FFF Friday: What I Learned From Robert Burns About Parenting

It’s been a long, long time since I’ve posted an FFF Friday feature, but I wanted to share this great piece from Fearless Admin Erin, who has recently spearheaded the resurgence of the #ISupportYou Movement along with a few other amazing women, who I’ll be introducing you to in the next few weeks.

In Fearlessness,

Suzanne (The FFF)

***

Erin’s Story

When I think back to the first few months after the birth of my son and try to sum it up, the well-known words of Robert Burns’ poem ‘To a Mouse’ seem very apt:

 

‘The best laid schemes o’ Mice an’ Men

Gang aft agley,

An’ lea’e us nought but grief an’ pain,

For promis’d joy!’

 

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I could not have felt more prepared or for my baby’s birth if I was Eileithyia herself. I study reproduction and lactation biology for a living, and my two best pals are Senior Midwives. Even before I was ever even thinking of becoming pregnant, I was having conversations about childbirth and lactation on a daily basis. In a sense, I had been preparing for pregnancy and birth for years.  Then, when the two lines came up on the pregnancy test my quest for knowledge intensified. I read multiple books on pregnancy, childbirth and breastfeeding. I attended a baby fair. I even shelled out a ridiculous sum of money on an even more ridiculous hypnobirthing course, but that’s a different story (I’m still bitter). I knew a helluva lot about pregnancy, labour and lactation; from the physiology I had studied as a scientist, to potential obstetric emergencies and how a medical team would respond should they occur.

Source: Wikipedia

Robert Burns – famous poet, unknown parenting expert. Image Source: Wikipedia

 

Perhaps, in hindsight, this was part of the problem.

 

As The Bard prophesised, the best laid plans don’t guarantee success. My wee Mouse decided he was ready to meet the world a full 4 weeks before his due date, on day 1 of my maternity leave. As we left calmly for the hospital, having been advised to come in following my membranes rupturing, I waved goodbye to the next four weeks of doing nothing but relaxing in the July sunshine with a couple of bonkbusters.  That was particularly disappointing because at 8 months pregnant and resembling a pufferfish, that was the closest to bonking I was going to get.

 

In the five hours that followed I had a textbook birth, and mercifully quickly. I enjoyed the sweet, sweet relief of the gas and air after being admitted to the labour ward at 10cm dilated (or ‘fully’ as the midwives called it to my amusement) and my son was delivered by my friends, who were both on duty that day. It was bloody perfect.

 

Just after he was born, one of my friends told me she was going to ask my husband to cut the cord as my son was ‘a bit flat’. I knew that this meant he needed some stimulation to breathe, but didn’t panic. The room was an oasis of calm and as he was premature, the Neonatal Team were already in the room so they got to work right away. After some suction, he let out a lovely big yell and all was well. We enjoyed some skin-to-skin while the duty midwife helped him latch and he appeared to enjoy his first breastfeed.

 

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After a glorious shower and the best tea and toast I have ever eaten, we were moved through to the postnatal ward. My friends went back to work and after a while my husband went home to shower, change and get me some supplies. I spent a lovely afternoon snuggling and staring in wonder at this wrinkled wee blue burrito I had been given and tried a few times to feed him. It looked like he was doing what he was supposed to but, having never done this before I wasn’t sure.  He was very sleepy and content so I wasn’t worried.

 

That evening, everything changed. During the routine tests, the Doc identified that our wee one’s blood glucose level was dangerously low and he was admitted to NICU. While there, he vomited up old blood and it was quickly established that he had no suck reflex. He was given a feeding tube and I was encouraged to hand express to stimulate my milk.

 

The first time I hand expressed with help from the midwife, I got 0.1ml colostrum. Yes, you read that right, 0.1ml. I sucked the droplets up into a 1ml syringe and it was brought to the NICU even though it was mostly empty. I continued to hand express through the night and got nothing. Not a drop.

