FFF Friday: “Never again will I judge.”

Kelli, this week’s FFF Friday guest poster, is refreshingly forthright in her admission of the judgments she made about formula feeding moms, before she became one herself. I think this is something that a lot of us can (ashamedly) admit, and illuminates the fact that until you’ve walked in someone’s shoes, you really don’t know how uncomfortable those kitten heels are.

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I had always planned on breastfeeding. I took the classes, read the books, and bought the best (and most expensive) pump available. I studied the breastfeeding failures of friends and family and decided that I would do better because I surely knew more than them and I would try harder than them. How smug and naive I was. At least they had no idea I was secretly judging them, because a true southern lady could never be so rude as to tell them what I really think. When you judge a person without having been in their position, you are making assumptions and you are usually wrong. I assumed I was better prepared. I assumed they were lazy. I assumed they didn’t try hard enough. I believed everything I read in breastfeeding literature as though it were the gospel truth. I just knew breastfeeding would come easily to me.
 
My son was born at 36 weeks, 1 day. It was a total surprise to me, as it was my first day off for the summer (I’m a teacher) and I was at the movies with my mom. I barely made it to the hospital and delivered him in less than 2 hours from beginning of labor to delivery. Being born so quickly left him with busted blood blisters and bruises on his head from being thrusted into my pevlic bone, which increased his jaundice. The pediatrician decided that it wasn’t bad enough to use phototherapy and she didn’t want it to interfere with breastfeeding. In the hospital, breastfeeding was easy. He latched on easily and I fed him on demand. He was a strong sucker, but he had difficulty in getting started sucking. The lactation consultant showed me how to stimulate him to suck and he was all good again. We were discharged on a Saturday and all was well. He weighed 7lbs 3 oz at birth and 6lbs 9oz at discharge.
 
Monday we took him for his first visit to the pediatrician and he had continued to lose weight (6 lbs 3 oz) and become more jaundiced (16 mg/dL of bilirubin). My milk had come in, but my breasts never felt full and I never experienced the “let down” feeling other women describe. I just figured it would take a few more days to get things good and established. A weight check appointment was scheduled for 2 days later. On Wednesday when we took him back, his weight was only 6lbs 5 oz and his bilirubin level was just over 20 mg/dL. The dreaded word was used – supplementation. We were given sample cans of formula and home health was sent out to set up phototherapy equipment at our house. I cried the entire time the man set up the equipment. Our son had to stay on lights 24/7, except for diaper changes – we even had to hold a lighted blanket on him during feedings. He had his first bottle of formula that night after breastfeeding. He guzzled it down and I felt awful that he was still so hungry. At one feeding he was so lethargic from the therapy and the jaunice that he wouldn’t nurse at all. I had to bottle feed him the little bit of breastmilk I had saved from pumping and still supplement with formula. Pumping wasn’t doing much good. I had saved only a couple of ounces by the end of a day.
 
Once off the phototherapy, I decided to stop supplementing because he wasn’t just spitting up, but projectile vomiting every drop of formula he ingested – just proof to me that formula was poisoning my baby. He stopped spitting up, but he screamed in hunger all night long. He was continuing having difficulties with getting started once latched on and I didn’t know what else to do. He was slowly gaining weight, but nowhere near his birthweight by 11 days old. We went back to the pediatrician and she referred me to the hospital lactation consultant. My mom was staying with me that week because my husband had returned to work and grad school and his grad school internship every night. She went with me to see the LC and we made a plan that I would basically pump and breastfeeding 24/7 for a few days to try to get my supply up, and my mom was going to stay at the house and help me do it for a few more days. He had eaten pretty well during the appointment, so I was confident that I could do it.
 
Then I got home. At the next feeding, he was up to his old tricks. He’d latch on and then look at me like I should be doing something to put the milk in his tummy. Then he’d push off the breast and scream. I was frustrated, sad, and beyond exhausted. He wouldn’t eat and I couldn’t make him, but he was so hungry. I’d thrown out all that devil formula because of the projectile vomiting and all, so we had nothing else. My mom remembered that my nephew had a lot of problems with regular formula and had to eventually use Similac Alimentum and did fine, so we went to the grocery store to buy a can. I stayed in the car with my son while my mom went in to get it and I cried the whole time. My mom saw my exhaustion and depression and devastation and decided to let me sleep that night while she took care of the baby.  He had 4 formula bottles over the night and my 2 pumping sessions had yielded only a total of 0.5 ounces. I woke up the next morning not really sure how our feeding plan would go. Should I try to keep breastfeeding even though he’s not really getting it? Should I pump only and supplement with formula? Should I just go to formula only? I was kind of paralyzed by the decision and I didn’t do anything for awhile.
 
