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Health mythbusters is a regular column in which FHP researchers challenge widely held beliefs about health issues. ÌýThis month, Kathyrn Hayward takes on a common breastfeeding myth.

Kathryn Hayward is a registered nurse, assistant professor and IPE Coordinator at the School of Nursing. She is a certified lactation consultant, and an active member of the Halifax Breastfeeding Community of Practice steering committee where she is leading a group working to bring a human milk bank back to Nova Scotia. Kathryn's research interests include breastfeeding the preterm infant, co-bedding twins and inter-professional education.

Many breastfeeding women struggle with a low milk supply."

Despite extensive research supporting breastmilk as the optimal food for human infants, many mothers quit earlier than they had originally intended (Odom, Li, Scanlon, Perrine, & Grummer-Strawn, 2013). Although 89% of Canadian mother’s initiate breastfeeding only 26% are still breastfeeding at 6 months (Gionet, 2015). Many of these mothers cite low milk supply as the reason for early cessation of breastfeeding. In actual fact very few women, less than 5%, have genuinely low milk supplies (Neifert et al., 1990). Actual physiological reasons for a low milk supply include uncontrolled anemia, hypothyroidism, retained placenta, post partum hemorrhage, breast surgery, hormonal problems, smoking and the medication such as hormonal birth control (Riddle & Nommsen-Rivers, 2016).

So if only 5% of mothers have a physiological reason for low milk supply why is it one of the most common reasons cited for early cessation of breastfeeding? Is low milk supply a breastfeeding myth? Most women who cite low milk production actually have a misperception that they have a low milk supply, also called Perceived Insufficient Milk (Neifert & Bunik, 2013). To these mothers, their perception of low milk is just as real as an actual low milk supply.

Perceived insufficient milk exists when a mother is producing enough milk for her infant, but incorrectly believes she does not have enough milk.Ìý She misinterprets normal infant behavior as her baby being hungry or unsatisfied at the breast. Breastmilk is more easily digested than breastmilk substitutes and as a result infants feed more frequently. Mothers often misinterpret this increased feeding as insufficient milk. During growth spurts, infants feed more frequently, with the increased demand sending a message to the body to produce more milk. It takes 24-48 hours for a mother’s milk supply to catch up with the increased need. It is often during these periods of growth that mothers are convinced that their supply is insufficient. Evenings are typically a fussy period for infants and often correspond with increased time at the breast. Infants are cluster feeders meaning they will have periods of increased frequency of feeding, often followed by a longer period of sleep. Typically this period of increased feeding happens at the same time each day. Mothers need to be aware that this behavior is normal and that it is not an indicator of a poor milk supply.

Many mothers are unfamiliar with the anatomy of a lactating breast. They often interpret the lack of a let down, breasts not leaking and/or their breasts becoming soft as a sign of low milk supply. Not all women experience leaking breasts or feel a let down when their milk flows. This is not an indication of a poor milk supply. As a mother’s milk supply adjusts to her infants needs, her breasts will soften, stop leaking and feel less full to the mother.

Over the last half century we have become a society of bottle feeders. As a result, mothers have easy access to the normal feeding practices of the bottle fed infant. They only need ask a friend or relative for advice if they need assistance. Breastfeeding mothers no longer have that easy access to support. As a result, when they or someone close to them questions their milk supply, they may choose to supplement with formula, unknowingly jeopardising their milk supply (Gatti, 2008).

Today, if an infant struggles to latch at the breast or latches poorly, the mother, her support system and even her health care providers may not recognise or know how to assist with this problem. A poor latch over time does not adequately stimulate the production of milk and as a result may decrease a mother’s milk supply.

We need to recreate a breastfeeding supportive society that will be able to provide the support that was once easily accessible to mothers. Parents and health care providers need to be educated about milk production and infant indicators of appropriate milk intake (weight and diaper output) (Witzel, 2013). In addition, health care providers working with mothers and infants need to have the knowledge required to adequately assess and support breastfeeding. Early access to competent help can positively impact mothers’ success in obtaining their breastfeeding goals, regardless if the problem is related to an actual lactation problem or perceived insufficient milk.

References:

Butte NF, Garza C, Smith EO, Nichols BL. (1984). ÌýHuman milk intake and growth in exclusively breast-fed infants. J Pediatr. 104(2),187–195

Gatti, L. (2008). . Journal of Nursing Scholarship, 40(4), 355-363.

Gionet. L. (2013). Breastfeeding trends in Canada. Health at a Glance. November. Statistics Canada Catalogue no. 82-624-X.

Neifert, M. R. & Bunik, M. (2013). . Pediatric Clinics of North America, 60(1), 115-145. doi: 10.1016/j.pcl.2012.10.001

Neifert M,Ìý DeMarzo S,Ìý Seacat J,Ìý Young D,Ìý Leff M,Ìý Orleans M. (1990). The influence of breast surgery, breast appearance, and pregnancy-induced breast changes on lactation sufficiency as measured by infant weight gain. Birth. 17(1), 31–38

Riddle, SW, & Nommsen-Rivers, LA. (2017). Low milk supply and the pediatrician. Current Opinion in Pediatrics, 29(2): 249-256.

Witzel, SJ (2013). When the milk won’t flow. Pharmacy Practice, 29(7), 28-34.

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