Why do so many mothers have difficulty making enough milk for their babies?

I frequently receive emails from disappointed mothers asking me why it is that they were not able to breastfeed exclusively. It is true that a small number of women are unable physically to produce all the milk the baby needs no matter what they do. But in most cases, what happens during labour and birth and the first few days after the birth is directly related to mothers having difficulties.

The mothers usually say they tried everything but it just did not work for them. They blame breastfeeding, they feel breastfeeding is not what it is promoted to be, and see breastfeeding as unreliable; often the mothers blame themselves. Nobody tells them it is not their fault and, in fact, it isn't their fault. It is the health care system that is to blame for not creating the necessary conditions for breastfeeding to work.

What can be done to create conditions that make exclusive breastfeeding possible?

1. The health professionals should avoid unnecessary interventions during labour and birth. An undisturbed birth is one of the essential prerequisites for breastfeeding to happen. Today, almost all women experience at least one unnecessary intervention. In some hospitals in the affluent world almost all women in labour end up with epidurals and in the US and Canada around 40% have a caesarean section.

2. The baby should be skin to skin with the mother immediately after the birth and this contact should not be interrupted until the baby has latched and finished breastfeeding. Babies are capable of crawling on their own to the breast and latching on without help. In many hospitals, skin to skin contact is symbolic only and lasts only 5 or 10 minutes, if that. The photo shows a mother skin to skin with her baby immediately after a caesarean section.

3. The health professional should check the baby's latch and provide practical help if the baby is not latched on well. If breastfeeding hurts, something is wrong, and the latch needs to be adjusted. Pain or discomfort during breastfeeding are signs that the mother needs help. Mothers should not be told that painful nipples are normal and they should just wait it out. Furthermore, a baby is less likely to get milk adequately if not latched on well. The earlier the mother gets good help, the better.

4. Mothers need to be shown how to know the baby is actually getting milk from the breast. A baby is not receiving milk from the breast just because he has the breast in his mouth and makes sucking movements.

5. Mothers should be provided with followup within a day or two of discharge from hospital, not in a week or two, by someone knowledgeable and experienced with helping mothers breastfeed.

You can read more about how birthing practices may affect breastfeeding in my eBook (also available as a paperback) called Breastfeeding: Empowering Parents: https://www.amazon.com/dp/B07FS6K9SF