In our modern world, very few mysteries remain. We can measure the distance from the earth to the stars, and explain the voids between. We can travel to the bottom of the darkest oceans, and reveal their secrets. We can see inside our own bodies, our veins, our cells, and we can even know the sex of a baby long before it is born. Little wonder, then, that when we ask ourselves, 'How much milk is my baby getting?', and we can't provide an answer, we find this disconcerting, to say the least.
Breast milk, and in particular, the quantity that has left our own body and is now residing happily in our baby's stomach, is difficult to measure. We might try pumping, so that we can see how many millilitres we can produce, but this does not give any real indication of how much our baby is actually getting out. Not only are babies mouths unsurprisingly more efficient than a plastic sucker, but the actual loving act of nursing and looking down at our babies face has been shown to encourage 'let down'. And as for let down, some of us, myself included, don't feel any sensation at all when our milk is coming out, and in my case, I have hardly ever even caught a glimpse of the seemingly magical fluid that has now sustained and nourished two human beings for the first six months of their life and beyond.
So, we can't measure our milk, and in some cases, we can't even feel it or see it. We might be just about able to hold our nerve, but what if our baby is not behaving as we had expected? The tiny soul who is entirely dependent on us for her survival suddenly begins to cry a great deal, or wake up hourly throughout the night. It is at these times that the doubts can begin to creep in, and they can often be fuelled by the comments of friends, family and even professionals: 'Are you sure they are getting enough milk?' 'Do you think they could be hungry?', 'What about just one bottle of formula at bedtime?', and so on.
Such comments are part of a wider cultural picture of treating babies as problems that need to be fixed, rather than simply accepting them as they are. It is our expectations that we need to change, not our babies. When a new mother tells us that her baby keeps waking her up at night, we should be offering reassurance that this is perfectly normal and entirely to be expected, rather than attempting to advise her on what can be done to get her baby to stop being so needy.
As well as being overwhelmed by her small baby's intense levels of dependency twenty four hours a day, a new mother might also be feeling shocked or even traumatised by her birth experience, in which she may have 'failed to progress', or 'needed intervention'. Her confidence in her body and its ability to function normally and without outside help may well have been undermined. She could not birth her baby naturally - it stands to reason that she also may not be able to feed it naturally. She may wonder, perhaps I am not making enough milk for my baby, or, worse still, perhaps my milk is lacking in some way?
Further doubt and anxiety may be added by advice to place the baby on a routine of feeding and sleeping. This idea of spacing out breast feeds according to the clock dates back to the 1940's, and it is no co-incidence that this is also the moment in time that women began to report trouble with their milk supply. If we try to space out nursing sessions too widely and, for whatever reason, choose not to nurse on demand, we may well be jeopardising our chances of continuing to breastfeed. We need to nurse on demand during the first few weeks in order to establish our milk, and even the Queen of Routine, Gina Ford, acknowledges this, urging mothers who follow her program to pump in between the routine feeds to keep their supply up.
Of course, if a new mother succumbs to the voices of doubt - be they inner or outer, valid or invalid - and reaches for the bottle of formula, then this is when the real Booby Trap is set in motion. For once we introduce milk from a source other than ourselves, we interfere with the chain of supply and demand, and our own supply actually will begin to diminish. That which we most feared, and sought to remedy, will in fact become reality. And in some cases, our motivation to continue breastfeeding can also diminish, and we become added to the statistics of women who wished to nurse their babies, but for whom it did not work out.
'Insufficient milk' is one of the most commonly given reasons by mothers for stopping breastfeeding sooner than they would have otherwise intended. And yet the stats just don't add up. Whilst around 25% of women state that a lack of milk was their main reason for stopping nursing in the first two weeks of their babies life, research has shown that in fact only a tiny percentage of women are actually physically unable to produce enough milk. A major piece of research published in the journal Medical Anthropology states that in only about 5% of cases is there something making it impossible for a woman to breastfeed. Another article from the NHS cites the figure for insufficient milk being as low as 0.2 to 1%.
It's important not to ignore the real human stories behind these statistics. Whilst the numbers of women who are genuinely not producing enough for their babies may seem low at perhaps 5 or less percent, this still amounts to many women for whom the breastfeeding experience is a tale of anguish, frustration and loss. And, perhaps sadder still, our stats tell us that there are many more women who don't actually have any physical problem with their supply, but who are doubting their ability to feed their baby naturally due entirely to external factors such as poor advice and support or negative cultural messages. In these cases, women who desire to nurse their babies are having their hopes dashed for no good reason.
It is hard to believe in something that we cannot see, feel or measure, particularly when something as hugely important as the welfare of our baby is at stake. But the message needs to be spread: in the majority of cases, 'insufficient milk' is a construct, a misconception, an invention, a myth. If you are having doubts that your milk is enough for your baby, don't feel panicked into drastic action, but instead nurse as much and as often as you can, and seek good reliable advice. (see below). Above all, believe in your body, it was built to nurse your baby.
If you need advice about this or any other aspect of breastfeeding consult your local LLL Leader or ring their helpline 0845 120 2918, or the ABM helpline 08444 122 949. For detailed information about low supply I highly recommend this and other reading from the wonderful site kellymom, and this article from The Baby Bond.
This article was amended on 15th March 2012.