Some women’s breasts can’t make enough milk, and the effects can be devastating
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Many new mothers worry about their milk supply. For some, support from a breastfeeding counsellor or lactation consultant helps.
Others cannot make enough milk no matter how hard they try. These are women whose breasts are not physically capable of producing enough milk.
Our recently published research gives us clues about breast features that might make it difficult for some women to produce enough milk. Another of our studies shows the devastating consequences for women who dream of breastfeeding but find they cannot.
Some breasts just don’t develop
Unlike other organs, breasts are not fully developed at birth. There are key developmental stages as an embryo, then again during puberty and pregnancy.
At birth, the breast consists of a simple network of ducts. Usually during puberty, the glandular (milk-making) tissue part of the breast begins to develop and the ductal network expands. Then typically, further growth of the ductal network and glandular tissue during pregnancy prepares the breast for lactation.
But our online survey of women who report low milk supply gives us clues to anomalies in how some women’s breasts develop.
We’re not talking about women with small breasts, but women whose glandular tissue (shown in this diagram as “lobules”) is underdeveloped and have a condition called breast hypoplasia.
Tsuyna/Shutterstock
We don’t know how common this is. But it has been linked with lower rates of exclusive breastfeeding.
We also don’t know what causes it, with much of the research conducted in animals and not humans.
However, certain health conditions have been associated with it, including polycystic ovary syndrome and other endocrine (hormonal) conditions. A high body-mass index around the time of puberty may be another indicator.
Could I have breast hypoplasia?
Our survey and other research give clues about who may have breast hypoplasia.
But it’s important to note these characteristics are indicators and do not mean women exhibiting them will definitely be unable to exclusively breastfeed.
Indicators include:
- a wider than usual gap between the breasts
- tubular-shaped (rather than round) breasts
- asymmetric breasts (where the breasts are different sizes or shapes)
- lack of breast growth in pregnancy
- a delay in or absence of breast fullness in the days after giving birth
In our survey, 72% of women with low milk supply had breasts that did not change appearance during pregnancy, and about 70% reported at least one irregular-shaped breast.
The effects
Mothers with low milk supply – whether or not they have breast hyoplasia or some other condition that limits their ability to produce enough milk – report a range of emotions.
Research, including our own, shows this ranges from frustration, confusion and surprise to intense or profound feelings of failure, guilt, grief and despair.
Some mothers describe “breastfeeding grief” – a prolonged sense of loss or failure, due to being unable to connect with and nourish their baby through breastfeeding in the way they had hoped.
These feelings of failure, guilt, grief and despair can trigger symptoms of anxiety and depression for some women.
Bricolage/Shutterstock
One woman told us:
[I became] so angry and upset with my body for not being able to produce enough milk.
Many women’s emotions intensified when they discovered that despite all their hard work, they were still unable to breastfeed their babies as planned. A few women described reaching their “breaking point”, and their experience felt “like death”, “the worst day of [my] life” or “hell”.
One participant told us:
I finally learned that ‘all women make enough milk’ was a lie. No amount of education or determination would make my breasts work. I felt deceived and let down by all my medical providers. How dare they have no answers for me when I desperately just wanted to feed my child naturally.
Others told us how they learned to accept their situation. Some women said they were relieved their infant was “finally satisfied” when they began supplementing with formula. One resolved to:
prioritise time with [my] baby over pumping for such little amounts.
Where to go for help
If you are struggling with low milk supply, it can help to see a lactation consultant for support and to determine the possible cause.
This will involve helping you try different strategies, such as optimising positioning and attachment during breastfeeding, or breastfeeding/expressing more frequently. You may need to consider taking a medication, such as domperidone, to see if your supply increases.
If these strategies do not help, there may be an underlying reason why you can’t make enough milk, such as insufficient glandular tissue (a confirmed inability to make a full supply due to breast hypoplasia).
Even if you have breast hypoplasia, you can still breastfeed by giving your baby extra milk (donor milk or formula) via a bottle or using a supplementer (which involves delivering milk at the breast via a tube linked to a bottle).
