Laurie wrote:

>
>
>Now that I've had 25 yrs of working with breastfeeding mothers, I would have
>to say that it is not rare for mothers to have insufficient supply.
>I can often predict which ones, based on their body type and breast shape.
>Since we have a followup clinic in 1-2 days post hospital
>discharge, I don't say anything to the mother, but often it bears out. I
>have seen enough cases of PCOS (because we have an OB doc on staff
>who sort of specializes in this, and infertility), that I believe it is
>definitely associated with lowered milk production. Certainly, lowered
>production
>is often multifactorial, and so when a mom has PCOS, diabetes, conceived
>with fertility drugs, twin premies, we will be very worried about her
>supply.


Now that is interesting, and must reflect the different culture, and 
the different population of women, because I have been doing this 25 
+ years and I would say it is really, really rare to have 
insufficient supply. But I see mostly healthy women and babies with 
no clinical issues, and you may see a lot more women who already have 
probs pre-pregnancy and beyond.

Insufficient intake - yes, yes, yes!

But insufficient supply, because of some underlying physiological or 
even pathological issue which means their babies cannot possibly 
thrive on breastmilk alone no matter what?  Very rare indeed, and I 
think I can only bring to mind a handful of women to whom this 
applied (and even then I am not sure that with better support in the 
very early days to get the baby feeding effectively and often we 
would not have seen a different outcome).

I have seen several more women who struggled, and whose babies looked 
thin and scrawny, but who hung on in there and their babies did, 
eventually, do ok, and many of them went on to breastfeed for a long 
time (that is, they didn't immediately stop when solids were 
introduced....I don't always know how long a mother continues, of 
course).

There is surely no cut-off between 'mother  who has plenty of milk' 
and 'mother who cannot produce enough'....it has to be a spectrum; 
there will be some mothers who feel they 'cannot produce enough' (or 
are told this) because their baby is not doing the right things to 
the scales, and there will be others (and their HCPs) who just accept 
they produce skinny kids.

When breastfeeding is going really well, you don't get skinny kids, 
that's for sure. A well-fed breastfed baby is typically a rounded, 
buttery, yummy little podge :)  But the skinny kids  who are not 
breastfeeding well may be breastfeeding well enough to survive.....I 
don't know where the line can be drawn, if all we are talking about 
is 'adequacy of volume of milk that gets into the baby' and infant 
feeding is a whole lot more than that!


(Note: I am not talking about babies who are persistently not growing 
at all or who are losing weight, here)

Heather Welford Neil
NCT bfc, tutor, UK

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