The truth can set us free (and help us breastfeed)

Buckle up, dear readers. This is gonna be a bumpy, long, and convoluted ride.

In the year since this blog’s inception, I’ve “met” a vast number of intelligent, dedicated moms who wanted to breastfeed and were unable to, for a variety of reasons. Many of these women have shared their stories for the FFF Friday series, but in addition, the comment threads on any given post will often include short but heart-wrenching tales of trying, more trying, failure, and either unresolved guilt or in happier cases, redemption.

I don’t know about the rest of you, but I started seeing certain patterns emerging in these stories. Often, it was moms who had suffered from infertility or miscarriages; conditions like PCOS, hypoplastic breasts; babies with insurmountable latching problems; supply issues… there was a sameness to our experiences, beyond the obvious emotional toll that were part and parcel of these feeding troubles.

But it wasn’t until recently, when two amazing FFF readers - Amy and amoment2think – emailed me with their own admirably insightful theories about lactation failure. Both raised questions about the prevalence and cause of supply issues; we discussed possible environmental causes (Amy has some fascinating theories about the effect of phytoestrogens on breast development and lactogenesis – the process by which our breasts are able to lactate) and evolutionary/lifestyle aspects of the problem. And as amoment2think postulated in her great guest post on this very subject, it seems as if many in the medical and advocacy communities have glossed over or under-diagnosed these problems, out of (this is totally my analysis, I could be way off here) fear that it might discourage women from nursing, or sway the pendulum back to a mistrust of women’s bodies, an over-medicalization of birth/nurturing our children.

As Amy and I went back and forth trying to find studies to support a pet theory we developed, I stumbled across some papers which have completely thrown my world upside down. Now, before I get into the meat of this post, I want to be clear that I am NOT a doctor, PhD, or anything that might qualify me to professionally assess this information. I am sure I will make some amateur mistakes while discussing my theories; my point is not to diagnose or “prove” anything, but rather to start a conversation which I hope can ultimately help the women who want to nurse do so successfully.

To begin, I should give you a cliff notes version of how my own breastfeeding failure went down. FC did appear to latch immediately after birth; however, in the 2 subsequent days (while I was in the hospital maternity ward) he never could stay on the breast longer than 30 seconds or so; this kept getting dismissed as him being “sleepy” after birth by the 3 hospital-supplied lactation consultants we saw during this time. I insisted something was wrong, as I had felt him latch the right way (or what felt to me like the right way, at least) in those precious moments following his birth, but was told that it was just a matter of him being a “slow learner”, and other than offering different “holds” and reassurance, we weren’t given any other guidance. After being dismissed from the hospital, we had to see our pediatrician right away since FC had lost approximately 10% of his birth weight (up to 10% is considered “normal”, but borderline; he’d been growth restricted and stopped growing around 33 weeks, so his weight gain was a concern to begin with). We saw another LC there, then another, and finally one who diagnosed him with a tongue tie and encouraged me to pump (I credit her for allowing him to have any breastmilk whatsoever; had she not come into our lives, I doubt we would’ve lasted past the first 5 days). While he gained weight on my pumped milk, supplemented with formula, it ended up that he had a severe milk and soy protein intolerance (MSPI) and the casein in my milk was even too much for him. We switched to hypoallergenic formula, and that’s how I became the FFF you know and love/hate, depending.

A few other factors that I think are imperative to the story:

1. I had 2 early miscarriages, and it turned out that a progesterone deficiency was likely to blame. FC and my currently gestating FC2 were both conceived/sustained on synthetic progesterone supplements. 


2. I had major problems with my reproductive system from the age of 12 when I started menstruating; endometriosis, horribly painful periods, debilitating PMS (I’m talking complete personality shifts, here), etc. I visited a slew of specialists through my teens and 20′s, and ended up being one of the first “test” cases of sustained birth control – I took continuous doses so that I only got my period 2-3 times a year when I would take “breaks” from the regimen,  load up on heavy painkillers, and take to my bed for 2 days, writhing in pain).

3. I had some signs of preterm labor around 33 weeks (right when FC stopped growing, but we didn’t know it at that point as my OB was kind of a moron), for which I was given terbutaline. I continued taking the terbutaline periodically until 36 weeks, when my OB said it would be okay to stop. 

4.. FC was born vaginally, but via emergency induction through pitocin, at exactly 39 weeks, when an ultrasound discovered that he had stopped growing around 33 weeks gestational age, and that my fluid was dangerously low.

