The question was asked how to discuss the risk of insufficient milk with a
pregnant woman who has some risk factors for low supply.  

As with diagnostic tests, if the issue in question is worth mentioning, it
should have some bearing on how you will proceed in providing support and
guidance to the woman.  I can't see how my handling of such a mother and her
baby would be any different given that I know that some women with
polycystic ovaries or hypothyroidism or just overweight develop milk supply
problems, and the vast majority, in my experience, do just fine.  Therefore
I would be unlikely to bring it up at all antenatally unless specifically
asked by the woman, in which case I would tell her the truth: that nobody
knows until the baby is born, how it will go, but we know what we can do to
maximize the odds of success.  That is, of course, to follow the ten steps
to successful breastfeeding.  

All mothers and babies deserve to have easy access to people who are
competent to help them fix problems that may arise with the establishment or
maintenance of breastfeeding.  Mothers with so-called risk factors deserve
no less, but no more, either.  Any woman who gets bad care can wind up
struggling with iatrogenic problems, no matter how perfect her health or her
motivation or even her birth.  I would hate to see any of those problems
chalked up to her thyroid gland, or her adiposity, or anything else about
her personally.

Breastfeeding is like giving birth in the sense that you need all the
self-confidence you can muster, and then some.  I am so short that if I had
had my first baby in Norway I would have been sent for x-ray pelvimetry,
while being told I would be allowed to go into labor and 'see how it goes'.
How's that for doublespeak?  I'm very happy that I was not subject to
anything so undermining, but was instead surrounded by caregivers who had
every expectation that my body would work, and we all knew that if it
didn't, they and I would be able to figure out what to do about it.  A
discussion of risk would have been entirely superfluous.

Rachel Myr
Kristiansand, Norway

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