 

In the NICU, I was given a hospital grade pump and started the routine of putting baby to the breast to try and stimulate both his suck reflex and my milk, feeding him with formula, and then pumping to try and get some breast milk for him.  This routine was to continue for the next three months.

 

After a week, he was discharged from hospital and we went home.  When the Public Health Nurse visited two days later he had lost weight, even though I had been feeding him the milk I had pumped, as well as formula. We were teetering very close to being readmitted which was a horrible thought and very scary.  Each feed was a struggle; try to nurse, cry (both of us usually), bottle feed, pump, repeat. It was relentless. The three of us were miserable.  It was clear I was producing very little milk. I kept records (hello, scientist remember!) and my maximum daily production, even when taking off-label drugs to boost supply – don’t try this at home, it’s extremely dangerous – was 150ml of milk. Five measly ounces. I was waking up in the middle of the night, even when I didn’t have to because my husband was doing the night feeds, to pump as little as 2ml of breast milk from each boob.  I attended a weekly breastfeeding group, staffed by a public Health Nurse and Lactation Consultant, where I was the only Mum to bring a bottle. I used to save the breast milk I had pumped for that bottle as the other ladies there were very scornful of formula. I look back now and can laugh at the ridiculousness of it all! What in the ever loving you-know-what was I thinking?

 

Through all of this, we were also dealing with an undiagnosed Cow Milk Protein Allergy (CMPA) which was horrendous. Our GP and hospital Paediatricians and Nurses palmed us off as paranoid parents. I was given the explanation that ‘babies cry’ and scoffed at. I felt like a failure. Like nobody was listening to me and I was going out of my mind with frustration. Frustration that my boobs weren’t doing what they were supposed to, even though I was doing everything the books told me to, and that they promised me would work. Frustration that my baby cried all day and nobody believed me that something was wrong. Frustration that I couldn’t get advice on formula feeding from my medical providers. Frustration that neither me, nor my husband had any idea what we should do. I was suffering from postpartum anxiety and not far from depression. That’s when a bit of internet searching led me to the Fearless Formula Feeder.

 

It’s no exaggeration to say that finding FFF changed my life. Immediately I felt listened to and validated. It felt like a massive weight was lifted off my shoulders. I cried. A lot. The amazing women in that group helped me and my family more than they will ever know; from practical advice on formula feeding that seemed so scarce elsewhere, to allowing me to process my initial feelings of failure and later my anger at having succumbed to the relentless societal pressure to exclusively breastfeed.

 

When and why had I become so fixated on this goal of exclusive breast feeding? I honestly have no idea. I think it’s so ingrained in our societal psyche that it just chips away at you without you really knowing. I also feel that a lot of it was fuelled by the information I was reading in books and websites from well-known (although sometimes self-appointed) breastfeeding experts. I was learning that if it hurts, you’re doing it wrong, my body was built to breastfeed and to just keep putting baby to the breast. I now see these statements as the gaslighting, naturalistic fallacy and useless advice that they are, respectively.  One surprising fountain of misinformation was the NHS. I mean, who questions the NHS? They’re a public health service, the NHS must be completely evidence based, right? Well, aye. If you don’t count the homeopathy and acupuncture…..

 

Oh.

 

In the end, I came to my senses. With a little nudge in the right direction from my midwife pal who told me very unceremoniously to “f*ck up”! It sounds harsh, but it’s sound advice here in Scotland and I thanked her profusely!  Because she’s a midwife, it felt like I had official permission to stop torturing myself. I ditched that damned pump and never looked back. Had it not been a rented hospital pump I would’ve smashed the bastard to smithereens with a mallet! Around the same time, my wonderful cousin pulled some professional strings resulting in a diagnosis of CMPA and finally getting the right formula for our son. Our red faced screamin’ demon turned into a angel overnight.

 

Now, almost three years later, I am honoured to be part of the Admin Team at FFF and to have been trusted with the I Support You baton, which I have reignited with my fellow Admins and new BFF Stephy! I hope sharing my experiences with other women who are just starting out on the rocky road of motherhood will do for them what the kind words of other Fearless Formula Feeders did for me.

