Why some mothers don’t produce milk after birthing

Divine* was always the go-getter. It did not matter whether this was at home, whether she was the only girl in a family of four; or at school where she was the biggest child in her class. Divine learnt early enough that she would always stick out, so she chose to do so on her own terms! 

Instead of complaining when she was picked, Divine learnt to get even. Because she was bigger than her agemates, she used her height and strength to push her opponents into a bargain. When other children called her fat, she simply carried herself like she was way older than them, hence entitled to more adult responsibilities than the little ones. The teachers loved her, the other children grew to respect her! 

This attitude put Devine ahead of her peers all through life. She always remained a big girl, drawing a lot of attention with her almost six-foot height. She refused to fight but she also refused to be a victim of bullying. She chose to excel in everything she did and would jokingly attribute it to being a big girl! 

Adolescence checked in really early for her and while she may have been a chubby child, Devine morphed into an amazingly beautiful young woman who could command the runway with grace. Her confidence masked any awkwardness she may have had. 

Academic excellence was her saviour, opening doors to choice schools, universities across borders and jobs that she desired. Devine was unstoppable! The cards were lining up for her and she was in control. All until a tiny 3,000g person happened and challenged Devine in every way she knew! 

Devine thought being a mum was something she would manage with the precision she handled the corporate world. She was elated to hold her little princess in her arms and naturally put her to the breast. Though she had been well prepared that lactation does not come immediately for all mums, it never occurred to her that it could be a problem she would struggle with. 

Three days down the line, Devine was a mess. She wouldn’t make a single drop of milk. Every possible intervention had been put in place to aid in milk production, to no avail. Mother and baby went home with a can of formula and a pile pf bottles. Even house calls with a lactation specialist couldn’t coax her breasts into cooperation. After two weeks, even the specialist threw in the towel. Her baby thrived on formula. She never made a drop. 

For the second baby, Devine was sure she would do fine. She had gotten over the anxiety of being a first-time mum and she was convinced that being more relaxed and open minded, she would be able to lactate some, even if not enough to meet baby’s needs. Mother nature had the last laugh and Devine resigned to investing in formula yet again. 

By the time she was going to hospital to deliver the third baby, Devine came armed, physically and psychologically. She brought her own formula, bottles and steriliser. She was not subjecting herself to any more psychological torture. She had long accepted that her breasts would never make a drop of milk. 

This conversation with Devine came up in a random meeting at birthday party for a mutual friend. She was unapologetic about the fact that many who interacted with her when her babies were infants judged her very harshly. In her words, in Africa, and indeed in many parts of the world, a mother’s rating is hugely dependent on her ability and willingness to breastfeed her offspring. Anything contrary automatically delegates one to being a bad mother. 

Many mothers struggle with secondary lactation insufficiency. This is when the mother is unable to make milk as a result of poor breastfeeding technique, lack of adequate rest, stress, pain, inadequate nutrition, medical complications, medication and poor social support system.

However, there is a rare category of mothers who will not make milk because of disruption in the hormone responsible for manufacturing of milk in the breast, called prolactin. This results in primary lactation insufficiency. Not even the African drumbeats can convince these mothers to lactate. 

During pregnancy, the reproductive hormones — oestrogen and progesterone — trigger development of the breast tissue in preparation for lactation. After delivery, the sudden drop of these hormones, in particular, progesterone, triggers the increase in prolactin, both in amount and in function.

Prolactin stimulates the breast glandular tissue to make milk. This is then supported by another hormone, oxytocin, which facilitates the milk letdown reflex. Both of these hormones are triggered by nipple stimulation, hence the longer the baby suckles, the more they facilitate milk production. Absence of prolactin means there is no manufacture of the milk. 

Conditions affecting prolactin production include injury to the pituitary gland in the brain, where the hormone, and indeed several others, are released from. One of the causes is Sheehan’s syndrome, a condition where excessive bleeding and shock during delivery compromises blood circulation to the pituitary gland, causing parts of it to die off. The effect involves multiple hormones, upsetting menstruation, thyroid function, and lactation. 

Other causes include infections in the brain such as tuberculosis and brain tumours. In extremely rare cases, genetic mutations result in a person lacking the special cells that manufacture the prolactin. This may run in families. Others may make abnormal antibodies that destroy these special cells or the prolactin that is manufactured. 

This rare condition is what Devine was eventually diagnosed with. Unfortunately, it has no cure. Man-made prolactin hormone isn’t commercially available and remains mostly as a research tool. Where it has been tested, it has shown good results but it may remain out of reach, considering just how few people need it.

Next time a mum whips out a bottle to feed her infant, instead of her breast, dear fellow Africans, let’s please hold our comments!

Dr Bosire is an obstetrician/gynaecologist