Are you receiving a lot of conflicting advice about breastfeeding?

Lactation remains a devastating health system blind spot (or devastating if you hope to breastfeed and can't, anyway!)

Women repeatedly tell researchers that there are two main reasons why they start their baby on formula - often at a time when they're feeling quite desperate.

Reason 1. The breastfeeding woman is in pain, with either

• Excruciating nipple inflammation, sometimes accompanied by cracks, ulcers, swelling, pus or bleeding, or

• Debilitating inflammation of her breast tissue, sometimes referred to as mastitis.

Reason 2. Her baby is unable to come on to the breast easily, or fusses a lot at the breast, back arching and pulling off repeatedly in distress. That is, baby is dialled up at the breast.

Then there are two other reasons for starting formula which mothers commonly report.

Reason 3. The breastfeeding woman isn't producing enough milk, which causes her baby to dial up with hunger.

Reason 4. Baby isn't gaining enough weight.

Yet in my clinical experience, many breastfeeding problems are preventable, and once a problem occurs it can often be quickly repaired - especially if it isn't allowed to continue for too long!

What's going on here? Why do so many women have such difficulty with breastfeeding in our society? Afterall, we are mammals. Our milk-making breasts develop from robust ancestral genetic codes which have sustained human-like young for over two million years of continuous evolutionary development. Most human mothers have the biological capacity to make enough milk for twins.

Yet for half or more breastfeeding women, those four distressing reasons that I've just listed get in the way.

The three main causes of breastfeeding problems are often not identified

Let me tell you what I've found, both in the clinic and in my research over the past three decades.

Three crucial breastfeeding problems, which cascade into a variety of other problems including low supply and baby weight gain concerns, are commonly not identified in our health care systems. These are

1. Nipple and breast tissue drag during breastfeeding

2. Not frequent enough removal of milk from the breasts

3. Baby has a conditioned dialling up.

It's not just that these problems often aren't identified. Instead, when these breastfeeding problems come up, you or your baby are likely to receive a diagnosis or explanation which requires medications, supplements, surgery, aids, exercises, or bodywork therapy.

Whole industries have developed around breastfeeding problems in my life-time, and this monetising of breastfeeding is only getting worse. Big corporations and also a plethora of small businesses are involved (- I'm not even considering formula companies when I talk about big money, although the multinational corporations who sell formula certainly profit from the unnecessary pathologising of breastfeeding women and their babies which is widespread amongst health professionals).

Seeking help is confusing for parents, because there is so much conflicting advice. Of course, everyone claims to practice in an evidence-based way. But it's almost always the case that even the most experienced clinicians have not been trained to understand implementation science and what genuinely evidence-based practice might mean.

Possums Breastfeeding & Lactation offers you effective and genuinely evidence-based ways of sorting out what's going on. In the Advanced section of Possums Breastfeeding & Lactation, I am transparent with you about the lenses I've used, what the research actually says, and how I've developed up the methods I suggest.

Only a small part of breastfeeding is strictly genetically coded. Most of what to do in breastfeeding is affected either by the way our body interacts with the society we're born into, or by the direct cultural knowledge about breastfeeding given to us by the other humans around us. After the lead up of the Industrial and Scientific Revolutions, and starting from around the time I was born, Homo sapiens has entered what social scientists call the Great Acceleration. We are living through a phenomenal explosion of human technologies, of change in the way social and technological factors affect our bodies and brains, and also of the way cultural knowledge about breastfeeding is transmitted. It's as if we have to learn about how to help breastfeeding work from the very beginning again, this time using the tools of science to repair the many sociocultural effects unique to our extraordinary human moment in time, and to reclaim what used to be easily transferred cultural knowledge.

A note about the photo at the top of this article

There is something not quite right about the fit and hold in the gorgeous photo of a mother and her little one at the top of the page. I can see there is likely to be substantial maternal nipple and breast tissue drag at play, due to the subtle angles visible in that cropped image - the angle and positioning of the little nose on the breast, the angle of the bubby's shoulder relative to the mother's body.

Unfortunately, many of the photos we see of breastfeeding show a fit and hold which may well be causing that mother and baby problems, or even eventually cause breastfeeding to fail.

When you see the whole of the photo, below, you can see that the baby's hands and arms are caught between baby's body and the mother's body, and that her little body is also rolled out a bit from the mother's body. Actually, the New York City lactation consultants who first proposed the diagnosis of posterior tongue tie as a cause of breastfeeding problems, in a newsletter of the American Academy of Pediatrics (2004), recommended this kind of positioning with their patients back then. But since then, breastfeeding knowledge has grown. A little one whose hands and arms are caught between her body and her mother's body like this will often back arch and fuss at the breast and have difficulty co-ordinating sucks and swallows or transferring milk effectively, due to positional instability.

Selected references

Perez-Escamilla R, Tomori C. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. The Lancet. 2023;401(10375):486-502.

Shoshitaishvili B. From Anthropocene to Noosphere: The Great Acceleration. Earth's Future. 2021;9:e2020EF001917. https://doi.org/001910.001029/002020EF001917.