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I have also used my sciencey skills to do some actual literature research about infant feeding, as opposed to internet googly research, and have been amazed, angered and incredulous at the sheer volume and audacity of misinformation out there. Let’s not even get started on the public moralisation of how a woman uses her breasts. As a scientist, I am still ashamed that I trusted what I read about breast and formula feeding without reviewing the original source of the claims. It’s the first bloody rule of science club; always read the original study! But, even scientists are busy and sometimes skip that bit. So, hopefully, by breaking down and summarising the data I can help people access accurate information in more palatable and bitesize chunks.  Go science!

 

I also wonder if perhaps my knowledge of the physiology of lactation gave me a false sense of security. Ultimately, no amount of reading or preparation can influence biology and thinking you can do will leave you, as Robert Burns said, with nothing but grief and pain for promised joy.

 

Burns was a passionate laddie, who wrote about his loves and influences so in that spirit, this story is my Ode to FFF; to the wonderful women who supported me and to the wonderful friends I have made along the way. Thank f*ck my boobs didn’t work!

Tamara Ecclestone, breastfeeding, and how it feels to see representations of love that you’re unable to give

Last week I was interested to see a picture of celebrity Tamara Ecclestone pop up on my newsfeed.

 

Source: BBC. http://www.bbc.co.uk/news/amp/38932320

Source: BBC.
http://www.bbc.co.uk/news/amp/38932320

Tamara was shocked. Shocked and saddened that her valiant attempt to normalise breastfeeding through a stunning photoshoot had not been received with the blanket adulation that she had expected. More than that though, for Tamara there is nothing but love in the images and it’s such a shame that it brings out anger in some of you it’s sad for you that that’s how you choose to live.  Personally, I think that love may well have been the order of the day, but there were also probably more scatter cushions than there were in the John Lewis Christmas sale this year.

I don’t know why she would expect blanket adulation because my experience of being a woman and having access to the internet has shown me that I could post an image of a packet of crisps with a vagina and somebody would try to concern troll over what birth control it was using.  Post a picture of breastfeeding and you are guaranteed to uncover that very special type of person who is mortally offended by a nipple.  This is annoying and these people deserve to be treated as the newts that they are and I delight in doing so. However, the four of five newts come with legions of likes, shares and messages of support, as I’m sure Tamara’s PR team know well.

The thing is, we’ve seen these images before, Gisele did it, [here]. Body confidence advocate Tess Holliday used the women’s marches two weeks ago to do it [here] and this week, it’s Tamara’s turn [here].  All of these images have striking similarities.  We see beautiful, wealthy, white and glamorous women gazing off into the distance while effortlessly nurturing wide-eyed babies (scatter cushions optional).  These women are professionals at re-packaging our bodies as an ideal and selling them back to us, they have a team of PR execs and agents to help them in their quest for self-promotion and this is exactly what’s happening here. Usually we are allowed to be angry about the lack of realism and unattainability of things like the thigh gap, but here the product is breastmilk and it’s different rules.

In the UK, 81% or women initiate breastfeeding whilst they are in hospital.  Given that figure, it’s hard to keep a straight face when someone tells you that seeing someone breastfeed is some sort of revelation, but they do.  By the time the baby is six weeks old that figure falls to 55% and by six months, it’s at 1%.  Of those women who stop breastfeeding, 80% of them desperately wanted to but could not. These women have internalised the mantra breast is best and they’ve given it everything they’ve got but come away feeling like abject failures when their breastfeeding dreams didn’t come true.

For them, when they see an image like that with the words powerful demonstration of love and nurturing it feels like a kick in the teeth. As I imagine it does for those among the 20% who don’t attempt to breastfeed because they’re transgender or survivors of sexual violence, on certain medications or adoptive parents, or because it simply isn’t the best choice for their family.  For those parents all they can hear is:

A powerful demonstration of love and nurturing THAT YOU CAN’T GIVE.