I really knew that breastfeeding wasn’t really possible if he wouldn’t suck. So I considered pumping and primarily feeding him the expressed breastmilk. As I thought about it more, the problem I encountered was that after that week, I would have no help at home because my husband’s schedule was wacko and my mom had to go back to work. How could I take care of a baby and pump around the clock? I worried about it and cried about it a lot. I knew formula wasn’t going to kill him (I was formula fed afterall), but I wanted to be able to give him the best there is. Then I had to deal with the realities: My son wouldn’t suck and there was nothing more I could do to teach him how to do it and I’d rather hold my baby than hold a machine to my chest every 2 hours. He was hungry and needed to gain weight quickly and the best thing for him is to just eat whatever he would eat, which was formula. That day (at 14 days old) he consumed the last of my pumping stash and was completely formula fed from then on.

I continued to cry about it and feel guilty about it. People assume that the stages of grief only apply to death and loss, but really you go through those stages any time a situation doesn’t meet your expectations. I wish I had the extra hands at home all the time, and then maybe pumping long-term would have been an option. I wish my son would have had a better sucking reflex and wouldn’t have had the issues with his weight and needed supplementation. Again though, I had to deal with the reality of our situation and not the “shoulds” and the things that modern society and other people say I ought to do if I want to be a good mother. Mostly I wish I had never judged others for their breastfeeding failures. Completely exhausted, heartbroken, and probably depressed, I finally understood their struggles and the amount of guilt and failure they must have felt.  

 
Now at 3 months old, my son is thriving. He’s doubled his birthweight and despite a struggle with acid reflux, he is mostly happy and healthy. I am happier too. We get to spend time laughing and singing (well, I sing and he coos back) and playing instead of struggling to get him to eat. I am so thankful for my husband (even in his absence) for recognizing the struggles I faced and being supportive of every decision I made, and being reassuring when I was ambivilent. I know I will try breastfeeding again when we get around to the second baby, but I will not hesitate to feed that child formula if it is the best thing for him or her. And never again will I judge.
 
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Willing to share the good, the bad, and the ugly about your own experience with breastfeeding or formula feeding? Email me at formulafeeders@gmail.com. It makes my whole day to see an FFF Friday submission in my mailbox… so get on it. It’s an easy way to make someone (ahem, me) happy.

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Surviving the “baby friendly” hospital: Tips for those planning to formula feed

As we’ve discussed before, if you frequent the Internet or read breastfeeding literature, you probably suspect there are only two kinds of hospitals in the United States: those that are ardently pro-breastfeeding, and those that sabotage breastfeeding from the get-go. I honestly think that most hospitals fall somewhere in between; there are so many great physicians and nurses out there who simply want to ensure that baby and mother are healthy and surviving, and while they hopefully support breastfeeding, they also do not pressure anyone into doing something they’re not comfortable with.

However, I also realize that there ARE hospitals in this world that do fulfill these black and white “myths”, and depending on what side of the fence you fall on (planning to breastfeed or planning to formula feed), it can be a daunting prospect to enter your labor and delivery suite knowing that you must stay on the defensive. For those planning on breastfeeding and potentially dealing with a less-than-breastfeeding-friendly care center, I highly recommend going here and here, where there are some excellent tips for handling the situation and keeping your breastfeeding goals intact.

This post concerns those who have chosen to formula feed from the start, though. And I have particular concern for these women, because as more hospitals veer towards implementing baby-friendly policies, I fear that they will be in a sensitive situation, at a time when the last thing they need is more pressure or worry. This is not intended as an argument against Baby Friendly Hospitals; it’s simply here to provide some guidance and foresight for those who might be making an “unpopular” choice within the microcosm of their intended hospital for delivery.

