Part 12: '98 and 3/4 per cent guaranteed'

But there is a positive side to my obsession.  I read everything and anything I can find about breastfeeding in the hope of answering the burning question, what could I have done differently?  And in doing so I discover, in amongst the many myths and misinformation that goes around about what counts as ‘normal’ breastfeeding behaviour, myths that lead many to fall at needless hurdles when, with the right advice and information they could have carried on, what is perhaps the biggest myth of all – the myth that ‘anyone can breastfeed’.  Because when I really look into it I discover that what I thought I knew is wrong. For an estimated 1-2% of mother/baby pairs – perhaps as many as one in fifty of us - breastfeeding is simply impossible, for a variety of reasons.  Some of these are obvious ones: breast surgeries, infant palate problems, incompatible medications.  Some are less obvious: retained placenta, for example, can stop the appropriate hormones kicking in to get lactation going, so that the milk never comes in. But setting these cases aside, according to The Breastfeeding Answer Book an estimated one in a thousand women will be unable to breastfeed exclusively simply due to primary lactation failure.  That is, for no other reason than that their breasts can’t produce enough milk. One in a thousand women.  A small proportion, yes, but certainly not vanishingly small.  Not so small that it should be completely unheard of, unspoken of by breastfeeding counsellors, and unmentioned when things don’t go to plan.

Lactation, like almost any bodily function, is a complicated business. Not only does the machinery have to be there in the first place – the milk making glandular tissue – there needs to be something – in the form of hormones – to switch that machinery on.  Primary lactation failure is not very well understood, but in some cases there may be a problem with the switches (as, for example, in some thyroid disorders), in other cases a problem with the milk making machinery itself.   The causes of insufficient glandular tissue are various and not well understood, though the condition is often noticed in women with PCOS, and those with high testosterone levels.  For some women the lack of tissue is visually recognizable, in the form of hypoplastic breasts, which tend to be widely spaced and tubular, often asymmetric, with large areolas.  But breast hypoplasia does not always mean insufficient glandular tissue, and insufficient glandular tissue does not always present as hypoplasia. A woman’s breasts may appear quite full, but if this fullness is due to fat cells, rather than glandular tissue, it may still not be able to produce sufficient milk. Women with IGT experience little or no breast changes during pregnancy, will tend not to notice their milk come in, or experience any let down sensation, but again, in some women all of these things can be absent and still be no indication of a problem with milk supply.  But if lack of breast changes, sensations of milk coming in, or let downs in the mother are accompanied with dehydration and weightloss in a nursing infant, that’s some indication, however fallible, that the problem may be one of IGT.

As I learn about all this I of course wonder about my own case.  It’s complicated, given the tongue tie and the mismanagement in the early days.  But something I’d never understood is why I never felt my milk coming in.  At first I had thought this too was the tongue tie, as my son just wasn’t stimulating my breasts enough to produce milk.  But milk coming in is meant to occur as a result of giving birth, not of breastfeeding.  Even women who never once put their babies to their breasts will feel it happening. So why not me?  And why no letdowns, no sensations of filling or emptying, no changes in breast size during my pregnancy?  My breasts are not hypoplastic to look at – they are, you might say, quite buxom. But then I remember my teenage years and their first appearance, and how, conscious of their straight sided rather than nice rounded shape I used to joke with my friends about my ‘triangular tits’.  So is this my answer?  Is this why even with all that feeding and pumping my milk supply never increased.  ‘Do all this’, said the LC who’d cut the tongue tie, ‘and you will see your breasts producing more milk.’  I should have read my Dr Seuss: ‘And will you succeed? Yes! You will, indeed! (98 and ¾ per cent guaranteed.)’

I can’t know that it was IGT.  There are just too many variables.  But in preparation for the new arrival I join the mailing list of MOBI: Mothers Overcoming Breastfeeding Issues, and through that I am introduced to a world of mothers living with IGT and other severe breastfeeding challenges.  Some with diagnoses of IGT, some without.  But mothers who have gone through the heartbreak of insufficient milk with baby after baby, doing everything right and still not producing a full supply. Many of these women manage to continue to breastfeed, using supplemental nursers for long term at breast supplementation using formula or donor milk.  Most are on a cocktail of lactogenic herbs and drugs, spending all of their spare money on high doses of over the counter domperidone for the sake of increasing a pump yield, if only from 15 to 30mls a session.  Some are virtually housebound for the first six months of their baby’s life, not wishing to feed their child in public from a tube taped to their breasts.  These are some determined women (and I have to remind myself, never compare).  And from them I learn, not how to guarantee myself a full milk supply next time around, but how to make the most of what I may have, and how to prepare for the possibility that a full milk supply may not be possible. And just as I resign myself to IGT being the root of our problems, an LC posts on the list about upper lip ties and breastfeeding problems and I, together with many other MOBI mums, take a look at our babies’ top teeth and gums and discover yet another potential cause of our woes.  Undiagnosed abnormal maxillary frenum attachment – could it have been that all along?

So I don’t have any easy answers, but forewarned is forearmed, as they say, and the challenges I faced last time around mean I have plenty of warning of a myriad of potential problems.  In case of IGT, for my pregnancy I follow the MOBI regime of herbs to take in pregnancy to increase glandular tissue, to the extent that I am comfortable with doing so.  I am stocked up with galactagogues for after the birth too, together with lactogenic foods such as oatmeal and barley malt.  I have family in place to help with my toddler while I babymoon for the early days, knowing so much more about normal newborn nursing behaviour and the importance of skin to skin contact in stimulating prolactin receptors.  Through another UK-based MOBI mum I have the number of a private ENT consultant who knows about lip ties as well as tongue ties, and I’m ready to go straight to him if I suspect any problem.  And I have the number to call if I need to rent a hospital grade double breast pump (with a variety of flange sizes to try!), and a pumping halterneck at the ready so that I can pump hands free.  And knowing that one’s mental state too can affect one’s milk, I’ve even submitted to breastfeeding hypnosis – lying back with the headphones on and letting myself be told, despite my reservations, that, yes, my breasts will make exactly the amount of milk my baby needs.  Of course, I don’t know what challenges I’ll face this time around, but I’ll go in all guns blazing.