Most people think it is automatic for a mother to produce breast milk after giving birth, yet it is not the case. There are exceptions where a mother produces less milk than the baby needs or nothing at all.
Although health experts advise mothers to breastfeed babies, especially in the first six months, some discover that the milk is either not there or not enough, writes Vicky Wandawa
Most people think it is automatic for a mother to produce breast milk after giving birth, yet it is not the case. There are exceptions where a mother produces less milk than the baby needs or nothing at all. Such people have to rely on baby formula that is sold in supermarkets or cow milk. Below are narratives from three mothers who went through the problem.
Sara Achom, 29, writer
"This is poison! Has she even tried to breastfeed?" a cashier boldly asked. "I am not selling it to you, I am a mother myself, I know what I am talking about," she added.
When my husband handed the chatty cashier a sh50,000 note for infant formula, she gave him a questioning look and asked how old the baby he was buying it for was. When he said it was three days, she lectured him for about five minutes, despite the growing queue of other shoppers behind.
But my husband knew the importance of breast milk, only that mine was not enough. Well, he finally brought the milk home.
From the time my baby was returned from the nursery a few hours after I had undergone a caesarian section, the nurses and my mother taught me how to hold it in the right position before breastfeeding. Breastfeeding looks easy, but that was one of the hardest lessons I had to take.
The colostrum (first milk) came and I was told that was just the beginning of ‘rivers' of milk to come. I remember telling my friends how I planned to breastfeed up to three years because I knew the benefits. But sadly, it did not happen. The milk was never enough.
I was not stressed, which experts say may cause low amounts of breast milk. My mother was there to help me; she even moved into my room to ensure I did not have to carry the baby each time she woke up. She made me lots of porridge, gave me fruits and food, but the breast milk was never enough.
And a month later, my baby cried a lot and each time we fed her on formula, she seemed to sleep soundly. So, from day one, I had to keep supplementing my breast milk with formula.
Whenever I returned home, I always struggled to finish a flask-full of porridge, but still, no milk came and at three months, the well of breast milk just dried up. I even tried to pump, in vain.
It is until I read about a small percentage of women, who cannot produce enough breast milk that I stopped beating myself up for not being able to. My baby has made a year this month. She is healthy and has hit her milestones. And we only visit the hospital for immunisation, not treatment.
Lillian Ogweng, 29, administration assistant
After giving birth, I wanted to breastfeed right away. It was hard at first, especially on how to position the baby, but I quickly learnt. I got the colostrum and was told to just keep breast feeding the baby until the actual milk came.
I kept doing so, but milk did not come out. Then I asked the nurses what the problem could be, but I was told to be patient. That night, the baby cried a lot. I was helpless and did not know what to do. The more I tried to breastfeed, the more the baby yelled.
A senior nurse came and asked me what was wrong and I told her I did not know. Because the baby kept crying, she suggested that the baby is taken to the nursery. I was scared! Usually when a mother hears that, she gets scared.
I did not want to imagine what problem it was. That nurse left and shortly after, a student-nurse came, and the baby was still crying. She then asked me for a cup, went and returned with infant formula. She gave the baby a few spoonfuls of the formula and the baby slept. The puzzle had been solved — the baby was crying because it was hungry!
When I was discharged after a day, I found a flask of millet porridge waiting for me at home. I took the porridge, and days later, ate katunkuma (bitter Thai eggplants), katogo of offals with matooke and drunk a lot of water. I used to actually take two full flasks of porridge, but the breast milk was so little that I still had to keep supplementing it with formula.
The fact that I could not produce enough breast milk left me crestfallen. Matters were worsened by the fact that a month later, the milk completely dried up. I fed the baby on formula for one more month until it became too expensive to afford. I resorted to Fresh Dairy Milk which was diluted to avoid constipation.
Whenever I saw a woman breastfeed, I would see them as being very lucky because I knew how hurting it was to not be able to produce enough breast milk. Our neighbour, a nurse, told me that the inability to produce enough breast milk happens to a small percentage of women. She added that she, too, went through the same experience with all her babies.
My baby was 2.7kg at birth and would have gained weight faster with the breast feeding. She remained small until six months when she started gaining weight after I fed her on porridge. She is now two.
She never got any infections and is a very healthy girl who hit all her milestones in time.
Natasha Atuheirwe, 30, pharmacist
When I was approaching my due date, my mother told me that when she gave birth to my siblings and I, she had to depend a lot on cow milk because no matter what she ate, she never produced enough breast milk. So she asked me to be prepared with an alternative to breast milk, just in case the same happened to me.
I fed on porridge and lots of food, to make enough milk for my little one. I started growing fat, but still, no milk. I had to supplement from day one. But I had hoped breast milk would come, so I ate and ended up very fat. I accepted the fact that I could not give her enough milk. My baby is now grown and healthy.