5. I had severe PPD which began – no exaggeration – the moment I delivered the placenta. 

I tell you this because in the research I’ve been doing for the past few days/nights (Fearless Husband is so fed up with me right now – like I wasn’t already obsessed with infant feeding from the book research and the blog, and now this), I’ve come across references that strongly suggest all of these factors might have played in to my breastfeeding failure. And like I said earlier, it appears that many readers of this blog share some of these attributes with me, which leads me to believe that there is something here.

I’ve seen plenty of research and citations regarding the association between poor breastfeeding success and PPD, certain drugs administered in labor, small-for-gestational-age infants… not as much on infertility, although TheLactivista pointed me in the direction of Lisa Marasco, a lactation consultant who has done a great deal of work with the PCOS community, who advises women to seek breastfeeding help prior to birth if they’ve dealt with fertility issues; I’m going to try and contact her to find out more about this, but it at least implies that others have noticed a possible link.

But in the blur of the past two research-heavy days, I came across some info that I was completely unaware of: the composition of milk, and how it relates to lactation function, latching issues, dehydration, failure to thrive, and breastfeeding failure. The scariest thing is, in all of these studies, the authors include warnings about the importance of acknowledging lactation problems, suggesting that the medical community might be adverse to discussing these things openly in fear of “discouraging breastfeeding”, but urging people to take these issues quite seriously. So why is this the first time I’ve ever heard discussion of this, despite doing a year of research on all things breastfeeding-related?

There are several elements of breastmilk and the mechanics of lactation that are interesting me right now, but for the purpose of this post, I want to focus on just one: sodium content. Breastmilk is made up of a number of components, including lipids, casein, whey, nonprotein Nitrogen, Lactose, and minerals, including potassium, calcium, magnesium, and sodium, our mineral of concern for this post.  (Source: Breastfeeding basics.org)

Sodium levels are highest directly after delivery. Just for a little perspective, human milk goes through a bunch of changes. In fact, the process of lactation is divided into two phases: lactogenesis 1 and 2. The first stage happens prior to delivery; the second, which is what I’m most concerned with here, occurs in the days after birth. We laypeople tend to think of this as the stage where it’s just colostrum coming out of our nipples, versus the time when our milk “comes in” (you know, when you feel all engorged and boobalicious). The problem is, things can go wrong in either stage of lactogenesis. And if something goes awry in stage 2, it can lead to breastfeeding trouble, failure, or in severe cases, dehydration or failure to thrive in an infant.

I could go on about the scientific reasons an overabundance of sodium in milk isn’t a good thing, but all you really need to know is that ingesting breastmilk which has too high a sodium content can lead to either hypernatraemia or hyponatremia, which are basically different types of dehydration.(Please note – these same conditions are also big problems for formula-fed infants due to improper formula handling, which is why I’m a big advocate for better education and support for formula feeders. I’m only discussing how this all relates to breastfeeding failure here, though – but I didn’t want anyone jumping down my throat about how the pro-formula feeder was ignoring a “risk” of formula feeding).

According to several studies I read, high sodium content in breastmilk is related to an inability to establish breastfeeding. This 2002 study, from the ADC Fetal & Neonatal Edition (Hypernatraemia in the first few days: Is the incidence rising? Arch Dis Child Fetal Neonatal Ed 2002;87:F158-F162 doi:10.1136/fn.87.3.F15) explains:

The sodium content of breast milk at birth is high and declines rapidly over the subsequent days… Women who failed to establish good breast feeding did not experience the normal physiological decrease in breast milk sodium concentration compared with those who had little difficulty in establishing a good milk flow…
Today the evidence suggests that the most common cause of hypernatraemic dehydration is low volume intake of breast milk. The infant becomes dehydrated while the kidneys are mature enough to retain sodium ions. Water loss occurs predominantly through the skin and from the lungs…

