And so it goes…

A dear friend of mine gave birth last week, after a long struggle to conceive. This woman has already been through so much, and I hoped she’d have the easiest birth and early motherhood experience possible to make up for the hell she’d been through up until this point.

Although the birth itself went pretty smoothly, I was disheartened to hear that breastfeeding was not going well. Apparently, while her daughter seemed to latch perfectly, her milk was still not in almost a week postpartum. She was doing everything right – she’d done the rooming in, nursing on demand drill; seen the LC in the hospital and had a private consultation as well; she was determined and excited to nurse. Her daughter was healthy and full-term, and the only health issue my friend had herself was a thyroid problem which all the “experts” has assured her wouldn’t affect breastfeeding.

But my friend’s little girl, who we’ll call Jane, had dropped 12% of her body weight, and had endured several days where she only had one wet diaper in a 12-24 hour period. She seemed to be getting sleepier and less interested in nursing, so my friend started pumping and cup-feeding her to avoid nipple confusion. When she asked her pediatrician if she should be concerned, the doctor told her she shouldn’t worry, that her milk would come in any day now, and as long as she was having any wet diapers, she’d be fine. This was contrary advice to everything my friend had read online – and while yes, Dr. Google is not the most reliable source of information, I had to agree that every physician I’d interviewed would assert that what her daughter was experiencing were warning signs of dehydration. And as my friend said, it was easy for the doctor and LC to say “wait and see” – it wasn’t their newborn dropping weight and growing weaker.

She was on  her way to see another LC when I spoke with her, and I was really torn. I think she wanted me to tell her that she should just switch to formula, but I couldn’t. I asked her if she wanted to breastfeed, and she said yes, she did, but she wasn’t sure if it was just because of pride or guilt…”Everyone keeps saying it’s the best thing I can do for my child,” she told me. On the other hand, she didn’t want to keep stressing over this one issue; she wanted to enjoy the child she’d gone to such great lengths to conceive and carry to term.

The problem was, I didn’t think this was a lost cause. If she wanted to breastfeed, then my concern was to get her to a place where this dream would be possible. And I felt so frustrated at her pediatrician and LC who had told her not to introduce formula, because her daughter had a “virgin gut”; who scared her off bottles because of nipple confusion but didn’t even mention the possibility of a Supplemental Nursing System (SNS) which has been shown to work really well in situations like these. As we discussed in the post on dehydration in newborns, these things tend to be a viscous cycle. The baby isn’t getting enough to drink; she’s growing too weak to nurse efficiently; this affects the supply/demand system so important to establishing a new mom’s supply… and so it goes.

The refusal of dogmatic breastfeeding “supporters” to consider using formula in the short term to fix the immediate situation and allow nature to sort itself out, just kills me. There’s an argument that in tribal cultures these problems “don’t exist”. That may indeed be true, but we live in the society we live in, and there are problems inherent in our system that DO complicate nursing. Most lactivists would be the first to admit this. Inductions and c-sections, hell, hospital births in general, can stymie the breastfeeding relationship. Our “bottle feeding culture” gives us a much steeper learning curve than those in cultures where breastfeeding is the norm.

It’s high time we acknowledged the reality of what we are facing as new moms trying to breastfeed. Stop blaming the freaking formula companies and work on educating our medical professionals (and I mean doctors, nurses, and lactation consultants) about the myriad of problems that women may face in the initial weeks of breastfeeding, so that these problems can be addressed and fixed. Instead, we ignore them, deny they can happen, and let women who wanted to nurse feel they have no alternative but to switch to formula, creating a cycle of guilt and regret… these are the women who end up here, needing to work through their conflicted feelings.

This afternoon, my friend updated me that they had started supplementing, but now Jane is refusing to latch altogether. And I worry. I worry that this won’t be salvageable. I worry that if things continue to deteriorate, she will be made to feel that it was the one or two bottles of formula which destroyed her nursing relationship. That the voices which said “virgin gut” and “just wait” and “nipple confusion” will haunt her. I worry that she will end up like I did, hating myself, hating those that I felt lied to me, that made me feel like a bad mom….