More resources
The following websites offer further information and support:
- Australian Breastfeeding Association
- Lactation Consultants of Australia and New Zealand
- Royal Women’s Hospital, Melbourne
- Supply Line Breastfeeders Support Group of Australia Facebook support group
- IGT And Low Milk Supply Support Group Facebook support group
- Breastfeeding Medicine Network Australia/New Zealand
- Supporting breastfeeding grief (a collection of resources).
Shannon Bennetts, a research fellow at La Trobe University, contributed to this article.
Renee Kam, PhD candidate and research officer, La Trobe University and Lisa Amir, Professor in Breastfeeding Research, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Stay In Shape At 70
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I have a question: what are the pros and cons of older people (60+) taking creatine every day?
It depends what else you’re doing, as creatine mostly helps the muscles recover after exercise. So:
- iff you’re doing resistance training (such as weights or bodyweight training), or HIIT (High Intensity Interval Training), then creatine monohydrate may help you keep at that and keep doing well.
- if you’re just doing light-to-moderate exercises, you might not get much benefit from creatine!
The topic merits diving deeper though, so we’ll queue that for one of our “Research Review Monday” days!
I wanted to ask if you think marine collagen is decent to take. I’ve heard a lot of bad press about it
We don’t know what you’ve heard, but generally speaking it’s been found to be very beneficial to bones, joints, and skin! We wrote about it quite recently on a “Research Review Monday”:
See: We Are Such Stuff As Fish Are Made Of
Natural alternatives to medication for depression?
Great question! We did a mean feature a while back, but we definitely have much more to say! We’ll do another main feature soon, but in the meantime, here’s what we previously wrote:
See: The Mental Health First-Aid That You’ll Hopefully Never Need
^This covers not just the obvious, but also why the most common advice is not helpful, and practical tips to actually make manageable steps back to wellness, on days when “literally just survive the day” is one’s default goal.
I am now in the “aging” population. A great concern for me is Alzheimers. My father had it and I am so worried. What is the latest research on prevention?
One good thing to note is that while Alzheimer’s has a genetic component, it doesn’t appear to be hereditary per se. Still, good to be on top of these things, and it’s never too early to start with preventive measures!
You might like a main feature we did on this recently:
See: How To Reduce Your Alzheimer’s Risk
Side effects of statins, are they worth it? Depression, are antidepressants worth it?
About statins, that depends a lot on you, your circumstances, and—as it happens—your gender. We covered this in a main feature recently, but a short answer is: for most people, they may not be the best first choice, and could even make things worse. For some people, however, they really are just what’s needed.
- Factors that make them more likely better for you: being a man, or having atherosclerosis
- Factors that make them more likely worse for you: being a woman in general
Check out the main feature we did: Statins: His & Hers?
As for antidepressants? That depends a lot on you, your physiology, your depression, your circumstances, and more. We’ll definitely do a main feature on that sometime soon, as there’s a lot that most people don’t know!
I am interested in the following: Aging, Exercise, Diet, Relationships, Purpose, Lowering Stress
You’re going to love our Psychology Sunday editions of 10almonds!
You may particularly like some of these:
- Seriously Useful Communication Skills! ← this is about relationship stuff
- Lower Your Cortisol! (Here’s Why & How) ← about “the stress hormone”
- How To Set Your Anxiety Aside ← these methods work for stress too
(This coming Psychology Sunday will have a feature specifically on stress, so do make sure to read that when it comes out!)
Hair growth strategies for men combing caffeine and minoxidil?
Well, the strategy for that is to use caffeine and minoxidil! Some more specific tips, though:
- Both of those things need to be massaged (gently!) into your scalp especially around your hairline.
- In the case of caffeine, that boosts hair growth. No extra thought or care needed for that one.
- In the case of minoxidil, it reboots the hair growth cycle, so if you’ve only recently started, don’t be surprised (or worried) if you see more shedding in the first three months. It’s jettisoning your old hairs because new ones were just prompted (by the minoxidil) to start growing behind them. So: it will get briefly worse before it gets better, but then it’ll stay better… provided you keep using it.
- If you’d like other options besides minoxidil, finasteride is a commonly prescribed oral drug that blocks the conversion of testosterone to DHT, which latter is what tells your hairline to recede.