Primary insufficient lactation is rare. Poor milk production is usually due to secondary insufficient lactation, caused by poor milk removal from the breast, which then becomes engorged. The child may then tire and fail to stimulate further lactogenesis. Small for gestational age or preterm infants suckle less powerfully than appropriately grown term infants. It has been suggested that the principal cause may be inadequate professional support of lactation, particularly in firstborn children who are breast fed. van der Heide et al attribute the severe weight loss of their two infants to “poor professional support of lactation and lack of weight control”. A survey of the literature shows that often the common thread is a mother who is primigravid and has a strong desire to breast feed. The problem can still occur in mothers who have previously successfully breast fed infants. Mothers may be of high intelligence and yet not identify the fact that their infant is poorly hydrated.
Note the discussion in the above paragraph regarding secondary insufficient lactation. THIS is where my heart started beating a bit faster. I didn’t experience major engorgement or see much milk until almost a week after FC’s birth, at which time I seemed to have copious amounts of the stuff. I started pumping the same day as my milk came in (or what I perceived as it “coming in”), thanks to that LC I mentioned earlier, so I suspect it was the pumping that kept my supply going. I pumped religiously, every 2 hours, round the clock. But for that first week pump-free week, FC’s feeding habits seemed to be described perfectly in this study from the Canadian Medical Association Journal (Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey, Livingstone et al)

Reduction in feeding frequency is associated with a marked rise in milk sodium concentrations. This association might be related to reduced production, which could in turn be secondary to neonatal factors, such as primary suckling deficiency or poor suckling as a result of infection, or to maternal factors, such as stress, mastitis, or sore or retracted nipples. A vicious circle can develop so that when breast milk production is reduced, the infant becomes weak and sucks poorly, and the drive for lactation drops further until dehydration occurs. Factors contributing to inadequate breast stimulation and drainage included difficulty latching onto the breast (6 neonates), inverted nipples (1 mother) and ankyloglossia contributing to a suckling disorder (1 neonate). Three babies were described as very sleepy in nature and feeding, attempted every 2-4 hours, lasted up to 90 minutes. In 2 other cases the infants were feeding sufficiently often but were unsettled after feeds. Two infants received supplements for 36 hours before presentation; both had test feeds of 0 g. The breast milk sodium concentration was elevated in 3 of 4 cases measured.


Efficient milk removal depends on correct maternal positioning and latching and normal infant suckling dynamics; 9 of the 21 infants demonstrated poor breast-feeding techniques, which resulted in ineffective milk removal. They breast-fed on demand every 2-4 hours for 20-90 minutes. The mothers experienced definite prenatal and postpartum breast enlargement, indicating normal mammogenesis and lactogenesis….All of these mothers had difficulty getting their babies to latch and breast-feed properly, and this resulted in insufficient milk removal by the neonate. Breast milk sodium was high in 1 of 5 cases measured.

Another interesting and scary aspect to this is the problem inherent in diagnosing hypernatremia in the first place. “The infant with hypernatremic dehydration secondary to breast-feeding is typically encountered somewhere between the first and third weeks of life,claim Scott E. Rand, MD and Amy Kolberg, MD in their study, Neonatal Hyponatremic Dehydration Secondary to Lactation Failure. A specific danger lies in the possible delayed recognition of this disorder, because most of the infants reported have nursed well and appear content. They therefore come to medical attention late, with severe dehydration, often weighing much less than 10% below birth weight….The parents may have failed to identify that the infant is ill, and professionals may also be falsely reassured by the infant’s apparent wellbeing. Signs may be non-specific, including lethargy and irritability….Evans and Davies described four breast fed infants who gave no signs of inadequate breast milk intake other than poor weight gain and poor growth in length and head circumference.”

I have no idea if our latching issues and subsequent failure to ever establish breastfeeding were related to sodium in my milk. I would say that the fact that I was able to sustain FC on mostly pumped breastmilk for a month makes this unlikely, but nearly all the studies I consulted do say that this is usually a temporary problem which can be resolved in time, so who knows. What I do know is that if an imbalance of sodium can either be caused by or cause breastfeeding and latching problems, women are not being informed of this.

There’s a lot of talk of “booby traps” (thanks to Best For Babes, a great organization that I believe truly does want to help women for all the right reasons) in the lactivist community, but most of these pertain to society’s lack of support for breastfeeding. I always said that my problems were not due to booby traps, but maybe I was wrong, Maybe it just wasn’t a booby trap anyone has acknowledged yet. Maybe this booby trap is an unfortunate side effect of all others – the hesitancy to alert women to rare (but apparently growing) lactation complications, because it might undermine confidence in our bodies – which is totally understandable, but in my opinion, misguided. In a study entitled Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis? (Moritz et al, PEDIATRICS Vol. 116 No. 3 September 2005, pp. e343-e347 (doi:10.1542/peds.2004-2647), the authors appear to feel likewise:

