A Tale of Two Cities

One of the most repetitive arguments we’ve seen on FFF is that there is no such thing as an anti-formula-feeding culture; that breastfeeding mothers are always the minority, no matter where you live in America. I find myself living a lactation-centric Groundhog’s Day as I try and explain that infant feeding trends vary greatly, depending on the city. I also add the caveat that while there are, indeed, many parts of the country where bottle feeding is still the norm, and I understand why breastfeeding moms might feel marginalized and angry….even in areas where bottle feeding is prevalent, women can still feel guilty and defective if they do not nurse.

I’m visiting my in-laws right now, who live in the Northwest suburbs of Chicago. About half of our childbearing friends live in the city; the others are back in the ‘burbs. They run the gamut with breastfeeding; most nursed for 3-6 months, with some supplementation; one breastfed exclusively, and a few others pumped and bottle fed, later turning to formula. Some say they felt pressured to breastfeed at the hospital, but for the most part, none of them appear to have struggled too dramatically with their feeding decisions.

On Sunday, my in-laws threw us a party, a kind of “meet-and-greet” for Fearlette, who was visiting her midwest posse for the first time. I got into quite a few conversations about my work, since all of my friends either had small children and wanted to reflect on their experiences, or are currently pregnant and facing these inevitable decisions. By the end of the party, I was starting to think that some of the FFF critics were right – I must live in some odd sort of ivory tower (milky white, maybe, instead of ivory) where breastfeeders are the majority, where breastfeeding pressure is so insidiously rampant. It seemed as if Chicago, despite its status as a progressive, urban, intellectual hub, was still a place where bottlefeeding was universally acceptable.

Then, on Monday, Fearless Husband and I left FC in the burbs with his grandparents, and took Fearlette with us to visit a few city-dwelling friends – including one couple who had just had their first baby 10 days earlier. We stopped at a baby store to buy said couple a gift, and somehow, my stupid clumsy self managed to trip while holding the 5-month-old Fearlette, and knocked her beautiful, fragile face on the cold, dirty Chicago sidewalk. (Incidentally, not breastfeeding is nothing compared to dropping your infant on its head on the Parental Guilt Scale. But don’t worry, I’m not going to start the Fearless Baby Dropper blog or anything.)

We ended up seeing a friend’s pediatrician for an emergency visit, and Fearlette was luckily fine, except for a small bruise on her forehead and a tiny scratch on her adorable nose. As the doctor was checking her out, she asked us how Fearlette had been in the time between the accident and arriving at the pediatricians office (about fifteen minutes, with Fearless Husband barreling down Michigan Avenue, cutting off bird-flipping cabbies and honking furiously). I told her that I’d fed her and she’d ate well. That was all I said – “I fed her, and she ate normally.” To which the doctor replied, “Oh, cool… so she finished her bottle like normal?”

Say what??

To my ears, this was shocking. Why would she assume I was bottlefeeding? Did my reputation proceed me? Maybe breastfeeding moms didn’t drop babies on their heads? Could she tell Fearlette was a formula-fed kid? Was the trademark Alimentum smell permeating the room?

But you know, I don’t think it was any of those options. I think it was simply a normal default response, just like how at my Californian pediatric office, the default is to assume you’re breastfeeding.

Again, I wondered: maybe it is just Los Angeles, New York, and parts of the Pacific Northwest that house overwhelmingly breastfeeding-prevalent cultures. Which didn’t make my blog very relevant, or bode well for future book sales.

After we confirmed that Fearlette was no worse for the wear, we continued on to our friends’ loft, to meet their new bundle of joy. The new mom was calmer and cooler than I’d ever been, and seemed to have her head on straight in an incredibly admirable way. She told me she was pumping, but only managing to provide a small amount (her daughter had never been able to latch, despite the assistance of the hospital lactation consultants; they’d told her to consult with a private LC who charged $200/visit, to which she replied no freaking way), so they were feeding a combo of breastmilk and formula. She told me that they’d pushed breastfeeding at the hospital, but she’d wanted to do it, so it hadn’t bothered her. Later though, she admitted that her friends kept telling her she should keep pumping, keep trying to get her daughter to latch, asking her about it constantly, telling her how important it was… and these were all Midwesterners. Living in the supposedly bottle-feeding Heartland. Hmmm.

