When hospitals are overly aggressive about breastfeeding promotion (Guest Post)

A guest post by Yunyan Jennifer Wang, Ph.D.

We’re reminded constantly that ‘breast is best’. The ads plaster the Metro, hospital walls and my Facebook feed. Breast milk is touted everywhere these days as liquid gold, the ambrosia of life granting a sacred bond between mother and child. So of course when I was pregnant with my first child in 2015, I planned to nurse my baby. I took the classes, bought milk freezer trays, researched gear in preparation to milk myself at work for the next two years, per WHO recommendations. However, six days after the birth of my child – I changed my mind.

Baby Aria was born via emergency C-section after 22 hours of labor at Johns Hopkins Hospital with a mild case of jaundice – a condition that commonly affects babies of Asian and African descent. As a rookie mom, so I consulted every nurse and lactation consultant who came through the door. I gathered lots of advice, even though some even seemed to conflict with one another. With each new nurse shift, my list of instructions grew longer until I was nursing for 40min, followed by pumping for 30min, repeated every 2.5 hr. Exhausted, I asked a nurse when I was supposed to sleep during all of this, she replied something all new mothers have heard and loathed – sleep when the baby sleeps (but you just told me to pump after nursing?). During the next four days, baby Aria had alarmingly few wet diapers and alternated between being with me and going back to the nursery for 24-hr light therapy sessions to treat jaundice. Throughout this time I was reassured that I was “doing a great job”, that nature had taken its course and my bleeding nipples were ‘normal’ according to one inexperienced nurse.

"Pregnant Alice down the rabbit hole of motherhood"

“Pregnant Alice down the rabbit hole of motherhood”

It seemed that baby got sick each time she came back to me. On day four, an inquisitive nurse weighed Aria before and after a long nursing session, confirming my nagging suspicion that she wasn’t getting any milk from me (<5g weight difference). I had come face to face with the fact that I had starved my child for three days, exacerbating her condition by dehydration. I thought this information would bring change to our care. But nothing happened. I would have felt better if a doctor came running in shouting – “Breastfeeding hasn’t been working for you!” Instead I was urged to continue as I’ve been told and I was still ‘doing a great job’.

On the eve of day five, we are still at the hospital due to her unrelenting jaundice. Severe sleep deprivation from pumping endlessly, cliff-diving hormones combined with guilt from harming my newborn created the perfect storm leading to a breakdown. I couldn’t understand why no one around me responded to reason, to empirical evidence. I lost faith in my healthcare providers’ judgment and my body’s ability to function like a mother. My head buzzed and my legs shook at the mere mention of breastfeeding. I stopped everything I was doing and asked to see a psychiatrist.

In the last 30 years, US hospitals have heeded the call to arms by the Surgeon General to promote breastfeeding. This includes the Baby-Friendly Hospital Initiative, a campaign launched by UNICEF and the WHO in 1991. This 10-step program includes posting breastfeeding literature in hospital rooms, training staff to support breastfeeding, giving other no food or drink to nursing infants unless medically indicated and giving no pacifier or artificial nipple. While these steps are well-intended, there is very little science behind these guidelines.

 

When anxiety became incapacitating, we decided to go for bottle-feeding. We were given dire warnings about nipple confusion, which could seal an infant’s fate to the bottle. A meta-study from last year[1] examined 14 studies on ‘nipple confusion’. Firstly, this is not a medical term. Secondly, it’s a misnomer since babies are less ‘confused’ than prefer the bottle, which is likely an indicator of difficulty and stress associated with nursing. The authors contended, “despite the limited and inconsistent evidence, nipple confusion is widely believed by practitioners” and concluded that causality is difficult to establish in these studies. JHH includes an Avent pacifier in every welcome packet, technically violating the initiative guidelines. Their argument is that pacifier use may help to prevent SIDS, as suggested by research from the APA [2]. So who is the authority on these topics? UNICEF? The CDC? Individual Hospitals? Medical studies? If some of the guidelines for the Baby-Friendly Initiative are outdated, shouldn’t there be review and revision for such a pandemic program?

 

All controversies aside, in our case the JHH staff continued to encourage nursing – which was in fact not working, while it was clearly medically necessary to feed my child somehow to prevent potential brain damage from jaundice. I agree that breastfeeding is ideal if possible. This is a mother’s choice. However in a hospital setting, if healthcare providers choose to ignore clinical signs to pursue political agendas, there is a conflict of interest. For us, the very thing that was supposed to provide nursing support instead endangered my child’s well-being and contributed to my not being able to nurse at all. I believe this was never the intention [3] of the hospital. Given a choice today, I would have traded my swanky single room for an L&D environment that hosted group nursing activities supported by lactation consultants and local support groups.

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Pushing for breastfeeding is deeply ingrained as our healthcare legislation. While I am a strong supporter for Obamacare, subsidizing just breast pumps at the hospital is unfair since it excludes a significant group of parents – such as GLBT, adoptive families, and those unable to breastfeed due to tongue-tie, latch issues, inverted nipples, medication and countless other reasons. A free breast pump isn’t always the answer when alternatives such as subsidized formula and milk banks are not accessible to all families. Ideally, all parents will have reasonable family leave (at least three months or past the ‘fourth trimester’) and there will be no stigma against working mothers taking several hours a day to pump at work. This is not yet the case in America. While we need to make those changes happen, it’s important to keep in mind not every family has a lactating mother overflowing with milk. We need to give help to all parents because all babies need to eat.

