>>An angry mom suggested recently that the numbers of women who can't
produce enough milk for their babies is way underestimated in the US and it
*must* be more than even the "pesky 4%" we hear.<<

Over the past three years I have had to revisit all of my own beliefs and
assumptions on this topic. On the one hand, I believe in the natural
process-- that our bodies were made to conceive, carry, deliver and nourish
our infants, and that this process should rarely fail. OTOH, I've been
confronted by too many cases of insufficient milk supply that had no good
explanation.

Barbara wrote about her own experiences with PCOS moms and insufficient milk
supply. I've documented 30 cases, and had contacts with more, and while a
few women have "clean" histories, a large number of them have hormonal
disturbances, especially PCOS, in their health histories. I've been stymied
by the lack of anything related to breastfeeding and PCOS in the literature,
but recently discovered that there HAS been some research and mention, only
it has been mostly pre-Medline. Irving Stein himself commented in 1943 about
hypoplasia of the breast being one of the possible symptoms of
Stein-Leventhal (PCOS). An article from 1972 actually took diagnosed PCOS
women and did radiography of their breasts and of their uterus and ovaries.
A good number of the women apparently had poor mammary tissue development,
many had enlarged ovaries or undersized uterus, and the authors were
actually trying to determine if *hypoplasia of the breast* could be used as
a predictor of PCOS/hormonal problems! Insufficient mammary tissue can be a
cause of poor milk production, and it is not always obvious to the eye. Why
all of this dropped out of the literature, I do not know; I can only
speculate that it paralleled the lack of interest in breastfeeding and
breast function.

PCOS is on the rise, estimated at 5-10% of all women, and is the leading
cause of infertility. Perhaps we are seeing more because we are defeating
the law of natural selection. We are also seeing a lot more diabetes in the
population (lack of breastfeeding, diet, or????), which also often goes
along with PCOS. One thing for sure, our lactation experiences are not
paralleling our mammalian counterparts, who rarely if ever suffer similar
problems. But, we must not deny the very real experiences of the mothers. As
Barbara mentioned, so many of these women suffer from shame, guilt, and
feelings of inadequacy, especially when it is suggested to them that if they
just tried harder, breastfeeding would work. My heart has been wrenched by
some of the stories I've heard, and women have wept when I've shared with
them why their problem probably has a physiological basis. If we can accept
that this is happening more often than we thought, then we can move to the
next phase, trying to decipher the underlying causes, and then hopefully to
some treatment strategies that are more than just darts at the wall, as we
often must do now.

~Lisa Marasco, IBCLC

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