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why some moms can’t (or shouldn’t) breastfeed

After months of struggling, I finally typed in these words on the Google search bar: What to do if I can’t breastfeed. The top article was a breastfeeding support website that said, realistically, only 2-3% of moms cannot produce enough milk to breastfeed. As any mom who has endeavored to breastfeed knows, most lactation specialists take the general stance to “keep going, you can do it” because many moms “give up too soon.” This is based on the understanding that when moms stick with it for at least 2 months, they can overcome initial challenges and develop a successful breastfeeding relationship.

It’s why I was so confused and disappointed when at 14 weeks we still weren’t able to breastfeed normally. As I searched for answers, I found additional studies that indicated about 5% of women can’t produce enough milk to breastfeed - and we don’t yet have the percentages for other barriers to breastfeeding, like acid reflux, unimproved latching, prescribed medications for mom, etc.

To grasp why it doesn’t work, it’s important to understand how things interact during those first few weeks. I found the book, Making More Milk to be an awesome resource, but to summarize here: baby’s latch and sucking in those beginning stages communicate to mom’s body how much milk to make. If this relationship is not optimal, perhaps for one of the reasons listed below, then mom’s body will cut back on milk production.

Optimal latch and sucking = optimal milk removal = optimal milk production. It also matters how frequently baby feeds, but it matters more that the milk is completely removed from its stores, which tells mom’s body to make more.

Less milk = less of baby wanting to feed at the breast. Babies like bonding too, but hunger is first.

The number one saboteur, especially for first-time moms, is low milk supply. If baby does not readily get enough food, he becomes discouraged and begins to either feed less or reject the breast altogether. If the bottle has been introduced for supplementation, it can be difficult for baby to stay at a breast that is hard to feed from. This was one of the challenges we faced within the first few weeks of my son’s life.

my personal struggles with breastfeeding

I share more details of our story here, but at the time 3 other friends who hadn’t been able to breastfeed were helpful in normalizing it. Most of the new moms around me, including 9 friends who had babies within a year of me, had successful breastfeeding relationships after persisting through the initial trials. I went to a friend’s wedding the weekend after we stopped trying, and a young mama asked me, “So, are you breastfeeding?”

I wanted to answer honestly and explain what it had been like for us. I wanted to tell her that for almost 4 months I tried to increase my supply with galactagogues, cluster pumping, hand expression, teas, herbs, and drinking enough water to fill a bathtub. That even once the pain subsided (or my nipples just became so calloused), my son still wouldn’t stay latched because he had challenges with lip and tongue tie, acid reflux, and breast refusal. I wanted to tell her that I had tried everything, even following advice from a blog to “make my breasts a happy place.” I wanted her to know that every person I sought help from told me to try the same things - and none of them changed our breastfeeding experience.

But I hardly knew her and the place was crowded, so I just said, “Well, sort of.” I doubt she’d heard that answer. What I meant but couldn’t explain then was that I was exclusively pumping so my baby boy could still get some breast milk. I was able to pump about 10-16 ounces a day for 5 months, at which point I wanted more time with my baby, my family and friends, and less time at the milking machine.

In my experience, most moms are supportive and encouraging with one another - we all know how hard this job is - and I don’t think this mom was trying to do anything other than connect with me. But, sadly, a lot of the messaging we receive makes breastfeeding feel like some sort of competitive sport. And while some of the causes listed below can be overcome with early intervention and the right tools, not every situation is “fixable.” Through a series of interviews, appointments, and months of research, I discovered numerous barriers to having a successful breastfeeding journey. If you struggled to breastfeed and couldn’t figure out why, I hope this helps you. Here are 20+ reasons why some moms can’t breastfeed:

reasons for low milk supply related to mom’s body:

1. Small, inverted, or misshapen nipples, which make your baby’s latch and/or sucking challenging

2. Insufficient glandular tissue (i.e. the tissue that makes milk), a.k.a. hypoplastic breasts

3. Previous breast surgery that may have affected ducts or nerve responses

4. Imbalance of crucial hormones due to thyroid dysfunction, diabetes, PCOS, or a similar disorder

5. Previous spinal cord injury, which affects sensory function and signals from breast to brain

6. Depression, stress and/or anxiety, which can either inhibit milk production or make the act of breastfeeding completely overwhelming

7. Certain types of substances, such as hormonal medications or prescription drugs to treat depression

8. A new pregnancy - It is not necessary to stop breastfeeding if you learn you are pregnant again, but many moms do stop in light of associated risks, such as uterine contractions, added fatigue and nausea, and preterm labor.

9. Burn trauma or scar tissue, which can negatively effect breast tissues and glands if internal, and the porousness of the nipples if external

10. Postpartum hemorrhage, which can injure the pituitary gland and therefore decrease prolactin (the milk-making hormone) production

11. Placental problems, which prevent full breast changes during pregnancy

reasons for low milk supply related to baby’s body:

1. Poor latch due to facial abnormalities such as lip or tongue tie (i.e. tight frenulum), cleft palate, high palate, or internal abnormalities that may be difficult to diagnose

2. GER or GERD (Gastroesophageal Reflux Disease), which causes the burning regurgitation of breast milk as soon as it is swallowed

3. Poor sucking reflex, perhaps due to airway problems which make coordinating sucking and breathing challenging (common in premature babies)

4. Baby is drowsy or non-demanding and therefore does not feed enough to stimulate milk production

5. Baby has hypotonia (weak muscles), so he has difficulty with both forming a good latch and sucking sufficiently

6. Baby has hypertonia (tense muscles), so she clenches or clamps down on the nipple when breastfeeding (Note: Babies who have negative feelings towards breastfeeding due to associated trauma from anytime since birth can have hypertonia; true hypertonic babies will be stiff and tense at times other than feeding.)

7. A sensory processing disorder, which means that baby is overwhelmed by sensory input and may resist the breast due to feeling overstimulated

8. Galactosemia - Although rare, this is a condition in which baby’s digestive system cannot break down the lactose in mom’s milk

9. Allergies, intolerances, or sensitivities to mom’s milk that will not go away even with major diet changes

reasons not related to low milk supply which may impact a mom’s choice to breastfeed:

1. Traumatic labor and birth experience

2. Premature birth and prolonged separation from mom

3. Past sexual trauma or abuse

4. Postpartum Depression (PPD), for which a new drug has recently been released (and the drug cannot pass through milk)

5. Treatment or medication for an autoimmune or other disorder which cannot be passed through milk

While this list is thorough, it is not exhaustive. There are many reasons why moms struggle to breastfeed or may not end up doing it at all. If you are giving it your best shot and try everything only to come up empty (maybe even literally), you are not alone. There are many tricks of the trade that can help recover your milk supply or help baby feed better, e.g. tongue exercises, special feeder bottles, and specific nursing positions. But if you find that it is just not working, please know that it’s okay to choose an alternative for your baby without feeling guilty. There’s a huge network of moms who exclusively pump, and there are many options when it comes to infant formula, including some whole food, homemade options. It’s okay if you need to grieve, too - I’m right there with you. And as I’ve said in another article - there’s just no other way to say it - your love, not your milk, is the gold standard.