- If you’d like other options besides prescription drugs, saw palmetto performs comparably to finasteride (and works the same way).
- You may also want to consider biotin supplementation if you don’t already enjoy that
- Consider also using a dermaroller on your scalp. If you’re unfamiliar, this is a device that looks like a tiny lawn aerator, with many tiny needles, and you roll it gently across your skin.
- It can be used for promoting hair growth, as well as for reducing wrinkles and (more slowly) healing scars.
- It works by breaking up the sebum that may be blocking new hair growth, and also makes the skin healthier by stimulating production of collagen and elastin (in response to the thousands of microscopic wounds that the needles make).
- Sounds drastic, but it doesn’t hurt and doesn’t leave any visible marks—the needles are that tiny. Still, practise good sterilization and ensure your skin is clean when using it.
See: How To Use A Dermaroller ← also explains more of the science of it
PS: this question was asked in the context of men, but the information goes the same for women suffering from androgenic alepoceia—which is a lot more common than most people think!
How to get to sleep at night as fast and as naturally as possible? Thank you!
We’ll definitely write more on that! You might like these articles we wrote already, meanwhile:
- Beating The Insomnia Blues ← this one is general advice and tips
- Time For Some Pillow Talk ← this one compares and reviews some popular sleep apps
- Insomnia? High Blood Pressure? Try these! ← this one tackles the matter from a dietary angle
Q: How to be your best self after 60: Self motivation / Avoiding or limiting salt, sugar & alcohol: Alternatives / Ways to sneak in more movements/exercise
…and, from a different subscriber…
Q: Inflammation & over 60 weight loss. Thanks!
Here are some of our greatest hits on those topics:
- Where Nutrition Meets Habits ← focusing on food that’s all three of: healthy + easy + cheap
- How To Keep On Keeping On ← exercise tips for when the motivation wanes
- Keep Inflammation At Bay ← science-based tips and advice
Also, while we’ve recommended a couple of books on stopping (or reducing) drinking, we’ve not done a main feature on that, so we definitely will one of these days!
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Your Simplest Life – by Lisa Turner
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We probably know how to declutter, and perhaps even do a “unnecessary financial expenditures” audit. So, what does this offer beyond that?
A large portion of this book focuses on keeping our general life in a state of “flow”, and strategies include:
- How to make sure you’re doing the right part of the 80:20 split on a daily basis
- Knowing when to switch tasks, and when not to
- Knowing how to plan time for tasks
- No more reckless optimism, but also without falling foul of Parkinson’s Law (i.e. work expands to fill the time allotted to it)
- Decluttering your head, too!
When it comes to managing life responsibilities in general, Turner is very attuned to generational differences… Including the different challenges faced by each generation, what’s more often expected of us, what we’re used to, and how we probably initially learned to do it (or not).
To this end, a lot of strategies are tailored with variations for each age group. Not often does an author take the time to address each part of their readership like that, and it’s really helpful that she does!
All in all, a great book for simplifying your daily life.
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Oral vaccines could provide relief for people who suffer regular UTIs. Here’s how they work
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In a recent TikTok video, Australian media personality Abbie Chatfield shared she was starting a vaccine to protect against urinary tract infections (UTIs).
Huge news for the UTI girlies. I am starting a UTI vaccine tonight for the first time.
Chatfield suffers from recurrent UTIs and has turned to the Uromune vaccine, an emerging option for those seeking relief beyond antibiotics.
But Uromune is not a traditional vaccine injected to your arm. So what is it and how does it work?
9nong/Shutterstock First, what are UTIs?
UTIs are caused by bacteria entering the urinary system. This system includes the kidneys, bladder, ureters (thin tubes connecting the kidneys to the bladder), and the urethra (the tube through which urine leaves the body).
The most common culprit is Escherichia coli (E. coli), a type of bacteria normally found in the intestines.
While most types of E. coli are harmless in the gut, it can cause infection if it enters the urinary tract. UTIs are particularly prevalent in women due to their shorter urethras, which make it easier for bacteria to reach the bladder.
