Mothers are taught that it’s rare not to produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group, and hospital breastfeeding class. The truth is we have limited studies that provide an accurate percentage of mothers who can produce enough milk for their babies for the recommended six months. Although actual rates of adequate milk production are unknown, some estimates range from 12-15 percent or more.
The WHO health policy that has been responsible for millions of preventable hospital admissions of newborns for insufficient feeding complications is Step 6 of the Ten Steps to Successful Breastfeeding: “Give no additional food or fluid other than breast milk unless medically indicated.” Complications of insufficient feeding from exclusive breastfeeding before copious milk production are now among the leading causes of newborn extended and repeat hospitalization, namely jaundice (hyperbilirubinemia), dehydration and hypoglycemia.
In 2017, the World Health Organization published its guidelines updating its recommendations for “Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services,” which outlines the evidence for the WHO recommendations on breastfeeding support for newborns in health facilities based on the Ten Steps to Successful Breastfeeding. Here is the evidence presented to justify the recommendation to avoid supplementation in breastfed newborns.
The WHO guidelines authors went on to conclude the following:
How did very low quality of evidence turn into moderate-quality evidence for exclusive breastfeeding particularly when the evidence showed improvement of breastfeeding rates in supplemented breastfed newborns? Continue reading
Cluster feeding is a phrase that is used to describe infant feeding behavior(s). Generally, it’s breastfeeding or bottle feeding that is in a different pattern from your baby’s typical feeding pattern. It is described as breastfeeding sessions or bottle-feeding sessions that are much shorter and more frequent, for 3-4 hours of the day. It often happens during a baby’s fussy period of the day. The Academy Of Breastfeeding Medicine defines cluster feeding as “several short feedings close together.” However, new mothers are being told constant and prolonged feeding around the clock in the hospital is “cluster feeding,” and this is where confusion that can result in harm begins. There is a point when cluster feeding becomes a clear sign of insufficient breast milk and/or insufficient transfer of milk, and those signs must be taken seriously for the health and safety of the infant. Mothers tell us they receive conflicting information and as a result, they become very frustrated, lose confidence and want to stop breastfeeding. Or, they persist with exclusive breastfeeding due to incorrect advice, and negative outcomes occur.
Cluster feeding is also a phrase that sometimes is also called “comfort-feeding.” As parents, we react to infant cries and feeding cues, so naturally, we will assume a baby is hungry and when we feed them, they will be satisfied. But some babies will snack and will not take a full feeding during their cluster-feeding time; this is normal. Some babies simply want to suckle on a pacifier after nursing or bottle feeding. This is because their bellies are full, but they want to suckle for soothing and not for feeding of milk. Some breastfeeding babies will suckle, using non-nutritive sucking patterns for soothing only. Some babies will also want to be held and snuggled or may want to be carried or want movement while suckling too!
Cluster feeding can also happen during growth spurts as well, but babies generally take in more milk during this time. It can also happen during times when a baby is not feeling well, teething or is tired or cranky. And it’s true—some babies don’t cluster feed at all. My exclusively breastfed babies never did and preferred sucking on a pacifier, after nursing for comfort.
When is cluster feeding considered normal?
If you are concerned that you are not making enough breast milk, or your baby isn’t transferring enough milk, you can do a simple check to see if you are.
Written by Dr. Ruth Ann Harpur, Clinical Psychologist
A systematic review of the scientific literature indicates that women who intend to breastfeed but who later feed their babies formula consistently report feelings of guilt, anger, worry, uncertainty, and a sense of failure despite the relief that introducing formula after experiencing difficulties with breastfeeding may bring (Lakshman, Ogilvie, & Ong, 2009). Recent research also indicates that this group of new mothers are at particular risk for postnatal depression (Borra et al., 2015).
Clinicians are uniquely placed to provide compassionate care at a vulnerable time for this group of parents. Their attitude and words can invoke a sense of shame, judgment, and failure, or they can inspire compassion, reassurance, and emotional healing.
When I struggled to breastfeed my son, I believed I was failing, not just at breastfeeding, but at motherhood. What was supposed to be the “best” way to feed my new baby was painful, anxiety-inducing, and landed my son back in the hospital for dehydration, eleven percent weight loss, and inability to take a bottle.
My hospital’s solution included many appointments with their lactation consultants, fenugreek from their new mother boutique, and a nurse-bottle-pump (triple-feeding) routine that drove me to the brink of despair and did nothing to increase my milk supply.
At no point in my son’s first two months did any of the lactation consultants, nurses, doctors, or any other medical staff offer a concrete explanation for my low milk supply or my son’s vice-clamp latch. Because no one seemed to know why we couldn’t get the hang of it, I felt I was not trying hard enough.
Sometime after my son’s first birthday (my original “breastfeeding goal”), I came across several online articles that explained insufficient glandular tissue, also called breast hypoplasia. I knew my breasts were an odd shape, but I was taught by the hospital lactation “experts” that breast shape and size didn’t determine breastfeeding ability. Looking at pictures of similar widely-spaced, tube-shaped breasts that produced little or no milk left me feeling a strange cocktail of emotions—validation, disbelief, anger.
I wondered why staff at my hospital, a long-time Baby Friendly Hospital Initiative (BFHI) accredited facility, hadn’t told me that I was at risk of insufficient milk production.