 

It’s been nine months and Aria is a spunky little girl who spends most of her mornings chasing after our cat at a steady crawl. I have been off meds for post-partum depression for 3 months and life is finally starting to feel normal again. I have talked to many local moms in Baltimore and discovered more than a handful of us feel bullied at the hospital and ended up feeling inadequate or had failed. On my morning commutes, I talk to Aria’s daycare teachers, Metro train conductors, coffee shop clerks and medical professionals. I realize it’s a huge challenge for moms at these presence-demanding jobs to can step away to pump for 30min every 3 hours in a private room in order to maintain an adequate milk supply. We all want to give our children ‘the best’, but what happens when this is not possible? If we are graced with #2 some day, I will prepare myself to nurse again. But if it doesn’t work out despite my best efforts, taking up the bottle certainly won’t be the end of the world this time around.

 

Jennifer is a neuroscientist at Johns Hopkins School of Medicine.
Sources
1. Zimmerman E, Thompson K. J Perinatol. (2015) Clarifying nipple confusion. Nov;35(11):895-9.

2. American Academy of Pediatrics Task Force on Sudden Infant Death S. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005; 116(5): 1245–1255.

3. Bass JL, Gartley T, Kleinman R. Unintended Consequences of Current Breastfeeding Initiatives. JAMA Pediatr. 2016 Aug 22

 

Full response to “An Effort to Increase Breastfeeding” in the Philadelphia Inquirer, June 2016

An abridged version of this letter appeared in on Philly.com on June 19, 2016. 

Breastfeeding has been a journalistic topic du jour for years now. As an author of a book about breastfeeding promotion, the founder of a website supporting all methods of infant feeding, and a trained breastfeeding counselor, I read every piece on this topic with interest; after all, public perception is affected by what we see in the media, especially in today’s shareable, digital environment. It was for this reason that I was dismayed to see the interview with Arnetta Stewart and Katja Pigur of The Maternity Care Coalition (“An effort to increase breastfeeding in Philly”, 6/5/16). Not only was the piece rife with incorrect, misleading rhetoric, but it was also sadly indicative of how our society is going terribly wrong in efforts to enhance maternal/child health.

The interview begins with a discussion of breastfeeding initiation rates. While the figures used are spot-on (78% of mothers initiating breastfeeding), the hand-wringing about their inadequacy is not. These statistics do not take into account the deeply personal reasons the remaining 22% do not breastfeed from birth – women who have undergone mastectomies, women on certain contraindicated or borderline medications, and women who have histories of sexual trauma, to name a few. Also, of the many women included in this figure, how many might be second or third time mother who have learned from prior breastfeeding attempts that the practice is not possible or preferable for them? Or women who simply do not want to breasfeed, and make a fully informed choice to use formula? Seen in proper context, 78% nationwide is pretty darn impressive.

Moving on, Ms. Stewart claims that “Babies that are breast-fed are healthier babies. They have fewer infections and colds because it boosts their immunity. Breast-fed babies are less likely to be obese. The reason is if you give a baby a bottle and turn it upside down, the milk just flows out. Breast-fed babies do not overeat. Babies that drink from a bottle are overfed, and their bodies begin to recognize being overfed as the norm.”

Notice that the language used here is absolute. Not “babies may be healthier,” but rather that they most certainly will. This is patently false; the vast majority of infant feeding research is associative, bogged down by shoddy research methodology and confounding factors. We do have enough evidence to suggest a health benefit from breastfeeding, but this does not mean that every formula fed baby will be sicker than his breastfed peer. Likewise, there are numerous ways to mitigate overfeeding in a bottle-fed baby; her description brings to mind a defenseless child choking on a rapid flow of formula, which with today’s advanced bottles is virtually unheard of. And breastfeeding has not been conclusively proven protective against obesity; this is one of the most contested and questioned benefits, with several studies suggesting otherwise.

Next, Ms. Stewart makes the mind-boggling statement that “Breast-fed babies usually speak earlier because the jaw muscles are strengthened by breast-feeding.” If there is any evidence out there to support this assertion, I haven’t come across it in 7 years in this field.
She claims that breast-feeding promotes bonding between mom and baby; perhaps in most cases, but certainly not for the women who I’ve counseled, women who despised breastfeeding or for whom the act of nursing triggered memories of sexual assault, severe physical pain, or feelings of failure. Bonding happens between two calm, connected individuals, and sometimes a bottle serves this better than the breast.

But of all the misleading claims in this piece, one stands out as particularly alarming. Says Ms. Stewart, “breast-feeding puts their children physically, mentally, and emotionally on the same playing field as moms of a higher income.” No, the way we feed our babies in the first year does not level the playing field. Better healthcare, secure and safe housing, and equal education for all begins to level it. Breastfeeding, not so much.

Breastfeeding is a human right, a healthy and empowering choice, and one that deserves support and promotion. That does not – cannot – mean over-selling its benefits or presenting it as a panacea to the real problems families face. It does not mean causing unnecessary panic for women who are unable to breastfeed with overstated blanket proclamations that mean very little on an individual basis.
The time has come for an evidence-based, culturally and emotionally sensitive discussion of infant feeding. Instead of absolutism and zealotry, we need neutral, evidence-based advocacy that put the needs and rights of both women and babies ahead of breastfeeding statistics.