I worry. And I don’t want to worry about my friends. Or myself. Or any of you.

Something has got to change, people. Seriously.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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20 thoughts on “And so it goes…

  1. Thank you, thank you, THANK YOU. The evil “Big Formula” arguments are on my last nerve. Personally, I find it a bit insulting. Like the diaper bag argument — I'm a smart woman, I can recognize a marketing ploy when I see one, I don't think I'm *really* going to more likely to formula feed because I got a diaper bag with samples (and I always see that worded as 'less likely to succeed at breastfeeding').

    It wasn't until after I quit pumping that I heard thyroid problems can cause supply issues and that it is not uncommon for the thyroid to go out of whack after birth. Same with anemia, my OB never mentioned that my low iron level could be affecting my supply. The only “help” I got was from the LC that immediately said I should be on Reglan, despite my past history of depression.

    At least I got a diaper bag out of the deal with the formula company. All I got from the medical professionals is a lot of bad memories.

  2. Goodness, I feel terrible for your friend because I was there, exactly there: the low milk production, the weight loss, the sleepiness, the further weight loss.

    How is her milk production? Can she pump and feed? We did that along with supplementation in order to get E gaining weight again.

    Let her know that the internet is here cheering her on, and that no matter what path she ends up taking, it's okay.

  3. This makes me sad. I too have a feeling that those voices, those phrases will haunt your friend. It's so hard to let go of the guilt and the pride when we don't succeed at breastfeeding… I feel like I'm right back in that place reading this.

    Anyway, as far as the tribal argument goes, well I hate that line of reasoning. The probable reality is that a lot of babies DIED because of breastfeeding failure or from difficulties in the the beginning of a breastfeeding relationship. Those who survived despite difficulties were probably fortunate enough to benefit from some form of a wet nurse, such as a lactating friend or sister of the mother. So, I hate that whole argument– that there were never breastfeeding problems in tribal living. There were. They were just solved in ways other than formula, ways that aren't really available to us now.

  4. I imagine you suggested it, but you might see if she can use nipple shields if she's not latching. My baby couldn't latch on my left boob for some reason (which was the start of our feeding problems) and the only thing that worked for us was the shield.

  5. Kathleen

    Anyway, as far as the tribal argument goes, well I hate that line of reasoning. The probable reality is that a lot of babies DIED because of breastfeeding failure or from difficulties in the the beginning of a breastfeeding relationship. …So, I hate that whole argument– that there were never breastfeeding problems in tribal living. There were.

    That's exactly what happened (and, I imagine, still happens in some places). It's horrifying, but the cold reality is that nature doesn't care about individuals and their babies.

    FFF, thank you so much for all the vital information you share. I'm so sorry your friend is struggling, and I hope she yet succeeds, but I'm glad she has a friend like you to help drown out the fanaticism.

  6. You know what? If your friend lives in the US, our water is safe enough to not have to worry about a baby's “virgin gut,” besides the fact that studies on gut virginity have focused on colostrum, which seals the gut, not exclusive breastfeeding. I hope that your friend does not get dragged into the either/or. Formula keeps babies alive. If she can keep up her milk even a bit, they can go on to have a satisfying nursing relationship after the first month crisis is over. Everything feels gigantic when the baby is so small, so I hope she is able to keep open the options she values. If the friend is reading this, hang in there! You are doing fine. Feeding with love is what matters.

  7. I feel for you and your friend. I often feel stuck in between a rock and a hard place when dealing with my friends as they enter into the new world of motherhood. I have tried to just explain my experience and why I made the decisions that I did. I try so hard not to lead my friends one way or another.
    I just remember back to when I was in their shoes and feeling so alone and not having anyone to truly trust. I felt everyone had an ulterior motive and not my family’s health in mind.
    She is obviously not comfortable with the answers and guidance she is getting (and neither are you – the friend she is looking to for help). She needs to trust those feelings. Just like there are a myriad of doctors with differing practice patterns there are a myriad of LCs. She needs to find the right one that fits her and her child’s needs. That could take a lot of time and energy she doesn’t have as a new mom, perhaps you as a friend with contacts and experience could help her along this journey. She is probably looking for someone she trusts and you are it. That is an awesome responsability. She may need someone to validate her feelings (however complicated) and help her gain the confidence in her mothering abilities.