Roughly 50% of women will experience at least one UTI in their lifetime, and up to half of those will have a recurrence within six months.
UTIs are caused by bacteria enterning the urinary system. oxo7051/Shutterstock The symptoms of a UTI typically include a burning sensation when you wee, frequent urges to go even when the bladder is empty, cloudy or strong-smelling urine, and pain or discomfort in the lower abdomen or back. If left untreated, a UTI can escalate into a kidney infection, which can require more intensive treatment.
While antibiotics are the go-to treatment for UTIs, the rise of antibiotic resistance and the fact many people experience frequent reinfections has sparked more interest in preventive options, including vaccines.
What is Uromune?
Uromune is a bit different to traditional vaccines that are injected into the muscle. It’s a sublingual spray, which means you spray it under your tongue. Uromune is generally used daily for three months.
It contains inactivated forms of four bacteria that are responsible for most UTIs, including E. coli. By introducing these bacteria in a controlled way, it helps your immune system learn to recognise and fight them off before they cause an infection. It can be classified as an immunotherapy.
A recent study involving 1,104 women found the Uromune vaccine was 91.7% effective at reducing recurrent UTIs after three months, with effectiveness dropping to 57.6% after 12 months.
These results suggest Uromune could provide significant (though time-limited) relief for women dealing with frequent UTIs, however peer-reviewed research remains limited.
Any side effects of Uromune are usually mild and may include dry mouth, slight stomach discomfort, and nausea. These side effects typically go away on their own and very few people stop treatment because of them. In rare cases, some people may experience an allergic reaction.
How can I access it?
In Australia, Uromune has not received full approval from the Therapeutic Goods Administration (TGA), and so it’s not something you can just go and pick up from the pharmacy.
However, Uromune can be accessed via the TGA’s Special Access Scheme or the Authorised Prescriber pathway. This means a GP or specialist can apply for approval to prescribe Uromune for patients with recurrent UTIs. Once the patient has a form from their doctor documenting this approval, they can order the vaccine directly from the manufacturer.
Antibiotics are the go-to treatment for UTIs – but scientists are looking at options to prevent them in the first place. Photoroyalty/Shutterstock Uromune is not covered under the Pharmaceutical Benefits Scheme, meaning patients must cover the full cost out-of-pocket. The cost of a treatment program is around A$320.
Uromune is similarly available through special access programs in places like the United Kingdom and Europe.
Other options in the pipeline
In addition to Uromune, scientists are exploring other promising UTI vaccines.
Uro-Vaxom is an established immunomodulator, a substance that helps regulate or modify the immune system’s response to bacteria. It’s derived from E. coli proteins and has shown success in reducing UTI recurrences in several studies. Uro-Vaxom is typically prescribed as a daily oral capsule taken for 90 days.
FimCH, another vaccine in development, targets something called the adhesin protein that helps E. coli attach to urinary tract cells. FimCH is typically administered through an injection and early clinical trials have shown promising results.
Meanwhile, StroVac, which is already approved in Germany, contains inactivated strains of bacteria such as E. coli and provides protection for up to 12 months, requiring a booster dose after that. This injection works by stimulating the immune system in the bladder, offering temporary protection against recurrent infections.
These vaccines show promise, but challenges like achieving long-term immunity remain. Research is ongoing to improve these options.
No magic bullet, but there’s reason for optimism
While vaccines such as Uromune may not be an accessible or perfect solution for everyone, they offer real hope for people tired of recurring UTIs and endless rounds of antibiotics.
Although the road to long-term relief might still be a bit bumpy, it’s exciting to see innovative treatments like these giving people more options to take control of their health.
Iris Lim, Assistant Professor in Biomedical Science, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How light can shift your mood and mental health
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This is the next article in our ‘Light and health’ series, where we look at how light affects our physical and mental health in sometimes surprising ways. Read other articles in the series.
It’s spring and you’ve probably noticed a change in when the Sun rises and sets. But have you also noticed a change in your mood?
We’ve known for a while that light plays a role in our wellbeing. Many of us tend to feel more positive when spring returns.