FFF Friday: “Sometimes life takes an ‘unnatural’ turn…”






It’s been awhile since I posted. Life’s been rather insane lately; job changes, life changes, location changes (I’m moving from Los Angeles to Chicago in June)… and in all honesty, it’s been sort of nice checking out of this particular reality for a moment. Sometimes, seeing all the madness and meanness inherent in the parenting world is exhausting. 

But ultimately, I always come back to one thing: to me, this stuff is frustrating and tiring. To a mom in the thick of it, this stuff is utter HELL. As we all move on, and our kids get older and new issues arise, it’s too easy to forget that other women are still suffering. That doesn’t mean we can’t let the anger and pain go – because after all, that’s the goal – but that we should stay protective of the next generation of mothers, too. 

That’s why I love Megan’s story. She has obviously processed her experience; she can speak about it with insight and eloquence, as well as some healthy distance. But she’s still telling her story. She’s still speaking up about the lessons she learned, hoping that others can benefit from finding their own kernel of truth in her account.

Please…keep talking. Even when I’m sloppy about posting these every week… find somewhere to speak up. Your stories matter. You matter.

Happy Friday, fearless ones,

The FFF

***

Megan’s Story: “Not Natural”

Being “all natural” is the latest catch phrase in motherhood, eating, and living. Don’t get me wrong; it sounds good and healthy and can be a worthy pursuit, but sometimes life takes an unnatural turn.

My road to motherhood has been anything but natural. It started marked by grief. We could never naturally conceive. Weeks of hormone injections, ultrasounds, and doctors visits all culminated in a cold sterile room with my husband sitting by my side for implantation. This is about as far from natural as baby making can be. Upon leaving, we were given a picture of two eight-celled embryos, our babies. It was surreal. We snapped a picture together. I grieved the lack of intimacy required but rejoiced we had made it so far.

I stared at those babies, prayed for those babies, hoped beyond hope for those babies to live, and one day at 7 am in my office bathroom I saw something I had never seen: two lines. Our first ultrasound showed one small heartbeat, and we were overjoyed. All the unnatural lead the way to a very real baby, and my journey to natural could continue despite the unnatural conception.

Fast-forward 41 weeks and 4 days, after a terribly long and generally uncomfortable pregnancy (I wasn’t one of those infertility patients who was so grateful it made me not complain—to my shame). I found myself at a birthing center, unable to physically stop the forces of my body from bringing this baby into the world. It was the most wonderfully horrible natural experience of my life, and suddenly my husband and I welcomed our son, Phineas Alexander, into the world. An unexpected gift. We were relieved, we were tired, we were happy.

I assumed I would breastfeed—it’s natural, after all—and he was on my chest immediately. By day three I realized something was wrong; he refused to latch all night one night. On day four, the lactation consultant stopped by and suggested he was tongue-tied. I had the first appointment I could with a doctor to correct his tongue so he could latch correctly. A Monday appointment guaranteed a weekend for significant damage to a normally chapping experience. A still lazy lower lip, even after correction, caused blood-mixed milk to spill from my always hungry baby’s mouth.

The natural way was killing me. I couldn’t wear clothing, I couldn’t snuggle my baby close, and I couldn’t hug my husband. Instead of feeling joy to see my baby awake, I would feel dread.

One day three weeks later, after about as much support as someone could hope for, I sat sobbing in my midwife’s office. She took one look at the situation and told me what my husband had already made clear: something had to change. “This is not normal chapping, these are the worst nipples I’ve seen in 30 years.” She sent me home with strict instruction to bottle feed my precious baby every two hours, as much as he would eat. I was to pump to keep up supply, and her words stuck with me as we left: “Maybe he’ll go back to the breast, after you heal.”

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Maybe. It took two and a half weeks for me to heal to a point where I could tolerate clothing. While Finn was thriving, I was once again grieving the loss of the expected—the natural. We tried going back, correcting the latch, re-teaching the suck, and this resulted in a gaping hole and the return of the blood-mixed milk. And the pump, oh the pump, was a leash that I hated, one that caused it’s own pain.  One night in the kitchen my husband was trying to comfort me, “we didn’t go through all we did to have a baby just to breastfeed. I want you to enjoy him.” I wept. I didn’t enjoy him and he might be my only.

At six weeks, I made the decision to wean him and stopped pumping. I became a formula-feeding mom. I was overjoyed. We are all healthy, the hourly tears have stopped, the baby is strong, and mom can snuggle. We tried “hard enough”, we tried every single thing any lactation consultant, the ENT doctor, and my midwife suggested. Even now with a nearly walking (!) 8 month old, people will casually ask me “Did you try…?” and it takes all that is within me to maintain composure and simply nod yes.

This journey has softened me; it’s given me compassion for those living the unexpected and trying to make the best decision in the moment; one they may second guess a million times. So I proudly tell our story in the natural birth lovin’ circles while mixing up his formula. I am thankful for the “unnatural”; without it my son would not exist and without it he would not have a full belly.

We live in an imperfect world, and what a gift it is that there is unnatural help along the way.