I’ve never encountered this situation, personally (with my first, I was committed to breastfeeding and found the hospital to be supportive but not dogmatic, which I appreciated; as for the second, well, that still remains to be seen – I’ve heard from friends that they’ve upped the ante quite a bit in the two years between my deliveries), so I asked readers and Twitter folks to share their tips/idea/experiences. The following are the best tips I could find on making your bottle-feeding postpartum experience as positive as possible.

1. Forewarned is forearmed. OttawaAli suggests, “Call the hospital ahead of time and find out the responsibilities of parents who plan to formula feed. What they need to bring, etc. Find out what is available at the hospital.” Adds Lililly, who recently survived her own baby-friendly experience, “Make sure to take all your own equipment that you will need. This may already be policy for formula feeders in the hospital but it also means you don’t need to use their stuff constantly.” If you are delivering in a truly baby-friendly designated hospital, they may not provide you with bottles, sterilized water, and formula. The easiest thing to do is to bring a bunch of those ready-to-feed, newborn-size bottles – you can order them on Amazon (for example, these little suckers are what our hospital gave FC when we had to supplement for his jaundice). That way, all you need to do is attach the nipples and you’re ready to go.


2. Enlist help. Says OttawaAli, “Let the care provider (OB or Midwife) know, and ask them their advice/ opinion on what to do and how the hospital handles people who do formula feed.” Another anonymous mom advises that you meet the staff ahead of time and “find your allies”. With the state of our healthcare system, neither of these suggestions may be feasible, but you probably will find some nurses more friendly and receptive than others. As soon as you find one you can trust, confide in them. Let them know your concerns and ask if they can help you out. 

Also, put your significant other, friends, or family to work. This is seriously the last thing you should be dealing with, considering you just birthed a baby. Rather than flowers or balloons, ask your loved ones to bring their game face and make them do your dirty work for you. They can talk to the charge nurse and politely let him/her know you have made your decision and expect it to be respected; bring you supplies if you need them; and generally be available for emotional support. 


Still, if push comes to shove, you might be surprised at your inner lioness. “I was frequently visited by an extremely pushy LC. The first visit, she gave me the Breast is Best lecture and said she would be back – even after I asked her not to come back,” Mary (of Another Mommy Blogger) tells me. “I explained to her that there were probably other new moms in the hospital who would love her advice and she was wasting her time with me. She came back one more time, by this time I was able to walk (I had a c-section). I got up and firmly (yet politely) told her to leave my room and she was not welcome back. My fiancé thinks I over reacted, but the postpartum hormones didn’t help and looking back, I’m proud that I didn’t just flip out on her!” I’m proud of you too, Mary. I probably would’ve kept quiet and then cried myself to sleep that night. Ah, the joys of postpartum depression…

3. Consider including your feeding intentions as part of your birth plan. That way, you have it in writing. You may want to include a wish to avoid a visit from the lactation consultant – just let them know it would be a waste of your time, and hers. OttawaAli also suggests making a sign for the bassinet, saying “something to the effect of ‘we have decided to formula feed, we hope that you will respect our decision’. 

4. Put pen to paper. With those postpartum hormones raging, it may be easy to fall prey to judgmental or guilt-inducing comments. Lillily provided my all-time favorite suggestion, via a lament about her own experience. “I wish I had written down all the reasons why I was going to use formula and why I’m a good mother so I could read it during weak moments.” If you have legitimate reasons why you don’t want to breastfeed, own those reasons. (This is not to say that you can’t change your mind – that happens all the time, in both directions, and that’s a really cool, go-with-the-flow way to approach things, too.) You are a good mom because you put your time and research (not to mention your heart) into making this decision; the best thing you can do for your baby is FEED him/her and be happy and confident doing it.

It’s important to note that the nurses and doctors are often caught in the crossfire, here. If hospital policy is breastfeed-or-bust, they have an expectation from their employer to comply. There’s a fair amount of political pressure, and no one wants to be seen as “anti-breastfeeding”. So give them a bit of a break. As Lauren, a postpartum nurse (and formula feeder) wrote to me, “We do not pressure anyone into breastfeeding. We are advocates for it, however we do not look down upon formula feeders. Every momma chooses what is best for her and her babe! Now the lactation consultants like to pressure, but only if you come in and declare “breastfeeding” – and that is because they don’t want anyone to give up if they really want to breastfeed.” 