But for others, big changes in light, such as at the start of spring, can be tough. And for many, bright light at night can be a problem. Here’s what’s going on.
llaszlo/Shutterstock An ancient rhythm of light and mood
In an earlier article in our series, we learned that light shining on the back of the eye sends “timing signals” to the brain and the master clock of the circadian system. This clock coordinates our daily (circadian) rhythms.
“Clock genes” also regulate circadian rhythms. These genes control the timing of when many other genes turn on and off during the 24-hour, light-dark cycle.
But how is this all linked with our mood and mental health?
Circadian rhythms can be disrupted. This can happen if there are problems with how the body clock develops or functions, or if someone is routinely exposed to bright light at night.
When circadian disruption happens, it increases the risk of certain mental disorders. These include bipolar disorder and atypical depression (a type of depression when someone is extra sleepy and has problems with their energy and metabolism).
Light on the brain
Light may also affect circuits in the brain that control mood, as animal studies show.
There’s evidence this happens in humans. A brain-imaging study showed exposure to bright light in the daytime while inside the scanner changed the activity of a brain region involved in mood and alertness.
Another brain-imaging study found a link between daily exposure to sunlight and how the neurotransmitter (or chemical messenger) serotonin binds to receptors in the brain. We see alterations in serotonin binding in several mental disorders, including depression.
Our mood can lift in sunlight for a number of reasons, related to our genes, brain and hormones. New Africa/Shutterstock What happens when the seasons change?
Light can also affect mood and mental health as the seasons change. During autumn and winter, symptoms such as low mood and fatigue can develop. But often, once spring and summer come round, these symptoms go away. This is called “seasonality” or, when severe, “seasonal affective disorder”.
What is less well known is that for other people, the change to spring and summer (when there is more light) can also come with a change in mood and mental health. Some people experience increases in energy and the drive to be active. This is positive for some but can be seriously destabilising for others. This too is an example of seasonality.
Most people aren’t very seasonal. But for those who are, seasonality has a genetic component. Relatives of people with seasonal affective disorder are more likely to also experience seasonality.
Seasonality is also more common in conditions such as bipolar disorder. For many people with such conditions, the shift into shorter day-lengths during winter can trigger a depressive episode.
Counterintuitively, the longer day-lengths in spring and summer can also destabilise people with bipolar disorder into an “activated” state where energy and activity are in overdrive, and symptoms are harder to manage. So, seasonality can be serious.
Alexis Hutcheon, who experiences seasonality and helped write this article, told us:
[…] the season change is like preparing for battle – I never know what’s coming, and I rarely come out unscathed. I’ve experienced both hypomanic and depressive episodes triggered by the season change, but regardless of whether I’m on the ‘up’ or the ‘down’, the one constant is that I can’t sleep. To manage, I try to stick to a strict routine, tweak medication, maximise my exposure to light, and always stay tuned in to those subtle shifts in mood. It’s a time of heightened awareness and trying to stay one step ahead.
So what’s going on in the brain?
One explanation for what’s going on in the brain when mental health fluctuates with the change in seasons relates to the neurotransmitters serotonin and dopamine.
Serotonin helps regulate mood and is the target of many antidepressants. There is some evidence of seasonal changes in serotonin levels, potentially being lower in winter.
Dopamine is a neurotransmitter involved in reward, motivation and movement, and is also a target of some antidepressants. Levels of dopamine may also change with the seasons.
But the neuroscience of seasonality is a developing area and more research is needed to know what’s going on in the brain.
How about bright light at night?
We know exposure to bright light at night (for instance, if someone is up all night) can disturb someone’s circadian rhythms.
This type of circadian rhythm disturbance is associated with higher rates of symptoms including self-harm, depressive and anxiety symptoms, and lower wellbeing. It is also associated with higher rates of mental disorders, such as major depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder (or PTSD).
Why is this? Bright light at night confuses and destabilises the body clock. It disrupts the rhythmic regulation of mood, cognition, appetite, metabolism and many other mental processes.
But people differ hugely in their sensitivity to light. While still a hypothesis, people who are most sensitive to light may be the most vulnerable to body clock disturbances caused by bright light at night, which then leads to a higher risk of mental health problems.