FFF Friday: “I’m grateful to the midwives who stepped out of line with hospital policies to connect with what was really going on…”

Last month, I received a PM from a woman named Sarah. She wrote: 

“It is hard to describe how depressed and lost one feels when someone takes it upon themselves to remind you of how exclusive breastfeeding halves the risk of SIDS, when they know you will be formula feeding. And when you tell them you don’t have a choice they just keep reiterating. As though you are choosing to kill your baby willfully and wantonly. And you start to doubt if you should even be a mother at all if you can’t breastfeed exclusively. It’s a lonely place.”

My heart broke for her. She was expecting her baby in the next few weeks, and I hoped against hope that when he or she arrived, all this self-doubt would wash away. 

And then, yesterday, she sent another message. She agreed to let me share it as an FFF Friday of sorts, even though that wasn’t her intent. I share this not to scare anyone who is currently expecting, because when Baby Friendly is done right, it can be a really positive experience. I share this to show that when Baby Friendly is done wrong, it’s done very wrong, and we can’t allow the good to overshadow the bad. It doesn’t matter that 20 women have a good experience if 5 are put through this kind of hell, because this kind of hell is inexcusable. End of story. And if anyone thinks what Sarah went through is acceptable, I doubt their opinions are malleable or their empathy is intact, so there’s no real reason to debate about it. 

Happy Friday, fearless ones. 

The FFF

** Please note – the names of everyone involved in this story have been changed, and the author refers to her baby as “they” rather than her or him to protect the child’s identity as well. Just so you don’t think she had twins! : ) ** 

 

Sarah’s Story

My baby, R, was two weeks old at 9.31pm two nights ago. Yesterday I lay next to them on our bed, watching them sleep and kissing their teeny tiny face, their squishy belly, their downy head and relishing them. I am still getting to know them, and our bond is still slowly growing as each day passes. Formula is largely responsible for being able to connect with them like this.

 

I would like to tell you about my experience so far of motherhood and feeding my baby while it remains fresh in my mind, because formula is at the centre of my story; formula and my breasts, and the both truly negligent and outstanding care I received – all within the same hospital.

 

There’s background to how feeding and by association, attachment, has gone down for me. I have a difficult history around fertility and mental health. I had two traumatic miscarriages before this baby was conceived, and their conception happened after painful, invasive fertility testing. A lot of emotions rode on the creation of their new life, and my pregnancy with them felt heavy every day with fear of loss. I found it difficult to connect with them as they grew inside me, and sought counselling to help me do so.

 

I also have mental health issues that I take daily medication to treat; medication that, while it does an excellent job at keeping me functional and well, passes into breast-milk, with unknown long term consequences for breastfed babies (not enough studies have been done, and even short term studies are limited in number and scope). Women who take these medications are generally advised to limit breastfeeding or use formula, though that information varies depending on who you talk to. The idea that breast-milk is the elixir of life weighs heavily in the “risk vs benefit” equation which means I’ve been told by some doctors that breastfeeding would be “worth it”.

 

After months of discussion with my husband (who has always maintained that breastfeeding or using formula was ultimately an issue of bodily autonomy and thus, my choice – I highly recommend being married to a feminist) I decided I wanted to breastfeed a little bit after our baby was born, but mostly use formula and let my supply dwindle naturally. This was for two reasons: so I could get enough rest to mitigate the likelihood of developing post natal depression and post puerperal psychosis, which I was in a high risk category for, and to minimise how much exposure our baby was getting to my medications.

 

The circus around advocating for this feeding plan began well before I gave birth. I raised it with one of the midwives handling my antenatal care and she refused to tick the “not breastfeeding” box on my antenatal card, insisting I speak to the lactation consultant. I left the appointment angry and disheartened at being patted on the head in this way. However, this LC was wonderful; she listened to my concerns, and said she would work with me to teach me how to bottle feed, and how to express colostrum which I was still keen to give our baby – provided I get advice saying it was safe to do so (I did). I spoke to a leading expert who recommended I breastfeed more than I was comfortable with (because breast is best, of course) and met with the LC again, who wrote a plan that included pumping – which I’d also never wanted to do -and demand feeding during the day, using formula at night to assist sleep. This was the start of the parade of conflicting, confusing and ultimately destabilising advice around feeding that marked the next few months.

 

My labour with R was long, intense and difficult. I didn’t eat or sleep for three days and was in labour for around 30 hours, with my waters breaking, my labour stalling and ultimately being induced with syntocin when everything stood still. By the time my little one was lifted onto my chest – a purple, heavy, wet and warm tiny human still attached to me by our shared cord that pulsed with lifegiving blood – I was completely exhausted. But they were here, finally, after so much fear that we’d never meet. During that first hour of skin to skin, they had their first breastfeed. Looking into their face in that moment I felt such a rush of love and contentment that I’ve never experienced before and don’t think anything will ever rival again.

 

I wish I could say my stay in hospital ended on such a high note; unfortunately it didn’t. I was transferred to the post natal ward for a long stay, with my husband staying on the fold-out beside my bed and R in a tiny cot on wheels at the end of my bed. Nobody in those first couple of days seemed to put two-and-two together and note my mental health history, detailed in my file, and the fact that I hadn’t slept at all in days. I was, as we say in Australia, completely knackered – but I’d anticipated this happening, having brought in seven syringes of precious colostrum I’d expressed ante-natally for my husband to drip feed R, and thinking we could use formula as well. Right? Wrong.

