As a physician and expectant first-time mother, I had no doubt that I would exclusively breastfeed my first-born child. I read a popular breastfeeding book and attended my hospital’s breastfeeding classes to prepare. I had a healthy pregnancy, and my son was born after an uncomplicated vaginal delivery weighing 8 pounds, 11 ounces. He was placed on my belly and latched on well immediately. He woke up about every three hours and I fed him for twenty to thirty minutes on demand.

We stayed in the hospital for two days, during which time we were visited by a pediatrician and a lactation consultant (IBCLC) each day of our stay. The IBCLC noted that his latch was perfect. He developed jaundice by the second day, although his levels were unremarkable. He had lost 5 percent of his birth weight and produced the expected number of wet and dirty diapers upon discharge at forty-eight hours. Our first two days were exactly as the breastfeeding books described. Before discharge, I was told by the IBCLC that he would be hungry and to just keep putting him to the breast and he would get enough colostrum, the first milk that mothers produce after birth.

We went home, and as predicted, he was hungry. So, I fed him longer and longer into the night. He would cry after latching on and I would put him back on the breast. He did not sleep. My husband and I were baffled by how demanding it was. After a long night of breastfeeding, we saw our pediatrician the next morning. We were told that our son had now lost 1 pound, 3 ounces, which we weren’t informed was 15 percent of his birth weight. He was jaundiced, but his bilirubin level (the blood test for jaundice) was not checked. Perhaps to keep from discouraging me, our pediatrician told us we could either supplement or keep breastfeeding frequently and wait for my milk to come in on day four or five. We decided to try one more day of breastfeeding without supplementation, and I fed near-continuously.

By his fourth day of life, we saw another IBCLC, who weighed him before and after nursing and discovered he had gotten absolutely no milk through breastfeeding. When I expressed and pumped, not a drop of milk came out.

I shook with fatigue and terror. I imagined the four days of life-endangering torture I had put my child through. We fed him formula from the sample our pediatrician gave us once we returned home, and he finally fell asleep. When my husband went to get him from his nap three hours later, he was unresponsive.

Being an emergency physician, I knew he was hypoglycemic—his blood sugar was too low. I quickly prepared a bottle of formula, which my husband squeezed into his mouth. He swallowed it and became more alert. But then he immediately started seizing. We rushed him to the emergency room and found that he had a barely normal glucose level, severe jaundice (commonly known as breastfeeding jaundice), and a severe form of dehydration called hypernatremia. I had only seen hypernatremia that severe in comatose patients with dementia who had not drank water in days. Having studied newborn brain injury in college, I realized he had starved—and that it had profoundly injured his brain.

At that moment, I wondered why this had happened, when the books assured me that not producing enough breast milk was rare. If it was so rare, why were my colleagues acting as if this was a routine occurrence? As I was explaining to the neonatologist why this had happened, I began to say that it was because my milk had not come in, but couldn’t finish the sentence out of shame. She guessed the end. Then she assured me, “Your son will be fine.” Didn’t she see that his laboratory data clearly indicated that he had sustained brain injury and that my previously perfectly healthy newborn would potentially be disabled for the rest of his life? Were they hiding it from me, or did they not know? What would be the future consequences of his brain injury, and why had I not heard of this kind of thing happening before?

If this had happened to two physicians taking home their first-born child, it had to be happening to an unimaginable number of new parents. I remembered breastfeeding jaundice being mentioned briefly during medical school, but no one had ever described what it really meant: that a baby could spend days starving at the breast, even to the point of brain injury or death. In a world where a million cribs are recalled if one baby dies, why had no one warned me that this apparently common, life-threatening, and potentially disabling event could happen to my child—and that I could have prevented with formula?

Exclusive breastfeeding from birth to six months is recommended by the World Health Organization (WHO), UNICEF, the Centers for Disease Control (CDC), and the American Academy of Pediatrics (AAP), among others. It means giving only breast milk, preferably through direct nursing, with no additional food, water, or formula from birth to six months with rare medical exceptions. The most prominent advice I had read and learned from breastfeeding classes and books was to avoid formula to prevent breastfeeding failure and long-term health problems for my child. Not once was I informed of the even worse health consequences of not feeding my child enough while following these guidelines. I lived with the faulty belief that all the child-related recommendations offered by respected health organizations would be the most rigorously studied and safest available. If something terrible and tragic resulted from these recommendations, I thought, it would have to happen to one in a million children. This turned out not to be the case at all . . .