Normal, motivating fear: “I don’t have enough milk.”
Most people don’t believe a mother has milk, until some special day, after the birth, when the milk is delivered, or “comes in.” Childbirth classes teach that at delivery, breasts contain “only colostrum” and only in small amounts, another factor undermining a mother’s belief in her milk supply. Physicians and nurses reach for a bottle of formula if a newborn has low blood sugar, or is jaundiced, because they don’t believe that newly delivered women have enough milk. In most US hospitals, mothers are handed a free sample of infant formula when they are going home with their new baby; yet another reason that her confidence is undermined. Fear of insufficient milk is ancient and universal; it is the rare mother who doesn’t have it. La Leche League got its name from a statue of the Virgin Mary called “Nuestra Senora de la Leche y Buen Parto”, meaning “Our Lady of milk and good delivery”. Plenty of milk and an easy delivery is every mother’s prayer.
If most women worry about their milk supply, then the fear must be normal. What are the roots of this fear?
During pregnancy, a mother doesn’t have to take care of her baby at all. Her body does everything: feeds her baby, keeps it safe and warm,and takes care of its wastes. She doesn’t have to worry about anything; it’s easy to be a perfect mother now.
Then, after delivery, everything changes. Now the new mother has to take on all the duties of a mother, nourishing her baby and keeping it warm and safe. All the responsibility for this child’s life falls on her shoulders in an instant; suddenly the baby is a reality and life becomes serious. This is a scary time.
Mothers express this fear in many ways. One way is to check on the baby every 5 minutes once they are home, to be sure that baby is still breathing. Another way is to doubt her milk supply. She is sure she doesn’t have enough milk because the baby wants to breastfeed “all the time”. She has seen hospital staff reach for a bottle of formula whenever they are concerned about her baby, so she can’t trust breastfeeding. She’s already learned in childbirth class that she won’t have milk until a few days after delivery. Hospital staff ask her if her “milk has come in yet”, another way to reinforce the notion that she doesn’t have milk, increasing her worry.
As a nurse in postpartum, I, like many other nurses, spent hours working to convince new mothers that they had milk. We got women to hand express, so they could see their milk while learning an important skill. We had long discussions with worried mothers about how it was alright that there were only small amounts of colostrum, because it is a concentrate. None of those things worked enough. Here are some new ideas.
I wish that the word ‘colostrum’ was banished from childbirth and healthcare professional classes. Mothers start making milk in the middle of their pregnancy, around the time they feel their baby move. This milk should be called “newborn milk” or “first milk” or “pregnancy milk” so new mothers will know that they have milk. Technically, colostrum is a term for the first milk; however, the term is not part of everyday vocabulary. I’ve worked with mothers that couldn’t remember or pronounce the word; one mother told me, “I don’t have any milk yet. I only have cholesterol.” Using this alien term confuses people and creates a vulnerability to using bottles of non-human milk, because she believes, “I don’t have milk yet” or “I don’t have enough milk yet.”
I wish that the term “milk coming in” was also banished from maternity care, as it is another way of telling a mother that she doesn’t have milk. If she gave birth on Sunday, staff will ask her on Monday if her milk has come in, as if she hasn’t had milk for months already. Women have milk; a few days after delivery, their milk volume increases. Using the phrase “milk volume increase” creates a positive image in her mind.
As for the woman who says “I don’t have any milk” , we can support her fear. We can say, “Most women are worried about their milk supply” or “All good mothers worry about their milk supply.” Having a new baby, particularly for the first time mother, is a frightening time; she now has to do the all right things to keep her baby alive. A frightened mother can’t be talked out of fear nor have the fear educated away; she has to express her feelings, and have her fear acknowledged. Everyone who works with a new mother is a potential witness.
After the fear is validated, then ask her, “Do you want me to tell you how you to know that your baby is getting enough milk?” Or, “Nurse a lot in these first few days so your milk volume will increase more quickly. If hospital staff treated the fear as a welcome sign of a committed mother, there would be no need for hours of useless discussion and education.
We can celebrate the new mother who doubts her supply.
