Far too often in this country, women are forced to bounce between a variety of specialists who lack the training and education to treat a serious health condition. I am referring to what is in essence mammary organ dysfunction and failure (MODF), a disorder in which a mother is unable to produce enough breastmilk to nourish her newborn infant. As a result, this places both the woman and her newborn child at increased risk for serious health consequences. Many people do not know that the mammary gland is actually an organ, similar to other vital organs that are necessary to sustain life. Under normal circumstances, a woman's breasts will produce an adequate milk supply to nourish her child exclusively for the first six months of life. In addition to nutrition, breastmilk offers immune protection, probiotics, and vital growth factors, among many other components, that adjust over time to meet the specific needs of her baby. Nothing manufactured can compare to the dynamic character of breastmilk; there is no doubt that human milk is made uniquely for human babies.
The first few hours and days after birth are critical for a mother’s milk supply. Frequent feedings, milk removal, and skin-to-skin contact are all early predictors of successful breastfeeding. Many hospitals have recently adopted the Baby-Friendly Hospital Initiative (BFHI) in an attempt to increase the likelihood of breastfeeding success, which in turn leads to better health outcomes for both women and their babies. In these hospitals, newborns room-in with their mothers twenty-four hours a day to encourage bonding and frequent feeding and do not receive formula unless the parents consent to its use. Unfortunately, these policies can only help women who are on track to bring in a full milk supply. In some cases, despite following all the rights steps to build and maintain an adequate milk supply, some women still cannot reach this goal.
Lactation is a complex process that requires the full cooperation and synchrony of a woman’s hormones, and it can easily be disrupted. Such disruption is not uncommon, and recent research suggests it might be more common now than ever, with factors such as advanced maternal age, obesity, and high rates of birth interventions playing a key role. While studies indicate that insufficient milk supply affects anywhere from 5-10% of mothers, research on this phenomenon is limited. The research is clear, however, about one of the most commonly cited reason for early weaning: insufficient milk supply.
Over the past few decades, we have gained a better understanding of the lactation process and the hormones that support it. One of these essential hormones, prolactin, is produced in the pituitary gland, a small, walnut-shaped gland situated at the base of the brain. Among its many functions, prolactin stimulates mammary tissue development during pregnancy and then triggers milk production after the baby arrives. Today, we have strong evidence that women suffering from MODF who take either synthetic prolactin or a medication that stimulates prolactin release will experience a significant increase in their milk production. In 2011, researchers conducted a clinical trial in which they administered synthetic prolactin to women with insufficient milk supply. The results clearly demonstrated that prolactin administration resulted in a marked increase in milk volume. Soon after the results were published, however, the pharmaceutical company that manufactured the prolactin discontinued its production.
Another way to increase prolactin levels is to administer a drug called domperidone, which was developed in the 1970s for relief of nausea and other gastrointestinal symptoms. As one of its side effects, domperidone stimulates the pituitary gland to produce prolactin. Not surprisingly, women who suffer from MODF often turn to domperidone, typically with positive results. In 2004, however, the Food and Drug Administration (FDA) banned its use for lactation purposes due to rare but fatal cardiac events associated with the drug. Despite the FDA warnings against its use, thousands of women currently suffering from MODF order domperidone from online foreign pharmacies, often without a prescription or their doctor’s knowledge.
Increasing a woman’s prolactin level is only one of many possible ways to address MODF. That more promising treatments for MODF are not widely available is unfortunate and, one might argue, unacceptable. Breastmilk provides infants with the essential and biologically specific nutrition necessary for them to thrive. When the organ that delivers this food fails, our next steps should focus on how to restore organ function rather than instructing the mother how to bottle-feed. Currently there are no medical specialties that directly diagnose and treat MODF. Clinical research that explores how and why MODF occurs is virtually nonexistent. Women are forced to either succumb to MODF or treat themselves by ordering medication online from a foreign, unregulated pharmacy in the hopes of increasing their milk supply. The time has come to strongly encourage the medical community to address MODF with the same level of commitment they apply to other causes of infant mortality and morbidity. Feeding artificial substances to our infants should not be our default response when lactation fails. Instead, we must allocate the funds and research efforts required to resolve MODF. Mothers who try desperately to ensure good health for their newborn child deserve no less from the doctors who take care of them both.
I welcome comments below from women who have suffered with MODF and would like to share their experiences.