Hi all
I would like to begin a new discussion.  I have been catching up on some
reading over the holiday and I read an article by a couple of our
breastfeeding counsellor/IBCLCs that stirs an interesting question in my
mind. (thanks to Dale Nigro and Louise Duursma)
I wonder, do we disempower mothers or undermine their confidence in
breastfeeding by using the term 'insufficient milk' or 'low supply' to
describe a situation where we see a breastfed baby who is not thriving?  If
we genuinely believe that it is rare for mothers to be incapable of
producing sufficient milk for their infants, then perhaps a better way to
describe this phenomenon is 'inadequate intake'.  If we truly believe that
lactation is demand driven, then, if an infant is taking in enough milk, the
mother will be making enough milk.  When cultural expectations or hospital
policies restrict the number of feeds/ suppress a baby's instinctive
behaviours, then the problem is not with supply but demand.
One of the consequences I see of this shift in language use might be that it
places more value on simply feeding babies more often.  When we tell a
mother that she has 'low supply', is she likely to feel that this is a
situation that she has the power to change?  Will she be receptive to the
suggestion that she feed the baby more often if the goal of that behaviour
is to 'build supply'?   Does this language use suggest that the mother's
body (and therefore the mother) has *failed* to produce enough milk? Are we
buying into the myth that breastfeeding is unreliable, that women's bodies
are fickle and that many women 'can't breastfeed'? Is it more achievable to
'build supply' or to 'feed more often'?  If we tell a mother that the baby
is not taking enough milk to thrive, is she likely to be receptive to the
idea of feeding the baby more often? Will she hear our confidence that if
she feeds more often, there will be milk there for the baby to take?  Will
she understand that this tiny new baby needs to be fed more often because
*the baby* is not able to take all the milk s/he needs in 6 feeds/day? Might
this shift take the pressure off the mother and reduce our reliance on
gadgets?
If a bottlefed baby is showing signs that s/he is not taking enough
calories, do we describe this as insufficient milk supply? Do we blame the
bottle? If the mother reported that she was offering the baby the prescribed
amount at the prescribed intervals but that the baby rarely finished the
bottle, I think we suggest that the baby is simply not taking enough milk.
We would exhort the mother to feed the baby small feeds more often until the
baby became more efficient.
I understand that lactation physiology is understudied and I understand that
there are cases (such as hypoplasia, partial mastectomy) where insufficient
production may well be the issue.  But these are rare and I am hoping we can
have a conversation about the language we use as a health promotion issue;
as a vehicle of attitudinal change. 
Regards
Nina Berry
Australia

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