On that note, I want to end this post with a story that I received through my plea for help with this subject matter. I think it exemplifies the difference caregivers can make.

R’s story:

“When I got to the hospital for my induction, we told the nurses we weren’t breastfeeding for medical reasons, so don’t come wake me for feedings or whatever. I don’t know if we got into details, but the nurses didn’t seem to care either way. But I had prepared my husband to keep pesky lactation consultants away once the baby arrived.

Then the baby arrived. And peed on the doctors. And had a seizure. And stopped breathing. Suddenly, lactation didn’t matter. I never got the “breastmilk will save your NICU baby speech” because my son wasn’t allowed food (for very good reason). We didn’t hold him until day 6, and that was also the first day he got real food, not through a PICC line, not through and IV. He got food through a feeding tube, and it was formula. None of the doctors or nurses seemed to care what he got – his diagnosis was no longer something life threatening, the new diagnosis meant he could eat, and we were all over the freaking moon. Nobody butted in and said “breastmilk is best”, all the doctors and nurses instead “boy that kid can EAT!” (Which is a very good sign for a NICU baby). Every time I made the long walk to the bathroom – and I made the walk a lot, as any post-partum mom knows – I passed the pumping room. I saw the heavy duty milking machines, occasionally saw the room closed and in use, and didn’t really think much of it. Believe me, in a Level IV NICU, where my 6 pound baby was a GIANT, everyone is so focused on keeping the dangerously premature and sick babies ALIVE that they don’t care much where the nutrition comes from.

My milk came in an hour after I held my son for the first time… I told our primary nurse about it, but she didn’t rush to get me on a pump, she just smiled and asked if I needed some wipes for my bra. And when it came time to take our brave little guy home (Day 12, he was the picture of health and still is), our primary nurse raided the pantry and got us extra formula samples at our request. Since Level IV NICUs very rarely ever discharge babies straight home (their patients are too sick for anything than a lower level NICU), she didn’t have more than a basic goody bag, and she tried to add as much as she could.

I’m guessing that my hospital experience is much more positive than most… But I can’t tell you how nice it was to have everyone NOT adding pressure I certainly didn’t need during the hardest 12 days of my life.

FFF Friday: “I had to redefine what it meant to be a good mother.”

Multiple moms are a special subgroup in the breast vs bottle debate. It used to be that if you had more than one baby, everyone expected you to bottle feed. Nowadays, through education and support, a lot of multiple mamas are nursing successfully, which is great news. But if you are someone who is struggling with breastfeeding, adding twins to the mix means double the stress, pain and confusion. In this week’s installment of FFF Friday, Stephanie explains how her dreams of breastfeeding crumbled under the reality of a premature birth, supply issues, and mothering two infants. 