That you can’t give, written as if by sparkler; bright, hot, fleeting and gas lit. Or worse, that you are too selfish to give. Of course there is anger.

The late John Berger wrote a lot about advertising and how it works.  To skim it, a good advertising campaign creates a tableau that we all recognise subconsciously to some extent, like the Madonna and Child. You foreground a product of lifestyle that is difficult but perhaps not impossible to imagine yourself attaining, this creates envy.  Then you distribute it far and wide. If it’s something that everybody can have it simply won’t sell as either an image or product.  I mean I love my Henry the Hoover, it never lets me down. I’m never going to make it look like Tamara makes breastmilk look because it is so very mundane and attainable.

If you haven’t yet read Berger’s book Ways of Seeing then you should, because he also makes the point that:

“[P]ublicity turns consumption into a substitute for democracy. The choice of what one eats […] takes the place of significant political choice. Publicity helps to mask and compensate for all that is undemocratic within society. And it also masks what is happening in the rest of the world.” [Berger: Ways of Seeing, p. 149]

 

Tamara and her photographer’s image, and those that came before are the epitome of the genre. Glamorous and unattainable, always just slightly beyond reach.  Why? Because for all of the hashtags and so called ‘normalising’, they do nothing to address the structural inequalities that mean that none of us really gets to choose to live the way we would really like. They are publicity as a mask.

The NHS is struggling and with maternity services, according to the National Health Executive report of January 2017, disturbingly high numbers of women are experiencing so-called ‘red-flag’ events.  What are ‘red-flag events’? They’re events that happen because we simply do not have enough care for women, even to the point that of women not receiving one-to-one care during established labour. If we can’t even ensure that women have that level of care when they’re giving birth can we hope for better during the post natal period and with breastfeeding support? No prizes here for guessing that no, we can’t:

During the post natal period, women were most likely to express disappointment with their experience in the postnatal wards and breastfeeding support. (Source:  National Health Executive report of January 2017)

On occasions where we have actually spoken to women who found themselves unable to breastfeed over dismissing them as bitter and hateful trolls, we find that something like 80% cite pain as a key reason that they were unable to continue. If a mother simply cannot get the help that she needs from a dedicated professional then she cannot continue.

Since 2010 the UK has faced austerity and whether or not you agree with the necessity, in March 2016 the Women’s Budget Group found that women are hit harder than men and households headed by women such as lone parents […] are hit harder. What does this mean for mothers? It means cash in hand, manual labour jobs where you can’t have your children with you. It means no maternity leave because you’re restricted to short-term, temporary contracts. It means not being able to afford the bus fare to get to the doctors when you have mastitis or to pay for the prescription for medicines you might need to treat it. It means choosing between heating and eating. It means that having the time, energy or will to go through the pain of establishing breastfeeding may well not be at the very top of your agenda.

If you do have a job that you are able to go back to, there is unsurprisingly yet more bad news. The House of Commons committee on Pregnancy and Maternity Discrimination, tells us that not only is there more discrimination reported now than a decade ago, but also there is no legal duty to provide a place to breastfeed or store milk. So even women who are able to afford the highest levels of childcare may not be able to continue to breastfeed their babies until two years of age.

These images are beautiful and modern reinterpretations of the Madonna and child tableau, chic and classic, but they do nothing to address any of the challenges faced by women today. baby-jesusEven if women in their droves started saying that had they just seen one more photo they could have breastfed on, I don’t know if this one would really help. We already know that wealthy, well-educated and thirty something are more likely to breastfeed, it’s already normal. Most of us could only dream of owning that many scatter cushions in a lifetime and one of her shoes could probably cover at least a month’s rent. As a twenty-two year old, pregnant dropout who just couldn’t get her breasts to co-operate, the only thing that image would have done for me is amplify my failure on every single count.  With the benefit of hindsight, and good research, I now know that I’m not alone.

