Hi Nina

You pose a very relevant and interesting question.  I agree that we are
doing a disservice to mothers by referring to low supply / insufficient milk
and feel that a change in terminology could, over time, facilitate a change
in attitudes, expectations and therefore behaviour.

Another part of the issue that surrounds the perception of low supply that I
could see being addressed by this change in language, is the over reliance
by mothers and health care professionals on the use of breast pumps.  I
often talk to mothers who have been put on a complicated regime of feeding,
expressing and topping the baby up with EBM and / or ABM, which combined
with the cleaning of equipment and normal baby care is too much for the
mother to cope with, especially if she has other children (a point that many
health care providers don't seem to take into consideration!).  Many times
this situation could be avoided by simply fitting an extra feed or two into
the day, or topping up at the breast - i.e. Feed more often.  These mothers
are often on the verge of giving up because ABM feeding in this instance
would be easier.

In the facility where I work, I often see mothers in the late stage of
pregnancy, coming in to purchase a breast pump - usually with the idea that
the bigger, more expensive the better.  If they are not returning to
work/study soon after the baby is born, then I suggest they wait and
purchase a pump only if they find a need.  As a society we seem to be hooked
on gadgets (not all are bad mind you - says she with 2 laptops in front of
her)

Many mothers seem to no longer have trust in their body's ability to feed
and nurture their baby after birth, as it did before birth.  I guess it is
no wonder with some the terminology surrounding birth and breastfeeding.

A change in language could also be the means to empower mothers to trust
their bodies and their instincts - I'm all for it!


Elizabeth Milne, IBCLC
Australian Breastfeeding Association Counsellor,
Sydney, Australia

 
 
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Nina Berry
Sent: Tuesday, 8 January 2008 9:15 AM
To: [log in to unmask]
Subject: Language: Insuffient milk/ Inadequate intake

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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