Booby Traps Series: Too many mothers with milk supply problems get formula, not breastfeeding help

This post is the 53rd in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Milk supply concerns are a top reason why women stop breastfeeding before they want to.  So you’d think that our health care providers would be equipped to help solve milk supply concerns, right?

Unfortunately, wrong.  In a 2004 study of obstetricians’ and pediatricians’ opinions and practices regarding breastfeeding, the authors found a significant number* of pediatricians recommending formula supplementation for healthy infants with slow weight gain.  This is consistent with an older study which found that more than 30% of physicians chose incorrect advice for mothers with low milk supply.

Of course, sometimes formula supplementation is necessary.  But “recommending supplementary feedings with formula to a breastfeeding mother,” the authors of the 2004 study note, and “may impede successful breastfeeding and might be unnecessary.”

The result?  “Mothers whose pediatricians recommended formula supplementation for a healthy infant not gaining enough weight were more likely to discontinue exclusive breastfeeding.”

The alternative to recommending formula is to assess what’s happening with breastfeeding and develop a plan to fix any problems.  In fact, this is how the American Academy of Pediatrics describes as the pediatrician’s role:  “Become knowledgeable in the principles and management of lactation and breastfeeding; Develop skills necessary for assessing the
adequacy of breastfeeding,” and “Coordinate with community-based health care professionals and certified breastfeeding counselors to ensure uniform and comprehensive breastfeeding support.”

So, why would pediatricians recommend formula instead of helping to fix breastfeeding?

1)  Because they might not understand the implications of their recommendation.  The authors note:  “Several studies…have found that pediatricians, obstetricians, and family practitioners may not know that supplementing during the first few weeks of life can cause breastfeeding failure.”

2) Because even if they understand this, they might lack the skills to help.  The study found that 56% of pediatricians said that they were not confident in their skills in “resolving problems with mothers not producing enough breast milk.”  As I’ve written before, pediatricians generally get inadequate training on breastfeeding management, and report not knowing enough to support their patients.

3)  Because even if they do have the knowledge and skills, they don’t have enough time to help solve breastfeeding problems.  48% of pediatricians identified “limited time during preventive visits to address breastfeeding problems” as a very important barrier to providing effective breastfeeding support.

4)  And because if they want to refer mothers for more help, they might not know how to do it. 51% of pediatricians said they weren’t confident of their knowledge of what referral services exist for breastfeeding support.

Interestingly, the study found that mothers who relied on books and other print materials had higher rates of exclusive breastfeeding.  Whether that was that was due to better advice or because they had a higher level of commitment which led them to seek out resources on their own is not clear.

The good news is that this is not an insurmountable problem.  As we’ve pointed out before, simply training pediatric residents better (with a free curriculum developed by the American Academy of Pediatrics) results in better clinical skills and translates into higher rates of exclusive breastfeeding.

This may be little comfort if you’ve received bad advice about supplementation, but it’s a cause for hope for future moms and babies.

If you have concerns about milk supply and are looking for help, we recommend seeking the help of a trained breastfeeding support person, such as an International Board Certified Lactation Consultant.  We also highly recommend The Breastfeeding Mother’s Guide to Making More Milk, and you may want to listen to this podcast with co-author Diana West.  And you’ll find good websites listed on our breastfeeding resources page.

Were you told to supplement with formula when what you really needed was breastfeeding help?  How did it affect your breastfeeding experience?

*The percentage was not included in the study, but it was significant enough to produce a measurable effect on exclusive breastfeeding for patients of those physicians.  I contacted a study author to request the number, but the data has been archived and is not available.


9 thoughts on “Booby Traps Series: Too many mothers with milk supply problems get formula, not breastfeeding help

  1. This was our experience exactly!

    I was given a nipple shield to use right after DS was born. The LC wasn’t concerned, just said to watch his pees and poos, which he had more than plenty of. However, he was gaining on the slow side. The only thing his doctor, a Family Practitioner, said about his weight was, “Similac. A couple ounces in the evening for the extra fat and calories.” I chatted with some LLL Leaders who all suggested that we could supplement with EBM and to make sure I was pumping after feedings since the shield can cause supply problems; but really they just suggested a nursing vacation, and to offer the breast more.
    Wouldn’t you know it though, the very next day DS decided he was done with the shield. I believe that, combined with my “conversational” offerings to nurse, had him gaining enough to get the doctor off my back about the formula.
    We had no other concerns besides weight; his length is at the top of the charts, his head was growing, he was meeting milestones and alert and happy! Why the obsession with the scale? Why can’t we view the whole picture?

    I believe that if I hadn’t done my own research we would have started weaning then. I respect doctors, but I also know that they have a lot on their plates…and they’re not all-knowing gods.