Breastfeeding-associated hypernatremia should be completely preventable. Unfortunately, physicians receive limited residency training to deal with breastfeeding complications, and there is general reluctance to provide supplemental formula to breastfed infants with insufficient lactation. Most pediatric texts do not give clear recommendations regarding how to treat breastfed infants with excessive weight loss or when to intervene with supplemental feeding. Obviously, the goal is to prevent dehydration, which must begin with adequate breastfeeding assistance in the newborn nursery that continues after discharge. To this end, breastfed infants should be evaluated by an experienced health care professional at no more than 3 to 5 days of age, as recommended in the most recent American Academy of Pediatrics guidelines. Infants should be evaluated with a weight check, physical assessment of hydration and jaundice, and evaluation of breastfeeding and infant elimination patterns. Most breastfeeding-associated hypernatremia could be prevented if infants with excessive weight loss or inadequate breast milk transfer were judiciously given expressed breast milk if available and formula if necessary until breast milk production increased and breastfeeding difficulties were addressed by a health care provider well trained in lactation support….Breastfeeding is the most complete and perfect form of nurture and nourishment for infants, and all efforts should be made to promote successful breastfeeding. Breastfeeding-associated hypernatremia is a completely preventable complication that seems to be relatively common… Primiparous women in particular need additional support, education, and follow-up monitoring to ensure successful breastfeeding and to avoid complications of insufficient lactation. The judicious use of expressed breast milk or formula could prevent most cases of breastfeeding-associated hypernatremia. Both physicians and parents need better education and clearer guidelines on preventing, recognizing, and treating breastfeeding-associated dehydration. A comprehensive approach to the prevention and treatment of dehydration, hypernatremia, and hyperbilirubinemia should be part of any breastfeeding promotion campaign by the American Academy of Pediatrics or the US Department of Health.

The authors of the aforementioned 2002 study, Hypernatraemia in the first few days: Is the incidence rising?, echo this sentiment:

Breast feeding undoubtedly produces health advantages for infant and mother. We are right to promote expansion of breast feeding in the developed and developing worlds. On the other hand, it is not acceptable to gloss over individual breast feeding tragedies lest the resultant publicity discourages mothers from choosing to breast feed their babies. Rather we must address the underlying problems that may arise during breast feeding, identify resources of finance and expertise to eliminate these, and continue to recommend breast feeding as the best method of nourishing healthy infants. Given the numbers of children involved, this topic must receive a very high priority in our health strategies.

So why the hell isn’t it? My son might never have been able to breastfeed for very long, thanks to his MSPI. But apparently, the amount of casein and lactose in human milk can vary from woman to woman – it doesn’t appear that much attention has gone into this aspect of lactation, either. What if our initial failure to nurse altered my second stage of lactogenesis, so that my casein/lactose was out of whack? (This might explain why certain kids with MSPI can tolerate breastmilk, while others cannot, despite their moms cutting all potentially offensive foods out of their diets.) I can’t help but wonder if we are not just “missing the diagnosis”, but missing the mark altogether. Breastfeeding might be natural, but our lives are not. We have children later, are exposed to all sorts of chemicals and toxins, and spend years filling our bodies with synthetic hormones and altering our menstrual cycles. Many of us were only able to conceive with help from medical science. Is it really that impossible to believe that these factors might be increasing lactation problems, or creating new ones altogether?

I can’t speak for everyone, obviously, but the idea that knowledge of potential difficulties could undermine my confidence or dissuade me from nursing is hogwash.  We are a nation of moms who over-research everything: maybe we’ve de-medicalized birth and nursing, but we’ve substituted the internet – Twitter, blogs – and parenting “theories” for the pediatrician of yore. We crave information. We seek guidance. We are equipped to handle much more complex ideas than ever before. The women I know who have tried and failed to breastfeed are a tough bunch; we can handle the truth.

This might mean allowing science and medicine back into our postpartum lives, just a little bit. It might mean admitting that breastfeeding may not work for everyone without a bit of intervention, rather than accusing women of “faking” lactation failure to assuage their guilt. That has to stop. Because when it comes down to it, a lack of knowledge, and a fear on the part of physicians and researchers of appearing “anti-breastfeeding”, is a booby trap too. By acknowledging that these problems exist; by not being afraid to bring these types of studies to light – studies that can legitimately save lives, not in a theoretical sense – we can help more women to nurse successfully.

As deliciously tunnel-visioned lactivist Jack Newman maintains, the only women who feel guilty about formula feeding are those that wanted to breastfeed, and failed. Let’s get to work making sure that they don’t fail, shall we?