 

Our precious syringes of colostrum were (apparently accidentally) defrosted all at once. What was supposed to last days had now to be used up in the next 12-24 hours, which scuttled our plan. Then, the first nurse I asked to make up a bottle of formula so I could get some sleep flatly refused. I didn’t know how to reply. She said she’d only give the remaining expressed colostrum I’d brought and when I expressed concern that this wouldn’t be enough to feed our baby she said I’d just have to wake up and express more and the baby would have to “make do with a snack” and I’d have to have a shorter sleep. Beyond tired, I agreed and walked back to my room wondering what had happened. Hadn’t they read the lactation plan our LC had written?

 

Over the next few days I was awake every few hours, wildly expressing, and trying to latch a hungry baby on to nipples that increasingly felt razor-shredded with shaking anxious hands. I had loved that first breastfeed and had such confidence in our plan, but now I was doubting myself, and hating breastfeeding on demand. Eventually we found a midwife that would make us up a bottle of formula but I now felt I was doing the wrong thing by giving R a bottle. A different LC visited and heavily encouraged breast-feeding even though I kept mentioning the lack of longitudinal safety data surrounding my medications. My sleep debt was growing and so was my despair at our plan going out the window.

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On day three the baby blues hit, compounded by sleep deprivation, and I felt my attachment with R withering away. I didn’t want to touch them or look at them or tend to them because every cuddle had now become about providing food – and it hurt, and I struggled with the latch, and I was so so worried about how much of my medication was coming through in my milk. Expressing so often encouraged my milk to come in, big time, and soon I was painfully engorged and living with ice packs down my bra to deal with the excruciating sensations. I was not coping.

 

Day four came and I was officially a mess. The tipping point came when I sat on the bed watching my husband have a long, warm, stress-free cuddle with our baby while I was hooked up to the pump feeling like I was going to pass out from lack of sleep. I began to cry in that ugly-cry way you do when you feel like you’ve hit bottom. My husband began to cry too. And this is where one heroic midwife entered the picture.

 

Jill* walked in at that exact moment to do some observations, and seeing our faces and our tears, nestled herself into the armchair by the window and asked “what’s happening?” I explained how tired I was, how this was never our plan, how much I hated pumping, and how I felt I was losing my attachment with my baby and it scared me. She listened as I spilled forth my distress in an angry rush, and paused, considering my words carefully and choosing her own just as carefully. This after all was a Baby Friendly Hospital and she was supposed to recommend breastfeeding.

 

She told me then the following: breastfeeding is not motherhood. Motherhood is about so much more than how we feed our babies.

 

She then went on to recommend I stop breastfeeding or dial it right back, and switch to formula. She said it was time to take the stress out of feeding and that I really, really needed to get some sleep ASAP. She also said she was going to call one of the obstetric doctors and someone from the psych team to come and talk to me because she was worried about how things were going mental health wise for me.

 

The doctor came first after being called and brief on the situation, and there are no words to describe how negligent and inadequate she was in how she handled her care of me. When she walked in I was curled up under the covers, having cried continuously for hours and still going.

 

She tried to get my husband to leave the room (which by instinct I didn’t allow – and am so glad I didn’t). He sat close by, holding R and listening. She then launched into a rehearsed sounding spiel about why breastfeeding was best for babies and why formula was detrimental. I felt myself inwardly curl away from her – she was not here to help, it was very clear. I said I needed sleep, I was not coping and she replied in a patronising tone “you do know that someone needs to feed the baby every four hours, whether you’re breastfeeding or using formula, don’t you?”

 

What a ridiculous, insulting question – as if I had intended to starve my baby? As if I didn’t have a perfectly capable partner sitting beside me, also quite able to hold a bottle and feed our child? Clearly, in her view, feeding was entirely the responsibility of mothers. I was pretty pissed off at that point, which only intensified when she turned to my husband and said “and how do you feel about your wife stopping breastfeeding?” My husband arched his eyebrows so high I thought they would pop off the top of his forehead, and replied bluntly “I feel like it’s her choice, not mine.” She then read some compulsory questions in a bored tone off a piece of paper like “have you had any thoughts of harming yourself or your baby?” and then when she’d ticked all her boxes, she left. I was in even worse shape, now full of rage.

 

Then someone visited me from the psych team. He was wonderful. He suggested that formula was the best, safest option at this point and he pieced the last week together for me. The long labour. The three days with no sleep or food. The difficulty breastfeeding, the stress from pumping, the concerns about medication, the continuing lack of rest…as well as worries about our baby being jaundiced and having some investigations on a sacral dimple over their lower spine (all of which turned out fine). With all of this laid out, he said it was understandable that I wasn’t coping.

 

He and our midwife Jill suggested that we send our baby to the Special Care Nursery overnight so we could both “reset” ourselves with a full night of sleep. We were both pretty horrified by the suggestion that we have our babe removed from our care so young…and I felt like a failure for things having gotten this far. I didn’t want to agree to this. We both initially said no. Eventually, after a lot of discussion, we agreed – knowing that if we didn’t, things would probably get worse.

