Sorry about the fragment sent -- trying to minimize and hit send instead.  Just didn't want to leave Pamela in suspense -- I was about say that she is without question a treasure -- we've gained much from her thoughtful Lactnet posts based on her wide ranging experiences.  And she is so right that breastfeeding tends to work -- humans have covered the planet because it does. 

But I question the tenth-of-a-percent estimate.  Our modern world can disrupt breastfeeding in so many ways, so it's sometimes tough to say when we're seeing secondary issues -- but some percentage of women do have profound, primary problems with making milk.  Any body system can have problems -- maybe 10% of women have trouble getting pregnant or carrying to term.  Some percentage of babies are born prematurely, and some percentage  of c-sections (well below our current rates) are lifesaving.  People have trouble secreting thyroid hormone or insulin basic to life.  

Breastfeeding does require confidence, but are we really doing women a service to imply that such primary problems are so rare?  Maybe we're seeing more of them -- with older mothers who overcame fertility issues, the endocrine disrupters in our environment, the prevalence of obesity and insulin resistance, women who wouldn't have lived to adulthood in less medically advanced times are now having babies, etc.  

Infant mortality rates before the modern era were high.  Women in a village and surrounded by family could likely find another lactating mother to help her out, a little or a lot.  So maybe that had masked how prevalent milk production issues may have been through human history.  La Leche League was named after a shrine devoted to Mary as a patron of bountiful milk -- so mothers have always worried about this issue.

Alison Stuebe, MD at the Academy of Breastfeeding Medicine blog (all very interesting!) wrote several very incisive and humane posts, pondering how badly the medical profession deals with primary lactation failure and how little research is done on the topic and how little we have in the way of medications and treatments.  
https://bfmed.wordpress.com/2010/04/24/when-lactation-doesnt-work/#more-134

Any amount of breastmilk and any amount of nurturing at the breast are valuable, so I'm certainly not writing off these mothers who got a bad deal of the deck -- it's wonderful to see how hard some mothers work to stay in the game for their babies.  But maybe they need to feel that they are on some common ground.

Margaret Wills, LLLL, IBCLC Maryland

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