 

Breastfeeding a new baby is already normal, breastfeeding a two year old has yet to become the norm. When every parent has the luxury of choice over how and for how long they feed their babies, it most likely will. Papering over the cracks with a few Instagram snaps and calling your critics angry and bitter isn’t going to cut it.  We need to meet every obstacle head on. We need to treat our fellow parents with empathy.  Above all, we need to support each other.

#ISupportYou.

Stephanie Maia is a UK-based writer for FearlessFormulaFeeder.com and the #ISupportYou movement.

Infant feeding the second, third or nth time around

by Stephanie Maia

 

In the time that I have been lucky enough to be a Mother, nine years to date, I have learnt two important things:

  1. It doesn’t always go to plan
  2. When you think you know what to do, it all changes

The first one of those I learnt bitterly in August 2008 when my nipples turned to meatballs and my baby wasn’t the only one in tears.  Breastfeeding.

Despite going to all the classes, reading all the books and trying my absolute hardest, my nipples almost immediately disintegrated before my eyes and I felt the burning shame of inadequate motherhood.  Or so I believed, given the amount of lactivist (can I swear?) ‘literature’ I had hungrily consumed during the nine month incubation period.  None of the books told me what to do if you accidentally gave birth to a cute, pink, starving but gummy piranha, they only talked about babies who softly do breast crawl until they bring their Cupid’s bow lips bouncing to a perfectly aligned nipple. Le sigh.

As it turned out, despite horrible treatment from cruel midwives who unceremoniously ditched me at the fist whiff of a bottle (it’s a ‘slippery slope so I may as well as not bother’ apparently). Working my own way through agonising thrush (‘If it hurts you’re doing it wrong’, no, if it hurts something IS wrong and you need support and love), I ended up combo feeding for well over a year.  The hurt and shame from those early weeks stayed with me though and over time they turned to anger and the anger to bona fide keyboard warrior status. No woman will be shamed by a lactivist on my watch.  I found my home as a Fearless Formula Feeder.

Roll on 2013 and I was there again with baby number two, still angry, still ready for the fight.  There was absolutely no way on this earth that I was putting myself, or my baby, through that again.  My beautiful little piranha had turned into an incredible four and a half year old and that was in part thanks to amazing science milk.  I had the bottles and I was not afraid to use them.

What happened this time then?  Well, this is where I got to lesson two, when you think you know what to do, it all changes.  This baby arrived and was that baby that I’d read about. She did the breast crawl and then latched with all of the elegance something that’s just emerged from the unmentionables under a spotlight possibly can.  Within five minutes of birth she became the ‘enthusiastic feeder’, clunky nickname but it’s stuck I’m afraid, that we know and love.  I’m not even going to get into the arrival of number three, but you can guess that we get a very different story again.

So, after an emotionally draining first feeding experience, and knowing that babies are more fickle than even politicians, how can you plan for a smoother ride next time?

Tip #1: Find your tribe

If you’re reading this, you’re online and you’re on a parenting-related forum so this definitely relates to you.  Find your tribe.  There are hundreds and hundreds of social media groups, birth boards and twitter feeds that you can follow out there.

Okay, maybe not THIS tribe, but you get the point…

Find one that speaks to you, like-minded people, people who support you and your parenting style.  Don’t waste your emotional energy worrying about that sanctimom who pops up at 2am to remind everyone of how great she is tandem feeding her kids AND her kittens whilst donating to the local goat bank, running a marathon and making banana bread (organic, for-the-win).  Not worth it.  Maybe you don’t need an echo chamber either, what you DO need though is supportive and helpful advice that fits with your parenting style.

