I posted this to LactNet back in August:


Rachel also mentioned the issue of how many women physiologically are
incapable of lactating.  The 5% figure was bandied about in the press the
summer of 1994.  Where did this come from?  I don't have the references on
this topic here at home, but I can tell you the tale, and you can check it
out for yourselves.

The Wall Street Journal published an article on July 22 or 23, 1994, which
mentioned the 5% figure of modern women who could not produce enough milk
for their infants.  When questioned, they said they got this figure from
Mary Ann Neifert, who runs a breastfeeding clinic in Denver.  She deals with
women who are already having problems, and of course the vast majority of
women have no problems, so she never sees them.  She said 5% of her clinic
population seem unable to produce enough milk.  She also said this was true
of the general population, however, and referred inquirers to one of Dana
Raphael's books (she has written several on breastfeeding, including "The
Tender Gift" and "Only Mothers Know" and I'm not sure which book was cited
in this context).  Anyway, if you go to Raphael's discussion of this, SHE
cites a study in New Zealand that found 5% of mothers in a hospital study
couldn't produce enough milk.  If you go read the New Zealand hospital
study, which was done in the 1950s, it turns out that the study had mothers
nursing their newborns for one minute on each side every 4 hours the first
day of life, for 2 minutes on each side every 4 hours the second day of
life, for 3 minutes on each side every 4 hours the third day of life, and so
on.  Under this strict rationing of breast stimulation, about 5% of the
women didn't produce any milk, or insufficient milk.   What is amazing is
that ANY of these women produced significant amounts of milk, given the
infrequency of feeding and the short duration of each feed.  And yet 95%
were producing at least some milk.
        The scientific literature shows conclusively that the more often the
infant nurses, the greater the mother's milk supply (assuming the baby is
latched on properly) AND the higher the fat content of her milk.  Michael
Woolridge of England has published extensively on this topic, and his
research shows that children allowed to nurse on cue regulate their own
intake in terms of quantity and fat content to be just what they need.
Scheduled feedings and limiting the duration of the child on the breast at a
feed are sure-fire ways to reduce milk supply.  For a fascinating
perspective on the history of the medical profession's love-affair with
scheduled feedings, see the article by A.V. Millard in the journal Social
Science and Medicine, 31(2):211-221.  The title of the article is "The Place
of the Clock in Pediatric Advice," and it was published in 1990.
        Many, many women are told by their pediatricians to nurse only so
many times a day, and to limit the duration of the baby's nursing sessions.
The baby doesn't remove enough milk, so less and less is made (breast milk
production is a demand-driven system) and the baby seems more fussy and
fails to gain weight properly.  The mother is told by her doctor that "She
doesn't have enough milk" and must supplement.  The supplements interfere
even more with the nursing, and soon the baby is completely weaned.  The
baby's health is the loser, as is the mother's self-confidence and
self-esteem.  The winners?  The infant formula industry.


New addition to note:  I think we all need to remember that the population
of women seen by LC and LLL leaders, and in Mary Ann Neifert's "problems"
clinic etc. is only a small proportion of the women out there who are
breastfeeding.  Many many women go home with their babies and have no
problems, and so never come to anyone's attention.  There is *no* evidence
that 5% of the general population of breastfeeding women are incapable of
producing enough milk for their children given unrestricted, properly
latched-on, time at the breast.

Kathy Dettwyler, at home with the flu, boo-hoo