FFF Friday: “It was more important for me to retain my sanity.”

FFF Amy, a mother of twins, is refreshingly confident about her feeding choices. She reminds us that by doing the best thing for your family – not anyone else’s – you are being the best parent you can be.

***

On January 23, 2009, I gave birth to identical twin boys.  They were born at 36wk, but did not need NICU time.  They were however, pretty small.  Before they were born, I had planned to breastfeed as much as possible, but knowing I had to go back to work after a few months, that would include a lot of expressed breastmilk and formula if they needed it.  Well, we had to supplement from Day 1—the boys were jaundiced, and we wouldn’t be allowed to leave the hospital until their weight stabilized.  So, we did SNS–this took two nurses since I was trying to tandem feed the boys, and I simply didn’t have enough hands to hold the babies, the breasts and the sns system. 

I didn’t get to pump until about 2 days after their birth, due to some confusion with the LCs and nurses in the hospital, but we got that sorted out—I was able to pump a few drops of colostrum.  We got to go home when the boys were 3 days old, and I realized immediately that trying to do sns-tandem feeding at home wo/the two nurses was going to be nigh on impossible.  Very difficult,even if I did just one boy at a time, which I didn’t want to do.  So, I never nursed again—switched to pumping, and formula right away. 

The milk came in around Day 4 post-partum, and if it had been just one baby, nursing, my supply might have been adequate.  But pumping for two was only producing enough for 50% of their diet to be breastmilk.  After two weeks, even though my supply had increased some, the babies were eating more and I was only producing 25-30% of their diet.  That’s when the constant plugged ducts started…I was pumping every 3-4hrs and without fail, I had another plugged duct or two every 3-4hrs.  Every pumping session began to take 45min or more, with the warm compress, massaging, and pumping—to get maybe 4oz of milk, at peak production.  After a week of constantly plugged ducts, I developed mastitis.  Now, I had burning pain, along with blocked duct pain, and had to be on antibiotics. 

I learned, over this first month of parenthood, that I don’t deal well with sleep deprivation.  And the round-the-clock pumping was depriving me of precious sleep.  I had constant pain.  I hated being tied to the pump.  I was heading towards PPD.  I never did get there though, thank goodness, because at 4wk post-partum, I gave up the pumping.  I decided my boys were thriving fine on formula, and they had gotten SOME breastmilk.  It was more important for me to retain my sanity, and get some sleep than to provide a small amount of breastmilk that was increasingly becoming a smaller percentage of their diet. 

I didn’t feel guilty, or like a failure.  I felt relief…thank god I could be done with that awful pump.  I wouldn’t have to bring it to work.  I could do something else in the scant few hours between bottle-feedings, instead of pumping and massaging my aching breasts, like sleep or enjoy my children.  My boys are now 18mos old and are long since off formula—switched to cow’s milk at one year and never looked back.  Sure, formula was more expensive.  Sure, I was well aware of the advantages of breastfeeding.  But my children are happy and healthy, and I’m happy and healthy and bottle feeding formula was the best choice for my family.  

***

Want to share your story for a FFF Friday? It’s as easy as hitting “send”. Just email me at formulafeeders@gmail.com, and then give yourself a pat on the back for helping other women come to terms with their emotions. I truly believe that sharing our experiences is a potent balm for any residual guilt/fears/anger surrounding breastfeeding and formula feeding.

Why we should support (positive) lactivism

In the immortal words of DJ Jazzy Jeff and the Fresh Prince, parents just don’t understand.
My folks were visiting this weekend, and we got into a rather frustrating conversation. This isn’t a rare event; we fall on different ends of the political spectrum, and we come from passionate, opinionated stock, so things tend to get heated at least once or twice per visit. But this time, I was especially annoyed – and hurt – because they seemed to be viewing my “cause” as something vastly different than what it actually is.
On the drive up to LA, they were listening to one of their favorite hosts discussing their local McDonald’s NIP controversy, replete with the resulting outrage from listeners. They began to tell me about this radio program by exclaiming that I should “go on this show”, suggesting that I’d be some sort of alternative voice in the debate. Strike one. I patiently explained that I was a big advocate for nursing in public, and that it really irked me when businesses and/or society made women feel like they couldn’t feed their babies how they see fit – in any way, ahem, ahem. “Sure,” they said, “But then all these women were calling in, badmouthing bottle feeders, talking about how formula kills…how it’s all the bottle feeding moms that are to blame…”
Well, I guess that would qualify as a first base hit. (Sorry, my baseball terminology sucks – you know what I’m saying, though. They hit the ball, but only a little bit. Clear?) I felt my temperature rise; I wanted to go off on the subject, but something struck me. A mini-revelation, so to speak.
I understood where these callers were coming from.
Don’t stress, FFFs, I’m not going all soft on you. I still think that turning the claws on formula feeders is misguided at best; cruel, ignorant and entirely counterproductive, at worst. But as I tried to help my parents understand why certain callers’ juvenile behavior couldn’t take away from the true topic at hand (i.e., the ridiculousness of not allowing a nursing mother in McDonalds – I mean come on, people, the only thing we could possibly fault this woman for is being in a McD’s in the first place), and why the callers had every right to stage a nurse-in, I realized:
 