We later stopped by another friend’s house, who didn’t have kids of her own, but told me about her three closest friends, all Midwestern new moms, who had struggled, “failed”, and felt morally compelled to breastfeed. How depressed they’d been. How they’d felt like failures.

Today, while the kids were napping, I checked out the Facebook site of a Chicago-area expectant mom’s group, where it mentioned that the thing most of their members were most stressed out about was breastfeeding. I reread an email I got from a Chicago-dwelling professor I interviewed, who spoke of her own exclusively-nursing peer group in a way that reminded me, eerily, of mine.

Later in the day, we went to a suburban children’s museum where there were “nursing areas” in every corner of the building. And yet I didn’t see any moms using them. I did see a couple of other parents bottle feeding.

And I realized: I have no clue if Chicago is a bottle-feeding or breastfeeding “culture”. These things are constantly in flux; for all I know, the friends who gave birth three years ago might have lived in an entirely different environment than the ones giving birth now. Heck, my own hospital in Southern California had gone all Baby-Friendly in the two year span between my two births. You just never know what the winds of change will bring.

Coming from Los Angeles, I felt far more comfortable bottle-feeding in the suburbs of Chicago. But that doesn’t mean that my friend doesn’t feel comparable pressure from her breastfeeding friends and pro-breastfeeding hospital, even if her general environment is not 100% anti-formula.

We also don’t know what is in somebody’s heart. If you are a person who desperately wanted to nurse, who always saw yourself as a “counterculture mama” and now feel like you don’t qualify as one because your boobs don’t work, living in a “bottle feeding culture” isn’t going to help.

I realize this post is going nowhere. I’m still feeling kinda out of sorts for causing even a small moment of pain for my daughter (I’m turning in my sling and wrap for a bucket seat – attachment parenting is apparently not for klutzes). I guess what I’m trying to say is that the number of baby-friendly hospitals, or pediatricians who allow formula samples in their waiting rooms, is not necessarily indicative of what “culture” we live in.  So much depends on your individual OB, pediatrician, and hospital. On your own peer group. On where you work, what neighborhood you are in. Where you went to college, and what blogs you read. Social pressure comes from many places, and in this global world we live in, we just can’t know what someone’s “culture” really is.

In the meantime, I am retreating to my breastmilky-white ivory tower of Los Angeles, where we mostly drive in cars. I can’t be trusted to walk on sidewalks.

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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16 thoughts on “A Tale of Two Cities

  1. I think you make a good point, showing that feeding norms vary by area/social group and that making assumptions helps no one. The doctor didn't care how your daughter got fed, just that she ate normally. The doctor was checking for signs of concussion, not stating his/her standpoint in the so-called breast v bottle debate.

    I can only imagine that some of the people I've seen posting online would have been seriously offended that the doctor assumed bottle feeding and would have taken it as “breastfeeding being marginalized.” That's silly, because they are taking it out of context and creating a conflict where there was none. If you had told the doctor, “oh she is breastfed, not bottle fed” the doctor probably would have said “that's great, as long as she's eating ok.”

    As for guilt about dropping your child–I think this happens to everyone–either the child gets dropped, or falls off of something (bed, changing table). It sucks but most babies are fine, and certainly will not remember it. I dropped one of my boys on his head, when I tripped over the doorstep. (I was just carrying him, he was over 18mos at the time) I called the doctor, crying hysterically, and they walked me through the “check for signs of concussion” thing and the boy was fine. I didn't even take him to the doctor. Of course I would have, if he'd seemed off in any way. I felt awful of course, but except for the goose egg, my son had no signs of the incident, and didn't suddenly hate me or something. In general, all the goose-eggs that my sons get are either self inflicted (running into a chair) or given to each other (fooling around and smacking heads together.)