 

Leaving my baby in the nursery that night with the very kind, gentle nurses who would attend to R while we were apart was easily the hardest thing I’ve ever done. After nine months of fearing I would lose them, of thinking miscarriage or stillbirth would rip us apart, it had turned out that my mental health (or so it felt in that moment) was what had done it. I sat clinging to R before walking away, unable to look at or speak to the nurses with fat hot tears rolling down my face. How had we gotten here? Once we were back in my room I was given two sleeping tablets to calm me down and sent to bed to sleep. We picked R up at 6am the next morning, practically sprinting back to the nursery.

 

Now with some sleep under my belt, I was able to function again and advocate properly for myself. Everything looked better and I could think clearly for the first time in about a week. I knew then that I wasn’t going crazy; this wasn’t my fault. It was about the feeding and the sleep, it wasn’t about me.

 

After that everything improved. Another wonderful midwife – Harriet – took to the task of teaching us to bottle feed properly, showing us tips and tricks to do it well. We researched, we read, we tried to learn what we needed to know to move things forward and away from the dark place we’d been in as a family and to right what had felt like a sinking ship. Jill had barred the useless second LC from visiting again and unhelpful people were kept away. My fantastic parents wholeheartedly backed our decisions, and gave us lots of pep talks.

 

We’ve been at home for two weeks now. We are formula feeding 95% of the time, but I sometimes breastfeed because I want to, for a burst of ten minutes a day, once or twice a day. I lay down on the bed to do it, as it makes for an easier latch. I stop when I get frustrated, because that time is precious and intimate and I do not want it to be marred by anxiety. Such tiny periods of time also limit any effects from my medication and mean my supply is slowly fading away, and I’m getting my head around that. I know it’ll stop eventually, and I’ll find a way to be ok with it. I’m working on my bottle feeding technique, and using that time for attachment, looking into their eyes, kissing them, chatting to them. Just getting to know each other.

 

Reflecting now on the turbulence of that first five days, and how it nearly wrecked me, I am overwhelmed with both anger at some of the care I received around feeding, and gratitude for the midwives who stepped out of line with hospital policies to connect with what was really going on, and helped me. There’s a Carl Jung quote which feels so apt here – “Learn your theories well, but put them aside when you touch the miracle of a living person.”

 

If only more health care providers could set aside their theories when they touch each mother’s nuanced, lived experience, so many more women would be flourishing as mothers rather than falling apart. Hell, if they even just read the file, that would be a start. As it is, I’m going really well now, and repairing the hurts my bond with my child sustained in that first five days. It could have been very different for me if it hadn’t been for Jill though; and this is what is core to my story.

 

Every midwife, every doctor, every LC, should be like Jill. Promoting feeding that sustains and nourishes the child, the mother, and the bond between them – not forcing both of them into a slow-motion train-wreck neither may survive. Thank goodness for the rebels. Maybe one day they’ll be the norm.

***

Share your story, Email me at formulafeeders@gmail.com

 

FFF Friday: “We will bond no matter how she is fed…”

Earlier in the week, I shared an expert’s perspective on the emotional and mental health impact of formula feeding. Megan’s story feels like the perfect corollary to the insight offered in that post; a raw, brave account of mental illness and how this illness influenced a truly informed decision not to breastfeed. 

It is so incredibly humbling to get stories like the one below. The fact that you trust me and this space enough to share them here is not taken lightly… and while I hate that any of you even have to write these heartbreaking accounts, I can’t help but celebrate your resilience and willingness to speak your truths in the hopes of helping others feel less alone. 

So thanks, Megan. And thanks to all of you who share and read and participate – you are all amazing.

Happy Friday, fearless ones,

The FFF

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Megan’s Story

During the summer of 2014, I spent two months separated from my husband.  I took our 4 kids, packed up and went to another state to stay with my parents.  Things were pretty tough.  Traumatic would put it mildly.  But there’s a happy ending.  We both desperately wanted our marriage to succeed.  With blood, sweat and tears on both sides, we reached a really good place by the end of the summer – a fantastic place, even!  That fall, reunited both physically and emotionally, we finally made significant progress in so many areas of our lives that we had been struggling to move forward with over the decade of our marriage.  We remodeled our house (which we bought bank owned and in need of repair).  We instituted family rituals and routines that we had always wanted in place, but never quite could manage because we often couldn’t be in the same room with each other – hurt feelings make it hard to pretend that everything is fine.  But mostly, we both felt very strongly that there was another child ready to come to our family.  It was a very exciting, exhilarating time.  And a very anxious time.  Things were still so new.  We had just demolished the foundation our entire lives had been built upon for the last 11 years, and our new foundation was yet to be truly tested.  We were about to do just that – and how.

 

The day after my birthday in September, I started what would be my last menstrual cycle.  We were so thrilled!  This baby was figuratively and literally a symbol of our renewed and healing relationship.  Hope for the future of our family.  Evidence and a symbol of just how far we had come, of the new life we had brought to our union.  I was basking in the glow of being pregnant again.