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Before I had my twins I was sure I would breastfeed – there was never a question about it.  I was sure that “Breast is Best” and that “good” mothers breastfed their children.  I would bask in the praise I received when someone asked if I was planning on breastfeeding and I answered “of course!”  I didn’t question the lactation consultants in my pre-natal breastfeeding class when they said that “if your breasts have changed at all during pregnancy, you won’t have supply issues”.  I didn’t even buy bottles before the babies were born because I didn’t want to be “tempted” to bottle fed in a weak moment.
Enter reality. After a complicated pregnancy involving weeks of hospitalized bed rest, my beautiful twin girls were born five weeks early. They were healthy, but small and weak and required a 2 week stay in the NICU to grow strong enough to eat on their own.  Their first meal was formula through a nasogastric tube fed to them by a NICU nurse while I was recovering a hallway away.  As soon as I was wheeled back from my c-section, the first thing I did was ask for a breast pump.  I began pumping per instructions from the lactation consultants and NICU nurses (8x per day/20 minutes/time). 
Despite my best efforts at pumping and putting the babies to breast when it was “allowed” by the doctor (once a day for 15 minutes) plus other more desperate measures like taking Reglan despite the warning on it that it may cause severe depression (and I had already been feeling the tug of PPD) I was never able to pump more than ¼ ounce at a time.  It took seven days for even a drop of milk to show up – I never felt engorged, never felt a let-down, or had any other signs that my “milk had come in”.  Once the babies came home, I followed the doctors’ instructions to breastfeed for 20 minutes every other feeding and then give them a bottle while continuing to pump 8x a day.  They would nurse for 20-30 minutes and I’d offer them a bottle of formula.  Being 5 pound sleepy preemies, these were not ravenous babies, and it was a struggle to get them to eat 2 ounces of formula.  Regardless, they still would drink their whole two ounces even if they had nursed right before – as if they were not taking in very much milk during a breastfeeding session.  I think I can safely say that I had milk production issues. 
After a week at home trying to pump, breastfeed, bottle feed and otherwise take care of two premature babies, I gave up.  I couldn’t eat due to a very upset stomach (a side effect of Reglan) and I was sure the Reglan was sending me into a depressive spiral.  As soon as I stopped taking Reglan, I began pumping even less than the dismal amounts I had pumped before. It was completely disheartening to pump for 20 minutes and only collect ¼ ounce of milk.  My husband and I were sure that giving up was the right decision – it was too grueling to keep it all up with little or no results. 
Giving up nursing meant I had to redefine what it meant to be a good mother.  I spent at least a year feeling like the worlds’ worst mother.  In retrospect, I probably was suffering from PPD, but my depression was focused almost exclusively on my failure to breastfeed.  Oh, the horrible thoughts I had during that time period.  I felt like I should give my babies away to a “real” mother (i.e. one who could produce milk), I felt like I should get pregnant again right away so I could try again to breastfeed, and I contemplated suicide because I was obviously a failure at the most basic level. 
It didn’t help that everywhere I turned I was hit over the head with the “Breast is Best” message.  From the posters in the pediatrician’s office to the message on the side of each formula can, I couldn’t escape it.  The worst was when I tried to find other mothers on the Internet with similar experiences and my searches usually lead me to forums where people told me that I was lazy, stupid, and ill-informed and that I was damaging my children by feeding them formula.  (Too bad I didn’t find FFF back then – it would have been immeasurably helpful!).  The moms in my local community were not much better.  When I explained why I was not nursing (back then I felt I had to explain it to everyone who looked askance at my bottles), I would inevitably be told that my supply issues were in my head or that I should have tried harder or longer or that they knew a mom who had worse nursing difficulties and overcame them. One particularly virulent pro-breastfeeder even told me my girls would lose up to 7 IQ points because I wasn’t breastfeeding.
Thankfully, time has finally given me perspective. I think failing at something that I thought was critical to being a good mother made me realize what actually makes a good mother. I am now able to look back and actually be thankful that breastfeeding didn’t work out.  I still mourn it in a small part of me, but I’m also thankful that my husband was able to cuddle and help feed our babies and that we could split up night feedings at times so I could function during the day.  I’m thankful that my girls didn’t have to suffer with hunger because I was forcing them to breastfeed when I obviously didn’t have enough milk for them.  Most of all, I’m thankful that I didn’t waste months hooked up to a pump instead of spending the all too short time while they were small holding and snuggling them.  Even though I felt like a terrible mother at the time, I now know that I actually was being a good mother by doing the right thing for our family.
Oh, and I guess we’ll never know if my girls really are missing those 7 IQ points.  They are healthy, happy, and thriving two year olds (and extremely verbal – they spend all day singing and chatting to me and to each other). And isn’t that what counts in the end?       
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Got a story that would work for a FFF Friday? I’d love to see it. When you’re ready, email it to me at formulafeeders@gmail.com.

The Daddy Dilemma: How much say should fathers have about breastfeeding?

As I mentioned previously, I recently suffered some minor complications with my pregnancy that rendered me unable to travel to my dear friend’s wedding. The reasons were twofold – first, because I was diagnosed with a condition that put me in a “high risk” category; and second, that I started bleeding and cramping a day before I was supposed to leave. The first reason, in my mind, was not enough of one to miss my oldest friend in the world’s most important day; Fearless Husband (FH) disagreed. We argued for a week, him siding with the alarmist perinatologist who advised me to cancel, me with our lacksadaisical obstetrician who said I should absolutely go. Ultimately, my body made up my mind for me; once the more emergent (and painful) symptoms occurred, my mommy instinct kicked in and told me I’d be a complete moron to travel across the country under the circumstances (actually, it wasn’t just mommy instinct that told me that – so did the OB on call, who seemed like a straight shooter and broke the tie between my battling healthcare providers).