  2. It DOES depend on so much. The city. The hospital. The neighborhood, even. The friends one hangs out with. It's constantly in flux.

    And, I think, (and I hope you realize that I'm not saying that it's all in our heads, because that's the LAST thing I mean, and I know that it's real) that a lot of it is perception. Not in terms of seeing something that's not there. But sort of like when you see a car you like (or don't) and then all of a sudden, all you see on the road is that car. I think that sometimes, in addition to the people who want to “help” (either way) coming out of the woodwork at a time when they normally wouldn't comment upon it, we (at least I know I do) have a tendency to hear the people who are saying we're doing it wrong, and not the people who say we're doing it right.

    (er, been reading for quite some time, first comment. love the blog.)

  3. I feared that all winter with the icy sidewalks and my general ability to fall over my own feet while standing still so I still really only wear her in a wrap around the house… Walking is for strollers.. hence then name I think 😉 Fear not, the Fearlette won't remember and later it won't seem so big anymore. *HUGS*

  4. There are definitely a lot of subcultures within each city. I live in DFW. Not exactly a crunchy hippie place. I don't know the stats, but I would say that both breastfeeding and bottle feeding are relatively normal here. I have seen people doing both in public. My pediatrician encouraged me to breastfeed, and she has a lactation nurse on staff, but she didn't make a fuss when I told her it was not working.

    Of people I know personally who live in this area, I would say almost all started out breastfeeding but only some EBF for the recommended 6 mo-1 yr.

    A few months ago I decided to go to a Mommy & Me Yoga class for a few weeks. The instructor put out these special soft chair things on the floor to support your back so you could feed baby on demand during class. There were about 10 people in the class with babies aging from 2-9 months. I was literally, the ONLY person in the entire class who did not breastfeed. Most babies had to be fed at some point during the class. It was a long drive for me and while I tried to top her off before I left, sometimes she would get hungry during class and I had to pull out my bottle. No one ever said anything to me but I found the experience quite mortifying. I felt this urge to explain myself, even though I shouldn't have to. It was pretty cool seeing other moms who cloth diaper but I felt like I could never belong to the natural parenting club because I formula feed. But like I said, this was more of my own perception, no one actually did anything to make me feel unwelcome.

    In addition, online parenting forums tend to be overwhelmingly breastfeeding-focused, and admitting you formula feed without a long and detailed explanation of how hard you tried to breastfeed, can make you somewhat of a pariah. So if you spend a lot of time online (like me) you can also feel like an oddity. Plus nastiness and hostility can abound online and FF moms are considered a target in many places.

    I'm glad I live in a city where both BF and FF are acceptable though, and where it's generally considered rude to comment on someone else's feeding their child. I wish it could be like that everywhere.

  5. Don't feel bad, I once fell down with my son too, and he was even bleeding a bit, but was okay after a good cry.

    I live in a small community where literally everyone starts off breastfeeding. Even with my 3rd baby almost every time I go out and feed my baby in public someone still comments “You're not breastfeeding?”. This time around I just say “no” or “it's never worked for me”. There's always this awkward silence where they wait for an explanation because what kind of person can't breastfeed? I better have a good excuse! With my first 2 babies I would've gone on with a long story of how hard I tried but my nipples are simply too inverted for BF to be possible. I'm strong enough now that I realize that I don't owe an explanation to everyone I meet, but it still bothers me that people can't just let me feed my baby in peace. It would feel very odd to me if a dr. just assumed feeding was FF, I probably would've thought I had heard it wrong!

  6. I love this post. I'm not sure why, but I think it's one of my more favorite ones of your blog. Perhaps it's because it is more ambiguous? More grey area-ish? There is no clear assumption here, other than simply mothers are often criticized for their choices. And depending on where you live, who you encounter, you may receive more support or less for your choices.