 

Eventually, however, elation began to give way to a gradual sinking… At first I just thought it was exhaustion from first trimester blahs’.  But as the days began to grow shorter, and colder, we began to see that this was depression.  Depression wasn’t something foreign to me.  I had struggled with major postpartum depression with 3 of my 4 babies, with depression in-between postpartum periods as well.  I had a history of childhood sexual abuse, though, so I mostly attributed my depressive episodes with my work to resolve the effects of that abuse.  I kept figuring “once I get past this issue, I’ll be able to move on with a normal mood”.  Grieving and untangling trauma can be very difficult, and often looks like depression.  As we neared December, however, I hit a new low, even for me.  I went from being just fine and functional in the morning, to being so low that afternoon that I began thinking not just suicidal thoughts, but even thinking that my children would be better off being spared the agony of living with such a mother.  I thought to myself, “I can see how those mothers end up drowning their children in the bathtub.  I can see how that would be merciful”.  Then I wondered, as I brought up the image of the logistics in my mind, how you would drown multiple children, and what would you do with the bodies?  If you did them one at a time, they would freak at seeing the bodies of their siblings…..”  OH MY GOD!!  Did I really just think that???  Right as I thought that, the very clear phrase came into my mind “I need medication”.  That snapped me out of it, and gave me a surge of energy and forward momentum to act on a solution.

 

I reached out to my husband.  I told him he needed to come home.  I was shaken, I was ashamed, I was afraid.  What was happening?  That was NOT like me.  What was going on?  I couldn’t wrap my brain around it, but I knew that this couldn’t happen again, something had to change!  Dealing with things in psychotherapy wasn’t addressing this issue.  What else would??  Could medication really help?

 

 

Near the end of the two months I’d spent at my parents, when things began to calm down and my husband and I had a solid timeframe and plan for our reunification and going back home, my mother sat me down and had a talk with me.  That summer she was finishing up her rigorous PhD program in psychology.  She later said she was too close to the situation to be able to see it clearly for a time, but by the end of the summer, she finally had drawn a few conclusions that put the pieces together.  She read me the DSM-V definition of Bipolar I.  I was crushed.  I fit the description to a t.  I didn’t want to believe it.  Bipolar meant something was wrong with me, and I didn’t want to own that.  That was shameful.  And it meant I had a part in the separation, and I wasn’t the innocent victim.  I needed to be the innocent victim, and I needed him to be the perfect bad guy.

 

Fast forward again to that dismal and garish December.  At this point, my mother’s conversation came back to me in vivid detail.  Maybe she was right!!  A sense of relief washed over me.  This wasn’t my fault!!  I can do something about this that would actually work!  Exercise wasn’t cutting it, praying and reading my scriptures diligently wasn’t cutting it, having a close connection with my husband wasn’t cutting it, having good friends wasn’t cutting it… But if this is bipolar and not just me not “trying hard enough”, then I could see a light at the end of the tunnel.

 

So, at 20 weeks pregnant with my 5th child, I was officially diagnosed with bipolar I disorder, and began taking lamotrigine.  It pulled me out of my depression!  What elation, what relief!  Of course, I obsessively looked up and read every scientific study I could get my hands on, and I was very worried about the effects on my baby, but most studies concluded that after the 1st trimester, baby was at relatively low risk.  Then I began to notice a ramping up of anxiety.  It started gradually, but I began to notice feeling really great, and very productive, but increasingly I began heading toward fully anxious, crawling out of my skin feelings.  And then I realized, 3 weeks in a row, getting to the point where I was becoming paranoid again.  That was enough.  I went back in to my doctor and pretty much insisted he start me on lithium.  I was 32 weeks pregnant.  It helped!  I was so excited, and the case studies on lithium said that as long as baby didn’t have any troubles eliminating or getting dehydrated, that as far as they could tell, lithium didn’t have any measurable side effects.  Yes, they knew it was transferred to baby in breastmilk, but didn’t really see consistent harmful effects.  I felt comfortable with those odds.

 

Then came the day, at 37.5 weeks, when I began to wonder how the hormones of breastfeeding would impact me postpartum.  My biggest fear was having a major mood set back after birth, and for good reason.  I had a very clear history of it.  And, the medications were still helping, but I wasn’t actually feeling rock solid stable yet.  I still was having some ups and downs, just not so extreme.  All the research said that breastfeeding was protective against PPD, but nothing was said about bipolar.  So I asked my psychiatrist and my OB what their clinical experiences were.  They both said that almost universally, when moms are having postpartum mood issues, they fairly immediately improved after ceasing to breastfeed.  Clinical experience has to account for something, doesn’t it?

 

I think the biggest reason I could see their point and trust it was that not even a week before these discussions, I had about 4 hours of “warmup” labor, and it put me into a manic place, followed a few days later by a depressive place.  We increased the dosage of both my mood stabilizers, and that noticeably helped.  So when both my providers agreed with each other about stability and breastfeeding in my situation, I whole heartedly could see their point of view.  If I wasn’t even mood stable before birth, what would be the after birth chances when things really got screwy with my hormones?  It also occurred to me that my psychotic episode the summer before happened while I was still breastfeeding my one year old.  They were right.  Breastfeeding was not the option for me if my main goal was emotional stability.  I was crushed.  And peaceful.  And then obsessive about ordering just the right bottle feeding supplies.  And then crushed.  And then peaceful.  And then obsessive about looking up research to tell me that my doctors were wrong and I could actually breastfeed and I would be able to stay mood stable at the same time….

