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.

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.

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.

More than 7 million people in Australia were born overseas. Some 5.8 million people report speaking a language other than English at home.

But how well are we looking after culturally and linguistically diverse (CALD) Australians?

In countries around the world, evidence suggests people from CALD backgrounds are at increased risk of harm as a result of the health care they receive when compared to the general population. Common problems include a higher risk of contracting a hospital-acquired infection or medication errors.

People receiving cancer care are at particularly high risk of harm associated with their health care.

In a recent study, we found CALD cancer patients in Australia had roughly a one-in-three risk of something going wrong during their cancer care. This is unacceptably high.

We reviewed medical records

We worked with four cancer services (two in New South Wales and two in Victoria) that provide care to high proportions of people from CALD backgrounds. These four cancer services offer a combination of care to patients in hospitals, clinics and in their homes.

We analysed de-identified medical records of people from CALD backgrounds who received care at any of the four cancer services during 2018. To identify CALD patients, we used information from their medical records including “country of birth”, “preferred language”, “language spoken at home” and “interpreter required”.

We reviewed a total of 628 medical records of CALD cancer patients. We found roughly one in three medical records (212 out of 628) had at least one patient safety event recorded. We defined a patient safety event as any event that could have or did result in harm to the patient as a result of the health care they receive. We also found 44 patient records had three or more safety events recorded over a 12-month period.

Medication-related safety events were common, such as the wrong medication type or dose being given to a patient. Sometimes the patients themselves took the wrong type or dose of a medication or stopped medication all together. We also observed a variety of other patient safety events such as falls, pressure ulcers and infections after surgery.

The number of incidents could even be higher than what we observed. We know from other research that not all patient safety events are documented.

We didn’t have a control group, which is the main limitation of our study. In other words, we didn’t examine medical records of patients from non-CALD backgrounds to compare how common patient safety events were between groups.

But looking at other data suggests the rate of incidents is much higher in CALD patients.

Studies over many years indicate around one in ten patients admitted to hospital experience a safety event.

One study from Norway found cancer patients have a 39% greater risk of experiencing adverse events in hospital when compared to other patients (24.2% compared to 17.4%).

Why is the risk of incidents so high for CALD patients?

We identified miscommunication as a key factor that put cancer patients from CALD backgrounds at risk.

For example, we observed from one patient’s notes that the patient didn’t take their medication because they were confused by the instructions given by different clinicians. This confusion might have stemmed from language barriers or health literacy issues.

In some medical records, we also saw interpreter requirements were unmet. For example, at the time of admission, assessment for language needs noted an interpreter was not required. However, later notes mentioned the patient had poor English or needed an interpreter.

Also, with the limited availability of interpreters, they’re often reserved for specialist appointments, and not used for “routine” tasks, such as during chemotherapy treatment. This may result in side effects from cancer medications not being properly identified and responded to, potentially leading to patient harm.

What can we do to improve things?

To make care safer, patients, their families and the clinicians who care for them should come together so that any solutions developed are practical, relevant, and informed by their combined experiences.

As an example, we developed a tool with consumers from CALD backgrounds and their clinicians that seeks to ensure that when patient medications are changed, there is common understanding between the clinician and the patient of their medication and care instructions. This includes recognising the side effects of the medications and who to contact if they have concerns.

This tool uses images and simple language to support common understanding of medication and care instructions. It takes into account specific cultural expectations and is available in different languages. It’s currently being evaluated in two cancer clinics.

To make cancer care safer for patients from CALD backgrounds, health systems and services will need to support and invest in strategies that are specifically targeted towards people from these backgrounds. This will ensure more equitable health solutions that improve the health of all Australians.

Ashfaq Chauhan, Research Fellow, Australian Institute of Health Innovation, Macquarie University; Melvin Chin, Senior Lecturer, School of Clinical Medicine, UNSW Sydney; Meron Pitcher, Honorary, Medicine, Dentistry and Health Sciences, The University of Melbourne, and Reema Harrison, Professor, Australian Institute of Health Innovation, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.