  • In a society where nursing is still so taboo (despite the very real pressure from the media, Internet, and medical communities to breastfeed) that a woman showing her breast to feed her infant is considered “inappropriate”, we can, and should, feel angry.
  • Following this logic, the anger has to be directed somewhere, and if you feel alone and ostracized, the easiest construct to blame is the one that made breastfeeding something “odd” or “other” in the first place – and that construct is our (perceived) formula feeding society, spearheaded by the evil empire of the formula conglomerates.
  • One would logically assume that another breastfeeding mom, or spouse/family member of a breastfeeding mom, would support a woman’s efforts to nurse her child. Therefore, someone who is being unsupportive is most likely a formula feeder. (Please note, I don’t believe that this is actually true. I think, typically, the people who are unfriendly to breastfeeding moms are most often men, or childless folks, or people from a different generation – some of these may be part of the aforementioned bottle feeding culture, but I’d submit to the jury that most modern moms, living in a time where breastfeeding is advocated by celebs, commercials, and our physicians, are not the ones actively throwing suckling babes out of fast food establishments. But I can understand the thought process involved which would immediately peg a “threat” to breastfeeding as pro-formula, by default.)
  • There’s also an element of envy and resentment towards the majority when you see yourself as the minority, or “other”. Considering I was a formula feeder living in a breastfeeding society, I get it. For instance, it’s very hard for me not to feel judged and angry when my closest friends keep pestering me about whether or not I’m going to nurse my second child. It’s frankly none of their business, and I’m not sure why they care so much.  I find it way easier to talk to bottle-feeding moms about this, and see them as “my kind” versus the breastfeeding masses. I fight these feelings, because I don’t like giving in to the basest elements of my soul, but sometimes I do just want to punch certain friends in the arm a few times for making me feel so “different”. I also have to fight the urge to make a decision solely based on wanting to fit in – that’s how powerful the pull of the crowd can be. So, I can empathize with a mother who feels alienated, and then finds a group of women online, or via a mom’s group, or LLL, or whatever, and takes up the cause of lactivism, bolstered by a sense of belonging and the security of a group dynamic.
  • In addition, until society sees breastfeeding as “normal”, nursing in public is going to be controversial. In order for breastfeeding to be seen as normal, the majority of women need to be breastfeeding. Hence, we need lactivism to deliver these kinds of results, so that no woman will have to endure the injustice of being told to cover up, or told that feeding her child past the age of 6 months is “creepy”, or any number of other insane things that nursing moms have to endure.
What this all comes down to is that I now understand why certain lactivists end up vilifying formula, or formula company marketing tactics, or pro-formula-feeding blogs (even if they are not pro-formula feeding as much as pro-feeding choice, but hey, whatever). And while I don’t condone the tactics some may use to try and increase breastfeeding’s prevalence in our society, I think, for the sake of all of us, we should hope that they succeed, and soon.
Why? Because when breastfeeding advocates finally see themselves as the “norm”, they will no longer have to try so hard to convert everyone to their way of thinking. That means no scare tactics, no guilt, no overstating research results, no trying to compare formula companies to cigarette companies. I hope we can all agree that all things being equal, breastmilk IS the ideal food for (most) human babies (not that formula isn’t a perfectly good alternative, but you get my point). And I also hope we can agree that a woman should have the right to feed her baby in public, whether it be by bottle, covered breast, or exposed breast. By making this a widespread belief, perhaps we can move on. Maybe the time and money spent on research that seeks to prove – again, and again, and again – that breastfeeding is superior to formula feeding could be used, instead, to truly discover which medications pass through breastmilk or effect a nursling in a significant way (and I’m talking long-term, far-reaching studies, not the kind we have available now, with tiny samples and only considering an abysmally short time span for side effects), or what is causing a rise in lactation failure.
Does this mean I’m going to shut up when people rage unfairly against the bottle feeders? That would be a resounding no-freaking-way. But I want to make it clear that I do support lactivism – the positive kind, at least – because I believe a pro-breastfeeding society is better for all of us. Not for the usual reasons; I don’t think it will significantly improve the health of our nation, or save us millions, or cure cancer and make our kids super-smart women/men of steel. I just think that if we can find a way to make breastfeeding more prevalent without alienating those who make an informed decision to formula feed, or who simply cannot nurse for whatever reason, we can move on to fighting for more important things. Like better schools, better health care, better access to chemical-free foods, etc, etc.