  8. I hope that your friend finds peace, no matter what she does. I wish I had better advice, but I got lucky and didn't have to learn any of it.

    I've heard nipple shields can help with latch (though someone above me already said that), and I know that when I felt like I was running low, so to speak, I ate oatmeal and it worked for me. (Lame advice, I realize.) I hope she gets help that works for her and her baby. <3

    There's an interesting post on Offbeat Mama about breastfeeding and formula feeding… ah, there it is: The b(r)east of both worlds — using formula AND breastfeeding. It doesn't offer advice on this issue, but I think it's fantastic how many women talked about how this worked for them, and how it didn't have to be one or the other.

    I don't know if it can offer any comfort to your friend, but it might.

  9. The first rule is feed the baby. If a mom isn't producing enough breastmilk and donor milk is not available, then formula is a good option.

    However, in this particular story, I think I got lost somewhere. It seemed to go from “my friend started pumping and cup-feeding her to avoid nipple confusion” to “the refusal of dogmatic breastfeeding supporters to consider using formula in the short term to fix the immediate situation and allow nature to sort itself out” fairly quickly.

    If she was pumping and cup feeding and not producing enough breastmilk, then perhaps there was a case for considering formula. However, if she was producing enough breastmilk, then this isn't really a problem that formula would solve and supplementing with formula is more likely to result in her milk supply decreasing than to result in nature sorting things out.

    To me, the problem isn't that formula exists. The problem is that formula is often suggested in situations where a mom's milk could be used instead. And yes, I do think that formula companies are heavily invested in ensuring that that happens.

    If she wasn't producing enough milk, then giving some formula supplements may make sense, as long as she was also pumping every time she supplemented if she did in fact want to continue breastfeeding. Ideally that formula should be given through cup feeding or finger feeding or some other non-bottle approach to avoid nipple confusion.

  10. I had to google SNS…amazing! I never heard of this! I had difficulty nursing in the beginning & so the insane struggle to pump/nurse/bottle feed insued. NO ONE told me about the SNS! And I saw three LC's.

    I also like the approach that it's okay to ff and bf.

    It's a shame that we don't have something neutral, such a “feeding consultant” when difficult issues surrounding feeding choices pops up. I seriously would have considered a SNS, rather than consuming all that time pumping & trying to beat the clock before infant baby would wake up again. And honestly, as a new mother recovering from a c-section, I should have been able to take that time to SLEEP.

    Sorry…I'm just terribly baffled that I had never heard of this SNS thing before.

  11. @Annie,

    First of all, thanks for stopping by. You know I'm a huge fan of your blog and I appreciate you joining the conversation.

    This is probably a case of pregnancy brain, but maybe I wasn't as clear about my friend's supply issues as I should have been. I think I did mention that she felt her milk hadn't come in yet, which I realize is not out of the range of “normal” at 6 days postpartum… she never felt engorged or saw any milk other than a few drops – and the problem was that her baby was losing weight and exhibiting other early signs of dehydration. She was pumping to try and get her milk going as well as feeding on demand AND at regular intervals as recommended by her LC and pediatrician; obviously, whatever she was getting out of the pump she was cup feeding to the baby, but as anyone who has fed a newborn with a cup can attest, spillage is inevitable, and it was heartbreaking to see the ounce or two she worked so hard to pump go spilling all over the place.

    I agree with you that in an ideal world donor milk would be a great alternative, but from what I've heard, it's just not readily available in the immediate present unless you are in a NICU situation. And as I said, I think the SNS system would be ideal, even if formula was the substance being used… I was outraged that no one had suggested this to her, especially in an affluent, extremely pro-breastfeeding area in SoCal where there is just no excuse not to be up on the research. That's where my frustration comes from – I feel people are acting like ostriches to paint this rosy vision of breastfeeding as “easy and natural” which for a variety of reasons, is just not the case for a growing number of women.

