When lactation doesn’t work

As a newly-minted doctor and breastfeeding activist, I used to believe that all mothers could breastfeed. Now, after almost a decade of clinical experience, I know better. Sometimes, breastfeeding physiology just doesn’t work. And frankly, as medical professionals, we handle these situation poorly.

Lactation happens through a choreographed interplay of hormones that build up milk-making machinery during pregnancy and then manufacture milk and deliver it to the baby during feeding. So-called “primary lactation failure,” when a mother’s milk never comes in, may happen because the machinery doesn’t develop , or because the signals to make and move the milk are not in sync or absent altogether.

When a mother’s milk isn’t flowing, physicians should check for any medications that may be interfering with milk production, as well as assess function of the thyroid and pituitary gland, which can be damaged during childbirth after heavy bleeding. Absent milk production can also occur if part of the placenta is left behind at birth. If these tests are all normal, a few drugs can boost the level of prolactin, the milk-making hormone. ABM covers these drugs in our Protocol on Galactogogues.