According to parenting.com, while some mothers may lactate poorly because of exhaustion, anxiety, depression, or postpartum surgery, about 2% cannot produce enough milk, regardless of their physical or emotional condition.
Indeed, such cases are rare, and Doreen Mazakpwe-Ssemujju, a doctor, breastfeeding consultant and director at Naturally Nourish, says in her practice, she only saw one mother who could not lactate well, despite a great physical and emotional condition.
"She had primary lactation failure. This is where a mother cannot produce milk because the right structures did not form during puberty," she explains.
The diagnosis is usually made when a mother's breast size does not change during pregnancy, because the change in size is a result of the body laying down the structures for milk production.
Just like Ssemujju, Anne Babirye, a lecturer of nursing theory and tropical medicine based at Rubaga Hospital, says in her 20-year career, she has not come across a woman who cannot lactate naturally, but points out that she has handled a number of cases to do with nipple malformation.
"I have examined some pregnant women with inverted nipples, but they have received therapy and by the time they give birth, the nipples are fine and they can bring milk," Babirye explains.
What could the problem be?
"Starting off on the wrong foot, perhaps," Ssemujju opines. She emphasises that for most women, correct nipple stimulation within the first hours after birth determines the volume of breast milk produced thereafter. She notes that hormones have a part to play, but the biggest determinant of how much milk a mother produces depends on nipple stimulation.
"Unfortunately, most mothers get it wrong at the very start, hence a sequence of failure to produce enough breast milk," she points out.
How? Semujju says most mothers and health workers do not know how the baby's lips should be positioned on the breast and nipple for sufficient breast feeding to take place.
"If a baby is put on the mother's breast and the baby's lips are a little pouted, then they are only suckling on the nipple, often causing painful cracks and making breastfeeding a nightmare for the mother. The baby's lips should be spread out, just like the structure of the breast pump, and cover the areola (black part of breast), because it is the one which contains the milk. That way, they are able to suck out the milk better," Ssemujju explains.
The breast feeding expert emphasises that for most women, the positioning of the baby lips from the start determines how much milk they can produce.
"When the baby's lips are only on the nipple, they barely get any milk. The body makes a lot of milk, but since only little is suckled out, it decides to produce less milk and before long, the mother will realise she barely has milk to sustain the baby and starts relying on formula," she explains.
And at eight weeks (about two months), the body has already established the milk supply and it would be difficult to increase.
What else could cause poor lactation?
There is a hormone, prolactin, specifically responsible for stimulating breast milk production. It is secreted from the brain in the pituitary gland. According to Ssemujju, if that gland is disturbed, which usually is the case during stress, then the levels of that hormone will go down.
Beatrice Balitenda, a counsellor and director of Inspirations Centre, says stress from trauma may inhibit milk production.
"A new mother keeps thinking to herself, ‘This person depends on me, and this gets them frightened,'" the counsellor explains.
She notes that the stress can also be a result of lack of sleep. "There are perhaps many visitors to see the baby and mother during the day, when the mother should be resting — since the baby may keep her up at night," Balitenda says.
Lilian Nakayiki Nyanzi, a nutritionist with Neulife Medical Centre, says breastfeeding mothers should eat the right food for breast milk production. Just like any other healthy person, a breast feeding mother should eat healthy and this means eating a well-balanced diet.
"This is a diet comprised of the three major food groups; energy giving foods, body building foods and protective foods. It is very important to eat from three food groups during lactation because of the increased body nutrient needs," Nyanzi says.
In addition to that, failure to attain a well-balanced diet during lactation predisposes the mother to maternal under nutrition, which consequently affects the mother`s nutritional status. Therefore, eating from three different food groups (balanced diet) is a sure way of meeting the body nutrient needs during lactation.
However, it is of great advantage to use a diversified diet instead of using one type of food like Bushera (millet porridge).
Am i a bad mother?
"Being unable to breastfeed does not mean you are a bad mother," Ssemujju says. Good parenting is more than breastfeeding. Ask yourself this question: Did you try your best to nurse your baby? If so, you tried and discovered that the best decision for you and your baby is to find an alternative, such as infant formula.
Furthermore, you can still bond with your baby. At feeding time, hold your infant close to you and make eye contact. Hold the baby in a breastfeeding position and have lots of skin-to-skin contact.
Breastfeed even with the little
There is gold in every drop of breast milk, so even if you have so little, feed as much as you can to build your baby's immunity.
"Some breast milk is better than no breast milk at all, whether you do it for even a day," Ssemujju says.
Deciding on the formula for the baby
Ssemujju advises that as one looks out for the best formula, they should ensure that one of its contents is iron because it is key for the baby's development.