 

And then my shipment of bottles, pacifiers and all things formula feeding came in.  I could barely look at the unopened amazon box for a few hours.  I placed it on my couch where it could torment me every time I passed it.  Then I’d have a good cry, and busy myself with something to forget it.  Then I finally screwed up enough courage to open the shipping box.  Then I had a good cry, but left all the bottles and things in their original packaging – I wasn’t really going to use these, was I???  Eventually, after enough tears and grumpiness, I decided I would stop thinking about it.  I invited my older daughters to help me open them.  They were thrilled.  They wanted to touch everything, suck on everything (of course) and figure out how everything worked. Bottles and pacifiers are definitely a novelty in our home.  To this point, the only bottles I had ever owned always lived safely covered in thick dust in the cabinet above the fridge (you know, the useless one you can never get in and out of because it’s too high and you always have stuff on top of your fridge in front of it?).  Boy is this a change.  It did comfort me that the small size bottles, when I held them up and imagined feeding my baby from them, felt very close…. Like maybe I could bring baby really close to me like if I was breastfeeding.  Bottles and pacifiers safely in the dishwasher and ready to be sanitized, I needed a good cry again.

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And why was I crying?  I had hope for stability.  I was making choices that would not only benefit my new baby, but all my children and my marriage too.  I was making a choice to skip the living hell that is the ups and downs of bipolar – a choice that would afford me the chance to be in the world of people, living in the moment and enjoying that living.  Bipolar depression is completely exhausting and isolating, and bipolar mania is terrifying and crazy making because you can’t trust your gut or calm down enough to take in the moment.  Why would I want that?  Wouldn’t I want the best thing for everyone I love, including myself?

 

That night, my husband held me while great sobs wracked my frame.  I didn’t want to grieve.  I didn’t want to have to grieve.  I didn’t want to need to grieve.  I wanted to just treat this as a matter of fact, and then move on.  Grieving is scary – what if I get going and can’t stop – what if it’s not actually grief but just that ugly old depression again?  I felt broken, helpless, like a failure… Why did I have to be bipolar?  Why couldn’t I be stable?  Why did I need medications?  Why weren’t they working better yet?  Where was the line between a normal emotional response and a bipolar swing?  In truth, I don’t think they can really be distinguished, after a point.  The feelings are there either way.  The options are learn to sit with it in a way that isn’t destructive, or adjust medications.  After my intense crying session, I felt better.  That was a good sign that this was grief!  But grief usually comes in waves. I woke up the next morning after nightmares about having to bottle feed next to my breastfeeding friends.  I felt so surreal, to be bottle feeding – and horrifying.  I got up, sad and even angry.  Angry that this is my situation.  Angry at myself, angry that this is just part of living and having a body.  I’m grateful for my body and the children I have been able to conceive and give birth to, and the four I was able to breastfeed, even if it was a great struggle for my mental health in every postpartum period.  I’m grateful for this baby too – this little miracle child of the seaming back together of my marriage that was hanging by a thread only just one year ago.  And I feel raw.  I don’t want one more thing put on my plate that I don’t feel I have the capacity to do and do well.  I don’t want to see anyone pregnant and brimming with excitement about breastfeeding.  I don’t want to imagine them taking their brand new baby onto their chest, and having their baby root and suckle.  I don’t want to imagine that and a hundred other images I have in my head from my own babies.  I just want to fall down face first and sob until I have no strength left to sob.   And I want to not have to sob, to be able to either breastfeed, or get over it.

 

So why is it so emotional?  Why can’t I just “get over it”?  I never realized how much of my self worth was wrapped up in my ability to breastfeed, and ultimately in my capacity for perfection.  Good mothers feed their babies, but the best mothers know that “breast is best” right?  Good mothers know that emotional stability and consistency are keys to raising well-adjusted children, but the best mothers are just born with that natural ability.  Good mothers often sacrifice and put their children first, but the best mothers never have needs of their own and can endlessly give whatever their children require without resentment or burnout.  Wow.  What a load of distorted thoughts!!!  Does any of this sound familiar to you?

 

The truth is – the best mothers recognize their limitations, and plan for them.  The best mothers accept reality, get help, surround themselves with supportive people, and don’t try to brute force themselves into good mental health through sheer force of will and determination.  The best mothers recognize that breastfeeding, while extremely biologically engineered to create bonding, is not the same as bonding.  It’s a tool.  Bonding is a choice – one that continues through the child’s entire life span, and has many stages and phases.  You can’t breastfeed your teenager back into a close relationship with you if you haven’t stayed close through his earlier childhood and tween years…..  The best mothers understand that our imperfections are gifts to ourselves and our children.  Seeing that we aren’t perfectly put together all the time lets them know that it’s okay that they aren’t perfectly put together all the time either.  It gifts us all a sense of “we’re in this together – I’m ok, you’re ok”.  Which brings the sweetest sense of safety, connection and reassurance I’ve ever known.

 

The best mothers know that when we love ourselves, warts and all, we are providing the greatest example for our children we possibly can.  An example of just showing up, being transparent, and having self-compassion and self-kindness.

 

And that’s why my bottles are currently sitting in my dishwasher sanitized and ready to be packed into my hospital bag.  That’s why I have histamines and decongestants ready to go to dry up my milk supply.  That’s why I have a list of friends and family who have agreed to help support me after birth.  That’s why I’m still taking my mood stabilizers.  That’s why I’m going to finish writing this, and then go enjoy the last precious days of being a family of only 6, before our world changes to welcome our new one.  She’s precious no matter my weaknesses, and we will bond no matter how she is fed, because I will be emotionally stable enough to enjoy her.

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Want to share your story? Email me at formulafeeders@gmail.com.

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