From today's ABC News website



WHEN BREAST IS *DEFINITELY* NOT BEST

“Mismanaged breastfeeding can go awry, and refusing to talk about the problem
is like sticking your head in the sand.”
— Dr. Marianne Neifert, pediatrician


By Jenifer Joseph
ABCNEWS.com
Oct. 21 —It’s typical TV doc-melodrama: Panicked parents come to an emergency
room with a tiny baby who’s not breathing.
    The child can’t be resuscitated and dies of malnutrition. The doctor, Dr.
Diane Grad, accuses the mother Susan of neglect. But Susan says she was
following the hospital’s breastfeeding guidelines and medical advice from a
lactation expert not to supplement with formula. Nevertheless, the baby just
wasn’t getting enough milk to survive. <Picture: Chicago Hope>
Dr. Diane Grad (Jayne Brook) struggles with her own motherhood issues on the
show Chicago Hope. (CBS)

    But news about the plot line for this week’s episode of Chicago Hope
leaked out, and has prompted an avalanche of concern among breastfeeding
activists, worried that the show will scare new mothers.
     “Women who may be eight or nine months pregnant could see this show,
where the baby dies from breastfeeding, and they may decide, ‘no, I don’t want
to breastfeed,’” says Kim Cavaliero, spokeswoman for La Leche League
International. “The reality is that this is extremely rare.”

Ripped From the Headlines
But it does happen, and real-life mothers sometimes get into unmerited trouble
as a result. The Hope story line is based on a condition called insufficient
milk syndrome, and on a tragic incident that occurred last May in New York.
     Tatiana Cheeks, a 21-year-old mother, didn’t realize her 6-week-old baby
wasn’t getting enough breast milk until he fell unconscious in her arms. By
the time she got to the hospital, he was dead. Not long after, Cheeks was
brought up on charges of negligent homicide for apparently having starved her
baby to death. They were later dropped.
     The two writers who worked on the Chicago Hope episode heard about
Cheeks’ situation and developed a script about it.
     One of them is executive producer Dawn Prestwich, who also suffered from
insufficient milk syndrome, in 1992. Despite her good efforts—15 hours a day
of breastfeeding and breast pumping—her infant son Noah was not gaining
weight. By the time he was 6 weeks old, he weighed three ounces less than he
had at birth.
     “Everything you read says, ‘Don’t supplement.’ I was so committed to
breastfeeding that I didn’t realize he was just not feeding,” says Prestwich.
To complicate matters, a lactation expert told her, “There’s no reason why you
shouldn’t be able to breastfeed, except perhaps an emotional one.”

Perfect Mom Syndrome
Fortunately, Prestwich switched to the bottle in time, and her son has been
happy and healthy ever since.
     Co-executive producer Nicole Yorkin didn’t have breastfeeding problems
with her two children. She nursed her first child for a full year, and is
doing the same with her second child, now 7 months old.
    But both she and Prestwich understood the dilemma facing new moms. The
pressure to do the right thing by your baby can become so great that some
women blindly follow absurd advice: Keep trying. Don’t supplement with
formula.
     “The show is about the tyranny of perfect motherhood,” says Yorkin. “It’s
not about breastfeeding not being good. And we want people to be aware that
there is something called low-milk syndrome. It does happen and it’s not that
rare.”

Can It Happen to You?
Dr. Marianne Neifert, well-known in parenting magazines as “Dr. Mom,” is one
of a handful of researchers looking into insufficient milk syndrome. In
studies conducted in the late ’80s, she found that up to 15 percent of women
have insufficient milk for one reason or another; in about 4 percent of women,
the problem is beyond the mother’s control.
     Neifert agrees with the Chicago Hope producers that the portrayal of this
disturbing reality is crucial to raising doctors’ and parents’ awareness.
     “These deaths are completely preventable,” she says, “but refusing to
talk openly about the problem” leaves women and their babies vulnerable.
     “Successful breastfeeding, like conception, is not a basic right,”
Neifert writes in a new book that will hit stores next month, Dr. Mom’s Guide
to Breastfeeding. “Rather, it is a precious gift. And not every woman receives
this particular gift.”
    Just in case the show does prompt anxiety among pregnant and nursing
mothers, La Leche and other advocacy groups have joined forces with Medela, a
breast pump company, to produce a public service announcement that they’ve
asked TV stations to air after the show.

Causes of Insufficient Milk Abnormal or underdeveloped breasts. Contrary to
popular opinion, it simply is not true that every breast is perfect for
breastfeeding. Women with tubular-shaped breasts and marked breast asymmetry
can have trouble breastfeeding. Previous breast surgery. A simple biopsy,
breast enlargement or reduction surgery can limit breastfeeding potential.
Research confirms that surgical incisions near the nipple-areola carry the
greatest risk. Breast radiation. Radiation, to treat breast cancer for
example, damages the milk-producing glands and ducts. Little or no milk is
produced after radiation therapy to a breast or chest. Failure of postpartum
breast enlargement. In a few women, milk fails to come in normally and doesn’t
increase abundantly after delivery. It can stem from illness such as
hemorrhage, high blood pressure, infection and emotional stress. Hormone
problems. A few women have hormone disorders that prevent full lactation.
Untreated thyroid disease has also been linked with insufficient milk. Older
age. Some lactation experts have observed that mothers in their late 30s and
40s have unexplained insufficient milk. Beginning after age 35, the milk-
producing glands gradually decrease in number and are replaced by fatty
tissue. Although many women over 40 are able to produce abundant milk, age may
explain some of the puzzling cases. Inadequate body fat. Lactation uses about
1,000 calories a day, about 500 of which come from body fat stores. Women who
have gained less than 20 pounds during pregnancy or those with chronic
illnesses resulting in low fat stores may not produce a full milk supply.