baby sucks that first bottle down like it's the best thing he's ever had in his life and you think "OMG that was totally it! My baby was just hungry, and now he's fed and everything will be right in the world once more."
Well... Ok, so here's the thing. All this is based on the assumption that the mechanics of breastfeeding and the mechanics of bottle feeding are the same but they're totally different. Hold any bottle upside down (even the slow-flow ones) and it will drip without any suction making the liquid come out. When a baby sucks (in only the way a baby can) milk squirts out of that thing like a laser beam! Your baby's mouth begins to fill with liquid much faster than she's used to and suddenly has to gulp and swallow really fast just to keep from drowning.
That's not exactly a voracious appetite in action that you're seeing, that's your baby trying to keep up with the insanely fast flow of the bottle. So they gulp and gulp and gulp until the bottle is gone. Now their tiny tummy is so full of the milk of a large animal, that the body just doesn't know what to do with it. So it says, "Ok, let's shut down until we can figure out what to do with this stuff." and your baby sleeps, your baby sleeps longer than you think she's ever slept. And you start to think you've just witnessed a miracle. But according to the leading researcher on newborn sleep patterns, this isn't actually healthy behavior for a normal human baby.
"Well how am I supposed to know if I'm making enough milk if the growth chart and topping-up aren't good indicators? Surely pumping will give me a good idea."
I'm afraid not. This goes back to the assumption that all things are equal. Just like bottles are not like breasts, pumps are not like babies. You'd think a culture with scientific advancements like the artificial heart, we'd be able to make a machine that can suck a boob with, at least as much efficiency, as a tiny person that craps their pants. Alas, scientists have yet to crack that one.
Babies are just CRAZY good at getting milk out of boobs. It's like they were made to do it or something. And even though there are breasts pumps that do better than others at mimicking a baby's suction patterns and can even make sounds like your baby to help stimulate the milk ejection reflex, it's just not the same. Also, there are a lot of variables with a pump, having the right pump for one, not all pumps are worth the money. Pump settings and flange sizes also make a big difference in the quantity of milk being pumped. Although, even if you have the ideal pump set to the perfect settings and the right sized flange the pump still won't be able to extract as much milk as your baby can. It's just not a good indicator of supply at all.
For example, I tandem nurse two toddlers, they were both fat babies at birth that doubled their birth weight by 4 months old, so... ya know... I make a decent amount of milk. But when I pump I usually only get about four ounces total from both sides in half an hour. That's 2 ounces per side. And believe it or not, a veteran pumper will tell you that's a pretty good yield. That's how steep the efficiency drop off is with pumping vs. breastfeeding. It makes me sad to hear that a mom who was pumping just to build a freezer stash, gave up breastfeeding altogether just because she didn't pump well and thought that it meant she didn't make enough milk.
And what's super tricky about that is that in the beginning most moms can pump a lot of milk! A couple of weeks after having my first I pumped 10 ounces from one side, in one sitting! But that's because your body is still establishing your supply. It's a supply and demand system, the more demand the higher the supply. It's great for building a stash but not awesome for you. Your body doesn't want to maintain the supply necessary to feed quintuplets if you only have one baby. After a while your body wants to streamline and cut out excess production. Once your baby is a few months old your body gets wise to the game you're running and will only put out a good amount of milk if an actual baby is sucking it out.
It's the same with the feeling of let-down or fullness, it goes away after a while. It doesn't mean the milk is gone, it's just that now that you have the right amount of supply established that fullness and sharp let-downs are no longer necessary. And can we entertain the thought that maybe that's a good thing? Feeling full kind of sucks (no pun intended). And let-down isn't a bad feeling but it doesn't really feel awesome either. And come on, you've had a baby sucking on your boob for months at this point, how much feeling are you really going to have?
"Ok, fine, how can I tell if I'm making enough milk. I need something visual, something measureable, something scientific."
Ok. Here it is. The perfect indicator that you are making enough milk is... your baby! The best indicator for how much is going in is how much is coming out. Yes, that's right. I'm talking pee and poop. If that's all happening in sufficient quantities, your baby is generally content (you know, for a baby) and meeting developmental milestones you're pretty much rocking it. If you're worried about your supply talk to an IBCLC. They're the ones who know what they're talking about when it comes to breastfeeding.
AHHH! It felt good to get that off my chest! Pun INtended. So if you are the random mom who quit breastfeeding earlier than she wanted here's my advice:
Don't beat yourself up. It's hard! Any amount of breast milk you gave your baby is better than none. Moms need support and understanding when they are doing this and I have yet to meet the mother who felt 100% supported (both emotionally and physically) by their family, friends and medical practitioners. There's still a lot of misinformation running around out there. It's not like you didn't go into this thing with the best of intentions: 77% of us plan to breastfeed and less than half of us make it to 6 months! It's not because women physically can't, or aren't aware of the benefits, it's because the support is just not that available.
So if you're that mom, that awesome mom, who tried and didn't reach her goal because of misinformation or inadequate support. You can still make a difference. You can help other moms overcome the hurdles that got you down. If we meet at a social gathering, let's totally be friends! The community needs more moms like you who can say, "I know better now, and I'm here to help!"