    This is real life. Again, I resort back to the notion that it would be soooo wonderful if new moms had a Feeding Consultant with whom they could discuss feeding options that are a good fit for each individual, as well as provide support. Nothing is black and white. And so the grey areas of choices available to us should be addressed and supported.

    As always, I admire your honesty and candor.

  7. I managed to have each of my 3 sons land on their heads, at least once….and I breastfed for 12 years. Only my daughter escaped this. My first son, I dropped on my head, when I tripped coming out of our house. My second one was being carried by his older brother, who was six at the time, when he was 5 weeks old and my eldest one tripped over the baby's carseat and knocked his little brother's head on the ground. He was devastated and my baby and I spent the night in hospital, but he was fine. Later, when the same baby was 8 months old, he was sitting on our terrace and I picked him up. His hand was in his mouth and I pulled it out, to find a slug in it. I got such a shock that I dropped him. My fourth child was sitting in a shopping cart in a grocery store and his older brother (slug boy) and his sister both climbed onto one side of it, tipping it over. Then there was a time when he fell out of bed and bumped his head too. No-one's perfect and I'm probably one of the most imperfect of mothers, breastfeeding or no breastfeeding. I'm ashamed to say that I'm posting this anonymously, for obvious reasons 😉

  8. This is SO true. Even within the Chicago suburbs its different. A friend of mine who had an insane struggle to breast feed and then quit because of a chronic health problem has gotten nothing but no end of grief from people.

    Me? i'm further west of Chicago and I get nothing but grief for breastfeeding.

    Its REALLY odd.

  9. I'm from “The Heartland” and it's really a mixed bag in my area. It's expected that all women will want to at least try to breastfeed, and there is still a lot of pressure to succeed, BUT there is very little support. I had a completely normal, unmedicated birth, and for whatever reason, the hospital staff took my daughter out of the room for several hours after I delivered. Being the haze that follows delivery, my husband and I lost track of time, but I didn't get to try breastfeeding her until she was several hours old, and if I had to guess, I would believe they had already given her a bottle in that time. The nurses were not knowledgable about breastfeeding and the lactation consultant was largely absent. She popped in once for less then five minutes. When I was struggling and asked a nurse to have her come back, she never did. I was discharged days later having never seen her again.

    Also, like others have said, it depends on who you're around all the time. I was the first in my peer group to have a baby (I was 25, which is apparently young for my group of friends), so I was the pioneering mom in the group, with no one to turn to. My mom did not breastfeed, and no one in my family did either. I had no one, and no support. I didn't have anyone to tell me “oh, that's okay, that's normal,” when things got difficult, and so I quit very early on. Now, I know several people who are successfully breastfeeding their children (although, interestingly, most don't live in my region, so they wouldn't have dealt with the same poor support I received). Had I not been the first to go through motherhood, maybe I would have had a friend to ask questions to.

    I've never gotten a dirty look for bottle-feeding, and I don't know anyone who has ever been persecuted around here for breastfeeding, either. It's basically like both are fine. Although, with the national push for breastfeeding, the bottle-feeding moms do still feel guilty and “wrong” for doing it. Anyway, that's my experience coming from your typical Midwestern suburb.

  10. I haven't experienced any real, overt judgment in-person. My part of the midwest (Iowa) is pretty “live and let live” about most things, infant feeding included. Most of my friends and co-workers are a little on the crunchy side, so breastfeeding for at least a while is the norm. My family and my husband's family are pretty traditional but really haven't seemed to care one way or the other (although I never did get a chance to see what my father-in-law would say if I just whipped out a boob to feed my kid in his presence…that alone is reason enough to try to breastfeed again next time!).

    For me, a lot of the pressure came from things that I read online or conversations that I had on online message boards. I think it just goes to show that, while the internet can be a great way to get more and better information than you might have available locally, it can also be a minefield of bad information and judgments thrown about from behind a veil of anonymity. The things I read online really caused me to get inside my own head and feel like I was failing. That, in turn, made me hesitate to seek help or support from my medical providers or friends and family for fear that they would also judge me in person.

