I would agree that the percentage of women who are unable to produce a full milk supply is much higher than 0.1%. There are very few parts of the human body that function with that low of a failure rate. For example, the heart, pancreas, lungs, etc. How many babies are born with heart defects? Or children develop Type 1 diabetes? Especially when we consider how many women have breast reduction surgery now, or have thyroid problems or diabetes that may be affecting insulin levels which can impact milk production. Anyway, the percentage of primary lactation failure is probably relatively small, but unknown at this point since it is difficult to know how many truly physically can't produce enough and how many are victims of lactation management problems. It's good to know that the 5% number is completely made up though. I remember hearing Betty Crase speak and it was interesting that I believe I remember her saying that the Physician who first quoted 5% in the 1930's was making an unscientific estimate of the patients that he saw in his practice. She also pointed out that at that time in the hospital, mothers routinely didn't start breastfeeding for the first 24 hours, fed on a 4 hour schedule, were in the hospital for a week and did not get the babies at night to breastfeed. So it's rather remarkable that 95% were able to successfully breastfeed actually!
I guess my one concern would be that although this article is factually correct, if I was a mother reading it who was unable to breastfeed, either because of primary lactation failure or due to lack of support, I might feel further criticized. I'm sure that wasn't your intent at all though. I feel like (although it's not fair) we are often demonized in the press and characterized as uncaring and harsh. I think we really need to go out of our way to be seen as kind and caring to all women. Although you are technically right that "breastfeeding is normal," for example, the way that a mother who is formula feeding may interpret that is that you are calling her "abnormal." Or what she is doing is "abnormal." Or worse that you are saying that her baby is abnormal. Instead of saying breastfeeding is normal, I wonder if it might be less hurtful to say something like, "Human milk is the physiologic norm for the human infant." And then go on to explain that a human body is expecting human milk, just like any other mammal grows best on its mother's milk, etc.
And again when you say something like, "some might describe bottle-feeding as a 'traditional harmful practice of the minority," as set out in the Innocenti Declaration.... I worry that mothers who are formula feeding (or even giving EBM in a bottle) may be hurt by this statement. It may give fodder to those who feel that we are harsh and uncaring. I would rather see us go out of our way to be as gentle as possible and not give more fuel to the arguments of our critics who already say that we are mean to people who can't or don't want to breastfeed. We as LC's have a PR problem in general, I think. It's best that we begin to address it. Especially statements like this seem to be a bad idea to me in an article in which your topic is trying to address whether or not women physiologically can't produce milk, and if we are being too harsh, especially too harsh because some women have primary lactation failure. I would think that kindness and gentleness will go farther with people. We should first of all start by acknowledging their feelings and concerns, even if we don't agree with specifically what they are saying. At least they will know that we are listening to their concerns and have compassion for their feelings.
Tricia Shamblin, RN, IBCLC
"If I speak with the tongues of men and of angels, but do not have love, I have become a noisy gong or a clanging cymbal." 1 Corinthians 13:1
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