Tip #2: Talk it out

Get to grips with what went on last time. Find a doctor, psychiatrist, counselor, therapist, friendly ear, plant or whatever you need.  Just talk out what happened last time.  You went from being responsible for finding at least one Maccy D a day to maintain life yourself (I’m working on minimums here) to being solely responsible for the nutrition of a temperamental and dangerously teeny tiny and beautiful creature, it was always going to be emotional.  You owe it to yourself to go through that and understand what happened. It’s valid and you’re worth it, and you have to do it all over again so get that emotional spring clean.

Tip #3: Make a Plan

Ask yourself what you want to do and put lines in the sand.  If you have absolutely no desire at all to dip your toe into breastfeeding ever again then proudly write that down.  If you don’t know yet, but you’ll see how you feel on the big day, pop it into your notes.  If you decide that you do want to try again, then absolutely try again but absolutely draw some lines in the sand.  Mine were that if I reached for the pump because it was too painful to feed or I found myself dreading her little eyes opening because it would mean the pain of feeding, formula.  If your plan is that you’re not ready to make a plan yet, go to step numbers one and two and wait until you’re ready.  Get your partner on board and prepare those laser eye daggers for any stray lactivists; you are informed and ready and it’s your body.

Tip #4: Remember your body is not a symbol

This is a really tough one because what we do and how we parent is, or becomes, a marker of our identity in many ways, see point one.  However, you need to remember that what you do with your body is not a political statement of any kind, it’s not a symbol or your moral worth, it is your body.

I am a Fearless Formula Feeder even though I haven’t formula fed in eight years and breastfed two subsequent children. What I do with my breasts is nothing to do with how I feel about a woman’s right to choose what she does with her body. You can be an environmentally aware vegan and formula feeder and so on and so forth. The way in which we use our reproductive organs on an individual basis is personal, our bodies are our own, not symbols.

Tip #5: Draw a timeline

Imagine your bump as baby and beyond. Go to thirty two years old if you feel, wild.  Then divide the line into months, then plot on what six months looks like or even four and a half.  Tiny. We don’t sweat the small stuff here at parents HQ, feed the baby with love, that’s it.

Tip #6: Look at what you’ve already achieved

Look at you soon-to-be eldest, look how healthy and happy and loved they are.  Think about all the times you’ve looked down on their sleeping faces and flushed cheeks. You can do this, you don’t need some person on the internet to tell you otherwise.

In case yours aren’t at school age yet, by the way, guess what isn’t number one topic in the playground? Oh yeah, breastfeeding.  Whether you’ve managed to build a nativity themed puppet theatre from a shoebox with ten hours’ notice and made pastéis de nata for thirty-eight plus parents along with Portuguese national dress costume, another matter. 

Tip #7: Repeat the Mantra

My body; my choice.  

My body; my choice.

My body; my choice.

My body; my choice.

Tip #8: Use your experience

You’re about to go from Bambi in the woods to Merida from Brave in the feeding world, very soon you will have aced it with keeping two small and demanding creature nourished. You’re an expert.  Harness the power of the SuperMum by looking out for that first timer struggling on their first outing to a café, a friendly word and knowing look could make the world of difference. There could be some Mum on a forum, somewhere in the world, crying into her dressing gown about something some emotional amoeba has said about infant feeding on the internet.  Be that Mum who says “been there, got that, tear free dressing gown now. You’re a star”.

You might feel like this, but it’s not forever.

Let’s be powerful about this, build each other up and get the message out there.

Tip #9: Enjoy your baby

How not to cliché 101 but….‘it goes quickly/time flies’. There, I did it.  

Whatever happens next, however that baby reaches your arms, savour and treasure those days for yourself. When I look back on those first few confusing days I have one single regret, that’s the names that I called myself and the tears that I cried over feeding.  Don’t go there, especially not twice and especially not over something like feeding.

You’re amazing, you’re informed, you’ve done it before and this is YOUR time, enjoy it.

 

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

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

We’re reminded constantly that ‘breast is best’. The ads plaster the Metro, viagra 100mg 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, mind 2016. 

Breastfeeding has been a journalistic topic du jour for years now. As an author of a book about breastfeeding promotion, viagra 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.

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