  2. I think this is unacceptable that medical professionals abuse their position of power and persuade mothers to supplement unnecessarily instead of prescribing lactation aide. I cant help but wonder what are the true intentions of most doctors (MAKE MONEY) and how does breastfeeding increase their income?? It doesn’t , Breastfeeding = Healthier babies= Less doctor visits= less money in doctors pockets. Unfortunately I experienced this first hand the morning after my son was born and lost 10 % of his birth weight. I was exhausted and emotionally drained after the struggle of breastfeeding latch issues post a c section and a unnecessary delay of 2 hours of my baby being brought to me. My pediatrician in hospital basically demanded that I supplement at that moment and I was so concerned for my baby i did (little did I know the cost of my decision and how it further discourages supply and flow for my baby) Luckily I hired a lactation consultant to come to the rescue and it took work but we did it!


  3. Our daughter gained weight the first 3 days, even regained her birth weight. Then something happened: constant fussiness, constant nursing. I wanted to exclusively breastfeeding and attended nursing meetings at my hospital with a certified lactation nurse. My daughter was losing weight. We weighed her before and after a nursing. She took in, after 30 minutes, a 1/2 oz.
    I was horrified. I drank Mothers Milk Tea, rented a hospital grade pump, nursed on demand and double pumped for 20 minutes afterwards. My supply woefully climbed to 4 oz, FOR THE WHOLE DAY. I had a natural delivery, no drugs, no birth complications other than normal exhaustion. I had no symptoms of babyblues at all. I drank fluids and never relented. We coslept skin to skin since day one. I began taking Rx to increase supply, which it did, up to 10 oz for the whole day. The Rx, however, altered my mood and when Christmas Break finally arrived (she was born October) I was depressed and crying every day.
    We had to supplement, within the second week. It was the right thing to do. I always let my daughter nurse first, for 40 minutes, then would double pump while giving her a bottle. She would fall asleep relaxed and I’d still have a pump on for another 15 minutes. We did this routine for 3 months, until I finally accepted I couldn’t do this anymore. The drugs were depressing me and life was supposed to be happy. Two weeks later, my milk supply dropped back down to 2oz a day (what it was before I did al the interventions). At 4 months it dried up. My daughter still nursed for comfort whenever we went to sleep even if I wasn’t making any milk.
    Just needed to post this for anybody else: it was so hard to find stories of other mothers who don’t make milk to exclusively feed and there is a lot of hurtful shame and ignorant thoughts about this. We did everything. And no, my boobs are symmetrical, and grew during pregnancy. Some women just don’t make enough. And that’s still ok. Supplementation saved my daughter. Don’t beat yourself up. Do what you need to but accept, like labor, sometimes things don’t go the way you plan. Enjoy your precious time with your newborn and supplement instead. With a sec


    1. Thank you for posting this. When I gave birth to my daughter (also natural, no drugs, no PPD) it took five full days for my milk to come in. During that time, I nursed on demand–and nursed, and nursed, and nursed–but my poor baby was still bawling with hunger and losing weight. I resisted supplementation because of this inflexible, dogmatic mantra “all formula is bad all the time.” Finally, on day 4, my wonderful doula told me “We can either supplement here at home, starting now, or we can supplement in the hospital tonight when she starts to get dangerously dehydrated.” I started supplementing with just an ounce or two after every feeding. It worked. My baby was much more comfortable, my milk came in 24 hours later, and I breastfed exclusively from there on out. None of the horrific things that supposedly happen the second you let a baby take a swallow of formula ever happened.

      Not all women have an immediate, abundant milk supply. That’s just how it is. Women shouldn’t be shamed for it, and their babies shouldn’t suffer for it.


  4. I wantedto exclusively bf and my body couldn’t make enough. We supplemented at 3 weeks and it saved my daughter. We did everything right. Normal full term pregnancy, no complications, drug free vaginal birth, instant bonding and immediate nursing, skin to skin contact, cosleeping, healthful eating and drinking plenty of fluids, nursing on demand. The first week was great the second week she lost weight and the third week I knew something was wrong because she was weak and nursing every 45 minutes. We had her weighed before and after at a lactation meeting and she only drank 1/2 oz. yes, her latch was perfect and no tied tongue or other issues. I began double pumping, supplementing with fenugreek, and we found out I only made 4 oz FOR THE WHOLE DAY. I took Rx to increase supply to 10 oz but after a month it began to depress me. We had to stop. My mood slowly stabilized and my milk supply, despite round the clock nursing and pumping every 3 hrs, was only 2 oz. supplementing saved my daughter! Never feel ashamed to supplement. We did everything right. Even our midwife said “some women just don’t make enough, don’t feel bad”. It was very hard to find other people who have gone through this so I am sharing my story.


  5. talk about a HUGE booby trap: posterior tongue ties and lip ties. Nobody knows about them, and then nobody knows how to fix them. HUGE problem!! Of all mu friends who had a hard time breastfeeding (production, pain, etc), all have multiple signs of a tie.

    My son had both– it was only God’s grace that I found out the problem and we were able to have Dr Kotlow see & clip his ties by laser. Amazing. He now is EBF and growing like a weed. But I had to fly from SC to NY and spend hours researching online because NO one in my area could help, not my family doc, midwife, ENT, pediatric dentist, 3 IBCLCs, pediatric ENT… an SLT and OT were willing to work with me and do reaearch on their own, and together we figured it out!


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