  12. It strikes me that the last FFF Friday post and this one both resonate this idea of getting past “all-or-nothing” in different ways. I also didn't ever hear about a SNS despite all my conversations with different LC's. It was also all about the pumping and supplements. I would love to have been able to set up an alternate “nursing” relationship with my son, but this was never even presented as an option, which makes me angry and sad.
    I hope your friend finds peace. She is lucky to have you as a friend; someone who can listen and support, and also understands that “dream.” Maybe she will be able to benefit from some of these alternative ideas? Also, I am right there with you on becoming a “feeding consultant” – already I have talked with friends about starting a “BFA – Bottle Feeder Anonymous” group. After all, nursing moms get their support groups with a trained LC, why shouldn't we get the same thing?

  13. I agree with a lot of points that have been made and I just want to mention that there are informal milk-sharing networks, such as eats on feets on facebook, that are opening up the possibility of receiving donated breastmilk to parents other than those with seriously sick babies. There was an article about it in Time Magazine recently.

  14. Bother with this thing losing my posts…
    Anyhow, I was saying I've been to a few lactation consultants and my measure of a good one is one that knows how and when to use formula appropriately while preserving the breastfeeding relationship (should that be what the mother desires). That information is very hard to come by and I had to teach myself about the ways to use supplementation for insufficient milk. I later found what I had figured out on my own written down in an excellent book: 'The Breastfeeding Mother's Guide to Making More Milk' written by a pair of IBCLC's who both had milk supply issues. it has a lot of information on causes, and more helpful, tips on dealing with the emotional fallout for when breastfeeding doesn't go as planned.

  15. I know we've talked about this before, but honestly, I am much more comfortable with using formula in the developed world than another woman's breastmilk, particularly as I battle my own chronic illness that can be passed through breastmilk and yet not be diagnosed. How can I be sure that the donor isn't sick with something that can be passed and yet she doesn't know she's sick? I know this is a small possibility, but I would take crushed bug guts over that risk any day.

  16. I understand your concern, Brooke and I know that the idea of using another woman's milk is something that a lot of people find “gross”. However, it seems that flash heating, which can be done easily in a domestic situation kills bacteria and viruses, whilst retaining the nutritional and much of the immunological properties of breastmilk. If I was receiving donated breastmilk from another woman, I personally wouldn't give it to my baby without first flash heating it. Given that, I also understand that breastmilk is not suitable for all babies (for instance those with galactosemia or those with a food intolerance where it cannot be guaranteed that the donating mother does not consume that particular substance). However, I feel that the issue of milk donation (both through milk banks and at an informal level) needs to be brought into the discussion, so that people can make their decisions about infant feeding taking into account all the information available.

  17. I think a good IBCLC does fit the definition of a “feeding consultant” that is described above. She (or he) supports breastfeeding as the preferred choice, will recommend using formula when necessary and will recommend methods that reduce the chance of nipple confusion, but will also never be compromised by partnering with a formula company. I worked with an IBCLC who did recommend supplementing with some formula using an SNS (ideally, if I could get my baby to latch) or by finger feeding until I had built up my supply enough that I didn't need to supplement anymore.

  18. I disagree Annie that an IBCLC is a “feeding consultant” in the way that I think many of us are imagining because, to me at least, they are coming to the table as breast as the preferred choice. It's great to have lactation consultants, but I think there might actually be a place for something a little less biased.

  19. I would have loved to see a “feeding consultant” while my daughter was in the NICU. The NICU had their own LCs, and while I didn't have a good experience with them, I won't say they were anti-formula. But it would have been nice to have someone that appeared a little bit more neutral and flexible, someone to talk to about a combo-feeding plan and things like formula and bottle prep for preemies. My daughter had different nurses all of the time, all of whom gave *extremely* varied advice and information, so it would have been nice to have one person that covered ALL aspects of feeding.

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