    I think on both sides of things, it's important to watch what we say and do, both in person and online. You never know who might be reading your words at 3:00 a.m., while hooked to a breast pump that's not getting much out or nursing a night-waking toddler in spite of her family's scoffing or giving her baby a bottle of hypoallergenic formula after trying every elimination diet in the book.

    I think it's also important to remember that, while formula may be a nutritionally inferior choice for most babies, it is not a MORALLY inferior choice. Canned produce is nutritionally inferior to fresh, organic produce. Fresh, organic produce is the biological norm. I'm going to bet there are studies that show that eating canned produce instead of fresh is tied to higher risks for something. But you don't see anyone shaking their head at the poor, uninformed woman behind them in the line at the grocery store who has cans of green beans in her cart. Either way, she and her family are eating vegetables. There's no moral judgment about fresh, frozen, or canned vegetables, and there shouldn't be about breastfeeding, pumping, or formula feeding. Either way the baby is being fed, and that's what matters.

  11. I do agree that it can sometimes be perception. Although where I live in Australia breastfeeding is the normal (I seriously am the only person I personally know who bottle feeds, every mother I know has breastfed for over 12 months) I have given birth in two different hospitals in South East Queensland and in both hospitals during every antenatal visit the midwife has to tick off on your check list that she has talked with you about the benefits of breastfeeding etc. You are very strongly encouraged to go to the free breastfeeding classes (and if you refuse it is also a requirement for the midwife to ask why you are not going each time you visit) and two out of the five sessions in the birthing class is all about breastfeeding. After birth all midwives are 100% focused on making breastfeeding work (skin to skin straight away, feeding within 1/2 hour etc) and you have a lactation consultant visit daily while at hospital. You need to demonstrate proper breastfeeding before you are discharged and if you are struggling you must stay longer or make an appointment on the spot to see 1 of the many free lactation consultants. There are no free samples where I was or any mention of formula at all. (if you need to formula feed while in hospital you must go to a locked private room where you can prepare and feed your baby away from other new mums so that they do not see you) There are also drop in clinics, 24hr free call breastfeeding help lines and many other 'support' networks. I do think it is all great for breastfeeding women (who deserve every bit of support they can get), but of course if you pull out a bottle then you didn't try hard enough to get the help you needed cause there is so much help available. 🙁

  12. @Lisa — While I would have felt pretty lame being sent to a locked private room to feed formula (since my son had some the day he was born) I do wish that they had made sure things were going well before I was discharged or that they had made me come back for more appointments with the LC (instead of just leaving it up to me to call if I felt I needed it).

  13. Chicago-area native here. Believe me, there are pockets where militant lactivism rules. My baby's first ped was in Skokie, wealthy northern suburb, and he acted as if I was routinely feeding my baby arsenic when I told him we had supplemented in the hospital. I've been to the store to get formula and received filthy, scorching looks from moms buying…gerber baby food, which I will never understand (gerber == evil nestle, don't they know??). And yet I've been to the mall with bottles and no one has batted an eye. BUT I have purposely avoided mommy groups thusfar, I've promised myself to avoid them till my baby's potty trained because I don't think I could help getting myself in trouble for my big mouth.

    Some of the 'burbs are more laidback, but if you want to find helicopter total motherhood moms, there are some places you can't swing your arms without smacking 'em (coughNAPERVILLEcough). And yet there are places where you could probably find yourself outside on the street in -80*F windchills for tactfully breastfeeding under a cover. On a related note, for all that there are some major Jewish centers in the Chicago area (heck, our new mayor is Jewish) you will also find pockets of folks who routinely accuse people who circumcize of being no better than child rapists.

    I would attribute that you ran into some relatively permissive people to the fact that many folks in the Chicago area are too preoccupied with surviving the weather (whatever it's doing at the moment, and if you don't like it, wait 5 minutes) to notice what others are doing.