 
If we can support positive lactivism, even if we can’t agree with every single thing these groups/individuals say or represent, we can use our power – the power of a supposed majority – to improve things for both nursing and non-nursing mothers. I can’t see the negative in that. I’m willing to take on the hate mail and negative comments this post is sure to receive to say it aloud: even if it’s for entirely selfish reasons, we can all stand to benefit from better breastfeeding rates.

Why we should support (positive) lactivism

In the immortal words of DJ Jazzy Jeff and the Fresh Prince, “Parents just don’t understand”.

My folks were visiting this weekend, and we got into a rather frustrating conversation. This isn’t a rare event; we fall on different ends of the political spectrum, and we are of passionate, opinionated stock, so things tend to get heated at least once or twice per visit. But this time, I was especially annoyed – and hurt – because they seemed to be viewing my “cause” as something vastly different than what it actually is.

On the drive up to LA, they were listening to one of their favorite hosts discussing the McDonald’s NIP controversy, replete with the resulting outrage from listeners. They began to tell me about this radio program by exclaiming that I should “go on this show”, suggesting that I’d be some sort of alternative voice in the debate. Strike one. I patiently explained that I was a big advocate for nursing in public, and that it really irked me when businesses and/or society made women feel like they couldn’t feed their babies how they see fit – in any way, ahem, ahem. “Sure,” they said, “But then all these women were calling in, badmouthing bottle feeders, talking about how formula kills…how it’s all the bottle feeding moms that are to blame…”

Well, I guess that would qualify as a first base hit. (Sorry, my baseball terminology sucks – you know what I’m saying, though. They hit the ball, but only a little bit. Clear?) I felt my temperature rise; I wanted to go off on the subject, but something struck me. A mini-revelation, so to speak.


I understood where they were coming from.

Don’t stress, FFFs, I’m not going all soft on you. I still think that turning the claws onto formula feeders is misguided at best, cruel, ignorant and counterproductive at worst.

FFF Friday: “The point is that you’re feeding her with love…”

Last week, I mentioned that I wanted to explore stories from women in primarily bottle-feeding areas as well as pro-breastfeeding communities. FFF Samantha lives in a small town, where her dedication to breastfeeding made her a “weirdo”; it’s hard for me to imagine that kind of experience, but I obviously realize millions of women across the world can relate to Samantha’s feelings of “otherness” as a breastfeeding mom. Ultimately, though, the struggle to feed her child extends past geographical or social boundaries, and I’m sure there are elements of her story to which all of us can relate.
 

