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When I had my first child 11 years ago, I was confident I wouldn’t have a problem breastfeeding. Not only had my three older sisters proved that the Anderson girls were lactation mavens, but the books and experts told me so: All women are made to breastfeed, they assured me, and all breasts are up to the task. And, sure enough, Dylan latched on like a champ and never let go.
So imagine my shock when, nine years later, my breasts let me down. Claire and Aidan, twins born at 34 weeks, were just too sleepy and weak to nurse efficiently, causing my milk supply to drop. Despite frequent feedings and pumping, various herbs, incessant fretting and several teary consults with lactation consultants, my milk never rebounded. I resigned myself to a regimen of nursing, pumping and supplementing with formula.
My story isn’t unique. Not only is low milk supply now recognized as a valid concern, it may even be on the rise. And women who, like me, have been convinced that it doesn’t occur are blindsided when it does, leading to feelings of failure and inadequacy. “There’s nothing worse than the devastation of not being able to breastfeed, or breastfeed exclusively, when you really want to,” says pediatrician Marianne Neifert, M.D., a co-founder and medical consultant to The Lactation Program in Denver, and author of 2009’s Great Expectations: The Essential Guide to Breastfeeding. “Women end up feeling it’s their fault.”
The chances are good that you won’t have a similar experience—a study that evaluated breastfeeding success at three weeks postpartum found that approximately 15 percent of women experience inadequate milk supply. But it pays to be on the lookout. “It’s a lot better to prevent low milk, when possible, than to try to remedy it,” Neifert says.
Occurring among approximately 4 percent of women, primary causes of low milk supply are the more difficult to treat and include such medical issues as breast and hormonal problems. “Previous breast surgeries, insufficient mammary tissue and thyroid or other hormonal disorders are some of the more common causes,” Neifert says. “A woman who has difficulties during delivery, such as very heavy bleeding, can also have problems.” So may a woman who is severely exhausted.
Environmental toxins: A woman’s surroundings—or even her mother’s— may play a role in her milk supply. A small study conducted in 2006 found that daughters of women who grew up in a pesticide-contaminated agricultural valley of Mexico had a much higher incidence of insufficient mammary tissue—or, in some cases, no mammary tissue—than those living on a hilltop in the same area.
“We’re seeing a dramatic increase in the number of women who have primary problems, possibly because of environmental contaminants,” says Diana West, IBCLC, a coauthor of 2008’s The Breastfeeding Mother’s Guide to Making More Milk. “Lactation consultants around the world are reporting increases in the numbers of women who can’t produce enough milk.”
Underlying fertility problems: “Interventions are allowing people to get pregnant when they wouldn’t otherwise, causing babies to be born to women who might not have fully functional reproductive systems,” West says. “For example, many women with PCOS [polycystic ovary syndrome, a condition that can cause ovulation problems] also have much less functional breast tissue.”