  14. I am in the trenches (hospital LC) and see the start-up phase daily. My goal is to simply support a woman in her goal for as long as she wants help – and to support her choice if she chooses to exclusively pump, or to move on to bottle feed. My hospital is not “baby friendly” but we are friendly to babies – and families – at least that’s my goal! Outpatient visits are available (Affordable Care Act covers this now) for those who call and want an appointment. It can feel overwhelming and exhausting in those early days -.even when everything is working perfectly (minimal pain, milk coming in, baby latching). There are so many variables which make early breastfeeding challenging. (anatomy, supply, baby, NICU, late preterm baby) Sometimes pumping is necessary to maintain a supply while baby / mom figure it out – and ultimately this can be stopped if mom feels it’s too much, of course. Some problems work themselves out – some are too overwhelming and ultimately – feed baby with love.
    The mommy competition / judgement is a huge factor in the emotions around this journey. I often recommend this blog to moms who are struggling or moving on to formula feeding. It’s been a great resource for me and has shaped my approach to a struggling mom many times.

    Our hospital based support group is not marketed as “breastfeeding support” – it’s “all things newborn”. There are FF moms, EP moms, and breastfeeding moms. (In the six months the moms attend – some moms may have done all three of these journeys.)

    One thing I’d love to see addressed here – or acknowledged – is that the Joint Commission has as one of it’s five Perinatal Core Measures – increasing exclusive breastfeeding rates in hospitals. This means that a healthy term baby of a breastfeeding mom should be able to spend the hospital stay without formula if there is no medical reason to receive it. Babies can be excluded as a “ding against ratio” if they go to NICU, are under 37 weeks, mom’s had a mastectomy (hello?) and a few other reasons. A low blood sugar in baby or a mom with a history of low supply who has a frantic baby – receiving formula in these cases is still a “ding” – or “OFI” – Opportunity for Improvement. (a baby would still get fed – just that JC won’t recognize this as a valid reason.) There will be increased pressure in making this happen – and ultimately there will likely be hospital reimbursement tied to increasing these percentages. (more pressure) Initially the numbers were going to be based on any baby who COULD be breastfed (???) – and at least now there is a “mom’s choice to exclusively breastfeed” number in the mix.

    In my hospital – feeding choice is asked as the initial history is taken – end of story. No pressure from staff. Yet. No signing a release. LCs only see moms who have chosen to breastfeed. Mom can decline visit from LC. Mom can tell LC to go away. 🙂

    Again – very thankful for this blog and the women who share their stories to help all of us learn – even LCs – how to better support a mom in her battle – and her choice.

  15. It does seem to vary. Around here, in the Vancouver, BC area, no one looked at me weird for breastfeeding in public, and no one looked at me weird (or said anything) about me pulling out a bottle of formula. There are pockets of people all over the area where I’d guess you get varying amounts of pressure, and the healthcare system definitely leans towards EBF rather than FF.

    I did end up getting invited to an attachment parenting moms meet-up where they were all breastfeeding toddlers and I was sitting there nursing my two-month-old and then giving her a bottle after because I’d run out of milk and my breasts weren’t going to replenish very quickly. I said something about everything we’d tried to up my supply and everyone was pretty supportive. I didn’t go back because then everyone started talking about how proud they were that their kids hadn’t been vaccinated. I had just scheduled the appointment for my daughter’s first round of immunizations and didn’t really want their unvaccinated kids potentially exposing my infant to something dangerous.

  16. I am in Los Angeles. I had to interview six peds before I found one that wasn’t going to shame me for formula feeding. Luckily for me I’m in my mid-30s and just rolled my eyes at these morons and told them that their intimidation tactics and lack of actual knowledge of formula made me glad I got to run far far away. #6 and his office said that they had a lot of formula feeding moms come to them, or transfer over when they had to stop breastfeeding and their orignal ped was a jerk about it. One of the other peds in the office said she saw no difference between formula and breastfed babies and thought it was stupid to push breastfeeding on moms who didn’t want to.

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