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Before I got pregnant, I knew nothing about breastfeeding. Literally, nothing. No one in my family had breastfed. I was the first in my social circle to get pregnant, so none of my friends were helpful. I just assumed I’d use formula, because it’s what everyone did, and I knew nothing else. My husband, Lee, is a scientist, though. He did know a bit (not a whole lot, since he’s a Physicist) about the benefits of breastfeeding, and told me that I needed to really look into it before coming to any conclusions.
So I did. Everything I read said that breastfeeding was superior to formula. Also, from what I was reading, it didn’t even seem hard! Everything talked about how natural it was, and that there should only be a mild soreness. I could totally deal with that! I have a crazy high pain tolerance. So, it was settled, I’d breastfeed our child. I mean, how could I ever have considered otherwise? It was the most logical, natural choice!
I told everyone my plans to breastfeed. I was so pleased with myself. I said that I’d go as long as my child wanted, a year, two years, even three! In my small town, where no one breastfeeds, I was now an even bigger weirdo than I had been already. “You want to do that?,” one of my coworkers asked in disgust, as she went on to talk about her breasts being “only for [her husband] to play with.” She giggled, and I tried to suppress my urge to vomit.
I couldn’t help but feel really good about myself. I was going to breastfeed. I was doing the “right” thing for my child, even when so many people around me didn’t. I was, obviously, the better parent.
Then Gabriella was born. Even after our traumatic birth experience, I had high hopes for breastfeeding. Except that they kept her for hours after she was born. I had only held her for a single minute. When they brought her back to me, three hours later, she was fast asleep. She didn’t want to breastfeed at all. So we waited. Eventually, she woke up, and a nurse helped me get her latched. It was odd, but not horrible. We switched sides, and for some reason, she seemed to get really upset. She sucked for only a moment, pulled off (painfully, I might add), and began wailing. What was wrong with my baby? What was wrong with me? Why did she hate me?
The lactation consultant was no help at all. She said, “everything is fine,” and she never came back again. Meanwhile, Gabby just kept screaming. A little sucking, ripping away from me, and screaming. It was horrible.
It didn’t get better when we got home. Instead the ripping away got worse as she got bigger and stronger. She started arching her back away from my breasts. She wanted nothing to do with them. She hated them. She cried all the time. I began to suspect that she had GERD, but her pediatrician said that we needed to “wait and see.” She told me that even if she did have it, they were not going to prescribe any medication, and that I would need to find a specialist instead. They wouldn’t even give us Zantac.
Then came the day when she refused to nurse. I couldn’t even get her latched. She just arched away from me. I called her usual doctor, who asked if it was a “true emergency.” I screamed at her that my child, “has gotten no fluids for the past 18 hours, did that feel like an emergency [to her]?” I hung up on her before she could answer, and called my uncle Tony, who is a pediatrician. Without seeing her once, he immediately diagnosed her with GERD, and told me that I needed to find a way to get fluids in her ASAP. He told me to try a bottle with Pediasure. I knew that you aren’t supposed to give bottles if you want breastfeeding to work, but seriously, what else should I have done? My child was getting dehydrated by the minute! I gave her the bottle, and she reluctantly drank it. He told me I should try pumping and giving the bottle to see if she can handle that.
I officially switched her to my uncle as her doctor, even though he is over an hour away from us. He prescribed a few different prescriptions in an effort to treat, what was determined to be, severe GERD, and we fiddled with them until she seemed to be okay. Not perfect, but a lot better.
I continued to give her pumped milk for weeks while we were adjusting the meds just right. When things settled down, I tried breastfeeding again, but she wanted nothing to do with it. She cried as soon as I started to unlatch my nursing tank. She refused to latch. My boobs were absolutely scary to her. They were a source of pain, and sickness. For other babies, nursing is a source of comfort and bonding, but not for Gabby. She knew them to provide nothing but discomfort.
I kept trying for several weeks longer, and she continued to flat-out refuse. My uncle said she developed a feeding aversion when it came to nursing, and that it was very unlikely that she would ever get over it. He told me I could keep pumping, or I could switch to formula, which was “okay too.”
I felt I needed to keep pumping; it was the least I could do at this point. Except, every time I would hook myself up that dreaded device, it was like the joy was being sucked out of me. Then one day, I thought, “wouldn’t my family be better off without me?” I knew something was really wrong.
I was diagnosed with PPD, and the only medication that helped was one that was not safe for breastfeeding. There really was no choice to even think about. Without this medication, my child wouldn’t have breast milk anyway, because her mother would likely kill herself. The choice was obvious.
My friends and family all said to me, “see we told you breastfeeding wasn’t worth it,” and, “we knew it wasn’t going to work for you.” Not the words of “encouragement” I needed. Online communities were no better. The breastfeeding moms would tell me that I did my child wrong. That I didn’t try hard enough to get her back on the breast, that I should have “chosen” a PPD med that was safe for nursing. No matter where I went, I couldn’t win.
It was my husband that really made everything better for me. He said, “Samantha, you are an amazing mother. Our daughter is so lucky to have you. Who cares how she is getting fed, the point is that you’re feeding her with love.” He’s a great guy :-)
Now we have a 100% healthy, funny, smart 17-month old (can’t believe she’s that old!), and I’m 100% at peace with everything.
 

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Have a story you feel like sharing with the FFF audience? Please email me at formulafeeders@gmail.com. All types of experiences with breastfeeding and formula feeding are welcome.

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