I’m rehashing this to illustrate a point about fathers and the relationship they have with their pregnant wives and unborn children. In my non-pissy moments, I realized that the situation must be scary and frustrating for FH. Our daughter is in my belly, not his. It may not be politically correct., but it is a visceral reaction – someone else has responsibility for taking care of his child, and he has little to no control over what that person does or doesn’t do. Even for the most evolved, post-feminist era man, that’s gotta sting. At one point in the week of should-I-stay-or-should-I-go arguments, FH said, “It’s not my decision; it’s not up to me. I guess I don’t even have a say in it. I’m just telling you how I feel.” Although we were mid-fight, I immediately softened. “Yeah, actually, you do have a say. This is your kid too. If you really, truly feel I am putting our child in danger, then of course you have a say,” I told him, feeling like the most selfish person on the planet for even considering taking the trip.

I think that the frustration modern dads feel about where they should draw the line between “controlling” their significant others’ physical lives in regards to procreation, and taking a true and equal part in co-parenting, affects the issue of breastfeeding. We hear talk about how fathers can support the breastfeeding mom (doing other tasks so that she can focus on feeding -  bringing her water, changing diapers, etc); on the flip side, there are stereotypical horror stories of how men can feel “left out” from, resentful of, or “turned off” by the nursing relationship. But this is oversimplifying things, I think. The question remains: what rights do male partners have in dictating whether a mother breastfeeds? If they believe that formula really does carry risk, then can we blame them for taking a strong stand on breastfeeding?

In my case, FH started out being the ideal breastfeeding-supportive father. But as things went from bad to worse, his (well-intentioned) Pollyannic attitude began grating on me. He claimed he was being supportive by not letting me give up, but in my dark days, that’s not how I saw it. I recall a message board friend (one who was a staunch breastfeeding advocate, no less) telling me that “until he feeds your child with the most sensitive part of his body, he has no right to tell you how to feel or what to do.” I agreed at the time, and it fueled my anger. What kind of misogynist shmuck had I married? If I wanted to give up, I could give up. He had no say.

But that’s not entirely true, is it? FC was his child; at the time, he 100% believed that by switching to formula, we were putting his health and welfare at risk. In this context, can I blame him for feeling angry at me for considering “giving up”? Didn’t he have a right? Didn’t he have a say? FC is as much his child as mine, after all.

Months later, the man I had dubbed “La Leche Lackey” had done a complete 180. He read the research, looked at the issue with open eyes, and saw how different our lives became once we listened to our child’s needs rather than the alarmist voices that guilted, scared, and divided us. He got angry; he felt cheated.

Still, I don’t think he feels any remorse about acting the way he did. The way he sees it, he thought he was being supportive of what I wanted, deep down; that I was too depressed and frustrated to see clearly. He also thought he was protecting FC, which was his job, as a dad.

I’m not sure what my point is here. I guess it’s simply to say that a dad’s role in breastfeeding is complex, and we need to consider it carefully. As a feminist, this issue is a toughie for me; it’s a slippery slope from what I’m expressing here to a confusing, conflicted conversation about reproductive rights. As a mother and part of a loving, committed, equal relationship, though, I have to hesitate. How can we ask men to be equal partners in childrearing while not allowing them a say in how those children are fed? And yet, if the manner of feeding requires significant embodied commitment on the part of a woman, it does delve into dangerous territory.

This is one of the reasons why I believe that formula is an important option to keep in our society. Breastfeeding is inherently female work (although men can and do lactate – I’m still waiting for some research to be done in that department; that would really be progress. If breastfeeding is all it’s cracked up to be, then how cool would it be for the other half of the population to be able to contribute to our milk supply?); formula allows us to have equal footing. Of course, many women find breastfeeding extremely rewarding; a gift, if you will, that women are given, much like the ability to grow life in the first place. But for those who don’t, it sure is nice to have a way that men can be true co-parents, in every sense of the word.

See? It’s a toughie. Let’s just call it a wash and get to work on the whole male lactation thing, shall we?

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