Bright light at night disrupts your body clock, putting you at greater risk of mental health issues. Ollyy/Shutterstock Where to from here?
Learning about light will help people better manage their mental health conditions.
By encouraging people to better align their lives to the light-dark cycle (to stabilise their body clock) we may also help prevent conditions such as depression and bipolar disorder emerging in the first place.
Healthy light behaviours – avoiding light at night and seeking light during the day – are good for everyone. But they might be especially helpful for people at risk of mental health problems. These include people with a family history of mental health problems or people who are night owls (late sleepers and late risers), who are more at risk of body clock disturbances.
Alexis Hutcheon has lived experience of a mental health condition and helped write this article.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Jacob Crouse, Research Fellow in Youth Mental Health, Brain and Mind Centre, University of Sydney; Emiliana Tonini, Postdoctoral Research Fellow, Brain and Mind Centre, University of Sydney, and Ian Hickie, Co-Director, Health and Policy, Brain and Mind Centre, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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You, Happier – by Dr. Daniel Amen
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The implicit question “what’s your brain type?” makes this book sound a little like a horoscope for science-enjoyers, but really, the “brain type” in question is simply a way of expressing which neurochemicals one’s brain makes most and/or least easily.
That’s something that a) really does differ from one person to another b) isn’t necessarily fixed forever, but will tend to remain mostly the same most of the time for most people.
And yes, the book does cover figuring out which neurotransmitter(s) it might be for you. On a secondary level, it also talks about more/less active parts of the brain for each of us, but the primary focus is on neurotransmitters.
It’s easy to assume “everyone wants more [your favorite neurotransmitter here]” but in fact, most people most of the time have most of what they need.
For those of us who don’t, those of us who perhaps have to work more to keep our level(s) of one or more neurotransmitters where they should be, this book is a great guide to optimizing aspects of our diet and lifestyle to compensate for what our brains might lack—potentially reducing the need to go for pharmaceutical approaches.
The style of the book is very much pop-science, but it is all well-informed and well-referenced.
Bottom line: if you sometimes (or often!) think “if only my brain would just make/acknowledge more [neurotransmitter], this book is for you.
Click here to check out You, Happier, and discover a happier you!
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The Connection Cure – by Julia Hotz
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You may recognize some of the things in the subtitle as being notable elements of the Blue Zones supercentenarians’ lifestyles, but this book looks at numerous quite diverse countries, and people from many walks of life.
What they have in common—and this is mostly a very person-centered book, relying a lot on case studies, with additional references coming from wider sociological data—is social prescribing.
What is social prescribing? That’s what the author (a journalist by general profession) answers comprehensively here, and it’s about looking at the ways medical problems can often have nonmedical solutions. It doesn’t necessarily mean that walking will cure your cancer or art will cure your diabetes, but it does mean that very often a key part of an unhealthy lifestyle is fundamentally something that can be fixed by one or more of: movement, nature, art, service, and belonging.
She looks at social prescribing in its birthplace (the UK, where cheap solutions that are nevertheless evidence-based are very much prioritized), in big countries like Canada and Australia, in aging countries like Singapore and South Korea, and yes, also in the #1 country of pill prescribing, the US.
The structure of the book is interesting, we first have 5 person-centered chapters addressing each of the social prescribing aspects and how they helped in two example case studies for each one, then 5 country-by-country epidemiological chapters looking at the big picture, then 5 person-centered chapters again, this time looking at personalizing social prescribing for oneself (this section of the book being headed “Social Prescribing For You And Me”), looking at what is going on in one’s life and health, which of the 5 elements might be missing, and what tangible goal-oriented benefits can—according to the evidence—be obtained by tending to what one actually needs in terms of social prescribing.
The style is narrative and journalistic, with very little hard science, but very little that’s wishy-washy either. It is, in short, a pleasant and informative read that helps the reader really understand social prescribing, the better to implement it in our own lives.
Bottom line: if you like having extra nonmedical approaches to avoid or alleviate medical problems, then this book will really help you achieve that.
Click here to check out The Connection Cure, and get social prescribing!
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